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.     

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.     

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.     

Vehicle-occupant deaths caused by tornadoes in the United States, 1900–1998

Abstract

Occupants of vehicles encounter an uncertain degree of risk during tornadic storms. The current National Weather Service guidelines suggest we abandon vehicles to lie in a ditch if no sturdy shelter is available. However, these guidelines were developed without the benefit of supporting research. As we are an increasingly vehicle-dependent society, it is important to explore the historical record of vehicle-occupant deaths to see if the National Weather Service guidance is appropriate. The objective of this paper is to investigate the number, distribution, and broad spatial and temporal trends associated with vehicle-occupant deaths that have occurred as a result of tornadoes, and to define the proportion of tornado-induced deaths that have occurred in vehicles.

There were 15,047 deaths caused by tornadoes from 1900 through 1998. Of those, 5685 occurred at a defined site, and 270 were known to have occurred in vehicles. The number of vehicle-occupant deaths, as a proportion of all site-known, tornado-induced deaths, was constant from 1959–1979, but decreased significantly between 1980–1998. The number of deaths was related to several influencing factors. Linear regressions and correlations were employed to determine the degree of relationship between the number of deaths and several explanatory factors. While population, number of vehicle registrations, and number of tornadoes all seemed to influence the number of deaths to some degree, the most significant factor to influence the number of deaths appeared to be vehicle safety features. Most vehicle-occupant deaths occurred during rare F4 tornadoes, when vehicles where thrown from roadways. Regionally, the Great Plains had the highest number of vehicle-occupant deaths from tornadoes.     

Cholera in Sudan: An account of an epidemic in a refugee camp in eastern Sudan, May-June 1985

In 1985 cholera has been a serious problem in the horn of Africa, particularly affecting the many famine victims and refugees in that region. In this paper the history of cholera in Africa is briefly summarized, as is the background to the current refugee situation in eastern Sudan. A cholera epidemic involving 1,175 cases in two adjacent refugee camps in eastern Sudan is described. In this epidemic there were thirteen inpatient deaths and thirty-eight known home deaths from cholera. The management of the epidemic is described in detail. Overall an average of 8 1. of intravenous fluid was used per case, a higher figure than was anticipated, probably because of the unexpected degree of vomiting and the shortage of trained nursing staff.
The relationship between cholera and malnutrition is explored and hypochlorhydria is suggested as the main reason for the increased susceptibility to cholera among malnourished populations. It was observed that severely malnourished adults and children appeared to nave less severe diarrhoea with their cholera, presumably because of reduced mucosal surface area and poor enterocyte function. Finally possible means of aborting cholera epidemics are discussed.     

The social impact of natural hazards: a multi‐level analysis of disasters and forms of trust in mainland China

This study aimed to assess the multi‐level effects of natural hazards on trust in Chinese society. Drawing on the Chinese General Social Survey conducted in 2012 and provincial disaster damage records, it examined the association between individuals’ past experiences of disasters and province‐level damage (measured by the number of affected people, deaths, and economic loss) and various forms of trust: in‐group; out‐group; generalised; and political. The findings indicate that Chinese individuals with experience of disasters have higher levels of out‐group trust but lower levels of political trust. Similarly, at the province level, damage owing to disasters over the past three years (2009–11) positively impacted on residents’ out‐group trust while negatively affecting their political trust. However, when provincial damage was aggregated for disasters over the past five years (2007–11), which included the devastating Sichuan earthquake on 12 May 2008, only total deaths had a positive effect on generalised trust.     

Disaster in the South Paciic: Impact of tropical cyclone "Nomu" on the Solomon Islands, May 1986

Tropical Cyclone "Namu" struck the Pacific nation of the Solomon Islands during 18-20th May 1986. It was sthe most serious natural disaster in the Solomons in lining memory. Nearly a third of the total population of 267,000 were diriven from their homes and 150 people were killed, with damage estimates beginning in AUD 25 million. It has been estimated by the Solomon Islands Ministry of Economic Planning that it will take seven years for the economy to recover. This paper discusses the major events of the disaster episode by employing the Powell and Rayner model of "disaster-time." Factors relating to current disaster Planning and management within the Solomon Islands are outlined. The paper also highlights assistance provided by Australla during the Post-impact sequence and illustrates the type of general disaster preparatory support which Australia provides to South pacific.     

Connectedness, social support and internalising emotional and behavioural problems in adolescents displaced by the Chechen conflict

The study investigated factors associated with internalising emotional and behavioural problems among adolescents displaced during the most recent Chechen conflict. A cross-sectional survey (N=183) examined relationships between social support and connectedness with family, peers and community in relation to internalising problems. Levels of internalising were higher in displaced Chechen youth compared to published norms among non-referred youth in the United States and among Russian children not affected by conflict. Girls demonstrated higher problem scores compared to boys. Significant inverse correlations were observed between family, peer and community connectedness and internalising problems. In multivariate analyses, family connectedness was indicated as a significant predictor of internalising problems, independent of age, gender, housing status and other forms of support evaluated. Sub-analyses by gender indicated stronger protective relationships between family connectedness and internalising problems in boys. Results indicate that family connectedness is an important protective factor requiring further exploration by gender in war-affected adolescents.     

