Background: Hurricane Sandy made landfall on the eastern coast of the United States on October 29, 2012 resulting in 117 deaths and 71.4 billion dollars in damage. Persons with undiagnosed HIV infection might experience delays in diagnosis testing, status confirmation, or access to care due to service disruption in storm-affected areas. The objective of this study is to describe the impact of Hurricane Sandy on HIV testing rates in affected areas and estimate the magnitude and duration of disruption in HIV testing associated with storm damage intensity.
Methods: Using MarketScan data from January 2011‒December 2013, this study examined weekly time series of HIV testing rates among privately insured enrollees not previously diagnosed with HIV; 95 weeks pre- and 58 weeks post-storm. Interrupted time series (ITS) analyses were estimated by storm impact rank (using FEMA’s Final Impact Rank mapped to Core Based Statistical Areas) to determine the extent that Hurricane Sandy affected weekly rates of HIV testing immediately and the duration of that effect after the storm.
Results: HIV testing rates declined significantly across storm impact rank areas. The mean decline in rates detected ranged between -5% (95% CI: -9.3, -1.5) in low impact areas and -24% (95% CI: -28.5, -18.9) in very high impact areas. We estimated at least 9,736 (95% CI: 7,540, 11,925) testing opportunities were missed among privately insured persons following Hurricane Sandy. Testing rates returned to baseline in low impact areas by 6 weeks post event (December 9, 2012); by 15 weeks post event (February 10, 2013) in moderate impact areas; and by 17 weeks after the event (February 24, 2013) in high and very high impact areas.
Conclusions: Hurricane Sandy resulted in a detectable and immediate decline in HIV testing rates across storm-affected areas. Greater storm damage was associated with greater magnitude and duration of testing disruption. Disruption of basic health services, like HIV testing and treatment, following large natural and man-made disasters is a public health concern. Disruption in testing services availability for any length of time is detrimental to the efforts of the current HIV prevention model, where status confirmation is essential to control disease spread.
Introduction: Fire hazards are an extreme risk to occupants of high-rise buildings. Little attention has been paid to emergency and evacuation preparedness among people living in high-rise buildings. This paper reports on emergency fire preparedness among residents of a high-rise building that has experienced multiple fires in the past.
Methods: An exploratory qualitative pilot study was conducted using key informant interviews. Six residents participated. Themes on preparedness for fires and emergency evacuation were extracted.
Results: Findings indicated varying levels of preparedness for fires and emergency evacuation among residents. Factors influencing residents’ emergency preparedness included fire risk perception, owner or renter status, and building-level emergency preparedness. Fire alarms were considered to be an ineffective evacuation cue. Severe cues such as seeing fire or smoke were more likely to prompt evacuation. Participants provided a series of suggestions to keep high-rise residents safe during fire emergencies.
Discussion: The study revealed fire preparedness knowledge, decision-making processes, and actual behaviors of residential high-rise occupants who experienced a fire emergency in their building. Main findings of the study are discussed in two themes: influences on fire emergency and evacuation preparedness, and evacuation decision-making and response to fire. Results from this pilot study will be used as the basis for a follow up study involving residents from multiple high-rise buildings.
Keywords: disaster, emergency preparedness, evacuation, fire, hazard, high-rise building, pilot study, qualitative research
Introduction: Health-related disaster research is a relatively small; but growing field of inquiry. A better understanding of the scope and scale of health-related disaster research that has occurred in low- and middle-income countries (LMICs) would be useful to funders, researchers, humanitarian aid organizations, and governments as they strive to identify gaps, disparities, trends, and needs of populations affected by disasters.
Methodology: We performed a scoping review using the process outlined by Arksey & O’Malley to assess the characteristics of peer-reviewed publications of empirical health-related disaster research conducted in LMICs and published in the years 2003-2012.
Results: Five hundred and eighty-two relevant publications were identified. Earthquakes were by far the most commonly researched events (62% of articles) in the review’s timeframe. More articles were published about disasters in China & South Asia/South East Asia than all other regions. Just over half of the articles (51%) were published by research teams in which all the authors’ primary listed affiliations were with an institution located in the same country where the research was conducted. Most of the articles were classified as either mental health, neurology and stress physiology (35%) or as traumatology, wounds and surgery (19%). In just over half of the articles (54%), data collection was initiated within 3 months of the disaster, and in 13% research was initiated between 3 and 6 months following the disaster. The articles in our review were published in 282 different journals.
