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ORIGINAL ARTICLE
Year : 2019  |  Volume : 8  |  Issue : 2  |  Page : 77-82

Social support and household disaster evacuation readiness in a flood-affected rural village in Tamil Nadu, South India


1 Department of Obstetrics and Gynecology, JIPMER, Puducherry, India
2 Department of Community Medicine, SVMCH and RC, Puducherry, India
3 Department of Psychiatry, JIPMER, Puducherry, India
4 Department of Preventive and Social Medicine, JIPMER, Puducherry, India

Date of Web Publication14-May-2019

Correspondence Address:
Dr. K C Premarajan
Department of Preventive and Social Medicine, JIPMER, Puducherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijhas.IJHAS_76_18

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  Abstract 


OBJECTIVE: To assess the social support and household disaster evacuation readiness among flood-affected households in a rural village of Tamil Nadu.
METHODS: We conducted this cross-sectional analytical study in the flood-affected Koonimedu village of Villupuram District, Tamil Nadu, 8 months after the flood. One adult member (age >18 years) from each of the flood-affected households was included and interviewed face to face at his/her house. Information on sociodemographic details, loss of property, and household evacuation readiness plan was obtained using a semistructured pretested questionnaire. Social support was measured using the Crisis Support Scale (CSS).
RESULTS: Nearly 60% of the households were still waiting for government assistance for house repair. Less than a quarter of households reported adequate social support. Availability of people to listen to them, able to discuss their thoughts and feelings, and contact with people in similar situations showed improvement after 8 months of flood. CSS score on feeling letdown showed a significant increase 8 months after the flood. Although all the households were ready to evacuate if flood recurs, none have undergone training on disaster preparedness. Majority of the households reported to secure ration card first during evacuation.
CONCLUSION: The level of adequate social support during flood as well as 8 months after the flood was low among the study population. Although all households have their own disaster evacuation plan, none have been given information and training on disaster preparedness.

Keywords: Disaster, disaster evacuation readiness plan, flood, social support


How to cite this article:
Ashok V, Naik BN, Rajkumar RP, Premarajan K C. Social support and household disaster evacuation readiness in a flood-affected rural village in Tamil Nadu, South India. Int J Health Allied Sci 2019;8:77-82

How to cite this URL:
Ashok V, Naik BN, Rajkumar RP, Premarajan K C. Social support and household disaster evacuation readiness in a flood-affected rural village in Tamil Nadu, South India. Int J Health Allied Sci [serial online] 2019 [cited 2019 Sep 18];8:77-82. Available from: http://www.ijhas.in/text.asp?2019/8/2/77/258187




  Introduction Top


Flood accounts for about 40% of all natural disasters worldwide and half of all deaths from disasters.[1] On an average, in India, 75 lakh hectares of land is affected and 1600 lives are lost due to flood every year. Properties such as crops, houses, and public utilities, value at approximately 1800 crores are lost every year. The frequency of major floods is more than once in 5 years.[2]

Extreme events such as flood can affect people's lives irrespective of their social status.[3] Floods not only lead to morbidity and mortality but also disrupt progress and developmental efforts built over time. Flood, a type of natural disaster, disrupts the health-care service delivery mechanism and damages water and sanitation infrastructure, property, community facilities, crops, food supply, etc. The affected population has the fear of recurrence, which leads to stress and affects the usual livelihood. This affects the socioeconomic status as well as mental health of flood-affected people imparting burden on the health-care delivery system of a country. Unlike physical damage, mental and social health is often neglected. Even one year after the Odisha super cyclone, the prevalence of posttraumatic stress disorder (PTSD) was reported to be 26% among affected adolescent girls and any morbidity as 37%. The hopelessness and lack of adequate postdisaster psychological support were reported to be the plausible causes for the persistence of PTSD.[4] Social support during or after the disaster like flood can help cope with stress and loss of property and valuables.[5] Psychological intervention directed at flood-affected people, especially the vulnerable group, is highly important in preventing PTSD.[6]

