Disease Control (Epidemics Control and Disaster Management) PDF

DIPLOMA IN ENVIRONMENTAL HEALTH DISEASE CONTROL (Epidemics Control and Disaster Management) 1.0 EPIDEMIC PREPAREDNESS AND MANAGEMENT HISTORICAL EVOLUTION OF EPIDEMIOLOGY: Although epidemiology as a discipline has blossome...

DIPLOMA IN ENVIRONMENTAL HEALTH DISEASE CONTROL (Epidemics Control and Disaster Management) 1.0 EPIDEMIC PREPAREDNESS AND MANAGEMENT HISTORICAL EVOLUTION OF EPIDEMIOLOGY: Although epidemiology as a discipline has blossomed since World War II, epidemiologic thinking has been traced from Hippocrates through John Graunt, William Farr, John Snow and others. The contributions of some of these early sand more recent thinkers are: a) 400 B. C. : Hippocrates attempted to explain disease occurrence from a rational rather than a supernatural 1  view point by suggesting that environmental and host factors such as behaviors might influence the development of disease. Disease Contributing Factors There are several factors that contribute to disease manifestation. These factors include those involving the Agent, the Host and the Environment. In this case are found in an Epidemiologic Triangle or Triad which is the traditional model of infectious disease causation. The components of this triangle as mentioned earlier are the external Agent; a susceptible host and an environmentthat brings the host and agent together. The representation of this Triangle is shown in the diagram below: AGENTS MODE OF HOST TRANSMISSION  Biological  Contact  Socio- economic,  virus,  Common age, sex, bacteria, vehicle nutrition, fungi,  Air immune protozoa  Vector status ENVIRONMENT  Population 2  Density  Political, War  Climate c. Host Factors: Host factors are intrinsic factors that influence an individual, or response to a causative agent. Age, sex and behaviours (smoking, drug abuse, lifestyle, sexual practices and eating habits) are just some of the many host factors which affect a person’s likelihood of exposure. Age, genetic competition, nutritional and immunologic status, anatomic structure, presence of disease or medications, and psychological makeup are some of the host factors which affect a person’s susceptibility and response to an agent.  Immune status: a person acquires a specific resistance against an infection after a person survives an attack. An increase in the number of the immune persons than the non-immunes is termed Herd Immunity.  Nutrition: the effect of malnutrition on an individual has both a direct and indirect influence on disease occurrence. Malnutrition predisposes to infection and infection to malnutrition. 3   Sex: Males are generally easily contract diseases than females  Age: Vulnerable groups include young ones, pregnant women, the elderly etc d. Agent Factors: Factors involving agent include among others are; The load of the agent must be a factor in establishing an infection and is simply a quantitative one although it also involves other factors. The determining factor is therefore virulence which includes a combination of infectivity, invasiveness and pathogenicity. e. Environmental factors: Environmental factors are extrinsic factors which affect the agent and the opportunity for exposure. Generally, environmental factors include physical factors such as geology, climate, and physical surroundings (e.g. a nursing home, hospital); biologic factors such as insects that transmit the agent; and socioeconomic factors such as crowding, sanitation, and the availability of health services (Political). This is broken down as follows: i) The biological environment is made up of;  People  Vegetation, such as trees, grass and crops  Animals, including stock and predators 4   Insects, such as mosquitoes and houseflies  Infective organisms, viruses, bacteria, amoebae, and worms ii) The physical environmental includes;  Land, mountains, valleys and plains  Soil  Water  Climate  Altitude  Chemicals and toxic substances iii) The cultural and social environments include;  Family and kingship  Customs and beliefs  Religions  Leadership and power structure iv) The economic and political environment includes;  Local community organisation and self-reliance  Rural and urban economies  Political organisation 5   Development policies Agent, host, and environmental factors interrelate in a variety of complex ways to produce disease in humans. Their balance and interactions are different for different diseases. When we search for causal relationships, we must look at all three components and analyse their interactions to find practical and effective prevention and control measures. For prevention, it is important to consider the living organisms which cause communicable diseases, the people they infect and the surroundings. In other words, there is need to consider the agents, hosts and the environment. The agents need a suitable environment in which to grow, multiply, spread and infect another host. If they cannot spread and infect others, they die out. There is, therefore, a balance between agent, host and environment as shown in the figure above. Hosts (people) are affected by their environment. For example, they may live in a hot and wet climate in which malaria thrives because there are many mosquitoes. People can also change their environment, for example, by draining swamps. Similarly, the environment can affect the agent, for example, the altitude and temperature regulate malaria. When the balance between host, agent and environment is constant, there will be a fairly steady 6  number of people getting sick all the time. When this happens, the disease is called to be endemic.Where the balance is shifted in favour of the agent (organism), for example, when many non-immune children are born in a community since a measles outbreak, many cases of measles will occur within a short period of time. This is called an epidemic. When all the non-immune have had the disease, it will decrease again. If the balance can be shifted against the agent, the disease will be controlled and the number of cases will decline. There are two important requirements for the proper management of any communicable disease. The first is trying to stop people getting the disease- prevention. The second is looking after those who have got the disease- treatment and cure.The two are closely related and together amount to control. Doing one without the other is doing only half the job. For the proper control of any communicable disease it is necessary to understand the nature of the infecting organism, how the host responds to infection and the transmission cycle. In summary, it may be said that there are many different routes of transmission for disease. The main ones are:  Direct contact (skin, mucous membrane or sexual contact)  Vector 7   Faecal contamination of food and water which are ingested  Contact with animals and their products (e.g. biting)  Air (inhalation)  Trans-placenta ( during pregnancy)  Blood contact ( injection, surgery, blood transfusion) The principles of control are to tip the balance against the agent. This is done by attacking the source, interrupting transmission and protecting the host. This control however, requires inter-sectoral cooperation. Control measures can be summarised as shown below: ATTACKING INTERRUPTING PROTECTING THE SOURCE THE THE HOST TRANSMISSION Treatment of Environmental Immunisation cases sanitation Isolation of Personal hygiene Chemotherapy cases and carriers Reservoir Behaviour change Personal 8  control protection Notification Vector control Disinfecting Sterilising b) 1662: Another contributor, John Graunt, from London, published a landmark analysis of mortality data in 1662 which was the first to quantify patterns of birth, death, and disease occurrence, noting disparities between males and females, high infant mortality, urban/rural differences, and seasonal variations. c) 1800: William Farr built upon Graunts’ work by systematically collecting and analyzing Britain’s mortality statistics. Farr, considered as the father of modern vital statistics and surveillance, developed many of the basic practices used today in vital statistics and disease classification. d) 1854:John Snow, considered as the father of epidemiology, conducted a series of investigations in London. Twenty years before the development of the microscope, he conducted studies of cholera outbreak both to discover the cause of the disease and to prevent its occurrence. He did this in 1854 when an epidemic of cholera erupted in the Golden Square of London. He started his investigation by determining where in the area persons with cholera lived and worked. Because Snow believed that water was a source of infection, he marked the location of water pumps on his spot map, then looked for a relationship between the distribution of households 9  with cases of cholera and the location of pumps. He noticed that more case households clustered around a particular pump and made conclusions after that. e) 19th and 20th centuries: Epidemiological methods began to be applied in the investigation of disease occurrence. In the 1930s and 1940s, epidemiologists extended their methods to noninfectious diseases. In 1980s