Jimma University
Institute of Health Science
Department of Epidemiology
Assignment 3 of Disaster Management
By: Mohammed Jihad Mamud
ID RM3400/12
Dept‘ Epidemiology
Submitted to: Department of Epidemiology.
Date 28/08/2020
Jimma, Ethiopia
1. Describe the key activities under rapid epidemiologic assessment with example
Rapid epidemiological assessment (REA) has evolved over the past 30 years into an essential tool
of disaster management. Small area survey and sampling methods are the major application. While
REA is protocol driven, needs assessment of displaced populations remains highly nonstandardized. The United Nations and other international organizations continue to call for the
development of standardized instruments for post-disaster needs assessment.
Key features of REA;
•
Rapid
•
Timely future
•
Cost-effective
•
Practically relevant
•
Strengthens local response
The duration of a rapid assessment depend on:

The size and geographical distribution of the affected population

The security situation

The conditions of access to transport and logistics

The human resources available and the methods used.
Conduct an assessment, with detailed qualitative and quantitative data and intervention plans,
should be completed as soon as possible after the rapid assessment.
Key Activities under REA are;
1. Planning the mission

Example; if we want to conduct REA in Jimma town on Awetu river flood disaster, 2020 first
we have to plan the mission by considering composition of team. Regarding composition of
team, we have to plan to involve all concerning body like public health specialist, local
authority, security personnel etc. on the other hand, the background information like current
political condition of Jimma town and background health data of Jimma town should
incorporated in our plan.
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2. Field Visit

Data: Demography, environment, health data and resource need

Methods: Areal inspection, direct observation, interview with agencies, minster of health and
local authorities, collection of health data from medical facilities, rapid estimation of
population size by mapping, review of records and rapid survey

Example; after we finalize our mission plan, we have to carryout the next REA activities
which is ‗‗Field visit‘‘. So, as our plan by selecting appropriate method we collect the planned
data. Demographic data, health and environmental data and under these the variables listed
above are there. So we have to collect data for all variables.
3. Analysis

Example; after field, the collected data should be analysed. Demographic pyramid is used to
know size population group within affected population, then we have to identify high risk
group based on their vulnerability status( the affected population‘s health status,
socioeconomic status, their cultural effect, and al vulnerability indicator should be assessed
to identify high risk groups. Based on high risk group, priority health intervention should be
identified.
4. Report writing.

The 4th activity is compiling the finding or report writing. It should include; the assessment
methodology (here we have to identify the methodology we used it may be one of the
following; Areal inspection, direct observation, interview with agencies, minster of health
and local authorities, collection of health data from medical facilities, rapid estimation of
population size by mapping, review of records and rapid survey.

Example if we used areal inspection, we should incorporate it in our report writing as our
assessment methodology. then the status of disaster also included in report, detail view of
affected population, the responses of Jimma Town Administration and Health office,
resource needed and recommendation of team should be incorporated in report writing
activity.
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5. Dissemination of the findings
The final activity is dissemination of findings. After we finalize report writing, it should be
disseminated accordingly. Our example is Aetu river folood disaster in Jimma town 2020 so,
Jimma town administration, Town health office, regional health bureau, concerning NGO and
should get the findings to mobilize resources and play facilitation role.
Another Health Assessment during Disaster
Key decisions in a health emergency, such as the need for intervention and the type and size of the
intervention, must be made rapidly. Unfortunately, precise and reliable data often require weeks to
organise, collect and analyse. The methods used are more complex. This means that some
decisions must be made using less precise and less reliable data. The assessment should be started
within a short time frame, ideally within the first three days after the event.
A rapid needs assessment is carried out to determine:

The magnitude of the emergency and population size affected;

The vulnerable population groups with high risk of death or disease;

What are the present health priorities and potential public health problems;

Availability of food, water and shelter, clinics and hospitals;

Environmental conditions;

What the government or military is doing, what the plans are;

Presence, plans and activities of international or local organisations;

