Estimates of HIV burden in emergencies.

OBJECTIVE: To quantify the proportion of people living with HIV who are being affected by emergencies. METHODS: Emergencies were defined as conflict, natural disaster and/or displacement. Country-specific estimates of populations affected by emergencies were developed based on eight publicly available databases and sources. These estimates were calculated as proportions and then combined with updated country-level HIV estimates for the years 2003, 2005 and 2006 to obtain estimates of the number of men, women and children living with HIV who were also affected by emergencies. RESULTS: In 2006, 1.8 (range 1.3-2.5) million people living with HIV (PLHIV) were also affected by conflict, disaster or displacement, representing 5.4% (range 4.0-7.6%) of the global number of PLHIV. In the same year, an estimated 930 000 (range 660 000-1.3 million) women and 150 000 (range 110 000-230 000) children under 15 years living with HIV were affected by emergencies. In emergency settings, the estimated numbers of PLHIV in 2003 and 2005 were 2.6 million (range 2.0-3.4 million) and 1.7 million (range 1.4-2.1 million), respectively, representing 7.9% and 5.1% of the global number of PLHIV). CONCLUSIONS: These estimates provide a rationale to ensure that HIV interventions are integrated into rapid assessment of all emergency and preparedness and response plans to prevent HIV infections and address excess suffering, morbidity and mortality among these often overlooked vulnerable groups.

Estimates of HIV burden in emegencies

Objective: To quantify the proportion of people living with HIV who being infected by emergencies. Methods: Emergencies were defined as conflict, natural disaster and/or displacement. Country-specific estimates of populations affected by emergencies were developed based on eight publicly available databases and sources. These estimates were calculated as proportions and then combined with updated country-level HIV estimates for the years 2003, 2005 and 2006 to obtain estimated of hte number of men, women and children living with HIV who were also affected by emergencies. Results: In 2006, 1.8 (range 1.3-2.5) million people living with HIV (PLHIV) were also affected by conflict, disaster or displacement, representing 5.4% (range 4.0-7.6%) of the global number of PLHIV. In the same year, an estimated 930 000 (range 660 000-1.3 million) women and 150 000 (range 110 000-230 000) children under 15 years living wiht HIV were affected by emergencies . In emergency settings, the estimated numbers of PLHIV in 2003 and 2005 were 2.6 million (range 2.0-3.4 million) and 1.7 million (range 1.4-2.1 million), respectively, representing 7.9% abd 5.1% of the global number of PLHIV. Conclusions: These estimates provide a rationale to ensure that HIV interventions are integrated into rapid assessment of all emergency and preparedness and response plans to prevent HIV infections and address excess suffering, morbity and mortality among these often overlooled vulnerable groups. (AU)

HIV behavioural surveillance surveys in conflict and post-conflict situations: a call for improvement.

Behavioural surveillance surveys (BSSs), an evolution from the knowledge-attitudes-practice surveys (KAPs), are a tool to track trends in HIV/AIDS knowledge, attitudes and risk behaviour among populations. The data collected support organizations in targeting specific HIV/AIDS prevention and care activities, monitoring their effectiveness and coverage, and allocating scarce resources. The objectives are to evaluate the quality and standardization of BSS-like surveys undertaken in conflict and post-conflict situations, and to provide recommendations to humanitarian agencies and governments on how to improve their quality. Survey methodology was classified as reproducible if the population-based sampling defined a sampling frame using probabilistic sampling. Survey indicators were compared to internationally-accepted HIV indicators. The results showed that 14 (45.2%) of the 31 BSS-like surveys evaluated between 1998 and 2005 in 14 countries were classified as reproducible. Surveys undertaken by non-governmental organizations (NGOs) were significantly less reproducible than those undertaken by non-NGOs (p=0.05). The majority of surveys used at least one identical or similarly worded internationally-accepted HIV indicator for prevention and misperception but not for practice and attitudes. Few reported disaggregated indicators according to age or gender. It was concluded that the majority of BSS-like surveys are of insufficient methodological rigor to be reproducible. Few surveys reported internationally-accepted HIV indicators by gender and age which makes interpretability and comparison difficult. United Nations agencies, NGOs, and governments undertaking BSSs in conflict and post-conflict settings should proceed with a BSS survey once the design and plan for execution has been prepared by experienced and qualified experts. These experts should then oversee the survey, assure data quality and incorporate training of others in the process. A practical and field user-friendly BSS manual is needed for conflict affected and displaced population situations, one which is customized to take into account the special circumstances of such populations.

