0
June 27, 1990, Vol 263, No. 24 >
ARTICLE | June 27, 1990

Prevention of Excess Mortality in Refugee and Displaced Populations in Developing Countries FREE

Michael J. Toole, MD, DTM&H; Ronald J. Waldman, MD, MPH
[+] Author Affiliations

Reprint requests to International Health Program Office, Centers for Disease Control, 1600 Clifton Rd, Atlanta, GA 30333 (Dr Toole).


JAMA. 1990;263(24):3296-3302. doi:10.1001/jama.1990.03440240086021
Text Size: A A A
Published online
Article
References

More than 30 million refugees and internally displaced persons in developing countries are currently dependent on international relief assistance for their survival. Most of this assistance is provided by Western nations such as the United States. Mortality rates in these populations during the acute phase of displacement have been extremely high, up to 60 times the expected rates. Displaced populations in northern Ethiopia (1985) and southern Sudan (1988) have suffered the highest crude mortality rates. Although mortality rates have risen in all age groups, excess mortality has been the greatest in 1- through 14-year-old children. The major causes of death have been measles, diarrheal diseases, acute respiratory tract infections, and malaria. Case-fatality ratios for these diseases have risen due to the prevalence of both protein-energy malnutrition and certain micronutrient deficiencies. Despite current technical knowledge and resources, several recent relief programs have failed to promptly implement essential public health programs such as provision of adequate food rations, clean water and sanitation, measles immunization, and control of communicable diseases. Basic structural changes in the way international agencies implement and coordinate assistance to displaced populations are urgently needed.

(JAMA. 1990;263:3296-3302)

REFERENCES

1 +
World Refugee Survey—1988 in Review . Washington, DC: US Committee for Refugees; 1989;.
2 +
Convention and Protocol Relating to the Status of Refugees . Geneva, Switzerland: United Nations High Commission for Refugees; 1968;. Publication HCR/INF/29/Rev 3.
3 +
D'Souza F.  Who is a refugee? definitions and assistance . Disasters. 1981;;5:173-175.
4 +
 Famine . The New Yorker . (March 13) , 1989;:85-101.
5 +
Ackerman G.  The food weapon and famine in Sudan . Christian Science Monitor . (January 24) , 1989;:19.
6 +
 In Sudan, both sides use food as a weapon . Washington Post . (November 29) , 1988;;sect A:25.
7 +
Kismaric C. Forced Out . New York, NY: Morrow Norton Penguin & Random House; 1989;.
8 +
Gersony R. Summary of Mozambican Refugee Accounts of Principally Conflict-Related Experiences in Mozambique . Washington, DC: Bureau for Refugee Programs, US Dept of State; 1988;.
9 +
Bureau for Refugee Programs. Assessment Manual for Refugee Emergencies . Washington, DC: US Dept of State; 1985;.
10 +
Aall C.  Disastrous international relief failure: a report on Burmese refugees in Bangladesh from May to December 1978 . Disasters. 1979;;3:429-434.
11 +
Toole MJ, Waldman RJ.  An analysis of mortality trends among refugee populations in Somalia, Sudan, and Thailand . Bull World Health Organ. 1988;;66:237-247.
12 +
 United Nations Children's Fund . State of the World's Children . Oxford, England: Oxford University Press; 1985;.
13 +
Glass RJ, Cates W Jr, Nieburg P, et al.  Rapid assessment of health status and preventive medicine needs of newly arrived Kampuchean refugees, Sa Kaeo, Thailand . Lancet. 1980;;1:868-872.
14 +
Hasselblad C, Davis C, Waldman R. First Report of the CDC Epidemiologic Team to the Somali Ministry of Health . Atlanta, Ga: Centers for Disease Control; 1980;.
15 +
Shears P, Berry AM, Murphy R, Nabil MA.  Epidemiological assessment of the health and nutrition of Ethiopian refugees in emergency camps in Sudan, 1985 . BMJ. 1987;;295:314-318.
16 +
Centers for Disease Control.  Nutritional status of Somali refugees—Eastern Ethiopia, September 1988-May 1989 . MMWR. 1989;;38:455-456, 461-463.
17 +
Seaman J.  Famine mortality in Ethiopia and Sudan . In: Proceedings of Seminar on Mortality and Society in Sub-Saharan Africa, Yaounde, Cameroun, October 19-23, 1987 , for the International Union for the Scientific Study of Population; Liege, Belgium.
