Health status of transitional resettlement sites after the earthquake in Mianyang city of Sichuan province

doi:10.4236/health.2009.14049

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Vol.1, No.4, 298-303 (2009)

doi:10.4236/health.2009.14049

SciRes

Health

Health status of transitional resettlement sites after the

earthquake in Mianyang city of Sichuan province

Ying-Hua Li, Ling Qian, Xue-Qiong Nie, Li LI, Xian-Peng Meng, Jin-Bin Zhang, Li Tong, Li

Xiao, He Xing, Chang-Sheng Huang, Tao Hu, Yan Ning, Yan Chen, Yu Ma, Mao-Xuan Tao

Chinese Center for Health Education, Beijing, China; liyinghua729@sina.com

Received 5 August 2009; revised 1 September 2009; accepted 1 September 2009.

ABSTRACT

Objective: To understand the health status of

transitional resettlement sites and the needs

of residents on health education, and to pro-

vide basis for conducting health education

after ear- thquakes and other public emergen-

cies. Method: From May 31 to June 2, 2008 (19

to 21 days after the earthquake), field obser-

vation, questionnaire survey, and structured

interviews were conducted in five transitional

resettlement sites. Information on health

status, health service, health education, and

residents’ needs on health education was col-

lected. Results: 430 questionnaires were dis-

tributed and 424 valid completed ones were

returned. Food and water were adequately

supplied. Clinics for health assistance were

established and environment disinfecting was

conducted regularly by public health profes-

sionals. Health education was available to

residents. The large proportion (98.6%, 97.9%,

88.7%, and 93.2% respectively) of the residents

acknowledged that water supply, food supply,

lavatories, and health service were adequate

to fulfill basic needs. The overall disease in-

cidence of surveyed residents was 44.8%, and

diarrhea and fever with respiratory symptoms

were the most common diseases. Among

residents’ needs on disease prevention knowl-

edge and skills, basic knowledge of infectious

diseases was most desirable (49.8%), and

safety knowledge of water uses was secon-

darily most desirable (36.8%). The most fa-

vored approach of obtaining knowledge was

watching television. Conclusions: In the pe-

riod of 20 days after the earthquake, Living

security, health facilities, and health care ser-

vice could satisfy residents’ basic needs.

Post-disaster health education should con-

centrate on basic knowledge and skills of

communicable diseases and health- risky be-

havior. Timely distributing disease prevention

materials could be effective.

Keywords: Earthquake; Disaster Areas; Health

Status; Health Education; Needs;

1. INTRODUCTION

On May 12, 2008, an earthquake with magnitude 8.0 hit

Wenchuan, Sichuan Province. The quake caused thou-

sands of deaths and injured, destroyed buildings and

roads, and brought about huge financial loss. In the af-

fected area, water and electricity supply were interrupted,

and health care facilities and systems were enormously

damaged, which resulted in the high risk for the outbreak

and epidemic of intestinal communicable diseases, vec-

tor-borne diseases, food-borne diseases, diseases of

natural focus, and infectious diseases transmissible be-

tween human and animals. Food and water safety, envi-

ronmental health, health care service, and

post-earthquake health education were the most impor-

tant issues in disaster relief. To understand the health

condition of transitional resettlement sites and residents’

needs on health education, Health Education Institute,

Chinese Center for Disease Control and Prevention

(China CDC) (Note：now named Chinese Center for

Health Education/ Heath News Communication Center,

Ministry of Health of China) conducted this study from

May 31 to June 2, 19 to 21 days after the earthquake.

2. METHODS

2.1. Participant

The resident in five transitional resettlement sites in

Mianyang city, Sichuan Province were surveyed by the

same questionnair, and they were from Beichuan

county, one of the worst-hit areas. Four hundred and

thirty questionnaires were distributed, and four hun-

dred and twenty four valid questionnaires were re-

Y. H. Li et al. / HEALTH 1 (2009) 298-303

299

turned. Sixty participants (14.2%) were currently liv-

ing in Huangtu transitional resettlement sites, seventy

two (17.0%) in Anzhou driving school, one hundred

and fourteen (25.9%) in Leigu, Beichuan, and sixty

eight（16.0%) in Gaoxin. Participants were Beichuan

County residents, 208 males and 216 females. The

average age was 35.3±13.3,, the minimum age was 10

and the maximum age 84. Most of them (70.5%）had

an elementary or middle school degree,and 78.3% of

them were from Qiang minority race.

2.2 Sampling Methods

Convenience sampling method was used to select five

sites for observation and participants for survey. Age and

gender were proportionally distribute.

