Preparedness Management Research Articles

Preparedness of Disaster Management of Landslides in the livelihoods of Kulon Progo district

A landslide is one of the natural disasters that frequently appear during the rainy season. Society has confronted this natural disaster, and it is important to decrease the vulnerable impact at the household level. Preparedness refers to the effort made to expand awareness and readiness for handling the dangers and preventative actions related to them. The aim of the paper is to analyze the correlations between livelihoods and preparedness stages in a landslide disaster area in Kulon Progo. The independent variables are defined as human-, social-, physical-, natural-, and financial capital and transformation in structure and process. Preparedness is the dependent variable. The Chi-squared analysis was applied to answer the objective. The unit analysis of this study is households, and we collected 300 households based on stratified random sampling at the research site. Kulon Progo has been chosen since the geographical pattern is hilly. Households appear to have the average level of disaster management preparedness (37.3%). Based on the strengthening of relations, the belief in keeping away from bad behavior based on ancestors’ advice has the highest CC to preparedness phase (0.396) with χ² 55.554**. It found that belief and religiosity levels have a strong contingency correlation among household capitals.

Forest fire occurrence, distribution and risk mapping using geoinformation technology: A case study in the sub-tropical forest of the Meghalaya, India

The study focuses on Meghalaya, the North Eastern State of India, for forest fire occurrence, distribution, and risk mapping using the different geospatial techniques is validated using different decision-making techniques such as MCDM, Space Time Cube Analysis (STC), and Emerging Hot Spot (EHS) Analysis. The archive data of Moderate Resolution Imaging Spectroradiometer (MODIS) near real time (NRT) fire data has been considered for this study. Fire points were obtained from Fire Information for Resource Management System (FIRMS), a web service provided by NASA. Using two decadal data, a NetCDF file was created which can store four-dimensional data. Based on this NetCFD file, forest fire trend and future prospect has been foreseen. After analyzing these points, a relationship with other fire triggering factors such as Human settlement, Roads, Climate, Elevation, Slope, Aspect, Forest Type, Forest Canopy density, Soil Moisture, Wind Speed, and Forest Health has been established. Forest risk map with four classes (extreme, severe, moderate, and mild) is also generated. These results are very effective for the managers, planners, and other stakeholders for disaster management. The suggested methodology can be implemented for the preparedness of forest fire management. The policy makers must act quickly to protect the Himalayan region with the highest biodiversity by adopting focused interventions and the strategic allocation of scarce resources in effective areas.

7.M. Round table: Preparedness & response for emergency situations: joined forces of H2020projects in the PREPAREcluster

Abstract In recent years, there have been increasing instances of cross-border crises, including climate change, terrorism, international trade disputes and global health threats. These emergency situations require large-scale planning for preparedness and response in order for countries to be able to cope with unforeseen challenges. Especially the COVID-19 crisis had a huge impact on European countries and the daily lives of its citizens. The pandemic has proven to be more than a health crisis; it is a human, economic and social crisis, impacting people, societies and economies at their core. The European Commission has recently funded many projects (in the Horizon 2020 program, H2020) to work on different aspects of crisis management, many with a focus on managing pandemics. While each project has distinct aims and challenges, they all work towards a common goal. It is for this reason that thirteen EU-funded H2020 projects, with a combined funding of €72 million, have united to form the PREparedness and resPonse for emergency situAtions in euRopE (PREPARE) cluster. Each of the thirteen projects is tackling challenges specifically looking at the preparedness and response phases of crisis management and working together they aim to achieve stronger results and greater impact for their cause. Together CO-VERSATILE, COVID-X, COVINFORM, EUR3KA, LINKS, NO FEAR, PANDEM-2, PathoCERT, PERISCOPE, PHIRI, RISKPACC, STAMINA and STRATEGY will explore synergies, research opportunities and deliver joint activities to maximise impact. Through mutual support, the cluster will strengthen the response to the ongoing crisis and the aim to be better prepared for future health crises. In a round table discussion, a selection of these H2020 will briefly present their contribution to crisis preparedness and resilience of European countries (25 min). These brief presentations will be followed by a round table discussion (35 min), touching upon topics such as common findings (building trust, health inequalities, training and capacity building, addressing stakeholder diversity); and the dissemination and exploitation of the results to the general public, to researchers, to (public) health professionals and policy makers, Finally, as many of these projects end in 2022/2023, what are the next steps or threats, what should be the highest priority for future Horizon Europe projects? The audience will be able to provide their view on the different topics through an interactive voting poll during the session. Throughout the session, the exchange of knowledge, experiences and opinions with the audience will be facilitated by the chairs. Key messages • The actionable outcomes of the major Horizon 2020 projects provide key-input for political decision-making in preparedness and response scenarios. • The PREPARE cluster builds a sustainable structure for large-scale planning for preparedness and response for countries to be able to cope with unforeseen challenges. Speakers/Panellists Claudia Habl Gesundheit Österreich GmbH, Austrian National Public Health Institute, Vienna, Austria Brigita Kairiene National Public Health Centre, Ministry of Health, Vilnius, Lithuania Claudia Houareau Robert Koch Institute, Berlin, Germany Jil Molenaar University of Antwerp, Antwerp, Belgium Claim Rafalowski Magen David Adom, Or Yehuda, Israel

