Abstract

Objective

To describe tools used for the assessment of maternal and child health issues in humanitarian emergency settings.

Methods

We systematically searched MEDLINE, Web of Knowledge and POPLINE databases for studies published between January 2000 and June 2014. We also searched the websites of organizations active in humanitarian emergencies. We included studies reporting the development or use of data collection tools concerning the health of women and children in humanitarian emergencies. We used narrative synthesis to summarize the studies.

Findings

We identified 100 studies: 80 reported on conflict situations and 20 followed natural disasters. Most studies (76/100) focused on the health status of the affected population while 24 focused on the availability and coverage of health services. Of 17 different data collection tools identified, 14 focused on sexual and reproductive health, nine concerned maternal, newborn and child health and four were used to collect information on sexual or gender-based violence. Sixty-nine studies were done for monitoring and evaluation purposes, 18 for advocacy, seven for operational research and six for needs assessment.

Conclusion

Practical and effective means of data collection are needed to inform life-saving actions in humanitarian emergencies. There are a wide variety of tools available, not all of which have been used in the field. A simplified, standardized tool should be developed for assessment of health issues in the early stages of humanitarian emergencies. A cluster approach is recommended, in partnership with operational researchers and humanitarian agencies, coordinated by the World Health Organization.

Résumé

Objectif

Décrire les outils utilisés pour évaluer les problèmes en matière de santé maternelle et infantile dans les situations d'urgence humanitaire.

Méthodes

Nous avons recherché de façon systémique, dans les bases de données Medline, Web of Knowledge et Popline, les études publiées entre janvier 2000 et juin 2014. Nous avons également fait des recherches sur les sites Internet d'organisations intervenant dans les situations d'urgence humanitaire. Nous avons inclus les études qui se rapportaient au développement ou à l'utilisation d'outils de collecte de données concernant la santé des femmes et des enfants dans des situations d'urgence humanitaire. Nous avons résumé ces études par une synthèse narrative.

Résultats

Nous avons retenu 100 études: 80 portaient sur des situations de conflit et 20 faisaient suite à des catastrophes naturelles. La plupart de ces études (76/100) s'intéressaient à la situation sanitaire des populations affectées tandis que 24 d'entre elles s'intéressaient à la disponibilité de services de santé et à leur couverture. Sur 17 outils de collecte de données identifiés, 14 concernaient la santé sexuelle et génésique, neuf la santé de la mère, du nouveau-né et de l'enfant, et quatre servaient à recueillir des informations sur la violence sexuelle ou exercée à l'égard des femmes. Soixante-neuf études avaient été réalisées à des fins de suivi et d'évaluation, dix-huit de sensibilisation, sept pour la recherche opérationnelle et six pour évaluer les besoins.

Conclusion

Des moyens pratiques et efficaces de collecte de données sont nécessaires pour orienter les actions permettant de préserver des vies humaines dans les situations d'urgence humanitaire. Il existe une grande variété d'outils disponibles, dont tous n'ont pas été employés sur le terrain. Il faudrait développer un outil simplifié et standardisé pour évaluer les problèmes sanitaires dès les premières phases des urgences humanitaires. Il est recommandé d'adopter une approche groupée, en partenariat avec les chercheurs opérationnels et les agences humanitaires, sous la coordination de l'Organisation mondiale de la Santé.

Resumen

Objetivo

Describir las herramientas utilizadas para evaluar los problemas de salud materna e infantil en entornos de emergencias humanitarias.

Método

Se realizaron búsquedas sistemáticas en las bases de datos de Medline, Web of Knowledge y Popline para encontrar estudios publicados entre enero de 2000 y junio de 2014. También se realizaron búsquedas en páginas web de organizaciones activas en emergencias humanitarias. Se incluyeron estudios que informaban sobre el desarrollo o el uso de herramientas de recopilación de datos relacionadas con la salud de las mujeres y los niños durante emergencias humanitarias. Se utilizó la síntesis narrativa para resumir los estudios.

Resultados

Se identificaron 100 estudios: 80 informaban sobre situaciones de conflicto y 20 sobre desastres naturales. La mayoría de los estudios (76/100) se centraban en el estado de la salud de la población afectada, mientras que 24 lo hacían en la disponibilidad y cobertura de los servicios de salud. De las 17 herramientas de recopilación de datos diferentes identificadas, 14 se centraban en la salud reproductiva y sexual, nueve trataban sobre salud maternal, neonatal e infantil y cuatro se utilizaban para recopilar información sobre violencia sexual o basada en el género. 69 estudios se habían realizado con fines de supervisión y evaluación, 18 para promoción, siete para investigaciones operacionales y seis para la evaluación de necesidades.

Conclusión

Se necesitan medios prácticos y efectivos de recopilación de datos para informar de acciones para salvar vidas en emergencias humanitarias. Existe una amplia variedad de herramientas disponibles, y no todas se han utilizado en este campo. Se debería desarrollar una herramienta simplificada estándar para evaluar los problemas de salud en las primeras etapas de emergencias humanitarias. Se recomienda un enfoque por grupos en cooperación con investigadores operacionales y agencias humanitarias, coordinados por la Organización Mundial de la Salud.

ملخص

الغرض

وصف الأدوات المستخدمة في تقييم مشكلات صحة الأمومة والطفولة في أماكن وقوع الحالات الإنسانية الطارئة.

