Wednesday, 26 June 2013

Post flood illnesses

1. Post flood impact:  The 2010 Pakistan flood affected 20 million people. The impact of the event and recovery was measured at 6 months in a cross-sectional cluster survey of 1769 households conducted six months post-flood in 29 most-affected districts. [1]

·         Households were headed by males, large and poor. 

·         The flood destroyed 54.8% of homes and caused 86.8% households to move, with 46.9% living in an IDP camp. 

·         Lack of electricity increased from 18.8% to 32.9% 

·         Lack of toilet facilities increased from 29.0% to 40.4%

·         Access to protected water remained unchanged (96.8%)

·         88.0% reported loss of income

·         Immediate deaths and injuries were uncommon but 77.0% reported flood-related illnesses.

2. Post-flood infectious diseases: Following a flood, there exists the potential for transmission of water-borne diseases and for increased levels of endemic illnesses such as vector-borne diseases. The Japan Disaster Relief (JDR) Medical Team was sent to Mozambique where a flood disaster occurred during January to March 2000. The team operated in the Hokwe area of the State of Gaza, in the mid-south of Mozambique where damage was the greatest. A total of 2,611 patients received medical care during the nine days. Infectious diseases were detected in 85% of all of patients, predominantly malaria, respiratory infectious diseases, and diarrhea. There was no outbreak of cholera or dysentery. The incidence of malaria increased by 4 to 5 times over non-disaster periods, and the quality of drinking water deteriorated after the event. Also, there was a heightening of risk factors for infectious diseases such as an increase in population, deterioration of physical strength due to the shortage of food and the temporary living conditions for safety purposes, and turbid degeneration of drinking water. [2]

3. Post-traumatic stress disorder:  A traumatic experience outside the scope of the usual human experience (flood) results in a certain number of people in a traumatic disorder. The disorder is observed in 30-80% of the survivors of catastrophic events and the prevalence in the course of life is 9.2%. The symptoms include reliving the experience of the traumatic event, avoidance of stimuli related to the trauma, generally dulled reactions and a lack of alertness. PTSD etiology comprises the following: stressor (strength, duration and circumstances of occurrence), personality (age, personality traits, previous experience, genetic predisposition and available social support) and organic factors (effects of autonomic nervous system and neurobiological changes in the brain). [3]

4. The Dhaka experience:  Bangladesh experienced one of the worst floods in recorded history in 1998. The city's roads were completely under water, and most areas were water-logged with drainage and sewage systems blocked. Rising water levels compelled many slum dwellers to move to temporary shelters and relief camps. Women and children were the worst affected. The lack of sanitation facilities and privacy forced women and children to defecate in their own homes. There was an acute scarcity of safe drinking-water, and food prices rose dramatically. Diarrhea, fever and colds were the most common illnesses affecting the poor. The floods left many of them unemployed, and in some families, the result was increased tension and incidents of domestic violence. In some areas, members felt pressured to repay micro-credit loans. Most NGOs, however, suspended loan repayments. 

5:  Effect of global warming: Severe flooding may become more frequent due to global warming. A historical cohort study following severe river flooding on 12 October 2000 in the town of Lewes in Southern England showed that having been flooded was associated with earache, and a significant increase in risk of gastroenteritis with depth of flooding. Adults had a 4-times higher risk of psychological distress. Flooding remained highly significantly associated with psychological distress after adjustment for physical illnesses. [5]

6.  Mold prevention strategies and possible health effects:  Extensive water damage after major hurricanes and floods increases the likelihood of mold contamination in buildings. The recommendations assume that, in the aftermath of major hurricanes or floods, buildings wet for <48 hours will generally support visible and extensive mold growth and should be remediated, and excessive exposure to mold-contaminated materials can cause adverse health effects in susceptible persons regardless of the type of mold or the extent of contamination.      

For the majority of persons, undisturbed mold is not a substantial health hazard. Mold is a greater hazard for persons with conditions such as impaired host defenses or mold allergies.

 To prevent exposure that could result in adverse health effects from disturbed mold, persons should:
·         Avoid areas where mold contamination is obvious;
·         Use environmental controls
·         Use personal protective equipment and
·         Keep hands, skin, and clothing clean and free from mold-contaminated dust.

In the aftermath of extensive flooding, health-care providers should be watchful for unusual mold-related diseases. [6]


1.       Kirsch TD, Wadhwani C, Sauer L, et al. Impact of the 2010 Pakistan Floods on Rural and Urban Populations at Six Months. PLoS Curr 2012 Aug 22;4:e4fdfb212d2432.
2.       Kondo H, Seo N, Yasuda T, et al. Post-flood--infectious diseases in Mozambique. Prehosp Disaster Med 2002 Jul-Sep;17(3):126-33.
3.       Mandić N. Post-traumatic stress disorder. Lijec Vjesn 1995 Jan-Feb;117(1-2):47-53.
4.       Rashid SF. The urban poor in Dhaka City: their struggles and coping strategies during the floods of 1998. Disasters 2000 Sep;24(3):240-53.
5.       Reacher M, McKenzie K, Lane C, et al; Lewes Flood Action Recovery Team Health impacts of flooding in Lewes. A comparison of reported gastrointestinal and other illness and mental health in flooded and non-flooded households. Commun Dis Public Health 2004 Mar;7(1):39-46.

6.       Brandt M, Brown C, Burkhart J, et al. Mold prevention strategies and possible health effects in the aftermath of hurricanes and major floods. MMWR Recomm Rep 2006;55(RR-8):1-27.

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