Abstract
BackgroundThe United Nations High Commissioner for Refugees (UNHCR) launched a health information system (HIS) in 2005 to enhance quality and consistency of routine health information available in post-emergency refugee camps. This paper reviews nutrition indicators and examines their application for monitoring and evaluating the performance of UNHCR nutrition programs in more than 90 refugee camps in 18 countries.MethodsThe HIS is a primary source of feeding program data which is collected using standardized case definitions and reporting formats across refugee camps in multiple settings. Data was aggregated across time periods and within and across countries for analysis. Basic descriptive statistics were then compared to UNHCR program performance standards.ResultsCamp populations covered by the HIS ranged from 192,000 to 219,000 between 2007 and mid-2009; 87% of under five children covered by the HIS were in Africa and 13% in Asia. Average moderate acute malnutrition (MAM) and severe acute malnutrition (SAM) rates reported in 74 of 81 camps for the 2007-2009 time periods were 7.0% and 1.6%, respectively. The supplementary feeding program (SFP) admission rate was 151/1000/yr with 93% of SFP admissions occurring in Africa. SFP performance consistently exceeded all UNHCR standards with the exception of length of enrollment. Average length of SFP enrollment was 12 weeks in Africa and 22 weeks in Asia as compared to the UNHCR standard of < 8 weeks. The therapeutic feeding program (TFP) admission was 22/1000/yr with 95% of TFP admissions in Africa. TFP performance met UNHCR standards with the exception of daily weight gain.ConclusionsInclusion of children identified as moderately and severely wasted in the HIS would allow UNHCR to better track and respond to changes in nutrition status. Improved growth monitoring coverage or active malnutrition surveillance would increase UNHCR's ability to identify and treat cases of acute malnutrition. Expansion of nutrition reporting to address the transition to community-based therapeutic care is essential for adequate performance monitoring in the future. In terms of program priorities, a focus on camps and countries with large refugee populations and high feeding program enrollment rates would have the greatest impact in terms of absolute reductions in the incidence and prevalence of malnutrition.
Highlights
In 2009, there were an estimated 10.5 million refugees of concern to the United Nations High Commissioner of Refugees (UNHCR) [1]
Program coverage refers to the proportion of children under-five with moderate acute malnutrition (MAM) enrolled in supplementary feeding program (SFP) or proportion of children under-five with severe acute malnutrition (SAM) enrolled in therapeutic feeding program (TFP)
The proportion of children identified in growth monitoring as having acute malnutrition or wasting, which is indicated by low weight-for-height, is not recorded in the health information system (HIS); instead, acute malnutrition prevalence from camp-level nutrition surveys is entered in the HIS intermittently
Summary
In 2009, there were an estimated 10.5 million refugees of concern to the United Nations High Commissioner of Refugees (UNHCR) [1]. Refugees represent a minority of the displaced population worldwide and less than half of refugees live in camps. UNHCR refugee camps are predominantly in rural areas of Africa and Asia in protracted or post-emergency contexts where their populations benefit from relatively stable environments and low mortality rates. As a result of emergency nutrition programming that includes routine distribution of food rations, identification of malnourished children through screening and growth monitoring, and rehabilitation of malnourished individuals through supplementary and therapeutic feeding programs, malnutrition is no longer a major a cause of mortality in refugee camp settings. The United Nations High Commissioner for Refugees (UNHCR) launched a health information system (HIS) in 2005 to enhance quality and consistency of routine health information available in post-emergency refugee camps. This paper reviews nutrition indicators and examines their application for monitoring and evaluating the performance of UNHCR nutrition programs in more than 90 refugee camps in 18 countries
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