Whether or not external support or intervention is needed; and

Critical upcoming hazards, like winter conditions.
A. Preparing for rapid health needs assessment
Adequate preparations are needed before a rapid assessment can be made. This includes the
following steps:
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1. Before the field assessment, collect background information about the emergency situation‘s
geographic location, the population affected and any political factors. Also collect the preemergency health data and information on the existing health system. Try to confirm all
information with the UN, the host government and other NGOs;
2. Coordinate with other organisations, government and military and assessments;
3. If a multidisciplinary assessment team cannot be recruited locally, get the proper authorisation
(work permits, travel permits, vaccinations etc.) for additional personnel from outside the
country. Local representation is absolutely essential and teams made up of expatriates must be
avoided;
4. The assessment team should then plan the field assessment as follows:

Define the terms of reference and the objectives of the assessment;

Based on the nature of the emergency, determine the priorities to be considered;

Select how and in what order the information will be gathered. If existing assessment
checklists are to be used, coordinate with other agencies. They must be carefully reviewed
and adapted to the local situation. All should use the same checklists;

Design or adapt the forms for recording and analysing the information collected. All
should agree on how and when the information will be reported;

Estimate the time frame and the resources needed (stationery, data processing tools,
personnel) for each stage of the assessment, such as training field staff and volunteers,
collecting and analysing data;

Assign specific tasks and responsibilities to each member of the assessment team;
5. Inform all departments within the organisation that need to be directly involved with the
assessment—logistics, finance, human resources etc. Identify the person at headquarters who
can be contacted from the field during the assessment;
6. Collect essential equipment. All members must have double communication means, survival
gear and GPS as deemed important, apart from maps, first aid kits etc.;
7. Check the security situation in the field and make contact with local authorities and other
organisations;
8. Ensure there is someone based locally to arrange the assessment team‘s transportation,
communication, accommodations and meals;
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9. Be aware of the common mistakes that can occur during any assessment. Try to prevent errors
by using the actions shown in the following table.
B. Defining the information needed
Defining in advance what information is needed about the emergency can improve the coverage
and quality of the needs assessment. It can also help to identify the sources of information to be
contacted on arrival at the site. Many checklists for rapid assessments have been developed,
some of which classify indicators under different data categories. They are supposed to guide
assessment teams in thinking about the information they might want to collect in the rapid needs
assessment as well as to ensure that they have covered the key issues. Assessment checklists
should not be considered as simple exercises for filling out data forms. Checklists that are used
should first be adapted to the context and culture of the specific emergency. Not all the
information in the checklist might be needed or be relevant for every assessment.
C. Conducting the rapid health needs assessment
A needs assessment can be carried out by following the same logical sequence as individual
patient assessments, which includes: briefly observing patients on arrival, taking their history
(interviews and review existing records), physical examination, interim diagnosis, planning a
follow-up assessment if necessary. Similarly, after collecting the background information, the
following steps may provide a logical approach to a field assessment:
1. Preliminary observations should be done if possible when approaching the site by vehicle or
aircraft. Assess the environment and extent of the disaster‘s damage and population
displacement.
2. Interview officials from the local government, the public health sector, local organizations,
volunteers, health workers and the affected community (leaders of different ethnic groups,
women) etc. in order to:

Confirm or update background information on the health needs and local response;

Identify individuals or groups of people in life-threatening situation;

Whether the host government will accept intervention.
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3. Review existing records at the local or national level (host country, agencies, media, and
health facilities) including maps, aerial photos, census health data etc. This helps establish
baseline information on demography, the displaced and the host populations‘ health status, the
existing services‘ function and capacity (e.g. relevance of the health information system).
4. Detailed visual inspection: walk around the displaced community and surrounding areas to
investigate rumours and gather valid impressions about the following:

The layout of the camp or settlement (from the highest level e.g. from the top of a hill, tree,
or building), the estimated number of people involved, the local infrastructure and the
resources;

The living conditions and access to sanitation, water supply, food supply, health services
and the level of insecurity;

How much normal life and the social structure has been disrupted, the affected
populations‘ coping mechanisms and any other issues of secondary priority such as
reproductive health needs and mental health.
5. Rapid surveys: Conduct rapid surveys using convenience or cluster sampling of households
to estimate the demographic profile, health status including immunisation status and priority
health problems of the affected population. Innovative methods of sampling can be adopted to
sample enough displaced persons per cluster where a disaster affected community is dispersed
within a host population setting. Examples include snowballing technique (locating the first
subject and enquiring for information on the next subject with similar characteristics) or
measuring the proportion of displaced persons among all the subjects surveyed within a
clusterand projecting this number to estimate the entire disaster affected population.