Climate Change and Pathways Used by Pests as Challenges to Plant Health in Agriculture and Forestry

Climate change already challenges people’s livelihood globally and it also affects plant health. Rising temperatures facilitate the introduction and establishment of unwanted organisms, including arthropods, pathogens, and weeds (hereafter collectively called pests). For example, a single, unusually warm winter under temperate climatic conditions may be sufficient to assist the establishment of invasive plant pests, which otherwise would not be able to establish. In addition, the increased market globalization and related transport of recent years, coupled with increased temperatures, has led to favorable conditions for pest movement, invasion, and establishment worldwide. Most published studies indicate that, in general, pest risk will increase in agricultural ecosystems under climate-change scenarios, especially in today’s cooler arctic, boreal, temperate, and subtropical regions. This is also mostly true for forestry. Some pests have already expanded their host range or distribution, at least in part due to changes in climate. Examples of these pests, selected according to their relevance in different geographical areas, are summarized here. The main pathways used by them, directly and/or indirectly, are also discussed. Understanding these pathways can support decisions about mitigation and adaptation measures. The review concludes that preventive mitigation and adaptation measures, including biosecurity, are key to reducing the projected increases in pest risk in agriculture, horticulture, and forestry. Therefore, the sustainable management of pests is urgently needed. It requires holistic solutions, including effective phytosanitary regulations, globally coordinated diagnostic and surveillance systems, pest risk modeling and analysis, and preparedness for pro-active management.

Preparedness and Costing on Fire Safety Installation in Commercial Buildings

Purpose: The study was carried out to analyze the awareness among the management, occupants and concerned authority of selected commercial buildings at Birtamode, jhapa and prepare the tentative cost of additional tools and equipment’s needed. Design/Methodology/Approach: This research is focused on two commercial buildings; Hanuman central and One stop mall (Birtamode Jhapa). These building are selected for research as both of the buildings are considered as largest shopping malls and they also vary in planning and construction technology. The fire safety preparedness and awareness of management, occupants were analyzed. After then preparedness and awareness of concerned authority like fire fighters, Municipality and Nepal police were analyzed. Data was collected from occupants, management and concerned authority based on the questionnaires survey, site visits with check list and key informant interview. Information regarding fire safety preparedness and awareness was presented in tabular form, charts and Key informants interview and questionnaire. Findings/Result: Fire safety preparedness were lacking due to lack awareness on evacuation procedure and equipment’s operation. Management seems to be more focused on financial aspect rather than safety. Lack of proper firefighting equipment’s, equipment’s in poor condition, unmanaged electrical wires is the existing problem in the buildings. Concerned authority (Birtamode Municipality) had a fire Fighting team with a six fire men with a tank and fire fighting vehicle. But the new technologies like GPS were not introduced to firefighter. There were many cases reported where due to communication gap between the fire fighter and residents, the response was late which resulted more damage. Lack of fire hydrant near the major commercial buildings created problem for fire fighter to refill their water tank. Narrow roads inside the municipality, poor implementation of fire safety code were major problem for fire fighters. The tentative cost for the installation of fire safety tools and equipment’s Rs 5, 15,000 and Rs 9, 50,000 for one stop mall and Hanuman central respectively. Originality/Value: The study may be a guiding document for professionals, entrepreneurs and occupants for improving awareness and preparedness by obtaining cost components against fire safety. Paper Type: Research paper