الطريقة

قمنا بإجراء بحث منهجي في قواعد معطيات Medline، وWeb of Knowledge، وPopline للدراسات المنشورة في الفترة من يناير/كانون الثاني 2000 وحتى يونيو/حزيران 2014، كما بحثنا أيضًا في المواقع الإلكترونية للمؤسسات الفاعلة في مجال الحالات الإنسانية الطارئة. وقمنا بتضمين دراسات توضح إعداد أدوات جمع البيانات أو استخدامها فيما يتعلق بصحة النساء والأطفال في الحالات الإنسانية الطارئة. كما اتبعنا أسلوبًا تجميعيًا سرديًا لتلخيص الدراسات.

النتائج

لقد حددنا 100 دراسة، فوجدنا أن 80 دراسة منها أوردت بيانات عن حالات الصراع فيما تابعت 20 دراسة منها وقوع كوارث طبيعية. ركزت معظم الدراسات (76 من إجمالي 100) على الحالة الصحية للشريحة السكانية المتأثرة، في حين ركزت 24 دراسة على مدى توافر الخدمات الصحية ونطاق تغطيتها. ومن ضمن 17 أداة من أدوات جمع البيانات المختلفة التي تم تحديدها، ركزت 41 أداة على الصحة الجنسية والإنجابية، وكانت تسع أدوات معنية بصحة الأم والوليد والطفل، فيما تم استخدام أربع أدوات لجمع المعلومات عن العنف الجنسي أو العنف الجنساني. تم إجراء تسعة وستين دراسة لأغراض الرصد والتقييم، فيما تمت 18 دراسة للمناصرة، وسبع دراسات للبحوث الميدانية، وست دراسات لتقييم الاحتياجات.

الاستنتاج

هناك حاجة لاتباع وسائل عملية وفعالة لجمع البيانات اللازمة التي تقوم على أساسها الإجراءات الحاسمة لإنقاذ الأرواح في الحالات الإنسانية الطارئة. وتتوفر مجموعة متنوعة وواسعة من الأدوات، والتي لم يتم استخدامها جميعًا في الميدان. وينبغي إعداد أدوات مبسطة وموحدة لتقييم المشكلات الصحية في المراحل الأولى من الحالات الإنسانية الطارئة. يُوصى باتباع نهج قطاعي (Cluster approach)، بالاشتراك مع الباحثين التنفيذيين ووكالات المساعدة الإنسانية، وبالتنسيق من جانب منظمة الصحة العالمية.

摘要

目的

旨在描述在人道主义紧急情况中用于评估孕产妇和儿童健康问题的工具。

方法

我们在联机医学文献分析和检索系统 (Medline)、Web of Knowledge 和 Popline 数据库中系统搜索了于 2000 年 1 月至 2014 年 6 月之间发表的研究报告。我们还搜索了在人道主义紧急情况中表现积极的组织的网站。 我们涵盖的研究报告了对与人道主义紧急情况中的妇女和儿童有关的数据收集工具的开发和使用。 我们采用叙述性综合法对研究进行了总结概括。

结果

我们确定了 100 项研究： 其中 80 项报告了冲突局势，其余 20 项报告了自然灾害。 大部分研究 (76/100) 侧重于受灾人群的健康状态，而其他 24 项研究侧重于卫生服务的可用性和覆盖范围。 在确定的 17 种不同的数据收集工具中，14 种侧重于性与生殖健康，九种与孕产妇、新生儿和儿童健康有关，四种用于收集与性或性暴力行为有关的信息。 69 项研究是以监控和评估为目的而开展的，18 项以宣传倡导为目的，7 项以操作性研究为目的，6 项以需求评估为目的。

结论

我们需要采取实用、有效的数据收集方式，以了解人道主义紧急情况中的生命拯救行动。 可用工具各式各样，然而并非所有工具都曾用于该领域。 我们应开发出标准化的简易工具，用于评估在人道主义紧急情况早期出现的健康问题。 建议采用聚类的方法，并且在世界卫生组织的协调下与操作性研究人员及人道主义机构开展合作。

Резюме

Цель.

Описать инструменты, используемые для оценки проблем материнского здоровья и здоровья детей в условиях чрезвычайной ситуации гуманитарного характера.

Методы.

Был проведен систематический поиск исследований в базах данных Medline, Web of Knowledge и Popline, опубликованных с января 2000 года по июнь 2014 года. Поиск также осуществлялся на веб-сайтах организаций, работающих в условиях чрезвычайных ситуаций гуманитарного характера. В обзор были включены исследования, в которых сообщалось о разработке или использовании инструментов сбора данных о здоровье женщин и детей в условиях чрезвычайных ситуаций гуманитарного характера. Для получения сводных данных по этим исследованиям использовался нарративный синтез.

Результаты.

Нами было выявлено 100 исследований: в 80 из них сообщалось о конфликтах, а в 20 речь шла о стихийных бедствиях. Большая часть исследований (76 из 100) была посвящена состоянию здоровья затронутого бедствием населения, а в 24 речь шла о доступности услуг здравоохранения об охвате населения такими услугами. Из 17 выявленных инструментов сбора данных 14 касались сексуального и репродуктивного здоровья, девять - здоровья матерей, новорожденных и детей, четыре опроса использовались для сбора информации о сексуальном насилии или насилии по половому признаку. Шестьдесят девять исследований были проведены с целью мониторинга и оценки ситуации, 18 - из соображений защиты прав человека, семь - в порядке операционных исследований, шесть - для оценки потребностей.