The accuracy of mortality reporting in displaced persons camps during the post-emergency phase.

For humanitarian organisations, accurate data are essential to identify emerging health problems and determine programme needs. We visited 45 post-emergency phase displaced persons camps and collected three months' mortality data which we compared with organisations' routine mortality reports. Organisations reported 612 deaths and we identified 741 deaths, for a mortality-reporting ratio, defined as the number of organisation-reported deaths divided by the number of investigator-identified deaths, of 83 per cent. For the majority of camps which under-reported deaths, mortality reporting ratios were significantly higher for women than men, and for camps with central mortality registers rather than those without. In the few camps which over-reported deaths, these occurred primarily among children younger than five years of age, probably due to the inclusion of abortions and stillbirths. Despite the overall under-reporting of deaths by humanitarian organisations, the existing health information systems appear to estimate mortality rates adequately in these post-emergency camps. However, organisations should improve the precision and completeness with which they report the characteristics of deaths in order to provide valuable data to target their programmes at the most vulnerable people.

Developing public health indicators in complex emergency response.

During the past decade, indicators for the assessment, monitoring, and evaluation of services provided by humanitarian organizations to populations affected by complex emergencies (CEs) were developed to improve the effectiveness and accountability of humanitarian response. The quality of data used to develop individual indicators and their relationship to positive health outcomes varies greatly. This article states the essential characteristics necessary for the development and implementation of effective indicators in CE response and proposes the establishment of an evidence-based grading system. The importance of trend analysis and the modification or addition of various indicators and their thresholds, according to phase and location of CEs, are stressed. Limitations in the development, implementation, and interpretation of these indicators, including those outside of the organizations' control are discussed. More evidence-based research is needed as to the type and thresholds of indicators that lead to improved health outcomes in populations affected by CEs. The use of indicators by non-governmental organizations, and how they affect their program's decision-making in different phases and settings within CEs need further study. Finally, the establishment of a regulating body with the authority to enforce the attainment of standards by use of these indicators is necessary to avoid inappropriate humanitarian assistance causing loss of life in the future.

War and mortality in Kosovo, 1998-99: an epidemiological testimony.

BACKGROUND: The total number, rates, and causes of mortality in Kosovo during the last war remain unclear despite intense international attention. Understanding mortality that results from modern warfare, in which 90% of casualties are civilian, and identifying vulnerable civilian groups, are of critical public-health importance. METHODS: In September 1999 we conducted a two-stage cluster survey among the Kosovar Albanian population in Kosovo. We collected retrospective mortality data, including cause of death, for the period of the conflict. FINDINGS: The survey included 1197 households comprising 8605 people. From February, 1998, through June, 1999, 67 (64%) of 105 deaths in the sample population were attributed to war-related trauma, corresponding to 12,000 (95% CI 5500-18,300) deaths in the total population. The crude mortality rate increased 2.3 times from the pre-conflict level to 0.72 per 1000 a month. Mortality rates peaked in April 1999 at 3.25 per 1000 a month, coinciding with an intensification of the Serbian campaign of "ethnic cleansing". Men of military age (15-49 years) and men 50 years and older had the highest age-specific mortality rates from war-related trauma. However, the latter group were more than three times as likely to die of war-related trauma than were men of military age (relative risk 3.2). INTERPRETATION: Raising awareness among the international humanitarian community of the increased risk of mortality from war-related trauma among men of 50 years and older in some settings is an urgent priority. Establishing evacuation programmes to assist older people to find refuge may prevent loss of life. Such mortality data could be used as evidence that governments and military groups have violated international standards of conduct during warfare.