Rapid Health and Needs assessments after disasters: a systematic review

Determinants of psychological distress during the COVID-19 pandemic among people who use drugs in Montreal, Canada

INTRODUCTION

Limited data exists on psychological impacts of the COVID-19 pandemic among people who use drugs (PWUD). This study aimed to determine the prevalence and correlates of severe psychological distress (PD) among PWUD in Montreal around the beginning of the pandemic.

METHODS

We conducted a rapid assessment study from May to December 2020 among PWUD recruited via a community-based cohort of people who inject drugs in Montreal (Hepatitis C cohort [HEPCO], N = 128) and community organisations (N = 98). We analysed self-reported data on changes in drug use behaviours and social determinants since the declaration of COVID-19 as a public health emergency, and assessed past-month PD using the Kessler K6 scale. Multivariable logistic regression was conducted to examine correlates of PD distress (score ≥13).

RESULTS

Of 226 survey participants, a quarter (n = 56) were screened positive for severe PD. In multivariable analyses, age (1-year increment) (adjusted odds ratio = 0.94, 95% confidence interval [0.90, 0.98]) and a decrease in non-injection drug use versus no change (0.26 [0.07, 0.92]) were protective against severe PD, while positive associations were found for any alcohol use in the past 6 months (3.73 [1.42, 9.78]), increased food insecurity (2.88 [1.19, 6.93]) and both moving around between neighbourhoods more (8.71 [2.63, 28.88]) and less (3.03 [1.18, 7.74]) often compared to no change.

DISCUSSION AND CONCLUSIONS

This study documented a high prevalence of severe PD among PWUD during the COVID-19 pandemic compared with pre-COVID-19 data. Social determinants such as food insecurity and mobility issues, alongside demographic and substance use-related factors, were linked to distress. Evidence-based risk mitigation strategies for this population could reduce negative consequences in future pandemics or disruptions.

The impact of the COVID-19 pandemic on people who use drugs in three Canadian cities: a cross-sectional analysis

BACKGROUND

The COVID-19 pandemic had a disproportionate impact on the health and wellbeing of people who use drugs (PWUD) in Canada. However less is known about jurisdictional commonalities and differences in COVID-19 exposure and impacts of pandemic-related restrictions on competing health and social risks among PWUD living in large urban centres.

METHODS

Between May 2020 and March 2021, leveraging infrastructure from ongoing cohorts of PWUD, we surveyed 1,025 participants from Vancouver (n = 640), Toronto (n = 158), and Montreal (n = 227), Canada to describe the impacts of pandemic-related restrictions on basic, health, and harm reduction needs.

RESULTS

Among participants, awareness of COVID-19 protective measures was high; however, between 10 and 24% of participants in each city-specific sample reported being unable to self-isolate. Overall, 3-19% of participants reported experiencing homelessness after the onset of the pandemic, while 20-41% reported that they went hungry more often than usual. Furthermore, 8-33% of participants reported experiencing an overdose during the pandemic, though most indicated no change in overdose frequency compared the pre-pandemic period. Most participants receiving opioid agonist therapy in the past six months reported treatment continuity during the pandemic (87-93%), however, 32% and 22% of participants in Toronto and Montreal reported missing doses due to service disruptions. There were some reports of difficulty accessing supervised consumption sites in all three sites, and drug checking services in Vancouver.

CONCLUSION

Findings suggest PWUD in Canada experienced difficulties meeting essential needs and accessing some harm reduction services during the COVID-19 pandemic. These findings can inform preparedness planning for future public health emergencies.