18 +
De Waal A.  Famine mortality: 1984-1985 . Popul Stud. 1989;;43:5-24.
19 +
Moren A.  Medical surveillance in a low-technology setting . Presented at the International Symposium on Health Care for Refugee and Displaced Populations; December 4-7,1988 ; Washington, DC.
20 +
Toole MJ. Review of Health and Nutrition Programme, Eastern Ethiopian Refugee Camps, December 2-22, 1989 . Geneva, Switzerland: Office of the United Nations High Commission for Refugees; 1990;.
21 +
Rutherford GW, Mahanjane AE.  Morbidity and mortality in the Mozambican famine of 1983 . J Trop Pediatr. 1985;;31:143-149.
22 +
Otten M. Nutritional and mortality aspects of the 1985 famine in north-central Ethiopia . Presented as a report to the Save the Children Federation; (March 26) , 1986;; Westport, Conn.
23 +
 Nutritional and health status of displaced persons—Sudan, 1988-1989 . MMWR. 1989;;848-850, 855.
24 +
Shears P, Lusty T.  Communicable disease epidemiology following migration: studies from the African famine . Int Migration Rev. 1987;;21:783-795.
25 +
Allegra D, Nieburg P, Grabe M, eds. Emergency Refugee Health Care—A Chronicle of Experience in the Khmer Asistance Operation, 1979-1980 . Atlanta, Ga: Centers for Disease Control; 1983;. Monograph.
26 +
Farah AH. The cholera epidemic in the northwest region of Somalia, March-April 1985 . Presented as a report to the Somali Ministry of Health by the Hargeisa Cholera Committee, revised version; (June) 1985;; Mogadishu, Somalia.
27 +
Mulholland K.  Cholera in Sudan . Disasters. 1985;;9:247-258.
28 +
Moren A, Stephanagi S, Antona D, et al. A Vibrio cholerae inaba outbreak in a refugee camp, Malawi, March-May 1988 . Presented as a report to Medecins Sans Frontieres and Epicentre; (January) 1989;; Paris, France.
29 +
Centers for Disease Control.  Enterically transmitted, non-A, non-B hepatitis—East Africa . MMWR. 1987;;36;241-244.
30 +
Measuring Change in Nutritional Status: Guidelines for Assessing the Nutritional Impact of Supplementary Feeding Programmes for Vulnerable Groups . Geneva, Switzerland: World Health Organization; 1983;.
31 +
Yates R. Medical review of refugee camps, Wad Kowli, Sefawa I and II, and Umballa, January 1985-April 1986 . Presented as a report to the Save the Children Fund; (June) 1986;; London, England.
32 +
Karell B. The Relationship Between Child Malnutrition and Crude Mortality Among 42 Refugee Populations. Atlanta, Ga: Emory University; 1989. Thesis.
33 +
Magan AM, Warsame M, Ali-Salad AK, Toole MJ.  An outbreak of scurvy in Somali refugee camps . Disasters. 1983;;7:94-97.
34 +
World Health Organization.  Scurvy and food aid among refugees in the Horn of Africa . Weekly Epidemiol Record. 1989;;64:85-87.
35 +
Nieburg P, Waldman RJ, Leavell R, et al.  Vitamin A supplementation for refugees and famine victims . Bull World Health Organ. 1988;;66:689-697.
36 +
Moren A, LeMoult D. Pellagra cases among Mozambican refugees, Tengani camp, Malawi 1989 . Epicentre report; (March) 1990;: Paris, France.
37 +
Holloway A. Major Issues in Refugee Health in Eastern Sudan—1989 . Washington, DC: Refugee Policy Group; 1989;.
38 +
Desenclos JC, Michel D, Tholly F, et al.  Mortality trends among refugees in Honduras, 1984-1987 . Int J Epidemiol. In press.
39 +
Boss LP, Brink EW, Dondero TJ.  Infant mortality and childhood nutritional status among Afghan refugees in Pakistan . Int J Epidemiol. 1987;;16:556-560.
40 +
Slutsker L, Steketee RW, Wirima JJ, Breman JG.  Infant mortality in Malawi . Presented at the Annual Epidemic Intelligence Service Conference, Centers for Disease Control; April 3-7,1989 ; Atlanta, Ga.
