1. Aboutanos, M. B. and Baker, S. P. Wartime civilian injuries: epidemiology and intervention strategies. J Trauma. 1997 Oct; 43(4): 719-26.
Keywords: Blast Injuries: epidemiology/ Craniocerebral Trauma: epidemiology/ Epidemiologic Methods/ Human/ Rape: statistics & numerical data/ *War/ Wounds and Injuries: *epidemiology/ Wounds, Gunshot: epidemiology
Notes: COMMENTS: Comment in: J Trauma 1998 Jul; 45(1): 175-6.
Abstract: BACKGROUND: Trauma is the most important public health risk in wartime. Most preventive efforts have addressed the political etiology of armed conflicts and the secondary effects of war (food, water, shelter, sanitation, and vector control). Little to no efforts have addressed the direct prevention and control of war trauma. METHODS: An extensive review of the literature, with compilation of the most important data. RESULTS: Civilians are the major wartime targets in recent wars, and account for most of the killed and wounded. The trend has been toward a greater proportion of injuries from powerful explosive devices such as artillery shells and mines. Lessons learned from Bosnia and Lebanon show that the most effective way to achieve successful surveillance and injury prevention is to enhance the local skills and resources. CONCLUSIONS: New approaches are needed to minimize trauma to civilians. Both political advocacy and local efforts (including modifying firearms and ammunition, bullet proof helmets for children, anti-sniper shields) are needed.

2. Anker, M. Epidemiological and statistical methods for rapid health assessment: introduction. World Health Stat Q. 1991; 44(3): 94-7.
Keywords: Cluster Analysis/ Data Collection: methods/ Health Resources: organization & administration/ *Health Surveys/ Human/ Quality Assurance, Health Care/ Sampling Studies/ World Health Organization
Notes: Abstract written by Tulane University.
Abstract: Lack of personnel, medical records, and financial resources often hinder the assessment of a health situation by conventional epidemiologic methods in developing countries. Nevertheless, health professionals in developing countries require prompt and reliable epidemiologic information in order to make necessary programmatic decisions. In order to address the dissonance between the necessity of epidemiologic methods and the practicality for their use in developing countries, there is growing interest in establishing a set of epidemiologic methods specialized for situations of restricted need. These methods would allow for a lesser need of resources and a simpler method of statistical analysis. Due, in part, to the increased degree of facility offered by these emerging epidemiologic methods, the methods are becoming known as methods of "rapid assessment." This introduction provides an introductory overview on the background of rapid assessment methods and outlines the topics of discussion addressed by the other rapid health assessment articles included in this issue of World Health Stat Q.

3. Baumann, M.; Deschamps, J. P., and Cao, M. M. Programme planning of pragmatic/professional actions and evaluation in the context of humanitarian actions. Sante Publique. 1998; 10(1): 71-85.
Abstract: Health action program planning is an approach that attempts to resolve the public health problems that are defined as priority. It is upon this approach that the determination of strategies, planning of objectives, the operational plan of activities and the pragmatic/professional evaluation of results, process, resources, community participation, partnerships and staff, are based. The goal concerning this is to provide the foundation of a conceptual and methodological reflection on humanitarian interventions as a planning approach within a community, and to propose elements of methods for program planning and comprehensive, quantitative evaluation. The approach and tool presented here were tested within the context of humanitarian missions carried out in other countries, and result from a two-year collaboration with Medecins du Monde.

4. Bertrand, W. E. Microcomputer applications in health population surveys: experience and potential in developing countries. World Health Stat Q. 1985; 38(1): 91-100.
Keywords: *Computers/ *Data Collection/ *Developing Countries/ Epidemiologic Methods/ *Health Surveys/ Human/ *Microcomputers/ Software/ Statistics
Abstract: Regrettably, because the content and technology are evolving so rapidly the literature on the application of microcomputer technology to health and development is either out of date, or hard to find (e.g. unpublished reports from consultants working with development agencies or universities). The time needed to review and publish an article or a book dictates that by the time it is published, any statements about current hardware will be obsolete. For example, a recent volume by Ingle et al., quite sound from the theoretical and practical point of view, is already out of date with respect to hardware details. For that reason, no hardware suggestions are made in this article. On the other hand, detailed reports of experience with first-generation microcomputers are very useful to the individual planning a developing country application. From the literature and our own field experience with respect to microcomputer applications in health/population surveys in developing countries, the following are useful summary points for projects currently going into the field. Careful planning is absolutely necessary if microcomputer technology is to be applied successfully to field data collection problems. Search out organizations with similar experiences. Collaboration among staff at all levels is essential for a system to be installed and utilized effectively. The particular technology combination selected must be adapted to the field situation. Remember survey complexity and size. Training is essential, and should be on-the-job and oriented towards specific tasks. If time consuming and repetitive tasks are given over to the microcomputer, the technology will be readily accepted and fully utilized. To the extent that a community of users can be formed, the entire adoption process will be stimulated and results improved. Most maintenance and some repairs should be carried out in the field by local project personnel. For most survey and data acquisition problems some custom programming will be needed; this requires a good working knowledge of a powerful programming language (although this is likely to change in the near future). For descriptive statistics and small data management problems off-the-shelf software is appropriate but can be expensive. Compare options. Standardization and compatibility must be considered in all applications. This is important! (ABSTRACT TRUNCATED AT 400 WORDS)

