BackgroundDuring humanitarian crises, health information systems are often lacking and surveys are a valuable tool to assess the health needs of affected populations. In 2013, a mortality and health survey undertaken by Médecins Sans Frontières (MSF) in the conflict affected Walikale territory of North Kivu, Democratic Republic of the Congo (DRC), indicated mortality rates exceeding humanitarian crisis thresholds and a high burden of mortality and morbidity due to malaria. In late 2017, after a period of relative stability, MSF reassessed the health status of the population through a second survey to guide ongoing operations.MethodsA two-stage cluster survey, selecting villages using probability proportional to size and households using random walk procedures, was conducted. Household members were interviewed on morbidity and mortality, healthcare use, vaccination status, and bednet availability.ResultsThe sample included 5711 persons in 794 households. The crude mortality rate (CMR) and under-five mortality rate (U5MR) were 0.98 per 10,000 persons/day (95% confidence interval (CI) 0.78–1.2) and 1.3 per 10,000 persons/day (95% CI): 0.82–2.0), respectively. The most frequently reported causes of death were fever/malaria (31%), diarrhoea (15%) and respiratory infections (8%). In 89% of households at least one person was reported as falling ill in the previous 2 weeks, and 58% sought healthcare. Cost was the main barrier amongst 58% of those who did not seek healthcare. Coverage of measles-containing-vaccine was 62% in under-fives. Sufficient bednet coverage (1 bednet/2 people) was reported from 17% of households.ConclusionThe second survey illustrates that although mortality is now just below crisis thresholds, the area still experiences excess mortality and has substantial health needs. The study results have supported the further expansion of integrated community case management to improve access to care for malaria, diarrhoea and respiratory infections. Such surveys are important to orient operations to the health needs of the population being served and also highlight the ongoing vulnerability of populations after humanitarian crises.

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BackgroundChild maltreatment is common in globally and in the European Region. In the European facts and the Global status report on violence prevention, 78% of the countries participating reported that they had developed action plans to prevent child maltreatment. Investing in Children: the European Child Maltreatment Prevention Action Plan 2015–2020 adopted by Member States has an aspirational target to reduce child maltreatment by 20% by 2020. To determine whether these plans are likely to result in programme implementation, a content analysis was undertaken.MethodsNational data coordinators from the 41 countries in the WHO European Region that took part in the global survey were contacted to request copies of national action plans (NAPs). Internet searches were also conducted on the official government web sites. On this basis, 35 NAPs were identified, of which four were sub-national. A content analysis was conducted using an established methodological framework (Schopper et al).ResultsAlmost all NAPs (97%) described multisectoral engagement. Whereas all NAPs had clearly stated objectives, in only one was there a quantified target. All NAPs had achieved government approval; however only 43% had a clearly stated budget for implementation and 66% had a clearly stated lead agency for coordinating the actions of the different actors. Whereas 94% had clearly outlined interventions and activities aimed at achieving the corresponding objectives, all focused on child protection interventions (such as detection, helplines), and fewer had an emaphsis on primary prevention activities such as home vsiitng and prenting support. Countries with NAPs were more likely to have primary prevention interventions than those without.ConclusionsThis analysis shows that progress is being made in developing action plans for child maltreatment prevention, but inadequate attention is being given to preventive interventions and most of the focus is on child protection. Governance mechanisms need to be strengthened to ensure more concerted national actions. It is proposed that one way forward would be the development of more NAPs with a clearly defined lead agency, budget and quantified targets. These findings will be discussed in the light of policy success stores from other areas such as road safety.