GH15-008, HQ Research, Enumerating and monitoring vulnerable sub-populations

项目总结/摘要 粗死亡率已被公共卫生界用作定义公共卫生的基石 紧急情况通常情况下，紧急情况下的死亡率是通过不完整的监测程序监测的， 调查往往做得很差，在政治上有利的情况下被忽视。该项目将试图 建立两种不同的技术，都比调查简单，不太可能被批评者驳回。1)的 一个多源三角测量过程，或建立国内流离失所者和死亡人数的敏感性，将借鉴 结核病规划和大城市无家可归人口监测中广泛使用的方法，但很少 用于评估死亡率。这一过程是对所有已知的死亡或国内流离失所者进行总结， 独立样本，检查两个列表之间的重叠可以是快速的，并且可能 超越了死亡和登记记录中典型的偏见。该项目将选择要枚举的地方， 衡量至少一个因严重灾害而流离失所的人口的死亡率，以及至少一个 被迫害或与严重的耻辱有关“。2)具有统计代表性的基于社区的 RHA与卫生部在刚果民主共和国Fizi卫生区建立了监测网络。社区 卫生工作者记录出生、死亡和移徙事件。初步分析显示， 系统检测到93%的出生和87%的死亡，两种措施的特异性>99%，阳性 预测值为98%（出生）和91%（死亡）。该项目将尝试看看是否可以类似的系统， 在戈马市设立了一个监测城市环境中的国内流离失所者的监测中心。虽然不适用于所有危机，但境内流离失所者 内罗毕和约旦以及国内流离失所者在几个月或几年内保持稳定的其他大城市中心， 可以通过这种方法进行监测。一旦建立，就可以从 统计上有代表性的样本可以很容易地加入监测过程。 为了最大限度地发挥政策影响，该项目的后几年将涉及与疾病预防控制中心、对外灾难援助办公室、 和其他捐助者，试图建立死亡率测量程序， 捐助方优先考虑的伙伴。如果没有广泛和可信的能力来衡量核心成果， 收入，营养不良和死亡率，人道主义紧急情况的资金将继续更多地基于 政治利益而不是公共卫生需要，成功的拯救生命的救援行动将继续存在。 与无效的努力没有区别。通过向工具箱中添加两个新的简单而廉价的选项， 在人道主义界，我们可以帮助建立一个注重结果而不是过程的社区。

Project Summary/Abstract Crude mortality has been used by the public health community as a cornerstone for defining a public health emergency. Typically mortality in emergencies is monitored by surveillance processes that are incomplete or surveys which are often done poorly and ignored where that is politically expedient. This project will attempt to establish two different techniques, both simpler than surveys, and less likely to be dismissed by critics. 1) The process of multiple source triangulation, or establishing the sensitivity of IDP and death tallies will draw upon methods used widely in TB programs and the monitoring of homeless populations in large cities, but is rarely used to assess mortality. This process of constructing a summary of all known deaths or IDP's, collecting an independent sample, and examining the overlap between the two listings can be rapid, and can potentially transcend the biases typical in death and registration records. The project will select places to enumerate and measure mortality in at least one population displaced by an acute disaster, and at least one population that is persecuted or associated with significant stigma'. 2) A statistically representative community-based surveillance network was established by RHA with the Ministry of Health in Fizi Health Zone, DRC. Community health workers recorded birth, death, and migration events. Preliminary analyses suggest that the surveillance system detected 93% of births and 87% of deaths, with a specificity >99% for both measures, and positive predictive values of 98% (births) and 91% (deaths). This project will attempt to see if a similar system can be established in the city of Goma, to monitor IDPs in an urban setting. While not applicable to all crises, IDPs in Nairobi and Jordan and other large urban centers where IDPs remain stable over months or years could potentially be monitored with this approach. Once established, collection of other desired information from a statistically representative sample could easily be added into the surveillance process. To maximize policy impact, the later years of the project will involve extensive coordination with CDC, OFDA, and other donors in an attempt to establish procedures for mortality measurement in the locations and with partners of priority to donors. Without a widespread and credible capacity to measure central outcomes like income, malnutrition, and mortality, funding of humanitarian emergencies will continue to be based more on political interests than on public health need, and successful life-saving relief operations will remain indistinguishable from ineffective efforts. By adding two new simple and inexpensive options to the toolbox of the humanitarian community, we can help develop a community focused on outcomes instead of processes.