Evaluation of the usefulness of maternal mortality ratio for monitoring long-term effects of a disaster: case study on the Bam earthquake

Assessing the effects of disasters and their aftermath on pregnancy and infant outcomes: A conceptual model

Although many studies have examined broad patterns of effects on pregnancy and infant outcomes after disasters, the causes of adverse outcomes are not always clear. Disasters cause interrelated exposure to environmental pollutants, psychological stressors, and lack of health care, and interacts with other social determinants of health. This topical review examines the short- and long-term effects of disasters on pregnancy and how they are mediated by social, behavioral, and environmental effects. In the short term, disasters are associated with physical trauma, adverse environmental exposures, and unstable housing. In the longer term, disasters may lead to relocation, changes in family functioning, and negative economic effects. These aspects of disaster exposure, in turn, lead to lack of access to health care, increased stress and negative mental health outcomes, and negative behavioral changes, including smoking and substance use, poor nutrition, physical overexertion and limited activity, and reduction in breastfeeding. All of these factors interact with social determinants of health to worsen effects on the most vulnerable women, infants, and communities. Few interventions after disasters have been tested. With the increase in disasters due to climate change and the ongoing coronavirus pandemic, the models of effects of disasters and their human health consequences need increasing refinement, and, more importantly, should be applied to interventions that improve disaster prevention, mitigation, and response.

A review of methodology and tools for measuring maternal mortality in humanitarian settings

Estimation of maternal mortality ratio (MMR) in humanitarian settings ('settings of conflict, displacement and natural disaster') is challenging, particularly where communities have dissolved and geographical areas are inaccessible. During humanitarian events, the reproduction of maternal mortality figures by the media is common, and are often based on inaccurate reports. In light of such uncertainties and challenges, the aim of this article was to review and appraise the methodology and data collection tools used to measure MMR in humanitarian settings. A critical review of both grey and peer-review publications was conducted, focussing on articles published from January 1995 until December 2016. In the final review, articles that provided an estimate of MMR from a humanitarian setting were included. The assessment of study quality was based on an adapted framework for the quality of mortality studies in humanitarian settings. Overall, 13 peer-review publications and one grey publication were included in the final review. These were grouped according to settings: camp, clinic, household and census. Studies varied in their definition of MMR, and few studies objectively defined the humanitarian setting. Household-based studies were based on retrospective designs and on the recall of surviving family members. Although many studies attempted to purposively sample the populations afflicted, there was substantial evidence of selection bias; few studies were able to confirm the maternal deaths through medical certificates, or attempted to visit homes to re-inquire about deaths using verbal autopsy. The variation in methods and tools applied suggest that maternal mortality estimates are more likely to be markedly different from the true unknown level. The implications are that a standardized methodology and tools are necessary: that are consistent in definition, use a representative sample where possible, attempt to triangulate and validate data sources, and reconfirm deaths through household visits with informant interviews.

A Promising Tool to Assess Long Term Public Health Effects of Natural Disasters: Combining Routine Health Survey Data and Geographic Information Systems to Assess Stunting after the 2001 Earthquake in Peru

Background

Research on long-term health effects of earthquakes is scarce, especially in low- and middle-income countries, which are disproportionately affected by disasters. To date, progress in this area has been hampered by the lack of tools to accurately measure these effects. Here, we explored whether long-term public health effects of earthquakes can be assessed using a combination of readily available data sources on public health and geographic distribution of seismic activity.

Methods

We used childhood stunting as a proxy for public health effects. Data on stunting were attained from Demographic and Health Surveys. Earthquake data were obtained from U.S. Geological Survey’s ShakeMaps, geographic information system-based maps that divide earthquake affected areas into different shaking intensity zones. We combined these two data sources to categorize the surveyed children into different earthquake exposure groups, based on how much their area of residence was affected by the earthquake. We assessed the feasibility of the approach using a real earthquake case – an 8.4 magnitude earthquake that hit southern Peru in 2001.

Results and conclusions

Our results indicate that the combination of health survey data and disaster data may offer a readily accessible and accurate method for determining the long-term public health consequences of a natural disaster. Our work allowed us to make pre- and post- earthquake comparisons of stunting, an important indicator of the well-being of a society, as well as comparisons between populations with different levels of exposure to the earthquake. Furthermore, the detailed GIS based data provided a precise and objective definition of earthquake exposure. Our approach should be considered in future public health and disaster research exploring the long-term effects of earthquakes and potentially other natural disasters.