Morbidity and mortality amongst southern Sudanese in Koboko refugee camps, Arua District, Uganda.

OBJECTIVE

To determine the causes of morbidity, mortality and assess the nutritional status of children under five years, in Koboko refugee camps, Arua District, Uganda.

DESIGN

Review and analysis of refugee treatment records between 1992 and 1994 from Maracha and Koboko hospitals and cross sectional nutritional survey of children under five years in camps.

SETTING

Between June 1992 and March 1994, an estimated 70,000 Sudanese refugees were encamped in five transit camps in Koboko county, Arua district. Koboko field hospital was immediately established and Maracha hospital designated the referral hospital for refugees.

PARTICIPANTS

Hospitalised refugees between 1992 and 1994 in Koboko and Maracha hospitals and children under five years in the camps formed the study populations.

INTERVENTIONS

Health facilities and therapeutic nutrition centres were established in the camps. Fortnightly general food distribution and therapeutic feeding programmes were instituted. Severe medical and surgical conditions were referred to Maracha hospital.

MAIN OUTCOME MEASURES

Outcome variables considered were morbidity, mortality, case fatality rates; weight/height, weight/age and height/age.

RESULTS

Out of 1476 refugees hospitalised in Koboko and Maracha hospitals, 267 died giving a case fatality rate of 18%. The leading causes of morbidity were diarrhoeal diseases (26.9%), ARI (13.6%), malaria (10.2%), trauma (7.6%) and malnutrition (5.0%). The main causes of mortality were similar, that is, diarrhoeal diseases (35.9%), ARI (23.9%), anaemia (7.2%) and HIV/AIDS (6.8%). Conditions associated with high overall case fatality rates were ARI (31.3%), HIV/AIDS (30.0%) and cardiac failure (29.3%) respectively. Nearly half of the children (48.6%), H/A -2SD were stunted, over a third (36.7%), W/A -2SD were underweight and (8.5%), W/H -2SD wasted.

CONCLUSION

Communicable diseases are the predominant causes of morbidity and mortality during the emergency phase of encampment. Timely and effective management of communicable diseases including malnutrition and trauma are crucial to avoid high mortality amongst refugees, coupled with the provision of essential requirements and services such as water, sanitation, food, shelter and immunisation.