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

(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

(A) Objectives: - Determine t5he size of a population - Determine the size and structure of vulnerable 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 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)

- 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.

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 = persons

(B) Mortality: it is often high in the first week or month of population displacement and decrease rapidly when aid becomes organized and 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 Indicators: - Total number of deaths per 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 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.

* 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.

@ 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 the population of = 5900 / ( ) = 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 / / day. * In emergency, the threshold of gravity of mortality in children under 5 is 2.5 deaths / / day.

( C) Priority Disease Objectives: - The current and grae pathologies within a population of refugees. - Identify possible pathologies having epidemic Indicators: - Prevalence = the number of cases of disease happening at the given period per 1000 person per week or 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 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.

(D) Vaccinal coverage against Objective: - Measure the proportion of children between 6 month and 15 y/o already vaccinated against Indicators: - Percentage of children vaccinated against 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 Presentation and interpretation of Results: - Vaccinal coverage data may give information concerning the need to carry out a new vaccination against meales. -

(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 Objective: - Determine the gravity of a nutritional situation. - Estimate the number of malnutrition children. - According to the survey data, implement the feeding Indicator: - Prevalence of severe acute 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.

* 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.

@ Interpretation of Results: Age W-H index -3Z-score< edema ( month) < -3Z-score W-H<-2Z-score Total (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

- 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.

(F) Food Objective: - Assess food availability for a population. - Measure individuals calorie rations received by Indicators: - Average number of kcal / person / day (2100kcal/person/day) - Percentage of families having a food distribution card. - Proportion of families receiving adequate 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

* 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 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%

* 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 Objective: - Measure the quantity and quality of water available to displaced 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 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.

* 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 Presentation and Interpretation of Results: * Quantity of available water: - It compare with the normal value.( 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 the quantity of container: 3000 x 23% = 690 container

(H) Living and Sanitation Objective: - Measure the proportion of a population benefiting from protected habitats. - Assess the proportion of families having latrines and waste 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 Methods: - From programme data and sampling survey in a 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%