Impact of a commercial destocking relief intervention in Moyale district, southern Ethiopia

A commercial destocking intervention was piloted in southern Ethiopia during the drought of early 2006. The intervention led to the purchase of an estimated 20,000 cattle valued at USD 1.01 million. On average, destocked households received USD 186 from the sale of cattle--approximately 5,405 households were involved. In terms of aid investment, the approximate cost-benefit ratio was 41:1. During the drought, income from destocking accounted for 54.2 per cent of household income (n = 114 households), and was used to buy food, care for livestock, meet various domestic expenses, support relatives, and either pay off debts or augment savings. Seventy-nine per cent of the income derived from destocking was used to buy local goods or services. Expenditure on livestock care amounted to 36.5 per cent of local spending, and included the private transportation of livestock to better grazing areas. The buoyant livestock export trade was considered to be an important driver of commercial destocking, demonstrating a positive link between livestock and meat exports, and pastoral vulnerability during drought.     

Impact of drought‐related vaccination on livestock mortality in pastoralist areas of Ethiopia

Under a national Livestock Policy Forum in Ethiopia the impact of livestock vaccination during drought was assessed in order to inform the development of a best‐practice guideline. For each of the different types of vaccine used during drought years there was no significant difference in livestock mortality, for any species, in vaccinated compared with non‐vaccinated herds. The limited impact of vaccination on livestock mortality was attributed to weaknesses in the design and implementation of vaccination programmes, including use of inappropriate vaccines, low vaccination coverage, problems with vaccine dosing, incorrect timing of vaccination and problems with vaccine storage. If these weaknesses could be overcome vaccination could be a useful means to protect livestock assets, with considerable benefit‐cost ratios. Vaccination should be conducted as a standard preventive measure during normal years, and programme design should be informed by participatory epidemiological studies.     

Risk factors for long‐term post‐traumatic stress disorder among medical rescue workers appointed to the 2008 Wenchuan earthquake response in China

This study aims to determine the risk factors for clinically‐significant post‐traumatic stress disorder (PTSD) among Chinese medical rescue workers one year after the response to the Wenchuan earthquake on 12 May 2008. A sample of 337 medical workers who performed response work within the first three months of the event completed an online questionnaire, which included information on demographics, social support, the management and organisation of the disaster response, and an assessment of PTSD. Symptoms consistent with PTSD were prevalent in 17 per cent of the rescue workers. Those who developed PTSD symptoms were more likely to have been injured, experienced a water shortage, been disconnected from family and friends during the response, and have passive coping styles and neurotic personalities. Factors that cannot be changed easily, such as personality traits, should be evaluated prior to deployment to ensure that rescue workers at higher risk of PTSD are provided with adequate support before and during deployment.     

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).     

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.     

Tsunami mortality and displacement in Aceh province, Indonesia

A survey of 388 Indonesian households displaced by the December 2004 tsunami was conducted in Aceh province in February 2005. Of tsunami-displaced households in Aceh Barat and Nagan Raya districts, 61.8 per cent reported one or more family members as dead or missing due to the tsunami, with an overall mortality rate of 13.9 per cent (95% confidence interval (CI): 12.4-15.4). Risk of death was greatest in the youngest and oldest age groups, and among females. Overall, 36 per cent of tsunami-displaced households indicated an intention to return to their original community within three months, and displaced households residing in host communities were 2.2 (95% CI: 1.2-2.8) times more likely to state an intention to return to their original villages or another community as those residing in camps. The tsunami recovery effort should focus on strategies that facilitate either prompt return or permanent, voluntary relocation for those displaced.     