Bangladeshi nursing students' perceived preparedness and readiness for disaster management

This study assesses Bangladeshi nursing students' perceived preparedness and readiness for disaster management activities and examines the influencing factors for the disaster readiness of the students. A self-administered descriptive cross-sectional survey was conducted among nursing students of eight nursing education institutes and hospitals in Dhaka city using the modified Disaster Preparedness Evaluation Tool (DPET) in Bengali (the lingua frank in the country). Three hundred and eighty respondents' data were analyzed using SPSS 25 software. Overall, student nurses' perceived levels of disaster preparedness (mean = 3.12; SD = 0.59), disaster response-ability (mean = 3.65; SD = 0.60), and disaster recovery-ability (mean = 3.45; SD = 0.69) were moderate; however, their perceived readiness for disaster management was low. The levels of disaster preparedness were significantly higher in respondents of public nursing institutes than in the respondents of private nursing institutes (p = 0.006). In addition, significant moderate positive correlations were found among the respondents' disaster preparedness, response-ability, and recovery-ability scores (p ≤ 0.01). Moreover, ordinal logit regression analysis showed that disaster response-ability (OR = 1.97; 95% CI: 1.27–3.05), disaster recovery-ability (OR = 1.59; 95% CI: 1.10–2.29), and gender (OR = 1.90; 95% CI: 1.10–3.28) had a statistically significant influence on the readiness for disaster management of the nursing students. Furthermore, more than half of the respondents recommended more workshops and training on disaster management to increase their disaster management capacity. In addition, one-fourth of them suggested more drills and practical knowledge for enhancing their disaster management capacity. As tomorrow's frontline health workers, student nurses should be well prepared and ready to effectively manage future disasters and emergencies in Bangladesh.

Exploring Managers’ Experiences of Hospital Disaster Preparedness: A Qualitative Study

Background: Preparedness is one of the important and effective pre-crisis management stages and involves all actions and programs that enable the organization to respond quickly and effectively in critical situations. To this end, this study aimed to explore the experiences of crisis managers and experts in hospital disaster preparedness. Methods: This qualitative study was conducted using conventional content analysis in 2019. The research population included hospital managers and crisis specialists in Ardabil Province. The participants were 14 managers and crisis specialists who were selected using purposive sampling. The data were collected through semi-structured interviews and analyzed using Griesheim and Landman’s qualitative content analysis approach. Results: The analysis of the data revealed four main categories including management and planning, infrastructural development, human resources, and intersectoral coordination. Conclusion: The findings of the present study highlighted the significance of preparedness for emergencies, management and planning, having codified instructions, and implementation and evaluation to increase the preparedness of hospitals to deal with emergencies.

Healthcare Supply Chain Management under COVID-19 Settings: The Existing Practices in Hong Kong and the United States.

COVID-19 is recognized as an infectious disease generated by serious acute respiratory syndrome coronavirus 2. COVID-19 has rapidly spread all over the world within a short time period. Due to the coronavirus pandemic transmitting quickly worldwide, the impact on global healthcare systems and healthcare supply chain management has been profound. The COVID-19 outbreak has seriously influenced the routine and daily operations of healthcare facilities and the entire healthcare supply chain management and has brough about a public health crisis. As making sure the availability of healthcare facilities during COVID-19 is crucial, the debate on how to take resilience actions for sustaining healthcare supply chain management has gained new momentum. Apart from the logistics of handling human remains in some countries, supplies within the communities are urgently needed for emergency response. This study focuses on a comprehensive evaluation of the current practices of healthcare supply chain management in Hong Kong and the United States under COVID-19 settings. A wide range of different aspects associated with healthcare supply chain operations are considered, including the best practices for using respirators, transport of life-saving medical supplies, contingency healthcare strategies, blood distribution, and best practices for using disinfectants, as well as human remains handling and logistics. The outcomes of the conducted research identify the existing healthcare supply chain trends in two major Eastern and Western regions of the world, Hong Kong and the United States, and determine the key challenges and propose some strategies that can improve the effectiveness of healthcare supply chain management under COVID-19 settings. The study highlights how to build resilient healthcare supply chain management preparedness for future emergencies.

