key activities in rapid assessment

8/10/2019 Key Activities in Rapid Assessment

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Key activities in rapid assessment

1. Planning the Mission

Composition of the health assessment teamThe rapid health assessment team should consist of: A public health epert!epidemiologist" A nutritionist" A logistician!administrative o#cer" A $ater and sanitation!environmental health specialist.

Collection of bac%ground geopolitical dataThe four main methods of collecting data are: &evie$ of eisting information

1. the geographical and environmental characteristics of thecountry and a'ected area (e.g. national" sub)national anddistrict maps sho$ing administrative and political divisions ofthe a'ected area" settlements" $ater sources" main transportroutes and health facilities*.

+. the si,e" composition and prior health and nutritional conditionof the emergency)a'ected population-

. the health services and programs functioning before and duringthe emergency

/. &apid surveys 0isual inspection of the a'ected area (ncludes mapping of the area

to indicate the a'ected area" the distribution and estimation ofthe population area and the location of resources (medicalfacilities" $ater sources" food distribution points" temporaryshelters etc.*

ntervie$s $ith %ey informants must include people from all sectorsof the population involved:

1. Clan" village and community leaders+. Area administrators or other governmental o#cials. 2ealth $or%ers" including traditional birth attendants" healers"

etc./. Personnel from local and international emergency response

organi,ations" including 3nited 4ations organi,ations"5. ndividuals in the a'ected population.

+. 6ield visit7ata: demography" environment" health data" resource needs

Methods: aerial inspection- direct observation- intervie$s $ith agencies" thedepartment of health and local authorities- collection of health data frommedical facilities- rapid estimation of population si,e by mapping" revie$ ofrecords and rapid surveys

. Analysis7emographic pyramids based from the obtained demographic informationsuch as the:


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1. Total population si,e (displaced persons and host population*-+. Population under 5 years of age. 8thnic composition and place of origin/. 9e ratio5. The number of persons in the follo$ing high)ris% groups:

pregnant and lactating $omen" members of households headed

by a $oman" unaccompanied children" disabled and $oundedpeople" and the elderly.

. The average si,e of a family!household;. Activity patterns in the host (and possibly the displaced*

populations that may a'ect the timing of surveys (e.g. $henpeople go to collect $ater" to the 4A99899M84T T==? 6=&MAT patterned to 7=2*

3. Action-oriented and prioritized - Clear recommendations should bemade to implementing organi,ations" giving highest priority needs.

4.Widely distributed - Copies of the report should be distributed to allorgani,ations involved in the emergency response.

5. Timely - The assessment and report should be


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Preventive Measure mpact of 9pread9ite Planning 7iarrhea diseases" acute respiratory infectionsClean >ater 9upply 7iarrhea diseases" typhoid feverBood 9anitation 7iarrhea diseases" vector)borne diseases"

scabies" acute respiratory infectionsAde@uate 4utrition Tuberculosis" measles" acute respiratory

infections0accination ofCommunicable 7iseases

Measles" etrapulmonary tuberculosis i.e. Tmeningitis Potts 7isease*" Polio" Mumps"7iptheria" Tetanus" Pertussis" 2epatitis . 8P

0ector Control Malaria" plague" dengue" other viralhemorrhagic fever.

Personal Protection(treated nets" insectrepellants*

Malaria" 7engue

Personal 2ygiene 9%in diseases" and parasitic infections2ealth 8ducation 9eually transmitted infections" common

communicable diseasesCase Management Cholera" shigellosis" tuberculosis" acuterespiratory infections" malaria" denguehemorrhagic fever" meningitis" typhoid fever

1. 9ite Planning

Impact o! Spread

7iarrhea diseases" acute respiratory infections

Speci"c Pre#enti#e $easure

1. The selection of sites must be $ell planned to avoid ris% factors forcommunicable disease transmission" such as overcro$ding" poorhygiene" vector breeding sites and lac% of ade@uate shelter.

+. 9ettlements should avoid the maDor breeding sites of local vectors" as$ell as marshy areas and Eat" lo$)lying ground at ris% of Eooding.

. The $ater source should be close enough to avoid transporting $aterby truc%s" pumping it over long distances or $al%ing long distances tocollect insu#cient @uantities.

/. Space There must be enough space for the present number ofemergency)a'ected population" $ith provision for future inEues andfor amenities such as $ater and sanitation facilities" food distributioncenters" storage sites" hospitals" clinics and reception centers.

