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Post-Tsunami Epidemiological Findings from Tamil Nadu, India

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Post-Tsunami Epidemiological Findings from Tamil Nadu, India Risk Factors for Mortality and Injury : C R E D Post-Tsunami Epidemiological Findings from Tamil Nadu Authors: Belgium India D. Guha-Sapir P.C. Joshi L.V. Parry J.P. Saulina Arnold O. Degomme Centre for Research on the Epidemiology of Disasters (CRED) School of Public Health, Catholic University of Louvain Brussels, April 2006 Brussels, Belgium http://www.cred.be Risk Factors for Mortality and Injury: Post-Tsunami Epidemiological Findings from Tamil Nadu Authors Belgium India D. Guha-Sapir P.C. Joshi L.V. Parry J.P. Saulina Arnold O. Degomme April 2006 Centre for Research on the Epidemiology of Disasters (CRED) School of Public Health, Catholic University of Louvain Brussels, Belgium © 2006 CRED WHO Collaborating Centre for Research on the Epidemiology of Disasters School of Public Health Catholic University of Louvain 30.94 Clos-Chapelle-aux-Champs 1200 Brussels The Centre for Research on the Epidemio- logy of Disasters (CRED) is based at the Catholic University of Louvain (UCL), Brussels. CRED promotes research, trai- ning and information dissemination on in- ternational disasters, with a special focus on public health, epidemiology and so- cial-economic factors. It aims to enhance the effectiveness of developing countries response to, and management of, disasters. It works closely with non-governmental and multilateral agencies and universities throughout the world. Printed in Belgium. 2 Table of Contents LIST OF TABLES AND FIGURES 5 PROJECT TEAM 6 ACKNOWLEDGEMENTS 7 EXECUTIVE SUMMARY 8 1. INTRODUCTION 10 2. BACKGROUND 11 2.1 The disaster in India 12 2.1.1. Nagapattinam District, Tamil Nadu state 13 3. EFFECTS AND RISK FACTORS : A LITERATURE REVIEW 14 3.1 Health effects of tsunamis 14 3.1.1 Mortality 15 3.1.2 Trauma injuries 15 3.1.3 Respiratory infections 16 3.1.4 Communicable diseases 16 3.2 Risk factors for mortality and injury 17 3.2.1 Young children and the elderly 17 3.2.2 Gender 17 3.2.3 Ability to swim 18 3.2.4 Distance to the sea 18 3.2.5 Socio-economic status and housing construction 18 3.2.6 Preparation, warning and evacuation 19 3.3 Methods for reducing mortality and morbidity 20 4. METHODOLOGY 20 4.1 Household survey 20 4.1.1 Sample selection 21 4.1.2 Survey questionnaire 22 4.1.3 Training 23 3 4.1.4 Implementation of survey 24 4.1.5 Data entry 24 4.1.6 Data validation 24 4.1.7 Data analysis 25 4.2 Focus Groups 25 5. RESULTS 26 5.1 Household survey 26 5.1.1 Characteristics of the sample 26 5.1.2 Effects of the tsunami 29 5.1.3 Analyses of risk factors 31 5.2 Focus group 37 5.2.1 Post-Tsunami relief efforts 38 6. DISCUSSION 39 6.1 Key risk factors and the implications for risk reduction and preparedness 39 6.1.1 Gender and swimming ability 39 6.1.2 Location at the time of the tsunami and distance of dwelling from sea 41 6.1.3 Construction material 41 6.1.4 An absence of warning 42 6.1.5 Public health considerations 43 6.1.6 Long-term considerations 43 7. CONCLUSIONS 44 8. RECOMMENDATIONS 45 REFERENCES 47 4 List of Tables and Figures Tables Table 1. Human impact of the 26 December 2004 earthquake and tsunami as of February 2006 11 Table 2. Death to injury ratios of seismic tsunamis, 1994-1996 14 Table 3. Hamlets included in the surve 21 Table 4. The number of households selected from each survey hamlet 22 Table 5. Focus group profiles 25 Table 6. An overview of survey sample characteristics 27 Table 7. Summary of survey results of tsunami impact, Nagapattinam District 30 Table 8. Summary of results of risk factor analyses 35 Figures Figure 1. Location of Nagapattinam District, Tamil Nadu state 13 Figure 2. Location of hamlets included in the survey 21 Figure 3. Investigators in training 23 Figure 4. Population pyramid 28 Figure 5. Mortality by age and gender 30 Figure 6. Post-tsunami outcome by age 32 Figure 7. Swimming ability by age and gender 33 Figure 8. Proportion of deaths by location of dwelling and individual at time of tsunami 34 Figure 9. Proportion of deaths amongst women as a function of age and ability to swim 40 5 Project Team Research Team CRED, Belgium University of Delhi, India . Professor Debarati Guha-Sapir, . Professor P.C. Joshi, Project Leader Focus Group Leader . Ms. Régina Below, Administrative . Ms. Mridula Paliwal, and finance coordinator, data Data entry and field support entry . Ms. Pebam Krishna Kumari, . Ms. Lian Parry, Research analyst Data entry and field support and survey coordinator, data entry . Dr. Olivier Degomme, Research and data analyst Field Logistics Team TNVHA, Chennai . Ms. J.P. Saulina Arnold, . Staff of TNVHA’s Chennai and Field survey and logistics co- Tharangambadi offices ordinator Investigators Mr. Senthil Rajan Ms. Mullaivadivazhahi Mr. K. Kumar Ms. Sulochana Mr. M. Kannan Ms. Jayabharathi Mr. K. Nandakumar Mr. Jayakumar