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Retrospective mortality, nutrition and measles vaccination coverage survey in Balukhali 2 & Tasnimarkhola camps, Cox’s Bazar, Bangladesh (November 2017): Report

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Summary

Background

On August 25, 2017, a counter-insurgency military operation in Rakhine State, Myanmar, led to the massive displacement of Rohingya civilians into Bangladesh. Fleeing violence, approximately 626,000 Rohingya crossed into Bangladesh in under three months. To inform humanitarian assistance and understand the needs of those displaced, Médecins Sans Frontières (MSF), with the support of Epicentre, performed a survey to estimate retrospective mortality, nutritional status and measles vaccination coverage among the population of Balukhali 2 and Tasnimarkhola settlements, in Cox’s Bazar District, Bangladesh.

Methods

In November 2017, MSF/Epicentre conducted a retrospective survey with systematic sampling among a population of 135,980 Rohingya (including 1,529 families) who had recently arrived in the two survey-targeted settlements in Bangladesh. The recall period for mortality extended from May 27- November 12, 2017, spanning roughly equal periods before and after August 25, 2017. Heads of family described the family structure, and provided the date, location and cause of death for family members who died during the recall period. Surveyors assessed the nutritional status of children aged 6 to 59 months by mid-upper arm circumference (MUAC) and evaluation for nutritional oedema. Heads of family verbally reported measles vaccination status, which surveyors confirmed by health card or vaccination record where available.

Results

Before the crisis (May 27-August 24, 2017), mortality rates (expressed as deaths/10,000/day), were 0.6 [95% CI: 0.4-0.8] for the total population, and 0.5 [0.2-1.1] for children under five years old. Following the crisis (August 25-November 12, 2017), mortality rates were 4.6 [4.1-5.2] and 3.8 [2.8-5.2] for children under five years old. During this period, 3.5% [95% CI: 3.1-3.9] of the total population, and 2.9% [2.1-3.9] of the under-five population, died. Violence caused respectively 77.4% and 57.5% of these deaths. Moreover, through the entire recall period (May 27-November 12, 2017), 96.6% of all deaths occurred in Myanmar. Seventy-five percent of the deaths were reported in the first month of the crisis; the majority of people were killed by shooting (70.3%), and others by beating (18.4%), landmines (3.8%) and sexual violence (3.2%).

Results of the malnutrition survey indicate a critical humanitarian situation, with global acute malnutrition (GAM) prevalence at 12.0% [95% CI: 10.2-13.9] and severe acute malnutrition (SAM) at 4.5% [3.4-5.8]. Measles vaccination coverage was low, with less than a quarter (22.4% [95% IC: 20.2-24.9]) of children aged between 6 to 59 months having verbal or written documentation of measles vaccination.

Conclusion

This survey provides epidemiological evidence of high rates of mortality due to violence among the displaced Rohingya in Myanmar and reinforces the need for a targeted and rapid humanitarian response to resolve the critical levels of acute malnutrition and under-coverage of measles vaccination in the settlements.