Performance of UNHCR nutrition programs in post-emergency refugee camps

Quality of care for children with acute malnutrition at health center level in Uganda: a cross sectional study in West Nile region during the refugee crisis

BACKGROUND

Arua district, in Uganda, hosts some of the largest refugee camps in the country. The estimated prevalence of moderate and severe acute malnutrition in children is higher than the national estimates (10.4 and 5.6% respectively, compared to 3.6 and 1.3%). This study aimed at assessing the quality of care provided to children with acute malnutrition at out-patient level in such a setting.

METHODS

Six facilities with the highest number of children with malnutrition were selected. The main tool used was the National Nutrition Service Delivery Assessment Tool, assessing 10 key areas of service delivery and assigned a score as either poor, fair, good or excellent. Health outcomes, quality of case management and data quality were assessed from the health management information system and from the official nutrition registers.

RESULTS

All facilities except two scored either poor or fair under all the 10 assessment areas. Overall, 33/60 (55%) areas scored as poor, 25/60 (41%) as fair, 2/60 (3.3%) as good, and none as excellent. Main gaps identified included: lack of trained staff; disorganised patient flow; poor case management; stock out of essential supplies including ready-to-use therapeutic foods; weak community linkage. A sample coverage of 45.4% (1020/2248) of total children admitted in the district during the 2016 financial year were included. The overall mean cure rate was 52.9% while the default rate was 38.3%. There was great heterogeneity across health facilities in health outcomes, quality of case management, and data quality.

CONCLUSION

This study suggests that quality of care provided to children with malnutrition at health center level is substandard with unacceptable low cure rates. It is essential to identify effective approaches to enhance adherence to national guidelines, provision of essential nutritional commodities, regular monitoring of services and better linkage with the community through village health teams.

Weight Trajectory in Refugee Children after Resettling in the United States: A Pilot Study

BACKGROUND

The objective of this study is to describe the weight trajectory of refugee children after resettlement in the US.

METHODS

A pilot study was conducted, utilizing longitudinal data obtained from the electronic health record of 129 children between 2 and 18 years of age (54% female, mean age 10 years) from the 3 primary countries of origin presenting to a refugee clinic (Bhutan, N = 71; Burma, N = 36, and Iraq, N = 22).. Mixed effects model analyses were utilized to characterize weight trajectory with calculation of a per year change in BMI-z score, adjusting for baseline BMI-z score, age, and time.

RESULTS

There was a significant increase in BMI-z (mean 0.15 units/year, p=0.04) among refugee children during their initial period after resettlement. Female children from Bhutan demonstrated the most rapid increase in weight, with a mean BMI-z gain of 1.00 units/year.

CONCLUSION

Female children from Bhutan demonstrated rapid weight gain after resettlement in the US. Further studies are needed to describe weight trajectory trends and evaluate possible reasons for rapid weight gain in this population.

Retrospective analysis of reproductive health indicators in the United Nations High Commissioner for Refugees post-emergency camps 2007-2013

BACKGROUND

The United Nations Refugee Agency's Health Information System issues analytical reports on the current camp conditions and trends for priority reproductive health issues. The goal was to assess the status of reproductive health by analyzing seven indicators and comparing them to standards and host country estimates.

METHODS

Data on seven indicators were extracted from the database during a seven-year period (2007 through 2013). A standardized country inclusion criterion was created based on the year of country implementation and the percentage of missing reports per camp and year. The unit of analysis was monthly camp reports by year within a country. To account for the lack of independence of monthly camp reports, the variance was computed using Taylor Series Linearization methods in SAS.

RESULTS

Ten of the 23 eligible countries met the inclusion criterion. The mean camp maternal and neonatal mortality rates, except for two country years, were lower than the host country estimates for all countries and years. There was a significant increase in the percent of births attended by a skilled birth attendant (p < 0.0001), and 8 of 10 countries did not meet the standard of 100 % for all reporting years. The percent of births performed by Caesarian section (p < 0.001), were below the recommended minimum standard for nearly half of the countries every year. There was a significant increase in the percent of women screened for syphilis across years (p < 0.0001) and the percent of women who received post HIV exposure prophylaxis (p < 0.0001) and 10 % reached the standard for all reporting years, respectively.