Earthquake mortality in Pakistan

A strong earthquake, measuring 7.6 on the Richter scale, hit northern Pakistan on 8 October 2005, causing massive destruction, including an official death toll of 73,276. Four cross-sectional surveys were performed in late 2005 to assess mortality before the event, on the day, and subsequently. Two surveys were community-based and two were situated in camps for internally displaced persons. Crude mortality rates were low in the 3.5 months preceding the earthquake (less than 0.1 deaths per 10,000 per day) and slightly higher in the six-to-eight weeks after the earthquake (ranging from 0.10–0.43 per 10,000 per day). On 8 October 2005, approximately two per cent of the population in one community survey died and around five per cent in the other three surveys. Children less than five years and adults more than or equal to 50 years tended to have a higher risk of mortality on the day of the disaster. These results corroborate the high mortality caused by the earthquake.     

Overview of deaths associated with natural events, United States, 1979–2004

Analysis of the National Center for Health Statistics' Compressed Mortality File showed that between 1979 and 2004, natural events caused 21,491 deaths in the United States. During this 26-year period, there were 10,827 cold-related deaths and 5,279 heat-related deaths. Extreme cold or heat accounted for 75 per cent of the total number of deaths attributed to natural events— more than all of deaths resulting from lightning, storms and foods, and earth movements, such as earthquakes and landslides. Cold-related death rates were highest in the states of Alaska, Montana, New Mexico, and South Dakota, while heat-related deaths were highest in the states of Arizona, Missouri, and Arkansas. These deaths occurred more often among the elderly and black men. Other deaths were attributed to lightning (1,906), storms and foods (2,741), and earth movements (738). Most deaths associated with natural events are preventable and society can take action to decrease the morbidity and mortality connected with them.     

The great Australian drought: 1982-1983*

The development of drought over eastern Australia from April 1982 to February 1983 is described. National wheat production for the 1982-1983 season was 63 per cent of the average for the previous five years, while for New South Wales and Victoria production was 29 and 16 per cent respectively. Production of other grains was similarly reduced. Net value of rural production was reduced from over $4,000 million to $2,300 million nationally, the percentage reduction being much larger in drought-affected States. Methods of assessing drought severity are discussed and it is concluded that the 1982-1983 drought must be regarded as one of the most severe in the last 100 years. Impact of drought is also discussed, including that on wheat production and sheep and cattle populations since 1885. It is suggested that the limits of grain growing areas, and of sheep and cattle populations, beyond which environmental degradation may occur, have been exceeded during that period. The view is expressed that more attention should be given to the development of strategies to ameliorate drought impacts.     

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.     

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.     

The Accuracy of Mortality Reporting in Displaced Persons Camps During the Post-emergency Phase

For humanitarian organisations, accurate data are essential to identify emerging health problems and determine programme needs. We visited 45 post-emergency phase displaced persons camps and collected three months' mortality data which we compared with organisations' routine mortality reports. Organisations reported 612 deaths and we identified 741 deaths, for a mortality-reporting ratio, defined as the number of organisation-reported deaths divided by the number of investigator-identified deaths, of 83 per cent. For the majority of camps which under-reported deaths, mortality reporting ratios were significantly higher for women than men, and for camps with central mortality registers rather than those without. In the few camps which over-reported deaths, these occurred primarily among children younger than five years of age, probably due to the inclusion of abortions and stillbirths. Despite the overall under-reporting of deaths by humanitarian organisations, the existing health information systems appear to estimate mortality rates adequately in these post-emergency camps. However, organisations should improve the precision and completeness with which they report the characteristics of deaths in order to provide valuable data to target their programmes at the most vulnerable people.     

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.     

Economic evaluation of measles catch-up and follow-up campaigns in Afghanistan in 2002 and 2003

This paper assesses the cost-effectiveness of, and the return on the investment in, the 2002 catch-up and the 2003 follow-up measles campaigns in Afghanistan from the perspective of the donor. The catch-up campaign targeted nearly 12 million children aged between six months and 12 years, while the follow-up campaign targeted over five million children aged between 9 and 59 months. Both campaigns successfully vaccinated approximately 96 per cent of the respective target populations, and are expected to avert an estimated 301,000 measles deaths over the next 10 years. The average cost per dose of measles vaccine delivered was USD 0.40. The cost per death prevented is USD 23.6, assuming a case fatality rate of 10 per cent and a discount rate of three per cent. With more than 42,000 measles deaths avoided for every one million US dollars spent, the campaigns are an excellent public health investment for precluding childhood mortality in a country affected by a complex emergency.     

