Data for Decision Making in Disasters: Advances and Controversies Prevention of Disaster Threats Workshop Kaunas, Lithuania 08 August, 2005 Eric K. Noji,

Data for Decision Making in Disasters: Advances and

Controversies Prevention of Disaster Threats Workshop

Kaunas, Lithuania 08 August, 2005

Eric K. Noji, M.D., M.P.H.Centers for Disease Control

Washington, DC

"The reason for collecting, analyzing and disseminating information on a disease is to control that disease.

Collection and analysis should not be allowed to consume resources if

action does not follow."

William H. Foege, M.D.International Journal of

Epidemiology 1976; 5:29-37

Uses of Data in Disasters

• Assessment and Surveillance

• Injury and disease profiles

• Research methodologies

• Disaster management

• Vulnerability and hazard assessment

Public Health Actions in Emergencies

•Before the disaster

•During the disaster

•After the disaster

Data Needs Before the Disaster

•Hazard Analysis

•Vulnerability Analysis

•Training and Education

Increasing disaster risk

Increasing population density Increased settlement in high-risks areas Increased technological hazards and

dependencyIncreased terrorism: biological,

chemical, nuclear?Aging population in industrialized countriesEmerging infectious diseases (AMR) International travel (global village)

While knowing the threat agent is important, understanding how each threat expresses its toll on the health and well being of communities, in boththe near term and the long run, iscrucial to our preparedness and response.

IMMEDIATE RELIEF

Next Steps

•Rapid needs assessment

•Disease Surveillance

•Public health interventions

Rapid Needs AssessmentRapid Needs Assessment

The collection of subjective and The collection of subjective and objective information, limited in objective information, limited in time, performed in acute time, performed in acute situations, which requires situations, which requires immediate action to be taken to immediate action to be taken to respond to the basic requirements respond to the basic requirements of the affected populationof the affected population

Objectives of Health Information Objectives of Health Information Systems in Emergency PopulationsSystems in Emergency Populations

Establish health care prioritiesEstablish health care priorities Follow trends and reassess prioritiesFollow trends and reassess priorities Detect and respond to epidemicsDetect and respond to epidemics Evaluate program effectivenessEvaluate program effectiveness Ensure targeting of resourcesEnsure targeting of resources Evaluate quality of health careEvaluate quality of health care

Goal of CMR in Emergency Goal of CMR in Emergency PopulationsPopulations

For < 5 years of age: Less than 2.0 per For < 5 years of age: Less than 2.0 per 10,000 per day10,000 per day

For > 5 years of age: Less than 1.0 per For > 5 years of age: Less than 1.0 per 10,000 per day10,000 per day

Morbidity AssessmentMorbidity AssessmentNecessary InformationNecessary Information

Diseases of public health importanceDiseases of public health importance MeaslesMeasles DiarrheaDiarrhea Acute Respiratory infectionsAcute Respiratory infections InjuriesInjuries MalnutritionMalnutrition

Diseases of epidemic potentialDiseases of epidemic potential CholeraCholera DysenteryDysentery MeningitisMeningitis Yellow feverYellow fever

Program or process indicatorsProgram or process indicators

Immunization coverageImmunization coverage Supplementary feeding attendanceSupplementary feeding attendance Antenatal and postnatal clinic coverageAntenatal and postnatal clinic coverage ORS distributionORS distribution Water consumationWater consumation Caloric intakeCaloric intake Latrine coverageLatrine coverage

The Assessment ProcessThe Assessment Process

Identify information needs and Identify information needs and resourcesresourcesCollect dataCollect dataAnalyze and interpretAnalyze and interpretReport conclusionsReport conclusionsDesign/modify disaster responseDesign/modify disaster responseBack to the beginning of assessmentBack to the beginning of assessment

Identify information needs and resourcesIdentify information needs and resources

After the DisasterAfter the Disaster

Lessons learnedLessons learned

Improving future disaster responseImproving future disaster response

Preventing or mitigating loss of life, Preventing or mitigating loss of life, severe illness and injuriessevere illness and injuries

Epidemiologic Methods in DisastersEpidemiologic Methods in Disasters

After a disaster (Reconstruction Phase):After a disaster (Reconstruction Phase):

Conducting post-disaster epidemiologic Conducting post-disaster epidemiologic follow-up studiesfollow-up studies

Identifying risk factors for death & injuryIdentifying risk factors for death & injury

Planning strategies to reduce impact-related Planning strategies to reduce impact-related morbidity & mortalitymorbidity & mortality

Source: EK Noji, Source: EK Noji, The Public Health Consequences of DisasterThe Public Health Consequences of Disaster


After a disaster (Reconstruction Phase):After a disaster (Reconstruction Phase):Developing specific interventionsDeveloping specific interventionsEvaluating effectiveness of interventionsEvaluating effectiveness of interventionsConducting descriptive & analytical studiesConducting descriptive & analytical studiesPlanning medical & public health response to Planning medical & public health response to

future disastersfuture disastersConducting long-term follow-up of Conducting long-term follow-up of

rehabilitation/reconstruction activitiesrehabilitation/reconstruction activitiesSource: EK Noji, Source: EK Noji, The Public Health Consequences of DisasterThe Public Health Consequences of Disaster

Myths and Realities in Myths and Realities in Disaster Situations Disaster Situations

Myth: Foreign Myth: Foreign medical medical volunteers with volunteers with any kind of any kind of medical medical background are background are needed. needed.

