Now showing items 1-20 of 77

    • Health Seeking Behaviour in Kamrangirchar

      Jeroen van der Heijden; OCA (2018-09-28)
    • Retrospective mortality survey in the MSF catchment area in Fizi health zone, South Kivu, Democratic Republic of Congo

      Lenglet, Annick; Bil, Karla; Mandelkow, Jantina; MSF-OCA (2018-07-31)
      . OBJECTIVES 2.1. PRIMARY OBJECTIVES To estimate the crude mortality rate for the total population (host and IDP) and for children under five years of age in the health zone of Fizi, South Kivu, DRC, in order to understand the current health status of the population in this catchment area. 2.2. SECONDARY OBJECTIVES  To determine the prevalence of self-reported morbidities in the two weeks preceding the survey in household members;  To determine the frequency and reasons for displacement;  To assess access to health care;  To determine the main causes of deaths during the recall period;  To measure the incidence and types of direct violence experienced by the civilian population;  To evaluate household ownership of basic non-food items;
    • The Impact of a Tick-Sheet in Improving Interpretation Accuracy of Chest Radiographs by Non-Specialists in an HIV positive cohort

      Kosack, Cara; Mesic, Anita; Spijker, Saskia; Bonnet, Maryline; Joekes, Elizabeth; MSF-OCA (2018-07)
      Study objective 3.1 Primary objective To determine if the application of a tick-sheet after four hour training on its use and on CXR interpretation, improves the interpretation accuracy of CXRs for active TB, by nonspecialists, in an HIV-positive cohort. 3.2 Secondary objective To determine whether the application of a tick-sheet reduces the inter-reader variability of CXR interpretation in a group of non-specialists by comparing the inter-reader agreement before and after intervention.
    • Multi-site evaluation of HIV testing algorithms

      Kosack, Cara; Page, Anne-Laure; Shanks, Leslie; Chaillet, Pascale; Beelaert, Greet; Fransen, Katrien; Benson, Tumwesigye T.; Savane, Aboubacar; Nganga, Anne; MSF-OCA (2018-07)
      Objectives 3.1 Primary objective  To evaluate the overall and site-specific performance of the diagnostic algorithm performed at 6 MSF African program sites (i.e. using RDT results from the program sites) comparing using the diagnostic algorithm with ELISA, LIA, EIA-Ag and DNA-PCR as gold standard. 3.2 Secondary objectives  To evaluate the accuracy (sensitivity, specificity and predictive values) of Orgenics ImmunoComb® II HIV 1&2 Combfirm as an HIV confirmatory test.  To model different HIV RDT testing algorithms in order to define acceptable testing algorithm in each study setting (i.e. using RDT results from reference laboratory).  To determine the inter-user reliability of RDT testing (i.e. program sites vs. reference laboratory)  To evaluate accuracy of each HIV RDT measured by the sensitivity (SN), specificity (SP) and predictive values based on the prevalence of each testing centre.  To evaluate the accuracy of HIV testing using DPS samples for quality control purpose in HIV testing.  To assess whether additional confirmatory testing (i.e. Orgenics ImmunoComb® II HIV 1&2 Combfirm) improves the accuracy of the diagnostic algorithm used at the different study sites.  To perform a descriptive analysis on the differentiation between HIV 1 and 2 of the discriminative RDTs.
    • Predicting Visceral Leishmaniasis in HIV Infected Patients (PreLeisH)

      Griensven, JV; Diro, Ermias; MSF-OCA (2018-07)
      Aim To study the asymptomatic period preceding the onset of active VL in HIV‐infected individuals from VL endemic regions in Ethiopia as an avenue to develop an evidence‐based screen and treat strategy to prevent progression to active VL.Primary: 1. To estimate the prevalence of asymptomatic Leishmania infection . 2. To estimate the incidence rate of asymptomatic Leishmania infection. 3. To describe the evolution of Leishmania infection markers over time. 4. To estimate the incidence rate of active VL. 5. To identify risk factors associated with the development of active VL. 6. To translate these risk factors into a clinical prognostic tool to identify individuals at high risk to develop active VL within 12 months . Secondary: 1. To identify patterns in host immune markers that are associated with asymptomatic Leishmania infection. 2. To describe the evolution of host immune markers over time. 3. To identify patterns in host immune markers that are associated with treatment failure. 4. To identify patterns in host immune markers that are associated with VL relapse.
    • Review of MSF-OCA surveillance and alert response in Freetown during the Ebola outbreak: lessons learned and challenges

