Change in cyclone disaster vulnerability and response in coastal Bangladesh.

The number of deaths owing to tropical cyclones in Bangladesh has significantly reduced. Category 4 Cyclone Gorky in 1991 and Sidr in 2007 caused 147,000 and 4,500 deaths respectively, whereas Category 1 Cyclone Mora in 2017 resulted in six. Face-to-face interviews with 362 residents, participant observation, and focus-group discussions answer a research question about how change in coastal areas has contributed to this outcome. The study considered institutional approaches of disaster risk management through legal frameworks, administrative arrangements, cyclone preparedness activities, cyclone detection and early warning dissemination, construction of shelter centres, strengthening of various types of coastal embankments, paved roads, and pre-cyclone evacuation. The findings indicate significant improvement in house structures and design, income levels and diversification, education, awareness, individual capacity, poverty reduction, and lowering dependency on agriculture-based earning. Furthermore, the availability of mobile telephones, radio, television, and social media platforms enhanced social connectivity and greater gender equality and empowerment helped to facilitate disaster preparedness, evacuation, and response.

Usefulness of disease surveillance data in enhanced early warning of the cholera outbreak in Southwest Cameroon, 2018.

INTRODUCTION: This study assessed the timeliness and completeness of disease surveillance data for early warning of the cholera outbreak during the socio-political crisis of Southwest Cameroon in 2018. It determined how routine integrated disease surveillance and response (IDSR) data was used for preventative actions and the challenges faced by key health staff in IDSR based decision-making. METHODS: This was a mixed-methods study conducted from June 1st to September 30th 2021. District Health Information System 2 (DHIS2) data from January 2018 to December 2020 for the Southwest region of Cameroon were analysed using simple linear regression on EPI Info 7.2 to determine a potential association of the sociopolitical crisis with timeliness and completeness of data. Qualitative data generated through in-depth interviews of key informants were coded and analyzed using NVivo 12. RESULTS: During high conflict intensity (2018 and 2019), average data timeliness and completeness were 16.3% and 67.2%, respectively, increasing to 40.7% and 80.2%, respectively, in 2020 when the conflict intensity had reduced. There was a statistically significant weak correlation between reduced conflict intensity and increased data timeliness (R2 = 0.17, p = 0.016) and there was also a weak correlation between reduced conflict intensity and data completeness but this was not statistically significant (R2 = 0.01, p = 0.642). During high conflict intensity, the Kumba and Buea health districts had the highest data timeliness (17.2% and 96.2%, respectively) and data completeness (78.8% and 40.4%, respectively) possibly because of proximity to reporting sites and effective performance based financing. Components of IDSR that should be maintained included the electronic report aspect of the DHIS2 and the supportive supervision conducted during the outbreak. Staff demotivation, the parallel multiplicity of data entry tools, poor communication, shortage of staff and the non-usability of data generated by the DHIS2 were systemic challenges to the early alert dimension of the IDSR system. Non-systemic challenges included high levels of insecurity, far to reach outbreak sites and health personnel being targeted during the conflict. CONCLUSION: In general, routine IDSR data was not a reliable way of providing early warning of the 2018 cholera outbreak because of incomplete and late reports. Nonetheless, reduced conflict intensity correlated with increased timeliness and completeness of data reporting. The IDSR was substantially challenged during the crisis, and erroneous data generated by the DHIS 2 significantly undermined the efforts and resources invested to control the outbreak. The Ministry of Public Health should reinforce efforts to build a reporting system that produces people-centered actionable data that engages health risk management during socio-political crises.

Role of phytoplankton in maintaining endemicity and seasonality of cholera in Bangladesh.

BACKGROUND: In Bangladesh, cholera is endemic and maintains a regular seasonal pattern. The role of phytoplankton in maintaining endemicity and seasonality of cholera was monitored in Matlab, Bangladesh. METHODS: Phytoplankton and water samples were collected from two ponds bi-weekly for 1 year. The association of Vibrio cholerae O1 with phytoplankton was studied by culture and direct fluorescent antibody techniques. The bio-physicochemical parameters of water were measured and data for cases of cholera were collected from the records of Matlab hospital. The correlation of cholera cases with levels of phytoplankton, V. cholerae and bio-physicochemical parameters of water was carried out using Pearson's correlation coefficients. RESULTS: V. cholerae O1 survived for 48 days in association with Anabaena variabilis in a culturable state, but survived for a year in a viable but non-culturable (VBNC) state. V. cholerae survived for 12 and 32 days in a culturable state in control water (without algae) and water with algae, respectively. There was a significant correlation between changing levels of cholera cases in the community and the blue green algae and total phytoplankton in the aquatic environment. A significant correlation was also found between the cholera cases and chlorophyll-a and VBNC V. cholerae O1 in the aquatic environment. CONCLUSIONS: This study demonstrated the role of phytoplankton in maintaining endemicity and seasonality of cholera in Bangladesh.

