Predicting the Unpredictable - Harder than Expected

Introduction: An earthquake is a hazard that may cause urgent needs requiring international assistance. To ensure rapid funding for such needs-based humanitarian assistance, swift decisions are needed. However, data to guide needs-based funding decisions are often missing in the acute phase, causing delays. Instead, it may be feasible to use data building on existing indexes that capture hazard and vulnerability information to serve as a rapid tool to prioritize funding according to the scale of needs: needs-based funding. However, to date, it is not known to what extent the indicators in the indexes can predict the scale of disaster needs. The aim of this study was to identify predictors for the scale of disaster needs after earthquakes. Methodology: The predictive performance of vulnerability indicators and outcome indicators of four commonly used disaster risk and severity indexes were assessed, both individually and in different combinations, using linear regression. The number of people who reportedly died or who were affected was used as an outcome variable for the scale of needs, using data from the Emergency Events Database (EM-DAT) provided by the Centre for Research on the Epidemiology of Disasters at the Université Catholique de Louvain (CRED; Brussels, Belgium) from 2007 through 2016. Root mean square error (RMSE) was used as the performance measure. Results: The assessed indicators did not predict the scale of needs. This attempt to create a multivariable model that included the indicators with the lowest RMSE did not result in any substantially improved performance. Conclusion: None of the indicators, nor any combination of the indicators, used in the four assessed indexes were able to predict the scale of needs in the assessed earthquakes with any precision.publishedVersio

Health System Resilience: What Are We Talking About? A Scoping Review Mapping Characteristics and Keywords

Background: Health systems are based on 6 functions that need to work together at all times to effectively deliver safe and quality health services. These functions are vulnerable to shocks and changes; if a health system is unable to withstand the pressure from a shock, it may cease to function or collapse. The concept of resilience has been introduced with the goal of strengthening health systems to avoid disruption or collapse. The concept is new within health systems research, and no common description exists to describe its meaning. The aim of this study is to summarize and characterize the existing descriptions of health system resilience to improve understanding of the concept.Methods and Analysis: A scoping review was undertaken to identify the descriptions and characteristics of health system resilience. Four databases and gray literature were searched using the keywords “health system” and “resilience” for published documents that included descriptions, frameworks or characteristics of health system resilience. Additional documents were identified from reference lists. Four expert consultations were conducted to gain a broader perspective. Descriptions were analysed by studying the frequency of key terms and were characterized by using the World Health Organization (WHO) health system framework. The scoping review identified eleven sources with descriptions and 24 sources that presented characteristics of health system resilience. Frequently used terms that were identified in the literature were shock, adapt, maintain, absorb and respond. Change and learning were also identified when combining the findings from the descriptions, characteristics and expert consultations. Leadership and governance were recognized as the most important building block for creating health system resilience.Discussion: No single description of health system resilience was used consistently. A variation was observed on how resilience is described and to what depth it was explained in the existing literature. The descriptions of health system resilience primarily focus on major shocks. Adjustments to long-term changes and the element of learning should be considered for a better understating of health system resilience

Moral Stress among Swedish Health Care Workers During the COVID-19 Pandemic: A Cross-Sectional Study

Aims: This study quantifies to what extent Health care workers (HCWs) experienced moral stress and to what extent their experiences of moral stress were related to gender and age as well as to working directly with COVID-19 patients and other work-related factors. Methods: This study consists of a cross-sectional survey that was conducted among 16,044 Swedish HCWs. A total of 153,300 HCWs and support staff who participated in the COVID-19 training offered by the Karolinska Institute were invited by email to participate in a web survey during autumn 2020. Results: This study is the first to quantify the frequency and severity of moral stress in a large group of HCWs. Moral stress was reported to a higher extent by HCWs involved in COVID-19 care and those involved in direct patient care. A lack of resources and the restrictions that hindered the patients’ family and friends from being involved were major causes of moral stress. Informal support was reported as being the most available and useful for dealing with moral stress. Conclusions: Our findings suggest that moral stress is common among HCWs who work with infected patients during a pandemic. The goal should not be to eliminate moral stress, as such stress may be viewed as a normal reaction to moral issues, but organizational structures (sufficient staffing and resources), could decrease the likelihood of morally stressful situations. Finally, to avoid the development of moral distress and its potential consequences, improvements could be made in providing HCWs with support tools for managing moral stress

Teaching extent and military service improve undergraduate self-assessed knowledge in disaster medicine: An online survey study among Swedish medical and nursing students

BackgroundThe purpose of this study was to identify the possible needs for undergraduate disaster medicine education in Sweden and to make informed recommendations for the implementation of disaster medicine content in medical and nursing schools in Sweden.MethodsAn online survey was distributed to undergraduate medical and nursing students through the directors of all medical and nursing programs at Swedish universities. The survey contained demographic questions, as well as questions about the amount of disaster medical education and previous experience with rescue, police, or military services. The final survey page contained self-assessments of disaster medical knowledge. Comparative statistics were applied between nursing and medical students, those with previous military service, and those without, as well as between universities.ResultsA total of 500 medical and 408 nursing students participated in this study. A median of 2 h of disaster medicine education was provided to senior medical students and 4 h was provided to senior nursing students. Senior medical students scored their disaster medical knowledge lower than nursing students (t-test, p < 0.001). A proportion of 1% had served in rescue services or police, and 7% of the participants had a history of military service, of which 67% served in a medical role. Those who had served in rescue services, police, or the armed forces had a higher self-assessed disaster medical knowledge base than those who had not (p < 0.007 and p < 0.001, respectively).ConclusionMost medical and nursing students in this study rated their disaster medical knowledge as insufficient. The correlation between the amount of disaster medical education and self-assessed disaster medical knowledge should influence and help direct Swedish educational policies

The Effect of Seasonal Floods on Health: Analysis of Six Years of National Health Data and Flood Maps.