      West, Kim; Greig, Jane; Lokuge, Kamalini; Caleo, Grazia; Stringer, Beverley; Korr, Gerit Solveig; MSF-OCA (2018-07)
      Aim: To reduce suffering, morbidity and mortality by containing and reducing the spread of Ebola Virus Disease (EVD), while preserving human dignity for the affected population in Sierra Leone. Purpose: To reduce and ultimately eliminate the transmission of EVD in a defined catchment population in Freetown. Objectives: • Provide epidemiological technical support to intensify surveillance, supervision of the alert response and enhanced case investigation in the defined area. • Assess and respond to current gaps in infection prevention and control, water and sanitation, and triage in health facilities within the defined area. • Assess community social mobilisation, health promotion, contact tracing and quarantine interventions in the defined area and respond to any gaps through advocacy towards the relevant pillar/organization and/or through direct MSF intervention. • Prioritise MSF and health staff safety & biosecurity at all times • Medical (non-Ebola) and humanitarian needs of the population are monitored, recorded, analysed and responded to through advocacy or MSF action.
    • A randomized trial of AmBisome monotherapy and combination of AmBisome and miltefosine for the treatment of VL in HIV positive patients in Ethiopia followed by secondary VL prophylactic treatment with pentamidine

      Hailu, Asrat; Diro, Ermias; Kolja, Stille; Ritmeijer, Koert; Yifru, Sisay; Griensven, Johan van; Zijstra, Ed; Dorlo, Thomas; Strub-Wougaft, Nathalie; Bardonneau, Clelia; Ellis, Sally; Alexander, Neal; Edwards, Tansy; MSF-OCA (2018-07)
      General Objectives The overall objective of this trial is to identify a safe and effective treatment for VL in HIV coinfected patients. Primary Objective: To evaluate at day 29 assessment the efficacy of a combination regimen of AmBisome® + miltefosine and AmBisome® monotherapy in Ethiopian co-infected HIV + VL patients. Secondary Objectives: 1. To evaluate relapse-free survival at day 390 (after initial cure at day 29 or cure at day 58 after extended treatment). 2. To assess safety of the regimens. Other objectives: 1.To evaluate of viral load and CD4 count in all patients 2. To evaluate the pharmacokinetics of ARV, Ambisome and miltefosine and immune function markers in a subset of patients
    • Evaluating the effectiveness and burden of diabetes care in a complex humanitarian emergency setting in Mweso, North Kivu, Democratic Republic of the Congo (DRC), 2015

      Caleo, Grazia; Ngadjo, Cyril; Roberts, Bayard; Kitembo, Augustin Wika; Jobanputra, Kiran; Perel, Pablo; de la Croix, Jean; Sadique, Zia; de Wit, Marit; MSF-OCA (2018-07)
      Executive summary Background: Since 2008 Médecins Sans Frontières-Operational Centre Amsterdam (MSF-OCA) has been working in Mweso health zone, North Kivu, Democratic Republic of the Congo (DRC). In collaboration with the local Ministry of Health (MoH), MSF-OCA supports the Hospital in Mweso and 4 out of 23 Primary Health Care clinics. Mweso Hospital routinely treats diabetic patients presenting with acute complications and in need of treatment (insulin and/or oral treatment). Since 2011, this has been extended to the out-patient clinic, but without clinical guidance or standard operating procedures (SOP), nor specifically trained staff. The Mweso project reports increasing numbers of patients with diabetes and diabetes-related complications, and requested from MSF-OCA to implement a formal diabetes service to improve quality of care for Diabetics. Rationale: A new model of diabetes care was implemented by MSF-OCA in Mweso in March 2015. The model (Integrated Diabetic Clinic within an Outpatient Department (IDC-OPD)) is based on simplified context-adapted clinical guidelines, clinical SOPs, adapted patient counselling & support materials, medications from World Health Organization(WHO) Essential Medicines list, and one-off staff training by a Diabetologist. This represents an opportunity to evaluate and refine this model of diabetes care to support its application in comparable settings. Furthermore there is an opportunity to benchmark diabetes burden in the MSF Catchment area and measure its diabetes care coverage in the area. Overall aim: To evaluate IDC-OPD in Mweso health zone, North Kivu, DRC. The specific objectives are to examine: • The reach (coverage) of the diabetes service to the intended target population. • The effectiveness of IDC-OPD in improving diabetes outcomes (fasting blood glucose and complications) • Adoption / acceptance of IDC-OPD by staff and patients • Implementation of IDC-OPD in terms of consistency/fidelity, adaptation and costs • Maintenance of IDC-OPD in patients and programme over time.
    • A prospective, randomized, controlled trial of negative-pressure wound therapy use in conflict-related extremity wounds

