The utility of geographic information systems (GIS) in rapid epidemiological assessments following weather-related disasters: Methodological issues based on the Tropical Storm Allison experience

doi:10.1016/j.ijheh.2005.01.020

International Journal of Hygiene and Environmental Health

Volume 208, Issues 1–2, 8 April 2005, Pages 109-116

https://doi.org/10.1016/j.ijheh.2005.01.020 Get rights and content

Abstract

Flooding is the most common natural disaster worldwide, and is the leading cause of weather-related deaths in the United States. Tropical storm Allison hit landfall near Galveston, Texas on June 5, 2001, causing the most severe flood-related damage ever recorded in the Houston metropolitan area. This devastating storm dumped 37 in of rain in 24 h on parts of the city, killing 22 people and causing more than $5 billion in damage. The main goal of the public health response to tropical storm Allison was to rapidly evaluate the immediate health needs of the community. Geographical information system (GIS) technology was instrumental to the timeliness of this effort. We conducted a rapid needs assessment in the areas most affected by flooding using modified cluster sampling facilitated by GIS methodology. Of the 420 households participating in the survey, we found a significant increase in illness (OR, 5.1; 95% CI, 2.7–9.4), injuries (OR, 4.8; 95% CI, 1.9–12.8), and immediate health needs (OR, 3.3; 95% CI, 1.7–6.1) among persons living in flooded homes compared to non-flooded homes. There were 60 households reporting serious damage, 24 of which were outside the 500-year flood plain. We also obtained reliable estimates of the extent of damage and household needs to help guide relief efforts. These findings underscore the usefulness of rapid needs assessment as a tool to identify actual health threats and to facilitate delivery of resources to those with the greatest and most immediate need. Our ability to swiftly plan and implement a rapid needs assessment over a large geographical region within 1 week following the damage would not have been possible without the utilization of GIS methodology and the availability of skilled personnel and timely data resources.

Introduction

Natural disasters represent a major threat to public health worldwide, adversely affecting the lives of millions every year. In the United States alone, hundreds of deaths and injuries result from extreme weather conditions annually (Noji, 1997). Flooding is the most common natural disaster worldwide, and flash flooding that is often associated with the heavy localized rainfall in a tropical storm is the leading cause of weather-related deaths in the United States (French and Holt, 1997). The public health impact of flooding includes damage to homes and consequent displacement of occupants. Infectious disease morbidity may be exacerbated due to crowded living conditions and compromised personal hygiene. Additionally, contamination of water sources, disruption of sewage and solid waste service, increased vector populations, injuries sustained during clean-up, and stress-related mental health and substance-abuse problems, and death may also be consequences of flooding (CDC, 1994; Cotton, 1993; French et al., 1983).

Tropical storm Allison struck the upper Gulf Coast of Texas, making landfall on Galveston Island on June 5, 2001, moving inland to central East Texas, reversing directions several times, and bringing torrential rains repeatedly to the entire region over the next 5 days before finally leaving Texas. Harris County, the center of the Houston metropolitan area, was among the hardest hit with some areas receiving up to 37 in of rain in 24 h (NWS, 2001). This region is a watershed characterized by networks of lowland drainages leading into normally sluggish bayous all very close to sea level. The record rainfall caused billions of dollars in flood-related damage, killing 47 people overall and 22 in the Houston area, leading to a presidential disaster declaration covering 31 Texas counties and 28 Louisiana parishes.

A primary objective of the public health response to tropical storm Allison was to quickly evaluate the immediate health and medical needs of the community. To accomplish this goal in the shortest time possible, we conducted a rapid needs assessment survey in the areas most affected by flooding using a modified cluster sampling method originally developed to assess immunization coverage (Henderson and Sundaresan, 1982; Lemeshow and Robinson, 1985). Cluster sampling methodology has been applied to rapid needs assessments following natural disasters (Hlady et al., 1994; Sommer and Mosley, 1972) and can be used to provide estimates of the number of people with specific needs after a disaster (Malilay et al., 1996).

The most important aspect of performing a rapid needs assessment following a disaster relates to the timeliness of the endeavor to assess the immediate health impact and afford expedient mitigation of damage. There was a narrow window of opportunity once the floodwaters began to recede and before clean-up efforts were in full effect. Our ability to plan and implement a rapid needs assessment over a large geographical region within one week following the damage would not have been possible without the utilization of GIS methodology. This paper details the integration of GIS methodology with the health assessment process and the steps taken during planning, implementation, and reporting of the rapid needs assessment following the disastrous flooding associated with tropical storm Allison.

