Course manual Introduction to Disaster Management

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Unit summary



Summary


The media plays a unique role in disaster management. Humankind is not powerless when faced with the fury of nature. They can find means to reduce the impact of disasters and safe lives. Communication technology and media are essential means of saving lives, reducing property damage, and increasing public understanding, irrespective of location, population, or level of economic development. Such communication can educate, warn, inform, and empower people to take practical steps to protect themselves from natural hazards.

Assignment




Assignment

Identify a recent national disaster in your country (natural or man-made) and discuss specific ways that the media helped and/or detracted from the:



  1. Preparation and public education process before the disaster

  2. Response and recovery effort after the occurrence of the event.



Self Assessment




Assessment

  1. Select the two major types of mass media from the choices below:

  1. Television and radio

  2. Radio and satellite radio

  3. Electronic and print

  4. Television and print

  1. Select the least accurate statement about the role of the media in disaster management.





  1. The media can influence the government to prioritize disaster risk issues

  2. The media can represent the unique needs of vulnerable communities and special populations and effect positive change.

  3. The media can help in the creation of early warning systems.

  4. The media can play a direct role in drafting emergency plans and standard operating procedures for Emergency Operations Centres.

Instructions: Answer True or False in response to the following statements.


  1. The media is always a trusted source for disaster related information __________

  2. The media hardly influences the social climate in a country, since people are too intelligent to be swayed by the personal opinions of reporters __________

  3. The media usually converges on important, high-profile events, such as national disasters________

  4. The media hardly ever exposes excessive and inefficient expenditure by government since it is a merely a mouth piece for rich and influential people__________



Answers:

Multiple Choice:

1 C; 2 D;


True/ False

3 F; 4 F; 5 T; 6 F.




References


Burkholder-Allen, K. (1999) Media Relations and the Role of the

Public Information Office: What Every DMAT Member should know.

Accessed on 25/01/08 at:

http://mediccom.org/public/tadmat/training/NDMS/MediaRelationsArticle.pdf

Otieno, K. (2006) Media Role in Disaster Risk Management.

Accessed on 25/01/08 at:



http://www.undp.org/drylands/docs/drought/workshop-10- 06/KOtieno_Media_Role_in_Disaster_Risk_Management.ppt
Rattien, S. (1994) The role of the media in hazard mitigation and disaster

management. Accessed on 25/01/08 at:



http://www.annenberg.northwestern.edu/pubs/disas/disas7.htm

Unit 10

Disaster Associated Health Issues – Part I: Emergency Health Services and Communicable Diseases.

Introduction


This unit briefly considers what is involved in Emergency Medicine. It identifies and describes risk factors for communicable diseases. When a disaster occurs, the general population expects the government and international agencies to rapidly mobilize the needed services with urgency. Preservation of life and health are of paramount importance to casualties. Immediately, medical professionals, First Aid and Emergency Medicine must be made available. As a consequence of disasters, it is also important to identify risk factors for communicable diseases and determine ways of minimizing these risks.

Upon completion of this unit you will be able to:





Outcomes

  • Identify the components involved in emergency medicine.
  • Describe a suitable infrastructure and procedures in accessing emergency medicine services. .


  • Identify the main communicable diseases common in disaster situations.

  • Discuss the risk factors that increase the likelihood of an outbreak of communicable diseases.

  • Identif
    y ways of preventing/minimising outbreaks of communicable diseases





Terminology

Acute Respiratory Infections (ARI):

Severe adenovirus infection of the respiratory tract characterized by fever, sore throat, and cough.
such as bronchitis.

Agent:

An infections disease agent is constantly searching for opportunities to multiply since their genes can transform rapidly, enabling it to be spread quickly to new locations, and infecting more vulnerable populations.

Communicable diseases:

An illness that arises from transmission of an infectious agent or its toxic product from an infected person, animal, or reservoir to a susceptible host, either directly or indirectly. These include acute respiratory infections, diarrhoeal diseases, sexually transmitted diseases and vaccine-preventable diseases that can cause serious outbreaks.

Diarrhoeal diseases:

Occurs when the stool weight is above 300g per day. This is mainly due to excess water, which normally makes up 60–85% of faecal matter. In this way, true diarrhoea is distinguished from diseases that cause only an increase in the number of bowel movements (hyperdefecation), or incontinence (involuntary loss of bowel contents). Diarrhoea is also classified by physicians into acute, which lasts one to two weeks, and chronic, which continues for longer than 23 weeks. Viral and bacterial infections are the most common causes of acute diarrhoea, such as cholera and dysentery.


