Post Disaster Public Health Challenges

Learning Objective To discuss the major post disaster public health challenges and their preventive strategies.

Disaster Challenge

Major Public Health Issues (Post disaster) Environmental pollution Water Contamination Poor Sanitation Malnutrition Protein Energy Malnutrition(PEM) Vitamin A deficiency Epidemics Spread of infectitious diseases

Causes of Outbreaks of Infectious Disease in Disasters Population displacement Environmental changes Loss of public utilities Disruption of basic health services Impact of food scarcity and hunger

Common Modes of Transmission Person-to-person Measles, Meningitis, ARI Feco-oral/Enteric Shigella, Cholera, Typhoid, Hepatitis Vector Malaria

Specific Infectious Diseases After Disasters Measles Acute Respiratory Infection Cholera Shigellosis Malaria Typhoid Hepatitis Meningitis

Displaced Populations 80 –90% Of Deaths 5 Conditions Malnutrition Measles Acute respiratory infection Diarrheal diseases (Cholera, Shigella) Malaria

Diagnosis and Treatment large numbers of patients limited resources austere conditions So Rely on Clinical Diagnosis Empirical Treatment

Measles -diagnosis Fever 3 Cs Cough Coryza Conjunctivitis Rash

Measles Vaccination Early in the emergency situation All children 6 months to 5 years Long term situations children 9 months to 5 years Any child vaccinated between 6 and 9 months -revaccinate at 9 month If insufficient vaccine available, in order of priority undernourished children 6 month to 12 years all other children ages 6 to 23 months all other children 24-59 months Concurrent vitamin A administration

Acute Respiratory Infections A leading cause of death among effected populations Pathogens Variety of viruses and bacteria Control: Provide adequate space, shelter, clothing, blankets, and ventilation

Cholera -Diagnosis Severe dehydration Rice water stools Painless Huge volumes Vomiting

Cholera Cot

Shigellosis -Diagnosis Bloody stools Cramps Fever

Malaria -Diagnosis Jaundice Cerebral symptoms Renal failure Fever Jaundice Cerebral symptoms Renal failure Splenomegaly

Malaria Diagnosis fever Pattern

Vector Control Methods Habitat Control Reducing Contact Chemical Control Insecticides, larvicides, rodenticides Repellents Biological Control

Vector Borne Diseases Diseases such as: Disaster environments are very conducive to the proliferation of diseases-carrying insects and rodents (vectors) Diseases such as: Malaria, filariasis, dengue, yellow fever, encephalitis, scabies, scrub typhus, plague, endemic typhus, relapsing fever leptospirosis

Typhoid Fever Diagnosis ROSE SPOTS

Typhoid Fever -Diagnosis Fever, Bradycardia

Hepatitis Diagnosis Fever Jaundice Malaise

Meningococcal Meningitis –Diagnosis Fever Headache Neck stiffness Purpuric rash Purulent CSF

Vector Control Measures Physical screens can be used to control immediate problem For the longer term -make environment less favourable Improve personal hygiene Sanitation Drainage Garbage disposal Food storage and handling practices Remove stagnate water Camp location Insecticide use must be monitored by professionals

Disaster Preparedness Pre-disaster Preparedness Post-disaster Preparedness Efficient action at all levels to save lives Reduce sufferings & Minimize damage to property

Factors for Disease Transmission After a Disaster Environmental considerations Endemic organisms Population characteristics Pre- event structure and public health Type and magnitude of the disaster

SEQs 1. What is a disaster? Classify natural disasters. Enumerate the specific infectious diseases likely to spread after disaster. 2. Which of the 4 phases do you consider to be the most important? Support your answer. 3. Giving examples (from your own country) state situations where Disaster Management could have been better implemented. 4. In the case of a natural disaster, both govt and individuals are responsible for how citizens are affected. List 3 actions/activities/methods each for both govt and individuals, which can be carried out to mitigate the effects of a known natural disaster.

MCQ-1 After the earth quake of 8th October 2005, Capital Development Authority issued a directive that in future all the buildings to be constructed in capital territory will be built on strong iron pillars so that the buildings can sustain earthquake shocks. In disaster management phases, action of CDA is included in: Disaster preparedness Disaster impact & response Rehabilitation/reconstruction Mitigation Recovery

MCQ-2 In a temporary camp, maximum distance between a dwelling and a toilet should be: <6 ----->50 Meters <5------>45 Meters <4------>40 Meters <8------ >55 Meters <9------->60 Meters

MCQ-3 In a transient camp, 3000 people are required to be settled. Minimum shelter space required for these refugees will be: 11500 m2 10500 m2 13500 m2 9500 m2 6000 m2

MCQ-4 In earth quakes: Injuries < deaths Injuries = deaths are equal Deaths <injuries Cannot be calculated None of the above

MCQ-5 Crude Mortality Rate (CDR=deaths/10000/day) is single most important indicator of serious stress in affected populations in a disaster hit area. If CDR is >2, it indicates situation is: Under control Serious condition Out of control Major Catastrophe No catastrophe

MCQ-6 More than 80 percent of all deaths in displaced populations are caused by following except: Acute Respiratory Infections Measles Malnutrition Tuberculosis Diarrhoea