from DRR and WASH workshop

1. Basics in emergencies

2. Why Health?
•
Our aim:
–
Saving lives
–
Reducing suffering - both through ensuring public health
•
Along with food and shelter, safe water and sanitation health is the
highest priority intervention in emergency situations. Unless
adequate health services are quickly provided to emergency-affected
children and their families, disease and death will follow.
•
And unless good hygiene is consistently practiced by affected people,
the danger of diarrhoea, cholera and other disease outbreaks will
persist.
•
This is true in all types of emergencies, from rapid onset natural
disasters to long-term crises caused by a range of complex factors.

3. Why Health? (cont’d)
•
Public health response is usually the first intervention in
emergencies as it directly associates with saving lives
because the high morbidity and mortality rates are
attributed to WASH infectious diseases in the first phase of
emergency.
•
Some diseases, especially diarrhoeal diseases cause
considerable dehydration, which can lead to death if not
promptly treated. Diarrhoeal diseases can be prevented
through access to clean, safe drinking water and through
proper hygiene and sanitation measures, including hand
washing and safe disposal of human waste.
Source: Oxfam India WASH strategy 2010-2015

4. Water and diseases
Water- Due to faecal-oral Diarrhoeas and Water contamination
borne bacteria and non- dysenteries , Poor sanitation
(and faecal oral bacteria Typhoid Poor personal hygiene
faecal- in water Shigellosis ,
oral) Hepatitis A
Water- Due to lack of water Skin and eye Inadequate water
washed infections Poor personal hygiene
Water- Due to long Schistosomiasis, Water contamination
based exposure to Guinea worm
microbes living
naturally in water
Water- Due to insect Malaria, River Breeding in water
related vectors which breed blindness, Filariasis, Biting near water
insect- in water Dengue, Yellow
vector Fever

5. Sanitation and diseases
Excreta-related Helminths transmitted Roundworm, Open defecation
helminths through soil Hookworm, Ground
Whipworm contamination
Excreta-related Transmitted by flies Diarrhoea and Dirty and unhygienic
insect-vector and cockroaches dysentery environment

6. Key Health Threats
•
Poor drainage, stagnant water
•
People drinking contaminated water
•
Unsafe excreta disposal
•
Solid waste deposition
•
Inappropriate shelter
•
Insecure environment
•
People not washing hands at key times

7. Major communicable diseases in
emergencies
•
Cholera
•
Malaria
•
Shigellosis
•
Scabies
•
Dengue
•
Leptospirosis
•
…… etc.

8. Groupwork: Factors affecting risk of
outbreaks
•
Population displacement
•
Population density
•
Disruption and contamination
of water supply and sanitation
services
•
Disruption of public health
programs
•
Ecological changes that favour
breeding of vectors
•
Displacement of domestic and
wild animals

9. Key Health Interventions
•
Provision of treatment in hospitals
•
Provision of immunization
•
Promotion of antenatal care
•
Provision of delivery services
Which of the above has the most impact?

10. Epidemiological terms and definitions
•
Endemic
–
The continuing presence of disease within a given geographical
area or population groups
•
Epidemic
–
An outbreak of disease that attacks many people at about the
same time and may spread through one or several communities
•
Pandemic
–
When an epidemic spreads throughout the world
•
Epidemiology
–
Study of distribution and determinants of diseases & health
related events and application of this knowledge for prevention
and control of diseases

11. Epidemiological Triad
HOST
Age
genetic susceptibility
nutritional status
previous exposure
immunization status
general physical condition
ENVIRONMENT
AGENT Shelter, altitude,
Bacteria, Viruses, humidity, sanitation,
Parasites, fungi food supply, water
Vector
(or) their products supply, temperature
overcrowding

12. Key indicators of health status: Mortality
•
Measured as number of deaths per 10000 population per
day. It is known as Crude Mortality Rate because it uses the
crude numbers for deaths and the population without any
adjustment for the composition of the population.
•
Crude mortality rate (CMR) is for entire population and
under 5 mortality rate (U5MR) is for children under 5 years
of age
No. of deaths X 10000
CMR =
Population X Period
21 people are reported dead in a camp with population of 20000, in a
period of one week. What is the CMR in this case?

13. Benchmark mortality rates in emergencies
•
Crude Mortality Rate:
–
0.5 Baseline
–
1.0-2.0 Serious
–
>2.0 Crisis
•
U5MR
–
0.8-1.2 Baseline
–
>2.0-4.0 Serious

14. Key indicators for health status: Morbidity
•
Morbidity is the number of NEW cases of a GIVEN DISEASE
among the population over a certain period of TIME.
•
Measured per 10000 population per day.

15. WEEKLY MORBIDITY / MORTALITY SURVEILLANCE FORM
District/Town/Settlement/Camp
Health Clinic
Reporting Period
Name of reporting officer
Reported main cause of
<5 years 5 years and older Total
illness/death
(final diagnosis) Cases Deaths Cases Deaths Cases Deaths
Acute watery diarrhoea
Bloody diarrhoea
Suspected cholera
Severe RTI/pneumonia
Suspected malaria/fever of
unknown origin
Malnutrition
Measles
Meningitis
Acute jaundice syndrome
Other/unknown
Total
Average CMR
Average U5MR

16. Faecal-Oral transmission routes
Fingers
Flies
New
Faeces Food
host
Fields
Fluids

17. Barriers to break the faecal-oral chain
Hand-washing at key times
Fingers
Protection of food (e.g. storage)
Safe eating (e.g. washing
fruits and vegetables before
Flies eating them raw
New
Faeces Food
host
Fields
SE
Pit latrines C
O
Protection of food
VIP latrines
N
(e.g. handling, preparation)
Fluids Protection of water in D
Protection of water sources
transit and in the shelter A
R
PRIMARY BARRIERS Y
B