Areas of Assessment and Indicators

1. Areas of Assessment and Indicators 指 導 者 : 張 珩 副院長 報 告 者 : 張 立 平

2. (A) Demography (B) Mortality (C) Priority Diseases (D) Vaccinal coverage against measles (E) Nutritional Status (F) Food Resources (G) Water Resources (H) Living and Sanitation Conditions

3. (A) Demography @ Objectives: - Determine t5he size of a population - Determine the size and structure of vulnerable groups. @ Indicators: - Total number of refugees per site( camp) - Structure of a population: (1) sex ratio (2) percentage of children under 5 (3) percentage of pregnant women (4)age pyamid. @ Methods: - Include counting habitats,census/registration,using programme activity * Counting habitats: (1) Exhaustive counting of habitats: - The average number of persons per household obtain from a small survey of sample at random ( minimum 30)

4. - Counting habitats may do by the foot, vehicle, aerial photography. - The total population = total number X average number of of habitats persons per household (2) Systematic sampling: - The total size = the number of X the number of of population habitats in the camp camps or sites (3) Estimation of population by mapping: - Using random sampling of several known surface areas that counts the number of persons living in this zones.( average population per square) - Population density in the number = 3.5m2 / person in normal of m2/ person * Census : it may do in the early morning or at night when refugees are at home that may represent the total population of refugees. * Registration: it may also organize when refugees arrive at sites and may couple with others activities as food cards, vaccination.. * Estimation from vaccinal coverage and activity data: - Vaccinal coverage survey of a specific age group ( eg: 6 to 59 months) may be used vaccination in the same age groups.

5. For example: *Admitting that vaccinal coverage against measles among 6 to 59 month old childrens is 80% (0.8) and that 5000 antimeasles vaccines were admitted in the same groups. the number of children 6 to 59 month = 5000 / 0.80 = 6250 *Knowing that children of this age group represent in general 17 to 20 % of the total population. the total population = 6250 / 0.20 = 31250 persons

6. (B) Mortality: it is often high in the first week or month of population displacement and decrease rapidly when aid becomes organized and co-ordinated. @ Objectives: - Measure the crude mortality rate of refugees population in displacement. - Measure the mortality rate of children under 5. - Determine the principal causes of death and their respective part in global mortality. @ Indicators: - Total number of deaths per 10000 persons per day. - Number of deaths in children under 5 /10000 / day. - Number of deaths per 1000 persons per month. - Number of deaths in children under 5 / 1000 / month. - Percentage of population deceased during a given time period. - Specific mortality rate due to a given disease. @ Methods: - Retrospective mortality ( the significance of deaths during a given time period) has passed at the moment of assessment. - Counting the number of graves in the given time period.

7. * Retrospective mortality survey: - The sample size should be high that obtain sufficient precisions.( 30 cluster of 30 families that approximately 4000) - Using interrogated memory of head of each family on the occurrence of deaths in his family in the assessment time period. - If the number of deaths is very high, the retrospective period may be decreased in a few week but the situation may not be serious, the time period may be spread for a few month. - The mortality rate = the total number the total number of deaths happened / of surveyed X 10000/day in the survey period individuals PS: { the total number = the sum of living persons + the sum of death of surveyed individuals in the survey period in the same time} * Mortality data from counting graves: - Counting the number of graves dug since the arrival of refugees. * Determining the causes of deaths: - Using the interrogated memory of the family’s head on the principal symptoms leading to death.( malaria: fever and shivering) - Using closer answer ( yes/no answer) during survey .

8. @ Interpretation of Results: - During the emergency phase, the survey time express with per day. - After the emergency phase, the survey period express with per month. * For example: - Six month after the massive arrival of displaced persons at Somalia, 5900 graves were counted for a population of 25000. - the population of = 5900 / (5900+25000) = 19% ( the average of 10.4 died in 6 months death/10000/day) * In emergency, the threshold of gravity of crude mortality rate in global is 1 death / 10000 / day. * In emergency, the threshold of gravity of mortality in children under 5 is 2.5 deaths / 10000 / day.

9. ( C) Priority Disease : @ Objectives: - The current and grae pathologies within a population of refugees. - Identify possible pathologies having epidemic potential. @ Indicators: - Prevalence = the number of cases of disease happening at the given period per 1000 person per week or month. @ Methods: - Because of absence of epidemiological data, to estimate the prevalence of a given pathology from a retrospective survey. - Using interrogated memory of the family’s head on the occurrence of a particular pathology in a household in the survey period. - An interrogation concerns a period not exceeding 15 days before the survey because of to decrease of memory bias. @ Expression and Interpretation of Results: - The prevalence = the number of cases of disease / 1000 / month - A prospective surveillance may rapidly implement to F/U the principal pathologies.

10. (D) Vaccinal coverage against measles: @ Objective: - Measure the proportion of children between 6 month and 15 y/o already vaccinated against measles. @ Indicators: - Percentage of children vaccinated against measles. @ Methods: - If survey has already been done for other health indicators, the vaccinal coverage survey is not necessary to do a separate . - In order to obtain accuracy of results of +/- 10%, it is sufficient to have a sample of 210 children . @ Presentation and interpretation of Results: - Vaccinal coverage data may give information concerning the need to carry out a new vaccination against meales. -

11. (E) Nutritional Status: - The displaced population often suffer from various nutritive deficiencies with both qualitative and quantitative level. - Children under 5 are the group of most seriously affected by Protein- Energy Malnutrition. @ Objective: - Determine the gravity of a nutritional situation. - Estimate the number of malnutrition children. - According to the survey data, implement the feeding programme. @ Indicator: - Prevalence of severe acute malnutrition. @ Anthropometric Indices: - include several measurement: age, height, weight, arm circumference. * Weight- height index( W-H): - Measuring the acute malnutrition. - The results varies little from on population to another. - Using for rapid nutritional survey in emergency situation. - It express as Z scores, percentage of a median compared to reference population.