41 +
Holloway A. Report of Health/Nutrition Services in UNHCR-Assisted Camps in Thailand, January 1983-June 1984 . Bangkok, Thailand: Office of the United Nations High Commissioner for Refugees; 1984;.
42 +
Foster SO, Weisfeld JS. Health Assessment of Palestinian Refugees in Beirut and Southern Lebanon . Atlanta, Ga: Centers for Disease Control; 1982;.
43 +
Spiegel R. Technical mission to Hargeisa, Boroma, and Burao, Somalia, 17-29 October, 1988 . Presented as a report to the Centers for Disease Control; (November) 1988;; Atlanta, Ga.
44 +
Hearings Before the United States Senate Committee on Labor and Human Resources, Subcommittee on Children, Family, Drugs, and Alcohol. 101st Cong, 2nd Sess. (1990) (testimony of Angela Berry Koch).
45 +
Yip R, Gove S, Hassan BF.  Assessment of hematological status of refugees in Somalia . Presented at the Annual Meeting of the American Public Health Association; October 20, 1987; New Orleans, La .
46 +
Desenclos JC, Berry AM, Padt R, et al.  Epidemiologic patterns of scurvy among Ethiopian refugees . Bull World Health Organ. 1989;;67:309-316.
47 +
Serdula M, Seward J.  Diet, malnutrition, and mortality . In: Proceedings of Seminar on Mortality and Society in Sub-Saharan Africa, Yaounde, Cameroun, October 19-23, 1987, of the International Union for the Scientific Study of Population ; Liege, Belgium.
48 +
Sommer A, Hussaini G, Tarwotjo I, Susanto D.  Increased mortality in children with mild vitamin A deficiency . Lancet. 1983;;1:585-588.
49 +
Levine M.  New concepts in the biology and biochemistry of ascorbic acid . N Engl J Med. 1986;;314:892-902.
50 +
Centers for Disease Control.  Nutritional and health assessment of Mozambican refugees in two districts of Malawi, 1988 . MMWR. 1988;;37:641-643.
51 +
Chen LC, Chowdhury AKM, Huffman SL.  Anthropometric assessment of energy-protein malnutrition and subsequent risk of mortality among preschool aged children . Am J Clin Nutr. 1980;;33: 1836-1845.
52 +
Kasongo Project Team.  Anthropometric assessment of young children's nutritional status as an indicator of subsequent risk of dying . J Trop Pediatr. 1983;;29:69-75.
53 +
Handbook for Emergencies . Geneva, Switzerland: United Nations High Commissioner for Refugees; 1982;:122.
54 +
United Nations Administrative Committee for Coordination, Subcommittee on Nutrition, and the International Nutrition Planners Forum.  Nutrition in times of disaster . Presented as a report of an International Conference; September 27-30, 1988; Geneva, Switzerland .
55 +
Biellik R. The Evaluation of Public Health Components of International Disaster Relief Operations: Indo-Chinese Refugees in Thailand, 1979-1982. Houston: University of Texas; June 1983. Dissertation.
56 +
Toole MJ, Nieburg P, Waldman RJ.  The association between inadequate rations, undernutrition prevalence, and mortality in refugee camps . J Trop Pediatr. 1988;;34:218-224.
57 +
Godfrey N.  Supplementary feeding in refugee populations: comprehensive or selective feeding programmes? Health Policy Plan. 1986;;1:283-298.
58 +
Taylor WR.  An evaluation of supplementary feeding in Somali refugee camps . Int J Epidemiol. 1983;;12:433-436.
59 +
Gibb C.  A review of feeding programmes in refugee reception centres in eastern Sudan, October 1985 . Disasters. 1986;;10:17-24.
60 +
Dick B.  Supplementary feeding for refugees and other displaced communities—questioning current orthodoxy . Disasters. 1986;;10:53-64.
61 +
Esrey SA, Feachem RG, Hughes JM.  Interventions for the control of diarrheal diseases among young children . Bull World Health Organ. 1985;;63:757-772.
62 +
Toole MJ, Steketee RJ, Waldman RJ, Nieburg P.  Measles prevention and control in emergency settings . Bull World Health Organ. 1989;;67:381-388.
