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Sentinel site community surveillance of mortality and nutritional status in southwestern Central African Republic, 2010

Grazia M Caleo12, Aly Penda Sy3, Serge Balandine2, Jonathan Polonsky24, Pedro Pablo Palma3, Rebecca Freeman Grais2 and Francesco Checchi25*

Author Affiliations

1 European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

2 Epicentre, 8 rue Saint-Sabin, Paris, France

3 Médecins Sans Frontières, Operational Centre Barcelona-Athens, Nou de la Rambla, 26, Barcelona, Spain

4 Health and Nutrition Tracking Service, Geneva, Switzerland

5 Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom

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Population Health Metrics 2012, 10:18  doi:10.1186/1478-7954-10-18

Published: 4 September 2012

Abstract

Background

During 2010, a community-based, sentinel site prospective surveillance system measured mortality, acute malnutrition prevalence, and the coverage of a Médecins Sans Frontières (MSF) intervention in four sous-préfectures of Lobaye prefecture in southwestern Central African Republic. We describe this surveillance system and its evaluation.

Methods

Within 24 randomly selected sentinel sites, home visitors performed a census, weekly demographic surveillance of births, deaths, and in- or out-migration, and weekly anthropometry on a sample of children. We evaluated the system through various methods including capture-recapture analysis and repeat census.

Results

The system included 18,081 people at baseline. Over 32 weeks, the crude death rate was 1.0 (95% confidence interval [CI]: 0.8-1.2) deaths per 10,000 person-days (35 deaths per 1,000 person-years), with higher values during the rainy season. The under-5 death rate was approximately double. The prevalence of severe acute malnutrition (SAM) was 3.0% (95% CI: 2.3-4.0), almost half featuring kwashiorkor signs. The coverage of SAM treatment was 29.1%. The system detected >90% of deaths, and >90% of death reports appeared valid. However, demographic surveillance yielded discrepancies with the census and an implausible rate of population growth, while the predictive value of SAM classification was around 60%.

Discussion

We found evidence of a chronic health crisis in this remote region. MSF's intervention coverage improved progressively. Mortality data appeared valid, but inaccuracies in population denominators and anthropometric measurements were noted. Similar systems could be implemented in other remote settings and acute emergencies, but with certain technical improvements.

Keywords:
Mortality; Malnutrition; Central African Republic; Surveillance; Rural; Humanitarian