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.     

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.     

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.     

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.     

An earthquake disaster in Turkey: an overview of the experience of the Israeli Defence Forces Field Hospital in Adapazari

On 17 August 1999 at 3:04 a.m., an earthquake of 7.4 magnitude (Richter scale) struck the Marmara region in Turkey. The city of Adapazari suffered 2,680 fatalities with approximately 5,300 injured. The Israeli Defence Forces (IDF) field hospital arrived at Adapazari, on day four after the quake. The team consisted of 102 personnel. The field hospital acted as a secondary referral centre. A total of 1,205 patients were treated in the field hospital between day four and day 14 of the earthquake. The frequency distribution of the medical problems seen in the field hospital was 32 per cent internal medicine, 13 per cent general surgery including plastic, 21 per cent orthopaedic surgery, 23 per cent paediatric disease, 10 per cent obstetrics and gynaecology and 1 per cent major psychiatric disorders. A mean number of 35 patients per day were hospitalised in the field hospital for between 24 hours to one week. The rapid establishment of the field hospital enabled the local medical facilities to 'buy time' in order to organise and restore surgical and hospitalisation abilities in this disastrous situation.     

Needs assessment of the displaced population following the August 1999 earthquake in Turkey

In August 1999 a major earthquake struck north-western Turkey. An assessment followed to identify the immediate needs of the displaced population. A random cluster sample of displaced families living in temporary shelter outside of organised relief camps was designed. Representatives of 230 households from the four communities worse affected by the earthquake were interviewed. Most families lived in makeshift shelters (84 per cent), used bottled water (91 per cent), obtained food from relief organisations (61 per cent), had access to latrines (90 per cent), had a member on routine medication (53 per cent) and obtained information by word of mouth (81 per cent). Many respondents reported having family members who were over the age of 65 (32 per cent) or under age three (20 per cent), who were pregnant (6 per cent), or who had been ill since the earthquake (64 per cent). The greatest immediate need reported by most families was shelter requirements (37 per cent), followed by food (23 per cent) and hygiene requirements (19 per cent). Ten days after the earthquake, basic environmental health needs of food, shelter and hygiene still predominated in this displaced population. Significant portions may have special needs due to age or illness.     

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.     

Profile of Mortality from the 1989 Loma Prieta Earthquake using Coroner and Medical Examiner Reports

Mortality patterns from earthquakes in the United States may differ from those observed in other parts of the world. We reviewed coroner and medical examiner records for all investigated deaths from seven California counties for 15 days following the Loma Prieta earthquake of October 17, 1989 (N = 327). Data on the circumstances surrounding death were used to classify each case as directly earthquakerelated, indirectly earthquake-related, or not earthquake-related. Fifty-seven deaths were judged as directly earthquake-related. Six other deaths were indirectly related. Ten circumstances accounted for all directly earthquake-related deaths, with the collapse of an elevated freeway accounting for 40 of these deaths. Forty-six (80.8 per cent) of the 57 directly earthquake-related deaths occurred in motor vehicles on public roadways. Fifty-three (93.0 per cent) of the directly earthquake-related deaths occurred within seconds or minutes of injury. Future earthquake deaths in the United States may best be prevented by identifying and modifying seismic hazards in earthquake-prone regions, particularly transportation structures.     

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.     

Post-traumatic stress disorder and comorbid depression among survivors of the 1999 earthquake in Turkey

This study examined the prevalence of post-traumatic stress disorder (PTSD) and comorbid depression some three years after the August 1999 earthquake in Turkey among a sample of 769 survivors relocated to a permanent housing site built for homeless survivors in the epicentre region. Time since trauma was 3.1 years for 81 per cent of the participants and 3.9 years for the remainder. Survivors were assessed using the Screening Instrument for Traumatic Stress in Earthquake Survivors, an easily administered self-rating scale with demonstrated validity. The estimated rates of PTSD and comorbid depression were 40 per cent and 18 per cent, respectively. Linear regression analyses showed that PTSD strongly related to fear during the earthquake, while depression related to loss of family members. These results suggest that catastrophic earthquakes have long-term psychological consequences and highlight the need for a cost-effective mental health care model for earthquake survivors.     