      Alga, Andreas; Bashaireh, Khaldoon; Wong, Sidney; Lundgren, Kalle; von Schreeb, Johan; MSF-OCA (2018-07)
      Extremity wounds and fractures constitute the majority of conflict-related traumatic injuries, both for civilians (1) and combatants (2). Conflict-related injuries often result in soft and boney tissue being contaminated with foreign material, generally leading to secondary infection (3,4). Negative-pressure wound therapy (NPWT) is widely used in the treatment of wounds and is considered to promote wound healing and prevent infectious complications. The technique involves the application of a wound dressing through which a negative pressure is applied. Any wound and tissue fluid is drawn away from the area and collected into a canister. Due to a plastic film overlaying the wound the risk of wound contamination is reduced. NPWT is supported for use in a range of surgical applications, including after or in between debridements as a bridge to definite closure of soft tissue wounds (5). The technique has previously been used in the treatment of acute conflict-related wounds with satisfactory results (6–8). Cochrane reviews of NPWT for the treatment of chronic wounds (9) and surgical wounds (10) were inconclusive due to the lack of suitably powered, high-quality trials. A recent systematic review of randomized, controlled trials (RCTs) of NPWT for the treatment of acute and chronic wounds concluded there is a lack of evidence and that good RCTs are needed (11). For the use in limb trauma, NPWT is considered suitable for complex soft tissue injuries (12). NPWT appears to be an effective and safe adjunctive treatment of high-energy combat wounds but existing results are retrospective and lack follow-up (13). The support of RCTs is needed to establish best treatment strategies. Summary of potential risks and benefits Both treatment methods (NPWT and conventional dressings) are well established and used in Jordan for the treatment of acute and chronic wounds. As neither of the two treatment modalities are known to be better in terms of outcome neither patient group may be regarded as receiving preferential treatment. NPWT is generally considered a safe treatment method. Potential benefits are shortened healing time and fewer infectious complications. Potential risks are pain, mainly associated with dressing changes (14) and bleeding, predominantly minor bleeding from granulation tissue (15). Conventional wound dressing has the potential benefit of being a safe treatment method used for many years. Since this method permits air into the wound there is a potential risk of contamination and the development of wound infection. Objectives We aim to evaluate the efficacy and safety of NPWT in the treatment of traumatic extremity wounds in a context associated with a high level of contamination and infection.
    • Field evaluation of the performance of HCV Serological Rapid Diagnostic Tests among HCV/HIV co-infected patients

      Gupta, Ekta; Carnimeo, Valentina; Samukcham, Inao; Loarec, Anne; Mahajan, Supriya; Choudhary, Manish; Bastard, Mathieu; Maman, David; Page, Anne Laure; MSF-OCA (2018-07)
      P R O T O C O L S U M M A R Y  Title: Field evaluation of the performance of HCV Serological Rapid Diagnostic Tests among HCV/HIV co-infected patients.  Aim: To evaluate the performance of serological HCV Rapid Diagnostic Tests (RDTs) to identify tests adapted to resource-limited settings, reliable for HIV-infected patients.  Study design: Prospective evaluation of the performance of serological RDTs for HCV screening.  Primary objective: o To evaluate the performance of serological HCV RDTs under field conditions using as reference standard a combination of enzyme immunoassay (EIA) and recombinant immunoblot assay (RIBA) for the detection of antibodies anti-HCV in HIV infected patients.  Secondary objectives: o To describe the accuracy (sensitivity, specificity) of the RDTs as screening tests o To describe the performance of the RDTs according to the HCV genotype and HCV VL o To describe the performance of the RDTs according to the CD4 counts and HIV VL o To describe the performance of the RDTs in presence of HBV co-infection (presence of antigen anti-HBs (HBsAg)) o To describe the operational characteristics of the tests including ease of use, technical complexity and inter-reader variability. o To evaluate predictive values of each HCV RDT based on the prevalence of the testing center.
    • Health and developmental outcomes of low-birth-weight infants born at the Centre de Référence d’Urgences Obstétricales (CRUO), Port-au-Prince, Haiti.