Endemic diseases:

Diseases that are prevalent in or peculiar to a particular locality, region, or people

Epidemic:

The occurrence of cases of a particular disease in excess of the expected. (Therefore, demanding that emergency control measures be implemented.)

Vaccine-preventable diseases:

Diseases such as measles, malaria and meningitis are able to be prevented through vaccinations


Emergency Health Services in Disasters


During the first few days following a disaster, the priority is usually to treat casualties and the sick or injured. Disasters like earthquakes often involve the management of mass casualties which normally requires the following activities: Search, rescue and first aid; Transport of health facilities and treatment; Triage; Tagging; and redistribution of patients between hospitals when necessary. Usually within 30 minutes of a disaster, up to 75% of the healthy survivors are actually engaged in urgent rescue activities.

The demand for curative care is highest during the acute emergency stage, when the affected population is most vulnerable to their new environment and before basic public health measures (e.g., water, sanitation and shelter) have been implemented. Thereafter, the priority should shift toward preventive measures, which can dramatically improve the overall health of the affected population. Otherwise, any prolonged interruption in routine immunisations and other disease-control measures may result in serious outbreaks of measles, cholera etc.

Disasters call for a co-ordinated response between curative and preventive health services, including food supply, water and sanitation, etc. In order to minimise mortality and morbidity it is also necessary to organize the relief response according to three levels of preventive health measures; namely primary, secondary and tertiary prevention (discussed in more detail further on).

Infrastructure and procedures in accessing emergency situations


  1. Managing a Mass Casualty Incident (MCI)

A mass casualty incident (MCI) is any event producing a large number of victims such that the normal capacity of local health services is disrupted. Common causes of an MCI include floods, fires, explosions, industrial accidents, or conflict situations.

The response may be delayed after a MCI due to poor communication. Valuable resources at the disaster site are used up in attempts to save the most gravely injured victims who cannot survive, while those who are more likely to survive receive little attention. Inadequate transportation may decrease the survival of victims in critical condition. The following patients will frequently reach the health facility first:



  • those nearest to the arriving ambulances;

  • those who are first to be rescued; and

  • those who are the most gravely injured.

If there is only one first referral health facility, it may quickly become overwhelmed. Limited resources are used to care for victims arriving first, even though most of them may have minor injuries. As a result, they tie up the personnel, examining rooms, supplies, etc. increasing the risk of death for critically ill victims whose survival depends on receiving prompt medical attention.

Understanding Triage

Triage is defined simply as sorting and prioritising patients for medical attention according to the degree of injury or illness and expectations for survival. Triage is carried out to reduce the burden on health facilities and it is normally done by the most experienced health worker assisted by competent staff on the triage team.


See also Wikipedia’s article on triage (in references).

Triage is a continuous process that begins when patients arrive at the medical post and continues as their condition evolves until they are evacuated to the hospital.

By providing care to victims with minor or localised injuries, health facilities are freed to attend to more critical tasks. Triage is necessary where health facilities cannot meet the needs of all victims immediately, particularly following an MCI.

The goal of managing a mass casualty incident is to minimise the loss of life or disability of disaster victims by first meeting the needs of those most likely to benefit from services.

This goal can be achieved by setting the following priorities for triage:

Priority for transportation to the hospital is based upon referrals of priority needs of patients.

Priorities for care in the field are often identified by visible colour-coded tags that categorise patient needs. However it is important to note that different jurisdictions use varying systems and the use of colour-coded tags may cause some confusion. (See Nocera and Garner, 1999).

Management of MCI begins with being prepared to mobilise resources and follow standard procedures in the field and at the hospital. Hospitals with a limited number of emergency workers may find it difficult to hold regular training sessions on MCI management. Countries with limited resources should focus on the following:


  • improving routine emergency services for sudden-impact, small-scale incidents (e.g., car accidents or accidents in the home). To avoid confusion, the same procedures that are necessary to save lives during an MCI should be performed as routine emergency services;

  • co-ordinating activities that involve more than an emergency medical unit (police, fire fighters, ambulances, hospitals, etc.); and

  • ensuring a quick transition from routine emergency services to mass casualty management establishing standard procedures for managing all incidents (small or large scale) — search and rescue, first aid, triage, transfer to hospital and hospital care.