Measuring mental health outcomes in Walbridge Fire 2020

In August 2020, Sonoma County experienced the Walbridge Fire (part of the Lake-Napa Unit Complex Fire). Following the repopulation of evacuated residents, the Sonoma County Department of Emergency Management circulated a Resident Experience Survey to learn from stakeholders how the fire impacted their lives, how emergency response to the fire met their needs, and to gather information to improve future disaster response activities. A total of 1,583 English and 55 Spanish surveys were completed. This paper describes a mixed-method research using survey data to understand broader mental health implications of the Walbridge Fire on residents. This study developed a quantitative Global Worry Model to explore which survey factors contributed to poorer mental health outcomes. Quantitative analytics looked at how language, loss, emergency alerts, and family size were measured for significance with a survey reported on a mental health questionnaire. Open-ended survey responses surrounding previous disaster experience, pre-existing health issues, and environmental conditions (smoke and the coronavirus disease 2019 pandemic) were contributory to responder's stress and anxiety. Final data analysis concluded that those who faced immediate loss presented with significant self-declared stress and anxiety.

A qualitative evaluation of the challenges in management for patients with chronic diseases during disasters in Iran

BACKGROUND

Iran's health care system faces significant challenges in managing the growing burden of non-communicable diseases, and these are exacerbated during the frequent natural disasters. The current study was designed to understand challenges in providing healthcare services to patients with diabetes and chronic respiratory diseases during such crisis periods.

METHODS

The conventional content analysis was used in this qualitative study. Participants included 46 patients with diabetes and chronic respiratory diseases, and 36 stakeholders with knowledge and experience in disasters. Data collection was carried out employing semi-structured interviews. Data analysis was performed using Graneheim and Lundman method.

RESULTS

Four major challenges in providing care to patients with diabetes and chronic respiratory diseases during natural disasters include integrated management, physical, psychosocial health, health literacy and the behavior and barriers to healthcare delivery.

CONCLUSIONS

Developing countermeasures against medical monitoring system shutdown in order to detect medical needs and problems faced by chronic disease patients including those with diabetes and chronic obstructive pulmonary disease (COPD), is essential in preparedness for future disasters. Developing effective solutions may result in improved preparedness and better planning of diabetic and COPD patients for disasters.

Challenges in Providing Care for Patients with Chronic Diseases during Disasters: A Qualitative Study with Focus on Diabetes and Chronic Respiratory Diseases in Iran

Background

Non-communicable diseases are of the major health challenges and the leading cause of death in Iran and at the global level. Moreover, Iran is a disaster-prone country and considering the exacerbation of diabetes and chronic respiratory diseases in natural disasters, its healthcare system is facing challenges. This study was designed to explore challenges in providing healthcare services to patients with diabetes and chronic respiratory diseases during disasters in Iran.

Materials and Methods

The conventional content analysis is used in this qualitative study. Participants included 46 patients with diabetes and chronic respiratory diseases, and 36 of stakeholders were experienced and had theoretical knowledge. Participants' selection started by means of purposive sampling and continued to the point of data saturation. Data collection was carried out employing semi-structured interviews. Data analysis was performed using Graneheim and Lundman method.

Results

Based on participants' experiences, four major challenges in providing care to patients with diabetes and chronic respiratory diseases during natural disasters include integrated management (with three subcategories: control and supervision, patient data management, volunteer management), physical, psychosocial health (with three subcategories: psychological impacts, exacerbation of signs and symptoms, special patient characteristics), health literacy and the behavior (with three subcategories: risk perception, values and beliefs, education and awareness) and barriers to healthcare delivery (with three subcategories: facilities and human resources, financial and living problems and insurances, accessibilities and geographic access).

Conclusion

Developing countermeasures against medical monitoring system shutdown in order to detect medical needs and problems faced by chronic disease patients including those with diabetes and chronic obstructive pulmonary disease (COPD), is essential in preparedness for future disasters. Developing effective solutions may result in improved preparedness and better planning of diabetic and COPD patients for disasters, and potentially promote health outcomes during and after disasters.

