Disease Surveillance and Control After a Flood: Khartoum, Sudan, 1988

Following a flood in Khartoum, Sudan, emergency disease surveillance was implemented to monitor the health status of the population. Simple, symptom-oriented case definitions for diarrheal disease, measles, respiratory disease, malaria, and jaundice were included on the report form used to collect daily counts of outpatients in a sample of both temporary and permanent clinics located in areas of the city most affected by the flood. Data collected from major teaching hospitals allowed comparison of pre- and post-disaster levels of morbidity and mortality. In addition, special surveys collected information unobtainable from health facilities. Sentinel clinic surveillance data indicated that diarrheal disease accounted for the greatest number of clinic visits, while malaria was the second most common reason for seeking medical attention. Malaria blood smear surveys showed that the parasitemia prevalence ranged from 11% to 19% in the general population and from 21% to 46% among febrile clinic patients. Hospital admission data demonstrated an increase in morbidity from diarrhea and malaria in August 1988, when compared to previous months and August of the previous year, although it is uncertain whether this increase was due to the flood. Nutrition surveys demonstrated that 23% of young children were moderately or severely undernourished, with substantial variation by area of the city. No major outbreaks of communicable disease were detected in the 4 weeks after the flood. Disease surveillance provided data useful in identifying public health problems, setting priorities, targeting interventions and controlling rumors. Disease control measures taken by the Ministry of Health included provision of potable water, standardization of medical care, and distribution of immunizations, oral rehydration salts, and vitamin supplements to children.     

Operation Child-ID: reunifying children with their legal guardians after Hurricane Katrina

Children constitute a vulnerable population and special considerations are necessary in order to provide proper care for them during disasters. After disasters such as Hurricane Katrina, the rapid identification and protection of separated children and their reunification with legal guardians is necessary in order to minimise secondary injuries (i.e. physical and sexual abuse, neglect and abduction). At Camp Gruber, an Oklahoma shelter for Louisianans displaced by Hurricane Katrina, a survey tool was used to identify children separated from their guardians. Of the 254 children at the camp, 36 (14.2 per cent) were separated from their legal guardians. Answering 'no' to the question of whether the accompanying adult was the guardian of the child prior to Hurricane Katrina was a strong predictor (27.8 per cent versus 3.2 per cent) of being listed as 'missing' by the National Center for Missing and Exploited Children (NCMEC). All the children at Camp Gruber who were listed as 'missing' by the NCMEC were subsequently reunited with their guardians.     

Post-Emergency Epidemiological Surveillance in Iraqi-Kurdish Refugee Camps in Iran

In 1991 a computerized, comprehensive epidemiological surveillance system was developed to monitor health trends in approximately 25,000 acutely displaced Kurds in Nowsood and Saryas refugee camps, Bakhtaran region, Northwestern Iran. In addition, community-based surveys offered information unobtainable from health facilities. Weekly population movements, attack rates, point-prevalence estimates, and case fatality ratios were calculated, and the data were analysed and compared. The overall crude mortality rate (CMR) in the camps under study was still 9 times higher than the reported CMR for Iraq. Health problems with very low rates (less than 1.0/ 1,000 population/week) included the triad of measles, meningitis and tetanus. However, morbidity for the most common conditions (acute respiratory infections, diarrhoea, skin infections, eye diseases and, finally, typhoid fever) was shown to increase at the end of the intervention, highlighting that the pressure of repatriation on refugees made them progressively worse. This article concludes that epidemiological surveillance systems should be implemented during mass-migrations in developing countries also in post-emergency settings. Furthermore, surveillance appears to be indispensable in order for the international agencies to keep abreast of events and to safeguard human rights when international attention subsides.     

Symptomatic profile and health‐related quality of life of persons affected by the Prestige catastrophe

This study analyses the impact of the Prestige oil spill on the mental health and the perception of physical health and functional capacity in the affected population. The sample comprised 926 residents from the section of the Spanish coast affected by the oil spill. The data was collected slightly more than one year after the accident. Scales referring to clinical symptoms (SCL‐36) and health‐related quality of life (SF‐36) were administered. The results suggest that individuals with higher degrees of exposure or residing in areas closest to the spill show lower levels of mental health in comparison to those with lower levels of exposure or living in areas farther away from the spill. This study also finds that women and fishermen tend to suffer more from the consequences of these types of disaster.     

