Emotional,physical, and social needs among 0–5‐year‐old children displaced by the 2010 Chilean earthquake: associated characteristics and exposures

An 8.8‐magnitude earthquake occurred off the coast of Chile on 27 February 2010, displacing nearly 2,000 children aged less than five years to emergency housing camps. Nine months later, this study assessed the needs of 140 displaced 0–5‐year‐old children in six domains: caregiver stability and protection; health; housing; nutrition; psychosocial situation; and stimulation. Multivariate regression was applied to examine the degree to which emotional, physical, and social needs were associated with baseline characteristics and exposure to the earthquake, to stressful events, and to ongoing risks in the proximal post‐earthquake context. In each domain, 20 per cent or fewer children had unmet needs. Of all children in the sample, 20 per cent had unmet needs in multiple domains. Children's emotional, physical, and social needs were associated with ongoing exposures amenable to intervention, more than with baseline characteristics or epicentre proximity. Relief efforts should address multiple interrelated domains of child well‐being and ongoing risks in post‐disaster settings.     

Stigmatisation and rejection of survivors of sexual violence in eastern Democratic Republic of the Congo

Studies report that between 6 per cent and 29 per cent of survivors of sexual violence in eastern Democratic Republic of the Congo (DRC) are rejected by their families and communities. This research project was designed to provide insights into survivors' experiences of stigmatisation and rejection. Surveys were conducted with 310 women as they sought psychosocial services in eastern DRC. In total, 44.3 per cent of women reported suffering rejection after sexual violence. The majority of women felt that their status in the household (58.0 per cent) and community (54.9 per cent) diminished after rape. The odds of rejection were greater among women reporting ongoing displacement, pregnancy owing to sexual violence, worsening family relations, and diminished community status. This work highlights the extremely high levels of loss associated with the war in eastern DRC, particularly among survivors of sexual violence. The rejection of a survivor of rape has concrete and devastating psychosocial consequences.     

Predictors for people's response to a tornado warning: Arkansas, 1 March 1997

On 1 March 1997, powerful tornadoes touched down in Arkansas (USA) on a Saturday afternoon. Twenty-six fatalities and 400 non-fatal injuries were reported. We performed a population-based cross-sectional study to determine factors associated with appropriate responses to tornado warnings. Of 146 survey participants, 140 (96 per cent) knew the difference between 'tornado watch' and 'tornado warning' and were aware of when the warning was announced. Of those 140 participants, 64 (45.7 per cent) responded to the warning by seeking shelter, and 58 (90.6 per cent) of those 64 acted within five minutes of hearing the warning. Four factors were positively associated with those seeking shelter: having graduated from high school (OR = 4.2, 95 per cent CI = 1.1-15.5); having a basement in one's house (OR = 3.8, 95 per cent exact CI = 1.1-17.1); hearing a siren (OR = 4.4, 95 per cent CI = 1.3-18.9); and having prepared a household plan of response when tornadoes occur (OR = 2.6, 95 per cent CI = 1.1-6.3). On the basis of these findings, we recommend: first, that people who live in tornadoprone areas have a personal plan of action to help them respond immediately to warnings; second, public-health education officials in areas with frequent tornadic activity should do more to educate the public about what they can do to protect themselves from a tornado; and third, that emergency-management officials planning protection measures for vulnerable communities should consider that most people have limited time (our study documented five minutes) in which to respond to a tornado warning. Thus, shelters in tornado-prone areas should be quickly accessible by residents.     

Epidemiology of tornado destruction in rural northern Bangladesh: risk factors for death and injury

The epidemiology of tornado-related disasters in the developing world is poorly understood. An August 2005 post-tornado cohort study in rural Bangladesh identified elevated levels of death and injury among the elderly (≥ 60 years of age) (adjusted odds ratio (AOR) = 8.9 (95 per cent confidence interval (CI): 3.9-20.2) and AOR = 1.6 (95 per cent CI: 1.4-1.8), respectively), as compared to 15-24 year-olds, and among those outdoors versus indoors during the tornado (AOR = 10.4 (95 per cent CI: 5.5-19.9) and AOR = 6.6 (95 per cent CI: 5.8-7.5), respectively). Females were 1.24 times (95 per cent CI: 1.15-1.33) more likely to be injured than males. Elevated risk of injury was significantly associated with structural damage to the house and tin construction materials. Seeking treatment was protective against death among the injured, odds ratio = 0.08 (95 per cent CI: 0.03-0.21). Further research is needed to develop injury prevention strategies and to address disparities in risk between age groups and between men and women.     