Health economic evaluation: cost-effective strategies in humanitarian and disaster relief medicine

The health economic evaluation is a tool used in disaster relief medicine to generate a cost-benefit analysis. Like all areas of healthcare, disaster relief operations must use finite financial resources, much of which comes from charitable donations and foreign aid. Interventions can be assessed using cost-effectiveness tools and equity assessments. Through these tools, interventions that maximise benefit for a given cost are highlighted in the immediate rapid response phase where food, clean water and shelter are prioritised, often with military support. Beyond this, applications of technology and pre-response training are discussed as cost-effective investments made in anticipation of a disaster. In particular, novel technology-based approaches are being explored to deliver medical advice remotely through telemedicine and remote consulting. This strategy allows medical specialists to operate remotely without the logistical and financial challenges of forward basing at the disaster site. Interventions in disaster relief medicine are often expensive. A specific and regularly reviewed health economic assessment ensures that healthcare interventions yield a maximal impact while limiting waste and working within the budgetary constraints of a disaster medicine response. This is a paper commissioned as part of the humanitarian and disaster relief operations special issue of BMJ Military Health.

The impact of a terrorist attack: Survivors' health, functioning and need for support following the 2019 Utrecht tram shooting 6 and 18 months post-attack

Background

Extremely violent events such as terrorist attacks and mass shootings form a severe risk for the health and wellbeing of affected individuals. In this study based on a public health monitor, we focus on the health impact (including PTSD symptoms, physical problems and day-to-day functioning) of the Utrecht tram shooting, which took place in the morning of March 18th 2019. A lone gunman opened fire on passengers within a moving tram. Four people died, and six people were injured in this attack. The attack resulted in nationwide commotion and drew much media attention. Aim of this study was to increase insight into the health effects for the survivors (those directly impacted by a terrorist attack and the bereaved), and whether they received the needed care and support.

Methods

Semi-structured interviews with accompanying questionnaires were conducted at six and 18 months post-attack. Overall, 21 survivors (victims/witnesses and loved ones of deceased victims) participated in the first series of interviews, 15 in the second series. Qualitative data were analyzed using reflexive thematic analysis, quantitative data was only described because of the low sample size.

Results

At both six and 18 months after the attack many survivors had been able to resume daily life, and most rated their overall health as (very) good or excellent. At the same time, a substantial portion suffered from health problems such as posttraumatic stress symptoms and other complaints, and needed professional care. Furthermore, those in need did not always find their own way to appropriate care through the existing health system: half of the survivors still needed support in finding the right care 18 months later.

Conclusion

Although the design and implementation of this public health monitor were accompanied by multiple challenges, it was possible to track a portion of the survivors and gain insight in the considerable health burden of the attack. Also, it is clear in this study that the health impact of terrorism affects survivors in the long run and requires attention from health authorities and professionals, as survivors were not able to find the right care by themselves.

Measuring Personal Damage in a Large-Scale Disaster: A Review of the Reports Published by the Japanese Fire and Disaster Management Agency on the Great East Japan Earthquake and Tsunami

Objective:

The study’s aim is to identify the challenges in estimating personal damages in the early stages of a disaster.

Methods:

The study reviewed personal damage data in the reports on the Great East Japan earthquake and tsunami published by Japanese public agencies from 2011 to 2020, including 159 situation reports by the Fire and Disaster Management Agency and 17 disaster-related indirect death reports by the Reconstruction Agency. The study compared the reported number of deaths, missing persons, and injuries with the latest statistics to evaluate how soon the disaster’s real damages were estimated.

Results:

The reported number of deaths significantly increased in the first 1.5 years, whereas the number of missing persons spiked in the first 30 days. It required approximately 1 year until the numbers approximated the current reference rate. The total casualties included 3739 indirect deaths.

Conclusion:

The results indicated an overestimation of missing persons, a possible underestimation of injuries, and the excess deaths due to indirect causes that complicated the estimation. The limitations of the current data collection approaches are the delay in reporting from the field and incomplete and unreliable information. A novel system is proposed, which directly collects data from all affected individuals anonymously.

