Background

People in humanitarian emergencies are likely to experience excess mortality but information on the causes of death is often unreliable or non-existent. This study aimed to provide evidence on the causes of death among children younger than 5 years in camps for internally displaced people in southern Somalia, during periods of protracted displacement and emergency influx amid the 2017 drought and health emergency.

Methods

We did a prospective, cohort study in 25 camps in the Afgooye corridor, on the outskirts of Mogadishu, Somalia. All internally displaced children aged 6–59 months were included and followed up with monthly household visits by community health workers. Nutrition, health, and vaccination status were ascertained and verbal autopsy interviews were done with the caregivers of deceased children. We calculated death rates in these children and used verbal autopsy to establish the cause-specific mortality fraction (CSMF). Bayesian InterVA software was used to assign likely causes to each death.

Findings

Between March, 2016, and March, 2018, 3898 children were followed up. 153 deaths were recorded during 34 746 person-months of observation. The death rate among children younger than 5 years exceeded emergency thresholds (>2 deaths per 10 000 children per day), reaching a peak of seven deaths per 10 000 children per day during the emergency influx. Verbal autopsy data were gathered for 80% of deaths, and the CSMF for the three leading causes of death were diarrhoeal diseases (25·9%), measles (17·8%), and severe malnutrition (8·8%). Coverage of measles vaccination during the first 3 months of the emergency was 42% and the CSMF for measles doubled during the influx. During protracted displacement, symptoms that could be attributable to HIV/AIDS related deaths accounted for 1·6% of the CSMF.

Interpretation

It is feasible to establish a health and nutrition surveillance system that ascertains causes of death, using verbal autopsy, in this humanitarian context. These data can inform policy, response planning, and priority setting. The high mortality rate from infectious diseases and malnutrition among children younger than 5 years suggests the need for strengthening a range of public health interventions, including vaccination and provision of water, sanitation, and hygiene.

Funding

UK Department of International Development.

中文翻译：

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使用口头尸检确定索马里摩加迪沙境内流离失所者营地中儿童死亡的原因：一项基于人口的前瞻性队列研究

背景

处于人道主义紧急情况的人们可能会经历过高的死亡率，但关于死因的信息往往不可靠或不存在。本研究旨在提供证据，说明在 2017 年干旱和卫生紧急情况期间长期流离失所和紧急人口涌入期间，索马里南部境内流离失所者营地中 5 岁以下儿童的死亡原因。

方法

我们在索马里摩加迪沙郊区的 Afgooye 走廊的 25 个营地中进行了一项前瞻性队列研究。包括所有 6-59 个月大的境内流离失所儿童，并由社区卫生工作者每月进行家访。确定营养、健康和疫苗接种状况，并与已故儿童的照顾者进行口头尸检访谈。我们计算了这些儿童的死亡率，并使用口头尸检来确定特定原因死亡率分数 (CSMF)。贝叶斯 InterVA 软件用于为每个死亡分配可能的原因。

发现

2016 年 3 月至 2018 年 3 月期间，对 3898 名儿童进行了随访。在 34 746 人月的观察中记录了 153 人死亡。5 岁以下儿童的死亡率超过了紧急阈值（每天每 10 000 名儿童中有 2 人以上死亡），在紧急情况涌入期间达到每天每 10 000 名儿童 7 人死亡的峰值。收集了 80% 死亡的口头尸检数据，三个主要死因的 CSMF 是腹泻病 (25·9%)、麻疹 (17·8%) 和严重营养不良 (8·8%)。在紧急情况的前 3 个月内，麻疹疫苗接种的覆盖率为 42%，在大量涌入期间，麻疹的 CSMF 翻了一番。在长期流离失所期间，可归因于 HIV/AIDS 相关死亡的症状占 CSMF 的 1·6%。

解释

在这种人道主义背景下，建立一个健康和营养监测系统，通过口头尸检来确定死因是可行的。这些数据可以为政策、响应计划和优先级设置提供信息。5 岁以下儿童传染病和营养不良的高死亡率表明需要加强一系列公共卫生干预措施，包括疫苗接种和提供水、环境卫生和个人卫生。

资金

英国国际发展部。