Cyclone disaster vulnerability and response experiences in coastal Bangladesh.

For generations, cyclones and tidal surges have frequently devastated lives and property in coastal and island Bangladesh. This study explores vulnerability to cyclone hazards using first-hand coping recollections from prior to, during and after these events. Qualitative field data suggest that, beyond extreme cyclone forces, localised vulnerability is defined in terms of response processes, infrastructure, socially uneven exposure, settlement development patterns, and livelihoods. Prior to cyclones, religious activities increase and people try to save food and valuable possessions. Those in dispersed settlements who fail to reach cyclone shelters take refuge in thatched-roof houses and big-branch trees. However, women and children are affected more despite the modification of traditional hierarchies during cyclone periods. Instinctive survival strategies and intra-community cooperation improve coping post cyclone. This study recommends that disaster reduction programmes encourage cyclone mitigation while being aware of localised realities, endogenous risk analyses, and coping and adaptation of affected communities (as active survivors rather than helpless victims).

Self-care as a response to diarrhoea in rural Bangladesh: empowered choice or enforced adoption?

The literature is growing on the subject of coping strategies. However, with the exception of some work on the promotion of oral rehydration therapy (ORT), very few studies have examined coping strategies as a response to the ongoing diarrhoeal disease burden. This is particularly relevant in the case of self-care, previously documented as the most readily implemented treatment in the developing world and an increasingly common health behaviour in rural Bangladesh. This study analysed the socioeconomic factors that influence the adoption of self-care and the role that varied asset availability plays in relation to households choosing, or being forced to implement, a coping strategy. Qualitative methods were used to collect data from three villages in Nilphamari District, North West Bangladesh, in 2004. The findings produced a detailed picture of asset availability and its influence on household use of self-care treatment practices. The strong role of aspects of social capital in building human capital was highlighted, as well as how these aspects of social capital can assist household welfare through self-care in times of diarrhoeal disease. In contrast, households exhibiting weakened social and human capital were more excluded from information on appropriate self-care treatments. Development agencies and health care policies might therefore strengthen levels of household resilience to diarrhoeal disease more cost-effectively by focusing on activities that facilitate self-care through support of social networks and education channels.

Vulnerability to coastal cholera ecology.

The battle to completely control cholera continues. Multiple strains, high levels of morbidity in some regions of the world, and a complex of influences on its distribution in people and the environment are accompanied by only rough resolution prediction of outbreaks. Uncertainty as to the most effective array of interventions for one of the most researched infectious diseases thwarts further progress in providing cost-effective solutions. Progress on the research front consistently points towards the importance of disease ecology, coastal environments, and the sea. However, evaluation of the link between cholera in people and environment can only be effective with analysis of human vulnerability to variable coastal cholera ecologies. As there are some clear links between the organism, cholera incidence and the sea, it is appropriate that cholera research should examine the nature of coastal population vulnerability to the disease. The paper reviews the cholera risks of human-environment interactions in coastal areas as one component of the evaluation of cholera management. This points to effective intervention through integrative knowledge of changing human and environmental ecologies, requiring improved detection, but also an acceptance of complex causality. The challenge is to identify indicators and interventions for case specific ecologies in variable locales of human vulnerability and disease hazard. Further work will therefore aim to explore improved surveillance and intervention across the socio-behavioural and ecological spectrum. Furthermore, the story of cholera continues to inform us about how we should more effectively view emergent and resurgent infectious disease hazards more generally.

Health ecology and environmental management in Mozambique.

A health ecology approach to infectious disease incidence recognises that the weighting and interconnectivity of influences on health vary in terms of nature and context, from place to place and over time. It helps explain inherent limitations in the prediction and management of major infectious disease events and consequently why victims of ill health and policy often lack appropriate strategies for disease avoidance and health disaster mitigation. With reference to ongoing research in Mozambique, the paper uses the approach for assessment of health insecurity and to provide a realistic framework for management of complex disease hazards.