Provide valid base-line information if missing;

Determine the priorities for the programme (e.g. cholera prevention and control, selective
feeding, measles immunization, etc.).
6.
Preliminary analysis: A timely and careful analysis of the assessment findings is necessary
to provide a basis for programme planning. However, the skills or the resources to carry out a
detailed analysis may not exist. Simple analysis procedures may be performed in the field,
including summarizing statistics, frequency tables, calculating percentages, rates, and plotting
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graphs. Key results must be compared to normal reference values or standards to improve
understanding and conclusions regarding the disaster situation and help determine the
appropriate response. For more details, please refer to the annex on data analysis.
7. Prepare a basis for ongoing health information: Use the assessment findings to set up a
health information system. Ongoing collection and analysis of information over time will
refine the findings of the initial assessment. Population surveys can be organized soon after
the assessment to:
8. Report findings: After the analysis, write an assessment report as soon as possible about the
key findings and recommendations under the following headings:
The assessment methodology;

The disaster situation;

The affected population;

The local response and capacity;

The external resources needed;

The recommended actions.
1.9 Dissemination: Give feedback to everyone who participated or has a stake in the assessment.
The report should include information about the following:

The assessment;

The disaster;

The affected population;

The local response and capacity;

The external resources needed;

The recommended actions.
9. Recommendation for follow up surveys: Try to indicate as early as possible; which in-depth
assessments are required urgently.
10. Special considerations during response: The findings should have some bearings on future
surveillance and intervention in recovery and long term rehabilitation efforts. Many health
care systems are disrupted after major disasters. Facilities left standing might be only
operating at a reduced capacity especially at the disaster‘s peripheral level mainly due to the
lack of resources and mismanagement. This health care gap will likely widen over time with a
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brain-drain of doctors and nurses from the periphery. As disasters become more frequent, the
time for recovery and return to any sense of normalcy will become a bigger problem for future
governments because many continue to spend large proportions of the health care budget
(even 60 to 80%) on higher level of care. These challenges must be considered during the
emergency response in most developing countries: how to set up emergency operations with
incompetent health care systems.
2. Suppose there was a repeated disease outbreak called Disease Y among attendants of
primary school children in Dedo district of Jimma zone. Also, there were many school
absentees. Establish surveillance and monitoring system for this particular scenario.
Show all the necessary steps
Surveillance of communicable diseases requires concerted efforts and collaboration between
stakeholders and partners in and between countries. At country level, intersectoral collaboration
and coordination between key partners is crucial for the implementation of effective and
comprehensive surveillance systems. Various surveillance networks and partnerships exist at
country level and between countries. The laboratory network is a good example of a country-level
network, while collaboration on surveillance and response activities between countries bordering
one another represents intercountry networking. Intersectoral collaboration is a necessity in order
to implement early warning and response functions. M & E is an opportunity to track network and
partnership activities, determine their effectiveness and provide recommendations for
improvement.
A. The necessary steps of surveillance
1. Case detection
Case detection is the process of identifying cases and outbreaks. Case detection can be through the
formal health system, private health systems or community structures. As above example we have
to go Dedo district of Jimma zone, the area from which cases were reported and identify whether
the disease caused absenteeism is case Y by using appropriate case definition.
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2. Case registration
Then we register the identified cases. This requires a standardized register to record minimal data
elements on targeted diseases and conditions. Monitoring should establish the proportion of
health facilities having the standardized registers. Evaluation could then examine the validity and
quality of information recorded as well as factors that affect the registration of cases.
3. Case confirmation
After registration of cases, we have to confirm the cases whether it is ‗‘Case Y‘‘ or not. Case
confirmation refers to the epidemiological and laboratory capacity for confirmation. Capacity for
case confirmation is enhanced through improved referral systems, networking and partnerships.
This means if Dedo district have no capacity to confirm case Y, we should collect specimen and
refer to other facility.
4. Reporting
Reporting refers to the process by which surveillance data moves through the surveillance system
from the point of generation. It also refers to the process of reporting suspected and confirmed
outbreaks. Different reporting systems may be in existence depending on the type of data and
information being reported, purpose and urgency of relaying the information and where the
data/information is being reported. The national guidelines for the different reporting systems
should be implemented.
5. Data analysis and interpretation
