Prof Dr Jan D Reinhardt 12 1 Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University Chengdu China 2 ID: 592680
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Epidemiology of Natural Disasters in Asia-Oceania
Prof. Dr. Jan D. Reinhardt
1,2
1 Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University, Chengdu, China2 Chair-elect, Committe for Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine, Geneva, SwitzerlandSlide2
PurposeParticipants understand the impact of natural disasters on health and functioning and its distribution in the population with a particular focus on Asia-Oceania (AO)Slide3
OverviewEpidemiologyNatural disastersHealth
consequencesFatalitiesCasualitiesMental healthCommunicable
diseaseDisability
Challenges & solutions for disaster epiConclusionSlide4
Epidemiology«The study of the distribution and determinants of health-related states or events in specified populations and the application of this study to the control of health problems» (Porta 2008)Describes extent of problemExamines etiology and risk factorsStudies history and prognosis
Evaluates therapeutic measuresProvides basis for health policy developmentSlide5
Natural DisastersNatural disasters are sudden ecological disruptions or threats that exceed the adjustment capacity of the affected community and require external assistance (Lechat, 1979; WHO, 1980).Slide6
Natural disaster - Types
Type
Examples
GeologicalEarthquake, tsunami, volcanic erruptionMetereologicalHurricane, heat wave, floodBiologicalEpidemicSlide7
„Natural“ disaster revisitedNatural disaster risk = f(hazard,
exposure, vulnerability)Hazard: Type, intensityExposure: people, infrastructure
Vulnerability (comunity, individual): „capacity to anticipate, cope with, resist, and recover from the impact of a natural hazard” (Wisner et al. 2004)
Disaster mostly strikes low-resource regions!Disaster mostly affects socially disadvantaged groups!Slide8
OccurenceAverage occurrence in AO per annum (2000-2015): 172 (95% CI 157-187)
42.2 % of global occurrence/year
Average
annual occurence of natural disasters in AO by disaster type (2000-2015); error bars represent 95 % Confidence IntervalsSlide9
Occurence and impactAverage occurrence in AO per annum (2000-2015): 172 (95% CI 157-187)
42.2 % of global occurrence/yearAverage affected population in AO per annum
(2000-2015): 168 mio (95% CI 93-243 mio)
87.5 % of global population affected/yearOver 1.8 mio left homeless on average/yearAbout 83 % of global population left homeless due to nat. disaster/yearSlide10
Occurence and impactLoss of Life and limbsPsychosocial well-being
HousingEconomic infrastructurePublic health infrastructureCommunication and transportation networks Medical facilities Healthcare workers, as displaced, injured or killedSlide11
Health consequencesFatalitiesCasualitiesMental health issuesCommunicable diseaseDisabilitySlide12
FatalitiesFrom 2000 to 2015 over 1.27 million people died due to natural disasters worldwideOver half of
those in AO (760,000 deaths)
Numbers of death due to natural disaster by disaster type in AO from 2000-2015
Data extracted from CRED, EMDATSlide13
FatalitiesDirect causes , e.g. trauma due to
building collapse (earthquakes) flying debris (hurricanes)drowning
(floods, hurricanes)
Indirect causes, e.g.motor vehicle accidents (Doocy et al., 2013)Children, elderly, people with disability are exposed to increased risk of death (Doocy et al., 2013, Reinhardt et al. 2012)Slide14
CasualitiesDue to blunt trauma, crush injuries, near drowning, and psychological sequelaeNumber of injuries typically exceeds fatalitiesTrend of increased odds of being injured as opposed to death over time
Medan injury to deaths ratios from 1975 to 2014 for AO; error bars indicate interquartiles.
P (Cuzick’s test for trend across ordered groups) = 0.001.
Data extracted from CRED, EMDATSlide15
CasualitiesOver 4.3 mio injured people reported globally due to natural disaster from 2000-2015Of those around 42% (1.8 mio) in AO
Numbers of injured people due to natural disaster by disaster type in AO from 2000-2015.
Data extracted from CRED, EMDATSlide16
Communicable diseaseCommunicable disease resulting
from dead bodies is largely a myth (Watson et al. 2007)Risk of
infectious disease is
, however increased due topopulation displacement with resulting overcrowdinglow levels of immunity to vaccine-preventable diseases disrupted or nonexistent public health serviceslack of clean waterinadequate nutritionpoor sanitationReliable epi data largely lackingSlide17
Mental HealthHigh incidence of post-traumatic stress disorder and other mental conditions (e.g. anxiety, depression)Psychological distress from adverse health consequences (e.g. disability),
loss of home and livelihood, death of family and friendsadverse experiences during event (e.g. watching
people die)Slide18
Mental Health
Selection
of predictors for PTSD (PCLC) in 459 victims from Wenchuan EQ; Least Angle Regression (Ni 2013)
disability
Witnessed deathSlide19
DisabilityDisasters cause sudden onset of health conditions with long-term medical and functional consequences spinal cord injuries (SCI), traumatic brain injuries (TBI),
amputations, long-bone fractures, peripheral nerve injuries,near drowningIn addition, pre-existing chronic health problems and disabilities may be exacerbatedLack of
good epi data on incidence
/prevalence of conditions and disabilitySlide20
DisabilityModerate evidence for effectiveness
of rehab measures
Rehab groups (red, green) show faster and greater improvement than controls (blue).
Data from 591 victims of Wenchuan EQ Slide21
Epi of disability in natural disaster:
Challenges & possible solutionsLack of representative data on incidence/prevalence of chronic conditions and disabilityPossible
solutions:Large random
samples from affected populations (general population, hospitalized population)Pre-approval and funding of research protocols to be activated in case that disaster strikesLong-term research follow upShort and easy to administer
measurement scales for functioningSlide22
Epi of disability in natural disaster:
Challenges & possible solutionsLack of knowledge on specifics of disability in disaster struck populationsPossible
solutions:Comparisons
of disaster victims with people with similar health conditions due to different etiologyMatched pairs method based on hospital data (e.g. rehab departments)Regular disability surveys in general populationSlide23
Epi of disability in natural disaster:
Challenges & possible solutionsLack of knowledge on which particular rehab measures work best in disaster victimsPossible
solutions:Pre-funded
and approved RCTsSystematic and unified documentation of treatments and treatment hours in hospital and pre-hospital situation for cohort studiesSlide24
ConclusionNatural disasters massively impact human health
and cause long-term disabilityMedical rehabilitation is an
important strategy of
disaster responseBetter data for epidemiological research in disasters is neededSlide25
Thank you!