12. * Arm circumference (MUAC: mid upper arm circumference): - The MUAC is the exact measurement for each child and express in mm. - It is done at the left arm with muscle relaxed. ^ Global acute malnutrition is defined as a MUAC below 125 mm . ^ Moderate acute malnutrition is defined as a MUAC between 110 and < 125 mm. ^ Severe acute malnutrition is defined as a MUAC below 110 mm. * Nutritional survey.: - The sample of children are between 6 to59 month . - If the age children are not known, the height or length between 65 and < 110cm are included in survey. ( 65cm< child< 84.5 cm----- measure lying down) ( child > 85 cm ------measure standing up) - In this survey, the sample size is at least 450 individuals.

13. @ Interpretation of Results: Age W-H index -3Z-score< edema ( month) < -3Z-score W-H<-2Z-score ------------------------------------------------------------------------------------- 6-17 1 14 1 18-29 3 15 1 30-41 0 15 4 42-59 2 22 3 ------------------------------------------------------------------------------------- Total 6 66 9 (0.6%) (0.72%) (0.9%) Table: Distribution of W-H indices within a sample of children(N=913) between 6 to 59 month, displaced of Benguela,Angola, Sep 1993

14. - In the summary, MUAC results of a sample of children between 6 and 59 months are expressed as: ^ At risk: < 135 mm ^ Global acute malnutrition : < 125 mm ^ Moderate malnutrition: 110 – 124 mm ^ Severe acute malnutrition: < 110 mm * Beyond 10 % of a prevalence threshold for children between 6 to 59 months ---- W-H index below –2Z-score or below 80% of the median is a sign of a grave nutrition situation. * If prevalence over 10% is malnutrition situation and may be necessary opening feeding center with hypercalorie diet treating 24 hr per day.

15. (F) Food Resources: @ Objective: - Assess food availability for a population. - Measure individuals calorie rations received by efugees. @ Indicators: - Average number of kcal / person / day (2100kcal/person/day) - Percentage of families having a food distribution card. - Proportion of families receiving adequate ration. @ Methods for estimating food ration: - From quantities planned by organization and does not provide information on real quantities distribution. - During food distribution sample survey of families selected from a community and measure the nutritional status of children at the same time. * Calculating from available food quantities: - From the available food quantities, demographic data, the average

16. * Food Distribution Survey (FDS): - The purpose is to assess the food calorie ration and displaced population effectively received and to measure the equity of the distribution among families. - All food received by the head of the family and its value in calories is calculated. - In emergency, the survey do with 35 heads of family and provides an estimate of a food situation. * Home surveys: - The survey is carried out within the household. - In sample survey, the certain factors indirectly linked to food ration. @ Presentation and Interpretation of Results: - Rations or actually distributed express as the average number of Kcal / person /day. - Adequate ration may calculate: ^ Survey results of 900 families show that 600 heads of families has food distribution card. Distribution coverage = 600 / 900 = 66%

17. * Equity of distribution: * Relation between the quantity of food received and family size: - If the relation exists that larger families had a tendency to receive less than other families. (G) Water Resources: @ Objective: - Measure the quantity and quality of water available to displaced people. @ Indication: - Average number of litres of water available per person per day . ( norms = 15 to 20 l/person/day) - Proportion of families having transportation and storage means. @ Methods: * Hand pump: - The average water flow of a hand pump has been assessed at 1 m3/h. - According to population data, the availability quantity water can measure in L / person / day. * Calculating the capacity of wells: - Using the cylinder volume formula and measuring the difference level of water to obtain the available water.

18. * Water tanks: - Estimating from the tank capacity and filling time. * Data from general water distribution: - The quantity of water available per person per day may calculate from distribution system. * Household surveys: - Using the interrogating memory of family’s head, the number and capacity of containers use in his family that may be carried out the quantity of available water. @ Presentation and Interpretation of Results: * Quantity of available water: - It compare with the normal value.( 15-20 l /person / day) * Water quality: - The quality of water is the presence of free residual chlorine and is an indicator of disinfected water. * Sampling survey results: Ex: If a survey show that 23% of family from the sample don’t have water container and that the total population of the camp is 3000. the quantity of container: 3000 x 23% = 690 container

19. (H) Living and Sanitation Conditions: @ Objective: - Measure the proportion of a population benefiting from protected habitats. - Assess the proportion of families having latrines and waste pits. @ Indicators: - Percentage of protected habitats. ( ex: 5 m2 of plastic sheeting/person) - Surface area available in m2 / person. ( norm: 3.5 m2 / person) - Ratio of number of person / latrines. ( norm: 30 person / latrine UNHCR) - Ratio of number of families / waste pits. @ Methods: - From programme data and sampling survey in a community. @ Presentation and Interpretation of Results: EX: Data from general distribution show that 300 latrines have been installed in a camp of 6000 persons. the ratio number of person / latrine = 6000 / 300 = 20 person / latrine EX: If a survey of 900 families , a total of 450 habitats have plastic sheeting. the proportion of family having a protected shelter = 450 / 900 = 50%