epidemiology was further extended to the studies of injuries and violence COMMON COMMUNICABLE DISEASES IN ZAMBIA a) Sexually Transmitted Diseases (Gonorrhoea, Syphilis, Trichomonas vaginalis, Lympho-granuloma venereum/inguinale, Acquired Immuno- Deficiency Syndrome) b) Contagious Communicable Diseases or Water-Washed Diseases(Ring worms, Scabies, 10 Leprosy, Trachoma, Conjunctivitis, Ebola, SARRS or Bird Flu) c) Oral-Faecal Communicable Diseases or Water-Borne Diseases (Poliomyelitis, Dysentery-Bacterial and Amoebic, Cholera, Typhoid, Salmonellosis, Ascariasis, Enterobiasis etc) d) Childhood Immunisable Diseases (TB, Whooping cough, Diphtheria, Measles, Meningitis etc) e) Communicable Diseases caused by contact with diseased animals and their products (Rabies, Tetanus, Anthrax etc) F) Communicable diseases caused by contact with wateror Water-Based Diseases(Bilharziasis etc) g) Communicable Diseases caused by insects that get contact with water or Water-Related Diseases e.g. Malaria 11  1.1 Types of Epidemics Management a) Progressive Epidemic: This refers to an increase, often sudden, in a number of cases of a disease above what is normally expected in that population in that area. It is the widespread outbreak of a health hazard causing serious effect, injury, ill health, discomfort or death to a significant number of humans, plants or animals. WHO defines an epidemic as an unusually large or unexpected increase in the number of cases of a disease for a given time, place or period. The common human epidemics in Zambia are cholera, measles, typhoid, HIV/AIDS, malaria and dysentery. There are also livestock diseases such as the Contagious Bovine 12  Pleural Pneumonia, Foot and Mouth Disease and Corridor Disease. Epidemics occur when an agent and susceptible hosts are present in adequate numbers, and the agent can be effectively conveyed from source to susceptible hosts. More specifically, an epidemic may result from:  A recent increase in the amount or virulence of the agent  The recent introduction of the agent into a setting where it has not been before  An enhanced mode of transmission so that more susceptible persons are exposed  A change in the susceptibility of the host response to the agent, and/or  Factors that increase host exposure or involve introduction through portals of entry b) Endemicity:This is the presence of a health hazard especially a disease within a localized area or only found in a particular group of people at any given time. c) Pandemicity:This is the presence of a hazard especially a disease within a wide geographical area at any given time. d) Sporadicity: This refers to a disease that occurs infrequently and irregularly e) Hyperendemicity: This refers to persistent, high levels of disease occurrence. f) Secular: This is the worldly or geographical distribution of a disease 13  g) Surveillance:This is the systematic ongoing collection, collation and analysis of data for public health purposes and the timely dissemination of public information for assessment and public health response as necessary i) Active: This is the collection of data about the occurrence of a disease by physically visiting the place and actively interviewing the people in that area ii) Passive: This is the collection of data about the occurrence of a disease through means that do not require the physical presence of the collector e.g. by means of letters, reports, telephone, e-mail, fax etc iii) Sentinel: This is the collection of special data from a few selected qualified staff who have good knowledge of that disease or condition. The first outbreak of cholera in Zambia occurred in 1978/79 in Mpulungu and Mbala districts of Northern Province. Since then Zambia has been experiencing cholera outbreaks and the major outbreak was in 1991/ 1992 which recorded a case fatality rate (CFR) of 25%. In terms of cholera cases, the trend has been decreasing since 1999. There were 11,615 cases and 337 deaths (CFR 2.9%).) in 1999. In 2000 the cholera cases reduced to 3,072 and 70 deaths (CFR 2.27% ) Not much change was noticeable in 2001 in terms of cholera cases at 3,000 but this was marked by high number of 165 deaths with a case fatality rate (CFR 5.5%). However, the figures nationally dropped to 587 cases with 15 deaths in 2002. The table below shows the national cholera figures from 1999 to 2006. In all the years Lusaka District contributed over 80 % of all the cholera cases recorded in the country 14  Table showing National Cholera Epidemic statistics from 1999 to 2006 Year Cases Death Case Fatality Rates (CFR) 1999 11,615 466 4.0 2000 3072 70 2.3 2001 3000 165 5.5 2002 587 15 2.6 2003 709 10 1.4 2004 7349 221 3.0 2005 2332 10 0.4 2006 5593 190 3.4 In Zambia Cholera outbreaks are not uncommon like they are in many other countries. Poverty level and poor sanitation are attributed to the continued occurrence of cholera outbreaks a picture that is observed particularly in Lusaka, where occurrence of cholera has always been associated to unplanned settlement where poverty and poor sanitation is not uncommon. In the past cholera outbreaks in Lusaka were more in George Compound but this has since changed after a water project that was put up in the area by JICA. Today the concentration of cholera is in Kanyama and Chawama mainly due to environmental factors of high water table coupled with massive dependence on pit latrines and shallow wells. Overcrowding (densely populated), is another factor among others that are associated with cholera outbreaks in some parts of Lusaka. Of paramount to note over the cholera outbreaks in Lusaka is that, the duration of cholera outbreaks in Lusaka is longest compared to other towns. It is also important to note that whereas implementation 15 of control measures seem to offer tangible benefits in other towns, in Lusaka the benefits are remote. Table showing Cholera Epidemic statistics in Lusaka district from 1999 to 2008 Year Cases Deaths Case Fatality Rates (CFR %) 1999 6,748 89 1.3 2000 2 0 0 2001 887 27 3.0 2002 0 0 0 2003 484 11 2.2 2004 6,058 176 2.9 2005 6,053 148 2.4 2006 2,437 63 2.6 2008 856 16 1.9 The graph below shows cholera trends in Lusaka district from 2003 to date January 2009. From the graph it can be observed that 2003 – 4 cholera outbreak was highest followed by the 2005 – 6 and the 2008 – 9 (current outbreak) while 2007 -8 cholera outbreak was lowest. 16  Lusaka Cholera Trends 2003 to 2009 900 800 700 600 500 No. cases 400 300 200 100 0 Wk 33 Wk 34 Wk 35 Wk 36 Wk 37 Wk 38 Wk 39 Wk 40 Wk 41 Wk 42 Wk 43 Wk 44 Wk 45 Wk 46 Wk 47 Wk 48 Wk 49 Wk 50 Wk 51 Wk 52 Wk 1 Wk 2 Wk 3 Wk 4 Wk 5 Wk 6 Wk 7 Wk 8 Wk 9 Wk 10 Wk 11 Wk 12 Wk 13 Wk 14 Epid Wks 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 Further observations from the graph suggest that every major cholera outbreak is followed by a minor one. The major cholera outbreaks appear to be linked to the amount of rainfall in a given rain season. From the above observations one would deduce that: while a lot of outbreak control efforts go into cubing a major cholera outbreak the results will not be observed during that cholera outbreak season but the next cholera outbreak which becomes minor 17 TABLE SHOWING THE LUSAKA DISTRICT ENVIRONMENTAL HEALTH WEEKLY REPORT FROM OCTOBER, 2008 TO 27TH JANUARY, 2009- EPIDEMIC ACTIVITIES. S ACTIVIT TOTAL No. COVER COMME / Y No. DON AGE NT N ELLIGI E (%) BLE 1 Cases 1,812 Coverag for e has contact improved tracing 2 Disinfecti 1,812 1,686 93 Coverag on of e has househol improved ds 3 Water 387 29 38 Efforts sample need to tasting be enhance d 4 Chlorine 1,812 1,686 93 Coverag bottles e has distributi improved 18  ng 5 Public - 60 - Talks churc given at hes public places 6 Drama - 81 - performa nces done 7 People 839,13 249,8 30 This given 6 37 needs to health be educatio improved n and impact known 8 No. of 1,466,2 890 0.06 Usage leaflets 79 and given out impact need to be known 9 Posters - 1,799 - given out 1 No. of 131,82 60,22 45.6 More 0 househol 8 4 improve 19  ds given ments HE expected 1 No. of - 2 - 1 PA vehicles used 1 Chlorine 131,82 74,92 56.8 2 distributi 8 4 on 1 Househo 60,224 45,24 75 3 lds with 2 access to safe water visited 1 Househo 60,224 22,16 37 A lot 4 lds with 0 more access needs to to toilets be done visited 1 Portable 55 46 83 Quiet 5 toilets good supplied coverage 1 Premises - 57 - 6 inspecte d 20  1 Markets 11 11 100 7 inspecte d 1 Health 1,812 1,686 93 8 education to households 1 No. Of 0 152 - 9 water samples taken for bacteriologi cal analysis 2 No. Of 100,00 19,37 1.9 0 latrines 0 5 limed 2 Portable 55 55 100 1 toilets put up 2 No of wells 3,730 438 9.3 2 chlorinated TABLE SHOWING SOUTHERN PROVINCE-WEEK ENDING 3RD FEBRUARY,2009 21  1. CONTACT TRACING Provinc New No. of No. of No. of No. of Populatio e case contact chlorine toilets houses n s s bottles disinfecte disinfecte potentiall traced distribute d d y d protected Souther 18 137 1,287 140 298 21,333 n 2. GENERAL DISINFECTION OF TOILETS Province Estimated Estimated no. No. of pit latrines no. of of disinfected Households toilets/latrines Southern 1,800 42 382 3. WATER QUALITY MONITORING Province Population No. of No. of Results Bct/Chem. water samples points collected