Information Technology in Disaster Management

In the present era of technology it has been simpler to deal with the disaster both natural and man made. Disaster Management activities rely upon substantial volumes of precise, applicable, on-time geo information that different organization systematically make and maintain. Information Technology is changing each part of human life. Disaster management desires forceful enhancements in its sources to decrease injury and save the lifetime of individuals. The advanced methods of information technology such as web, remote sensing, satellite communication, GIS, etc. can facilitate in coming up with and implementation of disaster management. Web provides a useful platform for disaster mitigation communications. On GIS is basic as effective preparedness, communication and training tool for disaster management on the other hand Remote Sensing as a tool can very effectively contribute towards identification of hazards areas. Communication satellite have become vital for providing emergency communication and timely help into natural disaster monitoring and mitigation mechanisms is critical for hazards reduction. There should be more emphasis on development of new technologies in disaster mitigation. The disaster preparedness and awareness is the only effective method of mitigating the impact of future disaster. In this paper an attempt has been made to highlight the role of information technology in management of natural disaster in Nepal.

Emergency Preparedness for Management of Suspected Cases of Viral Haemorrhagic Fever Among Healthcare Workers in a Tertiary Referral Center

Background: Effective viral haemorrhagic fevers (VHFs) control demand adequate emergency preparedness among healthcare workers (HCWs). Objective: This study assessed the emergency preparedness for VHF control among HCWs at Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra state, Nigeria. Materials and Methods: It was a cross-sectional study conducted among 345 HCW at the NAUTH, Nnewi, Nigeria. Data was analysed using statistical package for social sciences (SPSS, IBM, Chicago IL, USA) software version 21. Chi square and student’s t-test were used to test associations between categorical and continuous variables, respectively. A p-value of <0.05 was considered statistically significant. Results: Their mean age and length of service were 33.9 ± 8.88 and 6.6 ± 7.08 years, respectively. Two-third were doctors, nurses and lab scientists. A major proportion of the HCWs were aware of VHF (88.4%), and knew it could be acquired at workplace (83.8%) and at least 2 correct features (74.2%) or one preventive measure (79.1%). Only 53.0% and 47.2% knew that the hospital had a VHF control policy and standard operating procedure (SOP), respectively. Different category of HCWs varied significantly in awareness of VHF; and knowledge about the risk of acquiring it at workplace, features or preventive measures, and VHF control policy or SOP. Doctors, nurses and lab scientists performed better than other HCWs in VHF knowledge. Previous training on VHF or encounter with suspected case was highest among the doctors (P < 0.001) while adequate supply (P < 0.001) or regular use (P = 0.008) of PPE was highest among lab scientists. Suspected VHF case was encountered by 21.2% of the HCWs out of which 26% (19/73) notified relevant unit. Only 29.3% of the HCWs agreed that VHF control was adequate in their unit. Commonest reasons cited for disagreeing were lack of training (79.2%), standard precaution materials (63.6%), SOPs (59.7%) and inadequate support by hospital management (58.4%). Conclusion: Emergency preparedness for VHF control was poor among studied HCWs. Innovative surveillance/notification system, and best practices for infection control should be enforced. HCWs should be adequately trained on VHF control.

Internal contamination cases: The REAC/TS experience

The Radiation Emergency Assistance Center/Training Site or REAC/TS is a United States Department of Energy (DOE) emergency response asset and part of the National Nuclear Security Administration's (NNSA) Nuclear Emergency Support Team (NEST). REAC/TS started in 1976 to provide support to the US DOE and is under the Oak Ridge Institute for Science and Education (ORISE) and operated for the US DOE by Oak Ridge Associated Universities, a consortium of 125+ universities to further science and developing future scientists. As part of the support for the US DOE, REAC/TS is on call 24 hours a day, seven days a week for any radiological/nuclear (R/N) injuries or illnesses in the US and throughout the world. REAC/TS was one of the initial eight World Health Organization (WHO) Collaborating Centers, throughout the world, established in 1980 for radiation emergency management and subsequent member of WHO's Radiation Emergency Management Preparedness and Assistance Network (REMPAN). This article will discuss the REAC/TS experience with more recent internal contamination cases and discuss the many gaps existing in assessing and managing cases of internal contamination.

