The use of epidemiological tools in conflict-affected populations: open-access educational resources for policy-makers

Table of Contents

1. Welcome
2. Introduction: Epidemiology in crises
3. Ethical issues in data collection
4. Need for epidemiologic competence
5. Surveys - Introduction
6. Surveys - Description of sampling methods
7. Surveys - Sampling error, bias, accuracy, precision, & sample size
8. Surveys - Resources required for surveys
9. Surveys - Critiquing survey reports
10. Surveillance - When to do surveillance
11. Surveillance - Methods
12. Surveillance - Common problems
13. Programme data
14. Rapid assessment
15. Mortality - Indicators and their measurement
16. Mortality - Data sources
    1. Introduction
    2. Surveillance - Prospective death reporting
    3. Surveys (retrospective data collection)
    4. Recall period
    5. Determining the length of the recall period
    6. Data collection and the questionnaire
    7. Surveys - Quiz
    8. Surveys measuring mortality - Summary
17. Mortality - Interpretation and action
18. Nutrition - Introduction and background
19. Nutrition - Indicators and their measurement
20. Nutrition - Data sources
21. Nutrition - Interpretation and action
22. Health services
23. Vaccination programmes
24. Water supply, sanitation, and shelter
25. Violence
26. Presentation of results
27. Formulating conclusions and recommendations
28. Dissemination and action

Surveys measuring mortality - Summary

(go to Outline)

A few points to remember regarding measurement of mortality in surveys:

• Be sure the recall period will measure the mortality rate during the time period you need to answer your question. Do not select an arbitrary starting point for your recall period.
• Do not just ask the respondent how many people live in the household and how many have died. You may get inaccurate or intentionally distorted responses.
• Remember to calculate a sample size for your mortality estimate before beginning data collection. Often the sample size, in number of households, for other outcomes will be insufficient to measure mortality, especially if you want a precise estimate for a short recall period or are most interested in the age-specific mortality rate for children under 5 years of age. If this is true, it may not be worth attempting to measure mortality.
• Do not attempt to determine detailed cause of death from a survey. You may only be able to distinguish violent from non-violent deaths in a short survey interview.
• If you are doing a survey, you must prepared for a finding of high mortality, even though this may imply that your relief programme may not have been effective. Similarly, you must be prepared to accept a low result even though this may hamper your efforts to advocate for or obtain more funding.
• Be sure your findings will be used. There is no point in asking bereaved family members about their relatives' deaths unless the agency commissioning the survey is ready to implement interventions or do serious advocacy on the basis of the results.
• If you are thinking of commissioning a survey to measure morality for operational purposes (i.e. to benchmark the crisis' severity and/or monitor health status over time), you should also have the means to organize the survey and release findings within a short time period - 2-3 weeks in an acute emergency, 1-2 months in other settings. Late findings are of little use.