Minimum Requirements for a Standard Kit

List of Basic Needs

Maps, stationery

Medical disaster kit: oxygen, airway, intubation set, ventilation bag, suction device, chest tube set, tracheotomy set, etc.

Means for communication and transportation

IV fluids, drugs for shock, tourniquet

Area lighting, flashlights

Dressing/splint kit: compresses, antiseptics, suture ser, splints, gloves

Identification devices for area, staff and victims, : flags, arm bands, triage tags

Blood pressure cuff, stethoscope

Stretchers, boards, blankets

Scissors, adhesive tape

Protective devices: gloves, masks, etc.





Figure 9

In addition to the basic supplies provided through such kits, an MCI situation requires the immediate arrival of appropriate personnel which will comprise of the following: the command post team, the evacuation team, the incident commander, the search and rescue team, the security team the Triage officer and the triage team.

Basic MCI management is composed of a series of steps that collectively meet the immediate health needs of disaster victims. It begins with search and rescue from the disaster site and ends with referral to the health facility or release for home care. A possible organisation of an MCI management centre is illustrated in the following figure:



Figure 10: Possible organisation of an MCI management centre

Each team operates within a specific area, aiming to remove all victims away from the disaster site, and to transport the critical cases to health facilities.


Procedures for transportation

Casualties should be treated near their own homes whenever possible to avoid social dislocation and the added drain on resources of transporting them to central facilities. If there are significant medical reasons for such evacuation, the relief authority should make provision to return the patient to his or her home.

Providing proper treatment to casualties requires that the health service resources be redirected to this new priority. Bed capacity and surgical services must be expanded by selectively discharging routine inpatients, rescheduling non priority admissions and surgery, and using available space and personnel fully. A centre, manned 24 hours a day to respond to inquiries from patients’ relatives and friends, should be established and could be staffed by able lay people.


Transportation of Casualties

Evacuations of casualties may be organized when they are gathered at a First Aid post, a dispensary or any facility of the casualty-care chain, in which case they would have already been triaged and a priority category for evacuation has been assigned to each.



  1. Evacuation is contemplated when means are available and reliable, routes and time-frames are known and security has been ensured. Prior to the moving of casualties it is imperative that personnel at destinations have been informed and are ready to receive the casualty(ies).

  2. Evacuation vehicles assigned for medical purposes must be used exclusively for the latter. Their availability and hygiene should be respected. Other vehicles should preferably be used to transport the dead bodies if at all possible. In all cases priority should be given to the living casualties.

  3. Proper lifting techniques are used to ensure comfort of the casualty and personnel responsible for lifting should be in good physical condition.

  4. All departures of evacuation vehicles should be reported to supervisors in charge of managing evacuations providing the following information: departure time, number and condition of casualties, destination, estimated travel time and route, number of first aiders aboard.

  5. The means of transport should ideally be such that emergency and stabilization measures can continue and should be as safe as possible as it is important that the trip is not traumatic for the casualties.

  6. It should also be such that casualty can be accommodated in different lying or sitting positions depending on their condition. Furthermore it should be able to accommodate for a provider of care or a first-aider to accompany the casualty
  7. The means of transport should provide adequate protection against the elements (extreme temperatures, sun, rain, wind, etc.).


  8. Driving needs to be smooth and safe. Once a casualty has been stabilized it is unnecessary to drive at high speed and risk a road traffic accident. Extra care should be taken especially if the roads are bumpy or have potholes as hitting into them causes more pain to the casualty, may increase bleeding and displace traumatized limbs hence causing more complications.

  9. Casualties found on the roadside should be taken on board only if there is adequate space and no other alternative. If possible inform your team leader or the dispatch or command centre of the casualty care chain and ask for instructions. Occasionally “opportunistic casualties” i.e. people who, according to their triage priority, do not need to be evacuated at a given time, may be allowed on board an evacuation vehicle because space happens to be available.

  10. On arrival at the hospital, every injured person should be reassessed, stabilised, and given definitive care. The colour-coded tags are strictly for field triage and field use. They should not be used for documenting health care in the hospital.

  11. Hospitals should also regularly advise the Incident Commander about their health care capability and capacity so that the transfer of MCI victims is well organised. If the hospital’s capacity or capability is low, patients and victims may have to wait a long time for treatment in surgical or intensive care units.