CONCLUSION

Comprehensive, consistent and comparable statistics on reproductive health provides an opportunity to assess progress towards indicator standards. Despite some improvements over time, this analysis confirms that most countries did not meet standards and that there were differences in reproductive health indicators between countries and across years. Consequently, the HIS periodic monitoring of key reproductive health indicators at the camp level should continue. Data should be used to improve intervention strategies.

Mental, neurological, and substance use problems among refugees in primary health care: analysis of the Health Information System in 90 refugee camps

BACKGROUND

Population-based epidemiological research has established that refugees in low- and middle-income countries (LMIC) are at increased risk for a range of mental, neurological and substance use (MNS) problems. Improved knowledge of rates for MNS problems that are treated in refugee camp primary care settings is needed to identify service gaps and inform resource allocation. This study estimates contact coverage of MNS services in refugee camps by presenting rates of visits to camp primary care centers for treatment of MNS problems utilizing surveillance data from the Health Information System (HIS) of the United Nations High Commissioner for Refugees.

METHODS

Data were collected between January 2009 and March 2013 from 90 refugee camps across 15 LMIC. Visits to primary care settings were recorded for seven MNS categories: epilepsy/seizure; alcohol/substance use; mental retardation/intellectual disability; psychotic disorder; emotional disorder; medically unexplained somatic complaint; and other psychological complaint. The proportion of MNS visits attributable to each of the seven categories is presented by country, sex and age group. The data were combined with camp population data to generate rates of MNS visits per 1,000 persons per month, an estimate of contact coverage.

RESULTS

Rates of visits for MNS problems ranged widely across countries, from 0.24 per 1,000 persons per month in Zambia to 23.69 in Liberia. Rates of visits for epilepsy were higher than any of the other MNS categories in nine of fifteen countries. The largest proportion of MNS visits overall was attributable to epilepsy/seizure (46.91% male/35.13% female) and psychotic disorders (25.88% male/19.98% female). Among children under five, epilepsy/seizure (82.74% male/82.29% female) also accounted for the largest proportion of MNS visits.

CONCLUSIONS

Refugee health systems must be prepared to manage severe neuropsychiatric disorders in addition to mental conditions associated with stress. Relatively low rates of emotional and substance use visits in primary care, compared to high prevalence of such conditions in epidemiological studies suggest that many MNS problems remain unattended by refugee health services. Wide disparity in rates across countries warrants additional investigation into help seeking behaviors of refugees and the capacity of health systems to correctly identify and manage diverse MNS problems.

Severe Acute Malnutrition during Emergencies: Burden, Management, and Gaps

Natural and man-made disasters, including floods, droughts, earthquakes, and armed conflicts, create nutrition crises. Unfortunately, the frequency and severity of such disasters have been increasing since the beginning of the 20th century, and their contribution to the burden of acute malnutrition is increasing every year. However, their contribution to the burden of acute malnutrition is underrecognized due to the ways in which global statistics are built and causes of death are reported. Fortunately, the success of the current protocol for treatment of severe acute malnutrition (SAM) and the integrated approach to treatment has created a momentum allowing expanded coverage of treatment of SAM, especially in humanitarian emergency contexts. For this progress to be maintained and accelerated, changes in nutrition information systems at the national and global levels are needed, and the persisting barriers to the expansion and integration of treatment of SAM into routine health systems need to be removed. Emergency funding approaches and objectives have to include sustaining and amplifying the achievements of the short-term palliative interventions. Nutrition programs implemented in emergency contexts have the capacity to contribute to answering priority research questions, and this capacity should be more optimally utilized.