2.3. Observation

Administrators examined the heath condition, health

care, and health education at transitional resettlement

sites. Collected information included water and food

supply, living health condition, environmental health

(i.e., lavatories, and garbage collection and manage-

ment), health care and drug supply, and the condition of

health education.

2.4. Questionnaire Survey

The questionnaire was self-designed and some contents

were derived from environmental assessment question-

naire developed by China CDC and WHO [1-3], includ-

ing several dimensions: water and food supply, health

condition, health care, incidence of diseases, and post-

disaster needs. Participants were interviewed face-to-

face by administrators.

2.5. Personal In-Depth Interview

Participants were randomly selected from those who

were recruited for questionnaire survey. Interviews fo-

cused on post-disaster water and food supply, personal

hygiene stuff, the interruption of cooking food, residents’

evaluation on health education materials, and the major

difficulties they were facing.

2.6. Quality Control Survey Administrators

Received Standardized Trainings

They were guided and supported by local health depart-

ments. Participants were informed of the intent and im-

portance of the study. Leaders of each survey group su-

pervised the information collection process and assessed

every returned questionnaire

2.7. Statistical Analysis

Epi data 3.0 was used to help data entry, and SPSS 13.0

was used to conduct statistical analysis.

3. RESULTS

3.1. Health Condition and Health Care

It was indicated by observation and survey that there

was sufficient drinking water and food supply in transi-

tional sites. Lavatories were enough to serve temporary

residents. Every transitional site had established tempo-

rary health assistance and professionals to carry out en-

vironmental disinfection. Health education in form of

health materials, posts, lectures, and volunteer in-door

health promotion was delivered. However, water for

living was not adequate at several sites, and the types of

medicine were limited, as shown in Table 1 and Table 2.

3.2. Diseases and Sought for Health Care

Fifty eight participants (13.7%) ever had diseases or

symptoms. Diarrhea (54.2%) and fever with respiratory

symptoms (32.1%) were the most common health prob-

lems.

3.3. Health Education Condition and Needs

3.3.1. Residents’ Health Knowledge, Belief and

Practice

Participants had some health-related knowledge and high

level of awareness of drinking water safety and rabid.

However, unhealthy behaviors occurred among residents,

including drinking uncooked or unprocessed water, us-

ing domestic water that had not been disinfected, and

failing to discharge leftovers as shown in Table 3.

3.3.2. Health Education Needs

In response to the question of the two most desirable

things, 101 participants (23.8%) expressed that one of

them should be health and disease prevention knowledge,

while the majority of them supported that they should be

the living necessities including water, food, and resi-

dence. Thirteen participants thought that they did not

need any assistance. In response the question of the two

most desirable medical assistances, 188 participants

(44.3%) supported that one of them should be diseases

prevention knowledge and skills, while the majority of

them wanted convenient health care service. Twenty six

participants (6.1%) thought they did not need any health

assistance. When it came to knowledge and skills of

diseases prevention, basic information about communi-

cable diseases was most favored, as shown in Table 4.

3.3.3. Where to Access the Knowledge and

Skills of Disease Prevention

Participants gained knowledge and skills mainly from

the health education materials, including booklets, bro-

chures, foldouts, and posts, and the programs broad

casted by the speakers in transitional sites were the most

popular strategy to deliver health education. The most

favorable way is television and materials.

K. C. Chou et al. / Natural Science 1 (2009) **-**

300

3.4. Personal Interview Results

One hundred and thirteen participants were inter-

viewed. Twenty eight (24.8%) were currently living in

Huangtu transitional resettlement sites, twenty five

(22.1%) in Anzhou driving school, thirty six (31.9%)

in Leigu, Beichuan, eighteen (15.9%) in Yong’an, and

six (5.3%) in Gaoxin. There were 43 males (38.1%)

and 70 females (61.9%). The average age was 40.3±

6.5, the minimum age was 10 and the maximum age

was 71. Most of them (78.9%) were from 18 to 59

years old.

The percentages of participants who experienced in-

terruption of food, drinking water, domestic water, lava-

tory, safe living places, health care, bathroom stuff, and

food processing stuff were 45.0%, 45.5%, 44.4%, 46.2%,

53.3%, 48.1%, 53.8% and 83.0%, respectively.

Table 1. Health condition and Health care.

Items Condition Identified problems

Food

Collectively and adequately supplied; Mainly

packaged food; Infant formula milk powder sup-

plied; A few cooked food supplied.

Singleness of food types; Impossible

for cooking processing.

Drinking water Mainly bottled; Collectively supplied. Cooked water supply not sufficient

Domestic water

Water disinfection by big water processing equip-

ments; Collectively supplied; Water collection sites

with 50 meters or five-minute walking distance.

If water from rivers or springs was

used, disinfection could not be done by

residents.