Exploring the use of satellite images in the estimation of potential malaria outbreak regions

Malaria outbreaks affect nearly 40 per cent of the earth's population, most of whom live in tropical and subtropical zones. Malaria is an infectious disease that is transferred by the female mosquito of the species Anopheles. The life cycle of the malaria parasite develops in the anopheline and in the human body. These parasites require suitable environmental conditions in order to complete their development cycles within the mosquito. The relevant parameters are temperature, humidity, vegetation and water. A temperature range of 25–35°C and relative humidity range of 50–80 per cent is suitable for developing malaria outbreaks. As the fly-range of the mosquito is limited to 2–4 km, and since water pools are necessary for breeding, the vector abundance is significantly higher around water bodies. Vegetation cover also has an indirect role on malaria vector abundance. To seek to locate the regions with high potential for malaria outbreaks, we have constructed an experimental map of above-mentioned parameters via remote sensing images. A 7ETM⁺ image of Landsat platform is used in this study and maps of parameters such as land surface temperature, air temperature, air humidity, water pools and vegetated area were produced. However, a weighted combination of these layers showed some poor agreement with the distribution of positive malaria cases collected in the health centres in the region. The methodology first developed in this study is fast and accurate enough to be relied on for forecasting purposes, and could eventually lead—after further research and proper correlations—to improving the targeting of mitigation and relief operations by local health and related organizations.     

Severe drought and the vitamin A status of rural pre-school children in India

A community-based cross-sectional study was carried out in six drought-affected areas of India in 2003 to assess the impact of drought on the vitamin A status of 3,657 rural pre-school children. The prevalence of Bitot's spots was found to be significantly (p < 0.01) higher (1.8 per cent) during drought (odds ratio (OR) = 2.0; 95 per cent confidence interval: 1.6 -2.7). The dietary intake of vitamin A was lower during drought and in 81 per cent of households it was less than 50 per cent of the recommended rate. Severe drought has an adverse impact on the vitamin A status of rural pre-school children, particularly those with illiterate mothers and belonging to an older age group (p < 0.01). Communities need to be sensitised, therefore, to vitamin A deficiency through health and nutrition education, and there needs to be wider coverage of vitamin A supplementation, particularly among children in drought-affected and drought-prone areas.     

A multiple additive regression tree analysis of three exposure measures during Hurricane Katrina

This paper analyses structural and personal exposure to Hurricane Katrina. Structural exposure is measured by flood height and building damage; personal exposure is measured by the locations of 911 calls made during the response. Using these variables, this paper characterises the geography of exposure and also demonstrates the utility of a robust analytical approach in understanding health‐related challenges to disadvantaged populations during recovery. Analysis is conducted using a contemporary statistical approach, a multiple additive regression tree (MART), which displays considerable improvement over traditional regression analysis. By using MART, the percentage of improvement in R‐squares over standard multiple linear regression ranges from about 62 to more than 100 per cent. The most revealing finding is the modelled verification that African Americans experienced disproportionate exposure in both structural and personal contexts. Given the impact of exposure to health outcomes, this finding has implications for understanding the long‐term health challenges facing this population.     