5. Boss, L. P.; Toole, M. J., and Yip, R. Assessments of mortality, morbidity, and nutritional status in Somalia during the 1991-1992 famine. Recommendations for standardization of methods. JAMA. 1994 Aug 3; 272(5): 371-6.
Keywords: Cause of Death/ Guidelines/ Health Surveys/ Human/ Morbidity/ Nutrition Disorders: epidemiology/ Nutritional Status/ Population Surveillance: *methods/ Somalia: epidemiology/ *Starvation: epidemiology: mortality
Abstract: OBJECTIVES--To evaluate the various survey methods used in Somalia between 1991 and early 1993 while assessing documentation of mortality and malnutrition rates and common causes of morbidity and mortality. DATA SOURCES--Twenty-three population surveys were identified from the Center for Public Health Surveillance for Somalia, the United Nations Children's Fund, and other humanitarian organizations. STUDY SELECTION-- Only surveys with defined populations and apparently systematic methodology that focused on mortality, morbidity, and/or nutritional status were included. RESULTS--Extensive methodological differences were found among the 23 surveys. Target populations and sampling strategies varied widely. Twelve studies were considered not reproducible. Of the 16 studies assessing mortality, only eight assessed cause of death. Use of units of measurement and inclusion of denominators in rate calculations were inconsistent. None of the studies provided confidence intervals around the point estimates of the rates. Of the 11 studies providing information on morbidity, none provided case definitions. And in the 16 studies reporting nutritional status, a variety of measurement methods and definitions of malnutrition were used. Three studies presented information based on mid-upper-arm circumference measurements, and 10 presented weight-for- height data below 70% and 80% of the reference median; only four studies presented z scores. CONCLUSIONS--While the results of some studies may have influenced policy and program management decisions, their effects may have been limited by failure to adequately document results and by differences among studies in objectives, design, parameters measured, methods of measurement, definitions, and analysis methods. We recommend that agencies conducting population studies in emergency situations define clear study objectives, use standard sampling and data collection methods, and ensure precise written documentation of study objectives, methods, and results.

6. Centers for Disease Control and Prevention. Famine-affected, refugee and displaced populations: recommendations for public health issues. MMWR Morb Mortal Wkly Rep. 1992 Jul 24; 41(RR-13):1-76.
Keywords: Aged/ Centers for Disease Control and Prevention (U.S.)/ Child/ *Communicable Disease Control/ Communicable Diseases: epidemiology/ Developing Countries/ Female/ Health Promotion/ Health Status Indicators/ Human/ Morbidity/ Nutrition Disorders: epidemiology/ Population Surveillance: methods/ Public Health/ Public Health Administration/ *Refugees: statistics & numerical data/ Relief Work: *organization & administration/ *Starvation: etiology: mortality: therapy/ United States.
Notes: Includes suggested health indicators and collection forms.
Abstract: During the past three decades, the most common emergencies affecting the health of large populations in developing countries have involved famine and forced migrations. The public health consequences of mass population displacement have been extensively documented. On some occasions, these migrations have resulted in extremely high rates of mortality, morbidity, and malnutrition. The most severe consequences of population displacement have occurred during the acute emergency phase, when relief efforts are in the early stage. During this phase, deaths-- in some cases--were 60 times the crude mortality rate (CMR) among non- refugee populations in the country of origin (1). Although the quality of international disaster response efforts has steadily improved, the human cost of forced migration remains high. Since the early 1960s, most emergencies involving refugees and displaced persons have taken place in less developed countries where local resources have been insufficient for providing prompt and adequate assistance. The international community's response to the health needs of these populations has been at times inappropriate, relying on teams of foreign medical personnel with little or no training. Hospitals, clinics, and feeding centers have been set up without assessment of preliminary needs, and essential prevention programs have been neglected. More recent relief programs, however, emphasize a primary health care (PHC) approach, focusing on preventive programs such as immunization and oral rehydration therapy (ORT), promoting involvement by the refugee community in the provision of health services, and stressing more effective coordination and information gathering. The PHC approach offers long-term advantages, not only for the directly affected population, but also for the country hosting the refugees. A PHC strategy is sustainable and strengthens the national health development program.

7. Centers for Disease Control and Prevention. Nutritional and health assessment of Mozambican Refugees in two districts of Malawi, 1988. MMWR. 1998; 37(42): 641-643.
Notes: Abstract written by Tulane University.
Abstract: This article provides a summary of findings from a 1988 nutritional and health assessment of Mozambican refugees in Malawi. A two-stage cluster sampling method was employed with thirty villages being selected for each district cluster and thirty children per village being randomly selected for individual nutritional and health assessment. The results compared rates of malnutrition, vitamin A and vitamin C deficiency, as well as the prevalence of diarrhea and measles for the refugees living in each district. The rates were also compared with the rates of Malawi nationals living in the respective district. The findings indicated evidence of moderate malnutrition in both districts, with signs of vitamin A and vitamin C deficiency occurring only among Mozambican refugees living in Ntcheu District. The prevalence of diarrhea for two weeks before the survey appeared to be similar between districts for Mozambican children and in line with those rates also observed among Malawian children living in those same districts. Each respective district showed coverage of measles vaccination to be higher for the Mozambican refugee children than for the Malawian nationals also living there.