Residence condition

Mainly tents set by governments; Approximately

12 square meters for 8-10 residents; Temporary

wood buildings established for health care assis-

tance use.

Extreme density.

Lavatory

Mainly dry lavatories build after the tremor;

Cleaned every day; Within 50 meters and five-

minute walking distance.

The hygiene of the lavatories survived

from the tremor and commercial lava-

tories were not acceptable.

Environmental

health

Most garbage cans topped and depleted every day;

Insecticide applied two times a day; Mosquito nets

distributed to children; Livestock feeding stuff

possible at several sites and animals fenced.

Uncanned garbage found in transi-

tional sites.

Health care One or more health care place for each site, within

50 meters and five-minute walking distance.

Supply of medicine for chronic dis-

eases adequate.

Health education

Posts and brochures distributed; Health knowledge

promoted by medical professionals and volunteers;

Broadcasting programs available in some sites.

Materials mainly in the form of leaflets

and brochures; Content deficient in

diversity.

Table 2. Residents’ evaluation on health condition and health care.

Items Reaction Number %

Drinking water Completely satisfied 316 74.5

Basically satisfied 102 24.1

unsatisfied 6 1.4

Food Completely satisfied 295 69.6

Basically satisfied 120 28.3

unsatisfied 9 2.1

Lavatory Completely satisfied 222 52.4

Basically satisfied 154 36.3

unsatisfied 48 11.3

Lavatory condition Clean 341 80.4

Fairly clean 61 14.4

Less clean 22 5.2

Commit nuisance Commonly 14 3.3

Less commonly 73 17.2

Rarely 337 79.5

Mosquitoes and flies Many 143 33.8

Comparatively less 155 36.6

Few 126 29.7

Health care Completely satisfied 251 59.2

Basically satisfied 144 34.0

unsatisfied 29 6.8

Openly accessible at

Y. H. Li et al. / HEALTH 1 (2009) 298-303

301

Table 3. Health knowledge, belief, and practice.

Questions The number of yes

responses %

Knowledge and belief

Drinking uncooked or unprocessed water could do harm to health.402 94.8

Do not share washbasins and towels with relatives who had pink-

eye disease. 295 69.6

Rabid vaccine is needed after being biting or scratched by dogs

and cats. 391 92.2

Behavior

Ever drunk uncooked or unprocessed water 55 13.0

Disinfected domestic water that was collected by themselves

(n=110)* 51 46.3

Ate overdue food (n=167)* 6 3.6

Discharged waste water everywhere 27 6.4

Cleaned garbage everyday 62 14.6

Made efforts to prevent mosquitoes, flies, and rats 195 46.0

Ventilated living places 378 89.2

Washed hands before meals and after using the restroom. 396 93.4

Leftover reheating (n=163)*

Completely reheated 123 75.5

Just warmed 16 9.8

Did not reheat, because of lack of needed equipments 19 11.7

Did not reheat, since it is not needed 5 3.1

Separated the raw and the cooked (n=58)*

Yes. 54 93.1

No, since not allowed by living situations. 4 6.9

No, since it is not needed. 0 0.0

Note:* indicated that only those ever had overdue food, needed stuff for cooking, and self collected water were

surveyed.

Table 4. Participants’ needs on general support, health care, and disease prevention.

Items Number %

General supports（The most desirable two）

Safe living places 259 61.1

Sufficient water and food supply 178 42.0

Knowledge and skills of health and diseases prevention 101 23.8

Ability and skills of escaping from the tremor and helping each other 63 14.9

Psychological assistance 26 6.1

Others 65 15.3

Needs on health and disease prevention（The most desirable two）

Convenient health care service 191 45.0

Knowledge and skills 188 44.3

Disinfectants 182 42.9

Medicines 4 0.9

Needs on knowledge and skills of disease prevention

Basic knowledge of communicable diseases 211 49.8

Drinking water safety 156 36.8

Food safety 140 33.0

Prevent mosquitoes, flies, and rats 132 31.3

Local communicable diseases 126 29.7

Y. H. Li et al. / HEALTH 1 (2009) 298-303

302

Table 5. Where to access the knowledge and skills of disease

prevention.

Already gained Expected to gain

Where Number % Number %

Television 131 30.9 195 46.0

Broadcasting 159 37.5 127 30.0

Newspapers 102 24.1 94 22.2

Books 61 14.4 89 21.0

Medical professionals 100 23.6 123 29.0

CDC staff 123 29.0 126 29.7

Relatives/ friends 62 14.6 42 9.9

Propaganda materials 209 49.3 160 37.7

The speakers in tran-

sitional sites 24 5.7 20 4.7

Never gained 22 5.2 — —

Although the problem of cooking food remained unre-

solved, other life necessities were fully supplied by gov-

ernments. The total period of the interruption was con-

trolled to be within two days at every site. The existing

difficulties include the singleness of food which caused

digest problems and stomach upset of the elder and chil-

dren, extreme density of living places where both tem-

perature and humidity were at a high level, lacking of

bathing stuff, children education, job interruption, the

loss of household asset, and financial crisis.

