public health effects of & public health efforts made for the pakistan floods dr. abdul jamil...

Public Health Effects of Public Health Effects of & Public Health Efforts & Public Health Efforts made for the Pakistan made for the Pakistan

FloodsFloods

Dr. Abdul Jamil Dr. Abdul Jamil (Health & Nutrition Specialist)(Health & Nutrition Specialist)

UNICEF PeshawarUNICEF PeshawarMarch 8, 2012March 8, 2012

Unite for Unite for ChildrenChildren

BackgroundBackground Pakistan Floods of August 2010 were unprecedented

& devastating that affected 20 million people in 78 districts

Killed 1800 individuals, destroyed 2 million homes & 514 health facilities

Prior to this crises the country already had about 4 million IDPs & Refuges in KP.

Health indicators were dismal before the flood, MMR=203 [190-280] and U5MR 89.

Most of the flooded populations comprise the lowest socioeconomic quintiles that were already facing neglect. This crisis worsened their plight


Damages of Floods in KPDamages of Floods in KP1 Total population (million) 25.23

2 Total affected population (million) 4.366

3 Total affected districts (#) 10

4 Total Affected Households (#) 545,739

5 Total affected villages (#) 581

6 Total Dead (#) 1,011

7 Population Displaced 890,256

8 Population Inaccessible 660,000

9 Houses damaged-CD (#) 105,214

10 Houses damaged-PD (#) 68,079

11 Shops damaged (#) 500

12 Roads damaged (#) 283

13 Bridges damaged (#) 278

14 Educational Facilities damaged (#) 522

15 Health Facilities damaged (#) 133

16 Livestock (Losses) (#) 8,325

17 Crops (Losses) (# Acres) 466,451

18 WSS Damaged (#) 908


Effects of Natural Disasters Effects of Natural Disasters [Historical][Historical]

During the past two decades, natural disasters have killed millions of people, adversely affecting the lives of at least one billion more people and resulting in substantial economic damage.

Developing countries are disproportionately affected because of their lack of resources, infrastructure & disaster preparedness systems.

The potential impact of communicable diseases is often presumed to be very high in the chaos that follows natural disasters. Increases in endemic diseases and the risk of outbreaks, however, are dependent upon many factors that needs to be systematically evaluated with a comprehensive risk assessment. This allows the prioritization of interventions to reduce the impact of communicable diseases post-disaster.


Large scale displacements/ movements resulting overcrowding in camps or host areas. ‒ [burden on host infrastructure]

Inadequate shelter [Infrastructure damage]

Disruption of services

‒ HR displacements (LHWs), Effects on moral of staff

‒ Communication disruption leading to issues of supplies, referrals & monitoring

Contamination of water & disruption of sanitation & hygiene practices

Protection is cross cutting [Kidnapping, missing/lost children & women]

Public Health Effects of Floods Public Health Effects of Floods [Risk Factors][Risk Factors]


High exposure to and/or proliferation of vectors

‒ Incidents [snake bites, skin diseases, ARI, diarrhea]

Insufficient nutrient intake [food availability & quality]

‒ disruption of family and cooking services [issues in BF, CF, BMS]

Insufficient vaccination coverage

Lack of and/or delay in treatment

These effects are intense in absence of contingency plans, trained/skilled HR, prepositioned supplies

Public Health Effects of Floods Public Health Effects of Floods [Risk Factors][Risk Factors]


Different Risk Factors = Different EffectsDifferent Risk Factors = Different Effects

Risk Factor Increased Transmission

Increased progression to disease

Increase case-fatality (CFR)

Increased malnutrition Nearly all diseases Nearly all diseases Nearly all diseases

Displacement into overcrowded camps

Air-droplet diseases Diarrhea, dysentery, worm infestation, Tuberculosis, ARI

Diarrhea

Poor shelter Vector-borne diseases Malaria, Dengue Malaria

Insufficient vaccination coverage

Vaccine preventable diseases

Measles Measles

Poor water, sanitation and hygiene condition

Faecal-oral diseases DiarrheaDysentery

Diarrhea

Vector proliferation and/or increased human-vector contact

Vector-borne diseases MalariaDengue

Malaria

Lack of and/or delay in treatment

Maternal diseases APHPPH

Pregnancy related (Maternal deaths)


Which Epidemic disease should we Which Epidemic disease should we expect and when?expect and when?Risk Factor Main epidemic disease of

concernTiming after onset of risk factor

FloodingIntense rainy seasonTemperature abnormalities

MalariaDengueRift Valley Fever

At least 1 month

Movement of people from non-endemic into disease-endemic region

Malaria At least 1 month

Dry season Meningitis About 2 weeks

Overcrowding Measles, Meningitis As little as 2 weeks

Insufficient waterContaminated waterVery poor sanitation

CholeraShigella (bloody dysentery)Rotavirus

As little as 2 weeks

Poor nutritional intake Measles, cholera, Rota virusShigella (bloody dysentery)