Effect of Disaster Risk Reduction Training (Disaster Mitigation) Based on Community Participation on Flood Disaster Management Preparedness Knowledge

Disaster is an event or series of events that threaten and disrupt the life and livelihood of the community caused by natural factors and or non-natural factors or human factors resulting in casualties, environmental damage, property losses, and psychological impacts. Purpose of this research is to measure the ability of the people to understand the training of disaster risk management. This research is quantitative research with a quasi-experimental design with a pre posttest with control group approach. The result of this study finds that there is strongly correlation between training and knowledge of the people of Wawosolo with p value 0, 0001. Based on the result we suggest conducting training of the people to protect the risk of disaster.

COVID-19: An Assessment of Creative Communication, Crisis Preparedness, and Resilience Building in Hospitality Business in Bali

Two years of COVID-19 pandemic have brought global consequences, especially to those operating in business. This paper examines how risk and crisis preparedness contributed to business survival and resilience in the hospitality sector in Bali, Indonesia, a market significantly dependent on international visitors. This qualitative research employing a phenomenological approach. Initial data were acquired from two months of observation in Bali from March 2020 until the end of May 2020. In addition to observation, semi structured interviews were also conducted with informants from four different hotels, aiming to uncover if the hotels embraced some strategies from the proactive pre-crisis planning to strategic implementations during the crisis. We did not include the after-crisis stage as the pandemic is still ongoing. The researchers validated findings through triangulating interviews with Balinese authorities. We found that although the current crisis disrupted hotel business, it also provided opportunities for creative communication, security strategies, and new connections with public sector health management. Further, in the early stages of crisis management preparedness and focused communication were vital for the level of survivability of the hotels. The study concluded that during a crisis, a successful organization management team does not follow a linear and organized process to lead their business through the stressful and chaotic phases. Based on this study, we learned that business managers who adapted to the situation with crisis preparation, combined with raised awareness of public health issues, and use of commercial strategies focused on local communities can successfully reduce threats.

“A” stands for airway – Which factors guide the need for on-scene airway management in facial fracture patients?

BackgroundNumerous guidelines highlight the need for early airway management in facial trauma patients since specific fracture patterns may induce airway obstruction. However, the incidence of these hallmark injuries, including flail mandibles and posterior displacement of the maxilla, is contentious. We aim to evaluate specific trauma-related variables in facial fracture patients, which affect the need for on-scene versus in-hospital airway management.MethodsThis retrospective cohort study included all patients with any type of facial fracture, who required early airway management on-scene or in-hospital. The primary outcome variable was the site of airway management (on-scene versus hospital) and the main predictor variable was the presence of a traumatic brain injury (TBI). The association of fracture type, mechanism, and method for early airway management are also reported. Altogether 171 patients fulfilled the inclusion criteria.ResultsOf the 171 patients included in the analysis, 100 (58.5) had combined midfacial fractures or combination fractures of facial thirds. Altogether 118 patients (69.0%) required airway management on-scene and for the remaining 53 patients (31.0%) airway was secured in-hospital. A total of 168 (98.2%) underwent endotracheal intubation, whereas three patients (1.8%) received surgical airway management. TBIs occurred in 138 patients (80.7%), but presence of TBI did not affect the site of airway management. Younger age, Glasgow Coma Scale-score of eight or less, and oro-naso-pharyngeal haemorrhage predicted airway management on-scene, whereas patients who had fallen at ground level and in patients with facial fractures but no associated injuries, the airway was significantly more often managed in-hospital.ConclusionsProper preparedness for airway management in facial fracture patients is crucial both on-scene and in-hospital. Facial fracture patients need proper evaluation of airway management even when TBI is not present.