Psychological consequences among adults following the 1999 earthquake in Athens, Greece

One year after the 7 September 1999 earthquake in Athens, Greece, we investigated the psychological consequences among 305 individuals (71 per cent female) residing in the settlements of Ano Liosia Municipality. Adaptability was difficult (63 per cent) due to limited space (50 per cent). Insecurity feelings were predictive of difficult adaptability (chi2= 29.8, p<0.0001) and were common (63 per cent) among married subjects, independent of age (chi2= 5.0, odds ratio (OR): 0.49, 95 per cent confidence interval (CI): 0.26-0.90). Eighty per cent expressed stress feelings, mainly nervousness/tension (60 per cent). Adaptability (chi2= 5.3, OR: 0.5, 95 per cent CI: 0.27-0.9), age (chi2= 6.5, OR: 1.03, 95 per cent CI: 1.01-1.06), and female gender (chi2= 4.7, OR: 0.48, 95 per cent CI: 0.25-0.90) were independent predictors of stress feelings. The majority (55 percent) developed sleep disorders, chiefly insomnia (60 percent). Adaptability problems were the only predictor of sleep disorders (chi2= 6.4, OR: 0.5, 95 per cent CI: 0.33-0.87). Psychiatric medication use increased after the earthquake.     

Disaster risk insurance and catastrophe models in risk‐prone small Caribbean islands

Post‐catastrophe recovery and financial liquidity have long challenged small Caribbean islands. These states are vulnerable to multifarious natural hazards that often cause considerable socioeconomic dislocation. Such events inflict heavy losses on businesses and households, and significantly disrupt all aspects of government operations. After Hurricane Ivan devastated the economies of some islands in September 2004—with estimated losses of as much as 200 per cent of gross domestic product in some cases—regional governments, aided by the World Bank and international donors, approved the creation of a regional catastrophe insurance scheme. This parametric‐based mechanism is underpinned by derivatives‐based catastrophe modelling whose outputs determine policy triggers and pay outs. Hazard models, particularly catastrophe models, are not widely accepted as yet. Despite recent advancements, major concerns have rendered them peripheral tools for many establishments. This paper reviews the region's vulnerabilities and examines constraints on the application of these models and suggests a means of improving their efficacy and acceptability.     

Transformative experiences for Hurricanes Katrina and Rita disaster volunteers

The massive destruction caused by Hurricanes Katrina and Rita in 2005 provided an opportunity for many volunteers to be involved with disaster relief work. Exposure to devastation and personal trauma can have long‐lasting and sometimes detrimental effects on people providing help. This qualitative study explored the experience of volunteer relief workers who provided disaster relief services after the hurricanes. Three major themes emerged: emotional reactions that included feelings of shock, fatigue, anger and grief as well as sleep disturbances; frustration with leadership; and life‐changing personal transformation. Stress reactions were noted but appeared to be mitigated by feelings of compassion for the victims and personal satisfaction in being able to provide assistance. Suggestions are provided for further research.     

Concerns and future preparedness plans of a vulnerable population in New Jersey following Hurricane Sandy

Knowing how people prepare for disasters is essential to developing resiliency strategies. This study examined recalled concerns, evacuation experiences, and the future preparedness plans of a vulnerable population in New Jersey, United States, following Hurricane Sandy in 2012. Understanding the responses of minority communities is key to protecting them during forthcoming disasters. Overall, 35 per cent of respondents were not going to prepare for an event. Intended future preparedness actions were unrelated to respondents' ratings of personal impact. More Blacks and Hispanics planned on preparing than Whites (68 versus 55 per cent), and more Hispanics planned on evacuating than did others who were interviewed. A higher percentage of respondents who had trouble getting to health centres were going to prepare than others. Respondents' concerns were connected to safety and survival, protecting family and friends, and having enough food and medicine, whereas future actions included evacuating earlier and buying sufficient supplies to shelter in place.     

Mother's body mass index as a predictor of infant's nutritional status in the post-emergency phase of a flood

Maternal nutritional status is a determinant of child health. This paper studies the association between a mother's body mass index (BMI) and her infant's nutritional status over a one year time frame after the 1998 flood crisis in Bangladesh. The paper uses secondary analysis of data collected from 757 households in seven rural areas of Bangladesh affected by the 1998 flood using multiple-stage probability sampling techniques (n = 143). Logistic regression models were employed to investigate the predictive impact of maternal BMI on infant's nutritional status after controlling for a range of child and maternal factors. An underweight mother was a significant factor with regard to the risk of infants suffering stunting (odds ratio (OR) = 4.45, 95 per cent confidence interval (CI) = 1.04-18.94) and being underweight (OR = 3.51, 95 per cent CI = 1.02-12.05) a year later, but not wasting (OR = 2.09, 95 per cent CI = 0.51-8.67). The findings suggest that there is a post-emergency link between maternal and infant nutritional health.     

