Event-based surveillance (EBS) is the organised approach to the detection and reporting of 'signals,' defined as information that may represent events of public health importance, often through channels outside of routine surveillance systems. Signals can be designed to detect patterns of disease, such as clusters of similar illness in a community, or clusters of disease or death in animals. Signals can also include single cases of suspected high-priority events such a patient with viral haemorrhagic fever. EBS can be a key component of an effective early warning system, which enables countries to be better prepared for endemic and pandemic illness outbreaks. EBS uses an all-hazards approach that includes the principles of One Health. This review covers the concept and process of EBS, different sources for EBS data, and methods to obtain information from these sources. This overview will aid countries in implementing this important form of surveillance.

Background There is limited research on noncommunicable diseases (NCDs) in humanitarian settings despite the overall global burden and disproportionate growth in many conflicts and disaster-prone settings. This study aimed to determine the prevalence of NCDs and assess the perceived effect of conflict on NCD severity and access to treatment among conflict-affected adults (� 30 years) in Ukraine. Methods and findings We conducted two population-representative, stratified, cross-sectional household surveys: one among adult internally displaced people (IDPs) throughout Ukraine and one among adults living in Donbas in eastern Ukraine. One randomly selected adult per household answered questions about their demographics, height and weight, diagnosed NCDs, access to medications and healthcare since the conflict began, as well as questions assessing psychological distress, trauma exposure, and posttraumatic stress disorder. More than half of participants reported having at least one NCD (55.7% Donbas; 59.8% IDPs) A higher proportion of IDPs compared to adults in Donbas experienced serious psychological distress (29.9% vs. 18.7%), interruptions in care (9.7-14.3% vs. 23.1-51.3%), and interruptions in medication than adults in Donbas (14.9-45.6% vs. 30.2-77.5%). Factors associated with perceived worsening of disease included psychological distress (p: 0.002-0.043), displacement status (IDP vs. Donbas) (p: <0.001-0.011), interruptions in medication (p: 0.002-0.004), and inability to see a doctor at some point since the start of the conflict (p: <0.001-0.008). Conclusions Our study found a high burden of NCDs among two conflict-affected populations in Ukraine and identified obstacles to accessing care and medication. Psychological distress,

Most studies of mental health in humanitarian aid workers have found low levels of posttraumatic stress disorder, making it hard to disaggregate and look at differences between subgroups. This study sought to identify the risk and protective factors associated with resistant, resilient, and nonresilient trajectories of stress response over time that could be used to inform more targeted training and organizational support programs for aid workers. Aid workers from 19 qualifying humanitarian organizations who aged Ն18 years and were to deploy for 3 to 12 months completed questionnaires at 3 time points (pre, post, and follow-up). We identified 3 unique groups (nonresilient, resistant, and resilient) using latent class growth analysis and identified predictors of subgroup classification using multivariate logistic regression. Single individuals were less likely to be in the resilient group than in the resistant group compared to coupled individuals. Individuals with one prior deployment were three times more likely to be nonresilient than resistant compared to individuals with no previous deployments. There was no significant difference in resistant, resilient, and nonresilient classification for individuals with Ͼ2 deployments. Findings suggest a need for supplemental training and psychosocial support post the first deployment as well as resources focused on potential this should be cumulative rather than accumulative effects of stress and trauma exposure for more seasoned deployers.

Maternal, fetal, and neonatal health outcomes are interdependent. Designing public health strategies that link fetal and neonatal outcomes with maternal outcomes is necessary in order to successfully reduce perinatal and neonatal mortality, particularly in low- and middle- income countries. However, to date, there has been no standardized method for documenting, reporting, and reviewing facility-based stillbirths and neonatal deaths that links to maternal health outcomes would enable a more comprehensive understanding of the burden and determinants of poor fetal and neonatal outcomes. We developed and pilot-tested an adapted RAPID tool, Perinatal-Neonatal Rapid Ascertainment Process for Institutional Deaths (PN RAPID), to systematically identify and quantify facility-based stillbirths and neonatal deaths and link them to maternal health factors in two countries: Liberia and Nepal. This study found an absence of stillbirth timing documented in records, a high proportion of neonatal deaths occurring within the first 24 hours, and an absence of documentation of pregnancy-related and maternal factors that might be associated with fetal and neonatal outcomes. The use of an adapted RAPID methodology and tools was limited by these data gaps, highlighting the need for concurrent strengthening of death documentation through training and standardized record templates.

Over the past three decades there has been a surge in the prevalence of overweight and obesity worldwide in both adults and children. To date few studies have examined obesity in India and most have only looked at prevalence estimates. While studies in Western countries have identified parent weight status as a predictor of child weight status, there have been no studies examining this association in India. This study examined the relationship between parent weight status and child weight status using an internationally representative growth reference for children and Asian-specific action points for adults. Overall, this study found 29.6% of children and 77.7% of parents in a sample of private schools in Delhi, India were overweight/obese. Parent weight status was found to be associated with child weight status after controlling for child grade and sex. However, while maternal weight status was associated with child weight status (odds ratio=1.51, 95% confidence interval: 1.04-2.20), paternal weight status was not (odds ratio=1.10, 95% confidence interval: 0.81-1.48). The association was greatest between mothers and sons (odds ratio=2.13, 95% confidence interval: 1.39-3.27). These results provide initial evidence that parent weight status is associated with child weight status in Delhi, India. Future research should continue to explore the relationship between parent, particularly maternal, and child weight status to better understand the nature of the relationship and the differences between male and female children. Interventions to address child overweight and obesity in India should include parents as direct targets.