63 +
Malaria Branch, Center for Infectious Diseases. Primer on the Prophylaxis, Therapy, and Control of Malaria in Sahelian Refugee Camps . Atlanta, Ga: Centers for Disease Control; 1985;.
64 +
Rieder H, Snider D, Toole MJ, Waldman RJ, et al.  Tuberculosis control in emergency settings . Tubercle. 1989;;70:127-134.
65 +
Downing R.  A tale of two clinics—primary health care in refugee settings . Soc Sci Med. 1989;;70:127-134.
66 +
New York Times . (September 10) , 1989;:3.
67 +
United Nations High Commission for Refugees, December 1988; US Dept of State, Bureau for Refugee Programs, September 1988; and US Committee for Refugees. World Refugee Survey—1988 in Review, May 1989 . Geneva, Switzerland: United Nations High Commission for Refugees; 1990;. Press release.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
World Refugee Survey—1988 in Review . Washington, DC: US Committee for Refugees; 1989;.
2 +
Convention and Protocol Relating to the Status of Refugees . Geneva, Switzerland: United Nations High Commission for Refugees; 1968;. Publication HCR/INF/29/Rev 3.
3 +
D'Souza F.  Who is a refugee? definitions and assistance . Disasters. 1981;;5:173-175.
4 +
 Famine . The New Yorker . (March 13) , 1989;:85-101.
5 +
Ackerman G.  The food weapon and famine in Sudan . Christian Science Monitor . (January 24) , 1989;:19.
6 +
 In Sudan, both sides use food as a weapon . Washington Post . (November 29) , 1988;;sect A:25.
7 +
Kismaric C. Forced Out . New York, NY: Morrow Norton Penguin & Random House; 1989;.
8 +
Gersony R. Summary of Mozambican Refugee Accounts of Principally Conflict-Related Experiences in Mozambique . Washington, DC: Bureau for Refugee Programs, US Dept of State; 1988;.
9 +
Bureau for Refugee Programs. Assessment Manual for Refugee Emergencies . Washington, DC: US Dept of State; 1985;.
10 +
Aall C.  Disastrous international relief failure: a report on Burmese refugees in Bangladesh from May to December 1978 . Disasters. 1979;;3:429-434.
11 +
Toole MJ, Waldman RJ.  An analysis of mortality trends among refugee populations in Somalia, Sudan, and Thailand . Bull World Health Organ. 1988;;66:237-247.
12 +
 United Nations Children's Fund . State of the World's Children . Oxford, England: Oxford University Press; 1985;.
13 +
Glass RJ, Cates W Jr, Nieburg P, et al.  Rapid assessment of health status and preventive medicine needs of newly arrived Kampuchean refugees, Sa Kaeo, Thailand . Lancet. 1980;;1:868-872.
14 +
Hasselblad C, Davis C, Waldman R. First Report of the CDC Epidemiologic Team to the Somali Ministry of Health . Atlanta, Ga: Centers for Disease Control; 1980;.
15 +
Shears P, Berry AM, Murphy R, Nabil MA.  Epidemiological assessment of the health and nutrition of Ethiopian refugees in emergency camps in Sudan, 1985 . BMJ. 1987;;295:314-318.
16 +
Centers for Disease Control.  Nutritional status of Somali refugees—Eastern Ethiopia, September 1988-May 1989 . MMWR. 1989;;38:455-456, 461-463.
17 +
Seaman J.  Famine mortality in Ethiopia and Sudan . In: Proceedings of Seminar on Mortality and Society in Sub-Saharan Africa, Yaounde, Cameroun, October 19-23, 1987 , for the International Union for the Scientific Study of Population; Liege, Belgium.
18 +
De Waal A.  Famine mortality: 1984-1985 . Popul Stud. 1989;;43:5-24.
19 +
Moren A.  Medical surveillance in a low-technology setting . Presented at the International Symposium on Health Care for Refugee and Displaced Populations; December 4-7,1988 ; Washington, DC.
20 +
Toole MJ. Review of Health and Nutrition Programme, Eastern Ethiopian Refugee Camps, December 2-22, 1989 . Geneva, Switzerland: Office of the United Nations High Commission for Refugees; 1990;.
21 +
Rutherford GW, Mahanjane AE.  Morbidity and mortality in the Mozambican famine of 1983 . J Trop Pediatr. 1985;;31:143-149.