Discussion: The high number of publications studying consequences of an earthquake may not be surprising, given that earthquakes are devastating sudden onset events in LMICs. Researchers study topics that require immediate attention following a disaster, such as trauma surgery, as well as health problems that manifest later, such as post-traumatic stress disorder. One neglected area of study during the review’s timeframe was the impact of disasters on non-communicable and chronic diseases (excluding mental health), and the management of these conditions in the aftermath of disasters. Strengthening disaster research capacity is critical for fostering robust research in the aftermath of disasters, a particular need in LMICs.
Introduction: Using Interrupted Time Series Analysis and generalized estimating equations, this study identifies factors that influence the size and significance of Hurricane Sandy’s estimated impact on HIV testing in 90 core-based statistical areas from January 1, 2011 to December 31, 2013.
Methods: Generalized estimating equations were used to examine the effects of sociodemographic and storm-related variables on relative change in HIV testing resulting from Interrupted Time Series analyses.
Results: There is a significant negative relationship between HIV prevalence and the relative change in testing at all time periods. A one unit increase in HIV prevalence corresponds to a 35% decrease in relative testing the week of the storm and a 14% decrease in relative testing at week twelve. Building loss was also negatively associated with relative change for all time points. For example, a one unit increase in building loss at week 0 corresponds with an 8% decrease in the relative change in testing (p=0.0001) and a 2% at week twelve (p=0.001).
Discussion: Our results demonstrate that HIV testing can be negatively affected during public health emergencies. Communities with high percentages of building loss and significant HIV disease burden should prioritize resumption of testing to support HIV prevention.
Introduction: Earthquake is the most important cause of death from natural disasters in Iran. This paper brings attention to the main causes of loss of life due to the Kermanshah province earthquake (Nov 12 2017), and provides a wakeup call about the unsafe nature of buildings there. Methods: This study is based on official reports review and a field assessment in the areas affected by the earthquake in western Iran. Results: Although buildings in this area are mainly old structures, strangely, more than 70% of the destroyed buildings in this earthquake were under 5 years of age, newly built or renovated buildings according to mandated building codes. Discussion: Mandated building codes and construction rules and regulations are not respected even for the newly constructed or reconstructed structures buildings. Keywords: Earthquake, Iran, construct, reconstruct, Building codes
Introduction: Despite the large number of hazards occurring every year, it is often only the most catastrophic and rapidly occurring hazards that are covered in detail by major news outlets. This can result in an under-reporting of smaller or slowly evolving hazards such as drought. Furthermore, the type or country in which the hazard occurs may have a bearing on whether it receives media coverage. The Public Health England (PHE) global weekly hazards bulletin is designed to inform subscribers of hazards occurring in the world in a given week regardless of location or type of natural hazard. This paper will aim to examine whether the bulletin is reporting these events in a way that matches a number of international disaster databases. It will also seek to answer if biases within media outlets reporting of an event is impacting on the types of hazards and events being covered. Through the analysis of data collected, it is hoped to be able to consider the ethical implications of such a bulletin service and provide recommendations on how the service might be improved in the future.
Methods: The study used a year’s worth of global hazards bulletins sent by Public Health England. These bulletins aim to communicate hazards in the form of compiled articles from news outlets around the world. Data from these bulletins was collected and analysed by hazard type and the country in which hazards occurred. It was then compared to recognised hazard databases to assess similarities and differences in the hazards being reported via media or through dedicated hazard databases. The recognised hazard databases were those run by the Emergency Events Database (EM-DAT), European Civil Protection and Humanitarian Aid Operations (ECHO) and National Aeronautics and Space Administration (NASA) respectively.
Results: The PHE bulletin overall was found to be comparable to other global hazard or disaster databases in terms of hazards included by both country and type of hazard. The PHE bulletin covered a greater number of unique hazard events than the other databases and also covered more types of hazard. It also gave more frequent coverage to the United Kingdom and Canada than the other databases, with other countries appearing less frequently. More generally, the PHE bulletin and the databases it was compared to appear to focus more on hazards either occurring in developed countries or fast-onset ones such as landslides or floods. On the other hand, slow-onset hazards such as drought or those occurring in developing countries appear to be under-reported and are given less importance in both the bulletin and databases.
Discussion and recommendations: We recommend that the resources compared review their inclusion criteria and assess whether the discrepancies in hazard type and country can be ratified through changes in how hazards are assessed for inclusion. More research should be undertaken to assess whether similar findings arise when comparing databases in other areas within the remit of public health.