Bact. Chem. +ve -ve +ve -ve Southern 1,763 219 4 - 4 - - - 4. CHLORINATION OF WELLS Provin Populati Quantity No. # of Populati 22 ce on of chlorine of well/# on &type wat chlorinat received er ed well HT Hyp HT Hyp s H oc H o Southe 8,000 70k - - - 240 - - rn g 5. HEALTH EDUCATION Province Population IEC materials Distributed Leaflets Posters Fliers Billboards Others Southern 364 30 30 - - - 6. SUPERVISED BURIALS Province Population Deaths Total No. CFR Prevalence of cases Rate Southern 8,257 3 244 7.8 7. SUMMARY OF REQUISITES RECEIVED District Item Quantit Balance Quantity Comment y Used in stock Require s d 23 Choma Liquid 30 Nil 600x 12 Little chlorine boxes bottles granular chlorine Germ guard 8x5 lts 2x5lts 20x5lts More needed Mazabuk Germ guard 83x5lts 8 40x5lts a Erythromycin 10 20x100 20x1000 0 Doxycycline 11 9 10 100mg tabs Ascpine(pynol ) 8. INSPECTION OF PREMISES Type of Tota No. Coverag No. Warnin Comment premise l No. Inspecte e close g s s d d Choma 24 TABLE SHOWING COPPERBELT PROVINCE EPIDEMIC ACTIVITIES: WEEK ENDING 29TH JANUARY, 2009 1. CONTACT TRACING PROVIN New No. of No. of No. of No. of Populati CE case contac chlorine toilets houses on s ts bottles disinfect disinfect potentiall traced distribut ed ed y ed protecte d C/bELT 12 127 415 176 177 1,992 2. GENERAL DISINFECTION OF TOILETS Province Estimated Estimated no. No. of pit latrines no. of of disinfected Households toilets/latrines C/Belt 30,047 25,092 4,564 3. WATER QUALITY MONITORING 25 Province Population No. of No. of Results Bct/Chem. water samples points collected Bact. Chem. +ve -ve +ve -ve C/Belt 31,582 11,728 26 10 10 1 0 0 4. CHLORINATION OF WELLS Provi Populat Quantity No. of # of Populat nce ion of water well/# ion chlorine wells chlorina &type ted received HT Hyp HT Hy H oc H po C/Belt 58,368 0 0 49 0 4,944taps 8% Nil kg /605 wells 5. HEALTH EDUCATION Province Population IEC materials Distributed Leaflets Posters Flyiers Billboards Others C/Belt 77,752 100 5 25 - - 6. SUPERVISED BURIALS 26 District Population Deaths Total CFR Prevalence No. of Rate cases Chipulukusu 123,855 2 15 13 7. SUMMARY OF REQUISITES RECEIVED Item Received Quantity Balance Quantity Comments Used in stock Required Ringers Lactate 1132 308 3,000 Supplied by MoH Gloves medium 26x100 4x100 150x100 Bought by DHMT Methylated spirit 1x2.5lt 25x2.5 lts 5x2.5 lts Supplied by MoH Sodium 168x750 83x750 50x750 Supplied Hypochlorite(Jik) mls mls mls by MoH Carbolic Acid 10x5 lts 10x5lts 20 Supplied by MoH Heavy duty 5 pairs 5 pairs 50 pairs Supplied gloves by MoH ORS 200 636 2,900 Bought by DHMT HTH 40kg 10x50kg 20x50kg 27  Bottled chlorine 10x12 107x12 500x12 Lime 5x50kg 125x50kg 500x50kg Gowns 0 0 50 Gumboots 10 pairs 0 50 pairs Respirators 10 pairs Nil 50 pairs Buckets 10 Nil 100 28  1.2 Common Source of Epidemics: Epidemics can be classified according to their manner of spread through a population. This can be divided into the following: i) Common-Source outbreak: This is where a group of persons are all exposed to an infectious agent or a toxin from the same source. This is further divided into:  Point-source outbreak where a group is exposed over a relatively brief period, so that everyone who becomes ill does so within one incubation period e.g. an epidemic of leukemia in Hiroshima following the atomic bomb blast, the epidemic of hepatitis A among patrons of the Pennsylvania restaurant who ate green onions and the various food poisoning outbreaks in Zambia.  Continuous common-source outbreak: This is wherethe range of exposures and range of incubation periods tend to flatten and widen the peaks of the epidemic curve.  Intermittent common-source outbreak: This is where very often the epidemic curve has a pattern reflecting the intermittent nature of the exposure. ii) Propagated outbreak: This results from transmission from one person to another. Usually, transmission is by direct person-to- person contact, as with syphilis for example. Transmission may also be vehicle-borne (e.g. transmission of hepatitis B or HIV by sharing needles) or by vector-borne (e.g. transmission of 29  yellow fever by mosquitoes). In propagated outbreaks, cases occur over more than one incubation period. The epidemic usually wanes after a few generations, either because the number of susceptible persons falls below some critical level required to sustain transmission, or because intervention measures become effective. iii) Mixed outbreaks: These epidemics that have features of both common-source epidemics and propagated epidemics. The pattern of a common- source outbreak is followed by secondary person- to-person spread. iv) Others: Some epidemics are neither common- source nor propagated from person to person. Outbreaks of zoonotic or vector-borne disease may result from sufficient presence of vectors, and sufficient human-vector interaction e.g. Malaria, Dengue, Yellow Fever etc 30  1.3 Outline of the Investigation of an Outbreak:The steps in the investigation of an outbreak are listed below: i) Prepare for field work: Before leaving for investigation, consult laboratory staff to ensure that you take the proper laboratory material and know the proper collection, storage, transportation techniques. By talking with laboratory staff you are also informing them about the outbreak, and they can anticipate what type of laboratory resources will be needed. You also need to know what supplies or equipment to bring to protect yourself as some outbreak investigations require no special equipment while others such as SARS or Ebola hemorrhagic fever require personal protective equipment such as masks, gowns and gloves. You should also have a plan of action by outlying the objectives i.e. what you are trying to achieve; what you have to do first, second, third and so on. When all is set it is easier for you to hit the ground running. The investigation must be done by a team which must be carefully selected with each one roles spelt out to him/her. The need to communicate quickly must be established. Equally important is the need to have operational and logistical requirements at hand. Arrangements should be made where to meet the locals while travel, lodging and local transportation must also be taken care of. 31  ii) Establish the existence of an outbreak: One of the first tasks of field investigation is to verify that indeed a cluster of cases is an outbreak because some clusters turn out to be true outbreaks with a common cause, some are sporadic and unrelated cases of the same disease and others are unrelated cases of similar but unrelated diseases. Even if the cases turn out to be the same disease, the number of cases may not exceed what the health department normally sees in a comparable time period. It is important here to compare the observed with the expected. A survey may be necessary to establish the background or historical level of disease.Reporting may be because of changes in local reporting procedures, changes in the case definition, increased interest because of local or national awareness, or improvements in diagnostic procedures. iii) Verify the diagnosis: This is closely related to verifying the existence of an outbreak. Verifying the diagnosis is important because it ensures that the disease has been properly identified, since control measures are often disease-specific and because it is necessary to rule out laboratory error as the basis for the increase in reported cases. In this investigation, review the clinical findings and laboratory results and visit and interview one or more patients. iv) Construct a working case definition: This is a standard set of criteria for deciding whether an individual should be classified as having the health condition of interest. A clinical definition 32  includes clinical criteria and restrictions by time, place, and person. In an investigation certain criteria must be used such as confirmed, probable, and possible or suspect. To be classified as confirmed, a case usually must have laboratory verification. A case classified as probable usually has typical clinical features of the disease without laboratory confirmation. A case classified as possible usually has fewer of the typical clinical features. v) Find cases systematically and record information: This involves applying stimulated or enhanced passive surveillance by sending a letter describing the situation and asking for reports of similar cases. Alternatively, active surveillance may be conducted by telephoning or visiting the facilities to collect information on any additional cases. In some cases where investigators develop a data collection form, the following types of information must be obtained:  Identifying Information: Such as name, address, and telephone number are necessary  Demographic Information: Such as age, sex, race, occupation are needed  Clinical Information: Such as signs and symptoms  Risk Factor Information: Such as exposure to food or water 33   Reporter Information: Such as the source of information e.g. physician, clinic, hospital, or laboratory. vi) Perform descriptive epidemiology:This is done by systematically describing some key characteristics of the persons such as information on time, place, and person and this is called descriptive epidemiology. vii) Develop hypotheses: This is the coming up of your personal conclusions about the disease. This is done by asking some questions such as what is the agent’s usual reservoir. How it is usually transmitted? What vehicles are commonly implicated? What are the known risk factors? In other words, by being familiar with the disease, you can, at the very least, “round up the usual suspects.”Another wayto generate hypotheses is to talk to a few of the case-patients. The conversations about possible exposures should be open-ended and wide-ranging. In some cases it is important for investigators to visit homes and look through their refrigerators and shelves for clues to an apparent food-borne outbreak. viii) Evaluate hypotheses epidemiologically:After the hypothesis has been developed, it should now be evaluated for its plausibility. This is done by using a combination of environmental evidence, laboratory science and epidemiology. From the epidemiologic point of view, hypotheses are evaluated either by comparing the hypotheses with established facts or by using analytic epidemiology to quantify relationships and assess the role of chance. 