Riverina Exercise Part I: Initial Rapid Assessment

1
Riverina Exercise Part IInitial Rapid Assessment
2
Objectives

• List health problems common among displaced
  populations.
• Identify sources of health information on persons
  living in displaced persons camps.
• Calculate crude and age-specific mortality rates.
• Use morbidity, mortality, and nutrition data to
  identify and prioritize specific health problems
  in a displaced population and plan interventions.

3
Map
4
Question 1

• What particular health problems might you expect
  among the internally displaced persons in the
  camps of Riverina?

5
Question 1 Answer

• The usual major health problems in displaced and
  refugee populations are
• diarrheal diseases,
• acute respiratory infections,
• measles, malnutrition,
• and--sometimes--malaria.
• In the situation of Riverina, the problems are
  not likely to be different.
• One might not expect high rates of malnutrition
  initially because the population has not been
  subjected to a long period of food shortages.
• Malaria is unlikely to be a major problem during
  the dry season.

6
Question 2

• What key information will you gather in Delta
  City prior to your departure?

7
Question 2 Answer

• Key information would include
• maps of the area,
• information on local culture and languages,
• local environmental conditions,
• state of roads,
• clinics and hospitals in the area of the camps,
• NGOs active in the area,
• basic health statistics from both Regions 2 and
  3, including
• death rates, major endemic diseases, immunization
  coverage rates,
• other public health programs in the area.

8
Question 3

• List four objectives of your assessment.

9
Question 3 Answer

1. Assess the magnitude of the emergency (size of
   population affected).
2. Identify the main existing and potential health
   problems.
3. Assess the adequacy of local resources.
4. Develop recommendations related to the priority
   needs of the affected population.

10
Question 4

• You arrive in Alphaville on January 19. At a
  meeting in the district health commissioner's
  office, the local representative of Love the
  Children (LTC) says that the malnutrition rate in
  Saba is 20.
• List four questions that you will ask about the
  source of this figure.

11
Question 4 Answer

1. Who in the population was measured?
2. How was the sample drawn?
3. What was the measurement of malnutrition used?
4. How was malnutrition defined?
5. Is this acute or chronic malnutrition?

12
Question 5

• In general, what physical aspects of a refugee
  camp are of immediate concern to those organizing
  relief?
• What might be the main problems associated with
  the site of Saba Camp?

13
Question 5 Answer

• Availability of water.
• Drainage/possibility of flooding.
• Access/likely state of roads in the wet season.
• Availability of shelter materials.
• Availability of cooking fuel.
• Appropriate area for excreta disposal.

14
Question 6

• How might you go about assessing health problems
  in Saba camp?
• Who would you talk to?
• What type of data would you collect?
• What sources of data would you use?

15
Question 6 Answer

• Observation in camp and of new arrivals
• Interviews (with health workers, leaders among
  the displaced)
• Visit health facilities, review records
• Count graves
• Limited convenience surveys
• Screen new arrivals

16
Question 7

• Estimate both crude and under-five death rates
  for the period January 15-21 in Saba camp, based
  on the information on the population and the rate
  of new arrivals presented in the Introduction on
  Page 1. Interpret these data.

17
Question 7 Answer

• Overall crude mortality rate
• 31 deaths in 7 days average 4.4 deaths/day
• Population on Jan 15 6,000
• 500 new arrivals per day
• Population on Jan 21 6,000 (500 x 6)
  approximately 9,000
• Mid-point population 7,500
• Crude death rate for the period is 4.4/7,500 x
  10,000 5.9 per 10,000 per day.
• Normal CDR in Riverina is 19.5 per 1000 per year
  0.5 per 10,000 per day. Thus, CDR in Saba is
  almost 12 times normal rate.

18
Question 7 Answer

• Under 5 mortality rate
• 24 deaths in 7 days average 3.4 deaths/day
• Assume 20 of population is lt5 years of age
• Mid-point population of lt5 children 7,500 x 0.2
  1500
• Mean daily crude death rate for the period is
  3.4/1500 x 10,000 22.7 per 10,000 per day.

19
Question 8

• Is it fair to compare the death rates in Saba
  with national data?
• What are the possible causes of variation in
  numbers of deaths from day to day?
• How might you suggest the mortality reporting
  system be improved?

20
Question 8 Answer

• Daily mortality may randomly vary day to day due
  to small numbers of deaths over short time period
• Annual mortality rates more stable due to larger
  numbers of deaths
• However, annual rates give idea of background
  mortality
• Variation in number of deaths may be due to
• Random variation
• Variation in incidence of various diseases
• Inaccurate reporting of date of death

21
Question 8 Answer

• The mortality surveillance system could be
  strengthened by
• Systematic graveyard surveillance
• Finding community informants who report to the
  hospital daily
• Offering an "incentive" to reporting deaths to
  the administrative office (e.g., burial shrouds).
• Removing disincentives to reporting, such as
  decreasing food ration following a death in the
  family.

22
Question 9

• How do you interpret these data?
• (Do not attempt to calculate incidence rates.
  Rather, give an overall assessment of what you
  think the major morbidity problems are or
  potentially could be, given the above data.)

23
Question 9 Answer

• Diarrhea in children a problem.
• If there are about 1800 children lt5 years in the
  camp (20 of 9,000), then about 1 in 6 kids had
  diarrhea in one week.
• This is equivalent to each child having 8-10
  episodes a year (2-3 times the normal rate
  reported by WHO). CFR in children admitted with
  diarrhea is high (about 17).
• Dysentery may be a problem, and needs
  investigation is it really dysentery? what's the
  cause? Drug sensitivity?

24
Question 9 Answer

1. "Fever and headache" needs clarification and
   investigation. This is presumably not high
   malaria transmission season, but should do blood
   smears for malaria parasites on a sample of the
   febrile children.
2. 8 cases of measles should ring alarm bells. Make
   sure plans are underway to immunize children
   against measles.

25
Question 9 Answer

1. 5 admissions and 2 deaths from suspected
   meningitis should ring big alarm bells. This
   country is most likely in the meningococcal
   meningitis belt, and it's the dry season--peak
   season for meningitis. Need to investigate
   promptly.