"5·12"汶川大地震人员伤亡的时空分布特点

根据现场调查、新闻发布会和政府部门报表等相关数据,分析了"5·12"汶川大地震人员伤亡的空间分布和时间变化特点,阐述了总人口、总面积、设防烈度和地震实际烈度等因素对死亡人数的影响,定量描述了报道死亡人数随时间的变化情况,给出了部分地区因不同原因造成的人员死亡比例.     

Humanitarian aid and local responses: the aftermath of the rebuilding effort on Tongoa island,Vanuatu

Cyclone Pam swept through the archipelago of Vanuatu on 13–14 March 2015, with wind speeds exceeding those recorded anywhere in the South Pacific since the 1980s. Southern and central parts of the country were particularly affected. Material damage on Tongoa, one of the most afflicted islands, was extensive, but no deaths were reported. During the storm, villagers found shelter in their kitchen, in what is considered locally as a ‘lifeboat’. The aftermath was managed and mitigated by international aid organisations. On Tongoa, this included a ‘Shelter Cluster’ programme, under which villagers were given house rebuilding kits. Elaborating upon extensive ethnographic investigations on site between 2011 and 2018, this paper explores and reveals the ways in which this aid generated confusion among the local population. In a larger context of regular disasters triggered by natural hazards, locals have found endogenous ways of dealing with such extreme climatic events, for the most part without any external assistance.     

Changes in HIV/AIDS/STI knowledge, attitudes and practices among commercial sex workers and military forces in Port Loko, Sierra Leone

Sierra Leone suffered from 11 years of civil war (1991-2002) resulting in tens of thousands of deaths and mutilations together with massive population displacement. In 2001, ARC International, Sierra Leone conducted a baseline survey of 201 commercial sex workers (CSWs) and 202 military respondents on the knowledge, attitudes and practices surrounding HIV/AIDS and STIs in Port Loko, Sierra Leone. In 2003, a comparable post-intervention survey of 202 CSWs and 205 military respondents was performed. Comparison of baseline and post-intervention results showed that HIV/AIDS knowledge increased among both groups, with those able to name three effective means of avoiding AIDS increasing from 5 per cent to 70 per cent among CSWs, and 11 to 75 per cent among the military. Reported condom use during last sex increased among CSWs from 38 to 68 per cent and among military from 39 to 68 per cent. These results demonstrate that, despite the challenges inherent in a post-conflict country, good-quality AIDS-prevention programmes can be effective.     

Entitlements and the Wollo Famine of 1982–1985

The traglic recent events in Ethiopia and other parts of Africa have again foccussed attention on the different anaytical approaches to the problems iof famine. Perhaps the most important analytical contribution to this field has been Sen's "entitlements approach." One of the case studies Sen used to articulate this approach was of the 1972–1973 famine in Wollo Province, Ethiopia. This article provides a provisional assessment of the famine process in the Wollo during 1982–1985 to set against the analysis by Sen of the earlier famine. Some striking contrasts are revealed.     

Individual relocation decisions after tornadoes: a multi‐level analysis

This study examines how multi‐level factors affected individuals' relocation decisions after EF4 and EF5 (Enhanced Fujita Tornado Intensity Scale) tornadoes struck the United States in 2013. A telephone survey was conducted with 536 respondents, including oversampled older adults, one year after these two disaster events. Respondents' addresses were used to associate individual information with block group‐level variables recorded by the American Community Survey. Logistic regression revealed that residential damage and homeownership are important predictors of relocation. There was also significant interaction between these two variables, indicating less difference between homeowners and renters at higher damage levels. Homeownership diminished the likelihood of relocation among younger respondents. Random effects logistic regression found that the percentage of homeownership and of higher income households in the community buffered the effect of damage on relocation; the percentage of older adults reduced the likelihood of this group relocating. The findings are assessed from the standpoint of age difference, policy implications, and social capital and vulnerability.     

Evaluation of a population mobility,mortality, and birth surveillance system in South Kivu,Democratic Republic of the Congo

Prospective, community-based surveillance systems for measuring birth, death, and population movement rates may have advantages over the ‘gold-standard’ retrospective household survey in humanitarian contexts. A community-based, monthly surveillance system was established in South Kivu, Democratic Republic of the Congo, in partnership with a local implementing partner and the national ministry of health. Data were collected on the occurrence of births, deaths, arrivals, and departures over the course of one year, and a retrospective survey was conducted at the end of the period to validate the information. Discrepancies between the two approaches were resolved by a third visit to the households with discordant records. The study found that the surveillance system was superior in terms of its specificity and sensitivity in measuring crude mortality and birth rates as compared to the survey, demonstrating the method's potential to measure accurately important population-level health metrics in an insecure setting in a timely, community-acceptable manner.     