Health response to a large and rapid influx of Albanian refugees in southern Italy, 1991

Over a two-day period in March 1991, more than 23,000 Albanian refugees arrived without warning in the southern Italian port of Brindisi. A simple surveillance system was established within days of their arrival to monitor health problems that were expected to have a high frequency, were of concern to the Italian health care system because of potential spread to the local population, and were susceptible to therapeutic or preventive measures. The most commonly encountered health problems were pediculosis and scabies. Despite poor sanitary conditions, only one outbreak of gastrointestinal disease was reported. Obstetric events were common, and many resulted in adverse outcomes. Hospitalization rates were high, although in the early weeks of the emergency, many were unwarranted. This experience demonstrates the value of a simple, rapid surveillance system in prioritizing health problems and preventing rumors. In future, greater emphasis should be placed on outpatient management of simple medical problems.     

Inclusive education for children with disabilities in a refugee camp

Children in refugee camps, and particularly those with disabilities, face unique challenges in accessing education and are at high risk of being marginalised. Best practices suggest that main-streaming is the optimal strategy for serving students with disabilities. This study examines the extent to which mainstreaming in a refugee camp helps to promote children's prosocial behaviours, taking into account their emotional and behavioural problems. In Kakuma Refugee Camp, Kenya, researchers collected data from the parents of children currently enrolled in special needs education centres (n=65) and from those formerly enrolled at these facilities who transitioned to mainstream classrooms (n=81). Children in mainstream schools functioned better in terms of prosocial behaviours, but this relationship disappeared when factoring in children's emotional and behavioural difficulties. In the context of a refugee camp, mainstreaming alone is not likely to help children's psychosocial and educational functioning, which requires dedicated supports, appropriate facilities and infrastructure, and a dual focus on disability-specific and disability-inclusive initiatives.     

Tuberculosis in a Refugee Camp: A campaign to reduce transmission

In November 1985, tuberculosis was highly prevalent among the 6,250 Tigrayan refugees ofFau I camp in Eastern Sudan. It was therefore decided to launch an active case-finding campaign aimed at decreasing transmission, to be carried out by primary health care workers. The entire population of the camp was screened for symptoms of pulmonary tuberculosis and the sputum of people with productive cough was examined by direct microscopy. However, it was considered that this examination was insufficiently sensitive in the camp situation. For this reason, people with non-productive cough or sputum-negative were enrolled in a follow-up program whose length was determined by the severity of their symptoms.
The campaign was interrupted by circumstances that are typical of refugee situations. On the basis of results obtained a few conclusions can nonetheless be made on the appropriateness of introducing an active screening program in situations where a stable refugee population has good access to basic health care of good quality.     

北京市河流水生态健康时空异质性及改善路径研究

河流生态系统是人类社会得以生存与发展的基本条件,河流水生态健康对保障区域水安全,避免水灾害具有重要意义.随着城市化的不断推进,河流生态系统面临着巨大挑战,水生态风险及灾害呈现广发、频发和深发态势.通过汇总北京市五大流域河流水生态健康状况评估相关研究,识别区域水生态系统主要问题,诊断水生态健康问题产生的原因.结果表明,北...     

Childhood Immunisation in Rural Afghanistan: The EPI Programme, 1987-91

A decade of outright war followed by civil strife and conflict has hindered the development of health care services for the population of rural Afghanistan. Despite the absence of a functional health care system and the fragmentation of the Afghan resistance, and despite widely held views to the contrary, it has proved possible to set up a technically valid and politically acceptable Expanded Programme of Immunisation (EPI). This paper discusses some of its technical and programmatic aspects and the rationale behind some of the very unusual choices made – such as the use of DPTP, the inclusion of girls 3–14 years old for TT immunisation, a vertical programme structure and a predominance of mobile and outreach strategies. The paper argues against the mindless use of global or handbook recipes. The keys to success have been strategic vision, intimate knowledge of the local context and pragmatic choices for options that are simple and effective.     