Вывод.

Практичные и эффективные инструменты сбора данных оказываются необходимыми для мероприятий по спасению жизни, предпринимаемых в ходе чрезвычайных ситуаций гуманитарного характера. Доступно множество инструментов, однако не все они используются на практике. Следует разработать упрощенное стандартизированное средство оценки проблем со здоровьем на ранних этапах чрезвычайных ситуаций гуманитарного характера. Рекомендуется использовать кластерный подход и взаимодействовать с гуманитарными организациями и специалистами по операционным исследованиям при координации со стороны Всемирной организации здравоохранения.

Introduction

Humanitarian emergencies are natural disasters, man-made events or a combination of both that represent critical threats to the health, safety, security or wellbeing of a community.¹1 Guide to maternal, newborn and child health and nutrition in Emergencies. Uxbridge, England: World Vision; 2012 Available from:Available from:http://wvi.org/child-health-now/publication/maternal-newborn-and-child-health-and-nutrition-emergencies [cited 2015 July 13].
http://wvi.org/child-health-now/publicat... Humanitarian emergencies resulting from conflict, natural disasters, famine or communicable disease outbreaks have important health implications. Currently, there are approximately 39 million people displaced by conflict or violence.²2 Internal Displacement Monitoring Centre. Geneva: Internal Displacement Monitoring Centre 2014. Available from:Available from:http://www.internal-displacement.org/ [cited 2015 May 14].
http://www.internal-displacement.org/... Every year, millions are displaced due to weather-related or geophysical disasters. ⁽³3 Using data to improve humanitarian decision making. Geneva: United Nations Office for Coordination of Humanitarian Affairs (OCHA); 2013. Available from:Available from:http://reliefweb.int/report/world/overview-global-humanitarian-response-2014-enfrsp [cited 2014 May 14].
http://reliefweb.int/report/world/overvi... Women and children are generally the worst affected - representing over three-quarters of the estimated 80 million people in need of humanitarian assistance in 2014. ⁽⁴4 Overview of global humanitarian response. Geneva: the Office of the United Nations High Commissioner for Refugees (UNHCR); 2014. Available from:Available from:http://twine.unhcr.org/app/ [cited 2015 May 14].
http://twine.unhcr.org/app/... ^),(55 Humanitarian action for children. New York: United Nations Children's Fund; 2014. Available from:Available from:http://www.unicef.org/appeals/files/HAC_Overview_2014_WEB.pdf [cited 2015 May 14].
http://www.unicef.org/appeals/files/HAC_... Moreover, many countries with high maternal, newborn and child mortality rates are affected by humanitarian emergencies.

Humanitarian emergencies are frequently characterized by the collapse of basic health services. For better decision-making, coordination and response in such emergencies, humanitarian actors need access to appropriate information. ⁽⁴4 Overview of global humanitarian response. Geneva: the Office of the United Nations High Commissioner for Refugees (UNHCR); 2014. Available from:Available from:http://twine.unhcr.org/app/ [cited 2015 May 14].
http://twine.unhcr.org/app/... ^{), (6}6 Toole MJ, Waldman RJ. The public health aspects of complex emergencies and refugee situations. Annu Rev Public Health. 1997;18(1):283-312.http://dx.doi.org/10.1146/annurev.publhealth.18.1.283PMID 9143721
http://dx.doi.org/10.1146/annurev.publhe... ^{), (7}7 Jayatissa R, Bekele A, Piyasena CL, Mahamithawa S. Assessment of nutritional status of children under five years of age, pregnant women, and lactating women living in relief camps after the tsunami in Sri Lanka. Food Nutr Bull. 2006 Jun;27(2):144-52. PMID 16786980Studies have reported that during humanitarian emergencies, there can be either a shortage or, conversely, an overload of information. Both situations impair provision of effective humanitarian assistance. ⁽⁸8 Altay N, Labonte M. Challenges in humanitarian information management and exchange: evidence from Haiti. Disasters. 2014 Apr;38(s1) Suppl 1: S50-72.http://dx.doi.org/10.1111/disa.12052PMID 24601932
http://dx.doi.org/10.1111/disa.12052...

Sexual and reproductive health has historically been neglected in humanitarian emergency settings. ⁽⁹9 Esscher AO. Reproductive health in humanitarian assistance: a literature review. Uppsala: Centre for Public Health in Humanitarian Assistance, Uppsala University; 2004.Health services provided for women and children vary depending on location, climate, culture, existing infrastructure, population health and type of humanitarian crisis. The types of response also vary, with multiple governments and humanitarian agencies involved. Efficient, easy to use, comprehensive data collection tools are needed to aid situation analysis, decision-making and coordination of responses to humanitarian crises. ⁽¹⁰10 Lucas PJ, Baird J, Arai L, Law C, Roberts HM. Worked examples of alternative methods for the synthesis of qualitative and quantitative research in systematic reviews. BMC Med Res Methodol. 2007;7(1): 4.http://dx.doi.org/10.1186/1471-2288-7-4PMID 17224044
http://dx.doi.org/10.1186/1471-2288-7-4...

