Effect of the Sphere Standards on the incidence of communicable and infectious diseases in a returnee camp in South Sudan

Abstract

Background: The Sphere Standards are primarily focused on factors that acutely affect survival instead of guiding long-term development in displaced populations and have gained consensus in more than 200 aid organisations. However, research was not available to back up every Standard and in those cases the Standards were based on expert or consensus opinion. Therefore, research to validate or refine the Standards will be of benefit to the humanitarian community and the people they serve. Methods: A retrospective study was done at a UN High Commissioner for Refugees camp for returnees from Sudan to South Sudan before and after an intervention to introduce the Sphere Standards for water, sanitation, and hygiene (WASH). Data were collected from May 17, 2012, to July 31, 2012. The daily proportion of the camp diagnosed with a communicable or infectious disease was calculated by comparing the daily camp population to the daily counts from the camp's medical clinic. A χ2 analysis was done to compare the weekly disease proportions before and after the camp met the Sphere Standards for WASH. Findings: The camp clinic recorded 12 655 consultations. The weekly prevalences of the camp population diagnosed with diarrhoea, an upper respiratory tract infection, or a lower respiratory tract infection in the week before the camp met the Sphere Standards were 0·67%, 0·59%, and 0·34%, respectively. 2 weeks afterwards, they were 0·99%, 1·68%, and 0·57%, respectively. In the fourth week the prevalences for all three decreased (0·82%, 1·48%, and 0·39%, respectively). This pattern was statistically significant for all age groups and also for subgroup analysis on returnees younger than 5 years. Percentages for the diseases tracked ranged from 0·14% to 1·68% with p<0·05. Interpretation: Factors such as the massive influx of returnees to the camp and the introduction of local pathogens into the returnee camp population probably muted the initial effects of improved WASH on the camp. These results suggest that achievement and maintainence of the Sphere Standards will have a significant, although possibly delayed, effect on the incidence of communicable and infectious diseases during a complex humanitarian emergency. Funding: None.