Vulnerability and Adaptation to climate change induced – dengue fever in Jamaica
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Transcript of Vulnerability and Adaptation to climate change induced – dengue fever in Jamaica
Vulnerability and Adaptation to climate change induced – dengue fever in Jamaica
Mrs. Charmaine Heslop-Thomas
VULNERABILITY TO DENGUE FEVER IN JAMAICA
Charmaine Heslop-Thomas, Wilma Bailey, Dharmaratne Amarakoon, Anthony Chen, Samuel Rawlins, David Chadee, Rainaldo Crossbourne, Albert Owino, Karen Polson, Cassandra Rhoden, Roxanne Stennett,
Michael Taylor.
HISTORY
Virological evidence of the presence of dengue in the Caribbean in the 1950s.
The disease has been appearing with increasing frequency.
All four viruses are circulating.
The appearance of dengue 1 in Jamaica in 1977 resulted in 60,000 cases.
The last large epidemic appeared about 10 years ago.
RISK
Increase in temperature will shorten the incubation period of the virus.
The vector may become more infective more quickly.
Reproduce more rapidly.
Bite more frequently.
There may also be the increased risk of DHF.
EVIDENCE
A.aegypti is already appearing at higher elevations.
Simulations suggest a potential to spread into higher
latitudes.
A link between El Nino and the incidence in some Pacific islands.
OBJECTIVES
To assess the vulnerability of the population of Jamaica to dengue.
To identify specific factors that put communities at risk.
BACKGROUND
A warming trend noted in the last two decades.
An upward (but not significant) trend in rainfall indices.
The increase particularly marked in El Nino and El Nino +1 years.
In the Caribbean the association of the disease with temperature is stronger and the lag with temperature is greater than that with rainfall
DISTRIBUTION OF EPIDEMICS PEAKS AMONG ENSO PHASES 1981-2001
REGION TOTAL El Nino & +1
La Nina Neutral
Caribbean 8 7 -
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T & T 8 6 - 2
Barbados 6 5 - 1
Jamaica 5 4 - 1
Belize 4 3 1
Time series graph of reported cases of dengue with rainfall and temperature for Jamaica
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1995 1996 1997 1998 1999 2000
PROJECTIONS
Projections for Jamaica for the years 2020, 2050, 2080 using statistical downscaling methods and two scenarios (SRES A2 AND B2) indicate the possibility of increased warming in the next century.
TO SUMMARISE
Changing climatic conditions may enhance dengue transmission.
Immunity is low.
But individual and contextual circumstances could modify vulnerability.
TWO LEVELS OF ANALYSISGeneric and Specific Adaptive Capacity
Macro level – current social and economic trends.
Expert interviews in public sector organisations and NGOs. How do they interpret their roles? How prepared are they?
Local level study in communities that had experienced an outbreak. How vulnerable are they to an outbreak?
THE SURVEY
A 10 percent sample of household heads in:
- Granville/Pitfour, a suburb of Montego
Bay.
- Retirement beyond the city’s
boundaries.
- John’s Hall, a rural community
In addition, interviews were conducted with 14 experts.
Johns Hall
Irwin
Retirement
Tucker
GranvillePitfour
Dengue Cases 1998 - St James
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URBAN BOUNDARY 2001
DENGUE OCCURANCE
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MONTEGO BAY
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RURAL
THE MACRO LEVEL
The ending of the bauxite/alumina inspired boom in the 1970s.
IMF and its conditionalities. Their effect felt most keenly by the poor:-Job loss.-Devaluation and price increases.-Removal of subsidies on basic food items.
No real economic growth in more than 30 years.
POVERTY
Poverty peaked at 45 percent in 1991 and is fluctuating downwards.
Rural rates are persistently higher than urban.
Macro level downward trend not reflected in Kingston’s inner city.
Remittances are the most frequently mentioned source of income in the inner city.
REMITTANCES 1990-2001 JAMAICA
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1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Years
Remitta
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THE INTERVIEWS
A – THE MINISTRY OF HEALTH Most saw the possibility of increasing transmission.
No long term strategies are in place.
A resource constraint necessitates prioritising: HIV/AIDS is the priority.
The cost of surveillance, and control, public education is too high.
Environmental sanitation is the responsibility of communities.
THE INTERVIEWS
A - THE MINISTRY OF HEALTH (Continued) The positives:
a well organised system of primary health care built on interlocking system of clinics.
a long tradition of involvement in policy oriented research eg. their involvement in the current climate change project.
A decentralised system of health care.
Health Facilities in Jamaica
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HEALTH REGIONS
HealthGIS,Health Promotion & Protection Division,Ministry of Health, Jamaica.
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Health RegionsNorth EasternSouth EasternSouthernWestern
Parishes
St. Ann
Clarendon
St. Elizabeth
Trelawny
Portland
St. Catherine
St. Mary
Manchester
St. Thomas
St. James
Westmoreland
Hanover
St. Andrew
Kingston
THE INTERVIEWS
B. OTHER ORGANISATIONS Office of Disaster Preparedness and Emergency
Management; National Environment and Planning Agency; Water Resources Authority; National Meteorological Service.
