Rapid Assessment of Health Effects during Disasters

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Rapid Assessment of Health Effects during
Disasters

• Carol Rubin, DVM, MPH
• Health Studies Branch
• Division of Environmental Hazards and Health
  Effects
• National Center for Environmental Health
• Centers for Disease Control and Prevention

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Rapid Needs Assessment

• Objective to obtain information about the needs
  of an affected community as these needs change in
  the aftermath of a disaster event

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Fall of USSR
Hurricane Isabel North Carolina
Hurricane Mitch Honduras
World Trade Center attacks - NYC
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Hurricane Isabel, September 2003
Courtesy of NOAA
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Hurricane Isabel
Sept 15 - NCDHHS requests CDC technical
assistance in preparation for Hurricane
Isabel Sept 17 - (700am) CDC deploys team to
NC Sept 18 - (100pm) Hurricane Isabel makes
landfall Sept 18 - (300pm) Preliminary
information available 1st needs assessment area
identified and survey teams deployed to begin
sampling Sept 20 - (1200pm) Comprehensive
damage reports available Sept 20 (400pm) 2nd
needs assessment area identified begin sampling
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Selection of Affected Areas
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FindingsIn the second assessment area

• Two-thirds of households had no electricity
• (61,000 people)
• A quarter of the population had no running water
  (22,000 people)
• 13 of households (12,000 people) did not have
  access to a 3-day food supply

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Impact

• Resources directed where most needed
• Amount of relief appropriate for size of affected
  population
• Focused public health messages and education
  outreach

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Rapid Needs Assessment

• The rapid in Rapid Needs Assessment refers to
  the speed and accuracy with which data is
  collected, processed, and utilized.

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Rapid Needs Assessment

• Rapid Needs Assessment can also be used to
  periodically reassess post-disaster interventions.

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Hurricane Mitch, October 1998
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Affected Areas
Guatemala
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ARC Interventions

• Goal of sustainable change
• 1) Water security
• 2) Sanitation services
• 3) Provide community education in basic
  sanitation and hygiene practices
• Interventions tailored to account for specific
  conditions in each community

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Sampling

• Two study areas in each country
• 100 households per study area
• Initial assessment established baseline
• Three annual re-assessments
• Two days for each community assessment

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Findings

• Initial Rapid Needs Assessment
• Food, water, sanitation, health education
• 1st re-assessment
• Diarrhea an increasing problem, focus should be
  directed to hygiene education
• 2nd re-assessment
• Revise water plans to include upgrading the
  chlorination systems
• 3rd re-assessment
• Water and sanitation needs acceptable, but should
  conduct routine water monitoring and provide
  training on maintenance of systems

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Impact

• Community specific interventions
• Decreased diarrheal disease
• Built in-country capacity to conduct rapid needs
  assessments after future hurricanes

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Former Soviet Union, 1991
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Rapid Assessment of Nutritional Status

• December 1991 Break up of USSR
• January 1992 Influx of American aid
• March 1992 Rapid needs assessments conducted
  among most vulnerable groups
• Results used to target nutritional aid

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Sampling

• Representative sample of Pensioners 70 years and
  older
• 2 cities, 300 people each city
• Home-based surveys completed in 6 days
• Determined nutritional status and primary needs,
  and evaluated utility of existing demographic
  data to identify those most in need

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Findings

• Institutionalized elderly were in better
  nutritional condition than apartment dwellers
• Food usability restricted by dental problems
• Those receiving the lowest pensions were least
  likely to have receive external aid

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World Trade Center attacks
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Objectives of Needs Assessment

• Identify residents unmet needs
• Health
• Housing
• Psychological
• Provide information to NYC DOH
• Establish priorities and direct interventions

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Lower Manhattan Neighborhoods Selected for
Household Interviews
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Findings

• Two-thirds of residents had respiratory health
  symptoms
• More than one-third of residents had strong
  potential risk of PTSD
• Fewer than half did not perceive counseling as
  beneficial
• Only 50 of those desiring mental health services
  had access to them

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Impact

• Air quality information was made more available
  and accessible
• Respiratory health interventions were implemented
• Mental health outreach was expanded

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Rapid Needs Assessment

• Statistically sound way to quickly identify unmet
  needs
• Enables periodic re-assessment of needs
• Adaptable to unique disaster situations
• Allows for evidence-based decisions and
  interventions