Risk factors for mortality in the Bangladesh cyclone of 1991
Bern, C.; Sniezek, J.; Mathbor, G.M.; Siddiqi, M.S.; Ronsmans, C.; Chowdhury, A.M.; Choudhury, A.E.; Islam, K.; Bennish, M.; Noji, E.
Bulletin of the World Health Organization 71(1): 73-78
1993
ISSN/ISBN: 0042-9686 PMID: 8440041 Document Number: 327088
One of the most dangerous cyclone basins of the world is located in the Bay of Bengal and the population most affected lives in coastal areas in Bangladesh. A Bangladesh National Storm Warning Center was set up in 1970 and 311 cyclone shelters were built to accommodate 350,000 people. This paper reports on the rapid assessment of 2 cyclone areas (Chakaria on the mainland and Kutubdia, an offshore island) devastated in the aftermath of the April 29, 1991, cyclone. The aim was to identify factors contributory to survival or death and to improve early warning, shelter building, and preparedness. The hypothesis was that survival was based on the ability of people to reach a reinforced structure in time. Between June 14 and June 21, 1991, 45 clusters comprising 135 households and a total population of 1123 individuals were surveyed. Information was obtained from 45 primary informants for 25-30 neighbors. The results showed that 14% of the survey population died. 26% of children under 10 years of age died and 4% over age 10 died. Almost 40% of unsheltered children were at greatest risk of death. 31% of females older than 40 years died and 40% of those older than 60 years. The risk of dying was related to the type of shelter and the actions taken to seek shelter. 98% of the people were not in "pukka" or safe shelters (made of brick or concrete) during the storm. Although there was 3-6 hours warning, only 4% sought or reached safe shelter. When the storm first hit 10-60 minutes before impact, 13% were in safe shelters and 33% reached safe shelter by impact; none died. The 736 persons at risk drowned in flood waters. Women's and children's mortality was probably due to factors such as physical size, strength, and endurance. Mortality was 39% of the 285 swept away by the storm, 15% of those who clung to objects, 22% of those who found high ground, and 11% of those who sought shelter in trees. The reasons for not seeking shelter were given as misgauging the severity of the storm (45%), difficulty with high winds and flooding (16%), and not understanding 916%). Only 2 of 5 shelters were usable due to flooding. Warnings must state that women and children must seek shelter at the first warning, be more precise about time and place of impact, and the recommended action. Shelters must be made more accessible. The population in general must be better educated about cyclone preparedness and safety.