Implementing a Telehealth Support Tool for Community-Dwelling Older Adults During the COVID-19 Pandemic: A Qualitative Investigation of Provider Experiences

During the COVID-19 pandemic, policymakers had to quickly offer telehealth services to address older adults' needs. This study aimed to understand the experiences of providers who implemented a telephone-based telehealth tool named Socio-Geriatric Evaluation (ESOGER), which assessed health and social isolation risks in community-dwelling older adults in Quebec (Canada). This qualitative study used 20 semi-structured online/phone interviews with health and social service providers coming from publicly-funded healthcare facilities and community organizations. We included adopters and non-adopters of the telehealth tool. Interviews were audio-recorded and transcribed verbatim. We used reflexive thematic analysis to interpret the data. Three dimensions of providers' practice influenced the tool's implementation: service organization, working conditions, and interactions with older adults. Participants reported that the tool fostered continuity of care, provided guidance for their pandemic-related new tasks, and helped identify and support socially isolated older adults. Challenges to implementation included limited appropriateness of the telehealth tool for diverse services, feasibility barriers to adopting a new tool amid the health crisis, and acceptability challenges with some older adults. Despite relevance of the telehealth tool for providers, organizational, professional, and interactional barriers could hinder implementation success. Participatory approaches to telehealth may be promising avenues for future policies in this field.

Appraising Evidence-Based Mental Health and Psychosocial Support (MHPSS) Guidelines-PART II: A Content Analysis with Implications for Disaster Risk Reduction

High quality mental health and psychosocial support (MHPSS) guidelines are indispensable for policy and practice to address the mental health consequences of disasters. This contribution complements a review that assessed the methodological quality of 13 MHPSS guidelines. We analyzed the content of the four highest-ranking guidelines and explored implications for disaster risk reduction (DRR). A qualitative explorative thematic analysis was conducted. The four guidelines proved largely similar, overlapping or at least complementary in their MHPSS definitions, stated purpose of the guidelines, user and target groups, terminology, and models used. Many recommended MHPSS measures and interventions were found in all of the guidelines and could be assigned to five categories: basic relief, information provision, emotional and social support, practical support, and health care. The guidelines stress the importance of monitoring needs and problems, evaluating the effect of service delivery, deliberate implementation and preparation, and investments in proper conditions and effective coordination across professions, agencies, and sectors. The MHPSS knowledge base embedded in the guidelines is comprehensive, coherent, and sufficiently universal to serve as the "overarching framework" considered missing yet vital for the integration of MHPSS approaches in DRR. Although application contexts differ geographically, this common ground should allow policymakers and practitioners globally to plan, implement, and evaluate MHPSS actions contributing to DRR, ideally together with target groups.

Self-reported impacts of the COVID-19 pandemic among people who use drugs: a rapid assessment study in Montreal, Canada

BACKGROUND

People who use drugs (PWUD) are at high risk of experiencing indirect harms of measures implemented to curb the spread of COVID-19, given high reliance on services and social networks. This study aimed to document short-term changes in behaviours and health-related indicators among PWUD in Montreal, Canada following declaration of a provincial health emergency in Quebec.

METHODS

We administered a structured rapid assessment questionnaire to members of an existing cohort of PWUD and individuals reporting past-year illicit drug use recruited via community services. Telephone and in-person interviews were conducted in May-June and September-December 2020. Participants were asked to report on events and changes since the start of the health emergency (March 13, 2020). Descriptive analyses were performed.

RESULTS

A total of 227 participants were included (77% male, median age = 46, 81% Caucasian). 83% and 41% reported past six-month illicit drug use and injection drug use, respectively. 70% of unstably housed participants reported increased difficulty finding shelter since the start of the health emergency. 48% of opioid agonist treatment recipients had discussed strategies to avoid treatment disruptions with providers; 22% had missed at least one dose. Many participants perceived increased difficulty accessing non-addiction health care services. Adverse changes were also noted in indicators pertaining to income, drug markets, drug use frequency, and exposure to violence; however, many participants reported no changes in these areas. Among persons reporting past six-month injection drug use, 79% tried to access needle-syringe programmes during the health emergency; 93% of those obtained services. 45% tried to access supervised injection sites, of whom 71% gained entry.

