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Research Detail

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Sayem Ahmed
Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh

Md. Zahid Hasan
Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh

Montira J. Pongsiri*
Department of Population Medicine and Diagnostic Sciences, Cornell University, College of Veterinary Medicine, Ithaca, NY, USA

Mohammad Wahid Ahmed
Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh

Sylvia Szaboe
Centre for Population Change, Southampton, UK

While there is increasing evidence on the trends and impacts of climate change, both globally and in Bangladesh, there is a limited quantitative analysis on the impacts of natural disasters on population health and the association with socio-economic characteristics. Using data from the ‘Bangladesh Disaster-Related Statistics-2015’, we assessed disaster-related health outcomes namely, injury, disability, and death. We applied three logistic regression models to examine the relationships between individual socio-economic characteristics, reported disaster-related injury, disability, and death. Our study found that 145.9 disaster-related injuries, 14.4 disabilities, and 21.0 deaths per 100,000 population were reported in Bangladesh over 2009–2014. Floods were responsible for the highest percentage of injury, disability, and death followed by thunderstorms. The elderly and children were more likely to suffer from disaster-related injuries compared to adults. Disaster preparedness was a protective factor for both disasters related injury and disability. We observed geographic variation in the number of injuries, disability, and death across the districts in Bangladesh. Policy-makers can use the study findings to strengthen risk-monitoring, assessment, and preparedness strategies and actions for extreme weather events related to the rapidly changing climate.

  Natural disaster; Injury; Disability; Death; Thunderstorms; Bangladesh
  In Bangladesh
  00-00-2009
  00-00-2014
  Risk Management in Agriculture
  Extreme climatic event

Given the above context, this paper aims to assess socio-economic equity in disaster-related health outcomes (e.g. injury, disability, and death) in Bangladesh. Because of the geographical and climatic context of Bangladesh, our inquiry focuses specifically on the impacts of the most frequently occurring disasters, such as drought, flood, waterlogging, cyclone, tornado, storm/tidal surge, thunderstorm, river/coastal erosion, landslides, and hailstorm.

Data source and design In this study, we used data from the ‘Bangladesh Disaster-related Statistics-2015’, the largest and most recent disaster-related survey in the country conducted by the Bangladesh Bureau of Statistics (BBS) (BBS, 2016). A disaster was defined as a major adverse event resulting from natural processes of the earth, e.g. cyclones, drought, floods, erosion, volcanic eruptions, earthquakes, tsunamis, and other geologic processes. The survey was designed to measure the socio-economic characteristics of households and population, damage and loss of land and residence, health and sanitation conditions, different disasters faced, and perception and knowledge about climate change in the disasterprone areas. The respondents were asked for the disaster-related information between 2009 and 2014. All 64 districts of Bangladesh were considered as a sampling frame consisting of mauzas/mahallas (lowest administrative unit). Respondents were questionnaire was used to collect data in two phases. In both phases, the field operation was conducted for 45 days. About 1800 data collectors and employees of the Bangladesh Bureau of Statistics (BBS) were employed in the data collection after four days of comprehensive training,

