More than 4 years after the official end of war, the crude mortality rate remains elevated across DRC. Slight but significant improvements in mortality in the insecure east coincided temporally with recent progress on security, humanitarian, and political fronts.
Measuring rates and circumstances of population mortality (in particular crude and under-5 year mortality rates) is essential to evidence-based humanitarian relief interventions. Because prospective vital event registration is absent or deteriorates in nearly all crisis-affected populations, retrospective household surveys are often used to estimate and describe patterns of mortality. Originally designed for measuring vaccination coverage, the two-stage cluster survey methodology is frequently employed to measure mortality retrospectively due to limited time and resources during humanitarian emergencies. The method tends to be followed without considering alternatives, and there is a need for expert advice to guide health workers measuring mortality in the field.
Humanitarian emergencies, including complex emergencies associated with fragile states or areas of conflict, affect millions of persons worldwide. Such emergencies threaten global health security and have complicated but predictable effects on public health. The Centers for Disease Control and Prevention (CDC) Emergency Response and Recovery Branch (ERRB) (Division of Global Health Protection, Center for Global Health) contributes to public health emergency responses by providing epidemiologic support for humanitarian health interventions. To capture the extent of this emergency response work for the past decade, we conducted a retrospective review of ERRB’s responses during 2007–2016. Responses were conducted across the world and in collaboration with national and international partners. Lessons from this work include the need to develop epidemiologic tools for use in resource-limited contexts, build local capacity for response and health systems recovery, and adapt responses to changing public health threats in fragile states. Through ERRB’s multisector expertise and ability to respond quickly, CDC guides humanitarian response to protect emergency-affected populations.
Humanitarian emergencies often result in population displacement and increase the risk for transmission of communicable diseases. To address the increased risk for outbreaks during humanitarian emergencies, the World Health Organization developed the Early Warning Alert and Response Network (EWARN) for early detection of epidemic-prone diseases. The US Centers for Disease Control and Prevention has worked with the World Health Organization, ministries of health, and other partners to support EWARN through the implementation and evaluation of these systems and the development of standardized guidance. Although protocols have been developed for the implementation and evaluation of EWARN, a need persists for standardized training and additional guidance on supporting these systems remotely when access to affected areas is restricted. Continued collaboration between partners and the Centers for Disease Control and Prevention for surveillance during emergencies is necessary to strengthen capacity and support global health security.
BackgroundDiarrheal disease is a common cause of morbidity and mortality. Displaced populations are especially vulnerable due to overcrowded camps and limited access to water and sanitation facilities, increasing the risk for outbreaks. Hand washing with soap is effective against disease transmission, and studies suggest access to a convenient hand washing station may be the key to increasing hand washing behavior. This pilot study evaluated the acceptability, durability and use of a novel hand washing bag (HWB) at the household level among Sudanese refugees immediately following an acute emergency.MethodsWe distributed one HWB to every household (n = 874) in Adamazin Transit Center in western Ethiopia. The evaluation consisted of baseline and endline surveys, three monthly monitoring visits and focus group discussions (FGDs) over a six month period. FGD data were analyzed using the Risk, Attitudes, Norms, Abilities, and Self-Regulatory model. Survey and monitoring data were analyzed using SPSS. Note: Residents were resettled to Bambasi Refugee Camp during the study period where the endline survey was conducted.ResultsBaseline data suggested water quantity and availability of soap were below SPHERE standards, however participants responded positively to the HWB. At the end of the monitoring period, 73.9 % of the same households retained their original HWBs and 66.7 % of bags had water at the time of the visit. The mean lifespan of the HWB during the monitoring period was 2.73 months. From a new sample of households selected for the endline evaluation, 93.0 % had an original HWB, but only 39.4 % had water in the bag. Endline FGD participants felt the HWB was useful, but reported insufficient soap and hygiene messaging.ConclusionThe HWB performed well during the early phases of the emergency, however longer term results in this setting are unclear. The low levels of reported use measured by proxy indicators at six months indicated decreasing acceptability over time or a reflection of potential differences between the two sites. It is also unknown whether the HWB influenced hand washing behavior. Study findings were shared with the manufacturer in an effort to improve the bag’s acceptability, utility, and durability.
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