Surveillance of the Health and Nutritional Status of Rohingya Refugees in Bangladesh

Early in 1992, Bangladesh experienced an influx of Burmese refugees, reaching a total of 263,000 by May. As the health and nutritional status of the refugee population was reportedly poor, a need was felt to collect dependable data through epidemiological surveillance, on which interventions could be based. The nutritional and health status of children was dramatically poor in all camps surveyed and a deterioration was expected in the coming monsoon. Several problem areas could be identified. Based on these findings it was possible to undertake appropriate action and to avert threatening calamities. Epidemiological surveillance is an important monitoring tool to provide reliable data on the health and nutritional status of refugee populations and to help the organizations involved to prioritize and evaluate their actions.     

Effects of floods on the use and condition of pit latrines in rural bangladesh

The severe floods of 1987 in Bangladesh had devastating effects on many development activities. Here, the use and condition of improved sanitation facilities (double pit water sealed latrines) during the 1987 peak flood period are presented. Two surveys on the use and condition of the latrines were carried out in May (pre-flood) and September (post-flood) 1987 in a rural area 60 km north of Dhaka, with a population of about 4500. General usage of the latrines by the population aged five years or more decreased from 88% to 78% ( p < 0.001) after the flood. Only 40% of the 343 latrines which were in use and had no damaged component at the time of the pre-flood survey still had no damaged components after the floods. Fencing was the component which suffered the most damage. It was the only component which was installed and maintained by the users, project staff being responsible for all other components. The estimated post-flood repair cost was approximately US $4.0 per latrine. Development of an affordable and durable fencing is recommended.     

Mental health and media links based on five essential elements to promote psychosocial support for victims: the case of the earthquake in Chile in 2010

This paper reviews the role of news with respect to the mental health of a population exposed to a disaster. It is based on the five essential elements of psychosocial care presented by Stevan E. Hobfoll et al. (2007) that can be introduced after a potentially traumatic event: promoting a sense of safety, calming, self and collective efficacy, connectedness, and hope. This study developed a method to relate these elements to television coverage and applied it to the stories (n=1,169) aired by the main networks in Chile in the 72 hours after an 8.8 magnitude earthquake struck on 27 February 2010. Of the five elements, promoting a sense of safety occurred most often (82.72 per cent), whereas the others were barely present (less than 10 per cent). The study argues that these elements can increase the possibility of framing the news, given that the audience watching can also be affected by a disaster.     

城市防灾减灾设施的层级选址问题建模

提出了城市防灾减灾设施的层级选址问题,并对其进行了分类.针对高低级设施相对独立和相互从属的层级选址问题进行了建模.依据城市防灾减灾设施选址问题的特点,提出了两阶段的层级选址过程:(1)使用位置集合覆盖模型确定能覆盖全部需求点所必需的最少设施数量和位置,作为基本等级设施的选址;(2)对独立型层级选址问题,使用最大覆盖准则确定高级设施的位置,对从属型层级选址问题,使用极小和准则确定高级设施的位置.对层级选址问题模型的应用进行了讨论.     

Mortality rate and confidence interval estimation in humanitarian emergencies

Surveys are conducted frequently in humanitarian emergencies to assess the health status of the population. Most often, they employ complex sample designs, such as cluster sampling. Mortality is an indicator commonly estimated in such surveys. Confidence limits provide information on the precision of the estimate and it is important to ensure that confidence limits for a mortality rate account for the survey design and utilise an acceptable methodology. This paper describes the calculation of confidence limits for mortality rates from surveys using complex sampling designs and a variety of software programmes and methods. It contains an example that makes use of the SAS, SPSS, and Epi Info software programmes. Of the three confidence interval methods examined—the ratio command approach, the modified rate approach, and the modified proportion approach—the paper recommends the ratio command approach to estimate mortality rates with confidence limits.     

The Role of the Zairian Health Services in the Rwandan Refugee Crisis

In July 1994, a stream of Rwandan refugees entered the southern part of North Kivu Region, Zaire. The public health consequences of this crisis for the host population and health services have not been analysed up to now. The lack of human and financial resources did not prevent Zairian health structures and personnel from taking care of the many refugees settled outside the camps, following their arrival. The public health consequences of the crisis for the local population should be considered an integral part of the disaster.     

