Who should be undertaking population-based surveys in humanitarian emergencies?

<p>Abstract</p> <p>Background</p> <p>Timely and accurate data are necessary to prioritise and effectively respond to humanitarian emergencies. 30-by-30 cluster surveys are commonly used in humanitarian emergencies because of their purported simplicity and reasonable validity and precision. Agencies have increasingly used 30-by-30 cluster surveys to undertake measurements beyond immunisation coverage and nutritional status. Methodological errors in cluster surveys have likely occurred for decades in humanitarian emergencies, often with unknown or unevaluated consequences.</p> <p>Discussion</p> <p>Most surveys in humanitarian emergencies are done by non-governmental organisations (NGOs). Some undertake good quality surveys while others have an already overburdened staff with limited epidemiological skills. Manuals explaining cluster survey methodology are available and in use. However, it is debatable as to whether using standardised, 'cookbook' survey methodologies are appropriate. Coordination of surveys is often lacking. If a coordinating body is established, as recommended, it is questionable whether it should have sole authority to release surveys due to insufficient independence. Donors should provide sufficient funding for personnel, training, and survey implementation, and not solely for direct programme implementation.</p> <p>Summary</p> <p>A dedicated corps of trained epidemiologists needs to be identified and made available to undertake surveys in humanitarian emergencies. NGOs in the field may need to form an alliance with certain specialised agencies or pool technically capable personnel. If NGOs continue to do surveys by themselves, a simple training manual with sample survey questionnaires, methodology, standardised files for data entry and analysis, and manual for interpretation should be developed and modified locally for each situation. At the beginning of an emergency, a central coordinating body should be established that has sufficient authority to set survey standards, coordinate when and where surveys should be undertaken and act as a survey repository. Technical expertise is expensive and donors must pay for it. As donors increasingly demand evidence-based programming, they have an obligation to ensure that sufficient funds are provided so organisations have adequate technical staff.</p

Health Issues Affecting Displaced Populations: The Evolution of Public Health Response in Emergency and Post-Emergency Phases of Complex Emergencies

The field of humanitarian response has made tremendous strides over the past decade. In the Cambodian refugee camps in the 1980s, the establishment o

Notes from the Field in Kigoma, Tanzania

In these short notes the authors provide some insight to their visit to displaced persons camps in Kigoma, Tanzania. This trip marks the fourth set of camps examined in the Post Emergency Phase Indicators Project, a joint collaboration between the Johns Hopkins Center for Refugee and Disaster Studies, and the International Emergency and Refugee Health Branch at the Centers for Disease Control.Dans ces brèves notes, les auteurs fournissent un aperçu de leur visite au camps pour personnes deplacees de Kigoma, en Tanzanie. Ce voyage marque la conclusion de la quatrième série de visites de camps de réfugiés examinés dans Ie cadre du Projet sur les Indicateurs d'Etapes en Situation Post- Urgente (Post-Emergency Phase Indicators Project), une collaboration conjointe du Centre John Hopkins pour les Etudes sur les Réfugiés et les Désastres, et la Section pour la Santé des Réfugiés et l'Urgence Internationale, du Centre pour Ie Contrôle Epidemique

Self-force on a scalar charge in radial infall from rest using the Hadamard-WKB expansion

We present an analytic method based on the Hadamard-WKB expansion to calculate the self-force for a particle with scalar charge that undergoes radial infall in a Schwarzschild spacetime after being held at rest until a time t = 0. Our result is valid in the case of short duration from the start. It is possible to use the Hadamard-WKB expansion in this case because the value of the integral of the retarded Green's function over the particle's entire past trajectory can be expressed in terms of two integrals over the time period that the particle has been falling. This analytic result is expected to be useful as a check for numerical prescriptions including those involving mode sum regularization and for any other analytical approximations to self-force calculations.Comment: 22 pages, 2 figures, Physical Review D version along with the corrections given in the erratu

Continuous Quality Improvement Applied to Outpatient Health Care Delivery in Displaced Persons Camps

Continuous Quality Improvement (CQI) has been shown to be a highly effective approach for the evaluation and management of hospitals in developed countries, but it has barely begun to be utilised in less developed countries. This article defines the principles and the main tools of CQI and then applies them to the postemergency phase of a displaed persons camp situation, specifically towards improving the utilisation and the quality of care in an out patient department.L'Accroissement Continu de la Qualité s'est révélé une approche très efficace pour l'évaluation et la gestion des hôpitaux dans les pays développés, mais n'a à toutes fins pratiques jamais été mise à profit dans les pays moins développés. Cet article définit les principes et les principaux instruments, Accroissement Continu de la Qualité, et les applique à la phase post-urgente dans la situation des camps pour personnes déplacées. L'attention porte plus spécifiquementsur les possibilités d'amélioration de l'utilisation des services et de la qualité des soins en clinique externe

Antiretroviral therapy for refugees and internally displaced persons: a call for equity.

