Mortality Surveillance System: Case Study from Liben Refugee Camps, Nutri=on Emergency, Somali Region 2011 Naomi Sorkin, MSF–Holland, Andrea Bernasconi, MSF-Epicentre Background!
Underlying Question!
"In the summer of 2011, thousands of Somali refugees crossed the Ethiopian border fleeing physical violence and drought. As part of the emergency medical intervention, MSF Epicentre in partnership with MSF-Holland established a prospective active mortality surveillance system in one of the five camps in order to accurately monitor the crude mortality rate, under-five mortality rate and collect qualitative data on health seeking behavior for 25,500 refugees."
Weekly Mortality Rates, from August 2011!
What can Mortality Surveillance tell us? !
Implications! Golden standard to track U5 deaths, especially in setting where most health occurred at home. "
• Weekly mapping of mortality and associated morbidities allowed medical team to track trends and target outreach activities. " • Verbal autopsies were conducted during a home visit after each death. This gave the medical team more information on programmatic gaps as well as cultural barriers in seeking care"
Weekly Mapping of Mortality (example)!
• Decreasing CMR and U5CMR revealed the real time impact of medical services as well improved access to water, sanitation and food in the camp. " • The surveillance system also showed spikes in mortality associated with access issues in the camp, ie. nursing staff strike in week 44. "
Methods! • Weekly tent-to-tent systematic surveillance by community health workers, collecting data on births, deaths and associated morbidities."
Conclusions! • Mortality surveillance system is a" "powerful tool to establish in parallel with grave counting at the onset of any humanitarian emergency."
• Community health workers collected weekly mortality data, regularly updating mapping information using GPS data to track population growth and movement throughout the camp, and through verbal autopsies determine place of death, symptoms, duration of illness, and barriers in seeking care.
Acknowledgements ! MSF Epicentre, MSF-Holland, MSF-Spain" References: ! Checchi, Francesco and Les Roberts. (2008). “Documenting Mortality in Crisis: What keeps us from doing better?” Plos Med 5 (7) e146" Checchi, Francesco and Les Roberts (2005). “Interpreting and using mortality data in humanitarian emergencies: A primer for nonepidemiologists.” Humanitarian Policy Network, no. 52. " Contact: naomi.sorkin@gmail.com!
• While retrospective surveys can serve as a useful baseline, active surveillance will provide the most accurate picture of weekly mortality and establish a network of community health workers to track malnutrition defaulters and absentees, outbreak detection, and monitor population movement and distribution throughout the camp. "