TY - JOUR
T1 - Health programmes and policies associated with decreased mortality in displaced people in postemergency phase camps
T2 - A retrospective study
AU - Spiegel, Paul
AU - Sheik, Mani
AU - Gotway-Crawford, Carol
AU - Salama, Peter
N1 - Funding Information:
We thank the dedicated health workers in the field who helped us with this study. We also thank Azerbaijan Red Crescent Society, International Federation of Red Cross and Crescent Societies, International Rescue Committee, Tanzanian Red Cross Society, Ugandan Red Cross Society, United Nations High Commissioner for Refugees, and other health organisations that provided us with access to camps but wish to remain anonymous. We acknowledge the help with this paper of Stanley Becker, Muireann Brennan, Richard Brennan, Gilbert Burnham, Frederick Burkle, Unni Karunakara, John MacArthur, Robin Nandy, Courtland Robinson, and Brad Woodruff. Financial support was provided by the Center of Excellence in Disaster Management and Humanitarian Assistance, HI, USA.
PY - 2002/12/14
Y1 - 2002/12/14
N2 - Background: An estimated 35 million people have been displaced by complex humanitarian emergencies. International humanitarian organisations define policies and provide basic health and nutrition programmes to displaced people in postemergency phase camps. However, many policies and programmes are not based on supporting data. We aimed to identify associations between age-specific mortality and health indicators in displaced people in postemergency phase camps and to define the programme and policy implications of these data. Methods: In 1998-2000, we obtained and analysed retrospective mortality data for the previous 3 months in 51 postemergency phase camps in seven countries. We did multivariate regression with 18 independent variables that affect crude mortality rates (CMRs) and mortality rates in children younger than 5 years (<5 MRs) in complex emergencies. We compared these results with recommended emergency phase minimum indicators. Findings: Recently established camps had higher CMRs and <5 MRs and fewer local health workers per person than did camps that had been established earlier. Camps that were close to the border or region of conflict or had longer travel times to referral hospitals had higher CMRs than did those located further away or with shorter travel times, and camps with less water per person and high rates of diarrhoea had higher <5 MRs than did those with more water and lower rates of diarrhoea. Distance to border or area of conflict, water quantity, and the number of local health workers per person exceeded the minimum indicators recommended in the emergency phase. Interpretation: Health and nutrition policies and programmes for displaced people in postemergency phase camps should be evidence-based. Programmes in complex emergencies should focus on indicators proven to be associated with mortality. Minimum indicators should be developed for programmes targeting displaced people in postemergency phase camps.
AB - Background: An estimated 35 million people have been displaced by complex humanitarian emergencies. International humanitarian organisations define policies and provide basic health and nutrition programmes to displaced people in postemergency phase camps. However, many policies and programmes are not based on supporting data. We aimed to identify associations between age-specific mortality and health indicators in displaced people in postemergency phase camps and to define the programme and policy implications of these data. Methods: In 1998-2000, we obtained and analysed retrospective mortality data for the previous 3 months in 51 postemergency phase camps in seven countries. We did multivariate regression with 18 independent variables that affect crude mortality rates (CMRs) and mortality rates in children younger than 5 years (<5 MRs) in complex emergencies. We compared these results with recommended emergency phase minimum indicators. Findings: Recently established camps had higher CMRs and <5 MRs and fewer local health workers per person than did camps that had been established earlier. Camps that were close to the border or region of conflict or had longer travel times to referral hospitals had higher CMRs than did those located further away or with shorter travel times, and camps with less water per person and high rates of diarrhoea had higher <5 MRs than did those with more water and lower rates of diarrhoea. Distance to border or area of conflict, water quantity, and the number of local health workers per person exceeded the minimum indicators recommended in the emergency phase. Interpretation: Health and nutrition policies and programmes for displaced people in postemergency phase camps should be evidence-based. Programmes in complex emergencies should focus on indicators proven to be associated with mortality. Minimum indicators should be developed for programmes targeting displaced people in postemergency phase camps.
UR - http://www.scopus.com/inward/record.url?scp=0037079346&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0037079346&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(02)11915-5
DO - 10.1016/S0140-6736(02)11915-5
M3 - Article
C2 - 12493259
AN - SCOPUS:0037079346
SN - 0140-6736
VL - 360
SP - 1927
EP - 1934
JO - Lancet
JF - Lancet
IS - 9349
ER -