Document Type


Publication Date



Capstone Committee Chair: Harsh Sule, MD, MPP

Capstone Preceptor: Bon Ku, MD, MPP

Capstone Preceptor: Albert Crawford, PhD, MBA, MSIS


The purpose of this study was to determine what effect achieving the Sphere Standards relating to water and sanitation had on the incidence of communicable diseases in a returnee camp in South Sudan during a complex humanitarian emergency. The water and sanitation infrastructure of the returnee camp was tracked over time until it met the Sphere Standards. The total camp population was also tracked over the same period of time and compared to daily counts of diseases diagnosed in a medical clinic at the camp. A daily incidence of disease was then calculated for each communicable disease that was tracked. The daily incidences were grouped into one-week blocks. A chi-square analysis was then performed to look for differences in communicable disease incidence in the camp before and after the Sphere Standards were met. Data were available for the first four weeks that the camp was open; the camp met the Sphere Standards after one week. The incidence of camp residents with diarrhea, upper respiratory tract infections (URTI), and lower respiratory tract infections (LRTI) showed statistically significant increases over the first three weeks but then decreases in the final week. Subgroup analysis showed that this trend was also present on patients under age 5 and statistically significant for URTIs and LRTIs. The results suggest that achieving and maintaining the Sphere Standards will have a significant, although possibly delayed, effect on the incidence of communicable diseases during a complex humanitarian emergency.

53 slides, no audio.