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Anthony A. Martin, MD, MPH; Judith Moore, RN, MSc, DTMH; Carole Collins, MBBS, DTMH; Robin Biellik, DrPH; Umesh Kattel; Michael J. Toole, MD; Patrick S. Moore, MD, MPH

JAMA. 1994;272(5):377-381.

Abstract
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 10000 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 communitybased public health interventions to control common infectious diseases and reduce high mortality rates among refugees while placing a minimal burden on health workers.

(JAMA. 1994;272:377-381)

Author Affiliations
From the Division of Vector-Borne Infectious Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colo (Drs Marfin and P. S. Moore); Save the Children Fund-United Kingdom, London, England (Ms J. Moore, Dr Collins, and Mr Kattel); the World Health Organization, Kathmandu, Nepal (Dr Biellik); and the International Health Program Office, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Toole).

Footnotes
Address correspondence to Division of Respiratory Disease Studies, NIOSH/CDC, 944 Chestnut Ridge Rd, Morgantown, WV 26505-2888 (Dr Martin).

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