CONCLUSIONS

This snapshot suggests mixed impacts of the COVID-19 pandemic on PWUD in Montreal in the months following declaration of a provincial health emergency. There were signals of increased exposure to high-risk environments as well as deteriorations in access to health services. Pandemic-related measures may have lasting impacts among vulnerable subgroups; continued monitoring is warranted.

Rapid Behavioral Health Assessment Post-disaster: Developing and Validating a Brief, Structured Module

To develop and validate a brief, structured, behavioral health module for use by local public health practitioners to rapidly assess behavioral health needs in disaster settings. Data were collected through in-person, telephone, and web-based interviews of 101 individuals affected by Hurricanes Katrina (n = 44) and Sandy (n = 57) in New Orleans and New Jersey in April and May 2018, respectively. Questions included in the core module were selected based on convergent validity, internal consistency reliability, test-retest reliability across administration modes, principal component analysis (PCA), question comprehension, efficiency, accessibility, and use in population-based surveys. Almost all scales showed excellent internal consistency reliability (Cronbach's alpha, 0.79-0.92), convergent validity (r > 0.61), and test-retest reliability (in-person vs. telephone, intra-class coefficient, ICC, 0.75-1.00; in-person vs. web-based ICC, 0.73-0.97). PCA of the behavioral health scales yielded two components to include in the module-mental health and substance use. The core module has 26 questions-including self-reported general health (1 question); symptoms of posttraumatic stress disorder, depression, and anxiety (Primary Care PTSD Screen, Patient Health Questionnaire-4; 8 questions); drinking and other substance use (Alcohol Use Disorders Identification Test-Concise, AUDIT-C; Drug Abuse Screening Test, DAST-10; stand-alone question regarding increased substance use since disaster; 14 questions); prior mental health conditions, treatment, and treatment disruption (3 questions)-and can be administered in 5-10 minutes through any mode. This flexible module allows practitioners to quickly evaluate behavioral health needs, effectively allocate resources, and appropriately target interventions to help promote recovery of disaster-affected communities.

Identifying and Describing Impact of Disasters on Non-Communicable Diseases: A Systematic Review

BACKGROUND

Patients with non-communicable diseases are vulnerable to disasters. This is a systematic review describing the impact of disasters on non-communicable diseases.

METHODS

A systematic review was conducted using PRISMA standards. Relevant articles published from 1997 to 2019 collected by searching the Scopus, PubMed, Science Direct, databases. We specifically examined reports describing NCDs and including the key words "non-communicable disease and Disasters". NCDs included cardiovascular, respiratory, diabetes, cancer and mental health diseases.

RESULTS

Of the 663 studies identified, only 48 articles met all the eligibility criteria. Most studies have shown the impact of all natural disasters on non-communicable diseases (39.8% n=19). The largest study was the effect of earthquakes on non-communicable diseases (29.2% n=14). For the NCDs targeted by this research, most of the included studies were a combination of four diseases: cardiovascular disease, respiratory disease, diabetes and cancer (44% n=21). Followed by cardiovascular disease (14.6% n=7), chronic respiratory disease (12.5% n=6), diabetes and cancer (6.2% n=3) and mental health (12.5% n=6).

CONCLUSION

The incidence of disasters affects the management of treatment and care for patients with NCDs. Specific measures include a multi-part approach to ensuring that patients with non-communicable diseases have access to life-saving services during and after disasters. The approach of the health system should be expanded from traditional approaches to disasters and requires comprehensive planning of health care by policy makers and health professionals to develop effective strategies to enable patients to access medical, therapeutic and diagnostic services in natural disasters.