      Hillaire, Marjorie; Lenglet, Annick; Ariti, Cono; Ledger, Elizabeth; Reilly, Liam; Berthet, Marine; Faniyan, Olu; MSF-OCA (2018-07)
      Summary Title A prospective cohort study investigating health and developmental outcomes of low birth weight infants born at the Centre de Reference d’Urgences Obstretricales (CRUO), Port-au-Prince, Haiti. Primary objective: To describe and compare health and developmental outcomes between low birthweight (LBW) and normal weight infants up to 24 months post-partum, corrected for gestational age. Secondary objective To identify risk factors associated with negative health and developmental outcomes in LBW infants.
    • Knowledge, Attitudes and Practice (KAP) survey of Long-Lasting Insecticide-treated bedNets (LLITNs) in the refugee camps of Kule, Tierkidi and Nguenyyiel, in Gambela, Ethiopia, MSF-OCA catchment area.

      Doyle, Kate; Isidro Carrion Martin, Antonio; Piening, Turid; Ramirez, Angela; Fesselet, Jeff; Loonen, Jeanine; Rao, V Bhargavi; Brechard, Raphael; MSF-OCA (2018-07)
      Ethiopia is a land locked country in east Africa, known for its deep culture and history as well as its struggle with disease outbreaks, drought, malnutrition and major refugee inflex’s. According to UNDP Ethiopia is ranked at 174 in the human development index. Life expectancy at birth is 64.6 years, infant mortality rate is 41.4 (per 1,000 live births), under 5 mortality rate is 59.2 (per 1,000 live births) and deaths from Malaria are 106 (per 100, 000 people). Historically, Gambella region and Itang woreda area are places of ethnic tension between original Agnuak population, Nuers who have arrived in earlier refugee movements 20+ years back, and new Nuer refugees, and Highlanders. All incomers to the area are not refugees, and movement to/from both sides of the South Sudanese border is frequent. Tribal clashes and single incidents take place often; of late the bigger fighting has been less frequent. In Gambella region there are currently 6 camps and 5 reception centers. MSF activities are focused across 3 camps (Kule, Tierkidi and Nguenyyiel) and 1 reception center (Pamdong). While the current refuges crises has been present since early 2014, over the last 18 months more than 130,000 new arrivals have entered Ethiopia, leading to the creation of the latest camp, Nguenyyiel. As of 31st March 2018, official UNHCR data indicates a total South Sudanese population in the region to be 419,259, which now exceeds the local/host population. Key demographics include; 55% of population to be female; 64% to be under 18 years of age; 88% to be women and children. Within this total there are 3,076 unaccompanied minors (0.73%) and 23,238 are separated children (5.5%). It is assumed that also in 2018 the number of unregistered refugees will massively increase due to unwillingness for relocation to other regions creating the need for further extensions or new camps. As all people staying in Gambella camps are not registered with UNHCR, many who seek help with MSF are not officially entitled to it. ARRA health Centres in Tierkidi and Nguenyyiel refuse to treat those without ration card/registration. In case of need of further referral to Gambella hospital, MSF are forced to compromise with the treatment, as those patients are not granted a permit. Across the region, but specifically in the camps served by MSF, we see very high case load of malaria, with major spikes during the rainy season. In 2017, across Kule and Tierkidi camps, MSF treated more than 70,000 people for malaria. Prevention efforts in the camps have been very weak, with limited bed net distribution (last one in 2014) and poorly planned/executed IRS campaigns (Oct 2017—late rain season). MSF will now engage to take on a more active role in prevention and treatment mechanisms including mass bed net distribution, IRS campaigns, use of primaquine (decreased transmission); improved follow up of cases requiring re-treatment as well as participating in a study with the Ethiopian Public health institute looking into the presence of HRP2 gene deletion. PRIMARY OBJECTIVES  To estimate the Long-Lasting Insecticide-Treated bedNets (LLITN) coverage ratio for the total population in the MSF catchment area SECONDARY OBJECTIVES  To describe the population surveyed by sex and age  To measure the LLITN coverage ratio for children under five years of age and pregnant women  To estimate indoor residual spraying (IRS) coverage ratio for the total population in the MSF catchment area  To assess malaria knowledge, attitude and practices in the population including recognition of symptoms, and how to prevent malaria with special focus on LLITN.  To assess knowledge, attitude and practices about malaria treatment.
    • Effectiveness and safety of 20+ months treatment regimen for Multidrug Resistant Tuberculosis in Manzini Region, Swaziland