Communicable diseases common in disaster situations


The main communicable diseases are:
  1. Diseases transmitted by contact – Acute respiratory infections (ARI) which are common among people after a disaster especially among the children. These are spread through personal contact or being around people who are infected already. These include the common cold, influenza, bronchitis, diphtheria and pneumonia.


  2. Vector transmitted diseases are caused by mosquitoes and these include, malaria, yellow fever, dengue, leptospirosis and chikungunya (common in the Seychelles). These infections become prominent when the balance of nature is disturbed as is the case in a disaster.

  3. Disease can also be transmitted through faecal matter ingested orally as a result of drinking contaminated water or eating food and fruits that are contaminated. These diseases include cholera, typhoid fever, diarrhoea diseases, and leptospirosis. They can also be transmitted through poor personal hygiene or from a contaminated environment.

  4. Diseases transmitted through breathing contaminated air or from germs that are airborne can be problematic after a disaster. These diseases include tuberculosis, measles, meningococcal meningitis and whooping cough.

  5. Sexually transmitted diseases are on the rise in peaceful times let alone being in disaster mode. These diseases are transmitted through sexual contact with people who are contaminated with the different germs that are responsible such as HIV/AIDS, gonorrhoea, syphilis, Chlamydia and trichomonas.


Risk factors contributing to the spread of communicable diseases and outbreaks

Research has found that amongst developing countries there are patterns of communicable disease outbreaks that are similar. By studying these patterns we can begin to isolate and identify the risk factors that can lead to outbreaks of disease. Understanding the risk factors associated is essential in helping us to predict and prepare ourselves for combating communicable disease outbreaks.

Risk factors interact with each other in a variety of ways depending on the case and situation. Before appropriate intervention can be determined,

the risk factors must be identified. Five key factors are discussed however, it should be understood that there are many other risk factors.


Pathogenic Agents (bacteria, parasites, fungi)

Everyone everywhere has pathogenic agents and usually our bodies and environment learn to balance these out: however, under disaster situations, natural or man made (for example tsunamis and war), populations often need to migrate and find a new place to settle. When this happens, a health disaster is imminent as pathogenic agents too, find themselves in new environments and different populations. The primary victims of such incidents are often the displaced people given that they may have no immunity to new pathogenic agents they may confront. The local population may also be affected given that their susceptibility could be higher to new pathogenic agents.


Susceptibility of the Population

Populations can be understood by looking at 2 areas: the individual population and, the community population.

When disaster strikes, as in a war, the make-up or profile of community populations will change, for example post war populations always show a baby boom. When this happens, infectious agents who thrive better on the young and the very old, are likely to increase and can lead to an outbreak of disease.

Community populations are very much ‘context sensitive’ for example endemic populations where there is malaria, the at risk age level are infants less than two years. For non-endemic populations, everyone is susceptible to all forms of malaria.

For individual populations it is not feasible to determine each person’s level of immunity however, it is possible to look at groups of individuals at risk i.e. those who are naturally most vulnerable to specific pathogenic agents. For example, in developing countries most children from 2-3 years of age will have been vaccinated or have had measles and therefore their immunity would be high. The children at risk or susceptible to measles would be the 4-5 years olds.

It is very useful to look at groups at risk or those specific populations who are naturally vulnerable to certain pathogenic agents for when these agents are identified then intervention can be planned and processed.


Increased transmission

Pathogenic agents are easily transmitted particularly in situations where there is overcrowding and hygiene conditions are poor. These conditions easily occur when there is lack of water, unsatisfactory waste disposal and all factors resulting in an absence of sanitation measures.



Deterioration of the Health Service

All levels are affected when there is an obvious lack of health services. For example, no vaccinations are given and little or no care is provided for the sick.



Climatic Events

The increased frequency and intensity of extreme climatic events is recognized as a key vulnerability issue associated with climate change. This climate change may pose threats such as:



  • Flooding which can lead to increases in mosquito populations that transmit human diseases such as dengue fever.

  • Extreme rainfall events resulting in overflow of sewerage systems leading to further spread of pathogenic agents.

The factors discussed in this section, contribute in varying degrees to communicable disease outbreaks. The importance of identifying the risk factors is therefore critical if effective intervention is to prevail.

Practical and effective disease control measures need to be developed collaboratively between relief agencies and local health authorities. These measures should be based on the national diseases control policies.


