Rapid Community Needs Assessment After Hurricane Katrina --- Hancock County, Mississippi, September 14--15, 2005

On August 29, 2005, Hurricane Katrina moved northeast from Louisiana and made its second landfall over Hancock County, Mississippi, with measured wind speeds as high as 132 mph. Katrina's strong winds and high storm surge (an estimated 27 feet in Hancock County) ravaged the Mississippi coast, making it one of the strongest storms to strike the United States during the past 100 years and likely the nation's costliest natural disaster to date (1). Hurricane Katrina left thousands of residents without shelter, food, water, utilities, and access to health care. To obtain information about the effects of the hurricane on residents in Hancock County, the Mississippi Department of Health (MDH) asked CDC to conduct a rapid community needs assessment in what was presumed to be the state's most severely affected county. The objectives of the assessment were to 1) identify the public health needs of the community and 2) estimate the effect of the hurricane on households to assist response and recovery activities. This report describes the results of that assessment, which indicated that more than one third of the homes had been destroyed, many in the area lacked critical household services and remained dependent on relief agencies, and some were in need of health services such as medical care and prescription refills.

The 2000 U.S. Census reported 21,072 households with a total population of 42,967 in Hancock County. For this assessment, using a two-staged sampling plan, 200 of those households were selected. The sample of households allowed for 20% accuracy of the estimates and 30% oversampling to account for demolished homes. The first stage involved randomly selecting 40 of 659 census blocks with a probability proportional to the total number of households. This selection was restricted to those blocks with more than 20 households. During the second stage of sampling, five random waypoints (latitude and longitude) were generated for each selected block. Each of the waypoints represented the geographic location of one household for a total of 200 to be surveyed. At the time of the assessment, only 1990 U.S. Census data were available in the geographic information system. During the statistical analysis, estimates from the 40 clusters defined by 1990 census block boundaries were weighted according to 2000 U.S. Census data.

On September 14 and 15, less than 3 weeks after Hurricane Katrina struck the county, survey teams were provided waypoints and used global positioning system (GPS) instruments to navigate to those locations. Once at the waypoint, survey teams selected the home closest to that waypoint. If no home was located at the waypoint, the closest home north of the waypoint was selected.

One of the goals of this assessment was to estimate the extent of housing damage in Hancock County; therefore, the sampling protocol required teams to approach the target home to assess accessibility, occupancy, and extent of damage. If a home was destroyed, the teams made note of this, and the survey was considered complete. A neighbor, if available, served as the proxy for a vacant home.

Survey teams used a one-page questionnaire to interview an adult household member or proxy to assess basic needs (e.g., food and water), illnesses, hurricane-associated injuries, pre- and post-hurricane home occupancy, access to utilities, access to prescribed medications, and medical-care needs within that household. Another goal was to perform the assessment as rapidly as possible; therefore, the sampling protocol instructed teams to approach each target home once, complete the survey, and move to the next waypoint.

In addition to collecting information on household needs, survey teams distributed local health-care and relief agency telephone numbers; insect repellent; and educational materials regarding hand washing, mold, carbon monoxide poisoning, and other hurricane-related health concerns.

Surveys were completed for 197 households in Hancock County; three waypoints resulted in duplicate homes and were entered once. Eight of the 197 waypoints were in commercial areas or vacant lots with no homes in sight, leaving 189 eligible households for the analysis. Interviews were completed in 63 (33%) of the 189 households, and proxy interviews were completed in 14 (7%), for a total of 77 (41%) completed interviews.

Approximately 69 (36%) of the 189 homes were destroyed, and 43 (23%) did not have a resident at home at the time of the survey and might have been uninhabitable. Of those persons interviewed, 5% reported having had someone in the household go to a shelter. Of the households surveyed, 7% reported having at least one child aged <2 years. In addition, 49% of households reported having at least one resident aged >65 years.