Surveillance data should be analysed routinely and the information interpreted for use in public
health actions. Appropriate "alert" and "epidemic" threshold values for diseases with epidemic
tendencies should be used by the surveillance staff. Capacity for routine data analysis and
interpretation should be established and maintained for epidemiological as well as laboratory data.
6. Epidemic preparedness
Epidemic preparedness refers to the existing level of preparedness for potential epidemics and
includes availability of preparedness plans, stockpiling, designation of isolation facilities, setting
aside of resources for outbreak response, etc.
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7. Response and control
Public health surveillance systems are only useful if they provide data for appropriate public
health response and control. For an early warning system, the capacity to respond to detected
outbreaks and emerging public health threats needs to be assessed. This can be done following a
major outbreak response and containment to document the quality and impact of public health
response and control.
8. Feedback
Feedback is an important function of all surveillance systems. Appropriate feedback can be
maintained through supervisory visits, newsletter and bulletins. It is possible to monitor the
provision of feedback by the different levels of surveillance and to evaluate the quality of
feedback provided, and the implementation of follow-up actions.
B. Monitoring and Evaluation of Surveillance
The purpose is to promote the best use of public health resources through the development of
effective and efficient surveillance systems. It can serve as a guide for persons conducting their
first evaluation and as a reference for those who are already familiar with the evaluation process.
Epidemiologic surveillance is the ongoing and systematic collection, analysis, and interpretation
of health data in the process of describing and monitoring a health event. This information is used
for planning, implementing, and evaluating public health interventions and programs. Surveillance
data are used both to determine the need for public health action and to assess the effectiveness of
programs.
With this in mind, the guidelines that follow describe many measures that can be applied to
surveillance systems, with the clear understanding that all measures will not be appropriate for all
systems.
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Outline of tasks for evaluating a surveillance system
1. Describe the public health importance of the health event.
The following are the three most important categories to consider:
1. Total number of cases, incidence, and prevalence
2. Indices of severity such as the mortality rate and the case-fatality ratio
3. Preventability
B. Describe the system to be evaluated.
1. List the objectives of the system.
2. Describe the health event(s) under surveillance. State the case definition for each health
event.
3. Draw a flow chart of the system.
4. Describe the components and operation of the system.
a. What is the population under surveillance?
b. What is the period of time of the data collection?
c. What information is collected?
d. Who provides the surveillance information?
e. How is the information transferred?
f. How is the information stored?
g. Who analyzes the data?
h. How are the data analyzed and how often?
i. How often are reports disseminated?
j. To whom are reports distributed?
k. How are the reports distributed?
C. Indicate the level of usefulness by describing actions taken as a result of the data from the
surveillance system. Characterize the entities that have used the data to make decisions and
take actions. List other anticipated uses of the data.
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D. Evaluate the system for each of the following attributes:
1. Simplicity
2. Flexibility
3. Acceptability
4. Sensitivity
5. Predictive value positive
6. Representativeness
7. Timeliness
E. Describe the resources used to operate the system (direct costs).
List your conclusions and recommendations. State whether the system is meeting its objectives,
and address the need to continue and/or modify the surveillance system.
3. Demonstrate the necessary steps to investigate
rumours during disaster situation with
appropriate example
Rumors surveillance is one of the systems in early warning sign, which helps to gather
information on possible outbreak within and outside Country.
Once rumours (possible outbreaks) from the community are received, initiate proper investigation
as soon as possible.
 Necessary steps to investigate rumours during disaster situation example for covid 19 in
Jimma district
1. Planning the rumours investigation

Consider access to the site

Maintain resource for the team members

The willingness of the community

Consider the local climate, the daily family activities, and the migration patterns

Design appropriate questionnaires based on how the information will be analysed
o Consider case definition
o Training of the teams
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o

Arrange for translators
Standardize the sequence of data collection procedures
o
Involve epidemiological, clinical, and laboratory procedures
o
Data should be collected sequentially as
-
directly from the affected person or family member
-
perform a physical examination after the interview.
-
collect any required laboratory specimens
-
Preserve all laboratory specimens appropriately.
2. Organising the rumors investigation


Involve local authorities for
o
security clearance and publicity
o
introducing the team to the affected community.
Sketch an organizational chart
o to show the lines of authority, the roles of different teams, and the link between
functions
3. Supervising the Investigation

Supervise field workers
 checking how they conduct interviews during the survey

their accuracy in recording data.

