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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 6  |  Issue : 3  |  Page : 123-126

Postflood morbidity pattern in flood-affected population of Alappuzha district in Kerala


1 Department of Community Medicine, MGM Medical College, Navi Mumbai, Maharashtra, India
2 Department of Geriatric Medicine, MGM Medical College, Navi Mumbai, Maharashtra, India
3 Department of Pediatric, MGM Medical College, Navi Mumbai, Maharashtra, India
4 Department of General Medicine, MGM Medical College, Navi Mumbai, Maharashtra, India

Date of Submission18-Jan-2020
Date of Acceptance21-Jan-2020
Date of Web Publication16-Mar-2020

Correspondence Address:
Dr. Prasad Waingankar
Dr. Prasad Waingankar, Department of Community Medicine, MGM Medical College, Kamothe, Navi Mumbai 410209, Maharashtra.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mgmj.mgmj_6_20

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  Abstract 

Background: Kerala had witnessed what is seen as the century’s worst flood in the state in 2018. The torrential rain since June 1 in sporadic places and continuous rain since August first week had created havoc in the state. The spread of infectious disease is likely to occur where such disasters occur. Timely interventions can curtail a second disaster arising out of such circumstances. Materials and Methods: Records of health camps conducted were analyzed to get an idea about the morbidity patterns immediately after floods. Results: Acute respiratory infection accounted for a majority of the cases, both among adults (40.2%) and children (55.6%) followed by generalized weakness and musculoskeletal pain. Conclusion: Most of the illnesses seen were of infectious origin. Health education can play an important role to prevent spread.

Keywords: Disaster, epidemiology, flood


How to cite this article:
Thomas SC, Kotian SP, Male V, A. S, Thomas NS, Waingankar P. Postflood morbidity pattern in flood-affected population of Alappuzha district in Kerala. MGM J Med Sci 2019;6:123-6

How to cite this URL:
Thomas SC, Kotian SP, Male V, A. S, Thomas NS, Waingankar P. Postflood morbidity pattern in flood-affected population of Alappuzha district in Kerala. MGM J Med Sci [serial online] 2019 [cited 2020 Aug 13];6:123-6. Available from: http://www.mgmjms.com/text.asp?2019/6/3/123/280738




  Introduction Top


Natural disasters are on a rise owing to the changes in climate due to the unsustainable development processes by human beings. Climate changes are in the form of depleting the ozone layer, melting of glaciers, increase in sea level, and extreme weather conditions. The natural disasters are showing a rising trend threatening the very existence of humankind. A disaster refers to a catastrophe, mishap, calamity, or grave occurrence from natural or synthetic causes, which is beyond the coping capacity of the affected community.[1]

Hydrological disasters remained the most common in 2009, accounting for more than 53% of total natural disaster occurrence. A total of 180 hydrological disasters (82.8% floods and 17.2% wet mass movements) caused more than 57.3 million victims in 2009.[2] Hydrological disasters are the most frequently reported disasters in all Asian regions, with the exception of East Asia where meteorological disasters are more frequent.[3]

Hazard vulnerability profile of India indicates that the earthquakes account for 57% of all-natural disasters followed by droughts (16%), floods (12%), high-speed winds/cyclones (8%), and landslides (3%).[4]

The south Indian state of Kerala recently witnessed the worst flooding in nearly a century due to the unusually high rainfall. Annual rainfall in Kerala is about 3000mm and is by southwest and northeast monsoons. The state received 90% of the rainfall in six monsoon months resulting in heavy discharges in all the rivers, which found their way into the main rivers through innumerable streams and watercourses. Heavy rainfall from June 1, 2018, to August 19, 2018, in the state resulted in severe flooding of 13 of 14 districts and was declared as Level 3 calamity by the Government of India. In contrast to an expected rainfall of 1649.5mm, IMD reports a downpour of 2346.6mm during this period, which was 42% above the normal. During June, July, and August 1–19, Kerala received 15%, 18%, and 164% of rainfall, respectively, above normal. The disaster claimed many lives, agricultural lands, and houses.[5]

Morbidities and mortalities arising out of flood can be due to direct impact and indirect impact. The direct impact includes drowning as in case of flash floods and coastal floods, injuries during evacuation and cleanup activities, electrical shocks, and the transmission of communicable, waterborne, and vector-borne diseases. Indirect impact includes the interruption of basic public health services and other nonhealth-related impacts.

Objective

The objective of the study was to identify the short-term health effects among the flood victims.


