Hi, I'm Eva. >> And I'm Farah. >> We're both epidemiologists with the Emergency Response and Recovery branch at the Centers for Disease Control and Prevention, the CDC. We work on improving the quality and rigor of data collected to inform humanitarian responses in the context of natural disasters and complex humanitarian emergencies. We're going to talk about the kind of data collected in emergencies, the methods used to collect data, and some of the challenges faced during data collection in these settings. First, what are data? Data are raw unorganized facts from which we can derive information. They're often numbers, such as the number of persons displaced or the number of cases of a disease. However, data can also be worse, observations, or even just descriptions. They can be qualitative or quantitative. In an emergency, we collect data that can be used to inform action and improve the quality, efficiency or impact of the response. Given the resource constraints in an emergency, it is only ethical to collect data if they're used for action. This may include prioritizing needs and gaps, mobilizing available efforts and resources, coordinating response efforts to minimize duplication of efforts, advocating for resources, or monitoring interventions. It's often useful to categorize data based on the questions we aim to answer, the basic who, where, what. Or as often we say in epidemiology, person, place and time. For example, in an emergency we collect data to describe who is affected, not just in numbers, but their age, sex, the high risk groups. We want to know the basic demographics of the affected population. We also want to know where are the immediate and anticipated needs. Where is there poor access to water, where is access to healthcare lacking, where is the security situation a problem? And finally, what local and external resources are available. What partners are on the ground, what are they doing? And what is the level of community participation? >> Answering these questions can help describe the extent of the emergency, as well as identify gaps. These data can be interpreted by comparing them to standard indicators and benchmarks to help describe an emergency. An indicator is a measure, often a proportion, ratio, or rate. Whereas a benchmark is a reference point or a minimum standard for the indicator. In emergencies we often use the indicators and benchmarks to ensure we are meeting the minimum international humanitarian standards. Some key indicators we use in emergencies are crude mortality rate or CMR, which is the total number of deaths among the affected population and under-five mortality rate. Which is the number of deaths of children under five. In an emergency we measure CMR and under-five mortality rate in terms of the number of deaths per 10,000 persons per day, rather than per 1,000 per year. An under-five mortality rate is an important indicator as this age group is highly vulnerable during emergencies. There are many other specific indicators. For example, the prevalence of acute malnutrition where the amount of water per person per day. These indicators can be used to evaluate our interventions and monitor our response efforts. So what are some of the sources for this information? How do we collect the information when things aren't stable and the situation is chaotic? When systems aren't in place and things are not working. Consider, for example, a natural disaster. It causes power outages, knocks out cell communication towers, damages health centers and displaces health staff. Given these challenges and the need for information, we use a combination of methods to collect information in emergencies. The three main data collection methods we use are, initial rapid assessments, population-based cross-sectional surveys and surveillance. Each method has it's advantages and disadvantages and they are used for different purposes and at different times within the response. >> First let's discuss rapid assessments. The objective of an initial rapid assessment is exactly what it sounds like. It's a quick review of the situation, and immediate appraisal. It should be done within the first few days or as soon as the situation allows. The data are manly qualitative. Data are gathered by talking to key informants such as community leaders, local authorities, specialists, such as doctors and nurses and others who are familiar with the population. It's also important to talk to individuals or groups of individuals affected by the emergency as well. As observing what's on the ground in order to triangulate the difference source of information. Sites to gather this information are selected purposely, not randomly, for example to include the most affected areas. These methods mean that the information collected is not often representative of the entire situation. Instead the aim is to build the basic understanding of the situation to inform the immediate response in a way that does not draw too many resources away from the ongoing response activities. Given that rapid assessments can meet the urgent demands for information during the initial response, they are generally the first data collection method used. Information from a rapid assessment is used to guide priority interventions and allocate funding. A rapid assessment is a precursor for more detailed assessments and surveys. Some of the common challenges with rapid assessments are the data can quickly become outdated or irrelevant. Particularly in contacts with ongoing population movement. Another challenge is because data are generally collected at purposely selected sites, results are not often generalizable to all affected people or areas. And lastly, despite its name, experience from recent large scale emergencies suggests that it can often take a long time to do a rapid