We review tools for collection of data concerning the health of women and children in humanitarian emergencies. We identify which tools are available and where they have been used. For each study, we describe the setting and purpose of the study, the types of data collected and the tools used to collect the data.

Methods

Search strategy

We conducted a systematic review according to current guidelines. ⁽¹¹11 The PRISMA Statement [Internet]. York, UK: Prospero; 2014. Available from:Available from:http://www.prisma-statement.org [cited 2015 July 13].
http://www.prisma-statement.org... We searched MEDLINE, Web of Knowledge and POPLINE databases for studies in English published between 1 January 2000 and 30 June 2014. Searches incorporated medical subject heading terms, keywords and free text using the following search terms: "reproductive health", "sexual", "maternal", "newborn", "child/child health service*", "pregnan*", "neonat*" under one search string and "disaster", "post conflict", "war", "humanitarian", "refugee", "internally displaced" under another string. The Boolean operator "OR" was used for the terms under each search string and "AND" was used to combine the two strings. The detailed search strategy is available from the authors.

Through a snowballing process, we identified organizations known for their work in humanitarian emergencies and searched the websites of these organizations - including CARE International, the Centers for Disease Control and Prevention, Harvard Humanitarian Initiative, the Inter-Agency Standing Committee, the International Federation of Red Cross and Red Crescent Societies (IFRC), the Joint United Nations Programme on HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome), Knowledge for Health (K4Health), Médecins Sans Frontières (MSF), the Office of the United Nations High Commissioner for Refugees, Oxfam, the Reproductive Health Response in Crises Consortium, Save the Children, the United Nations Population Fund (UNFPA), the Women's Refugee Commission, the World Health Organization (WHO) and World Vision. The snowballing process was carried out using the reference list of included studies and the organizations known for humanitarian emergencies. We also searched the references and authors of all included studies.

Inclusion and exclusion criteria

Studies were included if they reported the development or use of data collection tools concerning the health of women and children in a humanitarian emergency. We included studies, even when tools for data collection were not specified or the method was not described (Fig. 1).

Two authors independently searched databases and websites. The titles and abstracts of identified studies were screened and excluded if not meeting the inclusion criteria. Full texts of remaining studies were assessed for eligibility. When it was not clear if a study should be included or not, two reviewers discussed the study and if consensus was not reached, a third reviewer was consulted. The reviewers summarized information on tools used, type of data collected and the purpose of the study. Data were classified into four categories, based upon the continuum of care: (i) sexual and reproductive health including sexual/gender-based violence and family planning; (ii) maternal and neonatal health; (iii) infant and child health; and (iv) sexually transmitted infections, including HIV/AIDS.

Studies that met the inclusion criteria were summarized using textual narrative synthesis. ⁽¹⁰10 Lucas PJ, Baird J, Arai L, Law C, Roberts HM. Worked examples of alternative methods for the synthesis of qualitative and quantitative research in systematic reviews. BMC Med Res Methodol. 2007;7(1): 4.http://dx.doi.org/10.1186/1471-2288-7-4PMID 17224044
http://dx.doi.org/10.1186/1471-2288-7-4... First, we developed a commentary report on the type and characteristics of the included studies, context and findings using a standard matrix. The reviewers then looked for similarities and differences among studies to discuss and draw conclusion across the studies.

Results

We identified 2227 studies: 2109 publications from databases and 118 studies from websites. After removal of duplicates, the titles and abstract of 1593 studies were screened and of these, 225 studies were identified as eligible for full text review. Of these, 112 were not specific to humanitarian or emergency settings and 13 were not relevant (Fig. 1).

Of the 100 studies identified, 69 studies described the number of people affected. The population consisted of 677 568 individuals; 65 971 were identified as women and 57 427 children; 37 660 (57%) of children were younger than five years (Table 1, available at:http://www.who.int/bulletin/volumes/93/9/14-148429).

