1. Post Disaster Public Health Challenges

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

3. Disaster Challenge

4. 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

5. 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

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

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

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

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

10. Measles -diagnosis
Fever
3 Cs
Cough
Coryza
Conjunctivitis
Rash

11. 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 months
Concurrent vitamin A administration

12. 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

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

14. Cholera Cot

15. Shigellosis -Diagnosis
Bloody stools
Cramps
Fever

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

17. Malaria Diagnosis
fever Pattern

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

19. 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

20. Typhoid Fever Diagnosis
ROSE SPOTS

21. Typhoid Fever -Diagnosis
Fever, Bradycardia

22. Hepatitis Diagnosis
Fever
Jaundice
Malaise

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

24. 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

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

29. 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

30. 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.

31. 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

32. MCQ-2
In a temporary camp, maximum distance between a dwelling and a toilet should be:
< >50 Meters
< >45 Meters
< >40 Meters
< >55 Meters
< >60 Meters

33. 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

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

35. 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

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