MANET Based Emergency Communication System Design During Disaster and Post Disaster

In the event of a natural disaster most of the communication networks become unavailable either because of damages sustained to the infrastructure such as antennas and other communication devices or because of power failure. During these times, communication plays a vital role in keeping the people informed about post disaster effects in the affected areas. There are two aspects in this circumstance. One is to immediately locate the affected persons and provide emergency assistance. The other is to offer calamity release during and after the disaster. The conventional method of establishing communication is usually done by establishing emergency command center and hosting the entire essential telecommunication infrastructure to provide communication between members of the search and recovery teams. This type of solution is expensive, tough to maintain, and the level of reliability is low. Because of these reasons the efficiency of the system is less. For improving the effectiveness of the communication during the times of natural calamity is to implement a communication system that does not rely on infrastructure based equipments. The proposed system makes use of Mobile Ad-Hoc Network (MANET) based communication. The proposed system also incorporates Global Positioning System (GPS), a satellite based location detection system that could be used to pinpoint a particular person who is in distress. Geographic Information System (GIS) and Remote Sensing (RS) are essential for effective preparedness, communication, and training tool for calamity management.

Schools preparedness for menstrual hygiene management: a descriptive cross-sectional study in the West Gonja Municipality, Savannah Region of Ghana

ObjectiveThis study aimed to investigate schools’ preparedness for menstrual hygiene management in the West Gonja Municipality of Ghana.DesignThis was a cross-sectional study with a mixed-methods approach.SettingJunior high schools in the...

Response of US psychiatric programs to the COVID-19 pandemic and the impact on trainees

BackgroundMedical training program and hospital response to the COVID-19 pandemic has varied greatly and has impacted trainee well-being. Which factors have specifically related to trainee wellness, however, has not yet been examined in depth. The aim of the study was to understand trainee perspectives on the individual psychiatry trainee programs’ hospitals’ objective COVID-19 preparedness management. We also sought and to gauge how program changes, and general pandemic-related concerns, have been associated with trainee satisfaction and burnout.MethodsA cross-sectional survey study of psychiatric trainees was distributed electronically throughout the country via various psychiatry residency program listservs in April 2020. Statistical analyses were performed utilizing simple linear regression.ResultsFrom 352 respondents (346 complete responses and 6 partial responses), the most frequent program changes were “decreased number of rotations requiring in-person patient care” and “increased call hours or duties.” Of pandemic-related concerns surveyed, the two greatest were “spreading COVID-19 to family/friends” and “co-residents’ burnout and anxiety.” A positive relationship was found between trainee satisfaction with perceived COVID-19 departmental response and comfort level of residents/fellows in expressing concerns with attending clinicians and department leadership.ConclusionsSince the start of the COVID-19 pandemic, trainees have experienced a variety of changes to trainee program policies and guidelines. Overall, poor communication and trainee dissatisfaction with departmental response correlated with concern of infection and anxiety/burnout. Insights garnered from this study could provide scaffolding for the best practices to reduce trainee physician anxiety/burnout for the current and future pandemics of this variety and magnitude.

Lived Experiences of Nurses During Quarantine: A Qualitative Study from North India

Introduction: The literature related to quarantined nurses’ lived experiences working in nondesignated COVID settings is scarce. This study aimed to explore the lived experiences of quarantined nurses after accidental exposure in nondesignated COVID areas in a tertiary care hospital. Material and Methods: It was a qualitative phenomenological study. Snowball sampling technique was used to interview 11 nurses. The in-depth interviews were conducted telephonically using a prevalidated interview guide during October 2020 to February 2021. The interviews were audiotaped, transcribed, and translated to English. Thematic analysis was done using Colaizzi’s phenomenological method. The findings depicting similar codes were grouped into subthemes and themes. The findings are presented thematically with corresponding participant quotes. Results: Out of 11, six (55%) participants were quarantined in home and five (45%) in the institutional facilities. The major themes that emerged were: “psychological reactions,” “quarantine: the positive aspect,” and “support system” among the home quarantined nurses. The major themes in the institutional facility quarantined nurses were: “psychological reactions,” “poor quality of institutional quarantine facility,” “quarantine: the positive aspect,” “support system,” and “quarantine: a learning experience.” The nurses experienced various negative emotions during quarantine. Conclusion: To safeguard the physical and mental health of nurses, comprehensive support should be provided by the authorities in terms of availability of basic amenities and quality services during quarantine. Regular training and constant motivation are needed to promote their mental preparedness for crisis management.