Mr. A. Christy Raj Mr. Asupathy Mr. W. David Williams Ms. Ananthi Ms. R. Elizabeth Padmavathi Mr. Subramani Ms. J. Sajitha Ms. Mahadevi Ms. J. Malathy Grace Ms. Jayakanthi Ms. Hepsibah Priyadarshini Mr. V. Selvam Prof. Samuel Santhosam Ms. Ganga Mr. T. Sivanantham Ms. Benitha Mr. S. Anbuselvam Ms. Santha Mr. V. Gunaseelan Ms. Selvi Ms. C. Usharani Mr. G. Sankar Mr. Reeganraj Mr. N. Kandasamy 6 Acknowledgements his study would not have been possible without the enthusiastic cooperation and dedication of Tmany individuals and organisations. The authors would therefore like to extend their sincere thanks and appreciation to: The staff of Tamil Nadu Voluntary Health Association who, under the direction of Ms. J.P. Saulina Arnold, demonstrated tireless effort and commitment to making the study a success despite challenging field conditions; Professor P.C. Joshi’s research team from Delhi University; Ms. Mridula Paliwal and Ms. Pebam Krishna Kumari for their tireless work, professionalism and good humour in the field; Mrs S. Chunkath, Health Secretary, Dr. Padmanabhan, Director, and Mrs S. Sahu, Ministry of Health and Family Welfare , State Government of Tamil Nadu and Dr. N. Swathandran, Medical Director, Nagapattinam District Hospital, as well as the staff of Nagapattinam, Sirkazhi, Vedharanyam and Mayiladuthurai Government Hospitals, for their generous cooperation and assistance throughout the study; The UN International Strategy for Disaster Reduction (ISDR) secretariat and the Platform for the Promotion of Early Warning (PPEW) for their support, input, and the resources made available to this project. Finally, the highest respect, thanks and acknowledgement go to the people of Nagapattinam District and to all others whose lives were forever changed on the 26th of December 2004. 7 Executive Summary he Indian Ocean tsunami of 26 December 2004 was a disaster of unprecedented dimensions Tcausing the deaths of over 220,000 people in 12 countries. In the worst affected region of Indonesia, the death toll was more than 165,000 while in India the disaster affected over 2,000 kilometres of coastline and claimed over 16,000 lives. International attention has now been turned to how and why this disaster could have caused such an enormous loss of human life, leading to enquiries into what preventative methods might mitigate the effects of such disasters in the future. Recognising the urgency to develop an early warning system for the Indian Ocean region, a multi- partner initiative “Evaluation and Strengthening of Early Warning Systems in countries affected by the 26 December 2004 Tsunami” was launched in 2005 and funded through the UN Flash Appeal for the Indian Ocean Earthquake-Tsunami. This UN/ISDR coordinated initiative has provided an overall integrated framework for strengthening early warning systems and building resilience of communities to disasters in the Indian Ocean. A major component of this initiative has been the assessment of community-based approaches in disaster mitigation and preparedness and the identification of vulnerability assessment methods in order to strengthen community response capabilities and informs policy makers of necessary measurements to be undertaken in that respect. The current study was initiated to identify specific risk factors for mortality and injury with the aim of strengthening the current evidence base on disaster impacts and vulnerabilities. In October 2005, research teams from the Centre for Research on the Epidemiology of Disasters (CRED) and the University of Delhi worked in conjunction with the Tamil Nadu Voluntary Health Association (TNVHA) to conduct a major household survey and focus group sessions in Tamil Nadu, India. A sample of 660 households was randomly selected from the most severely-affected hamlets in Nagapattinam District. A questionnaire designed to investigate possible risk factors at both the household and individual level was subsequently administered. Data from 651 households and 3131 individuals was collected and validated for statistical analyses. In addition to the survey data, four focus group discussions were held with men and women from fishing families, doctors and representatives from non-governmental organisations. Just over one quarter of the surveyed population were injured on the day of the tsunami. Most injuries occurred on the extremities, with abrasions and lacerations reported as the most common injury-type. As expected, the vast majority of deaths and injuries occurred on the day of the tsunami. Young children and the elderly had much higher risk of death than the rest of the population. Results confirmed that women were at significantly higher risk of mortality than men however upon closer analyses this gender difference was only relevant for women between 15 and 50 years of age. By contrast, while adult men were more likely to survive, they were at much higher risk of injury.
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