86.9% of participants supported that post-earthquake

health education was needed, and 41.6% of them thought

that brochures and books were the best method of educa-

tion since the content could contain a wide range of in-

formation, be systematic, and be understandable. 78.2%

of them had a positive evaluation toward the delivered or

posted health education materials.

4. DISCUSSION

The survey was conducted 19-21 days after the earth-

quake. The results indicated that basic life necessities

and health care facilities and service could fulfill resi-

dents’ needs. Water and food supply were adequate, and

there were sufficient lavatories and garbage recycling

sites that were cleaned every day. Environmental disin-

fection, mosquito, fly, and rat prevention had remarkable

effects. Few flies and rats were observed by residents.

However, many problems had been identified. There is

the risk of food safety issue since food was from outside

of the earthquake hit areas [4]. The mainly supplied food

was packaged noodles and cookies, which could effec-

tively prevent intestinal infectious diseases. However,

more efforts should be made to enrich the types of food

and provide appropriate food to the elder and children. It

was fairly crowded in temporary tents where the tem-

perature and humidity were high. Tents were not enough

to ensure family as the small unit to be accommodated.

Many health care sites only had emergency drugs like

anti-bacteria and flu treatment drugs, but the drugs for

chronic disease such as high blood pressure and diabetes

were not enough to satisfy the needs. Moreover, the

bathing stuff were so insufficient that residents could not

shower every day.

There were three kinds of lavatories available at each

site: dry ones established after the tremor, remaining

ones that survived from the tremor, and commercial mo-

bile lavatories. The dry lavatories were the most appro-

priate ones for environmental health. They were easy to

build at a lower cost and could serve many people. The

other two kinds of lavatory could not be cleaned easily

since the water supply was interrupted, which could re-

sult in the proliferation of flies and mosquitoes [5]. Ad-

ditionally, commercial mobile lavatories were not easy

to transport and their cost was high. Thus, it was sug-

gested that dry lavatories should be established in time

after earthquake.

The most common health problems among residents

were diarrhea, fever with respiratory symptoms, heat-

stroke, cold, and dermatitis. The post-tsunami effects

caused by stress sources such as lifestyle changes, the

death of relative, and the loss of incomes could cause

disorders of the immune system, make residents vulner-

able to varieties of diseases. The density and humidity of

the residence might be the cause for dermatitis.

The environment changed dramatically after the

earthquake. If residents lacked the knowledge and will-

ingness of disease prevention, or there were not enough

health facilities such as lavatories, personal hygiene stuff,

or even if related facilities were available but residents

did not have a healthy behavior pattern, communicable

disease could break out easily. Thus, post-earthquake

health education was highly important. According to the

results of the survey, residents had some unhealthy be-

haviors, like using non-disinfected river water as living

water. Post-earthquake health education should follow

the principles applying to outbreak public health emer-

gencies, be delivered in time, and focus on those at high

risk[6]. Booklets/brochures were the most favorable ma-

terials since they can have a wide range of information,

be systematic and understandable, be kept easily. Tele-

vision was the most method favored by the residents. It

was highly appropriate for those who receive less educa-

tion. As residents were being relocated, televisions

should be equipped. Furthermore, the speakers at each

site should be fully used to implement health education.

REFERENCES

[1] Chinese Center for Disease Control and Prevention.

(2008) A quickly assessment table of the needs of the

public health and disease control in earthquake areas

[EB]. http://www.chinacdc.net.cn.

[2] Chinese Center for Disease Control and Prevention. (2008)

The assessment keys of the food hygiene in earthquake areas

in earthquake areas [EB]. http://www.chinacdc.net.cn.

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[3] WHO Regional Office for South-East Asia. (2004) Rapid

needs assesment for water, sanitation and hygiene [EB].

http://www.who.org.mv/EN/Index.htm.

[4] Fan, Y.X., Cui, W.M. and Liu, X.M. (2008) The ques-

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areas with earthquake [J]. Chinese Journal of Food Hy-

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[5] Hui, B. (2008) The deject arrangement and disease hid-

den trouble in earthquake areas [J]. Chinese Journal of

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[6] Hu, J.F. (2004) Heath education and heath promotion in

public health emergency [J]. Chinese Journal of Health

Education (in Chinese), 20(2), 126-128.