Disease control in Haiti after the earthquake

15 Jan 2010

Paul Chinnock

Source: TropIKA.net

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The scale of the tragedy facing Haiti is hard to grasp; estimates of the number of dead have now reached 50,000 and the destruction of infrastructure is reported to be immense. This is a country where geography and history seem to have conspired to make it both prone to disaster and poorly placed to respond when catastrophe strikes.

As local communities and relief teams struggle to deal with the immediate aftermath of the earthquake, infectious disease will be, after injury, the leading health concern. Supplies of safe water are said to be scarce, thus creating opportunities for the spread of water-borne diseases. But Haiti, even at the best of times, has major infectious disease problem, and a health system that struggles to cope. It seems inevitable that efforts to control the infectious diseases of poverty in the poorest country in the Americas will suffer a severe setback.

Haiti’s disease burden

Infections are Haiti’s biggest killer, accounting for nearly 40% of all deaths. AIDS and diarrhoeal disease are the most common cause of mortality. The combination of malnutrition and diarrhoeal disease in many children seriously affects their development.

Haiti (population 10 million) has by far the highest prevalence of tuberculosis in the Americas – over 400 cases per 100,000 – and there are over 5000 TB deaths every year. The figures for the Dominican Republic, with which Haiti shares the island of Hispaniola, are a quarter of this level.

Hispaniola is the only part of the Caribbean where malaria is still present; most cases are in Haiti. It also accounts for 90% of the region’s cases of lymphatic filariasis (LF). The Dominican Republic has succeeded in interrupting LF transmission but in some parts of Haiti nearly a third of people are infected with the filarial parasite responsible for the disease. Efforts to eliminate LF and malaria from Haiti have recently been stepped up – see TropIKA.net News – but programmes such as this will undoubtedly now be disrupted.

In the coming months, how will Haiti’s health services cope with ‘routine’ tasks, such as ensuring that TB patients complete their full course of treatment? The country spends very little on health care (less than 1% of GDP) and many health facilities are reported to have been destroyed. International support on a major scale will be required to build a fully functioning health system.

It remains to be seen how well the international community and relief agencies will cope with both the immediate effects of the earthquake and the long-term consequences for health. It will be important to evaluate the effectiveness of the response so that lessons are learned. Research can play a vital role in increasing the effectiveness of disaster response and disaster preparedness systems. We also need to know how infectious disease control programmes can be sustained during and after disasters.

For more information on Haiti’s health profile, see the PAHO website.