22 +
Otten M. Nutritional and mortality aspects of the 1985 famine in north-central Ethiopia . Presented as a report to the Save the Children Federation; (March 26) , 1986;; Westport, Conn.
23 +
 Nutritional and health status of displaced persons—Sudan, 1988-1989 . MMWR. 1989;;848-850, 855.
24 +
Shears P, Lusty T.  Communicable disease epidemiology following migration: studies from the African famine . Int Migration Rev. 1987;;21:783-795.
25 +
Allegra D, Nieburg P, Grabe M, eds. Emergency Refugee Health Care—A Chronicle of Experience in the Khmer Asistance Operation, 1979-1980 . Atlanta, Ga: Centers for Disease Control; 1983;. Monograph.
26 +
Farah AH. The cholera epidemic in the northwest region of Somalia, March-April 1985 . Presented as a report to the Somali Ministry of Health by the Hargeisa Cholera Committee, revised version; (June) 1985;; Mogadishu, Somalia.
27 +
Mulholland K.  Cholera in Sudan . Disasters. 1985;;9:247-258.
28 +
Moren A, Stephanagi S, Antona D, et al. A Vibrio cholerae inaba outbreak in a refugee camp, Malawi, March-May 1988 . Presented as a report to Medecins Sans Frontieres and Epicentre; (January) 1989;; Paris, France.
29 +
Centers for Disease Control.  Enterically transmitted, non-A, non-B hepatitis—East Africa . MMWR. 1987;;36;241-244.
30 +
Measuring Change in Nutritional Status: Guidelines for Assessing the Nutritional Impact of Supplementary Feeding Programmes for Vulnerable Groups . Geneva, Switzerland: World Health Organization; 1983;.
31 +
Yates R. Medical review of refugee camps, Wad Kowli, Sefawa I and II, and Umballa, January 1985-April 1986 . Presented as a report to the Save the Children Fund; (June) 1986;; London, England.
32 +
Karell B. The Relationship Between Child Malnutrition and Crude Mortality Among 42 Refugee Populations. Atlanta, Ga: Emory University; 1989. Thesis.
33 +
Magan AM, Warsame M, Ali-Salad AK, Toole MJ.  An outbreak of scurvy in Somali refugee camps . Disasters. 1983;;7:94-97.
34 +
World Health Organization.  Scurvy and food aid among refugees in the Horn of Africa . Weekly Epidemiol Record. 1989;;64:85-87.
35 +
Nieburg P, Waldman RJ, Leavell R, et al.  Vitamin A supplementation for refugees and famine victims . Bull World Health Organ. 1988;;66:689-697.
36 +
Moren A, LeMoult D. Pellagra cases among Mozambican refugees, Tengani camp, Malawi 1989 . Epicentre report; (March) 1990;: Paris, France.
37 +
Holloway A. Major Issues in Refugee Health in Eastern Sudan—1989 . Washington, DC: Refugee Policy Group; 1989;.
38 +
Desenclos JC, Michel D, Tholly F, et al.  Mortality trends among refugees in Honduras, 1984-1987 . Int J Epidemiol. In press.
39 +
Boss LP, Brink EW, Dondero TJ.  Infant mortality and childhood nutritional status among Afghan refugees in Pakistan . Int J Epidemiol. 1987;;16:556-560.
40 +
Slutsker L, Steketee RW, Wirima JJ, Breman JG.  Infant mortality in Malawi . Presented at the Annual Epidemic Intelligence Service Conference, Centers for Disease Control; April 3-7,1989 ; Atlanta, Ga.
41 +
Holloway A. Report of Health/Nutrition Services in UNHCR-Assisted Camps in Thailand, January 1983-June 1984 . Bangkok, Thailand: Office of the United Nations High Commissioner for Refugees; 1984;.
42 +
Foster SO, Weisfeld JS. Health Assessment of Palestinian Refugees in Beirut and Southern Lebanon . Atlanta, Ga: Centers for Disease Control; 1982;.
43 +
Spiegel R. Technical mission to Hargeisa, Boroma, and Burao, Somalia, 17-29 October, 1988 . Presented as a report to the Centers for Disease Control; (November) 1988;; Atlanta, Ga.
44 +
Hearings Before the United States Senate Committee on Labor and Human Resources, Subcommittee on Children, Family, Drugs, and Alcohol. 101st Cong, 2nd Sess. (1990) (testimony of Angela Berry Koch).