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.     

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.     

A determination of the prevalence of gender-based violence among conflict-affected populations in East Timor

The Reproductive Health Response in Conflict (RHRC) Consortium designed a standardised questionnaire to measure gender-based violence (GBV) prevalence in conflict-affected settings. A preliminary field test was undertaken July-August 2002 in one urban and one rural district in East Timor to assess the prevalence of GBV among women 18-49 years of age during and after conflict. The field test used a cross-sectional survey design with a two-stage random selection process. During the year preceding East Timor's 1999 crisis, 23.8 per cent of respondents reported physical assault by an intimate partner; this rate was not significantly different in the year preceding the survey (24.8 per cent). Assault by perpetrators outside the family declined significantly from 24.2 per cent during the crisis to 5.8 per cent post-crisis for physical assault (p<.001) and 22.7 per cent during the crisis to 9.7 per cent post-crisis for sexual assault (p=0.046). The field test stimulated and informed additional research in East Timor, and the complementary findings of these research initiatives continue to be used to develop local policies and programming to prevent and address GBV.     

基于二维地震时间序列的PPAR模型在天山地区的应用研究

将PP理论和时间序列分析中的自回归(AR(K))模型结合起来,建立投影寻踪自回归预测模型,在固定研究区内,同时实现地震震级和时间的2要素预测,进而建立二维地震时间序列的投影寻踪自回归模型(PPAR模型)。研究中选取新疆天山地区不同空间尺度的14个实验区进行验算,首先选取范围较大地区作为实验区,然后,逐渐缩小研究区范围,建立相应的PPAR模型。针对每个区域分别尝试以未删除余震的序列、删除余震序列及同时删除余震和前震的序列建立模型,一般来说,以同时删除余震和前震的序列建立的模型具有普适性。研究结果表明:范围较大和地震发生频度高、强度大的研究区建立二维地震时间序列的PPAR模型,其内符、外符检验的合格率均较高,故所建的模型是可行的、有实际意义的。而对于范围相对较小、地震发生频度相对较低的研究区建立二维地震时间序列的PPAR模型,由于受样本量的制约,其信度降低,但其对震级和时间2要素的预测在现实的地震预报实践中仍具有一定实效和指示意义。     

Hurricane Harvey and Greater Houston households: comparing pre-event preparedness with post-event health effects,event exposures,and recovery

Most disaster studies rely on convenience sampling and ‘after-only’ designs to assess impacts. This paper, focusing on Hurricane Harvey (2017) and leveraging a pre-/post-event sample of Greater Houston households (n=71) in the United States, establishes baselines for disaster preparedness and home structure flood hazard mitigation, explores household-level ramifications, and examines how preparedness and mitigation relate to health effects, event exposures, and recovery. Between 70 and 80 per cent of participants instituted preparedness measures. Mitigation actions varied: six per cent had interior drainage systems and 83 per cent had elevated indoor heating/cooling components. Sixty per cent reported home damage. One-half highlighted allergies and two-thirds indicated some level of post-traumatic stress (PTS). Three-quarters worried about family members/friends. The results of generalised linear models revealed that greater pre- event mitigation was associated with fewer physical health problems and adverse experiences, lower PTS, and faster recovery. The study design exposed the broad benefits of home structure flood hazard mitigation for households after Harvey.     

Emotions and beliefs after a disaster: a comparative analysis of Haiti and Indonesia

A number of studies have examined emotional and belief responses following a disaster, yet there has been limited comparative analysis of responses to disasters in different places. This paper reviews the results of 366 questionnaires that evaluated key emotional and belief concepts in Haiti after the earthquake on 12 January 2010 (n=212) and in Indonesia after the earthquake in Yogyakarta on 27 May 2006 (n=154). The results indicate significant differences between the responses in the two settings, particularly in relation to feelings of impunity, self‐blame for the disaster, regret about pre‐earthquake behaviour, and a sense of justice in the world. Furthermore, the impacts of age, education, and gender on responses also were different in the two case study sites. Overall, the results suggest that understanding the cultural, religious, and social contexts of different disaster locales is important in comprehending the emotions and beliefs that manifest themselves in the wake of a major disaster.     

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.