Author Profile

Ali Ardalan

https://www.hsph.harvard.edu/ali-ardalan

Affiliation: Associate Professor and Chair, Disaster and Emergency Health, Tehran University of Medical Sciences, Tehran, Iran. Senior Fellow and Scientist, Harvard Humanitarian Initiative, Cambridge, USA. Email: [email protected], [email protected]

Associate Professor and Chair, Disaster & Emergency Health, Tehran University of Medical Sciences, Tehran, Iran. Senior Fellow and Scientist, Harvard Humanitarian Initiative, Harvard University, Cambridge, USA. Email: [email protected] , [email protected]

Recent Posts

Characteristics of an Effective International Humanitarian Assistance: A Systematic Review

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Introduction: The objective of this study is to identify the effectiveness characteristics, review the definition of them, and develop a conceptual mapping of existing domains in the field of International Humanitarian Assistance (IHA).

Methods: We conducted a systematic review and searched the major databases (Science Direct, Scopus, Springer and Pubmed) and grey literature, including references of potentially eligible articles and conference proceedings through March 2015. Articles were included if they focused on IHA effectiveness. Reviewers independently identified the eligible studies and extracted data.

Results: 10 studies were included and 48 characteristics were identified. There is a lack of scientific studies and agreement on the characteristics of IHA effectiveness. 

Conclusion: This study could be the step toward an understanding of IHA effectiveness characteristics and its definitions with the findings making a base line for more research in this area. 

Criteria for Site Selection of Temporary Shelters after Earthquakes: a Delphi Panel

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Introduction: After a devastating earthquake, the site selection for the sheltering of earthquake victims is an important task. In order to generate a list of appropriate criteria for deciding on temporary sheltering site selection, we systematically combined the experience of experts and the findings of published documents in this study.

Methods: Having explored published papers, we generated a list of criteria for the selection of the best location for temporary sheltering. In the next step, all criteria were presented to a group of experts in Iran and after a scientific discussion, the list was updated. In the last step, the final list of criteria was developed using the Delphi method in three rounds.

Results: Based on our previous systematic review, 27 criteria were presented for sheltering site selection. Expert interviews added 12 more items to them. The Delphi process approved 21 criteria of all proposed ones. These items then grouped into four categories: land suitability, socio-cultural considerations, service availability and disaster risk reduction.

Discussion: After an earthquake, our list of criteria may help the disaster team to select the best locations for temporary sheltering with minimum confusion. The consent of the earthquake victims and cost reduction of the operation would be the minimum benefits of using the appropriate criteria. These criteria also could be used by researchers to make objective and reproducible assessments of temporary sheltering site selection. Key words: Criteria, Earthquake, Model, Site selection, Temporary shelter,

Hospital Disaster Preparedness Tools: a Systematic Review

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Aim: Evaluating hospital disaster preparedness is one the best ways for hospital accreditation. The aim of this study was to evaluate the quality of outcome measure that offer the level of measurement, reliability and validity that are known as the ‘ psychometric properties’ of the current hospital disaster preparedness tools.

Methods: In total, 140 studies were retrieved. Studies which had been published from 2000 to 2014 and had used hospital disaster preparedness tools were appraised by using the PRISMA guideline. The content quality and the quality of the psychometric properties of the retrieved tools were assessed by using the World Health Organization Criteria for Hospital Preparedness as well as the COSMIN criteria.

Findings: Only 33 studies met the inclusion criteria. In total, eleven hospital disaster preparedness tools had been used in these 33 studies. These tools mainly focused on evaluating structural and non-structural aspects of hospital preparedness and paid little attention, if any, to the key functional aspect.

Conclusion: Given the paramount importance of evaluating hospital disaster preparedness and the weaknesses of current preparedness evaluation tools, valid and reliable tools should be developed by using experts’ knowledge and experience through the processes of tool development and psychometric evaluation.

Keywords: Hospital preparedness, Measurement tool, Disaster, Systematic review

Virtual Disaster Simulation: Lesson Learned from an International Collaboration That Can Be Leveraged for Disaster Education in Iran

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Disaster education needs innovative educational methods to be more effective compared to traditional approaches. This can be done by using virtual simulation method. This article presents an experience about using virtual simulation methods to teach health professional on disaster medicine in Iran.