Establishing the Status of Patients With Non-Communicable Diseases in Disaster: A Systematic Review

OBJECTIVE

People with NCDs are particularly vulnerable to disasters. This research systematically reviewed reports describing studies on the status of patients with NCDs before, during and after disasters.

METHOD

Relevant articles published from 1997 to 2019 were collected by searching the Scopus, PubMed, and Science Direct databases. We specifically examined reports describing NCDs and including the key words 'Non-Communicable Disease and Disasters.' NCDs include cardiovascular, respiratory, diabetes and cancer diseases.

RESULTS

The review identified 42 relevant articles. Most of the included studies were found to have described the conditions of patients with NCDs after disasters - 14 (13.3%), during disasters - 11 (26.2%), before disasters - 6 (14.3%), within all stages of disasters: before, during and after - 6 (14.3%), only during and after disasters - 4 (9.5%), and includes before and during disasters - 1 (2.4%).

CONCLUSION

NCDs pose major health issues in disasters. Development of strong counter measures against the interruption of treatment, as well as surveillance systems to ascertain medical needs for NCDs are necessary as preparation for future disasters.

Assessing Capacity and Implementation Status of the Disaster Risk Management Strategy for Health and Community Disaster Resilience in Malawi

Floods are among the most frequently occurring natural hazards in Malawi, often with public health implications. This mixed methods study assessed the capacity for and implementation status of the disaster risk management (DRM) strategy for the health sector in Malawi, using flooding in the Nsanje District as a case. Data were collected using desk review and a workshop methodology involving key officials from government ministries, national and international development partners, and the academia. The results show that Malawi had recently strengthened its DRM institutional frameworks, with a pronounced policy shift from reactive to proactive management of disasters. Health sector personnel and structures were key contributors in the design and implementation of DRM activities at all levels. Development partners played a significant role in strengthening DRM coordination and implementation capacity. Lack of funding and the limited availability, and often fragmented nature, of vulnerability and risk assessment data were identified as key challenges. Limited human resource capacity and inadequate planning processes at district level impeded full implementation of DRM policies. These findings call for community-level interventions for improved coordination, planning, and human resource capacity to strengthen community disaster resilience and improve public health. The approach used in this study can serve as a model framework for other districts in Malawi, as well as in other low- and middle-income countries in the context of Sendai Framework implementation.

Will it work here? A realist approach to local decisions about implementing interventions evaluated as effective elsewhere

There is increasing interest in what evidence is needed to inform decisions about transporting interventions evaluated as effective to new settings. There has been less attention to how local decision-makers decide whether to implement such interventions immediately or subject to further evaluation. Using the example of school-based social and emotional learning, we consider this drawing on realist methods. We suggest decisions need to assess existing evaluations not merely in terms of whether the intervention was effective but also: how the intervention was implemented and what contextual factors affected this (drawing on process evaluation); and for whom the intervention was effective and through what mechanisms (drawing on mediation, moderation and qualitative comparative analyses from primary studies and/or systematic reviews). We contribute new insights to local needs assessments, suggesting that these should assess: the potential, capability, contribution and capacity present in the new setting for implementation; and whether similar 'aetiological mechanisms' underlie adverse outcomes locally as in previous evaluations. We recommend that where there is uncertainty concerning whether an intervention can feasibly be implemented this indicates the need for piloting of implementation. Where there is uncertainty concerning whether implementation of the intervention will trigger intended mechanisms, this suggests the need for a new effectiveness trial. Where there is uncertainty concerning whether intervention mechanisms, even if triggered, will generate the intended outcomes, this suggests that decision-makers may need to look to other types of intervention as being needed for their setting instead.