Preventing and reducing outbreaks of communicable disease in emergency/disaster settings

  • Preventing communicable diseases outbreaks

  • Intervention at the source to prevent the development of infectious agents that can attack susceptible individuals.

  • Intervention to modify immune status (vaccination, general health status)

  • Intervention at the biological stage (minimize opportunities to exposure)


  • Intervention at the aftermath of a disease (managing communicable diseases outbreak).



  1. Levels of intervention

  1. Primary Prevention – can be defined as the biological and clinical manifestations of an infection. For example immunization and sanitation as well as awareness education on basic hygiene and sanitation methods.

  2. Secondary Prevention – means preventing a harmless form of a disease from developing into a more serious form liable to cause death or complications. The use of oral rehydration salts (ORS) at the beginning of a diarrhoeal attack, for example, prevents the development of dehydration. There are also indigenous medicines that can be given to the infected people to treat these conditions, in the absence of pharmaceutical provisions.



  3. Tertiary Prevention – covers rehabilitation following the illness (social re-integration, nutritional rehabilitation after measles, etc.)



  1. Curative Actions

The following is a list of measures for communicable-disease control:

  • The use of interviews for rapid assessment of communicable diseases in emergencies

  • Immunization

  • Tests carried out in the field

  • Chemoprophylaxis

  • Therapeutic

  • Health education

    The classic model of the natural cycle of communicable diseases involves:



  • risk/exposure factors

  • population’s susceptibility to the disease

  • biological manifestations of the disease
  • clinical manifestations of the disease


  • progression of the disease

  • return to a non-disease state


Communicable Diseases Control


Before, during and after disasters, the government disaster management teams and the communities must work hand in hand to prevent the transmission of communicable diseases. In the event that the diseases has started there must be efforts put in place to control. A number of diseases must be prepared for; this section focuses on some common issues in the small states of the Commonwealth. You may develop a list of disease specific to your area. (Please refer to table below)

Diseases

Description/Cause

Signs and Symptoms

Treatment

Tuberculosis (TB)

Bacterial infection that attacks the lungs

Cough-more than 3 weeks; coughing up blood; weight loss; night sweats

Several medicines including strong antibiotics must be taken for a long time. It is curable.

Leptospirosis

Caused by Leptospira agent. Enters the body through the mucous membranes; through exposure to water contaminated with urine of infected animals

Does not spread from person to person. Abrupt Fever. Flu-like Mimics dengue. Jaundice is common

Anti-microbial agents (e.g. penicillin, amoxicillin or doxycycline)


Acute Respiratory Illness (ARI)

Most common is pneumonia. Very dangerous in disaster because of overcrowding.

Any series of infections involved in the upper and lower respiratory region.



Cough. Severe difficulty breathing. Fast breathing. Chest in drawing in

Supportive Care

Antimicrobial treatment



Conjunctivitis

Bacterial or Viral infection or allergic reaction to dust and pollen etc. Persons can become infected with their hands, contaminated towels etc. after rubbing their eyes.

White yellowish discharge. Eyes stuck together. Watery eyes. Red and sore eyes. Burning and itching eyes

Keep hands clean to avoid spreading. Prescribed eye drop must be administered. In some countries local herbs might be used to treat the infection

Rashes

Caused by a number of pathogens, toxins etc. autoimmune conditions can cause rash in disaster evacuees.

Variety of rashes: Chicken Pox Measles Rubella Human papilloma virus Adenoviruses

Demonstration of topical creams. Supportive care. Calamine lotion, corn starch. Severe cases require antibiotics.

Diarrhoeal Disease

Caused by bacteria (e.g. salmonella, E-Coli.)

Can also be caused viruses (rotavirus) and parasites.

Chronic diarrhoea can cause under nutrition


Last several days, bowel weeps fluid. Fluid in the bowel leads to liquid stools. Inflammation Cramping, abdominal pain, Nausea, and vomiting.

Diarrhoea should be left to take its course.

No medication only the use of oral rehydration salts (ORS)


Cholera

Acute intestinal infection that is spread through contaminated water and food.

Copious, painless, watery diarrhoea and vomiting. Severe dehydration

Oral rehydration salts and Intravenous fluids

Hepatitis

Five types: A, B, C, D, and E.

Type A and E –transmitted through contaminated food and water.

Type B, C, D - by blood or serous fluids.


