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.