8. Coninx, R.; Dupuy, C.; Hermann, C.; Ribeiro, G. C.; Margot, M., and Lucic, K. Vaccination of the civilian population in a country at war: it can be done; it can also be evaluated. The ICRC experience in Mozambique. J Trop Pediatr. 1998 Jun; 44(3): 186-8.
Keywords: Adult/ Child, Preschool/ Cluster Analysis/ *Developing Countries/ Health Surveys/ Human/ Infant/ Knowledge, Attitudes, Practice/ Mozambique/ Program Evaluation/ *Red Cross/ *Rural Health/ *Vaccination: statistics & numerical data: utilization/ *War
Abstract: The medical division of the International Committee of the Red Cross undertook an expanded programme of immunization in rural areas of Mozambique controlled by the resistance. This programme was evaluated by a 30-cluster survey, which showed that 82 per cent of children between 1 and 5 years and 81.7 per cent of mothers of children of less than 1 year had had contact with the vaccination service. Full vaccination was achieved in 40.6 and 35.2 per cent respectively. The reasons for immunization failure were established. The study shows that vaccination of the civilian population of a developing country at war is possible and, importantly, the outcome of the programme can be assessed.

9. Dick, B. and Elo, O. Disaster preparedness and response. Trop Doct. 1991; 21 Suppl 1:9-14.
Keywords: Consumer Participation/ Delivery of Health Care: *organization & administration/ Developing Countries/ Disaster Planning: *organization & administration/ Relief Work
Notes: Abstract written by Tulane University.
Abstract: Developing countries in which there may be scarcity of resources and a weak health system infrastructure are most vulnerable to the effects of disaster. Pre-existing vulnerability as well as an impaired ability to respond to situations of disaster underlies the challenges facing developing countries when disaster strikes. In this article, the author addresses the need for humanitarian interventions to not only aid in the response to disasters, but for humanitarian response to aid in the capacity building of the country, in particular, within the scope of developing early warning systems and strengthening the primary health care system.
Principles of disaster preparation and response are addressed at the district level, and information and resources necessary for assessing community needs and appropriate intervention responses are also included.

10. Elias, C. J.; Alexander, B. H., and Sokly, T. Infectious disease control in a long-term refugee camp: the role of epidemiologic surveillance and investigation. Am J Public Health. 1990 Jul; 80(7): 824-8.
Keywords: Adolescence/ Adult/ Aged/ Child/ Child, Preschool/ Communicable Disease Control: *methods/ Female/ Health Education/ Hospital Records/ Human/ Infant/ Infant, Newborn/ Male/ Middle Age/ Patient Discharge/ Population Surveillance: *methods/ *Refugees/ Registries/ Thailand/ Vital Statistics
Abstract: This report demonstrates the role of epidemiologic surveillance and investigation in the control of infectious diseases in a long-term refugee camp. The applications of simple epidemiologic methods in a refugee camp on the Thai-Cambodian border are described for a one-year period. The development of a Health Information Office facilitated the collection of demographic and vital statistics data, administration of a disease surveillance system, regular monitoring of hospital and outpatient discharge diagnoses, and investigation of disease outbreaks. This office also organized community health education campaigns and disease control efforts. Examples of specific disease investigations are provided to demonstrate the utility of epidemiologic surveillance in the control of infectious disease. We conclude that simple epidemiologic methods play an important role in health planning in long- term refugee camps.

11. Guha-Sapir, D. Rapid assessment of health needs in mass emergencies: review of current concepts and methods. World Health Stat Q. 1991; 44(3): 171-81.
Keywords: *Epidemiologic Methods/ Food Supply/ *Health Services Needs and Demand/ Human/ Information Services/ Morbidity/ Mortality/ *Natural Disasters/ Refugees
Abstract: The increase in the number of natural disasters and their impact on population is of growing concern to countries at risk and agencies involved in health and humanitarian action. The numbers of persons killed or disabled as a result of earthquakes, cyclones, floods and famines have reached record levels in the last decade. Population density, rampant urbanization and climatic changes have brought about risk patterns that are exposing larger and larger sections of populations in developing countries to life-threatening natural disasters. Despite substantial spending on emergency relief, the approaches to relief remain largely ad hoc and amateurish, resulting generally in inappropriate and/or delayed action. In recent years, mass emergencies of the kind experienced in Bangladesh or the Sahelian countries have highlighted the importance of rapid assessment of health needs for better allocation of resources and relief management. As a result, the development of techniques for rapid assessment of health needs has been identified as a priority for effective emergency action. This article sketches the health context of disasters in terms of mortality and morbidity patterns; it describes initial assessment techniques currently used and their methodological biases and constraints; it also discusses assessment needs which vary between different types of disasters and the time frame within which assessments are undertaken. Earthquakes, cyclones, famines, epidemics or refugees all have specific risk profiles and emergency conditions which differ for each situation. Vulnerability to mortality changes according to age and occupation, for earthquakes and famines. These risk factors then have significant implications for the design of rapid assessment protocols and checklists. Experiences from the field in rapid survey techniques and estimation of death rates are discussed, with emphasis on the need for a reliable denominator even for the roughest assessment. Finally, the importance of adapting normal epidemiological and statistical methodologies to crisis situations is underlined in order to rationalize the recurrent and substantial expenditures made in response to natural disasters today.