Available evidence suggests that refugees and internally displaced persons (IDPs) in stable settings can sustain high levels of adherence and viral suppression. Moral, legal, and public health principles and recent evidence strongly suggest that refugees and IDPs should have equitable access to HIV treatment and support. Exclusion of refugees and IDPs from HIV National Strategic Plans suggests that they may not be included in future national funding proposals to major donors. Levels of viral suppression among refugees and nationals documented in a stable refugee camp suggest that some settings require more intensive support for all population groups. Detailed recommendations are provided for refugees and IDPs accessing antiretroviral therapy in stable settings

Child Acute Malnutrition and Mortality in Populations Affected by Displacement in the Horn of Africa, 1997–2009

Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected by displacement (1997–2009) were analyzed to investigate: (1) how elevated malnutrition and mortality were among displaced compared to host populations; (2) whether the mortality/malnutrition relation changed through time; and (3) how useful is malnutrition in identifying high mortality situations. Under-five mortality rates (usually from 90-day recall, as deaths/10,000/day: U5MR) and global acute malnutrition (wasting prevalences, < −2SDs of references plus edema: GAM) were extracted from reports of 1,175 surveys carried out between 1997–2009 in the Horn of Africa; these outcome indicators were analyzed by livelihood (pastoral, agricultural) and by displacement status (refugee/internally displaced, local resident/host population, mixed); associations between these indicators were examined, stratifying by status. Patterns of GAM and U5MR plotted over time by country and livelihood clarified trends and showed substantial correspondence. Over the period GAM was steady but U5MR generally fell by nearly half. Average U5MR was similar overall between displaced and local residents. GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%), but was not different between displaced and local populations. Agricultural populations showed increased U5MR when displaced, in contrast to pastoralist. U5MR rose sharply with increasing GAM, at different GAM thresholds depending on livelihood. Higher GAM cut-points for pastoralists than agriculturalists would better predict elevated U5MR (1/10,000/day) or emergency levels (2/10,000/day) in the Horn of Africa; cut-points of 20–25% GAM in pastoral populations and 10–15% GAM in agriculturalists are suggested. The GAM cut-points in current use do not vary by livelihood, and this needs to be changed, tailoring cut points to livelihood groups, to better identify priorities for intervention. This could help to prioritize limited resources in the current situation of food insecurity and save lives

COVID-19 in humanitarian settings: documenting and sharing context-specific programmatic experiences.

Humanitarian organizations have developed innovative and context specific interventions in response to the COVID-19 pandemic as guidance has been normative in nature and most are not humanitarian specific. In April 2020, three universities developed a COVID-19 humanitarian-specific website ( www.covid19humanitarian.com ) to allow humanitarians from the field to upload their experiences or be interviewed by academics to share their creative responses adapted to their specific country challenges in a standardised manner. These field experiences are reviewed by the three universities together with various guidance documents and uploaded to the website using an operational framework. The website currently hosts 135 guidance documents developed by 65 different organizations, and 65 field experiences shared by 29 organizations from 27 countries covering 38 thematic areas. Examples of challenges and innovative solutions from humanitarian settings are provided for triage and sexual and gender-based violence. Offering open access resources on a neutral platform by academics can provide a space for constructive dialogue among humanitarians at the country, regional and global levels, allowing humanitarian actors at the country level to have a strong and central voice. We believe that this neutral and openly accessible platform can serve as an example for future large-scale emergencies and epidemics

COVID-19 control in low-income settings and displaced populations: what can realistically be done?

COVID-19 prevention strategies in resource limited settings, modelled on the earlier response in high income countries, have thus far focused on draconian containment strategies, which impose movement restrictions on a wide scale. These restrictions are unlikely to prevent cases from surging well beyond existing hospitalisation capacity; not withstanding their likely severe social and economic costs in the long term. We suggest that in low-income countries, time limited movement restrictions should be considered primarily as an opportunity to develop sustainable and resource appropriate mitigation strategies. These mitigation strategies, if focused on reducing COVID-19 transmission through a triad of prevention activities, have the potential to mitigate bed demand and mortality by a considerable extent. This triade is based on a combination of high-uptake of community led shielding of high-risk individuals, self-isolation of mild to moderately symptomatic cases, and moderate physical distancing in the community. We outline a set of principles for communities to consider how to support the protection of the most vulnerable, by shielding them from infection within and outside their homes. We further suggest three potential shielding options, with their likely applicability to different settings, for communities to consider and that would enable them to provide access to transmission-shielded arrangements for the highest risk community members. Importantly, any shielding strategy would need to be predicated on sound, locally informed behavioural science and monitored for effectiveness and evaluating its potential under realistic modelling assumptions. Perhaps, most importantly, it is essential that these strategies not be perceived as oppressive measures and be community led in their design and implementation. This is in order that they can be sustained for an extended period of time, until COVID-19 can be controlled or vaccine and treatment options become available