Implementation and utilisation of community-based mortality surveillance: a case study from Chad.
Implementation and utilisation of community-based mortality surveillance: a case study from Chad.
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DOI：
10.1186/1752-1505-6-11
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发表时间：
2012-11-27
影响因子：
3.6
通讯作者：
Wong S
中科院分区：
文献类型：
--
作者：
Bowden S;Braker K;Checchi F;Wong S
前瞻性监测是衡量人道主义紧急情况死亡率的公认方法。然而，关于如何最佳地实施此类监控以及各机构如何实际使用数据的证据有限。本案例研究调查无国界医生组织 (MSF) 在乍得东部实施和利用死亡率监测数据的情况。我们的目的是描述和分析以社区为基础的死亡率监测系统、死亡率数据趋势以及利用这些数据来指导无国界医生组织的行动应对。该案例研究包括 5 个无国界医生营地，其中包括 2 个难民营和 3 个国内流离失所者营地。数据是通过主要知情人访谈和无国界医生组织 2004 年至 2008 年业务报告的系统审查获得的。死亡率数据由社区卫生工作者 (CHW) 收集。死亡率总体上逐渐下降。在 Farchana 和 Breidjing 难民营，粗死亡率 (CDR) 分别从 2004 年的每万人日 0.9 人下降到 2008 年的 0.2 人，并从 0.7 人下降到 0.1 人。在 Gassire、Ade 和 Kerfi 国内流离失所者营地，CDR 从 0.4 降至 0.04、0.3 降至 0.04 和 1.0 降至 0.3。 5 岁以下儿童 (U5DR) 的死亡率也呈现类似趋势。在 Kerfi 的一个地点，CDR 和 U5DR 跨越了紧急阈值，2008 年 7 月，CDR 迅速升至 2.1，U5DR 升至 7.9，然后到 2008 年 9 月迅速降至紧急水平以下。死亡率数据定期用于监测人口健康状况，并两次用作宣传工具。汲取的经验教训包括需要改进人口估计和标准化报告程序，以提高数据质量和传播；简单而灵活的数据收集模型的重要性；加大对社区卫生工作者监管的投资。这种基于社区的死亡率监测模式可以由在复杂环境中工作的人道主义机构进行调整和使用。然而，人道主义组织应努力传播定期收集的死亡率数据，并提高数据在行动规划和评估中的利用率。准确的人口估计仍然是一个挑战，限制了死亡率估计的准确性。
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. 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. 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. 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. 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.