The massive 7.0 earthquake that left a trail of destruction five days ago in Port Au Prince, has significant public health implications in Haiti.
According to a preliminary draft of a public health risk assessment (WHO, ReliefWeb), the infrastructure in Port Au Prince is completely inoperable. Water, sewage, food supply and gvernment facilities have been completely destroyed or seriously compromised. As a result, the increased prevalence for disease is significant (Pan American Health Organization). These diseases may include, vector born (malaria), dengue, and Lymphatic filariasis. “Most cases of malaria transmission occur in coastal areas at altitudes below 300 m, particularly in the heavily populated rice-growing areas in the south and Artibonite. Estimates made in 1988, as part of an effort to map out a strategy for malaria control, amounted to 250,000 annual malaria cases, with a 1% case fatality rate. Slide positivity indexes for the 1991–1994 period are unusually high, ranging from 31.2% to 42% (WHO).”
Moreover, as dead bodies compound and go unmanaged in the epicenter of Port Au Prince, the risk of intestinal infectious disease also increases. Vibrio furnissii (formerly aerogenic biogroup of Vibrio fluvialis), a new species isolated from human feces and the environment) has been associated with cholera and acute gastroenteritis. “From 1987 to 1994, the National Health Surveys detected a sharp decline in the incidence of diarrhea in children under 5 years old (from 43% to 27.6% for the two-week period preceding the surveys); however, values remain very high, reaching 47.7% in the age group 6–11 months old. Diarrheal diseases are the leading cause of illness and death in children under 5 years of age, often associated with acute respiratory infections and malnutrition (WHO).”
According to past access indicators in Haiti (WHO, CDC) hospitals and clinics have always been compromised, due to a lack of infrastructure, appropriate funding, general impovershment and blackouts. The challenge for visiting doctors and the international public health community will be unfathomable during the next couple of months. In addition, the lack of Hatian born doctors and nurses due to this tragedy is also trully compelling. International public health methods will be truly tested. Innovative strategies and delivery of care will be required to address surveillance and disease incidence during this catastrophic scene.
References
World Health Organization. [Online].Public Health Risk Assessment in Haiti. Retrieved from Public health risk assessment and interventions- Earthquake: Haitihttp://www.reliefweb.int/rw/rwb.nsf/db900SID/DKAN-7ZRMLR?OpenDocument on January 17, 2010.
Pan American Health Organization.(1998). hHealth Situation Analysis and Trends Summar. Retrieved from yttp://www.paho.org/english/sha/prflhai.htm on January 17, 2010.