Social supports are those social interactions that provide individuals with actual assistance or help them develop social relationships which are perceived as caring and immediately available at the time of need.[7] Social support has been implicated in alleviating postdisaster mental disturbances such as PTSD, anxiety, and fear.[8],[9]

Although India is traditionally considered as disaster prone, the support services are inadequate to provide comprehensive care to the disaster-affected people.[10] One of the reasons is lack of assessment on unmet needs of disaster-affected people. Sustainable Development Goal 13 urges the states to strengthen capacity against climate-related disasters. Apart from educating and creating awareness on disaster preparedness by officials, community itself can help minimize the damage impacted by the disaster.[11],[12] Family evacuation plan, which is context specific, not only helps to withstand the “ first 72 h self-sufficiency” but also provides easy access to important documents and property during temporary relocation to safer places. Information on family evacuation plan is an invaluable asset to the government and policymakers during disaster preparedness and mitigation.[13] Although experience from other countries provides some insight, data from India on household evacuation and preparedness are lacking despite recurrence of disaster such as flood. In this background, the current study was planned to assess the status of social support and household disaster evacuation readiness among flood-affected households in a rural village of Tamil Nadu.


  Methods Top


We conducted this cross-sectional descriptive study during August and September 2016 in Koonimedu village, a village affected by flood in December 2015. The coastal areas of Tamil Nadu are almost every year affected by cyclone or flood. Koonimedu is a block panchayat village bordering Pondicherry and Tamil Nadu in the coastal district of Villupuram, Tamil Nadu. Koonimedu village is divided into two parts; smaller part toward the Bay of Bengal and larger part toward the mainland by East Coast Road. Koonimedu village has nearly 1700 households and a population of approximately 7500.[14] People in Koonimedu village are mostly engaged in fishing in the sea and daily wage laborer as means of earning. Most of the houses are kutcha in Koonimedu village. The flood during 2015 had severely affected the villagers, causing huge property loss and leaving many people homeless.

Of the 350 households in the flood-affected area of Koonimedu village, 302 gave written informed consent, by the head of the households, to participate in our study. The response rate for the study was 87%. One adult respondent (aged 18 years or above) from each household was selected and enrolled by house-to-house visits. Respondents included preferably the head of the household and, in his/her absence, any adult member with the highest date of birth present at the time of visit. Respondents having any psychiatric disorder before the occurrence of flood were excluded and replacement was selected from the same household as mentioned earlier. The information on sociodemographic details, impact of flood on health and property, and disaster evacuation readiness of the flood-affected individuals were collected using a pretested semistructured questionnaire. The questionnaire was face and content validated. Language validation was done by translating to vernacular language (Tamil) and back translation into English. Final questionnaire was prepared after piloting. Information on social support was obtained using the Crisis Support Scale (CSS).[15] It measures social support at two time points: T1 – social support received at the time of disaster and T2 – social support received at the time of survey usually after some months or years. The CSS has 7 items in a Likert scale of “1” to “7” to be applied at two points “T1” and “T2.” In the CSS Likert scale, “1” to “7” refers to “never” and “always,” respectively. The 6th item elicits a negative response which needs to be reversed before calculating the total score. The maximum and minimum score an individual can obtain at a particular time was “7” and “49,” respectively. An individual was considered to have adequate social support if his total CSS score was >28. Cutoff score was based on the formula for Mean = minimum score + (maximum − minimum)/2. Further CSS was divided into four domains: emotional support (items 1, 3, and 4), contact with others (item 2), tangible (item 5), and negative (item 6). Evacuation was defined as “an operation whereby all or part of a particular population is temporary relocated, whether spontaneously or in an organized manner, from a sector that has been struck by a disaster or is about to be struck by a disaster, to a place considered not dangerous for its health or safety.”

