In the second half of 2016, 70 mortalities were reported from Zaatri camp with a Crude Mortality Rate (CMR) of (0.1/1,000 population/month; 1.8/1,000 population/year) which is slightly lower than the reported CMR in the first half of 2016 (0.2/1,000 population/month; 2.3/1,000 population/year) and is also lower than both the reported CMR in Syria prior to the conflict in 2010 (0.33/1,000 population/month; 4.0/1,000 population/year)1 and the reported CMR in Jordan in 2014 according to the Department of Statistics (0.51/1,000 population/month; 6.1/1,000 population/year)2.
Among the 70 deaths, 15% were neonatal with a neonatal mortality rate (NNMR) of 10.2/1,000 livebirths which is comparable to the NNMR in the first half of 2016 (9.7/1,000 livebirths) but is lower than Jordan’s NNMR of 14.9/1,000 livebirths; 36% were children under 5.
Reporting of NNM and neonatal audits has improved in 2016 taking into consideration age in terms of days, months and years, thus the NNMR is 2015 is likely to be overestimated.
Ischemic heart disease, cardiovascular disorder and cerebrovascular disease accounted for approximately 41% of all reported mortality cases.
CMR is influenced by the size of the population. Thus, despite the fact that CMR was calculated based on the median population in Zaatri in the second half of 2016 which was 79,895, it should be kept in mind that there may have been some fluctuations through the year due to people moving in and out of the camp as well as refugees leaving the camp.
Furthermore, the cases of deaths reported in Zaatri are the cases that took place inside the camp as well as cases referred to health facilities outside the camp. Nevertheless, this system does not capture death cases that take place outside the camp who have not followed the usual referral procedures; i.e. cases that by themselves directly approached health facilities outside the camp and have not been reported by their family members back in the camp.
Taking the two above mentioned factors into consideration, the calculated CMR for Zaatri in the second half of 2016 might be underestimated or overestimated.
There were 58.5 full time clinicians in Zaatri camp during the second half of 2016 covering the outpatient department (OPD) with 33 consultations/clinician/day on average which is comparable to the first half of 2016 and is within the acceptable standard (<50 consultations/clinician/day).
Thirty one alerts were investigated during the second half of 2016 for diseases of outbreak potential; watery diarrhea, bloody diarrhea, acute jaundice syndrome, acute flaccid paralysis, suspected measles and suspected meningitis. No outbreaks declared as a result of alert investigations.
For acute health conditions upper respiratory tract infections (URTI), influenza-like illness (ILI) and dental conditions were the main reasons to seek medical care in the second half of 2016.
For chronic health conditions, hypertension, diabetes and asthma were the main reasons to seek medical care in the second half same as the first half of 2016. Chronic health consultations accounted for 15.2% of total OPD consultations.
Mental health consultations accounted for 1.4% of total consultations. This is comparable to the first half of 2016 (1.5%), but is a marked decrease compared to 2015 (2.3%) and the reasons behind this are being explored. Severe emotional disorders (including moderate- severe depression) and epilepsy/seizures were the two main reasons to seek mental health care during the second half same as the first half of 2016.
Inpatient Department Activities
Inpatient department activities are conducted by Moroccan Field Hospital (MFH), JHAS/UNFPA and MSF-Holland in Zaatri camp, the latter was operational up until the first week of December. 2,015 new inpatient admissions were reported during the second half of 2016 with a bed occupancy rate of 44% and hospitalization rate of (4.2/1,000 population/month; 50.4/1,000 population/year) which is 1.3 times the hospitalization rate in the first half of 2016. The reason behind this increase is that delivery cases performed at JHAS/UNFPA clinic started reporting on the IPD section as of February 2016. Please note this does not include referrals for inpatient admissions outside of the camp.
Total referrals to hospitals outside the camp were 4,215 during the second half of 2016 with a referral rate of 8.8/1,000 population/month which is comparable to the referral rate in the first half of 2016 (9.2/1,000 population/month). Referrals for internal medicines accounted for 47% of total referrals.
3,539 pregnant women were reported to have made their first antenatal care (ANC) visit during the second half of 2016, only 71% of those made their first visit during the first trimester. Given that this number is 2.2 times the number of deliveries during the second half of 2016 there is likely to be significant reporting error (follow- up antenatal visits being reported as the first visit, or women accessing antenatal care in multiple locations and thus being reported more than once)..
Reported coverage of antenatal care in the second half of 2016 is low. In particular complete antenatal care coverage (77%) and antenatal tetanus immunization coverage (74%). This is comparable to the average coverage in the first three quarters of 2016 but has slightly improved since 2015 when it was even lower.
1,566 live births were reported in the second half of 2016 with a crude birth rate of 3.3/1,000 population/month which is comparable to the CBR in the first half of 2016 (3.3/1,000 population/month). All deliveries were attended by skilled health worker. 28% of deliveries were caesarian section.
Low birth weight is under-reported (1% of livebirths) due to the unavailability of the birth weight for many cases referred for delivery at hospitals outside the camp.
The number of obstetric complications treated is partially reported as the number of very low. It is expected that approximately 15% of deliveries will have a complication necessitating intervention.
Postnatal care (PNC) coverage for the second half of 2016 is 67% which is comparable to the coverage in the first half of 2016PNC coverage has improved compared to the second half of 2015 (52%) but cannot be compared to the first half of 2015 (131%) as there was incorrect collection and reporting during the first quarter of 2015 where any PNC visit was recorded regardless of number and timing of visit.