A Pacific needs analysis model: a proposed methodology for assessing the needs of facility-based emergency care in the Pacific region

Background

Emergency care (EC) describes team-based, multidisciplinary clinical service provision, advocacy and health systems strengthening to address all urgent aspects of illness and injury for all people. In order to improve facility-based EC delivery, a structured framework is necessary to outline current capacity and future needs. This paper draws on examples of EC Needs Assessments performed at the national hospitals of three different Pacific Island Countries (PICs), to describe the development, implementation and validation of a structured assessment tool and methodological approach to conducting an EC Needs Assessment in the Pacific region.

Methods

This is a retrospective, descriptive analysis of the development of the Pacific Emergency Care Assessment (PECA) table using patient-focused principles within an EC systems framework. Tool implementation occurred through observation, literature review and interviews using a strengths-based, action-research and ethnographic methodological approach in Timor-Leste, Kiribati and the Solomon Islands. The 2014 Solomon Islands EC Needs Assessment provides the main context to illustrate and discuss the overall conduct, feasibility, validity and reliability of the PECA tool and methodological approach.

Results

In each site, the methodological implementation enabled completion of both the PECA table and comprehensive report within approximately 6 weeks of first arriving in country. Reports synthesising findings, recommendations, priority action areas and strategies were distributed widely amongst stakeholders. Examples illustrate Face and Content, Construct and Catalytic validity, including subsequent process and infrastructure improvements triggered by the EC Needs Assessment in each site. Triangulation of information and consistency of use over time enhanced reliability of the PECA tool.

Compared to other EC assessment models, the Pacific approach enabled rich data on capacity and real-life function of EC facilities. The qualitative, strengths-based method engenders long-term partnerships and positive action, but takes time and requires tailoring to a specific site.

Conclusion

In PICs and other global contexts where EC resources are underdeveloped, a PECA-style approach to conducting an EC Needs Assessment can trigger positive change through high local stakeholder engagement. Testing this qualitative implementation method with a standardised EC assessment tool in other limited resource contexts is the next step to further improve global EC.

History of Disaster Epidemiology

Disaster epidemiology is not a new field, and the methods utilized to conduct disaster epidemiology studies are no different than the methods used in everyday applied public health research and investigations. The only difference is the circumstances under which the methods are employed. The challenges of conducting epidemiologic studies during a disaster are many—limited access to study sites and populations; access to reliable electricity, connectivity, and communication systems; and typically a short time frame in which to gather, analyze, and report data to decision-makers so that it can be utilized to prevent morbidity and mortality. However, many innovations have been developed by disaster epidemiologists to meet these challenges. Rapid needs assessments, innovative surveillance and tracking systems, and adapted epidemiologic study designs are some of the innovations that will be discussed in this chapter.

Rapid Health Needs Assessment after Typhoons Bolaven and Tembin Using the Public Health Assessment for Emergency Response Toolkit in Paju and Jeju, Korea 2012

Following natural disasters, rapid health needs assessments are required to quickly assess health status and help decision making during the recovery phase. The Korean Centers for Disease Control and Prevention (KCDC) developed the Public Health Assessment for Emergency Response (PHASER) Toolkit which was optimized for a weather disaster in Korea. The goal of this study is to assess public health needs following the 2012 typhoons Bolaven and Tembin in both urban and rural areas in Korea. We conducted pilot trials using the PHASER toolkit to assess health needs following typhoons Bolaven and Tembin in Paju and Jeju during summer 2012. We sampled 400 households in Jeju and 200 households in Paju using a multistage cluster sampling design method. We used a standardized household tracking sheet and household survey sheet to collect data on the availability of resource for daily life, required health needs, clinical results and accessibility of medical services. The primary outcomes were clinical results and accessibility of medical service after the typhoons. We completed surveys for 190 households in Paju and 386 households in Jeju. Sleeping disorders were identified in 6.8% (95% confidence interval [CI], 2.8%-10.8%) surveyed in Paju and 17.4% (95% CI, 12.8%-22.0%) in Jeju. We used the PHASER toolkit to assess healthcare needs rapidly after 2 typhoons in Korea. Sleeping disorders were frequently identified in both Paju and Jeju following the 2 typhoons.