34  ix) As necessary, reconsider, refine, and re- evaluate hypotheses: If the initial hypothesis did not yield any desired results, consider taking another step by convening a meeting of the case- patients to look for common links or visiting their homes to look at the products on their shelves. Consider new vehicles or modes of transmission. x) Compare and reconcile with laboratory and/or environmental studies: Environmental studies following inspections, should be compared with laboratory findings. xi) Implement control and preventive measures:The most important aspect is to control and prevent further infection. Control and prevention measures depend on the type of disease outbreak. xii) Initiate or maintain surveillance: Once control and prevention measures have been implemented, they must continue to be monitored. If surveillance has not been on-going, now is the time to initiate active surveillance. If active surveillance was initiated, it must be continued xiii) Communicate findings: After all this has been done, its important to provide both an oral and written communication to all who deserve the information. 1.4 Prevention and Control: Prevention and control measures will all the time depend on the type of disease. Diseases may be water-borne, water-washed, water-based, water-related, vector-borne, food-borne, air-borne and contagious. Measures to be put in place will therefore depend on the disease involved. It is 35  however important to implement these measures as required by statutes. 1.5 Epidemic Preparedness: This should be done under the following headings: a) Early Warning: This is the provision of timely and effective information, through identified institutions and mechanisms that allow individuals exposed to epidemic risks, to take action to avoid or reduce their risk and prepare for effective and efficient response. b) Early Detection:As soon as early warning signs have been received, it is important to detect what actually is causing the epidemic. Early detection will not only give information on the type of the disease, but will also give information on what measures to be taken to control the epidemic. The sooner the epidemic is detected and known, the earlier and easier it will be to control it. c) Notification: All epidemics shall be communicated from the area of occurrence by any fastest means on a daily basis. In this case the communication should be communicated from the lowest level of health care where the disease has occurred to the Ministry of Health through the hierarchy that is in existence. This hierarchy runs from the health post, rural health centre, district office, provincial office to national level. The national level is required to notify WHO equally on a daily basis. Special forms for notification are already in use. d) Verification, early Response:As soon as an outbreak has been reported, it is important to take action so that the disease does not spread. In this regard, it is necessary to verify the outbreak. Where laboratory examination has 36  to be done, it must be carried out with utmost urgency. Where specimens have to be got and taken to the laboratory, this must be done immediately. As soon as specimens or samples are taken to the laboratory, measures must be taken to control the disease without having to await the outcome of the results. This should be done as the disease which is being suspected would have been known from what has been learnt or from experience. This is to ensure that the disease is suppressed before the results come out. The results will only confirm the type of outbreak as a requirement by the statutes especially the International Health Regulations (2005) by the World Health Organisation (WHO). Early response to an outbreak is cardinal. e) Post Epidemic Assessment:Depending on the results of the epidemic or outbreak, all reasonably necessary measures shall be taken to ensure that the epidemic does not recur. In order to do this, post epidemic assessment of the situation and all activities that were carried out must be reviewed. Causes of the epidemic would have been known. All issues pertaining to the disease including the disease identification, the incubation period, period of communicability, causative agent, preventive and control measures etc must be examined and taken into consideration. Past experience regarding the disease trend in terms of incidence and prevalence must be considered too. Available resources in terms of logistics, supplies, funds, personnel must equally be taken into account. This will enable the health personnel to quickly take appropriate measures should the epidemic recur. Equally important is the time period when the epidemic is likely to happen. 37  f) Preparation Plan of Action:The preparation plan of action should be put in place depending on the information available. The information will under normal circumstances be consolidated after any previous epidemic and from the data obtained from the post epidemic assessment. Various committees should be formed; transport, funds, and all other requirements made easily available. Most important is the aspect of sensitizing the communities and the involvement of partners and the political leadership. g) The 4 Ps: The 4 Ps in the Preparedness Plan of Action include:  Plan  Prepare  Practice  Protect/Prevent 1.6 Disease Management: a) Diagnostic and Treatment Facilities, Health Education and Health Promotion:During an epidemic diagnostic and treatment facilities must be established to ensure proper management of cases. In an event of a communicable or notifiable disease, it is common knowledge that cases arising there-from are isolated and treated at different facilities from those arising from ordinary ones. While this is going on, health education and health promotion activities to both patients and communities must go on. The case management of cases involves the establishment of what are commonly known as treatment centres. 38  b) Epidemiological Surveillance: This is the continued watchfulness over the distribution and trends of incidence of a disease through the systematic collection, consolidation, and evaluation of morbidity and mortality reports and other relevant data. The critical characteristics of surveillance include:  Timeliness to implement effective control measures  Representation to provide an accurate picture of the temporal trend of the disease  Sensitivity to allow identification of individual persons with disease to facilitate treatment; quarantine, or other appropriate control measures  Specificity to exclude persons having disease In selecting a health problem for surveillance, the following are important:  Incidence: The number of cases of disease or infection occurring per unit of population during a specified period.  Prevalence: The number of cases of disease or infection existing at some particular time  Severity: The effects of the disease in a population or how severe a disease is in terms of morbidity and debility  Mortality: the consequences of the disease in relation to how many deaths have occurred in a period of time.  Socio-economic impact: Effects related to the socio- economic effects the area or country has experienced or likely to experience  Communicability: How quickly the disease can be transmitted among the people 39   Potential for outbreak: Any possibility or high chances for outbreak  Public perception and concern: What people think about the disease/hazard  International requirements:Measures that must be carried out by nations in the suppression of a disease outbreak. 