Posted at 10.09.2018
Background: The city consciousness, preparedness and response to open public health emergencies are essential for successful response to general public health emergencies and the study is carried out to look for the community recognition and belief on health sector preparedness and response to Cyclone Nargis which is the most detrimental natural disaster in history of Myanmar.
Methods: Total of 6 target group conversations are carried out in 3 villages which can be severely influenced by Cyclone Nargis. Manual thematic content examination is done to look for the community perception by qualitatively.
Results: Most the participants understood the warning for the cyclone nevertheless they are unaware on the particular intensity and where you can make landfall of cyclone. There are some gaps on preparedness anticipated to insufficient experience to previous cyclone and weakness in knowledge for how to get ready for cyclone. There may be some training and education on community health emergencies management before the cyclone but the software and coverage of working out and education were not enough to make satisfactory preparedness by community. Almost all of the participants get some varieties of health services and alleviate items by health sector with most them are positive behaviour towards health services given to them. However, almost all of the participants described they are not thinking about health education directed at them. Aside from a few members, they learn how to prepare for future cyclone and the knowledge should be preserved.
Conclusion: Based on the results, there was some weakness in community level understanding on how to prepare and respond to cyclone prior to the Cyclone Nargis. However, community awareness is significantly improved upon after Cyclone Nargis but health sector should be sure to sustain the understanding for optimum preparedness and respond to open public health emergencies.
Major emergencies, disasters and crises are approximately 450 to 800 major emergencies per calendar year and are influencing social, monetary of the city and public [1, 2]. Cyclone Nargis struck the coastline of Myanmar on 2 and 3 May, 2008 and transferred inland through Ayeyarwady Delta creating many fatalities, destroying infrastructure, influencing on economic and sociable activities. It had been the most disastrous natural disaster in history of Myanmar and the most lethal cyclone in Asia since 1991 . Although many emergencies are often unpredictable, however the impact of catastrophe can prevent and mitigate by strengthening the response capacity of nations and communities in danger . Community level preparedness is also important because people at community level are first responder to emergencies and catastrophe . It is also advised that humanitarian action and health services in emergencies and disasters must respect for the culture and health perceptions of the afflicted areas . Mortality due to the 2004 Indian Ocean tsunami was focused in the first few days of the devastation  and community preparedness is essential for prevent pointless death. Focus group talk pays to to determine the belief of disaster preparedness program and their frame of mind on disasters and emergencies . The analysis done by Nozawa M also exposed that the understanding and behavior of the community are essential for pursuing with evacuations advice . By concentration group discussion, it can also identify the socioeconomic and behaviors factors related to catastrophe preparedness and response which is useful for disaster management in the precise area [9, 10]. Additionally it is recommended that obtaining feedback from community about their notion on relief businesses is essential for future planning and response to devastation . By finding out the community notion on preparedness and respond to Cyclone Nargis, the results will be useful for the future public health crisis preparedness and response in Myanmar.
Cross sectional research design with qualitative method (target group dialogue) is employed for persistence on notion of community consciousness on preparedness and response by health sector to Cyclone Nargis.
The study human population is selected from Ngapudaw, Labutta, Bogale, Pyapon, Dedaye, Mawlamyinegyun, kungyangon townships which experienced high mortality scheduled to Cyclone Nargis. The study is completed in 3 villages, namely amar village and kyan-ka-dune village in pyapone township and mangalake community in kynechangone township which is greatly afflicted by Cyclone Nargis. In each village two emphasis group conversations, one for community members and one for government personnel and community market leaders, are completed. Each focus group of between 6 to 9 women and men are selected relating to criteria such as mature men and women with get older above 18 years old and at least one third are women; one group compose of government service employees such as health, education, agriculture, law enforcement and community innovator and another group compose of common community users.
The questionnaires such as information, alert, education and training, public health services and curative health services given to the community by health sector prior to and after Cyclone Nargis are ready for diagnosis of community belief on preparedness and respond to Cyclone Nargis by health sector. The target group conversations are documented by tape and records and the dialogue time range from 65 to 95 minutes.