45 +
Yip R, Gove S, Hassan BF.  Assessment of hematological status of refugees in Somalia . Presented at the Annual Meeting of the American Public Health Association; October 20, 1987; New Orleans, La .
46 +
Desenclos JC, Berry AM, Padt R, et al.  Epidemiologic patterns of scurvy among Ethiopian refugees . Bull World Health Organ. 1989;;67:309-316.
47 +
Serdula M, Seward J.  Diet, malnutrition, and mortality . In: Proceedings of Seminar on Mortality and Society in Sub-Saharan Africa, Yaounde, Cameroun, October 19-23, 1987, of the International Union for the Scientific Study of Population ; Liege, Belgium.
48 +
Sommer A, Hussaini G, Tarwotjo I, Susanto D.  Increased mortality in children with mild vitamin A deficiency . Lancet. 1983;;1:585-588.
49 +
Levine M.  New concepts in the biology and biochemistry of ascorbic acid . N Engl J Med. 1986;;314:892-902.
50 +
Centers for Disease Control.  Nutritional and health assessment of Mozambican refugees in two districts of Malawi, 1988 . MMWR. 1988;;37:641-643.
51 +
Chen LC, Chowdhury AKM, Huffman SL.  Anthropometric assessment of energy-protein malnutrition and subsequent risk of mortality among preschool aged children . Am J Clin Nutr. 1980;;33: 1836-1845.
52 +
Kasongo Project Team.  Anthropometric assessment of young children's nutritional status as an indicator of subsequent risk of dying . J Trop Pediatr. 1983;;29:69-75.
53 +
Handbook for Emergencies . Geneva, Switzerland: United Nations High Commissioner for Refugees; 1982;:122.
54 +
United Nations Administrative Committee for Coordination, Subcommittee on Nutrition, and the International Nutrition Planners Forum.  Nutrition in times of disaster . Presented as a report of an International Conference; September 27-30, 1988; Geneva, Switzerland .
55 +
Biellik R. The Evaluation of Public Health Components of International Disaster Relief Operations: Indo-Chinese Refugees in Thailand, 1979-1982. Houston: University of Texas; June 1983. Dissertation.
56 +
Toole MJ, Nieburg P, Waldman RJ.  The association between inadequate rations, undernutrition prevalence, and mortality in refugee camps . J Trop Pediatr. 1988;;34:218-224.
57 +
Godfrey N.  Supplementary feeding in refugee populations: comprehensive or selective feeding programmes? Health Policy Plan. 1986;;1:283-298.
58 +
Taylor WR.  An evaluation of supplementary feeding in Somali refugee camps . Int J Epidemiol. 1983;;12:433-436.
59 +
Gibb C.  A review of feeding programmes in refugee reception centres in eastern Sudan, October 1985 . Disasters. 1986;;10:17-24.
60 +
Dick B.  Supplementary feeding for refugees and other displaced communities—questioning current orthodoxy . Disasters. 1986;;10:53-64.
61 +
Esrey SA, Feachem RG, Hughes JM.  Interventions for the control of diarrheal diseases among young children . Bull World Health Organ. 1985;;63:757-772.
62 +
Toole MJ, Steketee RJ, Waldman RJ, Nieburg P.  Measles prevention and control in emergency settings . Bull World Health Organ. 1989;;67:381-388.
63 +
Malaria Branch, Center for Infectious Diseases. Primer on the Prophylaxis, Therapy, and Control of Malaria in Sahelian Refugee Camps . Atlanta, Ga: Centers for Disease Control; 1985;.
64 +
Rieder H, Snider D, Toole MJ, Waldman RJ, et al.  Tuberculosis control in emergency settings . Tubercle. 1989;;70:127-134.
65 +
Downing R.  A tale of two clinics—primary health care in refugee settings . Soc Sci Med. 1989;;70:127-134.
66 +
New York Times . (September 10) , 1989;:3.
67 +
United Nations High Commission for Refugees, December 1988; US Dept of State, Bureau for Refugee Programs, September 1988; and US Committee for Refugees. World Refugee Survey—1988 in Review, May 1989 . Geneva, Switzerland: United Nations High Commission for Refugees; 1990;. Press release.

Letters

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems