August 3, 1994, Vol 272, No. 5 >

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ARTICLE | August 3, 1994

Assessments of Mortality, Morbidity, and Nutritional Status in Somalia During the 1991-1992 Famine: Title and subTitle BreakRecommendations for Standardization of Methods FREE

Leslie P. Boss, PhD; Michael J. Toole, MD; Ray Yip, MD

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Reprint requests to Centers for Disease Control and Prevention, MS F-57, 1600 Clifton Rd NE, Atlanta, GA 30333 (Dr Boss).

JAMA. 1994;272(5):371-376. doi:10.1001/jama.1994.03520050051029

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ABSTRACT

ABSTRACT | REFERENCES

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 midupper-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.(JAMA. 1994;272:371-376)

REFERENCES

ABSTRACT | REFERENCES

Centers for Disease Control. Nutritional status of Somali refugees—eastern Ethiopia, Sept 1988— May 1989. MMWR Morb Mortal Wkly Rep . 1989;; 38:455-456, 461-463.

Boss LP, Brink EW, Dondero TJ. Infant mortality and childhood nutritional status among Afghan refugees in Pakistan. Int J Epidemiol . 1987;; 16:556-560.

Centers for Disease Control. Update: health and nutritional profile of refugees—Ethiopia, 1989-1990. MMWR Morb Mortal Wkly Rep . 1990;;39:707-709, 715-718.

Centers for Disease Control. Nutritional and health assessment of Mozambican refugees in two districts of Malawi, 1988. MMWR Morb Mortal Wkly Rep . 1988;;37:641-643.

Centers for Disease Control. Health and nutritional status of Liberian refugee children—Guinea, 1990. MMWR Morb Mortal Wkly Rep . 1991;;40:13-15.

Rutherford GW, Mahanjane AE. Morbidity and mortality in the Mozambican famine of 1983. J Trop Pediatr . 1985;;31:143-149.

Woodruff BA, Toole MJ, Rodrigue DC, et al. Disease surveillance and control after a flood: Khartoum, Sudan, 1988. Disasters . 1990;;14:151-162.

De Waal A. Famine mortality: a case study of Darfur, Sudan, 1984-85. Popul Stud . 1989;;43:5-24.

Seaman J, Holt J, Rivers J. The effect of drought on human nutrition in an Ethiopian province. Int J Epidemiol . 1978;;7:31-40.

Shears P, Lusty T. Communicable disease epidemiology following migration: studies from the African famine. Int Migration Rev . 1987;;21:783-795.

Yip R, Sharp TW. Acute malnutrition and high childhood mortality related to diarrhea. JAMA . 1993;; 270:587-590.

Moore PS, Marfin AA, Quenemoen LE, et al. Mortality rates in displaced and resident populations of central Somalia during 1992 famine disaster. Lancet . 1993;;341:935-938.

Centers for Disease Control and Prevention. Population-based mortality assessment—Baidoa and Afgoi, Somalia, 1992. MMWR Morb Mortal Wkly Rep . 1992;;41:913-917.

Manoncourt S, Doppler B, Enten F, et al. Public health consequences of the civil war in Somalia, April, 1992. Lancet . 1992;;340:176-177.

Centers for Disease Control and Prevention. Nutrition and mortality assessment—southern Sudan, March 1993. MMWR Morb Mortal Wkly Rep . 1993;;42:304-308.

Centers for Disease Control. Public health and nutritional profile of refugees—Ethiopia, 1989-1990. MMWR Morb Mortal Wkly Rep . 1991;;40:443-446.

Glass RJ, Cates W Jr, Nieburg P, et al. Rapid assessment of health status and preventive medicine needs of newly arrived Cambodian refugees, Sa Kaeo, Thailand. Lancet . 1980;;1:868-872.

Sandier RH, Epstein PR, Cook-Deegan RM, Shukri A. Initial medical assessment of Kurdish refugees in the Turkey-Iraq border region. JAMA . 1991;;266:638-640.

