Infectious disease surveillance during emergency relief to Bhutanese refugees in Nepal

JAMA. 1994 Aug 3;272(5):377-81. doi: 10.1001/jama.272.5.377.


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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Bhutan / ethnology
  • Cause of Death
  • Child
  • Child, Preschool
  • Cholera / epidemiology
  • Communicable Disease Control*
  • Communicable Diseases / epidemiology*
  • Communicable Diseases / mortality
  • Disease Outbreaks* / prevention & control
  • Disease Outbreaks* / statistics & numerical data
  • Dysentery / epidemiology
  • Humans
  • Infant
  • Meningoencephalitis / epidemiology
  • Middle Aged
  • Morbidity
  • Nepal / epidemiology
  • Population Surveillance* / methods
  • Refugees* / statistics & numerical data
  • Relief Work*