  Materials and methods Top


This is a descriptive study based on secondary data analysis. In a span of 6 days, the MGM Kerala Flood Relief Mission Team supported by the Mahatma Gandhi Mission Trust conducted 11 health camps in Alappuzha district and examined 1246 flood-affected persons from shelter camps and villages. Camps were conducted at various places in Budhanoor and Pandanad region of Chengannur taluka, and also Anjilipra, which belongs to Mavelikara taluka, 1 week after flood water started receding. The details of patients examined during the camp were recorded in a register for line listing. This has been used as a study tool for the secondary data analysis. In addition to the health checkup, health educational activities and house-to-house visits were also carried out. The data generated were analyzed to identify the morbidity pattern using Microsoft Excel.


  Results Top


Of the 1246 patients, the screened majority were adults (87%) and the remaining were children. All who were 15 years and younger were considered as children and rest as adults. [Chart 1] shows the distribution of patients by gender and age groups.
Chart 1: Distribution of patients as adults and children

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The top morbidities found were acute respiratory infections (ARIs), generalized weakness and musculoskeletal pain, skin infections, diarrhea, and other gastrointestinal disorder and trauma [Chart 2]. A significant number of patients were seeking consultation for noncommunicable diseases (NCDs), hypertension being the most common. ARI accounted for the majority of the cases, both among adults (40.2%) and children (55.6%), followed by generalized weakness and musculoskeletal pain. Other health problems identified included disruption of medication of the elderly due to loss of medications and prescriptions during the flood.
Chart 2: Morbidity pattern in flood-affected areas

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  Discussion Top


Appropriate and timely intervention can significantly reduce the morbidities that are infectious in origin after the floods.

ARI was the most common illness seen in our study. According to our study, 40.2% of adults and 55.6% of children had ARI. ARIs are classified into upper and lower acute respiratory infections and are a leading cause of morbidity in any precrisis setting. Logical reasoning suggests the ARIs increase after a disaster, especially when there is overcrowding in relief camps and also delay in diagnosis or treatment due to disruption of health systems. Bellos et al.[6] in a systematic review of 36 articles published between January 1980 and June 2009 provided evidence that ARI is a leading cause of morbidity and mortality in crises situation including natural disasters. The published data from refugee camps and surveillance or patient record suggest morbidity and mortality (20%–35% proportional mortality) and case fatality up to 30%–35% due to ARIs. The article also suggested that ARI disease burden comparisons with noncrisis settings are difficult due to noncomparability of data.

Second most common ailment seen from this study was generalized weakness and musculoskeletal pain. An experience of a mobile medical team in a disaster setting showed results similar to our findings. The team reported an incidence of upper respiratory tract infections at 34.1% and musculoskeletal problems to be 22.9%.[7]

Increase in diarrheal diseases is anticipated during flooding as there will be a disruption or contamination in water distribution system, lack of sanitation, poor hygiene, overcrowding at shelter homes, and inadequate chlorination or use of other water treatment methods. An increase in pediatric enteric infections,[8] bacillary dysentery,[9] cholera[10] is all reported after flooding. Number of diarrheal cases seen from our study is 3.8% among adults and 8.8% among children.

There is an equal need to address the NCD as a significant number of refugees sort consultation for the same. With confidence intervals of 95% (95% CIs), syndrome rates per 10,000 individuals disaggregated by syndrome group within 2 months postflood are 18.8 (14.2–23.5) for communicable diseases, 1.7 (0.9–2.5) for injuries, and 0.7 (0.5–1.0) for NCDs.[11] Findings of our studies show hypertensive cases to be 6% and diabetes cases at 4%.

Disruption of medication of the elderly was another problem. Tomio et al.[12] in original research mentions that the prevalence of interruption of medication was 9% in total and increased up to 23% in evacuated subjects. Ochi et al.[13] in a systemic literature review revealed that a considerable number of patients lose their medication during the evacuation and many lose essential medical aids such as insulin pens. As medication loss is partly a responsibility of evacuees, understanding the effect of medication loss may lead to raising awareness and better preparations among the patients and health-care professionals.[13]

Common morbidities seen in children after a disaster are fever, respiratory tract infections, and diarrhea, which require early recognition and which otherwise can lead to serious consequences. Studies have shown poor nutritional outcomes with a likelihood of stunting and underweight after a disaster if complemented with malnutrition and low socioeconomic status can have adverse health outcomes. Also, the likelihood of receiving vaccinations as per the immunization schedule is lower due to the disturbance in the health delivery system.[14]

From this study, ARIs, generalized weakness and musculoskeletal pain, skin infections, followed by diarrhea and fever are the common ailments noticed in the children. Our data limit us to make any comment on the long-term health effects of the flood on children such as the nutritional outcome and their growth. However, more and more studies are now focusing on the long term-effects of recurrent flooding on child malnutrition. A community-based survey conducted in rural eastern India revealed that children who are affected by the flood are likely to be stunted as compared to the non-flooded ones (adjusted prevalence ratio 1.60; 95% CI = 1.05–2.44). Also, children in flooded communities are found to have a higher prevalence of underweight (adjusted prevalence ratio 1.86; 95% CI = 1.04–3.30).[15]


