Role of Community Health Volunteers Since the 2015 Nepal Earthquakes: A Qualitative Study

Objective: Nepal female community health volunteers (FCHVs) were the first available health personnel in communities during the 2015 Nepal earthquakes. This study explored the facilitating factors and barriers of the FCHVs during health emergencies. Methods: In-depth interviews with 24 FCHVs and 4 health managers from 2 districts in Nepal (Gorkha and Sindhupalchowk) were conducted using semi-structured interview guides. The qualitative data were analyzed using thematic analysis methods. Results: FCHVs were the first responders to provide services after the earthquakes and were well accepted by the local communities. Different models of supervision existed, and differences in the workload and remuneration offered to FCHVs were described. A wide range of disaster-related knowledge and skills were required by FCHVs, and lack of prior training was an issue for some respondents. Furthermore, lack of access to adequate medical supplies was a major barrier for FCHVs in the 2015 earthquakes. The 5 identified themes were discussed. Conclusion: Providing regular disaster response training for FCHVs and strong leadership from the public sector with sustained investments will be essential for increasing the capacities of community health workforces to prepare for and reduce the impacts of future health emergencies in resource-poor settings

Is Urban Household Emergency Preparedness Associated with Short-Term Impact Reduction after a Super Typhoon in Subtropical City?

Climate change-related extreme events are increasing in frequency and severity. Understanding household emergency preparedness capacity in Health-Emergency and Disaster Risk Management (Health-EDRM) for at risk urban communities is limited. The main objective of the study is to explore the association among risk perception, household preparedness, and the self-reported short-term impacts of Typhoons for urban residents. A population-based, cross-sectional telephone survey using random digit-dialling was conducted among Hong Kong adults within 2 weeks following 2018 Typhoon Mangkhut, the most intense typhoon that affected Hong Kong, a subtropical city, in thirty years. Among the 521 respondents, 93.9% and 74.3% reported some form of emergency preparedness and typhoon-specific preparedness measure (TSPM) against Mangkhut, respectively. Respondents who perceived a higher risk at home during typhoons and had practiced routine emergency preparedness measures (during nonemergency periods) were more likely to undertake TSPM. Of the respondents, 33.4% reported some form of impact (11.1% were household-specific) by Typhoon Mangkhut. Practicing TSPM was not associated with the reduction of short-term household impacts. Current preparedness measures may be insufficient to address the impact of super typhoons. Strategies for health-EDRM for urban residents will be needed to cope with increasing climate change-related extreme events

Health Emergency Disaster Risk Management of Public Transport Systems: A Population-Based Study after the 2017 Subway Fire in Hong Kong, China

Background: Literature on health emergency disaster risk management (Health-EDRM) for urban public transport safety is limited. This study explored: (i) the confidence in public transport safety, (ii) the relationship between socio-demographic characteristics and risk perception of transport safety and (iii) the association between previous first-aid training and response knowledge. Method: This is a population-based cross-sectional telephone survey conducted in March 2017, one month after a major subway incident in Hong Kong. Respondents were randomly selected with the Random Digit Dialing method among Cantonese-speaking population ≥15 years. Sociodemographic information, type of transport used and the corresponding worries, response knowledge and previous first-aid training experience (as a proxy for individual skills in Health-EDRM training proxy) were collected. Results: Among the 1000 respondents, 87% used public transport daily. The self-reported confidence in subway safety was 85.6% even after a subway fire accident. Female, those with lower income and people unmarried were more likely to express worry about transport safety. About 46.1–63.2% respondents had the correct fire related health response knowledge. Previous first-aid training (32%) was found to be associated with fire response knowledge in a mixed pattern. Conclusions: Despite inadequacy in fire response knowledge, previous first-aid training appeared to be a beneficial factor for emergency response knowledge. Emergency responses education should be provided to the public to reduce health losses during emergencies

Sociodemographic Predictors of Health Risk Perception, Attitude and Behavior Practices Associated with Health-Emergency Disaster Risk Management for Biological Hazards: The Case of COVID-19 Pandemic in Hong Kong, SAR China