1.7 Organisational Framework of Epidemic Preparedness: a) National Anti-Epidemic Committee and Responsibilities b) An Action committee and Responsibilities c) Tasks and Responsibilities of Stakeholders d) Sequence of operations e) Inter-sectoral cooperation f) Equipment, supplies and other logistical support  Sprayers,  Medicines/drugs/supplies  Disinfectants  Transport  Transport media  Sampling equipment  Protective clothing  Food 1.8 Legal Requirements: a) WHO International Health Regulations, 2005 b) Public Health Act, CAP 295 Sec. 9(1) c) Public Health (Infectious Regulations) 40 2.0 DISASTER MANAGEMENT EVOLUTION OF DISASTER MANAGEMNT IN ZAMBIA. In view of the common disaster threats experienced in Zambia, the Government has been making efforts to create a permanent response mechanism to deal with these threats. In the first and second republics, the co-ordination of the response to emergencies was with the CONTINGENCY PLANNING UNIT located in the then Office of the Prime Minister. The Unit was established in 1966 and phased out in 1992. Following the major drought of 1991/92 that affected most of the Southern African region, and the major relief operation that followed, four key ministries of Health, Agriculture, Energy and Water Development and Community Development formed an ad-hoc committee 41  which was responsible for managing different aspects of response to drought. Management committees were co- chaired by ministries of Agriculture and Health. Despite efforts at co-ordination, the ministries tended to operate their own elements or response in isolation. This led to unnecessary overlaps, wastage of resources and bureaucratic delays. In the absence of formal relief framework, new structures were set up by Government to manage the logistics of bulky imports and relief programmes, which by passed existing government channels. These structures were created at national, provincial, district and village levels and became known as Programme to Prevent Malnutrition (PPM) to which the Programme Against Malnutrition (PAM) provided secretariat and technical backstopping services. As a result of the fragmented disaster framework that existed, it became necessary to create a Permanent Unit within government establishment to initiate, facilitate the implementation and coordinate disaster management policies and programmes. The mandate for overall disaster management and co-ordination was vested in the Office of the Vice-President. Consequently, and in line with the Public Service Reform Programme, government created the Disaster Management and Mitigation Unit (DMMU) with the office of the Vice-President in 1994. 2.1 Definition of the Following Terms: a) Disaster: This is an event that is associated with the impact of a human-induced or natural hazard which 42  causes a serious disruption in the functioning of a community or society, causing widespread human, material or environmental losses which exceed the ability of the affected community or society to cope using only its own resources. A disaster is declared when its management goes beyond the capacity of a local community or one single government agency, and requires the intervention and co-ordination of the state in order to mobilize resources at a national and sometimes international level. A disaster occurs when a trigger mechanism or hazard affects vulnerable human beings and their welfare. The severity of a disaster is thus closely linked to the level of vulnerability of the affected population and also depends on the population’s resilience (capacity to withstand the shocks of a disaster impact and /or recover from it). The capacity to withstand the effects of a disaster is greatly influenced by the populations prevailing socio-economic conditions or asset portfolios. High vulnerability to disasters is, therefore, a function of poverty, political and other social economic conditions, obtaining in a given environment. In understanding the economic impact of a disaster, the key elements are disruption of normal functions and inability to cope using available resources within the affected community. Hazards translate into disasters when they interface with vulnerable people or environment. In general, disasters only 43  happen to people who are put at risk as a result of their vulnerability which is generated by differences in wealth and control over resources and power. Political and economic factors play an important role in the causation of disasters. It therefore follows that effective management of hazards and vulnerable populations including the environment can best be achieved by changing the prevailing social, economic and political contexts. Consideration of these factors is critical in a proactive approach to disaster management. This should be at every link of the chain of preparedness, response, mitigation, restoration and prevention of the disaster management cycle. b) Disaster Management: This is a comprehensive, development based with set activities aimed at allocating responsibilities and managing resources for dealing with all humanitarian aspects of emergencies, in order to reduce the vulnerability of the populations at risk. Disaster management also ensures that adequate measures are put in place to deal with disasters when they occur in order that response to them is as efficient and effective as possible (Holloway, 1996). c) Hazard: This is a source of potential harm or a situation with the potential to cause or harm to the community, property and/or the environment. d) Risk: This is the probability of harmful consequences, or expected losses (death, injuries, property, livelihoods, economic activity disrupted or environmental damages) resulting from 44  interaction between natural or human induced hazards which create vulnerable conditions. e) Vulnerable: This is when the characteristics of a person or group in terms of their capacity to anticipate, cope with, resist and recover from the impact of a natural hazard. It involves a combination of factors that determine the degree to which people’s lives and/or their livelihoods are put at risk by a discrete and identifiable event in nature or in society. f) Watch: A watch is issued when a storm looks like can cause problems, like floods. In other words forecasters issue a watch when they think residents should watch out for storm problems otherwise a watch means a flood is possible. g) Advisory: An advisory is issued when some problems have began h) Warning: A warning is issued when there are big problems from a storm, like flash problems. In another words a words a watch means that things might turn bad; an advisory means that some problems have started; a warning means that they have turned dangerous. 2.2 Environmental Hazards a) Definition of Environmental Hazard/Degradation: This is the reduction of the capacity of the environment to meet socio-economic objectives and needs. Examples are land degradation, deforestation, desertification, loss of bio- 45 diversity, land, water, and air pollution, climate change, sea level rise, ozone layer depletion. b) Typology of Hazards: These Hazards are divided into TWO groups i.e. Natural and Man-made and are described further in terms of Extent (Voluntary or involuntary) and Scale (magnitude, intense or diffuse). c) Hydrological-meteorological Hazards: This is the natural phenomena of atmospheric, hydrological or oceanographic nature, which may cause the loss of life or injury, property damage, social and economic or environmental such as floods, debris and mud floods and tropical cyclones. It is also a period when the flows in rivers, lakes and ground water aquifers are below normal levels. d) Drought Hazards: These are defined as periods of abnormally dry weather that persist long enough to produce a serious hydrological imbalance (for example crop damage, water supply shortage, etc). The severity of the drought depends upon the degree of moisture deficiency, the duration and the size of the affected area. Drought is a natural hazard that frequently affects some parts of Zambia. Historically Zambia has recorded a number of intermittent drought episodes or poor rains during certain seasons. The serious droughts have been those experienced in 1986/7, 1991/2, 1994/5, 1997/8 respectively. There has generally been a decline in the annual rainfall which on average is about 650mm/year for the whole country. The El-Nino-Southern Oscillation (ENSO) in the Pacific Ocean has increased the potential for temperature and precipitation anomalies in Southern Africa. Impacts of Droughts: Macro level impacts of drought include: 46   Decline on crop and livestock production  Decline on hydroelectric power generation  Decline on primary industries and on water intensive non-agricultural production At household level, drought has the following effects:  Reduced physical availability of food  Reduced incomes Social Impacts: These include:  Shortage of water: women have to go long distances to fetch water which of takes time for other activities  Education services: Most parents do not have the money to pay school fees  Health Hazards: Closure of some schools due to epidemics Environmental Impacts: Drought retards the natural process of regeneration. Livestock destroys more vegetation by movement in search of food. Limited pastures and grazing areas cause overgrazing which lead to erosion and soil infertility when rain comes. Drought is a major cause of bush fires. The hardships experienced under drought conditions leave little room for investment into long term natural resource management as people are preoccupied with ensuring short-term food security at both household and national levels. 