Abstract
Prospective, community‐based surveillance systems for measuring birth, death, and population movement rates may have advantages over the ‘gold‐standard’ retrospective household survey in humanitarian contexts. A community‐based, monthly surveillance system was established in South Kivu, Democratic Republic of the Congo, in partnership with a local implementing partner and the national ministry of health. Data were collected on the occurrence of births, deaths, arrivals, and departures over the course of one year, and a retrospective survey was conducted at the end of the period to validate the information. Discrepancies between the two approaches were resolved by a third visit to the households with discordant records. The study found that the surveillance system was superior in terms of its specificity and sensitivity in measuring crude mortality and birth rates as compared to the survey, demonstrating the method's potential to measure accurately important population‐level health metrics in an insecure setting in a timely, community‐acceptable manner.
Highlights
Health-related events such as births, deaths, and population movement speak to the quality of life in a community, and act as quantifiable measures of health and wellbeing
To evaluate the sensitivity, specificity, and positive predictive value (PPV) of the system through a household survey conducted after one year of surveillance;
Stage 2: survey-based evaluation Six ReCos who were already participating in data collection for the surveillance system were chosen for training in how to conduct the household survey
Summary
Health-related events such as births, deaths, and population movement speak to the quality of life in a community, and act as quantifiable measures of health and wellbeing. Expert working groups in emergencies have called for such community-based, prospective surveillance (Purdin et al, 2009), yet it has rarely been employed outside of camps (Caleo et al, 2012) It has the limitation of needing a robust population denominator to calculate vital event rates, and the additional labour for ongoing data collection, supervision, and funding over the longer period of surveillance. Caleo et al (2012) implemented a community surveillance system in a rural population in the Central African Republic (CAR), involving weekly household visits over a 32-week period They were able to demonstrate high excess mortality in this population with good sensitivity (92.9 per cent) for capturing deaths through surveillance, as evaluated in a capture–recapture analysis. This is especially alarming owing to the disproportional impact of negative health events on internally displaced persons (IDPs) (Thomas and Thomas, 2004)
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