Basics in emergencies

Why Health?

• Our aim:– Saving lives– Reducing suffering - both through ensuring public health

• Along with food and shelter, safe water and sanitation health is the highest priority intervention in emergency situations. Unless adequate health services are quickly provided to emergency-affected children and their families, disease and death will follow.

• And unless good hygiene is consistently practiced by affected people, the danger of diarrhoea, cholera and other disease outbreaks will persist.

• This is true in all types of emergencies, from rapid onset natural disasters to long-term crises caused by a range of complex factors.

Why Health? (cont’d)

• Public health response is usually the first intervention in emergencies as it directly associates with saving lives because the high morbidity and mortality rates are attributed to WASH infectious diseases in the first phase of emergency.

• Some diseases, especially diarrhoeal diseases cause considerable dehydration, which can lead to death if not promptly treated. Diarrhoeal diseases can be prevented through access to clean, safe drinking water and through proper hygiene and sanitation measures, including hand washing and safe disposal of human waste.

Source: Oxfam India WASH strategy 2010-2015

Water and diseases

Water-borne (and faecal-oral)

Due to faecal-oral bacteria and non-faecal oral bacteria in water

Diarrhoeas and dysenteries , TyphoidShigellosis , Hepatitis A

Water contaminationPoor sanitationPoor personal hygiene

Water-washed

Due to lack of water Skin and eye infections

Inadequate waterPoor personal hygiene

Water-based

Due to long exposure to microbes living naturally in water

Schistosomiasis, Guinea worm

Water contamination

Water-related insect-vector

Due to insect vectors which breed in water

Malaria, River blindness, Filariasis, Dengue, Yellow Fever

Breeding in waterBiting near water

Sanitation and diseases

Excreta-related helminths

Helminths transmitted through soil

Roundworm, Hookworm, Whipworm

Open defecationGround contamination

Excreta-related insect-vector

Transmitted by flies and cockroaches

Diarrhoea and dysentery

Dirty and unhygienic environment

Key Health Threats

• Poor drainage, stagnant water • People drinking contaminated water• Unsafe excreta disposal• Solid waste deposition• Inappropriate shelter• Insecure environment• People not washing hands at key times

Major communicable diseases in emergencies• Cholera• Malaria• Shigellosis• Scabies • Dengue• Leptospirosis• …… etc.

Groupwork: Factors affecting risk of outbreaks• Population displacement• Population density• Disruption and contamination

of water supply and sanitation services

• Disruption of public health programs

• Ecological changes that favour breeding of vectors

• Displacement of domestic and wild animals

Key Health Interventions

• Provision of treatment in hospitals• Provision of immunization

• Promotion of antenatal care• Provision of delivery services

Which of the above has the most impact?

Epidemiological terms and definitions

• Endemic– The continuing presence of disease within a given geographical

area or population groups• Epidemic

– An outbreak of disease that attacks many people at about the same time and may spread through one or several communities

• Pandemic– When an epidemic spreads throughout the world

• Epidemiology– Study of distribution and determinants of diseases & health

related events and application of this knowledge for prevention and control of diseases

Epidemiological Triad

AGENTBacteria, Viruses,Parasites, fungi

(or) their products

ENVIRONMENTShelter, altitude,

humidity, sanitation,food supply, water

supply, temperatureovercrowding

HOSTAge

genetic susceptibilitynutritional status

previous exposureimmunization status

general physical condition

Vector

Key indicators of health status: Mortality

• Measured as number of deaths per 10000 population per day. It is known as Crude Mortality Rate because it uses the crude numbers for deaths and the population without any adjustment for the composition of the population.

• Crude mortality rate (CMR) is for entire population and under 5 mortality rate (U5MR) is for children under 5 years of age

CMR = No. of deaths X 10000 Population X Period

21 people are reported dead in a camp with population of 20000, in a period of one week. What is the CMR in this case?

Benchmark mortality rates in emergencies

• Crude Mortality Rate:– 0.5 Baseline – 1.0-2.0 Serious – >2.0 Crisis

• U5MR – 0.8-1.2 Baseline– >2.0-4.0 Serious

Key indicators for health status: Morbidity

• Morbidity is the number of NEW cases of a GIVEN DISEASE among the population over a certain period of TIME.

• Measured per 10000 population per day.

Cases Deaths Cases Deaths Cases DeathsAcute watery diarrhoeaBloody diarrhoeaSuspected choleraSevere RTI/pneumoniaSuspected malaria/fever of unknown originMalnutritionMeaslesMeningitisAcute jaundice syndromeOther/unknownTotal

Average CMRAverage U5MR

WEEKLY MORBIDITY / MORTALITY SURVEILLANCE FORM

Name of reporting officer

<5 years 5 years and older TotalReported main cause of illness/death (final diagnosis)

District/Town/Settlement/CampHealth ClinicReporting Period

Faecal-Oral transmission routes

Faeces

Fields

Fluids

Flies

Fingers

Food New host

Barriers to break the faecal-oral chain

Faeces

Fields

Fluids

Flies

Fingers

Food New host

Pit latrines

VIP latrines

Protection of water sources

Protection of food (e.g. storage)Hand-washing at key times

Protection of food(e.g. handling, preparation)

Protection of water in transit and in the shelter

Safe eating (e.g. washing fruits and vegetables before

eating them raw

PRIMARY BARRIERS SECONDARY BARRIERS