5. Soil conditionsThe soil type a'ects sanitation" $ater pipelines" roadand building construction" drainage and the living environment (interms of dust and mud*. The most suitable soil type is one that $illeasily absorb human $aste.

. The site should be accessible at all times (e.g. for food deliveries" roadsduring rains*.

;. The site chosen should be in a safe area" su#ciently distant fromnational borders and combat areas.


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F. 9ome potential sites may have special ritual or spiritual signi


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Speci"c Pre#enti#e $easures1. 7aily bathing" $ashing of hands after using the latrine" regular $ashing

of clothes" and good food and $ater storage practices can prevent thespread of Ey)borne diseases.

PRINCIP&ES % )*+IENE PR$TIN

n emergency situations" you have to coordinate closely $ith allagencies involved in relief $or% on a small number of hygienemessages of proven public health importance. Coordination of programcommunication activities avoids duplication of e'orts and $asting oftime and resources ) both of the programs and of the a'ectedcommunity. Apply the follo$ing essential principles to hygienepromotion:%ocus on a small number o! ris, practices.

To control diarrheal disease" your messages should highlight thepriority hygiene practices: hand $ash $ith $ater and soap" or $hennot available use ash after contact $ith feces- and safe disposal ofadultsI and childrenIs feces to prevent infection and contamination

i.e. clear scattered feces" control open defecation and shallo$ trenchlatrines" repair toilet facilities and!or build temporary family orcommunal latrines.In#ol#e speci"c participant (roupsnvolve fathers" mothers" children" older siblings" opinion leaders andother inEuential persons and groups in the a'ected community. Publichealth promoters need to identify primary child caregivers and those$ho inEuence and ma%e decisions for them. nvolve these inEuencersin the di'erent stages of a health promotion initiative.Identi!y te moti#es !or adoptin( positi#e bea#iorsy $or%ing $ith the various participant groups from a'ectedcommunities you can discover individual vie$s of the bene


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Programs include an e'ective mechanism for representative andparticipatory input from all users at all phases" including the initialdesign and location of facilities ma%ing sure that latrinesaccommodate the disabled- are $ell)lit and designed to protect $omenfrom seual molestation- and provide girls and $omen the privacy tocleanse themselves" $ash underclothes and sanitary rags.

All groups $ithin the a'ected community have e@uitable access to theresources or facilities needed to practice or continue the properhygiene practices.2ygiene promotion messages and activities address %ey behaviors andmisconceptions and reach all participant groups. &epresentatives fromthese groups participate in planning" training" implementation"monitoring and evaluation.Participants ta%e responsibility for the management and maintenanceof facilities as appropriate" and all populations of the a'ectedcommunity contribute e@uitably.

Note/ Plan the behavioral monitoring and set indicators from the start and

encourage follo$)up action. n other $ords" encourage your sta'" partnersand a'ected communities to do o!"t#$%& $ith the results of monitoring. nplanning the monitoring and evaluation indicators" you need to be concernedabout information for actionrather than Jinformation to be moreinformed

(BEHAVIOUR CHANGE COMMUNICATION IN EMERGENCIES: A TOOLKITpp '-') *oot%ot"

/. Bood 9anitation

Impact o! Spread7iarrhea diseases" vector)borne diseases" scabies" acute respiratory

infections

Speci"c Pre#enti#e $easures1. Waste 'isposal - )uman E0creta1%eces

8cretion


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>here it is necessary to introduce unfamiliar types of latrines" theemergency a'ected population may need training in the proper use ofthe system.>here acceptable latrines are provided" intensive education andpromotion is still needed to maimi,e the numbers of displacedpersons using them. This is especially important for the children" $ho

may not have used latrines before.Appropriate anal cleansing facilities must be provided.