Studies ranged in sample size from seven (in case studies of survivors of sexual violence) ⁽⁶³63 Longombe AO, Claude KM, Ruminjo J. Fistula and traumatic genital injury from sexual violence in a conflict setting in Eastern Congo: case studies.. Reprod Health Matters 2008 May;16(31): 132-41.http://dx.doi.org/10.1016/S0968-8080(08)31350-0PMID 18513615
http://dx.doi.org/10.1016/S0968-8080(08)... to 179 172 (in a rapid assessment of micronutrient deficiency following drought). ⁽⁷¹71 Nichols EK, Talley LE, Birungi N, McClelland A, Madraa E, Chandia AB, et al. Suspected outbreak of riboflavin deficiency among populations reliant on food assistance: a case study of drought-stricken Karamoja, Uganda, 2009-2010.. PLoS ONE 2013;8(5): e62976.http://dx.doi.org/10.1371/journal.pone.0062976PMID 23658790
http://dx.doi.org/10.1371/journal.pone.0... Eighty studies reported on conflict situations, while 20 studies reported on situations following a natural disaster (tsunami, hurricane or drought). Nineteen studies reported on the timing of data collection: three studies collected data within one week, ⁽⁷⁰70 Murray KO, Kilborn C, DesVignes-Kendrick M, Koers E, Page V, Selwyn BJ, et al. Emerging disease syndromic surveillance for Hurricane Katrina evacuees seeking shelter in Houston's Astrodome and Reliant Park Complex. Public HealthRep. 2009 May-Jun;124(3): 364-71. PMID 19445411^{), (72}72 Noe RS, Schnall AH, Wolkin AF, Podgornik MN, Wood AD, Spears J, et al. Disaster-related injuries and illnesses treated by American Red Cross disaster health services during Hurricanes Gustav and Ike. South Med J. 2013 Jan;106(1): 102-8.http://dx.doi.org/10.1097/SMJ.0b013e31827c9e1fPMID 23263323
http://dx.doi.org/10.1097/SMJ.0b013e3182... ^{), (79}79 Rodriguez SR, Tocco JS, Mallonee S, Smithee L, Cathey T, Bradley K. Rapid needs assessment of Hurricane Katrina evacuees-Oklahoma, September 2005.. Prehosp Disaster Med 2006 Nov-Dec;21(6): 390-5. PMID 17334185five within three months, ⁽⁷7 Jayatissa R, Bekele A, Piyasena CL, Mahamithawa S. Assessment of nutritional status of children under five years of age, pregnant women, and lactating women living in relief camps after the tsunami in Sri Lanka. Food Nutr Bull. 2006 Jun;27(2):144-52. PMID 16786980^{), (19}19 Arquès I, Vincent M, Olive C, Cabié A, Canivet I, Hochedez P. Clinical and microbiologic characteristics of children treated at the Fort de France university hospital after the 2010 Haiti earthquake. Pediatr Infect Dis J. 2013 May;32(5): 568-9.http://dx.doi.org/10.1097/INF.0b013e3182863c53PMID 23340552
http://dx.doi.org/10.1097/INF.0b013e3182... ^{), (49}49 Hapsari ED, Widyawati , Nisman WA, Lusmilasari L, Siswishanto R, Matsuo H. Change in contraceptive methods following the Yogyakarta earthquake and its association with the prevalence of unplanned pregnancy. Contraception. 2009 Apr;79(4): 316-22.http://dx.doi.org/10.1016/j.contraception.2008.10.015PMID 19272502
http://dx.doi.org/10.1016/j.contraceptio... ^{), (51}51 Hossain SM, Maggio DM, Sullivan KM. Relationship between food aid and acute malnutrition following an earthquake.. Food Nutr Bull 2009 Dec;30(4): 336-9. PMID 20496623^{), (52}52 Hudson L. Picking up the pieces: women's health needs assessment, Fond Parisien Region, Haiti. Boston (MA): Harvard Humanitarian Initiative; 2010. Available from:Available from:http://hhi.harvard.edu/publications/picking-pieces-womens-health-needs-assessment-fond-parisien-haiti [cited 2015 July 13].
http://hhi.harvard.edu/publications/pick... and 11 studies collected data six months to one year after the onset of the humanitarian emergency. ⁽²¹21 Ayoya MA, Golden K, Ngnie-Teta I, Moreaux MD, Mamadoultaibou A, Koo L, et al. Protecting and improving breastfeeding practices during a major emergency: lessons learnt from the baby tents in Haiti. Bull World Health Organ. 2013 Aug 1;91(8): 612-7.http://dx.doi.org/10.2471/BLT.12.113936PMID 23940409
http://dx.doi.org/10.2471/BLT.12.113936... ^{), (36}36 Nutritional assessment of children after severe winter weather - Mongolia, June 2001. Atlanta (GA): Centres for Disease Control; 2001.^{), (38}38 Doocy S, Robinson C, Moodie C, Burnham G. Tsunami-related injury in Aceh Province, Indonesia. Glob. Public Health 2009;4(2): 205-14.http://dx.doi.org/10.1080/17441690802472612PMID 19333809
http://dx.doi.org/10.1080/17441690802472... ^{), (46}46 Gitau R, Makasa M, Kasonka L, Sinkala M, Chintu C, Tomkins A, et al. Maternal micronutrient status and decreased growth of Zambian infants born during and after the maize price increases resulting from the southern African drought of 2001-2002. Public HealthNutr. 2005 Oct;8(7): 837-43.http://dx.doi.org/10.1079/PHN2005746PMID 16277799
http://dx.doi.org/10.1079/PHN2005746... ^{), (55}55 JSI Research and Training Institute. The long wait. Reproductive health care in Haiti. Boston (MA): John Snow Inc; 2009.^{), (60}60 Krause S, Heller L, Tanabe M. Priority reproductive health activities in Haiti. An inter-agency MISP assessment conducted by CARE, International Planned Parenthood Federation, Save the Children and Women's Refugee Commission. New York: Women's Refugee Commission; 2011.^{), (3}3 Using data to improve humanitarian decision making. Geneva: United Nations Office for Coordination of Humanitarian Affairs (OCHA); 2013. Available from:Available from:http://reliefweb.int/report/world/overview-global-humanitarian-response-2014-enfrsp [cited 2014 May 14].
http://reliefweb.int/report/world/overvi... ^{), (76}76 Ravindranath M, Venkaiah K, Rao MV, Arlappa N, Reddy CG, Rao KM, et al. Effect of drought on nutritional status of rural community in Karnataka. J Hum Ecol. 2005;18(3): 245-52.^{), (81}81 Salama P, Assefa F, Talley L, Spiegel P, van Der Veen A, Gotway CA. Malnutrition, measles, mortality, and the humanitarian response during a famine in Ethiopia. JAMA. 2001 Aug 1;286(5): 563-71.http://dx.doi.org/10.1001/jama.286.5.563PMID 11476658
http://dx.doi.org/10.1001/jama.286.5.563... ^{), (86}86 Talley LE, Boyd E. Challenges to the programmatic implementation of ready to use infant formula in the post-earthquake response, Haiti, 2010: a program review.. PLoS ONE 2013;8(12): e84043.http://dx.doi.org/10.1371/journal.pone.0084043PMID 24391877
http://dx.doi.org/10.1371/journal.pone.0... ^{), (87}87 Tan CE, Li HJ, Zhang XG, Zhang H, Han PY, An Q, et al. The impact of the Wenchuan earthquake on birth outcomes.. PLoS ONE 2009;4(12): e8200.http://dx.doi.org/10.1371/journal.pone.0008200PMID 19997649
http://dx.doi.org/10.1371/journal.pone.0...