12. Guha-Sapir, D.; Dedeurwaerdere, A.; Meert, P., and Zuber, P. Burundi: priorites dans le sectuer sanitaire. CRED document de travail #148. Fevrier; 1998.
Notes: Abstract is quoted from introduction to document.
Abstract: "Le Centre de Recherche sur l’Epidemiologie des Desastres (CRED) a ete mandate par ECHO pour une evaluation des programmes dans le secteur de sante qu’elle finance au Burundi. L’evaluation tente de dresser un panorama de la situation sanitaire actuelle du pays, d’identifier les populations les plus vulnerables, et d’evaluer plus particulierement les actions soutenues par ECHO dans ce contexte. Le present document est base sur les donnees et conclusions exprimees dans le rapport d’evaluation soumis a ECHO. Bien que prepare dans le context de cette mission, il en est independent.
La mission a eu lieu entre le 25 octobre et le 15 novembre 1997. L’equipe sur le terrain comprenait 4 personnes dont les noms sont mentionnes en annexe. La liste des personnes rencontrees se trouve egalement en annexe.
Des entretiens ont ete conduits avec les representants du gouvernement, des agences de l’ONU, des organisations internationales, et des organisations non-gouvernementales traitant de la sante et de la nutrition. Les rapports d’activites et les etudes les plus recentes ont ete recueillis systematiquement. Selon les programmes conduits par les interlocuteurs au niveaux national, provincial et local les donnees suivantes ont pu etre etudiees: morbidite, epidemies, etat nutritionnel, programmes existants, ressources humaines et materielles, identification des populations vulnerables."

13. Guha-Sapir, D.; Dedeurwaerdere, A.; Van Bauwel, A.; Dubois, V., and Golaz, A. Rwanda: health sector needs and recommendations for the transition phase. CRED working paper #149. 1998 Feb. Note: Abstract written by Tulane University. Abstract: Insecurity is increasing in both intensity and scope in Rwanda, a small, landlocked, densely populated country. Among several other problems, there are threats of refugees from neighboring countries, a shortage of food, a shortage of qualified human resources, and frequent major disease outbreaks. These problems have been crippling the development of the country and so far, inefficient international aid sent there to relieve them has been further hindering development in Rwanda. The country has certain health needs, including a stable drug supply, more qualified skilled personnel, disease surveillance, and vaccination programs-not just floods of food aid as has been consistent with most humanitarian aid in the region. It is recommended now that humanitarian actions only continue in the "Red Zone"-the western provinces of the country. Only in these emergency situations found in the Red Zone should emergency food distribution continue. Also, there should be implementation of a monitoring tool for decision-making. There should be more disease preparedness for disease outbreaks and continuity of access to drugs. Finally, there should be improved management of human resources. These recommendations and others should make the transition phase from relief to development in Rwanda much easier.

14. Hakewill, P. A. and Moren, A. Monitoring and evaluation of relief programmes. Trop Doct. 1991; 21 Suppl 1:24-8.
Keywords: Epidemiologic Methods/ Health Surveys/ Morbidity/ Nutritional Status/ Program Evaluation/ *Relief Work/ Survival Analysis
Abstract: Information is power. Every major relief programme of the past 15 years has shown that facts and figures are an indispensable tool for health staff. A simple graph of daily mortality rates can work miracles: mobilize human and material resources, focus the attention of decision makers, guide and refine the assistance programme that is being put in place. If you want useful data, look at these five areas: (i) mortality; (ii) incidence of the most important diseases; (iii) nutritional status; (iv) 'activities data', such as immunizations performed; and (v) the 'vital sectors', namely food, water, sanitation, shelter, etc. The most effective way of presenting information is graphically, so that anyone can see at a glance the trend from month to month. Finally, there are two golden rules. Always give feedback to the workers out in the field who are the primary source of information. And secondly, always act upon information: if your statistics do not lead to concrete action, you are probably better off not collecting them at all.

15. Hussein, K. The nutrition crisis among Mozambican refugees in Malawi: an analysis of the response of international agencies. Journal of Refugee Studies. 1995; 8(1): 26-47.
Abstract: This paper analyses the responses of four international aid agencies (United Nations High Commissioner for Refugees, World Food Programme, Medecins Sans Frontieres-France and Save the Children Fund, UK) to the nutrition needs of and outbreaks of a serious nutritional disease (pellagra) among Mozambican refugees in Malawi in 1989 and 1990. It argues that agency mandates, deficiencies in agency accountability, an unclear division of responsibilities between agencies, along with problems of inter-agency co-ordination, competition and conflict were primarily responsible for the pellagra outbreaks. It also argues that refugee nutritional requirements will not be met unless there is a better matching of short-term relief and long-term development approaches.

16. Lechat, M. F. The epidemiology of health effects of disasters. Epidemiol Rev. 1990; 12:192-8.
Keywords: *Disasters: prevention & control/ Epidemiologic Methods/ Human/ Mental Health/ *Wounds and Injuries: classification: mortality. Note: Abstract written by Tulane University. Abstract: The list of disasters that can afflict populations is long and includes earthquakes, volcano eruptions, fires, floods, irradiation, chemical leaks, etc. Each carries a significant risk of mortality as well as morbidity, which has as far reaching a range of outcomes-from abrasions and contusions to post-traumatic stress disorder-as the types of disasters that can inflict them. There are factors that uniquely affect the epidemiology of the health effects of each kind of disaster. These factors maybe the type of building a person lives in, as in the case of morbidity and mortality from earthquakes, or the person’s age, as in the case of mortality from a fire. There is a need for research into the epidemiology of the health effects of these and other types of disasters. Disaster management must now also accentuate the importance of disaster prevention and disaster preparedness.