+. Waste 'isposal 2 Solid Waste3urial o! !amily 4aste near te ome - n a settlement $ithsu#cient space" the population can be encouragedto dispose of their$aste $ithin their o$n plots. A small hole can bedug and the $aste" ifdry enough" can be burned before burying.Transport o! 4aste by ouseolders to a community compostpit - f the a'ected population are interested or eperienced incomposting their $aste" compost pits can ma%e a very e#cientdisposal system.

f the population understands the dangers of Eies and rats they $ill bemore inclined to manage the compost heap correctly.

c. Waste 'isposal 2 $edical WasteMedical $aste includes needles" scalpels" laboratory samples"disposable materials stained $ith body Euids" and body tissue. This$aste re@uires special care in handling" since needles and scalpels cancut handlers and transmit diseases such as 20!A79" hepatitis and Cand viral hemorrhagic fevers.Medical $aste should be burnt in an incinerator" preferably as close aspossible to the source" e.g. $ithin the clinic or hospital grounds" butalso do$n$ind of hospital buildings and d$ellings.n temporary situations" a +HH)litre drum can be used as an incinerator"

divided in half by a metal grate and $ith an access hole at the bottomto provide air for combustion and as a $ay of removing ash.

d. 'ust?arge amounts of dust can also be a health ha,ard" causing respiratoryproblems and contaminating food. Preventing the destruction ofvegetation is important in controlling dust.7ust can be settled by spraying $ater on the ground: this isparticularly useful around health centers and feeding centers.

e. 'isposal o! te 'ead7uring an outbrea% $ith a high mortality rate" the collection of bodiesand their rapid burial is a priority. Corpses should not be embalmed butburied or cremated promptly.Braveyard and crematorium attendants should be in place to recordthe name" age" gender" and address of the deceased" the cause ofdeath" the plot space used and the depth of burial. &ecords on thecause of death can be compiled to dra$ up a picture of the healthproblems in a camp.>hen death has been due to a highly infectious disease such ascholera" typhus" plague or viral hemorrhagic fever" it may be necessaryto dispose of the body as @uic%ly as possible.


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odies should be covered by at least one meter of earth to preventaccess by carrion feeders (such as Dac%als* or rodents (many speciescan burro$ at least t$o feet* and also to prevent access by burro$ingEies" some of $hich can dig do$n at least /5 cm.

5. 0ector Control

Impact o! SpreadMalaria" 7engue" Lello$ 6ever" other 0iral 2emorrhagic 6ever.

Speci"c Pre#enti#e $easures1. The main methods of vector prevention and control can be classi


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+!od$.!*/$p.!

+1 2$23

+1 o2"

+1 !$"

=ften fatal tonon)immunepeople

3suallyconsidered

non)fatal

3suallyconsiderednon)fatal

3suallyconsiderednon)fatal

mos@uito nets long)lasting insecticidalnets repellents residual spraying environmental

managementCase management: prophylactic drugs rapid diagnosis ande'ective casemanagementMonitoring the e'ectivenessofcontrol methods particularlyduringepidemics

Lello$ fever 6atal in up to5HNof cases

4o speci


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7iseases spread by rodents and their treatment and prevention

Role $ode o! transmiss

ion

'isease $orbidityand

mortality

4enuntreate

d

Treatment

Pre#ention

As avectorof disease

&odenturine

?eptospirosis

?o$ case)fatalityrates

Antimicrobial

&odent)proo


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EuidsConsumption of

rodentmeat

Tooplasmosis

4on)fatalbutrecurrent

7rugtherapy

. Personal Protection (insecticide treatment nets*

Impact o! SpreadMalaria

Speci"c Pre#enti#e $easure1. Personal protection against the spread of disease includes a variety of

methods: insecticide)treated nets" treated sheets and blan%ets"personal hygiene" insect repellents and clothing" and dusting po$der.

5. Ade@uate 4utrition

Impact o! SpreadTuberculosis" measles" acute respiratory infections

Speci"c Pre#enti#e $easures1. There are a number of routine practices that should be adhered to

$hen preparing food" in both the household and in health facilities.8nsure an ade@uate $ater supply.>hen preparing food or $ashing utensils" use a chlorinated $atersupply.9tore food in sealed containers.8nsure that food is covered during coo%ing and prior to serving.8nsure that coo%ed food is consumed once prepared.Cover food $hen served" if left unattended.Place hand)$ashing facilities outside latrines" living areas and%itchens. 8nsure that people use them.8nsure an ade@uate number of sanitary latrines and that they aremaintained and used.All areas in a feeding center must be cleaned daily.Cover $ater containers at all times.8nsure that $ater is ta%en either from a tap or from a cleancontainer.7ispose of garbage safely.