Reproductive health in Afghanistan: results of a knowledge, attitudes and practices survey among Afghan women in Kabul

A reproductive-health knowledge, attitudes and practices (KAP) survey was carried out among 468 Afghan women of reproductive age. A convenience sample of women was selected from attendees in the outpatient departments of four health facilities in Kabul. Seventy-nine per cent of respondents had attended at least one antenatal consultation during their last pregnancy. Two-thirds (67 per cent) delivered their first child between 13 and 19 years. The Caesarean-section rate was low (1.6 per cent). Two-thirds (67 per cent) of deliveries occurred in the home. The contraceptive prevalence rate was 23 per cent (16 per cent modern and 7 per cent natural methods). Twenty-four per cent had knowledge of any STIs, although most of these women did not know correctly how to prevent them. Most of the women (93 per cent) needed authorization from their husband or a male relative before seeking professional health-care. In multivariate analysis, women's schooling was significantly associated with antenatal-care attendance (AOR 4.78), institutional delivery (AOR 2.29), skilled attendance at birth (AOR 2.07) and use of family planning (AOR 4.59). Reproductive-health indicators were noted to be poor even among these women living in Kabul, a group often considered to be the most privileged. To meet the reproductive-health needs of Afghan women, the socio-cultural aspects of their situation--especially their decision-making abilities -- will need to be addressed. A long-standing commitment from agencies and donors is required, in which the education of women should be placed as a cornerstone of the reconstruction process of Afghanistan.     

Entitlements, coping mechanisms and indicators of access to food: wollo region, ethiopia, 1987-88

Vulnerability to famine and traditional responses to food insecurity in Wollo Region, Ethiopia are described. The timeliness of anthropometric and socio-economic indicators of access to food is then assessed, using data collected in Wollo by Save the Children Fund during 1987–88, a period of drought and subsequent food insecurity. The movements of different indicators are then examined for evidence of correspondence at sub-district level. The author concludes that although anthropometric status does not respond as early as crop yield or grain price, a deterioration in anthropometric status is detectable at a stage when livestock and migration indicators show little or no change and mortality rate remains unaffected. At sub-district level, changes in different indicators are not well-correlated.     

Social network characteristics and resource access among formerly displaced households in Lira,Uganda

In rural African communities, the support of extended family, friends, and neighbours is essential in borrowing or leveraging land, labour, food, and money, especially at times of social and financial turmoil. Little is known, though, about the nature of the networks and the conditions under which they may generate greater support in post‐conflict communities. This study, conducted in the Lira district of northern Uganda, examined the composition, proximity, and size of the networks that households utilise to gain access to resources during and after resettlement. Network structures with more kin and co‐resident ties were found to offer greater resource access to households in post‐conflict settings. Furthermore, there was a lack of meaningful linkages outside of a person's own village, especially with regard to households whose head has no or a low level of education. These findings enhance understanding of the specific role of relationships in social support for resource access among households in post‐conflict communities.     

Build back better: implementation in Victorian bushfire reconstruction

The ‘build back better’ (BBB) concept signals an opportunity to decrease the vulnerability of communities to future disasters during post‐disaster reconstruction and recovery. The 2009 Victorian bushfires in Australia serve as a case study for this assessment of the application of core BBB principles and their outcomes. The results show that several BBB measures were successfully implemented in Victoria and are relevant for any post‐disaster reconstruction effort. The BBB initiatives taken in Victoria include: land‐use planning determined by hazard risk‐based zoning; enforcement of structural design improvements; facilitated permit procedures; regular consultations with stakeholders; and programmes conducted for social and economic recovery. Lessons from the Victorian recovery urge the avoidance of construction in high‐risk zones; fairness and representativeness in community consultations; adequate support for economic recovery; the advance establishment of recovery frameworks; and empowerment of local councils.     

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.