17. Lillibridge, S. R. and Noji, E. K. The importance of medical records in disaster epidemiology research. J AHIMA. 1992 Oct; 63(10): 137-8.
Keywords: Centers for Disease Control and Prevention (U.S.)/ Epidemiologic Methods/ Kansas/ Medical Records/ *Medical Records Department, Hospital/ *Natural Disasters/ United States

18. Lillibridge, S. R.; Noji, E. K., and Burkle, F. M. Jr. Disaster assessment: the emergency health evaluation of a population affected by a disaster. Ann Emerg Med. 1993 Nov; 22(11): 1715-20.
Keywords: Disaster Planning: *methods/ Disasters/ Human/ Relief Work
Abstract: In the past decade, interest in the operational and epidemiologic aspects of disaster medicine has grown dramatically. State, local, and federal organizations have created vast emergency response networks capable of responding to disasters, while hospitals have developed extensive disaster plans to address mass casualty situations. Increasingly, the US armed forces have used both their ability to mobilize quickly and their medical expertise to provide humanitarian assistance rapidly during natural and man-made disasters. However, the critical component of any disaster response is the early conduct of a proper assessment to identify urgent needs and to determine relief priorities for an affected population. Unfortunately, because this component of disaster management has not kept pace with other developments in emergency response and technology, relief efforts often are inappropriate, delayed, or ineffective, thus contributing to increased morbidity and mortality. Therefore, improvements in disaster assessment remain the most pressing need in the field of disaster medicine.

19. Logue, J. N.; Melick, M. E., and Hansen, H. Research issues and directions in the epidemiology of health effects of disasters. Epidemiol Rev. 1981; 3:140-62.
Keywords: Adolescence/ Adult/ Child/ Child, Preschool/ *Disasters/ *Epidemiologic Methods/ Female/ Health Status/ Human/ Male/ Morbidity/ Mortality/ Natural Disasters/ Stress Disorders, Post-Traumatic: etiology/ United States
Notes: Abstract written by Tulane University.
Abstract: This article provides a review of research studies and methodological considerations necessary for investigation of the health effects of disasters. The author addresses the challenge of identifying etiologic agents causing increased health problems in disaster situations and provides suggestions for determining which health variables may be appropriate for measurement throughout different phases of disaster recovery. A conceptual system for classifying potential variables of disaster study is defined and epidemiologic research design issues for disaster situations are also addressed.

20. Mayaud, P.; Msuya, W.; Todd, J.; Kaatano, G.; West, B.; Begkoyian, G.; Grosskurth, H., and Mabey, D. STD rapid assessment in Rwandan refugee camps in Tanzania. Genitourin Med. 1997 Feb; 73(1): 33-8.
Keywords: Adolescence/ Adult/ Epidemiologic Methods/ Female/ Human/ Male/ Middle Age/ Pregnancy/ *Pregnancy Complications, Infectious: epidemiology/ Pregnancy Outcome/ Prevalence/ *Refugees/ Rwanda: ethnology/ Sex Behavior/ Sexually Transmitted Diseases: *epidemiology/ Support, Non-U.S. Gov't/ Tanzania: epidemiology
Abstract: OBJECTIVE: To obtain baseline information on sexually transmitted diseases (STDs) in the Rwandan refugees camps in Tanzania, prior to establishment of STD services. SETTING: The largest camps of Rwandan refugees in the Ngara District of Tanzania (estimated population 300,000). The study was carried out in 8 days in August 1994. SUBJECTS AND METHODS: A rapid assessment technique was used to measure STD prevalences among: (i) 100 antenatal clinic attenders (ANC); (ii) 239 men from outpatient clinics (OPD); and (iii) 289 men from the community. Interviews (by questionnaire) and genital examination were performed for all participants; sampling for females included genital swabs for the diagnosis of Neisseria gonorrhoeae (NG), Candida albicans (CA), Trichomonas vaginalis (TV), bacterial vaginosis (BV) and a blood sample for syphilis serology. Men provided urine samples which were screened for leucocytes using the leucocyte esterase (LE) dipstick; urethral swabs for Gram stain were taken from men with a reactive LE test and from those with symptoms or signs of urethritis. OPD males provided a blood sample for syphilis serology. RESULTS: All groups reported frequent experience with STDs and engaging in risky sexual behaviour prior to the survey. During the establishment of the camps, sexual activity was reportedly low. Over 50% of ANC attenders were infected with agents causing vaginitis (TV/BV/CA) and 3% were infected with NG. The prevalence of active syphilis was 4%. In the male outpatients, the prevalence of urethritis was 2.6% and of serological syphilis was 6.1%. Among males in the community, the prevalence of urethritis was 2.9% (the majority being asymptomatic infections). We noted frequent over-reporting of STD symptoms, unconfirmed clinically or biologically. CONCLUSIONS: STD case detection and management should be improved by training health workers in using the WHO syndromic approach, and through IEC campaigns encouraging attendance at clinics. Rapid epidemiological methods provide quick and useful information at low cost in refugee camps.