The workshop on the “Application of New Technologies in Disaster Management Simulation” was held in Tehran in January 2015. It was co-organized by the Disaster and Emergency Health Academy of Tehran University of Medical Sciences and Emergency and the Research Center in Disaster Medicine and Computer Science applied to Medicine (CRIMEDIM), Università del Piemonte Orientale. Different simulators were used by the participants, who were from the health system and other relevant fields, both inside and outside Iran.

As a result of the workshop, all the concerned stakeholders are called on to support this new initiative of incorporating virtual training and exercise simulation in the field of disaster medicine, so that its professionals are endowed with field-based and practical skills in Iran and elsewhere.

Virtual simulation technology is recommended to be used in education of disaster management. This requires capacity building of instructors, and provision of technologies. International collaboration can facilitate this process. Keywords: Virtual simulation, disaster management, education, training, Iran

Feasibility Assessment of Using Geoinformatics Technology in Disaster Disease Surveillance in a Developing Country, Iran

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Background and purpose: Geoinformatics technology retains an unprecedented trait of performing with a supersonic speed and precision in public health management whereas the existing disease surveillance systems in developing countries lack using this technology. This article aims to assess the feasibility of using geoinformatics technology in disaster disease surveillance in a developing country, Iran.

Methods: A self-administered questionnaire was developed based on technology acceptance model (TAM), and a semi-quantitative survey was conducted in order to collect data. Fifty TUMS & HS personnel, currently involve in disease surveillance and information technology, were included. Initially, a pilot study was conducted to test the validity and reliability of the questionnaire. Cronbach alpha, confirmatory factor analysis (CFA), and standard error of measurement (SEM) were calculated to validate the causal model.

Results: The results from structural equation analysis suggested that TAM provided a constructive picture of using geoinformatics technology in disaster disease surveillance at TUMS &HS. The study found attitude (ATT) had a significant influence on participants intention to use (ITU) a new technology, and perceived ease of use (PEOU) was a strong determinant of perceived of usefulness (PU). Subsequently, PU and PEOU explained ATT substantially; even though the analysis showed insignificant statistical association among these constructs. The high R2 (Coefficient of determination) of the constructs described respondents positive instinct towards accepting a new technology.

Conclusion: The study reveals that personnel intent to adopt geoinformatics technology in disaster disease surveillance; and at the same time, they possess a positive attitude towards the technology. This study also found PEOU has a strong influence on PU, so information sessions and training on geoinformatics technology need to focus primarily on the applications and impacts of technology on disaster disease surveillance.

Tehran Dust Storm Early Warning System: Corrective Measures

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On June 2, 2014 a sandstorm hit Tehran, the capital city of Iran which killed 5 and injured 44 people. The early warning system did not operate properly and the alarm was not transferred to at risk population and the related organizations in time and in a right manner. Additionally, people who were exposed to the winds didn’t know the appropriate safety measures. Focusing much more on establishing EWS to alert the risk prone population timely and public education for taking safety measures when exposed to the disastrous situation is recommended.

Communicable Diseases Surveillance System in East Azerbaijan Earthquake: Strengths and Weaknesses

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Background: A Surveillance System was established for 19 diseases/syndromes in order to prevent and control communicable diseases after 2012 East Azerbaijan earthquakes. This study was conducted to investigate the strengths and weaknesses of the established SS.

Methods: This study was carried out on an interview-based qualitative study using content analysis in 2012. Data was collected by semi-structured deep interviews and surveillance data. Fifteen interviews were conducted with experts and health system managers who were engaged in implementing the communicable disease surveillance system in the affected areas. The selection of participants was purposeful. Data saturation supported the sample size. The collected data was analyzed using the principles suggested by Strauss and Corbin.

Results: Establishment of the disease surveillance system was rapid and inexpensive. It collected the required data fast. It also increased confidence in health authorities that the diseases would be under control in earthquake-stricken regions. Non estimated denominator for calculating the rates (incidence & prevalence), non-participation of the private sector and hospitals, rapid turnover of health staff and unfamiliarity with the definitions of the diseases were the weak points of the established disease SS.