Evaluate the collection and processing of laboratory specimen for quality control

Carry out and check data entry daily and perform simple calculations

Conduct frequent staff meetings to identify and address any problems.
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4. Describe the different phases of Disaster communication life cycle with appropriate example
Phases of Disaster communication life cycle
1. The Pre-crisis Phase
During this phase of disaster the following activities should be carried out
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Be prepared
•
Assign crisis response roles
•
Collaborate with life safety partners, agencies (police, fire, EMS, mental health)
•
Develop consensus recommendations
•
Create Crisis Communication Plan
•
Prepare response statements, key messages
•
Test communication system & networks, including web ―ghost site‖
For example; Pandemic of CVID-19, communication during pre-crisis phase include; about
preparation, how the crisis response roles are assigned, about collaboration whit multi sectoral
team, preparation of communication plan, key messages and checking of appropriate
communication system.
2. Initial phase
During initial phase of disaster appropriate communications are as follows;
•
Initial statement ~ who, what where, when … not why! ~ priorities & action steps ~
reassure stakeholders
•
Get it right, repeat it & share with others (inform employees first!)
•
Understand info is usually incomplete
•
Accuracy is critical; okay to state, ―We don‘t know at this time …‖
Communication about affected population, time of disaster happened, about action to be taken
and priority population and intervention should be communicated.
For example; Pandemic of CVID-19, communication during initial phase include; about the
nature of the virus, about susceptible group, and the time of start and time it might be end,
about the prevention steps, like using face masks, sanitizer, social distancing and priority area
should be addressed.
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3. Maintenance
During maintenance phase of disaster appropriate communications are as follows;
•
Commit to frequent updates ~ provide more background, details of incident ~ progress of
response efforts ~ seek support of response
•
Listen, learn & assess what affected public is saying
•
Correct rumors, unclear facts, misinformation
•
Expect criticism & blame; stay focused on victim‘s needs
•
Deploy process to track communication activities, stakeholder responses
•
Seek alliances with other partners; report third-party support of your efforts
Communication about updates detail background of affected population, what response progress
looks like, how the affected population is seeking additional response should be addressed.
For example; Pandemic of CVID-19, communication during maintenance phase include; about
the virulence of COVID-19, about severity, the extent to which we are responding , listening to
affected population, collecting the rumor and communicating all these area is among activities of
maintenance phase communication.
4. Resolution
•
Focus communication on: ~ recovery efforts ~ cause (if possible) ~ actions taken to prevent a
repeat; when changes are implemented
•
Be prepared for media scrutiny on incident cause, organization‘s response
•
Promote behaviors that avoid risks
•
Take this time to improve response efforts
•
Promote organization‘s role, responsibility to its mission & focus
Communication about recovery efforts, action taken, behavioral promotion to reduce risks and
promotion of organizational role.
For example; Pandemic of CVID-19, communication during resolution phase include; about
the action taken, efforts, behavioral change communication to avoid recurrence et.
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5. The Evaluation Phase
•
―Hot wash‖ (debrief) ~ what did we learn? ~ what do we need to differently next time? ~ what
were our greatest challenges in responding to incident/crisis?
•
Document & share lessons learned; determine specific actions to improve crisis communication
& response capabilities
•
Evaluate performance of crisis communication plan, including social media efforts
•
Return to pre-crisis planning & activities
For example; during this phase, our communication should focus on lesson learnt, the
challenge we face during COVID-19 pandemic, specific action to improve crisis
communication and response capabilities and evaluation of crisis communication plan are some
of activities.
References
•
The Johns Hopkins and the International Federation of Red Cross and Red Crescent
Societies Public health guide in emergencies, Second edition 2008
The Johns Hopkins and Red Cross / Red Crescent PUBLIC HEALTH GUIDE FOR
•
Forbes, Sharon L., (2017) ―Post-disaster consumption: analysis from the 2011
Christchurch earthquake‖, The International Review of Retail, Distribution and Consumer
Research, 27:1, 28-42, DOI: 10.1080/09593969.2016.1247010
•
Emergency Plan of Action (EPoA) , Ethiopia: Cholera outbreak response, MDRET021 /
PET053, 16 July 2019
•
EMERGENCIES, 1st edition.
•
Humanitarian Bulletin Ethiopia , Issue #21| 02 – 15 Dec. 2019
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