      Verdecchia, Maria; MSF-OCA (2018-07)
      Objectives Primary:  To describe outcomes of all patients started on the national MDR-TB treatment protocol in Matsapha & Mankayane by the MSF Manzini Project, Swaziland since its inception in 2011. Secondary:  To identify any difference in outcomes between HIV-co-infected and non-co-infected MDR-TB patients.  To identify risk factors associated with poor outcomes (loss to follow up, treatment failure and death).  To evaluate time to culture conversion.  To evaluate time to poor outcomes (loss to follow up, treatment failure and death).
    • Longitudinal cohort to evaluate Hepatitis C treatment effectiveness in HIV co-infected patients: Manipur, India

      Himanshu, M; Singh, Karam Romeo; Shougrakpam, Jeetesh; MSF-OCA (2018-07)
      4. OBJECTIVES Primary objective The primary objective of this study is to assess the effectiveness of HCV curative treatments in patients with chronic hepatitis C (CHC), co-infected with HIV in Manipur, India. Secondary objectives a. To describe the demographic, clinical and biological characteristics of patients with chronic hepatitis C and HIV co-infection b. To assess the effectiveness of HCV curative strategies in patients with chronic HCV, co-infected with HIV stratified by regimen and by site c. To identify risk factors associated with differing virological responses d. To assess the safety of HCV treatment e. To monitor the safety of HCV treatment in HIV co-infected patients f. To document the clinical and biological tolerance of the HCV treatment g. To assess the feasibility of HCV treatment h. To assess comparative performance of elastography (Fibroscan®) and APRI (AST to Platelet Ration Index), to evaluate liver fibrosis among HIV/HCV co-infected individuals i. To describe causes of non-eligibility for treatment j. To describe the clinical and biological evolution of co-infected patients, not eligible for HCV treatment k. To assess treatment adherence
    • Assessing the feasibility of preventing injury risks and improving work safety amongst factory workers in an urban slum: a participatory before-and-after intervention study

      Caleo, Grazia; Dada, Martins; Gray, Nell; Sangma, Mitchell; Scoizzato, Luca; Bangs, Gary W.; Stringer, Beverley; Islam, Zahirul; Baset, Kamrun Ul; MSF-OCA (2018-07)
      Specific Objectives: 1. Explain dynamics of injury risk over time by: 1.1. Describing the circumstances of incidents leading to an injury (injury risks or dynamics of incident) 1.2. Describing the circumstances of near-miss incident where no injury or illness occurs (incident risks) 1.3. Measuring frequency and severity of injuries (burden) 1.4. Describe perceptions of risks amongst owner/manager/workers 2. Design acceptable interventions to reduce injury risks 3. Document intervention feasibility by: 3.1. Describing acceptability, capturing adherence to interventions and changes in risk perceptions 3.2. Describing practicality: 3.2.1. Documenting operational challenges and lessons learned 3.2.2. Capturing resources (human resources, time, materials and cost) of implementation 4. Describe any changes in worker safety behaviour and incident incidence rate
    • Improving utilisation of services for sexual and gender-based violence (SGBV): knowledge, attitudes, practices and perceptions (KAP) in Jahangipuri, Delhi India protocol

      Himanshu, M; Sharmin, Sabrina; Renjhen, Prachi; Saheb, Baba; Gupta, Vinita; MSF-OCA (2018-07)
      2 Research question and objectives 2.1 Research question To identify factors that could improve SGBV service utilisation and acceptance amongst MSF’s catchment population in Delhi, India 2.2 Primary objective To understand how to improve utilization of SGBV services for the population in MSF catchment area Delhi, India 2.3 Specific objectives 1. To understand community knowledge related to SGBV, including its consequences, treatment and clinical services 2. To understand attitudes towards health aspects of SGBV 3. To explore practices related to SGBV care seeking pathways, including barriers and enablers affecting service access and uptake 4. To understand which strategies/activities people consider would be effective in improving access and uptake of clinical services by survivors of SGBV
    • Mental health literacy of internally displaced Iraqi young people and their parents in Iraq: paving the way for mental health education and promotion in vulnerable communities.