Fever. Persistent vomiting. Jaundice-longer than 10 days Bleeding Dehydration Anorexia


No specific treatment. Maintain hydration, nutrition and adequate rest. Avoid Paracetamol, salicylates, and antihistamines

Malaria

Vector disease caused by various malaria blood parasites. The host is the Anopheles mosquito

Spontaneous night chills Fever at nights. Pain in the joints, nausea, vomiting, anaemia. Enlarged spleen


A combination of two anti-malarial drugs- it is more effective and if one does not work the other will.

Patients who have severe P. falciparum malaria or who cannot take oral medications should be given the treatment by continuous intravenous infusion.



Typhoid Fever

Caused by salmonella, ingested in food and water contaminated with faeces.

Malaise, headache. Aching limbs. Cough, constipation or diarrhoea. Bronchitis and delirium may develop

Prevention: vaccination. Several antibiotics can be used


Gonorrhoea

Sexually Transmitted Disease (STD) caused by a bacterium and flourishes in warm moist areas of the reproductive system.

Burning when urinating. White, yellow or green discharge. Men-swollen testicles. Some women get no symptoms


Gonorrhoea is treated with antibiotics (e.g. ciprofloxacin). Single injection, a single pill, or a week-long course of pills.

HIV

HIV (human immunodeficiency virus) is the virus that causes AIDS. This virus may be passed from one person to another when infected blood, semen, or vaginal secretions come in contact with an uninfected person’s broken skin or mucous membranes

There are no specific symptoms as a person can live with this for years without knowing. As the immune system weakens, any series of opportunistic infections can develop.

No cure. Antiretroviral drugs slow the progression of the virus and once started, they must be taken everyday for the rest of your life. (numerous side effects)

Figure 11

Monitoring and Evaluation of Communicable Diseases Control Programme

Emergencies are unstable and dynamic situations. Simply carrying out disease control measures after an initial assessment does not mean that communicable diseases will not cause problems among an affected population. Disease surveillance is useful for monitoring the incidence of communicable diseases as well as the effectiveness of disease control measures. This will determine whether selected control measures are appropriate and resources are adequate for preventing disease and preserving the health of the affected population.

Evaluation of the disease control program is vital because it measures effectiveness, identifies lessons for future programs, and promotes accountability. Communicable disease control programs can be evaluated in two ways:


  1. Internal Program Evaluation — This is normally carried out by program staff who regularly analyse and review monitoring information. They must also evaluate the effectiveness of all control measures or compare these measures across different situations.

  2. External Program Evaluation — This may be part of a wider evaluation exercise by agencies and donors. It may be planned, for example, after the acute phase of the emergency.

The Sphere Project proposes minimum standards and key indicators that can be used to evaluate a communicable diseases control programme in emergencies.

The following minimum standards and key indicators of the Sphere Project may be used to evaluate a communicable diseases control program in emergencies. Minimum standards and key indicators of the Sphere Project for the following components may be used to evaluate the following control programme:

  1. Measles Control

  2. Monitoring of communicable diseases

  3. Investigation and control of communicable diseases

  4. Human Resource capacity and training



  1. Measles Control

The following indicators are used to evaluate if a systematic response is mounted for each outbreak of measles within the disaster-affected population and the host population, and whether all children who contract measles receive adequate care:

  • A single case (suspected or confirmed) warrants immediate on-site investigation which includes looking at the age and vaccination status of the suspected or confirmed case.

  • Control measures include the vaccination of all children 6 months to 12 years of age (or higher if older ages are affected) and the provision of an appropriate dose of vitamin A.

  • A community-wide system for active case detection using the standard case definition and referral of suspected or confirmed measles case is operational.


  • Each measles case receives vitamin A and appropriate treatment for complications such as:

  • pneumonia, diarrhoea, and severe malnutrition, which cause the most mortality.

  • The nutritional status of children with measles is monitored, and if necessary, children are enrolled in a supplementary feeding program.

  1. Monitoring Communicable Diseases

The following indicators are used to evaluate the monitoring of communicable diseases:

  • The responsible surveillance and disease control unit or agency is clearly identified and all participants in the emergency know where to send reports of suspected or confirmed communicable diseases.

  • Staff experienced in epidemiology and disease control are part of the surveillance and disease control unit or agency.

  • Surveillance is maintained at all times to rapidly detect communicable diseases and to trigger outbreak response.