In addition to top-down Health-Emergency and Disaster Risk Management (Health-EDRM) efforts, bottom-up individual and household measures are crucial for prevention and emergency response of the COVID-19 pandemic, a Public Health Emergency of International Concern (PHEIC). There is limited scientific evidence of the knowledge, perception, attitude and behavior patterns of the urban population. A computerized randomized digital dialing, cross-sectional, population landline-based telephone survey was conducted from 22 March to 1 April 2020 in Hong Kong Special Administrative Region, China. Data were collected for socio-demographic characteristics, knowledge, attitude and risk perception, and various self-reported Health-EDRM behavior patterns associated with COVID-19. The final study sample was 765. Although the respondents thought that individuals (68.6%) had similar responsibilities as government (67.5%) in infection control, less than 50% had sufficient health risk management knowledge to safeguard health and well-being. Among the examined Health-EDRM measures, significant differences were found between attitude and practice in regards to washing hands with soap, ordering takeaways, wearing masks, avoidance of visiting public places or using public transport, and travel avoidance to COVID-19-confirmed regions. Logistic regression indicated that the elderly were less likely to worry about infection with COVID-19. Compared to personal and household hygiene practices, lower compliance was found for public social distancing

Sociodemographic predictors of knowledge, mosquito bite patterns and protective behaviors concerning vector borne disease: The case of dengue fever in Chinese subtropical city, Hong Kong.

Geographic pattern of dengue fever is changing due to the global environmental and climate changes in the 21st century. Evidence of community's knowledge, mosquito bite patterns and protective behavior practices in non-endemic regions is limited. This study examined the knowledge of dengue, mosquito bite patterns, protective behavior practices and their associated factors in Hong Kong, a non-endemic subtropical city. A population-based random telephone survey (n = 590) was conducted three weeks after the government announcement of a local dengue outbreak in August 2018. Sociodemographic status, awareness, knowledge, protective measures, bite patterns of mosquito were collected. Results indicated high level of community awareness of the local outbreak (95.2%), symptom identification (84.0%) and adoption of at least one mosquito protective measures (nearly 80%). About 40% of respondents reported that they were bitten by mosquitoes during the study period, a high mosquito season in Hong Kong. Mosquito bites were prevalent near grassy area (63.4%), at home (42.6%) and at public transportation waiting spots (39.6%). Younger people (< 25 years old), female, those who lived on lower floors (≤the 6th) and near grassy area were at higher risk of mosquito bites at home. Respondents perceived higher threat of dengue to society were more likely to practice mosquito prevention. While residential factors affected their indoor prevention, other socio-demographic factors affected the outdoor prevention. Practicing prevention behaviors were associated with self-reported mosquito bite at home. Furthermore, the general prevention uptake rate unchanged after the announcement of local dengue outbreak. Although the uptake rate of protective measures during August was high, 40% participants reported they were bitten. Also public locations are more common area for bites, which suggested stronger mosquito prevention and control on public environments and more personal protective behaviors should be advocated

Narrative Review of Primary Preventive Interventions against Water-Borne Diseases: Scientific Evidence of Health-EDRM in Contexts with Inadequate Safe Drinking Water

Waterborne diseases account for 1.5 million deaths a year globally, particularly affecting children in low-income households in subtropical areas. It is one of the most enduring and economically devastating biological hazards in our society today. The World Health Organization Health Emergency and Disaster Risk Management (health-EDRM) Framework highlights the importance of primary prevention against biological hazards across all levels of society. The framework encourages multi-sectoral coordination and lessons sharing for community risk resilience. A narrative review, conducted in March 2021, identified 88 English-language articles published between January 2000 and March 2021 examining water, sanitation, and hygiene primary prevention interventions against waterborne diseases in resource-poor settings. The literature identified eight main interventions implemented at personal, household and community levels. The strength of evidence, the enabling factors, barriers, co-benefits, and alternative measures were reviewed for each intervention. There is an array of evidence available across each intervention, with strong evidence supporting the effectiveness of water treatment and safe household water storage. Studies show that at personal and household levels, interventions are effective when applied together. Furthermore, water and waste management will have a compounding impact on vector-borne diseases. Mitigation against waterborne diseases require coordinated, multi-sectoral governance, such as building sanitation infrastructure and streamlined waste management. The review showed research gaps relating to evidence-based alternative interventions for resource-poor settings and showed discrepancies in definitions of various interventions amongst research institutions, creating challenges in the direct comparison of results across studies

Reflection of Challenges and Opportunities within the COVID-19 Pandemic to Include Biological Hazards into DRR Planning