-Health was not a part of their mandate-Sea level rise posed a greater threat.
The NGOs Long term considerations such as climate change were not on
their agenda.
THE COMMUNITIES
Granville/Pitfour, population of 6,300, a mix of formal and informal structures, 50% of respondents were living in informal structures. Heads self employed or in the service sector in Montego Bay.
Retirement, population of 1,783. Few informal dwellings.Heads in the service sector or public service in Montego Bay.
John’s Hall, population of 2,332. Rural squatters.Heads mainly female in domestic service and petty trading..
Vulnerability Indicators
Based on indicators identified in the literature: Immunity Knowledge of symptoms and vectors of disease. Use of protective measures. Measures of resilience and stress – education, employment,
income, female household headship, room densities, coping strategies, integration into the community.
Source of water, water storage. Distance from the nearest health facility
Composite of ranking for communities in St. James
Vulnerability indicators
Johns Hall (%) Score Retirement (%) Score Granville/Pitfour (%)
Score
No immunity 93 2 96 3 91 1
No knowledge of dengue fever
52.6 2 53.1 3 42 1
No knowledge of disease symptoms
72 3 69 2 59 1
No protection 95 3 92 2 89 1
None or primary education
67 3 45 1 49 2
No skill 63 3 57 2 50 1
Income MW or less
68 3 33 1 61 2
Unemployment 33 3 25 2 23 1
ContinuedComposite of ranking for communities in St. James
Vulnerability Indicators
Johns Hall (%) Score Retirement (%) Score GranvillePitfour (%)
Score
Not coping 63 3 51 2 50 1
No pipe at home 46 3 12 2 11 1
Water storage in drums
65 3 53 2 44 1
Overcrowding 7 1 16 2 22 3
Chronic illness 53 2 37 1 54 3
Distance from health facility
70 3 49 2 13 1
No social integration
32 1 59 3 54 2
Female household headship
60 3 47 1 55 2
Public Health responsibility for dengue control
56 3 47 1 51 2
Total Score 44 32 26
1. least vulnerable
2. vulnerable 3. highly vulnerable
Identification of vulnerable groups
Groups Vulnerability Total Measure
5 Most Vulnerable 17 Mean +1.5 SD
>12.5
4 81 Mean + 0.5 SD to Mean + 1.5 SD
9.9-12.5
3 Average 71 Mean ±0.5SD
7.3-9.9
2 73 Mean -0.5SD – to Mean -1.5SD
4.7-7.3
1 Least Vulnerable 15 Mean – 1.5SD
<4.7
Normality: Mean ±3SD
Mean-8.61
SD -2.59
Range 2-14
Mean ± SD = 0.84-16.38
Characteristics of the Most and Least vulnerable groups
Characteristics Group 5
(%)
Group 1
(%)
1.Female Household headship 94 40
2.Unskilled 88 13
3.Primary education or none. 77 7
4.Minimum wage or less 57 0
5.Not Coping 88 0
6.Water storage in drum 88 20
7. Clinic distance 64 13
8. No protection 88 53
9.No knowledge of dengue transmission
94 7
10. No social integration 53 47
11. No knowledge of dengue symptoms
88 13
12. No personal acceptance for dengue control
77 7
Community with highest proportion Johns Hall -53% Granville/Pitfour – 73%
Characteristics of Group 4 and Group 2
Characteristics Group 4 (%) Group 2 (%)
1.Female Household headship 64 36
2.Unskilled 68 33
3.Primary education or none. 79 28
4.Minimum wage or less 67 15
5.Not Coping 73 32
6.Water storage in drum 47 51
7. Clinic distance 96 51
8. No protection 46 19
9.No knowledge of dengue transmission
65 21
10. No social integration 84 51
11. No knowledge of dengue symptoms
54 44
12. No personal acceptance for dengue control
71 37
Community with the highest proportion
Granville/Pitfour -53% Granville/Pitfour-68%
Testing for vulnerability
Used the phi coefficient and chi –square to test if there was significant difference. a. household headship (Phi -0.6, p<.000).b. water storage in drums (Phi - 0.7, p<.000).c. knowledge of dengue transmission (Phi - 0.9, p<.000)
CONCLUSIONS 1
Substantial number of people living in informal settlements is vulnerable.
Between 55,000 and 60,000 persons in Montego Bay (over 25 %) live in such settlements.
The poor are vulnerable and many of the poor work.
If communities must take responsibility for environmental sanitation they must be given the tools – education.
Access to water must be tackled on two fronts - the provision of low-cost, secure drums.
-the granting of security of tenure to those who, because of their status, are denied access to running water.
CONCLUSIONS 2
Public sector organisations must be persuaded that:
-The threat of an outbreak of disease is not incompatible with a mandate to mitigate disaster or sustain development.-Healthy lifestyle is an outcome of sustainable development
-They can incorporate disease control into their education programme.
THANK YOU