Conclusion: During the time when surveillance system was active, no significant outbreak of communicable diseases was reported. However, the surveillance system had some weaknesses. Thus, considering Iran’s susceptibility to various natural hazards, repeated exercises should be conducted in the preparedness phase to decrease the weaknesses. In addition, other types of surveillance system such as web-based or mobile-based systems should be piloted in disaster situations for future.

Site Selection Criteria for Sheltering after Earthquakes: A Systematic Review

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Objective: Proper shelter site selection is necessary for long-term welfare of earthquake affected people. This study aims to explore the criteria that need to be considered after earthquakes.
Methods: Through a systematic review, 273 articles found that were published till April 2014. Among these, seven articles have been selected and analyzed for the criteria that they introduced for sheltering site selection after earthquakes.
Results: Out of 27 proposed criteria, accessibility and proximity to homes of affected people were stressed in all the papers. Moreover, seven other criteria were the same in most of the papers including suitable size, suitable distance from hazardous areas, geological hazards and land slope, suitable distance from medical centers, water supply and Security.
We categorized all the mentioned criteria in six main categories. Size and location, disaster risk reduction, relief and rescue facilities, feasibility of the site, environmental and social aspects are the main categories.
Conclusion: Selection and applying proper criteria for shelter site selection after earthquakes is a multi-disciplinary task. The decision needs relevant models and/or tools. Geographic Information System (GIS) is a useful tool for this purpose.

Key words: Disaster, earthquake, shelter, site selection, systematic review

Rapid Health Needs Assessment Experience in 11 August 2012 East Azerbaijan Earthquakes: A Qualitative Study

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Introduction: In disasters, health care providers need to find out the essential needs of the affected populations through Rapid Health Needs Assessment (RHNA). In East Azerbaijan earthquakes, a rapid assessment was performed by the provincial health system. The main purpose of this study was to explore the RHNA challenges.

Methods: In this qualitative study (Grounded theory), data was collected through semi-structured interviews with purposely selected health care workers. The data collection process continued until data saturation. All interviews were recorded and then transcribed. The Colaizzi’s descriptive method was used to analyze the data.

Results: The themes emerged from the analysis of the interviews were: 1) Logistic problems 2) Lack of RHNA tools 3) Inherent difficulty of RHNA in disaster situations 4) Lack of preparedness and 5) Lack of coordination between different organizations. These challenges result in inapplicable use of RHNA results.

Conclusion: The most important challenge in this RHNA process was the lack of East Azerbaijan health center preparedness. Although they were familiar with the importance of RHNA, they did not have any plans for conducting RHNA.

Health Sector Initiatives for Disaster Risk Management in Ethiopia: A Narrative Review

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Background: Natural and man-made disasters are prevailing in Ethiopia mainly due to drought, floods, landslides, earthquake, volcanic eruptions, and disease epidemics. Few studies so far have critically reviewed about medical responses to disasters and little information exists pertaining to the initiatives being undertaken by health sector from the perspective of basic disaster management cycle. This article aimed to review emergency health responses to disasters and other related interventions which have been undertaken in the health sector.

Methods: Relevant documents were identified by searches in the websites of different sectors in Ethiopian and international non-governmental organizations and United Nations agencies. Using selected keywords, articles were also searched in the data bases of Medline, CINAHL, Scopus, and Google Scholar. In addition, pertinent articles from non-indexed journals were referred to.

Results: Disaster management system in Ethiopia focused on response, recovery, and rehabilitation from 1974 to 1988; while the period between 1988 and 1993 marked the transition phase towards a more comprehensive approach. Theoretically, from 1993 onwards, the disaster management system has fully integrated the mitigation, prevention, and preparedness phases into already existing response and recovery approach, particularly for drought. This policy has changed the emergency response practices and the health sector has taken some initiatives in the area of emergency health care. Hence, drought early warning system, therapeutic feeding program in hospitals, health centers and posts in drought prone areas to manage promptly acute malnutrition cases have all been put in place. In addition, public health disease emergencies have been responded to at all levels of health care system.

Conclusions: Emergency health responses to drought and its ramifications such as acute malnutrition and epidemics have become more comprehensive in the context of basic disaster management phases; and impacts of drought and epidemics seem to be declining. However, the remaining challenge is to address disasters arising from other hazards such as flooding in terms of mitigation, prevention, preparedness and integrating them in the health care system.

Key Words: Disaster, Emergency Health, Health System, Ethiopia