Data were collected from refugee populations in the recovery phase. Our review did not identify any studies that collected data during the disaster preparedness phase, which is defined by UNFPA as, "the period preceding a humanitarian crisis - use of early warning signals to avert crises or prepare response". ⁽¹¹¹111 Managing WHO humanitarian response in the field. Geneva: World Health Organization; 2008. Available from:Available from:http://www.who.int/hac/techguidance/tools/full_manual.pdf [cited 2015 July 13].
http://www.who.int/hac/techguidance/tool... Seventy-six studies examined the health status of the population affected, while 24 examined the availability and coverage of health services, usually measured using the minimum initial service package. ⁽⁶⁰60 Krause S, Heller L, Tanabe M. Priority reproductive health activities in Haiti. An inter-agency MISP assessment conducted by CARE, International Planned Parenthood Federation, Save the Children and Women's Refugee Commission. New York: Women's Refugee Commission; 2011.A variety of indicators were collected with some studies using specific toolkits for field settings (Table 2).

Data were collected for monitoring and evaluation purposes in 69 studies. In 18 studies, data were collected for the purpose of advocacy; seven studies were operational research and six studies described a needs assessment. No studies that we identified had the primary aim of collecting data to support a funding request.

Data collection tools

We identified a total of 17 different tools which were mainly structured questionnaires (Table 3).

Among 100 included studies, 19 specified the use of any of the 17 identified tools. Eight studies used a rapid assessment field tool; ⁽⁵⁵55 JSI Research and Training Institute. The long wait. Reproductive health care in Haiti. Boston (MA): John Snow Inc; 2009.^{), (59}59 Krause S, Morris C, McGinn T. Displaced and desperate: assessment of reproductive health for Colombia's internally displaced persons. New York: Women's Commission for Refugee Women and Children, Reproductive Health for Refugees Consortium; 2003.^{), (60}60 Krause S, Heller L, Tanabe M. Priority reproductive health activities in Haiti. An inter-agency MISP assessment conducted by CARE, International Planned Parenthood Federation, Save the Children and Women's Refugee Commission. New York: Women's Refugee Commission; 2011.^{), (85}85 Sullivan TM, Sophia N, Maung C. Using evidence to improve reproductive health quality along the Thailand-Burma border.. Disasters 2004 Sep;28(3): 255-68.http://dx.doi.org/10.1111/j.0361-3666.2004.00257.xPMID 15344940
http://dx.doi.org/10.1111/j.0361-3666.20... ^{), (104}104 Assessment of reproductive health for refugees in Zambia. New York: Women's Commission for Refugee Women and Children, on behalf of the Reproductive Health for Refugees Consortium; 2002.

105 Still in need: reproductive health care for Afghan refugees in Pakistan. New York: Women's Commission for Refugee Women and Children; 2003.^-106106 Lifesaving reproductive health care, ignored and neglected: assessment of the Minimum Initial Service Package (MISP) of reproductive health for Sudanese refugees in Chad. New York: Women's Commission for Refugee, Women and Children; 2004.^{), (109}109 Reproductive health coordination gap, services ad hoc: MISP assessment in Kenya - September 2008.; New York: Women's Commission for Refugee Women and Children 2008.seven used the assessment toolkit for conflict affected women³⁵35 Casey SE, McNab SE, Tanton C, Odong J, Testa AC, Lee-Jones L. Availability of long-acting and permanent family-planning methods leads to increase in use in conflict-affected northern Uganda: evidence from cross-sectional baseline and endline cluster surveys. Glob. Public Health 2013;8(3): 284-97.http://dx.doi.org/10.1080/17441692.2012.758302PMID 23305269
http://dx.doi.org/10.1080/17441692.2012.... ^{), (90}90 Tomczyk B, Goldberg H, Blanton C, Gakuba R, Saydee G, Warwah P, et al. Women's reproductive health in Liberia: the Lofa County reproductive health survey. Atlanta: CDC; 2007.^{), (93}93 Baseline study: documenting knowledge, attitudes and behaviours of Somali refugees and the status of family planning services in UNHCR's operation in Nairobi, Kenya - August 2011. New York: Women's Commission for Refugee Women and Children; 2011.^{), (94}94 Baseline study: documenting knowledge, attitudes and behaviours of Somali refugees and the status of family planning services in UNHCR's operation in Amman, Jordan - August 2011.; New York: Women's Commission for Refugee Women and Children 2011.

