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 -

1

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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ture

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rainfall dengue temp

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

500 0 1/4 1/2 3/4 1

10500

1000

1000METRES

YARDS

4 KILOMETRES

MILE32

32

URBAN BOUNDARY 2001

DENGUE OCCURANCE

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river

gully

MONTEGO BAY

URBAN

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

0100200300400500600700800900

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002

Years

Remitta

nces U

S$millio

n

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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LEGEND

20 0 20 40 60 Kilometers

HEALTH REGIONS

HealthGIS,Health Promotion & Protection Division,Ministry of Health, Jamaica.

S

N

EW

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