We estimated the impact of natural disasters on the selected outcome variables. The key outcome variables were injury, disability, and death due to different disasters in the last six years. The ‘Bangladesh Disaster-related Statistics-2015’ survey collected self-reported injury and disability information associated with natural disasters. In this study, the injury was defined as any accidental force applied to the body during the natural disasters that caused harm (Schuh-Renner et al., 2019). The difficulty with mobility, basic activities (e.g. dressing and bathing) of daily living after affected by the natural disasters were considered as disability (Manini et al., 2017). The participant was asked, ‘Member of your household, who got sick, either injured or got disabled due to natural disaster during 2009–14’ to capture the injury and disability information. The prevalence of injury, disability, and death were estimated per 100,000 populations across different socioeconomic characteristics (e.g. age group, sex, marital status, education, occupation, physically challenged condition, disaster warning, disaster preparedness, number of disasters faced, place of residence, region of residence, and asset quintile). Physical or psychological situation that hinders the daily movement, sensations, and activities of a man or woman was defined as the physically challenged condition (BBS, 2016). The dummy variable ‘got disaster warning’ denoted 1 if a household received any advanced notice or forecast on disaster and 0 otherwise. Preparedness was defined as measures that are designed to ensure that communities will have the knowledge and understanding of their risk environment to enable them to better cope with disaster associated causalities (BBS, 2016). Number of disasters faced was defined by how many times the person was affected by a disaster. We analysed the effects of drought, flood, water logging, cyclone, tornado, storm/ tidal surge, thunderstorm, river/coastal erosion, landslides, hailstorm, and other disasters in this study. Households’ wealth was categorized into five quintiles ordered from the poorest to the richest based on the available assets of the household, including housing material, sanitation facilities, access to utility services, and access to drinking water.

Statistical analyses Principal component analysis (PCA) was applied to survey responses on ownership of a set of key assets and the values of the index were based on the first principal component (Vyas & Kumaranayake, 2006). Household size was adjusted while estimating PCA score. PCA is a commonly used technique when computing asset indices; although traditionally applied to continuous variables (Filmer & Pritchett, 2001). Higher scores of the index indicated more affluent households. The chi-square test was performed to assess the association between categorical variables. We applied three different logistic regression models to identify the associations between individual/household characteristics and disaster-related injury, disability, and death. In first two models, disaster-related injury and disability were treated as dependent variables and other socio-economic characteristics as independent variables (e.g. age group, sex, marital status, education, occupation, physically challenged condition, disaster warning, disaster preparedness, number of disasters faced, place of residence, region of residence, and asset quintile). However, in the third model, disaster-related death was analyzed for all of these characteristics except marital status, education, occupation, and physical challenges due to the unavailability of the information. All statistical analyses were performed using STATA version 13 (StataCorp., 2013).

  CLIMATE AND DEVELOPMENT
  https://doi.org/10.1080/17565529.2020.1772705
Funding Source:
1.   Budget:  
  

Our analysis identified significant socio-economic determinants of disaster-related injury, disability, and death. These determinants can help local, regional and national level government decision-makers to design their disaster planning and response efforts while paying special attention to the most vulnerable groups such as children, the elderly, and the physically challenged. Certainly, there is a need to improve disaster preparedness and warnings. Warnings must be clear, shared widely in a timely way, and unambiguous as to how people should prepare, what they should expect, and how they can respond. A ‘first responder’ interagency group could be assigned the shared responsibility to improve and promote disaster warnings. Community health workers could also play an important role to advocate health and safety behaviours and to encourage compliance with preparedness advice. Application of spatial mapping techniques which include these important socioeconomic factors could help policy-makers visualize who is most at risk and where including their relative proximity to critical infrastructures such as roads and healthcare facilities. Such tools could help identify additional important social inequities.

We used self-reported data for disaster-related health outcomes that may be affected by recall bias and reporting bias. Another limitation is that we used cross-sectional survey data. Therefore, the estimates regarding the association between disaster-related health outcomes and socio-economic characteristics may not reflect cause-effect relationships.

However, the survey was administered nationally with an appropriate sample design to generate a national estimate of disaster-related health outcomes between 2009 and 2014. This kind of survey is limited in LMIC settings. There is a high burden of disaster-related injury, disability, and death in Bangladesh. The study findings showed that age, education level, physically challenged condition, urban residency, and asset quintiles were important socio-economic factors associated with the reported disaster-related health outcomes. This understanding can inform national and regional level policy planning including the allocation of scarce resources to the highest risk areas. Such understanding can help to identify practical policy interventions to improve socioeconomic conditions in the most at-risk areas which could mitigate the adverse health impacts of disasters. This should be a high priority in Bangladesh given its highly dense population and vulnerability to disasters.

  Journal
  


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