  Conclusion Top


No major outbreak of any illness noticed. Most postdisaster syndromes are to be addressed by prevention, early diagnosis, and early treatment. However, it is unclear how much of this morbidity can be directly attributed to flood. As people are living in crowded or temporary communal settings after a disaster with limited access to clean water and other resources, health education plays an important role in disease prevention. People need to be educated regarding the sanitation, personal hygiene practices, and protection against waterborne and vector-borne diseases, and also against self-medication. There is an equal need to create consciousness among people regarding disaster preparedness. Also, the support of nongovernmental organizations and private sectors is vital for the local health authority in the restoration of an affected society.

Financial support and sponsorship

MGM Kerala Flood Relief Mission was supported by the Mahatma Gandhi Mission Institute of Health Sciences (MGMIHS), Navi Mumbai, Maharashtra, India.

Conflicts of interest

There are no conflicts of interest.


  References Top




 
  References Top

1.
Government of India Ministry of Home Affairs. National Policy on Disaster Management; 2009. Available from: http://ndma.gov.in/en/national-policy.html. [Last accessed on 2019 Aug 27].  Back to cited text no. 1
    
2.
Vos F, Rodriguez J, Below R, Guha-Sapir D. Annual Disaster Statistical Review 2009: The Numbers and Trends. Brussels, Belgium: CRED; 2010.  Back to cited text no. 2
    
3.
Guha-Sapir D, Hoyois Ph, Wallemacq P, Below R. Annual Disaster Statistical Review 2016: The Numbers and Trends. Brussels, Belgium: CRED; 2016.  Back to cited text no. 3
    
4.
Chopra BK, Venkatesh MD. Dealing with disasters: Need for awareness and preparedness. Med J Armed Forces India 2015;71:211-3.  Back to cited text no. 4
    
5.
Government of India, Central Water Commission Hydrological Studies Organisation Hydrology (S) Directorate. Study Report: Kerala Floods of August 2018. New Delhi: CWC; 2018.  Back to cited text no. 5
    
6.
Bellos A, Mulholland K, O’Brien KL, Qazi SA, Gayer M, Checchi F. The burden of acute respiratory infections in crisis-affected populations: A systematic review. Confl Health 2010;4:3.  Back to cited text no. 6
    
7.
Ahmad R, Mohamad Z, Mohd Noh AY, Mohamad N, Che Hamzah MSS, Mohammed NAN, et al. Health major incident: The experiences of mobile medical team during major flood. Malays J Med Sci 2008;15:47-51.  Back to cited text no. 7
    
8.
Berendes DM, Leon JS, Kirby AE, Clennon JA, Raj SJ, Yakubu H, et al. Associations between open drain flooding and pediatric enteric infections in the MAL-ED cohort in a low-income, urban neighborhood in Vellore, India. BMC Public Health 2019;19:926.  Back to cited text no. 8
    
9.
Liu X, Liu Z, Zhang Y, Jiang B. The effects of floods on the incidence of bacillary dysentery in Baise (Guangxi Province, China) from 2004 to 2012. Int J Environ Res Public Health 2017;14:E179.  Back to cited text no. 9
    
10.
Jutla A, Whitcombe E, Hasan N, Haley B, Akanda A, Huq A, et al. Environmental factors influencing epidemic cholera. Am J Trop Med Hyg 2013;89:597-607.  Back to cited text no. 10
    
11.
Salazar MA, Pesigan A, Law R, Winkler V. Post-disaster health impact of natural hazards in the Philippines in 2013. Glob Health Action 2016;9:1-7.  Back to cited text no. 11
    
12.
Tomio J, Sato H, Mizumura H. Interruption of medication among outpatients with chronic conditions after a flood. Prehosp Disaster Med 2010;25:42-50.  Back to cited text no. 12
    
13.
Ochi S, Hodgson S, Landeg O, Mayner L, Murray V. Disaster-driven evacuation and medication loss: A systematic literature review. PLoS Curr 2014;6:1-29.  Back to cited text no. 13
    
14.
Datar A, Liu J, Linnemayr S, Stecher C. The impact of natural disasters on child health and investments in rural India. Soc Sci Med 2013;76:83-91.  Back to cited text no. 14
    
15.
Rodriguez-Llanes JM, Ranjan-Dash S, Degomme O, Mukhopadhyay A, Guha-Sapir D. Child malnutrition and recurrent flooding in rural eastern India: A community-based survey. BMJ Open 2011;1:e000109.  Back to cited text no. 15
    


    Figures

  [Chart 1], [Chart 2]



 

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