Infectious disease surveillance during emergency relief to Bhutanese refugees in Nepal.

OBJECTIVE

To implement simplified infectious disease surveillance and epidemic disease control during the relocation of Bhutanese refugees to Nepal.

DESIGN

Longitudinal observation study of mortality and morbidity.

SETTING

Refugee health units in six refugee camps housing 73,500 Bhutanese refugees in the eastern tropical lowland between Nepal and India.

INTERVENTIONS

Infectious disease surveillance and community-based programs to promote vitamin A supplementation, measles vaccination, oral rehydration therapy, and early use of antibiotics to treat acute respiratory infection.

MAIN OUTCOME MEASURES

Crude mortality rate, mortality rate for children younger than 5 years, and cause-specific mortality.

RESULTS

Crude mortality rates up to 1.15 deaths per 10,000 persons per day were reported during the first 6 months of surveillance. The leading causes of death were measles, diarrhea, and acute respiratory infections. Surveillance data were used to institute changes in public health management including measles vaccination, vitamin A supplementation, and control programs for diarrhea and acute respiratory infections and to ensure rapid responses to cholera, Shigella dysentery, and meningoencephalitis. Within 4 months of establishing disease control interventions, crude mortality rates were reduced by 75% and were below emergency levels.

CONCLUSIONS

Simple, sustainable disease surveillance in refugee populations is essential during emergency relief efforts. Data can be used to direct community-based public health interventions to control common infectious diseases and reduce high mortality rates among refugees while placing a minimal burden on health workers.