Introduction: To report on activities aligned with the Sendai Framework for Disaster Risk Reduction 2015-2030, national governments will use the Sendai Monitor platform to track progress using a series of indicators that inform seven Global Targets originally agreed in 2015. In February 2017, the UN General Assembly adopted a set of 38 agreed indicators based on work led by an open-ended intergovernmental expert working group (OIEWG) on indicators and terminology relating to disaster risk reduction. In January 2018 the United Nations Office for Disaster Risk Reduction released technical guidance documents in advance of the launch of the Sendai Monitor in March 2018. Methods: This paper discusses several challenges to recording and reporting on loss data under the Sendai Framework. Additional insights to elaborate on discussion build upon commentary and examples raised during a workshop held on developing loss data that was hosted by the United Nations Office of Disaster Risk Reduction (UNISDR), the Integrated Research on Disaster Risk (IRDR) programme, and Public Health England (PHE) from February 15-17 2017 at the Royal Society in London, United Kingdom. The meeting’s purpose was to refine technical guidance notes concerning Global Targets A, B, C, and D, which had been drafted in coordination with the work of the OIEWG. The workshop was attended by representatives from UN Agencies, UN Member States, international scientific bodies, academic bodies, the government of the United Kingdom and the private sector. Results: Global Targets A, B, C and D of the Sendai Framework have common and specific complexities which require acknowledgement and support in recording, reporting and using disaster loss data. Discussions during the February 2017 loss data workshop highlighted a number of complexities and the need for common standards and principles for loss data. Individual target complexities include attribution of health impacts, assessing impacts, consistently calculating economic losses and measuring disruption to critical infrastructure. Discussion: Transparent monitoring is critical to ensure political will, financial efforts and effective evidence support the global shift towards more sustainable development. Data involves common challenges which can undermine accuracy and understanding of reporting across the frameworks that outline the United Nations’ 2030 Agenda. Disaster loss data adds further challenges which require support and innovation to ensure stakeholders across sectors in all sectors have appropriate technical guidance that can support useful loss data management processes. The February 2017 workshop highlighted systemic challenges with working with loss data and highlighted several pertinent pathways to progress on the breadth and reliability of disaster loss data across different settings.
Abstract Background: Animal ownership has been identified as a risk factor for human survivability of natural disasters. Animal guardians have been reported to react or act in ways that may put their own safety and that of emergency services personnel at risk when faced with a natural disaster. Recent research has suggested that this risk factor could be reconfigured as a protective factor, whereby desires to save animals from natural disaster harm could motivate increased planning and preparedness behaviours amongst animal guardians. However, there has been no research to determine if bushfire planning and response behaviours differ between pet owners with low and high attachment; and how the relationship may differ in relation to small or large animals. Methods and procedure: We investigated the relationship between people’s emotional attachment to different types of pets and their preparation and actions during the Pinery bushfire in South Australia in November 2015. Thirty-four people who were impacted by the fire participated in an online survey. Data were collected about their preparedness, planning and response behaviours as well as their animal attachment (high or low). Results: We identified 10 characteristics (behaviours, attributes, skills and beliefs) associated with high animal attachment scores, and eight associated with low animal attachment scores. Discussion: Our discussion of the differences in demographics, preparedness, planning and response characteristics of participants with high and low animal attachment confirms research suggesting that animal guardians take risks to save their animals during disasters. Our findings also support recent propositions that animal attachment and ownership could be used to increase the natural disaster preparedness and survivability of animal guardians. However, making sure that animal attachment functions as a protective factor requires active and effective intervention through education, behaviour change and social marketing strategies. Whilst our study is high in ecological validity, future research with larger samples sizes is required to determine the generalisability of our findings to animal owners and guardians in other locations, facing fires with other characteristics, especially for owners and guardians with low levels of attachment.
Introduction: Despite existing policy actions on Disaster Risk Reduction (DRR), many community members in Bududa still continue to settle in high-risk areas re-zoned for nonsettlement. There seems to be an apparent information asymmetry on expectations between the community and Government. The challenge then is ‘how to consult communities and seek their opinion in an adequately representative unbiased way’. This paper sets out to explore policy options on resettlement management as a DRR approach and how engaging with communities in a public discourse using the Deliberative Polling (DP) approach; to obtain their opinions and insights on these policy issues, revealed underlying challenges to policy implementation.
Methods: A qualitative study was conducted in Bududa in eastern Uganda with fourteen group discussions; comprising 12-15 randomly assigned participants of mixed socio-economic variables. Trained research assistants and moderators collected data. All discussions were audio taped, transcribed verbatim before analysis. Data were analyzed using latent content analysis by identifying codes from which sub-themes were generated and grouped into main themes on policy options for resettlement management.
Results and Discussion: We used Deliberative Polling, an innovative approach to public policy consultation and found that although the community is in agreement with most government policy options under resettlement management, they lacked an understanding of the rationale underlying these policy options leading to challenges in implementation. The community members seemed uncertain and had mistrust in government’s ability to implement the policies especially on issues of compensation for land lost.
Key Words: Policy, Deliberative Polling, Climate change, risk-reduction, landslides, Uganda