21. Moren, A. Health and nutrition information systems among refugees and displaced persons. Background document #5 Information Systems. Paper presented at Workshop Report on Refugees’ Nutrition 1995 November, Paris.
Notes: Abstract written by Tulane University.
Abstract: Managing a complex emergency requires monitoring the health, nutrition, and mortality of the affected population. Implementation of an appropriate health and nutrition information system can provide information allowing for the measurement of impact, coverage and process indicators, a system for early warning of epidemics and quantitative data to help guide decision making. This article presents a discussion of impact, coverage and process indicators useful in a complex emergency context. Methodologic issues for data collection and interpretation of results are also included. Of particular focus are the following issues of data enquiry: obtaining estimates of the size of population, crude, cause-specific, age specific, and gender specific mortality, computing disease specific incidence rates, indicators for program implementation, and anthropometric and survey methods for assessment of the nutrition situation.

22. Noji, E. K. Disaster epidemiology and disease monitoring. J Med Syst. 1995 Apr; 19(2): 171-4.
Keywords: Communicable Disease Control/ Disaster Planning: organization & administration/ Disasters: *statistics & numerical data/ Emergency Medical Services: organization & administration/ Epidemiologic Methods/ Human/ Population Surveillance/ Relief Work: organization & administration/ Wounds and Injuries: epidemiology: prevention & control
Abstract: Better epidemiologic knowledge of the mechanisms of death and of the types of injuries and illnesses caused by disasters is clearly essential to determining the appropriate relief medications, supplies, equipment, and personnel needed to effectively respond to such emergencies. The overall objective of disaster epidemiology is to measure scientifically and describe the health effects of disasters and the factors contributing to these effects. The results of such investigations allow disaster epidemiologists to assess the needs of disaster-affected populations, efficiently match resources to needs, prevent further adverse health effects, evaluate relief effectiveness, and plan for future disasters.

23. Noji, E. K. Disaster epidemiology: challenges for public health action. J Public Health Policy. 1992 Autumn; 13(3): 332-40.
Keywords: Cause of Death/ Disaster Planning/ *Disasters/ Emergency Medical Services: supply & distribution/ *Epidemiologic Methods/ Human/ Morbidity/ Program Evaluation/ Wounds and Injuries: etiology
Abstract: Better epidemiologic knowledge of the causes of death and types of injuries and illnesses caused by disasters is clearly essential to determine appropriate relief supplies, equipment and personnel needed to respond effectively to such situations. The overall objective of disaster epidemiology is to scientifically measure and describe the health effects of disasters and contributing factors to these effects, with the goals of assessing the needs of disaster-affected populations, efficient matching of resources to needs, further prevention of adverse health effects, evaluation of program effectiveness, and contingency planning. In addition, the epidemiologist has an important role to play in providing informed advice about the probable health effects which may arise in the future, in establishing priorities for action and in emphasizing the need for accurate information as the basis for relief decisions. This presentation outlines a number of important areas where epidemiologists can contribute to making disaster management more effective.

24. Porter, J. D. H.; Van Loock, F. L., and Devaux, A. Evaluation of two Kurdish refugee camps in Iran, May 1991: the value of cluster sampling in producing priorities and policy. Disasters. 1993; 17(4): 341-347.
Abstract: Following the end of the Gulf war in March 1991, Kurdish refugees from Iraq crossed the border into Western Iran. To plan public health interventions and to assist in priority setting for scarce resources, a rapid epidemiological assessment of two camps, Hafez and Kaliche, was conducted in May 1991. A 30 cluster sampling method was used to determine the demographics of the camp population, the morbidity and mortality from certain diseases, and the nutritional status of the children <5 years of age. The estimated population of the camps at the time of the survey was 28,500 and 22,500 for Hafez and Kaliche respectively; children <5 years of age accounted for approximately 25 per cent of both camp populations. The mortality rate was highest in Hafez and estimated to be 2.5/10,000 per day (95%CI: 0.3-5) for adults (>14 years of age) and 4.9/10,000 per day (95%CI: 2.4-7) for children. Diarrhoeal and respiratory diseases accounted for major morbidity in both camps with diarrhea the commonest stated cause of death. Little malnutrition was found but it was greater in Hafez where 6 per cent (19/327) of the children between 1 and 5 years of age had a mid upper arm circumference (MUAC) <12cm and eleven (5.2 per cent) of the 211 children measured for height and weight were below 80 per cent of the median (95%CI: 2.6%; 7.8%). The survey identified that morbidity and mortality were less severe than in the Kurdish camps on the Turkish border and provided information for camp authorities to plan appropriate relief interventions.

