RESUMEN
INTRODUCTION: In September 1999, militia-initiated violence in East Timor forced the displacement of approximately 290,000 persons to West Timor in Indonesia. Whereas the security and health status of the East Timorese in East Timor had been well-monitored, by contrast, the health status of 150,000 refugees in approximately 200 camps in West Timor was essentially unknown. The death of a child during transfer from a refugee camp there to a United Nations transit camp prompted further investigation. METHODS: The present study population was the largest West Timorese camp of 14,088 refugees. Despite security constraints, a rapid epidemiological assessment was undertaken. Retrospective analysis of camp mortality data, key informant interviews and environmental assessment were included. RESULTS: A crude mortality rate of 2.3/10,000/day and an under 5 year mortality rate of 10.3/10,000/day were found. Environmental sanitation, personal hygiene, water quality and vector control were inadequate. International aid agencies provided medical care with variable case definitions, no treatment protocols, non-standard treatment practices, inappropriate antibiotic use, variable referral practices and no secondary prevention. Syndromic diagnoses of causes of dealth guided recommendations for interventions. Follow-up reports indicated that excess camp mortality was eliminated within a month. CONCLUSIONS: All conflict-affected populations must have an ongoing examination of essential health data to identify urgent unmet needs, guide appropriate health interventions and monitor progress. Sentinel health events must be promptly reported and investigated. Syndromic diagnoses are useful in targeting life-saving public health interventions. All humanitarian health assistance must have transparency, technical supervision and peer review to ensure compliance with minimum standards.
Asunto(s)
Mortalidad , Refugiados/estadística & datos numéricos , Adulto , Niño , Estudios de Cohortes , Femenino , Humanos , Indonesia/epidemiología , Masculino , Vigilancia de la Población , Estudios Retrospectivos , ViolenciaRESUMEN
The landmark Humanitarian Response Review, commissioned by the United Nations Emergency Relief Coordinator in 2005, has catalyzed recent reforms in disaster response through the Inter-Agency Standing Committee. These reforms include a "cluster lead" approach to sectoral responsibilities and the strengthening of humanitarian coordination. Clinical medicine, public health, and disaster incident management are core disciplines underlying expertise in disaster medicine. Technical lead agencies increasingly provide pre-deployment training for selected health personnel. Moreover, technical innovations in disaster health sciences increasingly are disseminated to the disaster field through multi-agency initiatives, such as the Standardized Monitoring and Assessment of Relief and Transitions (SMART) initiative. The hallmark qualification of competency to render an informed opinion in the health specialties remains specialty board certification in North American healthcare traditions, or specialty society fellowship in British and Australasian healthcare traditions. However, disaster incident management training lacks international consensus on hallmark qualifications for competency. Disaster experience is best characterized in terms of months of full-time, hands-on field service. Future practitioners in disaster medicine will see intensified efforts to define competency benchmarks across underlying core disciplines as well as key field performance indicators. Quantitative decision-support tools are emerging to assist disaster planners and medical coordinators in their personnel selection.
Asunto(s)
Medicina de Desastres/normas , Competencia Profesional/normas , Sistemas de Apoyo a Decisiones Administrativas , Medicina de Desastres/organización & administración , Salud Global , Humanos , Salud Pública/normasRESUMEN
The National Notifiable Disease Surveillance System received 1,072 tuberculosis (TB) notifications in 2005, of which 1,022 were new cases and 50 were relapses. The incidence of TB in Australia was 5.3 cases per 100,000 population in 2005 and has remained at a stable rate since 1985. The high-incidence groups remain people born overseas and Indigenous Australians at 20.6 and 5.9 cases per 100,000 population, respectively. By contrast, the incidence of TB in the non-Indigenous Australian-born population was 0.8 cases per 100,000 population. Rates in the Australian-born, both Indigenous and non-Indigenous have been declining since 1991, while rates in the overseas-born have been increasing. TB control in Australia relies on pre-migration screening and provision of free and effective treatment.
Asunto(s)
Notificación de Enfermedades/estadística & datos numéricos , Tuberculosis/epidemiología , Adolescente , Adulto , Factores de Edad , Anciano , Animales , Australia/epidemiología , Niño , Preescolar , Control de Enfermedades Transmisibles , Emigración e Inmigración , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Grupos de Población , Vigilancia de la Población , Tuberculosis/etnología , Tuberculosis/prevención & controlRESUMEN
Avian influenza is a panzootic and recurring human epidemic with pandemic potential. Pandemic requirements for a viral pathogen are: a novel virus must emerge against which the general population has little or no immunity; the new virus must be able to replicate in humans and cause serious illness; and the new virus must be efficiently transmitted from person to person. At present, only the first two conditions have been met. Nonetheless, influenza pandemics are considered inevitable. Expected worldwide human mortality from a moderate pandemic scenario is 45 million people or more than 75% of the current annual global death burden. Although mathematical models have predicted that an emerging pandemic could be contained at its source, this conclusion remains controversial among public health experts. The Terrestrial Animal Health Code and International Health Regulations are enforceable legal instruments integral to pandemic preparedness. Donor support in financial, material and technical assistance remains critical to disease control efforts - particularly in developing countries where avian influenza predominately occurs at present. Personal protective equipment kits, decontamination kits and specimen collection kits in lightweight, portable packages are becoming standardized. Air transport border control measures purporting to delay importation and spread of human avian influenza are scientifically controversial. National pandemic plans prioritize beneficiary access to antiviral drugs and vaccines for some countries. Other medical commodities including ventilators, hospital beds and intensive care units remain less well prioritized in national plans. These resources will play virtually no role in care of the overwhelming majority of patients worldwide in a pandemic. Prehospital care, triage and acute care all require additional professional standardization for the high patient volumes anticipated in a pandemic.