2.3 Disasters: 47  a) Environment and Disasters: Environmental disasters which occur mostly as land degradation can be a serious problem in some parts of the country. Human activities such as mining, overgrazing, over population, soil erosion and deforestation, have led to some big tracks of land being so seriously degraded that it can no longer support life. b) Characteristics of Disasters: The characteristics of disasters are that they have a negative impact on the economy, cause loss of life, damage to property and degradation of the environment. Tremendous setbacks in economic growth and development have also been the main result, as scarce national resources have had to be redirected from productive investments to relief and emergency operations. In general, disasters only happen to people who are put at risk as a result of their vulnerability which is generated by differences in wealth and control over resources and power. c) Kinds of Disasters: These include natural and human. d) Natural Disasters: i) Floods:A flood is a high flow of water, which overtops either the natural or artificial banks of a river or stream. Such an event cannot be described as a hazard unless it threatens human life and property as well as the ecosystem. Disasters that are associated with flood hazards in Zambia have been caused by river flooding from heavy or severe rainfall, sometimes associated with hailstorms which can destroy crops and buildings. In addition, human 48  manipulation of watersheds, drainage basins and flood plains can also exacerbate floods and their negative effects. The release of excess water on the Kariba Dam on the Zambezi River has sometimes caused devastating effects downstream and in Mozambique. An example is the Tropical Cvclone Bonita (5th- 19th January, 1996) is remembered for its long lifetime and its general westerly movement across some countries in the region such as Angola, Madagascar, Mozambique, Namibia, Zambia, and Zimbabwe, though flooding affects almost all provinces in the country, it is worse in areas where surface vegetation has been removed and in low lying flood plains and valleys in Zambezi, Kafue, Luapula, Chambeshi and Luangwa river basins. The country has also experienced urban floods in poorly drained shanty compounds like the Kanyama flood disaster as well as Chowa in Kabwe. Floods are the most common and widespread of all weather-related natural disasters. Floods have the capacity to change the course of rivers and bury houses in mud. Flash Floods: This is a rapid flooding of low- lying areas such as rivers, lakes and water basins. It may be caused by heavy rains associated with a storm, hurricane, or tropical storm or melt water from ice or snow flowing over ice sheets or snowfields. These floods can also occur after the collapse of natural ice or debris dam, or human structure. Flash floods 49  are distinguished from a regular flood by a timescale less than six hours. The temporary availability of water is often utilized by plants with rapid germination and short growth cycle, and by specially adapted animal life. Dams are constructed and designed to hold a rivers water in reserve. If a dam were to break, all the trapped water would rush down the river at the same time and cause a flash flood. Causes of Flash Floods: These are caused when a barrier holding back water fails or when water falls too quickly on saturated soil or dry soil that has poor absorption capacity. The runoff collects in low-lying areas and rapidly downhill. Flash floods most often occur in normally dry areas that have recently received precipitation, but may be seen anywhere downstream from the source of precipitation, even many miles from the source. I areas on or near volcanoes, flash floods have also occurred after eruptions, when glaciers have been melted by the intense heat. Flash floods mainly occur in the highest mountain ranges of Zambia. Types of Floods: These include:  Flash Floods: As described above  Coastal Floods: Hurricanes and tropical storms can produce heavy rains, or drive ocean water on to land. Beaches and coastal houses can be swept away by the 50  water. Coastal flooding can also be produced by sea waves called TSUNAMIS, giant tidal waves that are created by volcanoes or earthquakes in the ocean  Flash Floods in Arroyos: An arroyo is a water-carved gully or a normally dry creek found in arid or desert regions. When storms appear in these areas, the rain water cuts into the dry, dusty soil creating a small, fast-moving river. Flash flooding in an arroyo can occur in less than a minute, with enough power to wash away sections of pavement. In deserts, flash floods can particularly deadly as storms in arid regions are infrequent, but they can deliver an enormous amount of rain in a very short time. Another reason is that these rains often fall on poorly- absorbent and often clay-like soil, which greatly increase the amount of runoff that rivers and other water channels have to handle. In addition, these regions may not have the infrastructure that wetter regions have to divert water from structures and roads, such as storms drains and retention basins, either because of sparse population, poverty or because residents believe the risk flash floods pose is not high enough to justify the expense. In some areas, desert roads frequently cross Dry River and creek beds without bridges. In these cases, there may be clear weather, 51  when unexpectedly a river forms ahead of or around the vehicle in a matter of seconds.  River Floods: Flooding along riversis a natural event. Some floods occur seasonally when winter snows melt and combine with spring rains. Water fills river basins too quickly, and the river will overflow its banks. Often the land around a river will be covered by water for miles around.  Urban Flood: This is flooding that occurs on undeveloped land that has lost its ability to absorb rainfall. Rain water cannot be absorbed into the ground and therefore becomes runoffs, filling parking lots, making roads into rivers, and flooding basements and businesses NB. Flash flooding is associated with streams, gullies, and ditches. Urban flooding is concerned with streets and River flooding is to do with a river filling up and going out of its banks. ii) Drought: Drought-induced crop failures have been the most common disasters experienced in Zambia in the recent past. Certain areas of the country, notably western, Southern, Central, Eastern and Lusaka provinces have been particularly susceptible to periodic droughts. The impact of drought, which is usually multi-sectoral, leads to the disruption of 52  productive activities that are dependent on water and agricultural raw materials.Drought impacts are difficult to quantify because they are non-structural, unlike the impacts of floods, hurricanes and most natural hazards. A drought emanates from severe weather and naturally a consequence of natural reduction in the amount of precipitation over an extended period of time, usually a season or more in length. Other climatic factors (high temperatures, high winds and low relative humidity) are often associated with it in many regions of the world. Drought is also related to the timing, that is, principal season of occurrence delays in the start of the rainy season and occurrence of rains in relation to critical crop stages. Thus drought can be defined according to:  Meteorological Drought: which is based on long-term precipitation departures from normal and that there is a deficit of rainfall that make a dry spell an official drought  Hydrological Drought: which is the deficiencies in surface and subsurface water supplies. It is measured as stream flow, and as lake, reservoir and ground water levels.  Agricultural Drought: this occurs when there is insufficient soil moisture to meet the needs of a particular crop at a particular time. This results in critical periods of the growth cycle in which crops are under developed or destroyed with depleted yields. The agricultural drought is typically evident after meteorological drought but before a hydrological drought. 