Factors associated with a malaria outbreak at Tongogara refugee camp in Chipinge District, Zimbabwe, 2021: a case\u2013control study

BackgroundMalaria is a leading cause of morbidity and mortality among forcibly displaced populations, including refugees, approximately two-thirds of whom reside in malaria endemic regions. Data from the rapid disease notification system (RDNS) reports for Manicaland Province in Zimbabwe showed that despite implementation of malaria control initiatives, there was an increase in number of malaria cases above action thresholds at Tongogara refugee camp in Chipinge district during weeks 12–14 of 2021. An investigation that described the outbreak by person, place and time was conducted. Malaria emergency preparedness, response, and appropriateness of case management were assessed. The factors associated with contracting malaria were determined to enable the formulation of appropriate interventions, establish control, and prevent future malaria outbreaks among this vulnerable population.MethodsA 1:1 unmatched case–control study involving 80 cases and 80 controls was conducted using interviewer-administered questionnaires at household level. Data was entered into Epi Data version 3.1 and quantitative analysis was done using Epi Info™ version 7.2.2.6 to generate medians, proportions, odds ratios and their 95% confidence intervals.ResultsMalaria cases were distributed throughout the 10 residential sections within Tongogara refugee camp, the majority being from section 7, 28 (35%). Despite constituting 11% of the total population, Mozambican nationals accounted for 36 (45%) cases. Males constituted 47 (59%) among cases which was comparable to controls 43 (54%), p = 0.524. The median age for cases was 15 years [Interquartile range (IQR), 9–26] comparable to controls, which was 17 years (IQR, 10–30) (p = 0.755). Several natural and man-made potential vector breeding sites were observed around the camp. Risk factors associated with contracting malaria were engaging in outdoor activities at night [AOR = 2.74 (95% CI 1.04–7.22), wearing clothes that do not cover the whole body during outdoor activities [AOR 4.26 (95% CI, 1.43–12.68)], while residing in a refugee housing unit reduced the risk of contracting malaria [AOR = 0.18 (CI, 0.06–0.55)].ConclusionsThe malaria outbreak at Tongogara refugee camp reemphasizes the role of behavioural factors in malaria transmission. Intensified health education to address human behaviours that expose residents to malaria, habitat modification, and larviciding to eliminate mosquito breeding sites were recommended.

Interdisciplinary Care and Preparedness for Kidney Failure Management in a High-Risk Population

Rationale & ObjectiveInterdisciplinary care may improve health outcomes in patients with chronic kidney disease (CKD). Few studies have evaluated this model of health care delivery in racial and ethnic minorities.Study DesignRetrospective cohort study.Setting & ParticipantsIncident end-stage kidney disease (ESKD) patients at Montefiore Medical Center from October 1, 2013, to October 31, 2019.ExposurePre-ESKD interdisciplinary care.OutcomesPre-ESKD transplant listing and optimal kidney replacement therapy (KRT) start (use of arteriovenous access at hemodialysis initiation, outpatient hemodialysis start, preemptive transplant, or peritoneal dialysis as the first modality).Analytical ApproachWe constructed multivariable logistic regression models adjusted for sociodemographic and clinical factors to determine the odds of transplant listing and optimal KRT start between interdisciplinary versus the usual care group.ResultsOf the 295 incident ESKD patients included in our study, 84 received interdisciplinary care and 211 received usual nephrology care. The mean age was 59.9 years (standard deviation, 13.9 years), 47% were women, and 87% were African American or Hispanic. Baseline characteristics were similar between the groups, except that the interdisciplinary care group had a lower prevalence of hypertension (60% vs 75%). Compared with usual care, a higher proportion of patients in the interdisciplinary care group were listed for kidney transplant (44% vs 16%) and had an optimal KRT start (53% vs 44%). Receipt of interdisciplinary care was associated with a higher odds (OR, 5.73; 95% CI, 2.78-11.80; P < 0.001) of transplant listing compared with usual care after adjusting for important sociodemographic and clinical factors. The odds of an optimal KRT start also favored interdisciplinary care (OR, 1.60; 95% CI, 0.88-2.89; P = 0.12) but did not achieve statistical significance.LimitationsThe study was non-randomized and had a small sample size.ConclusionsInterdisciplinary care is associated with better ESKD preparedness compared with usual nephrology care alone in racial and ethnic minorities. Larger studies are needed to determine the effectiveness of interdisciplinary care in patients with advanced CKD.