      Hitchman, Eleanor; Slewa-Younan, Shameran; Lunenborg, Norbert; Bil, Karla; Lenglet, Annick; Jorm, Anthony F.; MSF-OCA (2018-07)
      4. Objectives 4.1 Primary objectives To determine levels of MHL relating to trauma related mental health disorders, namely posttraumatic stress disorder (PTSD) and depression among the displaced Iraqi young people in northern Iraq (see study population). 4.2 Specific objectives 1. To estimate MHL relating to PTSD (and Depression) in a group of displaced Iraqi young people (13-17 years old) and the parents of children (8-12 years old) pertaining to: a. Problem recognition (including “self-recognition”) b. Beliefs about the severity of the problem described and its prevalence in the target population c. Beliefs about causes and risk factors d. Beliefs about how best to support someone with PTSD/depression e. Beliefs about the helpfulness of specific treatments and treatment providers f. Beliefs about likely outcome with and without treatment g. Beliefs about possible barriers to treatment h. Stigma and perceived discrimination towards someone with PTSD/depression 2. To determine associations between specific aspects of MHL as outlined above, and individuals’ demographic characteristics (age, gender, religion, ethnicity, lengthen of displacement etc.) and symptom levels. 3. To estimate the prevalence of mental health distress (major depression, anxiety disorders or suicidality ) using the Self Reporting Questionnaire (SRQ-20) in care takers of children 8-12 years old; 4. To estimate the prevalence of constructs of intrusion, avoidance and arousal in children 8-17 years of age in the study population; 5. To estimate the prevalence of self-reported depression in children 8-17 years old. The categories specified in objective 1 above were chosen because they were considered to be the aspects of MHL most likely to be of interest in informing the determinants of mental health in the proposed population. Objective 2 which seeks to examine the associations between specific aspects of MHL and individuals’ demographic characteristics and symptoms levels is important because associations of this kind can indicate specific targets for health promotion programs.
    • Vaccination coverage survey for diphtheria, Streptococcus pneumoniae, polio and tetanus in Rohingya refugee settlements in Ukhiya and Teknaf Upazilas, Cox’s Bazar, Bangladesh

      Pereboom, Monique; White, Kate; Van Leeuwen, Crystal; Siddiqui, Ruby; Guzek, John; Sangma, Mitchell; MSF-OCA (2018-07)
      OBJECTIVES PRIMARY OBJECTIVES a) To describe the vaccine coverage (penta / dT) in children aged 6 months to 14 years for diphtheria in the Rohingya Settlement Camps; SECONDARY OBJECTIVES To describe the vaccine coverage of pentavalent, bOPV and PCV vaccines in children aged 6 weeks to 6 years of age in the Rohingya Settlement Camps; To describe the vaccine coverage for diphtheria and tetanus vaccination among 7 - 14 year olds to assess vaccination rates in this age-group in the Rohingya Settlement Camps
    • Evaluating the input of the nurse to quality of medical/or healthcare in humanitarian settings

      Gilday, Josie; Chatler, Tracey; Treacy-Wong, Vicky; Stringer, Beverley; MSF-OCA (2018-07)
      Key objective • Develop a basic framework to evaluate quality nursing care in humanitarian settings.
    • Retrospective mortality and baseline health survey in Kutupalong and Balukhali settlement camps, Bangladesh

      Siddiqui, Ruby; White, Kate; Guzek, John; MSF-OCA (2018-07)
      2.1. PRIMARY OBJECTIVES To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age 2.2. SECONDARY OBJECTIVES  To describe the population in terms of age, sex and household composition;  To determine the coverage of measles, polio, MenACWY, DPT-Hib-HepB (Pentavalent), cholera (OCV) and pneumococcal virus (PCV) vaccination in 6-59 month olds;  To determine the rate of severe and global acute malnutrition in 6-59 month olds;  To identify the most prevalent morbidities in the population in the two weeks preceding the survey;  To describe the health seeking behaviour in terms of access to primary and secondary care;  To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;  To identify major causes of death, by age group and sex;  To gain knowledge of violence-related events 2.1. PRIMARY OBJECTIVES To estimate the scale of the emergency through measurement of crude mortality rate for the total population and for children under five years of age 2.2. SECONDARY OBJECTIVES  To describe the population in terms of age, sex and household composition;  To determine the coverage of measles, polio, MenACWY, DPT-Hib-HepB (Pentavalent), cholera (OCV) and pneumococcal virus (PCV) vaccination in 6-59 month olds;  To determine the rate of severe and global acute malnutrition in 6-59 month olds;  To identify the most prevalent morbidities in the population in the two weeks preceding the survey;  To describe the health seeking behaviour in terms of access to primary and secondary care;  To estimate crude mortality rate for the total population and for children under five years of age before and after the SPLA advance into Equatoria, South Sudan;  To identify major causes of death, by age group and sex;  To gain knowledge of violence-related events