Reality: The local population almost Reality: The local population almost always covers immediate lifesaving always covers immediate lifesaving needs. Only medical personnel with skills needs. Only medical personnel with skills that are not available in the affected that are not available in the affected country may be needed. country may be needed.

Myth: Any kind of Myth: Any kind of international international assistance is assistance is needed, and it's needed, and it's needed now! needed now!

Reality: A hasty response that is not Reality: A hasty response that is not based on an impartial evaluation only based on an impartial evaluation only contributes to the chaos. It is better to contributes to the chaos. It is better to wait until genuine needs have been wait until genuine needs have been assessed. assessed.

Myth: Epidemics Myth: Epidemics and plagues are and plagues are inevitable after inevitable after every disaster. every disaster.

Reality: Epidemics do not Reality: Epidemics do not spontaneously occur after a disaster spontaneously occur after a disaster and dead bodies will not lead to and dead bodies will not lead to catastrophic outbreaks of exotic catastrophic outbreaks of exotic diseases. The key to preventing disease diseases. The key to preventing disease is to improve sanitary conditions and is to improve sanitary conditions and educate the public. educate the public.

Myth: Disasters Myth: Disasters are random are random killers. killers.

Reality: Disasters strike hardest at the Reality: Disasters strike hardest at the most vulnerable group, the poor --most vulnerable group, the poor --especially women, children and the especially women, children and the elderly. elderly.

Myth: Locating Myth: Locating disaster victims in disaster victims in temporary temporary settlements is the settlements is the best alternative. best alternative.

Reality: It should be the last alternative. Reality: It should be the last alternative. Many agencies use funds normally spent Many agencies use funds normally spent for tents to purchase building materials, for tents to purchase building materials, tools, and other construction-related tools, and other construction-related support in the affected country. support in the affected country.


Challenges for EpidemiologistsChallenges for EpidemiologistsApplying epidemiologic methods in the context of:Applying epidemiologic methods in the context of: Physical destructionPhysical destruction Public fearPublic fear Social disruptionSocial disruption Lack of infrastructure for data collectionLack of infrastructure for data collection Time urgencyTime urgency Movement of populationsMovement of populations Lack of local support and expertiseLack of local support and expertiseSource: EK Noji, Source: EK Noji, The Public Health Consequences of DisasterThe Public Health Consequences of Disaster


Challenges for EpidemiologistsChallenges for EpidemiologistsSelecting study designs:Selecting study designs: Cross-sectional:Cross-sectional:

Studies of frequencies of deaths, illnesses, injuries, Studies of frequencies of deaths, illnesses, injuries, adverse health affectsadverse health affectsLimited by absence of population countsLimited by absence of population counts

Case-control:Case-control:Best study to determine risk factors, eliminate Best study to determine risk factors, eliminate confounding, study interactions among multiple factorsconfounding, study interactions among multiple factorsLimited by definition of specific outcomes, issues of Limited by definition of specific outcomes, issues of selection of cases & controlsselection of cases & controls



Challenges for EpidemiologistsChallenges for Epidemiologists

Selecting study designs:Selecting study designs: Longitudinal:Longitudinal:

Studies document incidence and estimate Studies document incidence and estimate magnitude of riskmagnitude of riskLimited by logistics of mounting a study in Limited by logistics of mounting a study in a post-disaster environment and subject a post-disaster environment and subject follow-upfollow-up



Challenges for EpidemiologistsChallenges for Epidemiologists Need standardized protocols for data collection Need standardized protocols for data collection

immediately following disasterimmediately following disaster Need standardized terminology, technologies, methods Need standardized terminology, technologies, methods

and proceduresand procedures Need operational research to inventory medical supplies Need operational research to inventory medical supplies

and determine 1) actual needs, 2) local capacity, 3) and determine 1) actual needs, 2) local capacity, 3) needs met by national/international communitiesneeds met by national/international communities

Need evaluation studies to determine efficiency and Need evaluation studies to determine efficiency and effectiveness of relief efforts and emergency effectiveness of relief efforts and emergency interventionsinterventions



Challenges for EpidemiologistsChallenges for Epidemiologists Need databases for epidemiologic research based on Need databases for epidemiologic research based on

existing disaster information systemsexisting disaster information systems Need to identify injury prevention interventionsNeed to identify injury prevention interventions Need to improve timely and appropriate medical Need to improve timely and appropriate medical

care following disaster (search & rescue, emergency care following disaster (search & rescue, emergency medical services, importing skilled providers, medical services, importing skilled providers, evacuating the injured)evacuating the injured)

Need measures to quickly reestablish local health Need measures to quickly reestablish local health care system at full operating capacity soon after care system at full operating capacity soon after disasterdisaster



Challenges for EpidemiologistsChallenges for Epidemiologists Need uniform disaster-related injury definitions Need uniform disaster-related injury definitions

and classification schemeand classification scheme Need investigations of disease transmission Need investigations of disease transmission

following disasters and public health measures to following disasters and public health measures to mitigate disease riskmitigate disease risk

Need to study problems associated with massive Need to study problems associated with massive influx of relief supplies and relief personnelinflux of relief supplies and relief personnel

Need cost-benefit and cost-effectiveness analysesNeed cost-benefit and cost-effectiveness analysesSource: EK Noji, Source: EK Noji, The Public Health Consequences of DisasterThe Public Health Consequences of Disaster

Documents

Data for Decision Making in Disasters: Advances and Controversies Prevention of Disaster Threats Workshop Kaunas, Lithuania 08 August, 2005 Eric K. Noji,