Starting about 1-2 months

Interruption of routine vaccination activities

Measles A few months


Insufficient Food intakeInsufficient Food intake


Undernutrition and Child MortalityUndernutrition and Child Mortalityo Nearly 9 million children under five died in

2009, more than 2/3 of them during the first year of life, Millions more survived only to face diminished lives unable to develop to their full potential

o Five diseases-pneumonia, diarrhoea, malaria, measles and AIDS – together account for half of all deaths of children under 5 years old. Undernutrition is a contributing cause of more than one third of these deaths.

o The single largest common denominator in global child deaths is malnutrition

o Severe wasting is an important cause of these deaths

o Proportion associated with acute malnutrition often grows dramatically in emergency contexts

Malnutrition54%


Different risk factors = different effectsDifferent risk factors = different effects From the previous slide we can immediately see that:

‒ Malnutrition is a critical modulator of all infectious disease dynamics

‒ Living in overcrowded camps affects the risk of the two most important routes of transmission [air-droplet, faecal-oral]

‒ Lack of treatment can undo gains in prevention

Worst scenario = gradually declining vaccination coverage + sudden mass displacement into camps + nutritional crisis + no health services

‒ i.e. the first 3-4 weeks of many emergencies!


Priority measure to reduce the impact Priority measure to reduce the impact of communicable diseasesof communicable diseases

Ensuring Safe water and sanitation

Site planning and provision of adequate shelter

Provision of adequate food

Primary healthcare services and nutrition

Establishment of surveillance/early warning system to ensure rapid control

Immunization [Especially Mass measles vaccination]

Prevention of Malaria and Dengue


Public Health Efforts made------Public Health Efforts made------ Immediate Relief Work mainly carried out by Govt., Army,

UN Agencies, bilateral donors, I/NGOs. In addition civil society, volunteers & independent teams provided support.

It included:

‒ Evacuation, IRA/McRAM

‒ Shelter Arrangements

♦ Camps, communities, institutions

‒ Cooked, Ready to use Foods, Water supply, Sanitation

‒ Health [Immunization, PHC, MCH]------Mobile & Static

‒ Nutrition [Supp. & Therapeutic Foods, Monitoring BMS, Estab of BF corners, Hygiene promotion]

Cluster Formation/Revivals

‒ Health, Nutrition, Shelter, WASH, Education, Protection, Agriculture


--------Public Health Efforts made--------Public Health Efforts made Capacity Building of humanitarian community and Govt.

Resource Mobilization

‒ Flash Appeals, Humanitarian Response Appeals

‒ Information Management [3 Ws Matrix, Pooling of Resources, Avoiding Duplication]

‒ Surveillance and assessments [DEWS, NIS, FANS]

Recovery-Reconstruction----[PDMA].

The threat was converted into opportunities

‒ What was gained, this turned to be an opportunity for CB, self assessment and better planning


Public Health Efforts made [KP]Public Health Efforts made [KP] Around 5,000 healthcare providers and field workers were

trained in emergency health and nutrition interventions [Better and coordinated Response]

Around 4 million children 5-13 years were vaccinated against measles [No measles outbreak]‒ Routine Immunization services were strengthened;

providing routine immunization services to around 0.5 million children

Millions+++ free consultations were provided to flood affectees for PHC services [No major outbreaks of diarrhea, ARI and other diseases]

Over one million women were provided maternal health [ANC/PNC] services and >5,000 safe deliveries conducted [decreased maternal deaths]


Public Health Efforts made [KP]Public Health Efforts made [KP] Around 2 million children and 1 million women were

assessed for acute malnutrition. Malnutrition level between 10-20%. ‒ > half a million acute malnourished children and mothers

were treated through CMAM protocols

‒ >2 million mothers/caretakers were reached with messages on appropriate health, nutrition and hygiene messages.

‒ >1 million children dewormed, >1 million children and women were provided mm supplements.

‒ [Cure rate>90%, death rate<1%, default rate<10%]

Millions+++ were provided safe drinking water and sanitation services

Millions+++ were provided food and non food [hygiene] packages


ConclusionConclusion Infectious diseases do not exhibit unexpected properties in

crises, but crises exacerbate existing or bring about new risk factors

‒ Higher transmission rate, probability of progression to disease and/or CFR

‒ Excess morbidity and mortality Think of which processes a risk factor or intervention

affect:

‒ Transmission?

‒ Progression to disease?

‒ CFR? Humanitarian relief in the health sector aims to reduce

excess morbidity and mortality by reducing CFR

THANKSTHANKS

public health effects of & public health efforts made for the pakistan floods dr. abdul jamil...

Documents

health facilities damaged

health indicators

health facilitiesprior

bridges damaged

wss damaged

roads damaged

total affected districts

total affected households