  1. Investigation and Control of Communicable Diseases

The following indicators are used to evaluate whether diseases of epidemic potential are investigated and controlled according to internationally accepted norms and standards:

  • Diseases of epidemic potential are identified by the initial assessment; standard protocols for prevention, diagnosis, and treatment are in place and appropriately shared with health facilities and community health workers/home visitors.

  • Case reports and rumours of disease occurrence are investigated by qualified staff.

  • There is confirmation of the diagnosis.
  • Outbreak control measures are instituted, which include attacking the source, protecting susceptible groups, and interrupting transmission of the disease.


  • Qualified outreach personnel participate in the control measures at the community level by providing both prevention messages and proper case management according to agreed guidelines.

  • Public information and health promotion messages on disease prevention are part of control activities.

  • Community leaders and outreach personnel facilitate access to population groups and disseminate key prevention messages.

  • Only drugs from WHO’s Essential Drugs List (1998) are used.

  1. Human Resource Capacity and Training

The following indicators can help evaluate whether the staff are suitably experienced and trained and that they are adequately managed and supported by their agency:

  • Staff and volunteers involved in surveillance (as part of assessment, monitoring, or review process)are thoroughly briefed and regularly supervised.

  • Staff responsible for communicable disease control have previous experience or training and are regularly supervised in the use of recommended treatment protocols, guidelines, and procedures.

  • Carers are informed about priority prevention activities such as the need for vaccination, use of soap, bed nets, latrines and good health seeking behaviours.

The techniques and resources used for monitoring or evaluating must be consistent with the scale and nature of the disease control program. At the end of the evaluation, a report must be written which describes the methodology used and how conclusions were reached. This report should be shared with all concerned, e.g., the affected population, host authorities, donors, and other humanitarian agencies.


Rapid Assessment

Assessment undertaken after a major change, such as an earthquake or sudden refugee displacement. It provides information about the needs, possible intervention types and resource requirements. A rapid assessment normally takes one week or less. It is then followed by detailed assessments.


The use of interview as a rapid assessment method

Very often those involved in relief in emergencies may not always have access to sources of information which can allow them to determine the main communicable disease that are affecting the population. It is not uncommon that at the outset of a disaster, the only available source of information is the population itself.

Opportunities for direct investigation with a population are limited, and it is usually difficult to start off by running biological tests in order to diagnose the main communicable diseases. Initially relief workers will have to content themselves with the information they can collect through interviews with community members.

Such interview may prove adequate to indicate which measures need to be taken, depending on the data sought. For example, a relatively simple questionnaire permits a rapid assessment of the main causes of death among the children of the affected population. The procedure to follow can be summarized as follows:



  • Draw up a list of syndromes which appear to be the main causes of death. In the case of communicable diseases, these would consist primarily of measles, diarrhoeal diseases, malaria, and meningitis.

  • Describe the symptoms used to identify the communicable disease/s in question; the medical personnel and the individuals questioned may have markedly different interpretations of the same clinical manifestation. A minimal knowledge of local terminology is essential.

  • Verify the information, this is difficult in the case of mortality, since the data receive cannot be confirmed except by information from other sources e.g. the cause of death for hospitalized children.
Health Education

Health education is not limited to the problem of communicable diseases. However, communicable diseases are a useful starting point for initiating health education in a disaster situation. The risks involved in communicable diseases must be well understood by the affected community, and the need for their participation in controlling them.


Health education should take into consideration other components that influences behaviour. For example, the place where people live, the people around them, the work they do; hence telling people what they can do to be healthy is insufficient

In emergency situations, relief workers rarely have much influence over the causes of the crisis. Unfortunately, they must settle for modifying or adapting the victims’ behaviour to conform to their new living conditions- which will be temporary, at best – without exercising any real impact on the social environment.

The problems that confront an affected population may not be new to them, but present themselves in a different form. Moreover, the urgency of certain situations necessitates immediate action, before the population has a chance to understand its purpose.

A population confronted with an emergency in itself is obliged to change its behaviour quickly. Such changes, however, cannot be dictated by outsiders; they must be formulated by the people concerned, and disseminated by them as well, in their own words and should reflect the local cultural context.



Developing a Health Education Programme

On the basis of this principle, the following sequence might be proposed to begin the process of health education:



  1. Identification of health problems by the community.

  2. Study of behaviours adopted to cope with these problems: should they be modified?

  3. Determination of the objectives of health education programme.

  4. Identification of practical measures acceptable to the community, to modify these behaviours.

  5. Implementation of the measures.

  6. Evaluation of results.




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