Valparaiso's 2014 Fire: Evaluation of Environmental and Epidemiological Risk Factors During the Emergency Through a Crowdsourcing Tool

OBJECTIVE

To describe and relate the main environmental risk factors in the emergency process after a large urban fire in Valparaiso, Chile, in April 2014.

METHODS

An observational, cross-sectional descriptive study was performed. All 243 reports from an ad hoc web/mobile website created on the Ushahidi/Crowdmap platform were reviewed. Reports were recorded in a new database with dichotomist variables based on either the presence or absence of the relevant category in each report.

RESULTS

Almost one-third of the reports presented data about garbage (30%) and chemical toilets (29%). Reports related to water, infrastructural damage, and garbage had significant associations with 4 categories by chi-square test. In the logistic regression model for chemical toilets, only the variable of water was significant (P value=0.00; model P value: 0.00; R2: 11.7%). The "garbage" category confirmed infrastructural damage (P value: 0.00), water (P value: 0.028), and vectors (P value: 0.00) as predictors (model P value: 0.00; R2: 23.09%).

CONCLUSIONS

Statistically significant evidence was found for the statistical dependence of 7 out of 10 studied variables. The most frequent environmental risk factors in the reports were garbage, chemical toilets, and donation centers. The highest correlation found was for damaged infrastructure, vectors, and garbage. (Disaster Med Public Health Preparedness. 2017;11:239-243).

The role of applied epidemiology methods in the disaster management cycle

Disaster epidemiology (i.e., applied epidemiology in disaster settings) presents a source of reliable and actionable information for decision-makers and stakeholders in the disaster management cycle. However, epidemiological methods have yet to be routinely integrated into disaster response and fully communicated to response leaders. We present a framework consisting of rapid needs assessments, health surveillance, tracking and registries, and epidemiological investigations, including risk factor and health outcome studies and evaluation of interventions, which can be practiced throughout the cycle. Applying each method can result in actionable information for planners and decision-makers responsible for preparedness, response, and recovery. Disaster epidemiology, once integrated into the disaster management cycle, can provide the evidence base to inform and enhance response capability within the public health infrastructure.

Rapid health needs assessment experience in 11 august 2012 East azerbaijan earthquakes: a qualitative study

INTRODUCTION

In disasters, health care providers need to find out the essential needs of the affected populations through Rapid Health Needs Assessment (RHNA). In East Azerbaijan earthquakes, a rapid assessment was performed by the provincial health system. The main purpose of this study was to explore the RHNA challenges.

METHODS

In this qualitative study (Grounded theory), data was collected through semi-structured interviews with purposely selected health care workers. The data collection process continued until data saturation. All interviews were recorded and then transcribed. The Colaizzi's descriptive method was used to analyze the data.

RESULTS

The themes emerged from the analysis of the interviews were: 1) Logistic problems 2) Lack of RHNA tools 3) Inherent difficulty of RHNA in disaster situations 4) Lack of preparedness and 5) Lack of coordination between different organizations. These challenges result in inapplicable use of RHNA results.

CONCLUSION

The most important challenge in this RHNA process was the lack of East Azerbaijan health center preparedness. Although they were familiar with the importance of RHNA, they did not have any plans for conducting RHNA.

Conducting rapid health needs assessments in the cluster era: experience from the Pakistan flood

Due to its unprecedented scale, the Pakistan flood disaster tested the limits of disaster management and coordination. Under the leadership of the World Health Organization, the Global Health Cluster system for coordinating activities improved collaboration and efficiency in conducting rapid needs assessments. However, the involvement of non-Cluster members was lacking, and information on existing service provision was not collected adequately. The present rapid health needs assessment process under the Cluster system will be discussed, using the recent floods in Pakistan as an example.