Multistage sampling methods are being used for selection of 3 sites for target group discourse to assess the city awareness about disaster preparedness and response. Two townships are decided on by simple arbitrary sampling methods among Ngapudaw, Labutta, Bogale, Pyapon, Dedaye, Mawlamyinegyun and Kungyankone townships which endured the high mortality during Cyclone Nargis. Finally, one or two villages from each township are determined by simple random sampling methods. The members for community participants are choose from different occupations, education levels and different sections of town by purposive sampling.
The ethical approvals from Ministry of Health, Myanmar and Faculty of Tropical Remedies, Mahidol University already are getting prior to handle the focus group dialogue. The emphasis group talk is completed in Apr 2010. Two facilitators and two word takers are used to carry out the focus group discussion. The data from target group debate is coded by two people in summary the answers from participants on information, preparedness and reaction to Cyclone Nargis by health sectors. Agreement between your two coders is determined and if agreement is good, manual thematic content examination is used to analyze by qualitatively to learn their experiences on information, warning, education and training, public health services and curative health services given to the city by health sector prior to and after Cyclone Nargis.
The total of 22 community associates is involved with 3 community associates categories. The youngest is 18 yrs. old and the oldest is 58 years old with mean age is 34. 4 years in this group. A lot of the community associates are farmers while others are students, vendors, anglers, manual labors, and dependents. A couple of 20 individuals in government personnel, community market leaders and NGOs member with 7 health personnel, 5 community market leaders, 5 NGOs participants and 3 from other authorities departments. The youngest in this group is 24 yrs. old and the oldest participant is 67 yrs. old with mean age is 41. 1 years.
Most of the individuals in community participants groups knew the news of warning and there were a few of the individuals who still didn't hear the information. Lots of the participants who knew the warning said announcement was manufactured in frequent interval from radio and tv set. However, they noticed the alert only in short time prior to the storm made land land on the area. Most the participants were not aware of the level and where to hit the Cyclone Nargis.
"I understood from the tv set and alert was announced after every music. However, I didn't even realize the cyclone was approaching to my town and only understood the warning 2-3 hours ahead. " (19 years old student)
Almost all the participants in the federal government staff and community members noticed the information of the surprise. But some of these still didn't notice areas which were struck by Cyclone and they didn't relay information to the villagers.
"As a village innovator, I didn't relay the warning to villagers. Most of them (villagers) knew plus they didn't expect this intensity. " (42 years of age village leader)
For the foundation of warning, most of the villagers received Nargis caution from media such as radio and television set.
"A lot of the villagers knew from radio and they didn't do anything. Because of insufficient electricity in my community, we relied on radio for information. "(37 years of age woman)
Generally, the villagers knew the Cyclone Nargis information from mass media nonetheless they lack the knowledge on interpretation of the warning. The villagers recognized the warning in a nutshell time which is insufficient to make sufficient preparedness for the Cyclone.
Majority of individuals discuss they didn't have almost nothing of preparedness credited to insufficient previous experience on how to respond to cyclone. There were also anticipated to spaces in knowledge on Cyclone Nargis heading to their area. A few mentioned on spiritual believe (KARMA) for doing little or nothing.
"Every individual has the beginning and fatality as religious believe and I didn't prepare anything. " (53 yrs. old woman)
"I didn't have any preparedness because I've never experienced like this before. The alert didn't include how to get ready and it didn't disturb my meal. " (39 years old women)
They left their house after cyclone harmed their house and visited religious and general population complexes for shelter.
"My house ruined by Cyclone at 10pm, my family went to village monastery. Every villager went to monastery because it was situated in high ground and very good. Our village was quite fortunate with a few deaths to have shelter in monastery but in Laut-me village some causalities happened. " (23 years old girl)
One participant from authorities personnel and community leaders mentioned excitement exercises in his area following the Indian Ocean tsunami in 2005 but villagers weren't interested.
"Tsunami drill was carried out in my village at nationwide level through division and townships after tsunami in 2005. However, the villagers weren't interested. " (53 yrs. old health staff)
Overall, the villagers didn't learn how to prepare for Cyclone due to lack of interest and weakness in education or training on Cyclone preparedness before Nargis.
Majority of the members pointed that there was some spaces or weakness of training on catastrophe preparedness and response in their area one year before Cyclone Nargis. One health staff mentioned the obtaining training for catastrophe management in undergraduate program before Nargis but she wasn't acquainted with how to use in public areas health crisis situations.