油页岩地下开采巷道围岩的流变特性及工程应用

为研究油页岩巷道围岩的流变特性,采用岩土SJ-1B三轴蠕变仪对油页岩进行了三轴蠕变试验。根据试验结果,建立了油页岩非线性蠕变方程。根据上述非线性蠕变方程,以吉林桦甸油页岩矿一井运输大巷为工程背景,分析了围岩的应力场和位移场,并对不同支护强度和应力状态下的蠕变变形进行了系统的分析。研究结果表明,油页岩蠕变具有非线性,控制油页岩巷道围岩过量变形的根本途径是改变围岩的应力状态,以及适当提高锚杆、锚索的初始预应力。本文为有效控制油页岩开采时巷道围岩的有害变形提供了理论依据。     

The impact of drought on production, consumption and nutrition in southwestern kenya

In this paper I compare the effects of the 1984 drought on agricultural production, income, food consumption, and nutrition of farm and non-farm households in South Nyanza District, Kenya. Survey work covered the period 1984 to 1987. It was the late arrival of the long rains in spring 1984, rather than an absolute shortfall in rain, that caused most of the fluctuations in agricultural production. Agricultural households who were least affected by the drought were able to cope by increasing the amount of cultivated land and by relying more on coarse grain production. Coping strategies for the landless households in South Nyanza were more limited and this group of households therefore experienced greater fluctuations in income between the drought and non-drought periods than did most types of agricultural households. Surprisingly, changes in food consumption between the drought and non-drought periods were small for most households. In spite of differences in production, food availability and incomes, however, the health and nutritional status of pre-school-aged children was not significantly different in the two time periods. Differences in health and nutritional status appear to be influenced more by community-level health and sanitation factors than by differences in agricultural production and incomes in drought and non-drought years.     

Mortality and morbidity in refugee camps in eastern Sudan: 1985-90

Civil war has disrupted life in Ethiopia since the 1960s and many people have sought refuge in Eastern Sudan, particularly during the famine emergency of 1984–85. UNHCR has provided the main financial support for the refugee programme, but began scaling down operations in 1990. Nearly 300,000 refugees still live in camps and benefit from food and health programmes. Health services are co-ordinated by the Sudanese Refugee Health Unit which operates a centralised health and nutrition surveillance system with the co-operation of the NGOs responsible for health care in the camps. A revision of the monthly reporting system and the establishment of a computer database in 1990 provided an opportunity to review the situation in the camps over the five years since the emergency. Child death rates for example, appear to have been reduced to levels below those expected in rural Africa. Patterns of mortality, morbidity, and nutritional status are outlined here and point to the general effectiveness of the health care programme. The surveillance system can, however, be used to identify those camps which have persistent problems, while monthly comparisons with the situation in previous years can provide early warning of deteriorating conditions.     

Health care system hazard vulnerability analysis: an assessment of all public hospitals in Abu Dhabi

Hazard vulnerability analysis (HVA) is used to risk‐stratify potential threats, measure the probability of those threats, and guide disaster preparedness. The primary objective of this project was to analyse the level of disaster preparedness in public hospitals in the Emirate of Abu Dhabi, utilising the HVA tool in collaboration with the Disaster Medicine Section at Harvard Medical School. The secondary objective was to review each facility's disaster plan and make recommendations based on the HVA findings. Based on the review, this article makes eight observations, including on the need for more accurate data; better hazard assessment capabilities; enhanced decontamination capacities; and the development of hospital‐specific emergency management programmes, a hospital incident command system, and a centralised, dedicated regional disaster coordination centre. With this project, HVAs were conducted successfully for the first time in health care facilities in Abu Dhabi. This study thus serves as another successful example of multidisciplinary emergency preparedness processes.     

Ocean waves and roadside spirits: Thai health service providers' post-tsunami psychosocial health

A massive earthquake off the west coast of Sumatra in Indonesia triggered a tsunami on 26 December 2004. At least five million people around the world were affected, and the total number of deaths exceeded 280,000. In Thailand, the tsunami struck six southern provinces, where the disaster's immediate impact was catastrophic. Based on ethnographic fieldwork in Phang Nga Province (2007), this paper provides an overview of the disaster's psychosocial consequences for Thai health service providers, the vast majority of whom were bypassed by regional post-tsunami mental health initiatives. The available tsunami literature only briefly attends to health providers' experience of professional 'burn-out', rather than explores the tsunami's wide spectrum of psychosocial effects. This research aims to remedy such oversights through 'critical medical' and 'interpretive phenomenological' analysis of the diverse and culturally-situated ways in which health providers' experienced the tsunami. The paper concludes by arguing for disaster-related psychosocial interventions to involve health providers explicitly.