Multiple households lacked critical services such as telephone service (53%), electricity (41%), and functioning indoor toilets (37%) (Table). Of the 77 households surveyed, 26% were still dependent on relief agencies for water. Many residents reported having a problem with mosquitoes (49%) and trash removal (33%). Although the reported number of households with members who had sustained an injury was low (6%), 20% of the households reported having at least one member who had experienced an illness, and 13% reported having a member with mental health problems after the hurricane. One third (33%) of reporting households had a member who had sought medical care. In addition, 34% of the households had a member who needed medical care at the time of the interview, and 29% of the households reported having a member who would require a prescription refill within 3 days.

The results of the assessment were provided to MDH and Mississippi Emergency Management Agency officials. The findings were used to underscore the need for continued relief-agency support for supplying water, expediting restoration of trash and debris removal services, and publicizing the names and locations of functioning medical care facilities, pharmacies, and mental health services in the community.

Reported by: M McNeil, MD, J Goddard, PhD, Mississippi Dept of Health. A Henderson, PhD, M Phelan, MS, S Davis, MSPH, Div of Health Studies, Agency for Toxic Substances and Disease Registry; A Wolkin, MSPH, D Batts, MD, Div of Environmental Hazards and Health Effects, National Center for Environmental Health, CDC.

Editorial Note:

Lack of information on the availability of public health services and basic needs is a major obstacle to delivering appropriate relief in the aftermath of serious disasters. Rapid community needs assessments are a tool that can be used to quickly obtain information on the status of a community (2,3). As needs change, repeat assessments also can be instrumental in determining changing community needs.

A cluster sample design, such as the one used in Hancock County, can be applied when limited information is available regarding persons who did not evacuate and when identifying geographic features are destroyed or missing. This assessment used geographic information systems (GIS) to randomly select households to interview in each selected cluster and GPS units to navigate to those selected households. This represents one of the first times that GIS and GPS have been used in such situations.

The findings in this report are subject to at least four limitations. First, no stable population estimates existed, so the survey design was based on preexisting population distribution. Second, the response rate for the survey was 41%. The assessment was conducted during daytime hours, and the occupants of the selected homes and proxies might have been at work or might have evacuated the area. All information was obtained during a single attempt to locate and identify a household member or proxy to interview. No repeat attempts to visit the targeted households were possible. Third, because of a small sample size, the confidence intervals are wide, offering less precision in the results. Finally, the survey obtained household information and could not make inferences about individual persons.

More than 2 weeks after Hurricane Katrina struck, many residents were still without power, telephone service, and functioning indoor toilets. Trash removal posed an ongoing problem, and mosquitoes were a concern of many residents, despite distribution of insect repellent. In response to the survey findings, MDH implemented aerial pesticide spraying for the county and provided education on preventing mosquito breeding and bites and recognizing signs and symptoms of mosquito-borne illness. This assessment also revealed additional health needs (e.g., for prescription medication and medical care) in the community and led MDH to identify methods to assess and publicize available medical facilities, pharmacies, and mental health services.

Filling gaps in information during the response and recovery phases of disasters is critical to discovering and addressing any needs that might produce adverse human health outcomes. Rapid community needs assessments continue to be an important tool in this process.

Acknowledgments

The findings in this report are based, in part, on contributions by the Mississippi Hospital Augmentation Team, US Public Health Svc; and the Mississippi Illness and Injury Surveillance Team, CDC.

References

1. National Weather Service. Extremely powerful Hurricane Katrina leaves a historic mark on the northern Gulf Coast. Mobile, AL: National Weather Service; 2005. Available at http://www.srh.noaa.gov/mob/0805Katrina.
2. CDC. Rapid community health and needs assessments after Hurricanes Isabel and Charley---North Carolina, 2003--2004. MMWR 2004; 53:840--2.
3. CDC. Rapid assessment of the needs and health status of older adults after Hurricane Charley---Charlotte, DeSoto, and Hardee Counties, Florida, August 27--31, 2004. MMWR 2004;53:837--40.

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