Data for Decision Making in Disasters:
Advances and Controversies
Prevention of Disaster Threats Workshop
Kaunas, Lithuania
08 August, 2005
Eric K. Noji, M.D., M.P.H.
Centers for Disease Control
Washington, DC
"The reason for collecting, analyzing and
disseminating information on a disease is
to control that disease. Collection and
analysis should not be allowed to
consume resources if action does not
follow."
William H. Foege, M.D.
International Journal of Epidemiology
1976; 5:29-37
Uses of Data in Disasters
•
•
•
•
•
Assessment and Surveillance
Injury and disease profiles
Research methodologies
Disaster management
Vulnerability and hazard assessment
Public Health Actions in
Emergencies
• Before the disaster
• During the disaster
• After the disaster
Data Needs Before the Disaster
• Hazard Analysis
• Vulnerability Analysis
• Training and Education
Increasing disaster risk
 Increasing population density
 Increased settlement in high-risks areas
 Increased technological hazards and
dependency
 Increased terrorism: biological,
chemical, nuclear?
 Aging population in industrialized countries
 Emerging infectious diseases (AMR)
 International travel (global village)
While knowing the threat agent is
important, understanding how each
threat expresses its toll on the health
and well being of communities, in both
the near term and the long run, is
crucial to our preparedness and
response.
IMMEDIATE RELIEF
Next Steps
• Rapid needs assessment
• Disease Surveillance
• Public health interventions
Rapid Needs Assessment
The collection of subjective and
objective information, limited in
time, performed in acute
situations, which requires
immediate action to be taken to
respond to the basic requirements
of the affected population
Objectives of Health Information
Systems in Emergency Populations

Establish health care priorities
 Follow trends and reassess priorities
 Detect and respond to epidemics
 Evaluate program effectiveness
 Ensure targeting of resources
 Evaluate quality of health care
Goal of CMR in Emergency
Populations

For < 5 years of age: Less than 2.0 per
10,000 per day

For > 5 years of age: Less than 1.0 per
10,000 per day
Morbidity Assessment
Necessary Information

Diseases of public health importance
Measles
 Diarrhea
 Acute Respiratory infections
 Injuries
 Malnutrition


Diseases of epidemic potential
Cholera
 Dysentery
 Meningitis
 Yellow fever

Program or process indicators

Immunization coverage
 Supplementary feeding attendance
 Antenatal and postnatal clinic coverage
 ORS distribution
 Water consumation
 Caloric intake
 Latrine coverage
The Assessment Process
Identify information needs
and
resources
Collect data
Analyze and interpret
Report conclusions
Design/modify disaster response
Back to the beginning of assessment
Identify
information needs and resources
After the Disaster
Lessons
learned
Improving
future disaster
response
Preventing
or mitigating loss
Epidemiologic Methods in Disasters
After a disaster (Reconstruction Phase):
Conducting post-disaster epidemiologic
follow-up studies
Identifying risk factors for death & injury
Planning strategies to reduce impact-related
morbidity & mortality
Source: EK Noji, The Public Health Consequences of Disaster
Epidemiologic Methods in Disasters
After a disaster (Reconstruction Phase):
Developing specific interventions
Evaluating effectiveness of interventions
Conducting descriptive & analytical studies
Planning medical & public health response to
future disasters
Conducting long-term follow-up of
rehabilitation/reconstruction activities
Source: EK Noji, The Public Health Consequences of Disaster
Myths and Realities in Disaster
Situations
Myth: Foreign
medical
volunteers with
any kind of
medical
background are
needed.
Reality: The local population almost
always covers immediate lifesaving
needs. Only medical personnel with skills
that are not available in the affected
country may be needed.
Myth: Any kind of
international
assistance is
needed, and it's
needed now!
Reality: A hasty response that is not
based on an impartial evaluation only
contributes to the chaos. It is better to
wait until genuine needs have been
assessed.
Myth: Epidemics
and plagues are
inevitable after
every disaster.
Reality: Epidemics do not
spontaneously occur after a disaster
and dead bodies will not lead to
catastrophic outbreaks of exotic
diseases. The key to preventing disease
is to improve sanitary conditions and
Epidemiologic Methods in Disasters
Challenges for Epidemiologists
Applying epidemiologic methods in the context of:
 Physical destruction
 Public fear
 Social disruption
 Lack of infrastructure for data collection
 Time urgency
 Movement of populations
 Lack of local support and expertise
Source: EK Noji, The Public Health Consequences of Disaster
Epidemiologic Methods in Disasters
Challenges for Epidemiologists
Selecting study designs:
 Cross-sectional:
Studies of frequencies of deaths, illnesses,
injuries, adverse health affects
Limited by absence of population counts
 Case-control:
Best study to determine risk factors, eliminate
confounding, study interactions among multiple
factors
Limited by definition of specific outcomes, issues
of selection of cases & controls
Epidemiologic Methods in Disasters
Challenges for Epidemiologists
Selecting study designs:
 Longitudinal:
Studies document incidence and estimate
magnitude of risk
Limited by logistics of mounting a study in
a post-disaster environment and subject
follow-up
Source: EK Noji, The Public Health Consequences of Disaster
Epidemiologic Methods in Disasters
Challenges for Epidemiologists
 Need standardized protocols for data collection
immediately following disaster
 Need standardized terminology, technologies,
methods and procedures
 Need operational research to inventory medical
supplies and determine 1) actual needs, 2) local
capacity, 3) needs met by national/international
communities
 Need evaluation studies to determine efficiency
and effectiveness of relief efforts and emergency
interventions
Source: EK Noji, The Public Health Consequences of Disaster
Epidemiologic Methods in Disasters
Challenges for Epidemiologists
 Need databases for epidemiologic research based
on existing disaster information systems
 Need to identify injury prevention interventions
 Need to improve timely and appropriate medical
care following disaster (search & rescue,
emergency medical services, importing skilled
providers, evacuating the injured)
 Need measures to quickly reestablish local health
care system at full operating capacity soon after
disaster
Source: EK Noji, The Public Health Consequences of Disaster
Epidemiologic Methods in Disasters
Challenges for Epidemiologists
 Need uniform disaster-related injury definitions
and classification scheme
 Need investigations of disease transmission
following disasters and public health measures to
mitigate disease risk
 Need to study problems associated with massive
influx of relief supplies and relief personnel
 Need cost-benefit and cost-effectiveness analyses
Source: EK Noji, The Public Health Consequences of Disaster