There is limited knowledge on the effect of seasonal flooding on health over time. We quantified the short- and long-term effects of floods on selected health indicators at public healthcare facilities in 11 districts in Cambodia, a flood-prone setting. Counts of inpatient discharge diagnoses and outpatient consultations for diarrhea, acute respiratory infections, skin infections, injuries, noncommunicable diseases and vector-borne diseases were retrieved from public healthcare facilities for each month between January 2008 and December 2013. Flood water was mapped by month, in square kilometers, from satellite data. Poisson regression models with three lag months were constructed for the health problems in each district, controlled for seasonality and long-term trends. During times of flooding and three months after, there were small to moderate increases in visits to healthcare facilities for skin infections, acute respiratory infections, and diarrhea, while no association was seen at one to two months. The associations were small to moderate, and a few of our results were significant. We observed increases in care seeking for diarrhea, skin infections, and acute respiratory infections following floods, but the associations are uncertain. Additional research on previous exposure to flooding, using community- and facility-based data, would help identify expected health risks after floods in flood-prone settings

‘We have a plan for that’: a qualitative study of health system resilience through the perspective of health workers managing antenatal and childbirth services during floods in Cambodia.

OBJECTIVE: Health system resilience can increase a system's ability to deal with shocks like floods. Studying health systems that currently exhibit the capacity for resilience when shocked could enhance our understanding about what generates and influences resilience. This study aimed to generate empirical knowledge on health system resilience by exploring how public antenatal and childbirth health services in Cambodia have absorbed, adapted or transformed in response to seasonal and occasional floods. DESIGN: A qualitative study using semi-structured interviews and thematic analysis and informed by the Dimensions of Resilience Governance framework. SETTING: Public sector healthcare facilities and health departments in two districts exposed to flooding. PARTICIPANTS: Twenty-three public sector health professionals with experience providing or managing antenatal and birth services during recent flooding. RESULTS: The theme 'Collaboration across the system creates adaptability in the response' reflects how collaboration and social relationships among providers, staff and the community have delineated boundaries for actions and decisions for services during floods. Floods were perceived as having a modest impact on health services. Knowing the boundaries on decision-making and having preparation and response plans let staff prepare and respond in a flexible yet stable way. The theme was derived from ideas of (1) seasonal floods as a minor strain on the system compared with persistent, system-wide organisational stresses the system already experiences, (2) the ability of the health services to adjust and adapt flood plans, (3) a shared purpose and working process during floods, (4) engagement at the local level to fulfil a professional duty to the community, and (5) creating relationships between health system levels and the community to enable flood response. CONCLUSION: The capacity to absorb and adapt to floods was seen among the public sector services. Strategies that enhance stability and flexibility may foster the capacity for health system resilience

Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia.

INTRODUCTION: Resilient health systems have the capacity to continue providing health services to meet the community's diverse health needs following floods. This capacity is related to how the community manages its own health needs and the community and health system's joined capacities for resilience. Yet little is known about how community participation influences health systems resilience. The purpose of this study was to understand how community management of pregnancy and childbirth care during floods is contributing to the system's capacity to absorb, adapt or transform as viewed through a framework on health systems resilience. METHODS: Eight focus group discussions and 17 semi-structured interviews were conducted with community members and leaders who experienced pregnancy or childbirth during recent flooding in rural Cambodia. The data were analysed by thematic analysis and discussed in relation to the resilience framework. RESULTS: The theme 'Responsible for the status quo' reflected the community's responsibility to find ways to manage pregnancy and childbirth care, when neither the expectations of the health system nor the available benefits changed during floods. The theme was informed by notions on: i) developmental changes, the unpredictable nature of floods and limited support for managing care, ii) how information promoted by the public health system led to a limited decision-making space for pregnancy and childbirth care, iii) a desire for security during floods that outweighed mistrust in the public health system and iv) the limits to the coping strategies that the community prepared in case of flooding. CONCLUSIONS: The community mainly employed absorptive strategies to manage their care during floods, relieving the burden on the health system, yet restricted support and decision-making may risk their capacity. Further involvement in decision-making for care could help improve the health system's resilience by creating room for the community to adapt and transform when experiencing floods

Improved Response to Disasters and Outbreaks by Tracking Population Movements with Mobile Phone Network Data: A Post-Earthquake Geospatial Study in Haiti

Linus Bengtsson and colleagues examine the use of mobile phone positioning data to monitor population movements during disasters and outbreaks, finding that reports on population movements can be generated within twelve hours of receiving data

Low referral completion of rapid diagnostic test-negative patients in community-based treatment of malaria in Sierra Leone

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