The socioeconomic effects of a landslide in Western Washington

Abstract

Landslides can create permanently unstable sites that cannot be repaired or developed, and as a result, can cause severe economic and social consequences for families and communities. This study examines the economic and social effects of a landslide that struck Western Washington in February 1999. Two years after the landslide, property owners completed a confidential questionnaire. Property owners experienced significant personal financial losses and received little financial assistance to recover. Most (93%) did not receive any relief from their insurance policies, and 7% received only temporary rental assistance. Participants reported a variety of monetary and personal losses that were associated with emotional distress. They also reported a variety of gains and new perspectives on life. In this paper, we consider mechanisms to reduce the economic losses of landslides as well as implications and future research directions.     

A post‐earthquake psychopathological investigation in Armenia: methodology,summary of findings,and follow‐up

The post‐earthquake psychopathological investigation (PEPSI) was designed to probe the short‐and long‐term effects of the earthquake in northern Armenia on 7 December 1988 on survivors' mental and physical health. Four phases of this study have been conducted to date, and, overall, more than 80 per cent of a sub‐sample of 1,773 drawn from an initial cohort of 32,743 was successfully followed during 2012. This paper describes the methodology employed in the evaluation, summarises previous findings, details the current objectives, and examines the general characteristics of the sample based on the most recent follow‐up phase outcomes. Despite a significant decrease in psychopathology rates between 1990 and 2012, prevalence rates of post‐traumatic stress disorder and depression among study participants in 2012 were greater than 15 and 26 per cent, respectively. The paper also notes the strengths and limitations of the study vis‐à‐vis future research and highlights the importance and potential practical implications of similar assessments and their outcomes.     

Mental health in South Sudan: a case for community‐based support

This paper² provides a snapshot of the mental health situation in South Sudan between 2013 and 2016, taking account of the personal reflections of both authors who were engaged in mental health and psychosocial support (MHPSS)³ programming in the country at this time.⁴ It begins by presenting an overview of MHPSS activities from this period, including governmental and non‐governmental organisation (NGO) services, and relevant research and coordination mechanisms. It goes on to illustrate the challenges to the provision of support, as well as the overarching structural, governance, and human resource constraints faced by the sector. Finally, recommendations are put forward for improving services and care for people suffering from psychosocial and mental health issues, as well as suggestions for areas of focus in the future. The importance of an integrated, community‐based model is emphasised, and opportunities for organisations engaged in reconciliation efforts and mental health service provision to collaborate are proposed.     

Livestock mortality in pastoralist herds in Ethiopia and implications for drought response

Participatory epidemiology methods were employed retrospectively in three pastoralist regions of Ethiopia to estimate the specific causes of excess livestock mortality during drought. The results showed that starvation/dehydration accounted for between 61.5 and 100 per cent of excess livestock mortality during drought, whereas disease‐related mortality accounted for between 0 and 28.1 per cent of excess mortality. Field observations indicate that, in livestock, disease risks and mortality increase in the immediate post‐drought period, during rain. The design of livelihoods‐based drought response programmes should include protection of core livestock assets, and it should take account of the specific causes of excess livestock mortality during drought and immediately afterwards. This study shows that, when comparing livestock feed supplementation and veterinary support, relatively more aid should be directed at the former if the objective is to protect core livestock during drought. Veterinary support should consider disease‐related mortality in the immediate post‐drought period, and tailor inputs accordingly.     