2. n emergency situations" the aim should be to ensure that the foodneeds of the population are met through the pro#ision o! anade6uate (eneral ration. There are t$o forms of selective feedingprogram:

Supplementary !eedin( pro(rams 7S%Ps8 provide nutritiousfood in addition to the general ration. They aim to reduce the


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prevalence of malnutrition and mortality among vulnerable groups andto prevent deterioration of nutritional status in those most at ris% bymeeting their additional needs" focusing particularly on young children"pregnant $omen and nursing mothers.

Terapeutic !eedin( pro(rams 7T%Ps8are used to rehabilitateseverely malnourished persons. The main aim is to reduce ecess

mortality. n most emergency situations" the maDority of those $ithsevere $asting are infants and young children. There have" ho$ever"been cases $here large numbers of adolescents and adults havebecome $asted. n such situations" separate T6P facilities may beestablished for these groups.

3lan,et supplementary !eedin( programs should be neededonly temporarily $hen prevalence of malnutrition eceeds 15N" or1HNin the presence of other aggravating factors

Tar(eted supplementary !eedin( (i.e. etra food given toselected individuals* is indicated if the prevalence of malnutritioneceeds 1HN" or 5Nin the presence of other aggravating factors (e.g.high mortality and!or epidemic infectious diseases*.

Indications !or speci"c inter#entionsTable .1 provides guidelines for the implementation of selective feeding

programs.

'ecision Cart !or te Implementation o! Selecti#e %eedin(Pro(rams

%indin( Action Re6uired6ood availability at household levelbelo$+1HH %cal per person per day

Unsatisfactory situationmprove general rations until localfood availability and access can bemade ade@uate

Malnutrition prevalence 15N ormoreO 1H1/N $ith aggravating factors

Aggravating factors: general food ration belo$ themean energy re@uirement" crude mortality rate more than 1per 1H HHH per day" epidemic of measles or $hoopingcough" high incidence of respiratory ordiarrheal diseases.

Serious Situation4 Beneral rations (unless situation islimited to vulnerable groups*" plus:blan%etsupplementary feeding forallmembers of vulnerable groupsespeciallychildren and pregnant and lactating$omen therapeutic feeding programs forseverely malnourished individuals

Malnutrition prevalence 1H1/NO 5GN $ith aggravating factors

Aggravating factors: general food ration belo$ themean energy re@uirement" crude mortality rate more than 1per 1H HHH per day"

Risky Situation 4o general rations" but: supplementary feeding targetedtoindividuals identi


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epidemic of measles or $hoopingcough" high incidence of respiratory ordiarrheal diseases.Malnutrition prevalence under 1HN$ith no aggravating factors

A//"pt"

Acceptable Situation4 4o need for population

interventions Attention for malnourishedindividuals through regularcommunity services

9ource: T#" !%&"!"%t o* %.t$t$o% $% !7o "!"&"%/$"1 Beneva">orld 2ealth =rgani,ation" +HHH1Co!!.%$/" d$"" /o%to $% "!"&"%/$" A 8"d !%. pp '

Types o! selecti#e !eedin( pro(ramPro(ram b9ecti#es Criteria !or selection and tar(et (roup

Targetedselectivefeedingprogram

Correct moderate malnutrition

Prevent the moderatelymalnourished from becomingseverely malnourished

&educe mortality andmorbidity ris%in children under 5 years

Provide nutritional support toselected pregnant andlactating$omen

Provide follo$)up services tothose discharged fromtherapeuticfeeding programs

Children under 5 years moderatelymalnourished

Malnourished individuals (based on $eightfor) height" M3AC or clinical signs*: (1* olderchildren" 5 to 1H years- (+* adolescents- (*adults and elderly persons- (/* medicalreferrals

9elected pregnant $omen from date ofcon


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Therapeuticfeedingprogram

Provide medical!nutritionaltreatment for the severelymalnourished

Children under 5 years severely malnourished

9everely malnourished children older than 5years" adolescents and adults admitted"based on available $eight)for)heightstandards or presence ofoedema

?o$)birth)$eight babies=rphans Q 1 year (only $hen traditional carepractices inade@uate*

Mothers of children younger than one year$ith breastfeeding failure (only in eceptionalcases $here re)lactation through counselingand traditional alternative feeding has failed*

9ource: UNHCR;


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5. 0accination sites must be located in such a $ay as to ensure easyaccess- additional sites may be re@uired for speci

key activities in rapid assessment

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