53  iii) Cyclones: This is a body of moving air below normal atmospheric pressure, which often brings rain or a violent tropical storm that brings about a lot of injury, destruction of property or death. iv) Earthquakes: This is a series of vibrations at the earth’s surface caused by movement of the earth’s crust that often brings about a lot of injury, destruction of property or death. Earthquakes strike suddenly, violently, and without warning at any time of the day or night. If an earthquake happens in a heavily populated area, it may cause many deaths and injuries and extensive property damage. There are no guarantees of safety during an earthquake. But identifying potential hazards in advance can save lives and reduce injuries and property damage. Earthquakes occur because the outer layer of the earth is being deformed slowly by stresses that are placed on the crust. These stresses then build up along locked portions of the crust. This results into waves of vibrations within the earth and create ground movement. The point where the fault first slips is the FOCUS or HYPOCENTRE of the earthquake while a theoretical point on earth’s surface directly above the focus is the EPICENTRE of the earth. Eventually the stresses become too great or one of the faults to withstand and cause the ground to slip abruptly along a geological fault plane or near the boundary, and the crust suddenly moves, like a spring that has been 54  wound too tightly. This sudden movement of the ground is called the EARTHQUAKE. v) Wildfires:The threat of wild land fires for people living near land areas or using recreational facilities in the wilderness areas. Dry conditions at various times of the year and in various parts of the country can increase the potential for wild land fires. Advance planning in the way to protect buildings can lessen this devastation. vi) Tornadoes: These are nature’s most violent storms. Caused by powerful thunderstorms, tornadoes can cause fatalities in a very short time. A TORNADO can therefore be defined as a rotating, funnel shaped cloud that extends from a thunderstorm to the ground with whirling winds that can reach 300 miles an hour. Some tornadoes are clearly visible while rain or low hanging clouds obscure others. In certain instances, tornadoes develop so rapidly with little or no advance warning. Before the tornado hits, the wind may die down and the air may become still. vii) Hurricanes:A hurricane is a type of tropical cyclone, a generic term for low pressure system that generally forms in the tropics. A typical cyclone is accompanied by the thunderstorms, and in the Northern Hemisphere, a counter clockwise circulation of winds near the earth’s surface. Hurricane winds can cause great damage to coastlines and several hundred kilometers inland. The strongest wind can exceed 155 miles per hour 55  and at this speed most buildings and vegetation can be destroyed. viii) Dam failures: Dam failure or levee breeches can occur with little warning. Intense storms may produce a flood in a few hours or even minutes for upstream locations. Flash floods occur within six hours of the beginning of the heavy rainfall, and dam failure may occur within hours of the sign of breeching. ix) Plant Pests and Disease Infestation: These cause damage to crops and natural vegetation with varying degrees of intensity and spread. The major pests that pose potential threats of a disaster in the country are the army worm, armored cricket, larger grain borer, cassava mealy bug and locusts. These pests have caused disasters when they cause intensive and extensive damage to crops like cassava and maize. x) Livestock Diseases: In the past years, the numbers of reported outbreak of various livestock diseases have been on the increase. This increase has been partly due to the change in government policy that requires livestock keepers to pay for veterinary services. Livestock diseases that pose threats include Foot and Mouth disease, East Coast Fever, Contagious Bovine Pleura-Pneumonia, Anthrax and African swine fever. xi) Plant Parasite Invasion: The encroachment of water hyacinth (weed) poses a serious threat to strategic and vital infrastructure in the country. Examples of the infrastructure in the country that 56  get affected are: road and rail bridges, dams and hydroelectric power stations. xii) Refugees and Internally Displaced Populations: A sudden influx of refugees and internally displaced populations can be described as a disaster because of the exceptional measures that are required to be put in place in order to manage the situation. Some refugees may have travelled long distances from their usual place of residence. Having left their usual area of residence internally displaced people and refugees need to be resettled, and provided with basic needs such as shelter, water, sanitary and health amenities. xiii) Accidents: An accident is an unintended and harmful result caused by human activity or error that threatens or causes injury, death, destruction or loss of property. In Zambia common accidents relate to road traffic, industrial, fire, mine and explosions. xiv) Tsunamis: This word means HARBOUR WAVE. It is also known as TSUNAMI WAVE TRAIN. At one time it was called a TIDAL WAVE. A tsunami produces waves of water that move inland, and this inland movement of water is very great and lasts for long time. A tsunami therefore is a series of extremely long waves that are created by the displacement of a large volume of a body of water. This displacement is caused by sudden motion on the floor of the ocean of an earthquake or a volcanic eruption or landslide. 57  xv) Landslide: This is when masses of rock, earth, or debris move down slope debris and mud flows are rivers of rock, earth, and other debris saturated with water. These develop when water rapidly accumulates in the ground during heavy rainfall or rapid snowmelt, changing the earth into a flowing river of mud or SLURRY. The debris and mud move rapidly with little or no warning at very high speed. The travel several kilometers from their source and pick up whatever is on their way such as cars, trees, etc. Landslides are caused by land mismanagement especially in mountain, canyon and coastal regions. Land-use zoning, professional inspections and proper design can mitigate many such problems. These can also be avoided by not building near steep slopes, close to mountain edge, near drainage ways, or natural erosion valleys. xvi) Thunderstorms and Lightning: Thunderstorms are particularly dangerous and these actually in most cases are accompanied with lightning. Also associated with thunderstorms are tornadoes, strong winds, hail and flash floods. xvii) Volcanos: A volcano is an opening or rupture in a planet’s surface or crust which allows hot magma, volcanic ash and gases to escape from below the surface. Volcanoes are found in areas such as the East African Rift Valley, the Rio Grande in North America etc. There are types of volcanoes. 58   Stratovolcanoes or Composite Volcanoes: These are tall conical mountains composed of lava flows and other ejecta in alternate layers, the strata that give rise to the name.  Submarine Volcanoes: These are mostly found on the ocean floor where some are active and in shallow water. These manifest their presence by blasting steam and rocky debris high above the surface of the water. Others lie very deep in the waters so that their eruptions may not be evident as the water prevents such evidence. Because of the rapid cooling effect of water as compared to air, and increased buoyancy, these volcanoes often form steep pillars over their volcanic vents as compared to above-surface volcanoes. They may become so large that they break the ocean surface as new Islands. e) Human Disasters: These include the following: i) Epidemics: The major epidemics with frequent occurrences in many parts of Zambia have included cholera, dysentery, malaria, meningitis, tuberculosis and HIV/AIDS pandemic. The outbreak of water- borne diseases such as cholera and dysentery has been a common occurrence almost every rain season in most of the crowded urban areas of the country, where they spread rapidly. ii) Famine: This has been a common occurrence in semi-arid and drought-prone areas of the country. The major causes of famine include drought, disease 59  and pest attacks to domesticated animals and plants. Corridor and stalk borer being the common animal and plant diseases respectively. In addition to the human loss, there is also social cost to society as a result of diverting resources for development to meeting the cost of disaster relief. iii) Influx of Refugees and Internally Displaced Persons: Intrusion, war, occupation of land, government programmes, persecution and even generalized violence or conflict could produce internally displaced populations. Over the years, Zambia has experienced refugee influxes arising from civil unrest in neighbouring states. At one time Zambia hosted over 500,000 refugees in Eastern, North-Western, Western and Northern provinces. iv) Fires: These have occurred in urban and rural areas, caused by a number of factors including arson, human error or accidents. Infrastructure that has been affected include: Kafue Gorge Power Station, Indeni Refinery, Cabinet Office, Shoprite Kasama, Society House, National Tender Board at Kulima Tower and major markets Soweto in Lusaka and Chisokone in Kitwe. v) Deforestation: This is an aid to major creeping disaster in Zambia. The increase in population growth rate, spreading of shifting cultivation, improper grazing, charcoal burning, timber harvesting, permanent settlements and wild fires 60  have created “environment “ that is a recipe for disasters. vi) Accidents: Roads, industrial, marine, rail and air accidents can prove disastrous when large numbers of casualties are involved. In Zambia, these have occurred and have had negative effects including injury, damage to and destruction of property, psychological problems and loss of life. f) Disasters Associated With Complex Humanitarian Emergency: This is a human crisis in a country, region at international level or society where there is total or considerable breakdown of authority resulting from internal or external