Health Effects of the 1991 Bangladesh Cyclone: Report of a UNICEF Evaluation Team

To assess the impact on health of the cyclone and tidal wave that struck the southern coast of Bangladesh on the evening of 29 April 1991, a team of health professionals visited cyclone affected areas from 4–27 June, 1991. Team members met with health workers and officials of the Government of Bangladesh and with staff pom nongovernmental organizations, and conducted field surveys in two severely affected areas.
Mortality among the 135 households surveyed (pre-cyclone population 1,123) was 14 per cent. At highest risk of deaths were children of less than 10 years (26 per cent mortality) and women of more than 40 (31 per cent mortality). Almost all deaths occurred as a result of drowning from the tidal wave that accompanied the cyclone. Although 95 per cent of the population surveyed had received warning of the cyclone four or more hours before it struck, the 300 existing cyclone shelters had capacity for only 450,000 of the 5,000,000 people affected by the cyclone. Deaths following the cyclone were few. Diarrhea caused by Vibrio cholerae and Shigella dysenteria type 1, both of which are endemic in Bangladesh, occurred in the post-cyclone period. Reports by the national Diarrhea Surveillance System of large increases in diarrheal incidence following the cyclone were difficult to assess because of inconsistencies in pre-and post-cyclone reporting methods. No increase in other infectious diseases was identified.
Although water availability had been a major concern following the cyclone, the tubewell system was functioning well in the area that was surveyed. Distribution of relief assistance by the Government of Bangladesh and by non-governmental organizations was good, with 95 per cent of families surveyed receiving food aid within five days of the cyclone.
The major health effect of this cyclone was acute deaths due to drowning. Preventing deaths during future cyclones will require increasing accessible shelter.     

An Examination of the 1990-91 Famine in Sudan

Shortly before and during the harvest of 1990, a series of warnings were issued by concerned international and UN agencies that Sudan would experience a very poor harvest followed by an acute food shortage over the period 1990-91. The 1990 harvest was estimated to be similar to that obtained in 1984. After the very poor harvest in 1984, Sudan experienced a major famine during which deaths may have numbered in the hundreds of thousands. There were fears that this experience might be repeated in 1990 - 91. By the time of the subsequent 1991 harvest, it was clear to all that a severe food crisis had been experienced. There were severe shortages of water and food and very high malnutrition rates of children were noted by UNICEF across a wide range of areas. Despite these adverse indications, starvation deaths were probably numbered in thousands, rather than hundreds of thousands. Famine mortality, which may include deaths from famine associated disease, was similarly low. The initial predictions, it now seems, may have over-estimated famine mortality almost one hundred times. Several potential explanations of the over-estimate are examined. These include prediction errors, government and donor responses to the drought such as food aid and immunization, and traditional community and household level coping strategies in times of food shortage.     

Practical experience with the management of a cholera outbreak in a refugee cAMP in eastern Sudan, 1985

From May to November 1985 most refugee camps in Eastern Sudan were affected by cholera. This article summarizes the experience from the refugee camp Wad Sherife with the emphasis on the practical aspects of management of cholera in a refugee context. Paramedical personnel from the refugee community were used to a great extent both in curative and preventive measures. The home visitors played an important role in the early detection of the cases and in trying to prevent the spread of cholera in the camp. A total of 1793 cases were admitted during a three month period. The results show a case fatality rate of 1.8%. A significantly higher number of women were affected in the age group 15–44. As seen in other refugee camps in Eastern Sudan, there was a relatively high intravenous fluid consumption with an average of about 6 litres in adults.     

Deaths in natural hazards in the solomon islands

Archival and library search techniques have been used to establish extensive databases on deaths and damage resulting from natural hazards in the Solomon Islands. Although the records of fatalities are certainly incomplete, volcanic eruptions, tropical cyclones, landslides, tsunami and earthquakes appear to have been the most important. Only 22 per cent of the recorded deaths have resulted from meteorological hazards but a single event could change this proportion significantly. Five events in the fatality database account for 88 per cent of the recorded deaths. Future death tolls are also likely to be dominated by a small number of events. While the expected number of deaths in a given period is dependent upon the length of record considered, it is clear that a disaster which kills one hundred or more people in the Solomons can be expected more frequently than once in a hundred years.     

The Yellow Fever Epidemic in Western Mali,September—November 1987: Why Did Epidemiological Surveillance Fail?

Recent yellow fever epidemics in West Africa have underlined the discrepancy between the official number of cases and deaths and those estimated by a retrospective epidemiological investigation. During the yellow fever epidemic that broke out in western Mali in September 1987, a total of 305 cases and 145 deaths were officially notified, but estimates revealed true figures abut five times higher. This paper attempts to discuss the factors that hindered early case detection and more complete reporting. They were, first, the insufficient training on the clinical diagnosis, the blood sampling method for laboratory confirmation, and the curative treatment of patients (resulting in low utilization of services); second, the lack of an action plan to prepare in advance a quick response to the epidemic, affecting reporting procedures at the peripheral level and active case-finding during the outbreak; and third, the lack of laboratory facilities for a quick confirmation of the disease.
The difficulties experienced during the yellow fever epidemic in Mali demonstrated the importance of a preparedness strategy for epidemic control, based on an integrated approach of epidemiological surveillance within basic health service activities. The need for regional collaboration and for institutionalized funds in the donor community that could be mobilized for epidemic preparedness activities is also emphasized.