Humanitarian aid workers regularly encounter the challenge of setting up functioning surveillance systems immediately after a disaster. Detecting potential outbreaks of diseases, such as cholera, that might arise from disturbed living conditions, displacement and lack of clean water and sanitation is, therefore, extremely difficult. Fears of cholera outbreaks are often rife in such conditions and the pertinence of using cholera vaccines, now available on the market, merit attention. The case of Aceh province, Indonesia, following the 2004 tsunami is examined here: the government of Indonesia decided to carry out a mass vaccination campaign using oral cholera vaccines, a two-dose product that has not been used widely in the particular circumstances of complex emergencies. The preparation and implementation of this campaign faced many hindrances that unfavorably impacted on the time taken to vaccinate the target population and the costs involved. An estimated 69.3% of the target population received immunization. Evidence gathered during the Aceh campaign could be compared with those of a campaign held in another emergency context--Darfur (Sudan). In spite of many dissimilarities, both experiences illustrate the fact that the question of feasibility and relevance of interventions, as well as prioritization of health needs in complex emergencies, remain crucial to alleviate the affected population's suffering in the most efficient way. Following these two campaigns, WHO recommendations on the use of oral cholera vaccines in complex emergencies were issued in 2006.

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A cross-sectional questionnaire survey, using the current status method for the assessment of breastfeeding, was conducted among women working in the plantations in Sri Lanka. The exclusive breastfeeding rate was 32.4 per cent. The mothers' return to work and the feeling of having insufficient milk were significantly and negatively associated with exclusive breastfeeding. Women will sometimes start with powdered milk several weeks before going back to work, suggesting that work itself is not the only reason for introducing powdered milk. Although the health authorities have endorsed the concept of exclusive breastfeeding, further health education is needed for the full acceptance of exclusive breastfeeding in the population.

From May to November 1985 most refugee camps in Eastern Sudan were affected by cholera. This article summarizes the experience from the refugee camp Wad Sherife with the emphasis on the practical aspects of management of cholera in a refugee context. Paramedical personnel from the refugee community were used to a great extent both in curative and preventive measures. The home visitors played an important role in the early detection of the cases and in trying to prevent the spread of cholera in the camp. A total of 1793 cases were admitted during a three month period. The results show a case fatality rate of 1.8%. A significantly higher number of women were affected in the age group 15-44. As seen in other refugee camps in Eastern Sudan, there was a relatively high intravenous fluid consumption with an average of about 6 litres in adults.

Children living on plantations in inland districts of the southeastern part of Sri Lanka frequently develop a skin condition on the legs described as mosaic skin or xeroderma. This condition is characterized by atrophic, dry, shining and scaly skin. The etiology is unknown. A food frequency survey indicated a low energy intake, a diet with a low fat content, and anthropometric data have shown a high prevalence of malnutrition within this group. The skin condition brought attention to a possible deficiency of essential nutrients, especially essential fatty acids. In order to investigate the possible association with a deficiency of essential fatty acids, blood samples were collected from both children having signs of xeroderma and controls. The total amount of phospholipids was low, but the fatty acid profile of this lipid class was similar to the controls. A vitamin A deficiency was indicated by low levels of its transport proteins. A multifactorial etiology where vitamin A deficiency may play a role is discussed.