95 Baseline study: documenting knowledge, attitudes and behaviours of Somali refugees and the status of family planning services in UNHCR's Ali Addeh site, Djibouti - August 2011.; New York: Women's Commission for Refugee Women and Children 2011.

96 Baseline study: documenting knowledge, attitudes and behaviours of Somali refugees and the status of family planning services in UNHCR's operations in Nakivale refugee settlement, Uganda - August 2011.; New York: Women's Commission for Refugee Women and Children 2011.^-9797 Baseline study: documenting knowledge, attitudes and behaviours of Somali refugees and the status of family planning services in UNHCR's Operations in Kuala Lumpur, Malaysia - August 2011.; New York: Women's Commission for Refugee Women and Children 2011.and three used the emergency obstetric care assessment toolkit from the averting maternal disability and deaths programme. ⁽³⁴34 Casey SE, Mitchell KT, Amisi IM, Haliza MM, Aveledi B, Kalenga P, et al. Use of facility assessment data to improve reproductive health service delivery in the Democratic Republic of the Congo. Confl Health. 2009;3(1): 12.http://dx.doi.org/10.1186/1752-1505-3-12PMID 20025757
http://dx.doi.org/10.1186/1752-1505-3-12... ^{), (77}77 Emergency obstetric care: critical need among populations affected by conflict. New York: Reproductive Health Response in Conflict Consortium; 2004. Available from:Available from:http://reliefweb.int/sites/reliefweb.int/files/resources/BC6A813B05F7F888C1256FF000434314-RHRC_mar_2004.pdf [cited 2015 July 13].
http://reliefweb.int/sites/reliefweb.int... ^{), (78}78 Emergency obstetric care project impact report: reproductive health response in conflict consortium - April 2006.; New York: Reproductive Health Response in Conflict Consortium 2004.The alcohol use disorders identification test; ⁽¹¹²112 Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT, the alcohol use disorders identification test: guidelines for use in primary health care. 2nd ed.; Geneva: World Health Organization 2002.the compendium for measuring intimate partner violence victimization and perpetration¹²²122 Thompson MP, Basile KC, Hertz MF, Sitterle DB. Measuring intimate partner violence victimization and perpetration: a compendium of assessment tools. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Violence Prevention; 2006.and Twine (a web-based toolkit developed by the Office of the United Nations High Commissioner for Refugees) ⁽⁴4 Overview of global humanitarian response. Geneva: the Office of the United Nations High Commissioner for Refugees (UNHCR); 2014. Available from:Available from:http://twine.unhcr.org/app/ [cited 2015 May 14].
http://twine.unhcr.org/app/... were used in one study each. The remaining 79 studies did not specify which tools had been used to collect the data.

Of the 17 toolkits identified (Table 3), 14 could be used to collect data on sexual and reproductive health, eight on maternal and newborn health, four on child health and seven on sexually transmitted infections and HIV. Some of the tools were designed to collect more than one category of data (e.g. Twine). Of the 14 tools used for data collection on sexual and reproductive health, four were specifically designed for gender-based violence. A further 13 studies also collected data on gender-based violence, but no data collection tool was identified.

Similarly, there was no specific tool to collect child health data, but four toolkits had questionnaires that included the collection of some data on child health data. Twine contains a specific section for child health data collection, including nutrition.⁴ Refugee health: an approach to emergency situations¹¹³113 Médecins Sans Frontières. Refugee health: an approach to emergency situations. London: Macmillan; 1997.is designed to collect data on children for diseases under surveillance, nutritional status and common communicable diseases. The Sphere handbook¹²⁸128 Humanitarian charter and minimum standards in humanitarian response. Rugby: The Sphere Project; 2011.has rapid assessment tools to collect health service assessment data as well as sample surveillance reporting forms. These can be used to collect information on children younger than five years and provide outbreak alerts for this age group. These tools incorporate early warning and response network surveillance for early detection of epidemic-prone diseases in emergency settings. We did not identify specific tools for sexually transmitted infections and HIV, but relevant data are collected as part of seven of the more general sexual and reproductive health toolkits. ⁽¹³⁰130 United Nations Population Fund (UNFPA). Guidelines on data issues in humanitarian crisis situations. 2010. Available from:Available from:http://www.unfpa.org/publications/guidelines-data-issues-humanitarian-crisis-situations [cited 2013 Sept 11].
http://www.unfpa.org/publications/guidel...

Discussion

Our review provides an overview of the data collection tools available as well as the published experience of the use of these tools. We advocate the use and harmonization of existing tools rather than the development of new tools. As we could not identify any studies reporting on data collection for disaster preparedness or disaster response, there is a need to adapt existing tools or develop new tools to facilitate data collection specifically for these phases. We excluded tools used primarily in non-humanitarian settings and may not have captured all available tools or data collected in humanitarian emergency settings.