Meijman B, van der Kam S. Report of a household survey in Sarajevo, April, 1993. Med News . (August) 1993;;2:5-9. Médecins Sans Frontières, Paris, France.

Centers for Disease Control and Prevention. Famine-affected, refugee, and displaced populations: recommendations for public health issues. MMWR Morb Mortal Wkly Rep . 1992;;41( (suppl RR-13) ):1-76.

Results of Morbidity, Mortality, Nutritional, and Vaccine Assessment Cluster Survey of Johwar, Somalia . Mogadishu, Somalia: Center for Public Health Surveillance for Somalia; February 1993;. Unpublished report.

Gessner B, et al. Health and Mortality Assessment of Displaced Persons in Baidoa . Mogadishu, Somalia: Center for Public Health Surveillance for Somalia; November 1992;. Unpublished report.

Health and Mortality Assessment in Merca-Qorioley Areas, Somalia . Paris, France: Medecins Sans Frontières—France; November-December 1992;.

Brown V. Hoddur/Somalie: Impact of Health and Nutrition Related Relief Activities . Paris, France: Médecins Sans Frontières/Epicentre; January 1993;.

Results of Morbidity, Mortality, Nutritional, and Vaccine Assessment Cluster Survey in Bardera, Somalia, 1-6 January . Mogadishu, Somalia: Center for Public Health Surveillance for Somalia. Unpublished report.

Mercer A. Health Surveillance Review, Baidoa, Somalia, Jan/Feb 1993 . Amsterdam, the Netherlands: Médecins Sans Frontières—Holland; 1993;.

Survey Results, Belet Weyne . Mogadishu, Somalia: Save the Children Fund (UK); February 1993;.

Nutrition, Mortality, & EPI Coverage: Ministry of Health/Save the Children Fund Survey . Mogadishu, Somalia: February 1993;. Unpublished report.

Results of Morbidity, Mortality, Nutritional and Vaccine Assessment Cluster Survey of North Mogadishu, Somalia, 14-21 January 1993 . Mogadishu, Somalia: Center for Public Health Surveillance for Somalia; 1993;.

Allen P. Inter-agency/MOH Nutrition Surveys of the Main Towns in Somaliland, Sept/Oct 1991 . London, England: Save the Children Fund (UK); 1991;.

O'Reilly F. Nutritional Survey, Belet Weyne . Mogadishu, Somalia: Save the Children Fund (UK); September 1992;.

Kismayo: displaced population nutritional survey. Center Public Health Surveillance Somalia Epidemiol Bull . October 1992;;1(No. (2) ).

Nutrition and Health Assessment, Bakool . Mogadishu, Somalia: Center for Public Health Surveillance for Somalia; February 1993;.

Report on UNICEFIRMO Nutrition Survey of Displaced Camps in Bosaso . Mogadishu, Somalia: UNICEF Somalia; November 1992;.

Henderson RH, Sundaresan T. Cluster sampling to assess immunization coverage: a review of experience with a simplified sampling method. Bull World Health Organ . 1982;;60:253-260.

Measuring Change in Nutritional Status . Geneva, Switzerland: World Health Organization; 1988;.

Bern C, Martines J, deZoysa I, Glass RI. The magnitude of the global problem of diarrheal disease: a ten-year update. Bull World Health Organ . 1992;;70:705-714.

Toole MJ, Steketee RW, Waldman RJ, Nieburg P. Measles prevention and control in emergency settings. Bull World Health Organ . 1989;;67:381-388.

Report of the Subcommittee for Children of the WHO Expert Committee on 'Physical Status: The Use and Interpretation of Anthropometry .'Geneva, Switzerland: World Health Organization. In press.

World Health Organization Working Group. Use and interpretation of anthropometric indicators of nutritional status. Bull World Health Organ . 1986;; 64:929-941.

World Health Organization. Report of the Consultation on Rapid Nutrition Assessment in Emergencies . Alexandria, Egypt: WHO Regional Office for the Eastern Mediterranean (EMRO); 1992;.

Figures

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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