Rapid Community Needs Assessment

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					    Public Health CBRN course




Rapid Community Needs
      Assessment
    Bonnie Henry, MD, FRCPC
Goals of Session
 To learn the principles of rapid
  community risk assessment using
  modified cluster sampling methods
 To understand when this technique
  may be useful in response or
  recovery from a disaster
Goals of Rapid Needs Assessment

 To rapidly obtain population-based
  estimates of need in the early
  aftermath of a disaster
 Should also be a way of reaching the
  affected areas with information about
  relief efforts and services
History
 Based on methods developed by the WHO
  for estimating immunization coverage in
  the EPI program
 Used to estimate community impact of
  Hurricane Andrew in South Florida in 1992
 Also used after the Sept 11, 2001 attacks
  in NYC to assess needs in residents of
  Lower Manhattan
Who would use the data
 Government organizations
 Disaster relief organizations (Red
  Cross etc)
 Provincial, regional and local public
  health and healthcare organizations
 Law enforcement
 Utilities, (especially electricity, water)
 Media, etc.
Cluster Sampling Methods
 Systematic sampling
  of 30 ‘clusters’
 Create a grid over the
  area to be sampled
   – ¼ mile squares on
     street map
 Assign each square or
  ‘cluster’ a number
Cluster Sampling Methods
 Determine the interval you need to end up
  with 30 clusters to sample
  – For example if you have 120 squares in your
    grid you will have an interval of 4 (120/30=4)
 Randomly determine where to start
  – In this case pick a number between 1 and 4
  – You can use a random number generator or
    the serial number on a $5 bill
 Select your 30 clusters
Cluster Sampling Methods
 Go to the centre of the first cluster (i.e.
  square or cluster 3 on your map)
 Determine your sampling unit
  – Usually people or households
 Determine the number of units to be
  sampled in each cluster (i.e. 10
  households)
 Proceed in a randomly picked direction to
  the first occupied household
Cluster Sampling Methods
 Interview the first adult at the occupied
  residence
 Then go consecutively to the next
  occupied household until you have
  reached 10 in that cluster
 If a multi-unit dwelling or apartment
  building pick first occupied unit for
  interview
 Move on to next selected cluster
    Example: Systematic sampling




Source: D. Coulombier, Epicentre
Source: MSF
   Sampling methods – organization of sampling units; Cegrane
   camp, Cegrane, Macedonia - 1999




Source; B. Woodruff, US-CDC
Sampling interval = 12; Starting number = 3; Cycle = 3




1        2     3   4      5   6   7   8   9   10   11 12   13    14 15    16    17 18




19       20 21 22         23 24 25 26 27 28        29 30    31    32 33    34    35 36




    37       38 39 ....


Source: EPIET
Interview Methods
 Interview team usually 3-4 people
  including an epidemiologist and volunteer
  interviewers
  – from medical schools, public health staff etc.
 Use a simple questionnaire
 Ensure team able to provide information
  on:
  – Location of medical treatment, supply
    distribution sites
  – Provide preventive health messages on food,
    water safety, handwashing, injury prevention
    etc.
    Sample Questions
   How many and what percentage of surveyed
    households reported the following?
    –   Not enough food
    –   No running water
    –   No electricity
    –   No heat/air conditioning (in temperature extremes)
    –   No functioning toilet
    –   No telephone
    –   No car or truck
    –   Injured resident(s)
    –   Ill resident(s)
    –   Resident(s) in need of medical care
    –   Resident(s) unable to obtain needed medications
    –   Resident(s) in need of counseling
    –   Resident(s) with special needs
    –   Displaced from home
Time frame for initiating study
 After ground transportation is
  restored
 Approximately 3 and 10 days after
  the event for severely affected areas
 Assessments of less severely
  affected areas phased in as possible
Benefits
 Practical and standardized methods allow
  for rational assessment (not based on
  rumours only)
 Gives a picture of what needs are and
  helps direct relief operations
  – E.g. switch from mass casualty trauma
    services to primary care and preventive
    services
 Can monitor over time
“Being roughly right is generally
more useful than being precisely
wrong”


            Guha-Sapir, D. Rapid assessment of health needs in mass emergencies:
        Review of current concepts and methods. World Health Stat Q. 1991;44:171-181.