"In health assistance training program, this issue (disaster management) was included. I didn't relay the training on the villagers because these were not interested. " (30 years old health personnel)
Some members said the devastation preparedness issue was involved with basic education curriculum for university children but parents weren't interested.
All the villages from which the members resided received some kinds of health services after Cyclone Nargis and on the other hand, the arriving of medical clubs with their villages ranged from 2 times to 2 weeks. They required treatments from medical teams if they got medical problems and there have been few issues of inexperienced medical clubs.
"Medical teams included both experienced and inexperienced groups. It is better to come by experienced medical teams. " (35 years old farmer)
Almost all the members received some alleviate materials such as normal water and sanitation items, foundation nets and medicines from health sector but difference in obtaining relieve items among villages were pointed out by some villagers.
"First medical team found its way to 10 days and nights after Cyclone and villagers seek treatment from the team. They sent out drinking water purification tablets however the villagers didn't learn how to use and the smell was quite strong. " (43 yrs. old man)
Most of the villagers described the success in sanitary latrine building however the others said it was not successful in their villages because of the facts that the poor villagers could not construct sanitary latrine by offering of only latrine pans.
"----- built the sanitary latrines free of charge and there was almost no sanitary latrine at the villages before Nargis. The villagers created them because the business provide not only latrine skillet, but also give structure cost. " (45 yrs. old farmer)
Few villagers talked about having less psychosocial healthcare and dead bodies' clearance in their villages. Majority said they only visited health education if indeed they received some incentives such as reducing items.
"Health education on communicable diseases were present, most of the villagers did not join because they were busy and not settled. " (24 years of age woman)
The health employees also remarked that the villagers were seeking treatments from medical clubs that resulted in success of immunization program while others. However, they pointed out the lack of interest on health education by villagers. Generally, the villagers had taken health services distributed by health areas if required however, not considering health education.
Almost all villagers said these were satisfied with health care provided nevertheless they preferred those who paid them all bills including referral bills. In addition they preferred the train station medical clubs to mobile groups due to availability of health services all the changing times.
"We were content with all medical clubs, they gave enough drugs. The diseases were also treated and villagers wanted treatment. But, we preferred onsite team for seeking treatment with time of need. " (19 yrs. old woman)
Most of the participants are positive attitudes towards relive items provided by health sector and community market leaders also pointed out the villagers were satisfied with obtaining relieve items because they're poor.
"We preferred organizations (--------) for presenting both treatments and alleviate items. A lot of the villagers were satisfied if the team provided relieve items. " (42 years of age village leader)
Health personnel brought up coordination between NGOs and township health team was good plus some complaint of inappropriate or more than enough supply of items was provided to them.
"Township set up the coordination conferences and there was no overlapping of medical groups in one area. But, a few of items found its way to more than enough amount such as malaria drugs, B1 tablets and medical tools. Our township was not malaria common. " (53 years old health staff)
Majority of villagers stated lack of fascination with health education because they were busy with the work. The health personnel also pointed out the success of some health programs such as immunization after Cyclone Nargis but stressed on insufficient interest on health educations by villagers.
"Villagers came to health education only if given relieve items because these were poor and quite negative attitudes towards health education. " (34 years of age health staff)
Generally, villagers possessed positive attitudes into the medical groups and relived items given by medical teams. On the other hands, they didn't want to take part in health education anticipated to several reasons.
The villagers pointed out that pneumonia, ARI, diarrhea diseases, injury and mental health problems were common health issues in their area immediately and within 6 months after Cyclone Nargis. Health employees also arranged with the normal health problems brought up by villagers. The health employees also reported that there is no outbreak of communicable diseases within 6 months after Cyclone.
"The villagers suffered diarrhea, common chilly, pneumonia especially in children, abs pain. Some suffered the injuries due to Nargis. We got enough drugs with no costs. " (25 years old fisherman)
Generally, medical problems discuss by villagers was appropriate for common diseases reported by health management information systems/INGOs after Cyclone (11).