25. Roseberry, W. L.; Heymann, D. L.; Ndoye, I., and Nsubuga, P. S. Rapid sexually transmitted disease assessment in two developing countries. Sex Transm Dis. 1994 Mar-1994 Apr 30; 21(2 Suppl): S84-5.
Keywords: Cost-Benefit Analysis/ *Developing Countries/ Female/ *Health Status Indicators/ Human/ Incidence/ Male/ Mass Screening/ Military Personnel/ Population Surveillance/ Pregnancy/ Pregnancy Complications, Infectious: diagnosis: *epidemiology: prevention & control/ Prevalence/ Prostitution/ Reproducibility of Results/ Senegal: epidemiology/ Sensitivity and Specificity/ Sexually Transmitted Diseases: diagnosis: *epidemiology: prevention & control/ Uganda: epidemiology
Abstract: Two rapid assessment studies of the magnitude of sexually transmitted disease (STD) were performed in Senegal and Uganda in 1989 and 1990. The study objectives were: to develop and validate STD indicators for the "rapid" assessment of the frequency of STD in populations; and to develop a standardized survey methodology to assess STD prevalence using these indicators. The World Bank, World Health Organization (WHO), and Senegal and Ugandan government officials desired a product similar to the WHO/UNICEF immunization coverage survey instrument, which is an accepted and proven methodology, implemented by national programs and donors worldwide. Three indicators were used: 1) past or present signs of selected STD; 2) symptoms as noted by a clinician; and 3) simple laboratory tests performed and results obtained at examination. Each indicator was validated against a confirmatory laboratory test considered the gold standard in indicating the presence or absence of an STD. Male military members, women seeking prenatal care, and female prostitutes were the three population groups chosen. With the exception of the rapid plasma reagin (RPR) test for syphilis, symptoms, signs, and simple laboratory tests failed to accurately predict STD in individuals in all three of these population groups. Indicators for the major STD other than syphilis among populations not seeking STD care will have to be the "gold standard laboratory tests" until easy-to-perform and low-cost alternatives are found.

26. Ross, D. A.; Taylor, N.; Hayes, R., and McLean, M. Measuring malnutrition in famines: are weight-for-height and arm circumference interchangeable? Int J Epidemiol. 1990 Sep; 19(3): 636-45.
Keywords: Age Factors/ Anthropometry: *methods/ *Body Height/ *Body Weight/ Child, Preschool/ Human/ Infant/ *Natural Disasters/ Nutrition Disorders: *diagnosis: epidemiology/ Rural Health/ Sudan: epidemiology/ Support, Non-U.S. Gov't/ Transients and Migrants
Abstract: Data from two surveys in Sudan have been used to examine whether weight- for-height (WFH) and mid-upper arm circumference (MUAC) can be used interchangeably at a population level to define the proportion of children aged one to four years that are malnourished, whether they identify the same individual children as malnourished, and whether the relationship between WFH and MUAC varies with age. A MUAC cut-off of 13.0 cm consistently defined approximately the same proportion of children malnourished as 80% WFH in all seven groups of children examined, even though the proportion of children with less than 80% WFH varied between 8.6% and 30.7%. However, sensitivity/specificity analysis showed that many of the children identified as malnourished by the two indices were not the same individuals. Both the MUAC cut-off defining the same proportion malnourished as 80% WFH, and the sensitivity/specificity values, varied substantially with age. Studies of other populations have revealed both different MUAC cut-offs defining the same proportion of children malnourished as 80% WFH, and different sensitivities and specificities of MUAC relative to WFH. We do not recommend the direct comparison of data from surveys using WFH and those using MUAC.

27. Schofield, E. C. and Mason, J. B. Evaluating energy adequacy of rations provided to refugees and displaced people. Additional document B. Paper presented at the workshop on the Improvement of the Nutrition of Refugees and Displaced People in Africa, Machakos, Kenya, 5-7 December 1994.
Notes: Abstract is quoted from introduction to article.
Abstract: "In recent years there has been much debate about the setting and evaluation of appropriate ration levels (expressed as energy requirements) for refugees. Figures that exist can be used as a basis for interpreting the adequacy of rations being supplied and to check on these was the initial purpose of the work described here. Such figures could also be used for planning rations, and this has emerged as a second purpose of these calculations.
This paper will examine some of the main issues. These include, the purpose of rations, the basis of their calculation, and current proposals for ration levels. It will go on to suggest a pragmatic method for evaluating and setting rations for some of the varying contexts met when refugees need help."

28. Seaman, J. Management of nutrition relief for famine affected and displaced populations. Trop Doct. 1991; 21 Suppl 1:38-42.
Keywords: *Disasters/ Emergencies/ Food Supply/ Health Surveys/ *Nutrition/ Nutritional Status/ Population Surveillance/ *Relief Work
Notes: Abstract written by Tulane University.
Abstract: The problems and needs of displaced people are different depending upon whether the populations have migrated to camps or are still in their home communities. In this article, nutrition specific actions for famine and displaced populations are addressed. Three levels of food distribution are discussed: basic rations, supplementary food, and therapeutic food. The article provides an overview of the kind of information that needs to be collected by surveys and how to monitor and evaluate a nutrition program. Finally, guidance is offered in dealing with some common nutritional problems: how to interpret anthropometric data, working with dispersed populations, and dealing with inadequate food supplies.

29. Selwyn, B. J.; Frerichs, R. R.; Smith, G. S., and Olson, J. Rapid epidemiologic assessment: the evolution of a new discipline. Introduction. Int J Epidemiol. 1989; 18(4 (Suppl 2)):S1.
Notes: Abstract is quoted from introduction to article.
Abstract: "The Rapid Epidemiologic Assessment (REA) Program [seeks] to develop REA methods for health planning and decision-making and to develop or validate more efficient or innovative epidemiologic methods for making timely decisions about health problems and programmes for health care or disease control.
At the onset of the programme it was recognized that REA was not a standard epidemiologic discipline. However, as demonstrated by this special supplement, the area of research has developed considerably since the initiation of the BOSTID Project. REA has now evolved into an important area of epidemiologic research. The goal of this supplement is to stimulate further research into the development of innovative techniques to use in epidemiology in the assessment of health problems to evaluate interventions. Increasingly scarce resources are available for health in many developing countries. It is hoped that the development of improved methods of epidemiologic assessment will aid in the allocation of these resources and subsequently improve health status in the under-served areas of the world."

