Implementation and utilisation of community-based mortality surveillance: a case study from Chad

Conflict and Health

Sidney Wong⁴  Francesco Checchi³  Kai Braker¹  Sarah Bowden² 

[1] Médecins Sans Frontières (MSF), Am Köllnischen, Park 1, Berlin, 10179, Germany;School of Medicine, Cardiff University, Cochrane Medical Education Centre, Heath Park, Cardiff, CF, 14 4YU, UK;Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St, London, UK;Médecins Sans Frontières (MSF), 67–74 Saffron Hill, London, EC, 1N 8QX, UK

关键词: Community health workers;    Médecins sans frontières (MSF);    Internally displaced persons (IDPs);    Refugees;    Chad;    Post-emergency;    Conflict;    Humanitarian;    Death rate;    Surveillance;    Mortality;   

Others  :  810325
DOI  :  10.1186/1752-1505-6-11

 received in 2012-07-11, accepted in 2012-11-24,  发布年份 2012

【 摘 要 】

Background

Prospective surveillance is a recognised approach for measuring death rates in humanitarian emergencies. However, there is limited evidence on how such surveillance should optimally be implemented and on how data are actually used by agencies. This case study investigates the implementation and utilisation of mortality surveillance data by Médecins Sans Frontières (MSF) in eastern Chad. We aimed to describe and analyse the community-based mortality surveillance system, trends in mortality data and the utilisation of these data to guide MSF’s operational response.

Methods

The case study included 5 MSF sites including 2 refugee camps and 3 camps for internally displaced persons (IDPs). Data were obtained through key informant interviews and systematic review of MSF operational reports from 2004–2008.

Results

Mortality data were collected using community health workers (CHWs). Mortality generally decreased progressively. In Farchana and Breidjing refugee camps, crude death rates (CDR) decreased from 0.9 deaths per 10,000 person-days in 2004 to 0.2 in 2008 and from 0.7 to 0.1, respectively. In Gassire, Ade and Kerfi IDP camps, CDR decreased from 0.4 to 0.04, 0.3 to 0.04 and 1.0 to 0.3. Death rates among children under 5 years (U5DR) followed similar trends. CDR and U5DR crossed emergency thresholds in one site, Kerfi, where CDR rapidly rose to 2.1 and U5DR to 7.9 in July 2008 before rapidly decreasing to below emergency levels by September 2008.

Discussion

Mortality data were used regularly to monitor population health status and on two occasions as a tool for advocacy. Lessons learned included the need for improved population estimates and standardized reporting procedures for improved data quality and dissemination; the importance of a simple and flexible model for data collection; and greater investment in supervising CHWs.

Conclusions

This model of community based mortality surveillance can be adapted and used by humanitarian agencies working in complex settings. Humanitarian organisations should however endeavour to disseminate routinely collected mortality data and improve utilisation of data for operational planning and evaluation. Accurate population estimation continues to be a challenge, limiting the accuracy of mortality estimates.

【 授权许可】

   
2012 Bowden et al.; licensee BioMed Central Ltd.

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