The villagers, community leaders and government workers stressed the value of building of cyclone shelter and catastrophe resistance building, presence of life jacket, normal water and food as preparedness for Cyclone. They also desired to store drugs, tents and normal water and sanitation items in health centers because of highways blockage after Cyclone. They wish to get advanced alert on Cyclone and carry out of drill and training on disasters. There are also a few villagers, who don't want to make any preparedness anticipated to idea on KARMA (spiritual notion).
"Life jackets should be allocated to villagers and villagers should prepare for water pots and drinking water because the ponds could not be used after Cyclone because of entry of seawater. " (47 years old woman)
"As being a hospital, we ought to predisposition of essential drugs, normal water and sanitation items, and short-term tents for patients because a healthcare facility can be destroy by Cyclone. Drill should be carried out as planning for devastation. " (53 years old health staff)
Overall, the participants had awareness how to prepare and response to future Cyclone which knowledge should be suffered.
Data from the study uncovered that some villagers and community participants will not be familiar with the weather warnings and there must be conditioning of education programs for community on familiar with weather warnings. Weather warnings will include how to prepare and response for Cyclone. Warnings also needs to be through town market leaders because of unawareness the warning from mass media by some villagers. Education on common disasters term such as power of hurricane can boost the community knowledge about hazards risks . It is also recommended that the warning should be advanced for enough time on evacuation and preparedness by community and should include how to prepare and response. The communities are first responder to emergencies and addititionally there is advisable that conditioning of community based training about how to prepare and response to disaster . The villagers will take shelter in public areas and religious building in emergency situation and community and religious complexes should be disaster resistant. World Health Corporation also advised that development of disaster resistant health facilities as safe medical center initiatives [14, 15]. Sometimes, it may take 48 to 72 hours to take outside the house medical teams to attain the disaster afflicted area  and community search and save team with predispositions of medicines and gadgets should be strengthened at township levels based on need diagnosis for immediate response before the exterior medical team arrived . Subject areas on health sector devastation management should be building up in training of basic health staffs because basic health staffs are presenting the essential healthcare at community level. Without proper coordination among different stakeholders, response to general public health emergencies/disasters may have negative impact . Good coordination for medical services between stakeholders in response to Cyclone Nargis should be maintained for future general public health emergency response. The alleviation operation must look into the local context affected by catastrophe and sometime the relief operation fails to consider the local beliefs and contexts . The the majority of the target group members are positive attitudes towards health services directed at them but also consider the voices of concern from a few individuals especially the prone people in future public health disaster response [13, 18]. It is also recommended that distribution of drugs and medical accessories should be based on requirements at community level. Sustainability of community understanding is also very important to public health emergencies management and health sector also needs to consider how to make attractive for health education given to disaster affected populace . In addition, Ricon et al unveiled that previous contact with hurricane might not have have an effect on on better preparedness to future hurricane in USA . Cyclone shelters should be created in big villages located in surprise surge area because devastation resistance buildings decrease the risk of disasters . Drill is the better practice for evaluation of general population health emergencies preparedness and drill affecting community should be achieved at least every year for readiness for preparedness .
There are also restrictions about the analysis. Firstly, study populace will not indicate the conception of the whole population credited to small sample size. Secondly, information bias may likely to turn out because the analysis is completed two years following the events.
There is some weakness in community recognition, preparation and reaction to Cyclone Nargis. Community level planning, recognition, preparedness and response are essential for elimination and reaction to public health disaster. It is discovered that community consciousness is significantly better after Cyclone Nargis and health sector must maintain the city level awareness due to low consistency and high impact mother nature of major disasters.
The writers declare that there haven't any competing hobbies.
NWM, JK, PS were involved in the conceptualization and design of the analysis. NWM well prepared research equipment and other study logistics, accumulated data in Myanmar. KWT helped in research management and data support in Myanmar. KC, PS, AKM, PP provided conceptual platform and technical support for the study. NWM and JK performed analyses and drafted the manuscript. All creators read and approved the ultimate manuscript.
We wish to give thanks to Myanmar Ministry of Health for agreement to handle the analysis. We give special thanks to Pyapone Region Health Department and Kungyankone Township Health Division and the participants for concentration group discussions to be a part of study. Thank you DAAD and SEAMEO-TROMED for his or her partly support in research offer.