Spatial Modelling of Gastroenteritis Prevalence Following the February 22, 2011 Earthquake and Identification of Successful Factors Preventing Outbreaks at Emergency Centres
The potential for a gastroenteritis outbreak in a post-earthquake environment may increase because of compromised infrastructure services, contaminated liquefaction (lateral spreading and surface ejecta), and the presence of gastroenteritis agents in the drinking water network. A population in a post-earthquake environment might be seriously affected by gastroenteritis because it has a short incubation period (about 10 hours). The potential for a gastroenteritis outbreak in a post-earthquake environment may increase because of compromised infrastructure services, contaminated liquefaction (lateral spreading and surface ejecta), and the presence of gastroenteritis agents in the drinking water network. A population in a post-earthquake environment might be seriously affected by gastroenteritis because it has a short incubation period (about 10 hours). The aim of this multidisciplinary research was to retrospectively analyse the gastroenteritis prevalence following the February 22, 2011 earthquake in Christchurch. The first focus was to assess whether earthquake-induced infrastructure damage, liquefaction, and gastroenteritis agents spatially explained the recorded gastroenteritis cases over the period of 35 days following the February 22, 2011 earthquake in Christchurch. The gastroenteritis agents considered in this study were Escherichia coli found in the drinking water supply (MPN/100mL) and Non-Compliant Free Associated Chlorine (FAC-NC) (less than <0.02mg/L). The second focus was the protocols that averted a gastroenteritis outbreak at three Emergency Centres (ECs): Burnside High School Emergency Centre (BEC); Cowles Stadium Emergency Centre (CEC); and Linwood High School Emergency Centre (LEC). Using a mixed-method approach, gastroenteritis point prevalence and the considered factors were quantitatively analysed. The qualitative analysis involved interviewing 30 EC staff members. The data was evaluated by adopting the Grounded Theory (GT) approach. Spatial analysis of considered factors showed that highly damaged CAUs were statistically clustered as demonstrated by Moran’s I statistic and hot spot analysis. Further modelling showed that gastroenteritis point prevalence clustering could not be fully explained by infrastructure damage alone, and other factors influenced the recorded gastroenteritis point prevalence. However, the results of this research suggest that there was a tenuous, indirect relationship between recorded gastroenteritis point prevalence and the considered factors: earthquake-induced infrastructure damage, liquefaction and FAC-NC. Two ECs were opened as part of the post-earthquake response in areas with severe infrastructure damage and liquefaction (BEC and CEC). The third EC (CEC) provided important lessons that were learnt from the previous September 4, 2010 earthquake, and implemented after the February 22, 2011 earthquake. Two types of interwoven themes identified: direct and indirect. The direct themes were preventive protocols and indirect themes included type of EC building (school or a sports stadium), and EC staff. The main limitations of the research were Modifiable Areal Units (MAUP), data detection, and memory loss. This research provides a practical method that can be adapted to assess gastroenteritis risk in a post-earthquake environment. Thus, this mixed method approach can be used in other disaster contexts to study gastroenteritis prevalence, and can serve as an appendage to the existing framework for assessing infectious diseases. Furthermore, the lessons learnt from qualitative analysis can inform the current infectious disease management plans, designed for a post-disaster response in New Zealand and internationally Using a mixed-method approach, gastroenteritis point prevalence and the considered factors were quantitatively analysed. A damage profile was created by amalgamating different types of damage for the considered factors for each Census Area Unit (CAU) in Christchurch. The damage profile enabled the application of a variety of statistical methods which included Moran’s I , Hot Spot (HS) analysis, Spearman’s Rho, and Besag–York–Mollié Model using a range of software. The qualitative analysis involved interviewing 30 EC staff members. The data was evaluated by adopting the Grounded Theory (GT) approach. Spatial analysis of considered factors showed that highly damaged CAUs were statistically clustered as demonstrated by Moran’s I statistic and hot spot analysis. Further modelling showed that gastroenteritis point prevalence clustering could not be fully explained by infrastructure damage alone, and other factors influenced the recorded gastroenteritis point prevalence. However, the results of this research suggest that there was a tenuous, indirect relationship between recorded gastroenteritis point prevalence and the considered factors: earthquake-induced infrastructure damage, liquefaction and FAC-NC. Two ECs were opened as part of the post-earthquake response in areas with severe infrastructure damage and liquefaction (BEC and CEC). The third EC (CEC) provided important lessons that were learnt from the previous September 4, 2010 earthquake, and implemented after the February 22, 2011 earthquake. The ECs were selected to represent the Christchurch area, and were situated where potential for gastroenteritis was high. BEC represented the western side of Christchurch; whilst, CEC and LEC represented the eastern side, where the potential for gastroenteritis was high according to the outputs of the quantitative spatial modelling. Qualitative analysis from the interviews at the ECs revealed that evacuees were arriving at the ECs with gastroenteritis-like symptoms. Participants believed that those symptoms did not originate at the ECs. Two types of interwoven themes identified: direct and indirect. The direct themes were preventive protocols that included prolific use of hand sanitisers; surveillance; and the services offered. Indirect themes included the EC layout, type of EC building (school or a sports stadium), and EC staff. Indirect themes governed the quality and sustainability of the direct themes implemented, which in turn averted gastroenteritis outbreaks at the ECs. The main limitations of the research were Modifiable Areal Units (MAUP), data detection, and memory loss. It was concluded that gastroenteritis point prevalence following the February 22, 2011 earthquake could not be solely explained by earthquake-induced infrastructure damage, liquefaction, and gastroenteritis causative agents alone. However, this research provides a practical method that can be adapted to assess gastroenteritis risk in a post-earthquake environment. Creating a damage profile for each CAU and using spatial data analysis can isolate vulnerable areas, and qualitative data analysis provides localised information. Thus, this mixed method approach can be used in other disaster contexts to study gastroenteritis prevalence, and can serve as an appendage to the existing framework for assessing infectious diseases. Furthermore, the lessons learnt from qualitative analysis can inform the current infectious disease management plans, designed for a post-disaster response in New Zealand and internationally.