Communication,neighbourhood belonging and household hurricane preparedness

This paper reports on an examination of data on how local residents in Tuscaloosa, a mid‐sized city in the state of Alabama, United States, responded to Hurricane Ivan of September 2004. The evaluation revealed that an integrated connection to community‐level communication resources—comprising local media, community organisations and interpersonal networks—has a direct impact on the likelihood of engaging in pre‐hurricane preparedness activities and an indirect effect on during‐hurricane preparedness activities. Neighbourhood belonging mediated the relation between an integrated connection to community‐level communication resources and during‐hurricane preparedness activities. Neighbourhood belonging was determined to increase the likelihood of taking preparedness actions during Hurricane Ivan, but not prior to it. In addition, we discovered an interesting pattern for two different types of risk perceptions: social and personal risk perceptions. Social risk perceptions increase the likelihood of taking preventative steps before a hurricane while personal risk perceptions are positively related to engaging in preventative action during a hurricane.     

Evaluation of Two Kurdish Refugee Camps in Iran, May 1991: The Value of Cluster Sampling in Producing Priorities and Policy

Following the end of the Gulf war in March 1991, Kurdish refugees from Iraq crossed the border into Western Iran. To plan public health interventions and to assist in priority setting for scarce resources, a rapid epidemiological assessment of two camps, Hafez and Kaliche, was conducted in May 1991. A 30 cluster sampling method was used to determine the demographics of the camp population, the morbidity and mortality from certain diseases, and the nutritional status of the children <5 years of age. The estimated population of the camps at the time of the survey was 28,500 and 22,500 for Hafez and Kaliche respectively; children < 5 years of age accounted for approximately 25 per cent of both camp populations. The mortality rate was highest in Hafez and estimated to be 2.5/10,000 per day (95%CI:0.3–5) for adults (> 14 years of age) and 4.9/10,000 per day (95%CI:2.4–7.4) for children. Diarrhoeal and respiratory diseases accounted for major morbidity in both camps with diarrhoea the commonest stated cause of death. Little malnutrition was found but it was greater in Hafez where 6 per cent (19/327) of the children between 1 and 5 years of age had a mid upper arm circumference (MUAC) <12 cm and eleven (5.2 per cent) of the 211 children measured for height and weight were below 80 per cent of the median (95%CI:2.6%;7.8%). The survey identified that morbidity and mortality were less severe than in the Kurdish camps on the Turkish border and provided information for camp authorities to plan appropriate relief interventions.     

Analysis of hazardous material releases due to natural hazards in the United States

Natural hazards were the cause of approximately 16,600 hazardous material (hazmat) releases reported to the National Response Center (NRC) between 1990 and 2008-three per cent of all reported hazmat releases. Rain-induced releases were most numerous (26 per cent of the total), followed by those associated with hurricanes (20 per cent), many of which resulted from major episodes in 2005 and 2008. Winds, storms or other weather-related phenomena were responsible for another 25 per cent of hazmat releases. Large releases were most frequently due to major natural disasters. For instance, hurricane-induced releases of petroleum from storage tanks account for a large fraction of the total volume of petroleum released during 'natechs' (understood here as a natural hazard and the hazardous materials release that results). Among the most commonly released chemicals were nitrogen oxides, benzene, and polychlorinated biphenyls. Three deaths, 52 injuries, and the evacuation of at least 5,000 persons were recorded as a consequence of natech events. Overall, results suggest that the number of natechs increased over the study period (1990-2008) with potential for serious human and environmental impacts.     

Risk of flood-related mortality in Nepal

In July 1993, severe flooding devastated Sarlahi district in Nepal. The next month, a follow-up study of a large population cohort was undertaken. The study is unique in that a prospective research database was used to verify residency prior to the flood and to confirm vital status afterwards. It evaluated 41,501 children aged between two and nine years and adults aged 15-70 in 7,252 households. Flood-related fatality rates were 13.3 per 1,000 for girls and 9.4 per 1,000 for boys, 6.1 per 1,000 for women and 4.1 per 1,000 for men. Flood-related fatality rates for children were six times higher than mortality rates in the same villages a year before the flood (relative risk (RR) = 5.9, 95 per cent confidence interval (CI) 5.0-6.8). Flood-related fatality was associated with low socio-economic status preflood (RR = 6.4, 95 per cent CI 2.7-20.0), and having a house constructed of thatch (RR = 5.1, 95 per cent CI 1.7-24.5).