Most of the tools specify which methods are needed to collect the required data, including both quantitative and qualitative methods in specific contexts. The methods used depend upon the purpose of data collection, the available resources and the nature of the information sought. Table 4 summarizes commonly reported methods to collect data during an emergency.

Of the 100 studies included in this review, only 19 described the data collection tools used and only six commented on their applicability in field settings. Authors may not be aware of the existence of a wide range of toolkits, or the importance of documenting their experiences.

To improve the response to humanitarian emergencies, target groups need to be identified and their specific needs understood. For sexual, reproductive, maternal, newborn and child health the underlying contexts which prevent or enable access to services also need to be considered. ⁽¹³⁰130 United Nations Population Fund (UNFPA). Guidelines on data issues in humanitarian crisis situations. 2010. Available from:Available from:http://www.unfpa.org/publications/guidelines-data-issues-humanitarian-crisis-situations [cited 2013 Sept 11].
http://www.unfpa.org/publications/guidel... The international humanitarian community continues to highlight the importance of documenting and addressing the problem of sexual and gender-based violence. ⁽³⁷37 D'Errico NC, Kalala T, Nzigire LB , Maisha F, Malemo Kalisya L . 'You say rape, I say hospitals. But whose voice is louder?' Health, aid and decision-making in the Democratic Republic of Congo. Rev Afr Polit Econ. 2013;40(135): 51-66.http://dx.doi.org/10.1080/03056244.2012.761962
http://dx.doi.org/10.1080/03056244.2012.... A central repository of data collected during a humanitarian emergency, where a core set of indicators is agreed on, would be useful. The repository would allow any user to submit or explore data to inform decision-making and enable comparisons between and across settings.

Only eight studies were conducted within the first six months of a humanitarian emergency. The majority of studies (69/100) and data collected were used to monitor and evaluate ongoing interventions. This may reflect the necessity of providing immediate life saving measures during the early stages of humanitarian emergencies. Rapid assessments are vital in the early stages of humanitarian emergencies. Information is required to highlight changing needs to inform appropriate provision of relief and urgent medical assistance. Most importantly, rapid assessment tools need to be simple to use. ⁽¹³¹131 Malilay J, Flanders WD, Brogan D. A modified cluster-sampling method for post-disaster rapid assessment of needs.. Bull World Health Organ 1996;74(4): 399-405. PMID 8823962

It is encouraging to note that the tools developed so far seem to have used a cluster approach for data collection. Introduced in 2006 as part of the UN Humanitarian Response, a cluster is defined as:

"a group of agencies that gather to work together towards common objectives within a particular set of emergency response". ⁽¹³²132 Humanitarian health action: the cluster approach.; Geneva: World Health Organization 2015. Available from:Available from:http://www.who.int/hac/techguidance/tools/manuals/who_field_handbook/annex_7/en/ [cited 2015 May 14].
http://www.who.int/hac/techguidance/tool...

The approach aims to improve the effectiveness of humanitarian assistance by improving predictability and timeliness of a response process through a coordinated effort. ⁽¹¹¹111 Managing WHO humanitarian response in the field. Geneva: World Health Organization; 2008. Available from:Available from:http://www.who.int/hac/techguidance/tools/full_manual.pdf [cited 2015 July 13].
http://www.who.int/hac/techguidance/tool... The cluster approach can strengthen accountability among key actors and enhance the complementary nature of different organizations involved in providing humanitarian assistance. Although the health and nutrition clusters are critical for maternal, newborn and child health, the available tools consider other clusters as cross-cutting areas including protection, water and sanitation, camp coordination and management. ⁽¹³²132 Humanitarian health action: the cluster approach.; Geneva: World Health Organization 2015. Available from:Available from:http://www.who.int/hac/techguidance/tools/manuals/who_field_handbook/annex_7/en/ [cited 2015 May 14].
http://www.who.int/hac/techguidance/tool...

Conclusion

There is a need to evaluate, standardize and harmonize existing data collection toolkits and to develop others that can be used in the response phase of humanitarian emergencies. Information is needed on the applicability of existing tools in relation to the types of populations and the emergency situations in which they are used. It would be useful to develop shortened versions of existing tools adapted specifically to use in the response phase, together with a more comprehensive version for the later phases of an emergency. Humanitarian assistance reports should include analyses of the lessons learnt when using data collection toolkits. This information can assist modification of existing tools and development of new tools. Whenever new toolkits are developed by interagency working groups, it is important to take the perspectives of field users into account. Wider dissemination of the availability of data collection tools among humanitarian workers can be achieved by educating staff at headquarters and country offices of humanitarian organizations, or by including the toolkits in disaster risk reduction training.

To plan and evaluate interventions and actions that will save lives in humanitarian emergencies, appropriate data are needed. To ensure that tools used to obtain such data are easy to use and comprehensive, it is essential that both individuals involved in field operations and in operations research continue to work together. New standardized tools should be developed and existing ones adapted based upon standards for data collection in emergencies with inputs from humanitarian agencies. ⁽¹¹¹111 Managing WHO humanitarian response in the field. Geneva: World Health Organization; 2008. Available from:Available from:http://www.who.int/hac/techguidance/tools/full_manual.pdf [cited 2015 July 13].
http://www.who.int/hac/techguidance/tool... This work could be coordinated by WHO.

Funding:

This work was funded by the World Health Organization, reference number 200833146

References

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