assessment and disseminate the results. >> So next let's talk about surveys. Compared to rapid assessments, surveys are a more standardized assessment that generally requires more planning, training, and resources. As a result, they are conducted once the situation has begun to stabilize, to provide a intermediate appraisal of the situation. We usually carry out cross-sectional surveys which involve collecting data at one specific point of time. And therefore we say it provides a snapshot of the situation. Surveys are designed to produce population estimates. Another contrast to rapid assessments. To do so, they collect data from a representative sample of all eligible subjects in the population. Surveys generally use a structured questionnaire to collect these data. These questionnaires may include measurements, such as water quality tests, or anthropometry. They may also include observations, such as the number of water storage containers. Survey questionnaires also generally include questions that can be answered with yes or no or multiple choice answers. Measurements, observations, and questions with discrete answers all collect quantitative data. Good quality surveys use rigorous standardized data collection methods. However, there are many challenges when conducting surveys in emergencies, including selecting a representative sample requires updated population information. A particular challenge in emergencies, the resulting large scale displacement. Additionally, surveys capture one time period. To monitor trends, you need to compare multiple surveys over time. Another challenge is designing and managing a survey requires more advanced technical expertise. >> The third method is surveillance. Surveillance is the continuous or on-going observation of a place, person, group, or activity to gather information. For example, a video camera in a bank is conducting on-going surveillance of activities occurring at that bank. All functioning health systems have a surveillance component which provides a continuous ongoing appraisal of the health situation. However in emergencies, surveillance systems maybe be disrupted or underperforming. Therefore, it's necessary to establish a simplified surveillance system until routine data collection can resume. This allows us to track trends and monitor changes among the affected population. Like surveys, surveillance data are primarily quantitative and use standardized data collection forms. We often use the surveillance to record health events. We aim to document every case within the target population. This can be done using active methods where you go out to communities and solicit the information. Or using passive methods, such as recording all cases that come to the health center. Oftentimes we rely on a combination of both active and passive reporting in emergencies. Some of the more common challenges in surveillance are applying a standardized case definition. A case definition is the criteria for determining whether a person has a particular disease or health event. It's a standard way of categorizing health events. In an emergency, when there are a lot of different healthcare providers working with different agencies, standardizing the way provider's report can be a major challenge even with routine training. Another challenge is that most surveillance systems are passive, and therefore only capture data from cases that present to a health center. Those who are unable to seek care will not be included. If many cases are not captured, sensitivity is low, and the data may be not be representative of the general population. And lastly, you often get reporting from a reporting stake with very little public health action. In other words, data are routinely collected, but no one is interpreting or using that information. >> So what is the best method? When should you use which method? Well this depends on the situation. Let's run through some examples to help illustrate the information needs and contacts information which inform which method we use, or which method would be most appropriate. For example, what if we wanted to assess whether recently arrived refugees residing in a camp had sufficient access to safe water and sanitation facilities? You may start by talking to a key informant. Maybe an NGO that's providing water to the camp to gather information as to how much water is delivered to the camp and how many people are currently living there. You could also walk around the camp and see what water sources and sanitation facilities are present. Or you could talk to the refugees about access and use of these facilities and whether they meet their needs. All of these kind of methods are commonly used in rapid assessments. It may also be appropriate to conduct a survey. A survey would provide population representative estimates of information such as the average amount of water available per person per day, or proportion of toilets per person. What if we also wanted to know the main health problems among the affected population? Early on in the response, it may be appropriate to talk to key informants, such as healthcare providers and community leaders to give you a quick overview of the health situation. You could also review facility-based surveillance data, but that would only give information on those seeking care. Eventually, you could conduct a survey which could provide information about everyone in the population, including both those seeking care and not seeking care. We've provided a very general overview of three data collection methods typically used in an emergency. However, every emergency is different and has it's own challenges which affect data collection. Regardless of the data collection method, it's essential to ensure high quality data are collected and used to inform response efforts.
