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
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
    1. Factors in interpreting data on acute protein-energy malnutrition
    2. Prevalence of acute protein-energy malnutrition
    3. Trends over time
    4. Underlying causes
    5. Malnutrition and mortality
    6. Interventions for acute PEM
    7. Interpreting results of micronutrient assessment
    8. Interventions for micronutrient deficiencies
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

Interventions for micronutrient deficiencies

(go to Outline)

There are several potential interventions to address micronutrient deficiencies in emergency-affected populations:

• Provide a more varied diet. This is very difficult. The major source of many essential micronutrients is fresh food, particularly fruit, meat, vegetables, and dairy products. It is very difficult to procure, ship, store, and distribute such food to large populations who are often located in remote places. Markets within the population can sometimes supply more varied foodstuffs, but people often do not have the money to purchase food in a market.
• Provide micronutrient supplements to groups as risk. For example, give all pregnant women iron tablets to prevent the development of iron deficiency anaemia during the pregnancy. However, supplementation programmes have notoriously low coverage and compliance. For these reasons, they do not often have a large effect on micronutrient deficiency.
• Fortify the relief food distributed. This has become the most common intervention; however, because fortified relief food is more expensive than unfortified food, programmes on tight budgets sometimes cannot afford it. Also, fortification does not work well for some micronutrients. For example, vitamin C is relatively unstable and does not last in foods which are stored for a long time or cooked at high temperatures.