COVID-19 has reinforced the need to revisit the integration of health within disaster risk reduction (DRR) strategies for biological hazards in a system-wide approach. In November 2020, DRR experts attended the Asia-Pacific Partnership for Disaster Risk Reduction (APP-DRR) Forum to share progress and learnings in the areas of health system resilience, data management, residual risk management, risk communication, digital literacy, and knowledge product marketing. Advancements for health in DRR included the importance of multi-sectoral, multi-hazard action plans; adaptation to technological advancements in data collection, dissemination and protection; promoting the health and wellbeing of essential and nonprofessional workers; and improving inclusivity in digital literacy. COVID-19 has affected progress towards the Sustainable Development Goals (SDG) and created a unique opportunity within DRR to re-evaluate the adequacy of response mechanisms against concurrent, cascading or interacting risks of future biological hazards. Health emergency disaster risk management (Health-EDRM) is a new World Health Organization paradigm that includes DRR at intra-, inter- and multidisciplinary levels. Scientific advancement under Health-EDRM is necessary for health and non-health actors in DRR education and research. Continuous education on the multifaceted risk governance is a key to building awareness, capacity and accelerating towards achieving the international DRR and the SDG targets

Population Adherence to Infection Control Behaviors during Hong Kong’s First and Third COVID-19 Waves: A Serial Cross-Sectional Study

Background: Although COVID-19 has affected over 220 countries by October 2021, there is limited research examining the patterns and determinants of adherence to infection control measures over time. Aims: Our study examines the sociodemographic factors associated with changes in the frequency of adherence to personal hygiene and social distancing behaviors in Hong Kong. Methods: A serial cross-sectional telephone survey in the general population was conducted during the first (March 2020) (n = 765) and third wave (December 2020) (n = 651) of the local outbreak of the COVID-19 pandemic. Respondents were asked about their level of compliance with various personal hygiene and social distancing recommendations. Results: By the third wave, mask use increased to 100%, and throughout the study periods, &gt;90% practiced frequent hand hygiene. However, adherence to social distancing measures significantly waned over time: avoidance of social gatherings (80.5% to 72.0%), avoidance of public places/public transport (53.3% to 26.0%), avoidance of international travel (85.8% to 76.6%) (p &lt; 0.05). The practice of ordering food takeout/home delivery, however, increased, particularly among high-income respondents. Higher education, female gender and employment status were the most consistently associated factors with adherence to COVID-19 preventive practices in the multivariable models. Conclusions: In urban areas of this region, interventions to improve personal hygiene in a prolonged pandemic should target males and those with low education. In addition to these groups, the working population needs to be targeted in order to improve adherence to social distancing guidelines

Major trauma care in Hong Kong and Germany: a trauma registry data benchmark study

Background Trauma remains a leading cause of death and effective trauma management within a well-developed trauma system has been shown to reduce morbidity and mortality. A trauma registry, as an integral part of a mature trauma system, can be used to monitor the quality of trauma care and to provide a means to compare local versus international standards. Hong Kong and Germany both have highly developed health care services. We compared the performance of trauma systems including outcomes among major trauma victims (ISS > 15) over a 3-year period (2013-2015) in both settings using trauma registry data. Methods This study was a retrospective analysis of prospectively collected data from trauma registries in Hong Kong and Germany. Data from 01/2013 to 12/2015 were extracted from the trauma registries of the five trauma centers in Hong Kong and the TraumaRegister DGU(R) (TR-DGU). The study cohort included adults (>= 18 years) with major trauma (ISS > 15). Data related to patient characteristics, nature of the injury, prognostic parameters to calculate the RISC II score, outcomes and clinical management were collected and compared. Results Datasets from 1,864 Hong Kong and 10,952 German trauma victims were retrieved from respective trauma registries. The unadjusted mortality in Hong Kong (22.4%) was higher compared to Germany (19.2%); the difference between observed and expected mortality was higher in Hong Kong (+ 2.7%) than in Germany (- 0.5%). The standardized mortality ratio (SMR) in Hong Kong and Germany were 1.138 (95% CI 1.033-1.252) and 0.974 (95% CI 0.933-1.016), respectively, and the adjusted death rate in Hong Kong was significantly higher compared to the calculated RISC II data. However, patients in Hong Kong were significantly older, had more pre-trauma co-morbidities, more head injuries, shorter hospital and ICU stays and lower ICU admission rates. Conclusion Hong Kong had a higher mortality rate and a statistically significantly higher standardized mortality ratio (SMR) after RISC II adjustment. However, multiple differences existed between trauma systems and patient characteristics