conflict. Even though Zambia has not really experienced such situations, the instability caused by the Lenshina up-rising , the Mushala rebellion and cases of serial killers had potential to lead to complex emergencies. MANAGEMENT OF DISASTERSDISATER MANAGEMENT IN ZAMBIA Managing Disasters (ethics in handling disasters, planning for disaster management, Pre-Disaster Planning- Leadership and decision making in crisis), Disaster Preparedness, Response, Recoveries, Rehabilitation and Reconstruction: This is the observation and analysis of disasters, to improve measures relating to prevention, mitigation, preparedness, emergency response and recovery. This includes measures to help the livelihoods, assets and production levels of emergency-affected communities, to re- 61 build essential infrastructure, productive capacities, institutions and services destroyed or rendered non- operational by a disaster, and to help bring about sustainable development by facilitating the necessary changes caused by disaster and improving on the status quo where possible. In general any disaster/emergency management is the continuous process by which all individuals, groups, and communities manage hazards in an effort to avoid the impact of disasters resulting from hazards. Action to be taken depends on perceptions of risk of those exposed. Effective emergency management relies on thorough integration of emergency plans at all levels of government and non-government involvement. Activities at each level affect the other levels. Disaster management is therefore the discipline of dealing with and avoiding risks. It involves preparing for disaster before it occurs, disaster response (emergency evacuation, quarantine, mass decontamination etc) and supporting, and rebuilding society after natural or man-made disasters have occurred. Future and Background Trends in Disaster management: Mitigation Measures and Programmes for Disaster Management Plans: This is a situation to address a disaster or impending disaster within a fairy finite time, such as from early warning to response and recovery, including mechanisms for generation of disaster-specific operational plans. In coming up with plans to mitigate disasters, it is important to identify the disaster management structure whose objectives are: 62   To design and implement disaster management activities  To co-ordinate and monitor the Disaster Management Programmes in order to rationalize resource utilization and ensure effective implementation of the programmes  To reduce Zambia’s vulnerability to disaster in the identified areas of concern  To put in place appropriate measures that minimize the negative effects of disaster  To activate response mechanisms for effective, timely search and rescue operations, in order to save lives and minimize damage to property, in times of a crisis  To put in place measures to restore livelihoods and other life support systems of the affected communities Measures that should be taken in order to keep Disaster Plans Active and Viable: These include: a) Training: b) Education of Communities: c) Policy Development and Implementation: d) Provision of Resources: i) Funds: ii) Staff: iii) Equipment: iv) Infrastructure (Laboratory): v) Transport: e) Review of Previous Experience: 63 The Disaster Management Cycle Includes:  Disaster Impact  Response/relief  Recover  Rehabilitation  Reconstruction  Development  Prevention  Mitigation  Preparation This is further organised as follows: 1.0 Post-Disaster Phase: a) Relief/Response b) Recover  Rehabilitation  Reconstruction 2.0 Pre-Disaster Phase: a) Prevention b) Mitigation c) Preparedness The Disaster Management Structure is composed as shown below:  The National Disaster Management Committee  The National Disaster Technical Committee i) Finance and tender Sub-Committee ii) Health, Water and Nutrition Sub-Committee iii) Infrastructure Relief and Logistics Sub-Committee iv) Agriculture, and Environment Sub-Committee 64  v) Security Sub-Committee vi) Training and Public education Sub-Committee vii) Early Warning Systems Sub-Committee  Disaster Management and Mitigation Unit  Provincial Disaster Management Committees (Provincial Disaster Management Coordinators)  District Management Committees  Satellite Disaster Management Committee  Private Sector NGOs, INGOs ,UN system, Media In dealing with disasters it is important to consider the phases involved. These are: Satellite Disaster Management Committee:  Pre Disaster Phase: During the non-emergency phase the satellite Disaster Management Committee will assume the following roles and responsibilities:  Formulate Early Warning information dissemination mechanisms for local communities and other stakeholders  Prepare Annual Preparedness Plans, and submit the plans to the District Disaster Management Committee for consideration and further processing  Hold regular meetings, at least twice a year, of which they shall submit the minutes to the Disaster Management Committee  Conduct risk and vulnerability assessment  Conduct public education and awareness campaigns in communities regarding the foreseeable disasters identified through assessments 65   Initiate training activities in relation to risk and vulnerability reduction  Initiate projects related to risk reduction and vulnerability already identified in the assessment conducted  Mobilise resources to help in building capacity for satellite committees and the community to conduct risk and vulnerability reduction activities  Disseminate warning messages to the community  Put in place a communication mechanism for passing on message to community members and district authorities through the Chairperson of the DDMC on matters related to disasters  Educate the communities through public awareness campaigns regarding Early Warning mechanisms  Prepare for possible relief operations in relation to disaster risks identified  Mobilise resources for disaster response and implementation of risk reduction programmes  Submit quarterly reports to the DDMC indicating risk reduction activities being undertaken  Identify activities on risk mitigation/reduction  Maintain inventory of resources (material, financial and expertise including contact details).  During Disaster Phase: During the Disaster Phase, the SDMC shall through its Chairperson assume the following roles and responsibilities:  Activate preparedness plans through formation of local relief teams to lead the relief operation among responders 66   Notify the Chairperson of the DDMC immediately, of the impending/or the actual disaster that has happened using the appropriate format  Conduct an assessment of what has happened  Disseminate warning messages to the communities affected or likely to be affected where possible  Help co-ordinate the relief operations among the various responders  Continue monitoring and communicating details of the event to the Chairperson of the DDMC  Mount search and rescue operations where necessary  Notify and initiate cooperation, where applicable, with the next Satellite Committee for possible assistance that may be required  Mobilise and distribute local relief resources  Post Disaster Phase: During this phase, the SDMC through its Chair, shall assume the following roles and responsibilities:  Generate a post disaster report within 48 hours  Initiate and co-ordinate the evaluation of the disaster and relief operations  Evaluate and update the local disaster management plans  Identify and quantify the resources needed for rehabilitation, recovery and reconstruction  Initiate development programmes for recovery and risk reduction  Re-assess and update communication and Early Warning mechanisms 67   Account for resources which are directly controlled by the Satellite committee  Initiate training, in line with development programmes, for recovery and risk reduction based on lessons learnt  Initiate counseling programmes  Carry out other activities incidental to the event  Make recommendations on follow-up actions  Take necessary steps to ensure that recommended follow-up actions are undertaken within short-term; medium-term; and long-term interventional frameworks District Disaster Management Committee:  Pre-Disaster Phase: During this phase, the DDMC shall through its Chairperson assume the following roles and responsibilities:  Hold regular meetings, of which they shall submit the minutes to the PDMC  Formulate and update District Preparedness Plans which will include modalities for mobilization of resources  Integrate the District Preparedness Plan into overall District Development Plan  Ensure that the Satellite Committee remain functional at all times  Conduct training programmes of all heads of Satellite committees and other community leaders for them to carry out their roles and responsibilities effectively  Operate an emergency operations centre 68   Undertake risk and vulnerability assessment in the communities through Satellite Committees  Operate a district database in the District Planning Unit for information relating to Disaster Management  Develop and update preparedness plans for effective and efficient relief recovery and mitigation programmes  Plan and co-ordinate the implementation of