Boss L P, Toole M J, Yip R
Centers for Disease Control and Prevention, Atlanta, GA 30333.
JAMA. 1994 Aug 3;272(5):371-6.
To evaluate the various survey methods used in Somalia between 1991 and early 1993 while assessing documentation of mortality and malnutrition rates and common causes of morbidity and mortality.
Twenty-three population surveys were identified from the Center for Public Health Surveillance for Somalia, the United Nations Children's Fund, and other humanitarian organizations.
Only surveys with defined populations and apparently systematic methodology that focused on mortality, morbidity, and/or nutritional status were included.
Extensive methodological differences were found among the 23 surveys. Target populations and sampling strategies varied widely. Twelve studies were considered not reproducible. Of the 16 studies assessing mortality, only eight assessed cause of death. Use of units of measurement and inclusion of denominators in rate calculations were inconsistent. None of the studies provided confidence intervals around the point estimates of the rates. Of the 11 studies providing information on morbidity, none provided case definitions. And in the 16 studies reporting nutritional status, a variety of measurement methods and definitions of malnutrition were used. Three studies presented information based on mid-upper-arm circumference measurements, and 10 presented weight-for-height data below 70% and 80% of the reference median; only four studies presented z scores.
While the results of some studies may have influenced policy and program management decisions, their effects may have been limited by failure to adequately document results and by differences among studies in objectives, design, parameters measured, methods of measurement, definitions, and analysis methods. We recommend that agencies conducting population studies in emergency situations define clear study objectives, use standard sampling and data collection methods, and ensure precise written documentation of study objectives, methods, and results.
评估1991年至1993年初索马里使用的各种调查方法，同时评估死亡率和营养不良率的记录情况以及发病和死亡的常见原因。
从索马里公共卫生监测中心、联合国儿童基金会和其他人道主义组织中识别出23项人口调查。
仅纳入针对特定人群且方法明显系统、侧重于死亡率、发病率和/或营养状况的调查。
在这23项调查中发现了广泛的方法学差异。目标人群和抽样策略差异很大。12项研究被认为不可重复。在评估死亡率的16项研究中，只有8项评估了死因。测量单位的使用以及率计算中分母的纳入不一致。没有一项研究在率的点估计周围提供置信区间。在提供发病率信息的11项研究中，没有一项提供病例定义。在报告营养状况的16项研究中，使用了各种测量方法和营养不良的定义。3项研究基于上臂中部周长测量提供信息，10项研究提供低于参考中位数70%和80%的身高别体重数据；只有4项研究提供了z评分。
虽然一些研究的结果可能影响了政策和项目管理决策，但其影响可能因未能充分记录结果以及研究在目标、设计、测量参数、测量方法、定义和分析方法上的差异而受到限制。我们建议在紧急情况下进行人口研究的机构明确研究目标，使用标准抽样和数据收集方法，并确保对研究目标、方法和结果进行精确的书面记录。