Asunto(s)
Planificación en Desastres , Virus de la Influenza A , Gripe Humana/epidemiología , Análisis por Conglomerados , Países en Desarrollo , Humanos , Subtipo H5N1 del Virus de la Influenza A , Gripe Humana/transmisión , Gripe Humana/virología , Síndrome Respiratorio Agudo Grave/transmisión , Viruela/transmisión , Organización Mundial de la SaludRESUMEN
Mycobacterium ulcerans gives rise to severe skin ulceration that can be associated with considerable illness. The cost of diagnosis, treatment, and lost income has never been assessed in Australia. A survey of 26 confirmed cases of the disease in Victoria was undertaken. Data were collected on demographic details, diagnostic tests, treatment, time off work, and travel to obtain treatment. All costs are reported in Australian dollars in 1997-98 prices. The cost varies considerably with disease severity. For mild cases, the average direct cost is 6,803 Australian dollars, and for severe cases 27,681 Australian dollars. Hospitalization accounts for 61% to 90% of costs, and indirect costs amount to 24% of the total per case. M. ulcerans can be an expensive disease to diagnose and treat. Costs can be reduced by early diagnosis and definitive treatment. Research is needed to find cost-effective therapies for this disease.
Asunto(s)
Costos de la Atención en Salud , Infecciones por Mycobacterium no Tuberculosas/economía , Mycobacterium ulcerans/crecimiento & desarrollo , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/economía , Niño , Preescolar , Atención Domiciliaria de Salud/economía , Hospitalización/economía , Humanos , Lactante , Persona de Mediana Edad , Infecciones por Mycobacterium no Tuberculosas/patología , Infecciones por Mycobacterium no Tuberculosas/terapia , Estudios Retrospectivos , VictoriaRESUMEN
Rapid epidemiological assessment (REA) has evolved over the past 30 years into an essential tool of disaster management. Small area survey and sampling methods are the major application. While REA is protocol driven, needs assessment of displaced populations remains highly non-standardized. The United Nations and other international organizations continue to call for the development of standardized instruments for post-disaster needs assessment. This study examines REA protocols from leading agencies in humanitarian health assistance across an evaluation criteria of best-practice attributes. Analysis of inconsistencies and deficits leads to the derivation of a Minimum Essential Data Set (MEDS) proposed for use by relief agencies in post-disaster REA of health status in displaced populations. This data set lends itself to initial assessment, ongoing monitoring, and evaluation of relief efforts. It is expected that the task of rapid epidemiological assessment, and more generally, the professional practice of post-disaster health coordination, will be enhanced by development, acceptance, and use of standardized Minimum Essential Data Sets (MEDS).
Asunto(s)
Planificación en Desastres/normas , Guías como Asunto , Estado de Salud , Evaluación de Necesidades , Refugiados/estadística & datos numéricos , Sistemas de Socorro/normas , Australia , Desastres , Métodos Epidemiológicos , Femenino , Servicios de Salud del Indígena , Humanos , Masculino , Prohibitinas , Población Rural , Naciones Unidas , Organización Mundial de la SaludRESUMEN
Inter-agency coordination in humanitarian assistance dates as a discipline from the 1960s. The United Nations, Red Cross, governmental, and non-governmental agencies have evolved different mechanisms to achieve it. Present practices in field-based, inter-agency coordination of the health sector remain variable and non-standardized. International experiences in coordination of humanitarian assistance reveal numerous issues of jurisdiction, authority, capacity, and competency. New tools to help overcome these issues in the health-sector coordination include binding principles of engagement, protocols for the assumption of responsibilities, standardized minimum essential data sets, and health-sector component summaries.
Asunto(s)
Conflicto Psicológico , Conducta Cooperativa , Atención a la Salud/organización & administración , Planificación en Desastres/organización & administración , Desastres , TerrorismoRESUMEN
Rapid epidemiological assessment (REA) has evolved over the past 30 years into an essential tool of disaster management. Small area survey and sampling methods are the major application. While REA is protocol driven, needs assessment of displaced populations remains highly non-standardized. The United Nations and other international organizations continue to call for the development of standardized instruments for post-disaster needs assessment. This study examines REA protocols from leading agencies in humanitarian health assistance across an evaluation criteria of best-practice attributes. Analysis of inconsistencies and deficits leads to the derivation of a Minimum Essential Data Set (MEDS) proposed for use by relief agencies in post-disaster REA of health status in displaced populations. This data set lends itself to initial assessment, ongoing monitoring, and evaluation of relief efforts. It is expected that the task of rapid epidemiological assessment, and more generally, the professional practice of post-disaster health coordination, will be enhanced by development, acceptance, and use of standardized Minimum Essential Data Sets (MEDS).