Section snippets

Sample selection

The sample selection has been described previously (Waring et al., 2002). Briefly, initial surveillance by the City of Houston Office of Emergency Management (OEM) determined a widespread area of severe flooding in the northeast quadrant of the city, and three smaller areas, two in the northwest quadrant and one in the southwest quadrant. Based on time constraints, available resources, and manpower, a decision was made to conduct the survey in two sampling areas: area A, which comprised the

Results

The survey was conducted 1 week after the flooding. Consistent with the survey protocol, questionnaires were completed for 420 out of 708 households, for an overall response rate of 59.3%. As expected, the majority of non-responses (89%) were due to no one being home at the time of the survey. There were only 20 refusals and four households in which a language barrier prevented communication. There was no significant difference in the rate of non-response between the two areas. The majority of

Discussion

Based on our estimates, the northeast quadrant of the city (area A) sustained more widespread damage than areas to the northwest and southwest (area B). However, the survey revealed that parts of area B, such as the Texas Medical Center and neighborhoods in the far northwest quadrant, suffered some of the most extensive damage. This information was useful in directing aid to focal areas that may have otherwise been delayed or overlooked.

The finding of an increased prevalence of illness is

Acknowledgments

The authors would like to thank M. des Vignes-Kendrick, MD, MPH; Amber D’Souza, MS, MPH; Scott Bishop, MS; and Sharon Marsh from Houston Department of Health and Human Services; Randolph Daley, Ph.D. and Brad Winterton, DVM, MS from CDC; and all the health department volunteers from HDHHS, Harris County Health Department, and Texas Department of Health for making this possible.

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For instance, Daley et al. (2001) explain the needs assessment process conducted 10 days after the 1999 Turkey earthquake; surveys were made with the affected population in the selected 33 settlement areas in four cities in two days. Waring et al. (2005) focus on evaluating the immediate needs of the communities affected by the storm Allison that hit Texas in 2005; based on time constraints and resources, the assessments focused on two sampling areas and performed within a day. Garces et al. (2010) explain the site selection process for assessing the conditions of the fisheries in the Aceh region of Indonesia after the 2008 Asian Tsunami; the assessment is conducted at the 15 selected villages in four days.
In the immediate aftermath of a disaster, relief agencies perform rapid needs assessment to investigate the effects of the disaster on the affected communities. Since assessments must be performed quickly, visiting all of the sites in the affected region may not be possible. Therefore, assessment teams must decide which sites to select and visit during the assessment horizon. In this paper, we address site selection and routing decisions of the rapid needs assessment teams which aim to evaluate the post-disaster conditions of different community groups, each carrying a distinct characteristic. We define the Selective Assessment Routing Problem (SARP) that constructs an assessment plan to cover different characteristics in a balanced way. The SARP is formulated as a variant of the team orienteering problem with a coverage objective. We develop an efficient tabu search heuristic, which produces high-quality solutions for the SARP. We illustrate our approach with a case study, which is based on real-world data from the 2011 Van earthquake in Turkey.
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The utility of geographic information systems (GIS) in rapid epidemiological assessments following weather-related disasters: Methodological issues based on the Tropical Storm Allison experience

Abstract

Introduction

Section snippets

Sample selection

Results

Discussion

Acknowledgments

J. Hazard. Mater.

Ann. Emergency Med.

Soc. Sci. Med.

Health Place

Trans. R. Soc. Trop. Med. Hyg.

Ann. Epidemiol.

Sleeping sickness surveillance: an essential step towards elimination

Trop. Med. Int. Health

Morbidity surveillance following the Midwest flood—Missouri

MMWR—Morbidity Mortality Weekly Rep.

Rapid assessment of vectorborne diseases during the Midwest flood—United States, 1993

MMWR—Morbidity Mortality Weekly Rep.

Healthcare Solution Series—Level 2

Mapping of volatile organic chemicals in New Jersey water systems

J. Expo. Anal. Environ. Epidemiol.

Accessibility of selected hospitals and medical procedures by means of aerial and transit network-based measures

Health Serv. Manage. Res.

Health threat from mosquitoes rises as flood of the century recedes

J. Am. Med. Assoc.

GIS and disease

Annu. Rev. Public Health

Public health, GIS, and the internet

Annu. Rev. Public Health

ArcView GIS, Vers. 3.2a

Mortality from flash floods: a review of National Weather Service reports, 1969–1981

Public Health Rep.

Epidemiologic Surveillance Following Disasters