RAPID HEALTH ASSESSMENT PROTOCOLS FOR EMERGENCIES
( By WHO - OMS, 1999 )

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Annex 2 - List of reference values for rapid health assessment in developing countries

1. General




























Cut-off values for emergency warning


More than


Health status



daily crude death rate


1/10 000 population


daily under-5 death rate


2/10 000 children under 5


Nutrition status



acute malnutrition (weight-for-height <- 2Z scores) in under-5s


10% of children under 5


growth faltering rate in under-5s


30% of monitored children


low weight at birth (less than 2.5 kg)


7% of live births























Standard structure of population


Average in the population


0-1 year


4%


0-5 years


18%


fertile women


24%


pregnant women


5%


expected births


4.4 per 100 population per year


2. Vital needs




















Water


Indicator


Average requirement


quantity


no. of litres/person/day


20 litres/person/day


quality


no. of users/water point


200 people/water point


(1 cubic metre = 1 tonne = 1 000 litres)



(not more than 100 metres from housing)































Food


kcal (MJ) content


Radon, kg/person/month


cereals


350 (1.46)/100g


10.5


pulses


335 (1.40)/100g


1.8


oil


860 (3.59)/100g


1.2


sugar


400 (1.67)/100g


1.2


kcal value of recommended ration, person/day:


2100 kcal (8.79 MJ)


Total kg/person/month for feeding


14.7 kg


Sanitation

Latrine: ideally one per family; minimum, one seat per 20 people (6-50 m from housing)
Refuse disposal: one communal pit (2m 5m 2m) per 500 people













Household fuel


Average need


Firewood


15 kg/household/day


Note: with one economic stove per family, the needs may be reduced:


5 kg/stove/day














Space for accommodation



Individual requirements (shelter only)


4 m2/person


Collective requirements, including shelter, sanitation, services, community activities, warehousing and access


30 m2/person


3. Health needs and care
















Prevalent health hazards


Expected attack rate in emergency situations


Acute respiratory infections in children under 5


10%/month in cold weather


Diarrhoeal diseases in children under 5 (other than dysentery and cholera)


50%/month


Malaria, in total non-immune population


50%/month

















































Essential primary health care activities


Target


Optimal coverage of target


under-5 clinic and growth monitoring


all children of 0-59 months


100% of under-5s per month


antenatal clinic


all pregnancies


50% of pregnancies per month


tetanus toxoid


all pregnancies


30% of pregnancies per month


assisted deliveries


all deliveries


1/12 of total annual deliveries per month


BCG


all new births


1/12 of total annual births per month


DTP1-TT1


all children 0-1 year


1/12 of total group per month


DTP2-TT2


all children 0-1 year


1/12 of total group per month


DTP3


all children 0-1 year


1/12 of total group per month


Measles


all children 9-12 months


1/12 of total group per month


STD/HIV prevention (by condoms)


all sexually active males


12 condoms per man per month



































Health personnel requirements


Output of one person/hour of work


Activity



vaccination


30 vaccinations


under-5 clinic and growth monitoring


10 children


antenatal clinic


6 women


assisted delivery


1 delivery


outpatient department consultation


6 consultations


outpatient department treatment (dressings, etc.)


6 treatments


Note: one person/day = 7 hours of field work



Health workers emergency requirements (e.g. refugee camp) for vaccinations, growth monitoring, antenatal clinic, assisted delivery, outpatient department consultations and treatments, registry and clerical duties


60 staff 10 000 population




















































Health supplies requirements


Needed


Essential drugs and medical equipment



The WHO emergency health kit


1 kit for 10 000 population/3 months


Nutritional rehabilitation


Needs of each under-5 patient


oil


90g/day


milk


120g/day


sugar


70g/day


Safe drinking-water


amount


a) to prepare 1 litre of stock solution 1%:


use 1 litre of water, plus:



15g calcium hypochlorite 70%



or 33 g bleaching powdera 30%



or 250 ml sodium hypochlorite 5%



or 110 ml sodium hypochlorite 10%


b) to disinfect drinking-water with the stock solution:


use 0.6 ml or three drops of solution per litre of water;



use 60 ml of solution per 100 litres of water.


(Note: allow the chlorinated water to stand at least 30 minutes before using)



a Chlorinated lime or bleaching powder is a white powder which is a mixture of calcium hydroxide, calcium chloride and calcium hypochlorite. It typically contains 20-35% available chlorine.

4. Needs for epidemic response



















Cholera



Likely maximum attack rate


6% over 4 months


100% cases needing ORS


6.5 packets/patient


20% cases needing IV fluids


3 litres/patient


20% cases needing antibiotics: doxycycline 300 mg, 1 dose


1 tab per course














Meningococcal meningitis



100% cases treated with oily suspension chloramphenicol


6 amps per course


100% population to be vaccinated


1 dose/person






















Measles



Likely maximum attack rate in non-immunized under-12s


10%


100% non-immunized under-12s to be vaccinated


1 dose/child


100% under-12s to be given vitamin A


children 6 months to 1 year


100 000 IU/child



children 1 year and over


200 000 IU/child





















Typhus




100% population to be deloused




Individual spraying with permethrin 1%


adult


30g



infant and child


15g


5. Essentials of logistics






































































Weights and volumes




Food per week


individual ration per month


14.7 kg



amount per 10 000 people


36.8 tonnes


(1 tonne of food grains/beans in standard 50kg bags occupies 2m3)


Drugs and supplies:


1 WHO emergency health kit


860 kg, 4m3


Vaccines:


1000 doses of measles


3 litres



1000 doses of DTP


2.5 litres



1000 doses of BCG


1 litre



1000 doses of polio


1.5 litres



1000 doses of tetanus


2.5 litres


Food for therapeutic feeding:


standard under-5 patient ration


2 kg/week


Family-size tents:


35-60 kg unit


1 tonne, 4.5m3


Blankets


compressed


1 tonne, 4.5m3



loose


1 tonne, 9m3


Warehouse requirements


approximately 25m2 for 1000 population



1.2 m2 for 1 tonne of bagged food grains stacked 6m high


Average truck capacity


50 tonnes


Small aircraft capacity


3 tonnes



Sources: WHO/EHA, UNHCR Emergency Tools Series, draft 1992; UNICEF Assisting in Emergencies, 1986
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