30. Smith, G. S. Development of rapid epidemiologic assessment methods to evaluate health status and delivery of health services. Int J Epidemiol. 1989; 18(4 Suppl 2):S2-15.
Keywords: *Delivery of Health Care/ *Developing Countries/ *Epidemiologic Methods/ *Health Status/ Human
Abstract: This paper describes the evolution of the concept of rapid epidemiologic assessment (REA) from a series of ideas to a defined area of epidemiologic research. Five broad areas of research are defined: small area survey and sampling methods, surveillance methods, screening and individual risk assessment, community indicators of risk or health status, and case-control methods for evaluation. REA techniques can provide health information more rapidly, simply and at less cost than the standard data collection methods and yet still yield reliable results. The use of these methods is described with examples from both a research programme designed to stimulate the development of REA methods and from other studies in the literature. The further development of REA techniques can lead to better decisions regarding the delivery and allocation of health services in both developing and industrialized countries.

31. Toole, M. J. The rapid assessment of health problems in refugee and displaced populations. Medicine and Global Survival. 1994; 1:200-207.
Abstract: An epidemic of population displacements resulting from an increasing number of regional conflicts has resulted in massive burdens for host countries and relief organizations. During the 1990s, the number of refugees and internally displaced persons has risen from 30 million to more than 47 million. Rapid assessment of the health status and health needs of refugee populations from the outset of a crisis is essential for organizing an effective response with appropriate supplies of emergency foods and medicines. Examples of rapid assessments in recent crises affecting Rwandan, Iraqi, and Somali refugees suggest a need for standardization of assessment methods, for more reliable interpretation of collected data, and for greater security for assessment personnel.

32. Waszak, C. and Tucker, B. The reproductive health needs of adolescent refugees. 1995 Nov; RPN 20.
Abstract: The case studies highlighted in this article illustrate the diversity of reproductive health needs among adolescent refugees. An important finding during the site visits was the presence of several "natural leaders" among all groups: former Burmese students teaching at the English school in Bangkok, Vietnamese students who worked for the UNHCR in Panat Nikhom, and teenage Hmong girls who were responsible for the care of children from several families within the compound. These young individuals were potential collaborators in the development of reproductive health services in refugee situations and could play an important role in conducting needs assessments, gathering information, and implementing and evaluating reproductive health programmes. Programmes designed to meet the needs of adolescent refugees can be strengthened by the involvement of adolescents at all phases of development.

33. Weinberg, J. and Simmonds, S. Public health, epidemiology and war. Soc Sci Med. 1995 Jun; 40(12): 1663-9.
Keywords: Bosnia-Herzegovina: epidemiology/ Chronic Disease: epidemiology/ Communicable Disease Control: *organization & administration/ Delivery of Health Care: organization & administration/ Disease Notification/ Human/ Population Surveillance: *methods/ Relief Work: *organization & administration/ Sentinel Surveillance/ *War/ *World Health Organization
Abstract: The delivery of humanitarian aid in wartime is difficult. However, it is essential that aid is provided in the most effective manner possible, targeted on those most in need whilst minimizing waste. Furthermore the delivery of aid should be sensitive to the future needs of the communities in conflict. This requires information on the needs of the vulnerable population. There is little experience of collecting data on the impact of war on a civilian population. The war in Bosnia disrupted surveillance of communicable disease. The local authorities were assisted by the World Health Organization in re-establishing surveillance. The data generated was valuable in planning interventions to minimize the possibility of major outbreaks of infection, reduce the impact of infectious disease and in guiding the humanitarian aid effort. The experience described suggests that public health surveillance of the civilian population in wartime is possible and useful. Besides the need for planning, the public health doctor in wartime has a role as an advocate for those suffering; this function can be carried out much more effectively if it is based on objective data collection rather than hearsay.

34. Young, H. and Jaspars, S. Nutritional assessments, food security and famine. Disasters. 1995 Mar; 19(1): 26-36.
Keywords: Cause of Death/ Child, Preschool/ Female/ *Food Supply/ Human/ Infant/ Male/ *Nutrition Assessment/ Nutrition Surveys/ Population Surveillance/ Protein-Energy Malnutrition: etiology: mortality/ Sampling Studies/ *Starvation/ Sudan
Abstract: The widely held view that malnutrition is a late indicator of famine is challenged on the basis of evidence that people often deliberately reduce their food intake as an early response to inadequate food security. This broadens the possible interventions in response to high malnutrition rates to include measures to support livelihoods under threat of collapse. In the late stages of famine, social disruption and distress migration often result in a degraded health environment which may raise the threshold of nutritional status associated with an increased mortality risk. It is important to assess the underlying causes of malnutrition and the associated health risks. At present, the main objective of nutrition surveys is usually to obtain a reliable estimate of the prevalence of malnutrition among children under five years of age, with little analysis of the underlying causes of malnutrition. Experience from the 1984-85 famine in Darfur led to the development of an alternative approach to nutritional assessment, which could be applicable elsewhere in Africa. The combination of quantitative and qualitative methods was particularly valuable as a means of gaining a wider and deeper understanding of the nature of the nutritional situation.