IAWG GESC February 12, 2014

NYC, NY

Retrospective Analysis of Reproductive Health and HIV/AIDS Indicators in

United Nations High Commissioner for Refugees Post-emergency Camps

Center for Global HealthInternational Emergency and Refugee Health Branch

Dr. Basia Tomczyk

Outline

Background Objectives Methods Next Steps Advocacy

HIS Overview The HIS was developed in 2006 to systematically track health outcomes in refugee settings

HIS is a user-friendly, web-accessible database of pre-tabulated health indicators (n=110)

At the start of 2010, HIS was operational in :21 countries 85 refugee camps 24 different partners 1.5 million camp-based refugees

Global Evaluation of RH in Crises

Unique opportunity to assess reproductive health care at the facility level

Access to surveillance data improves understanding of a WRA health status

Global Evaluation of RH in Crises

The purpose of this study is to conduct a retrospective review of RH indicators, assess MDG-based RH and HIV/AIDS benchmarks and propose additional and/or substitute indicators using the UNHCR HIS database and indicators

ObjectivesAnalyze trends in antenatal care, delivery, postnatal care, family planning, SGBV and HIV/AIDS indicators

Benchmark RH indicators against existing minimum standards in comprehensive reproductive health

Provide examples of good practice and gaps in RH service delivery, using HIS to explain differences

Make recommendations for advocacy, program management and resource allocation

Methods Design

Retrospective analysis of trends of RH indicators

Study PopulationBangladesh, Burundi, Cameroon, Central African Republic, Chad, Congo (DR), Congo (Rep), Djibouti, Ethiopia, Ghana, Guinea, Kenya, Liberia, Namibia, Nepal, Rwanda, South Sudan, Sudan, Tanzania, Thailand, Uganda, Yemen and Zambia.

Methods Inclusion criteria

Countries with all camp HIS data that have records that are plausible. (For example, no indicators are more than 100%)

All camps within the country must have had at least one HIS evaluation

Countries with camps that have at least 6 months of data (Doocy et al. used 6 months)

Methods Inclusion criteria

Countries with camps that have no more than one month of missing data

Data from 2007 to obtain sufficient trends

Methods Data analysis

RH indicators will include all components of ANC, delivery, PNC and SGBV and HIV/AIDS care

Primarily descriptive data analysis

Data will be analyzed using SAS version 9.3

Ethical Issues

Submitted to CDC for project determination and was determined not to be human subjects research

No personal or facility identifying information

Limitations The quality and completeness of data is known to

be somewhat variable during the first months of using the system

Sensitive subjects, such as SGBV and post abortion care, may not be reported accurately

The UNHCR HIS is limited to camp settings

HIS data is predominantly collected in health facilities

Next Steps

Review updated data and spreadsheets via Twine

Data cleaning, triaging indicators (cannot be more than 100%)

Populate table shells, rates, etc

Write peer review publication

Submit to clearance

Key Advocacy Messages

A retrospective analysis of trends in RH gathered from facilities and aggregated on a country level provide valuable information not previously analyzed

Identifying longer-term trends in RH issues among refugees will provide information on a country and global level

Key Advocacy Messages

Compare the indicators to the Millennium Development Goals and refugee health standards helps to acknowledge RH in crises

Provide data for public health action, interventions, policies, and further research

Project Partners

Co-PIs Ms. Nadine Cornier Dr. Christopher Haskew Mr. Curtis Blanton

Student Intern Jennifer Whitehall

For more information please contact Centers for Disease Control and Prevention1600 Clifton Road NE, Atlanta, GA 30333Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348E-mail: cdcinfo@cdc.gov Web: www.cdc.govThe findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Thank you!