Biostatistical descriptive analysis was done using SPSS Version 22 (IBM Corp., Armonk, NY) and OpenEpi Version 3.2 (Open Source Epidemiology Statistics for Public Health, Emory University, Atlanta, GA, US). An individual was said to have PTSD if his/her impact of event scale-revised score was more than or equal to 33. Paired t-test was applied to compare CSS score between two time points. P < 0.05 was set to determine statistically significant changes. Ethical clearance for this study was obtained from the Institute Ethics Committee, JIPMER, Puducherry.


  Results Top


Majority (60%) of the respondents were female. Elderly constituted only 15% of the total respondents. Nearly one-third of the respondents did not have formal education. Majority of the households belonged to lower socioeconomic status (76%) and had kutcha house (57%). In about 41% of the households, vulnerable population were present [Table 1].
Table 1: Adequate social support as perceived by flood-affected households of Koonimedu village, Tamil Nadu (n=302)

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Of the total of 302 study participants, 66 (21.9%) reported illness among family members, mostly upper respiratory tract infections, during flood. None the participants or their family members reported to be suffered from injury or death as a result of flood in December 2015. About 93% (282) of the participants reported their house to be damaged as a result of flood in December 2015. However, only 39% of the households had spent their own money for repair and others were still waiting for government assistance. The median (interquartile range) cost incurred to repair damaged house was Rs. 2000 (1000–5000).

Nearly 22% of the studied population reported adequate social support at the time of flood and about a quarter of respondents after 8 months of flood. Individuals belonging to lower socioeconomic class had proportionately lowest social support at both time points. Households having kutcha houses reported proportionately highest adequate social support at both time points [Table 1]. A significant change in CSS score was noted between the two time points (T1 and T2) among the flood-affected households [Table 2] and [Table 3]. Availability of people to listen to them, able to discuss their thoughts and feelings, and contact with people in similar situations showed improvement after 8 months of flood. However, sympathy from others and receiving practical help showed decreased CSS score. CSS score on feeling letdown showed a significant increase 8 months after the flood.
Table 2: Change in social support score over a period of 8 months from the occurrence of flood as perceived by households in Koonimedu village, Tamil Nadu (n=302)

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Table 3: Change in score in different dimensions of social support assessed by the Crisis Support Scale over a period of 8 months as perceived by households in Koonimedu village, Tamil Nadu (n=302)

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All the participants reported to be ready for evacuation in case of emergency and reported easy access to ration card, home documents, and certificates. However, none of the participants had received any formal training on disaster preparedness and evacuation readiness plan. Maximum (41.4%) participants reported to shift to relative house followed by community hall (20.9%) if flood recurs [Figure 1]. Majority of the study population reported that the first thing they would secure was ration card (52%) followed by property documents (32%) [Figure 2].
Figure 1: Identified places for shifting by the flood-affected people in case disaster such as flood recurs in Koonimedu village (n = 302)

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Figure 2: Valuables to be secured first during evacuation as reported by the study participants in Koonimedu village, Tamil Nadu (n = 302)

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  Discussion Top


Cyclone originating in the Bay of Bengal hits the coastal area of Tamil Nadu, Puducherry, Andhra Pradesh, and Odisha almost every year. More recently, in November–December 2015, a cyclone with torrential rain hit the coastal area of Tamil Nadu.[16] The flood as a result of cyclone caused enormous damaged to property and infrastructure.

In our study, only a quarter of flood-affected households were found to have adequate social support which is very less compared to perceived adequate social support received by Tsunami 2004 victims as reported by Kumar et al.[17] This could be due to lower intensity and extend of damage caused by the flood in December 2015 compared to Tsunami of December 2004. The amount of social support was found to have increase after 8 months of occurrence of flood; however, least increase was noted among households belonging to lower socioeconomic status. This could be due to more need for tangible items and cash to restore the normal life among low socioeconomic status people. We also found that as time passed after the flood, the social support received by households with vulnerable population increased more compared to households without vulnerable population.

The current study reported a significant increase in emotional support, contact with each other, and negative feelings over a period of 8 months since the occurrence of flood in December 2015. However, the negative feeling or feeling letdown has increased. This could be because majority (60%) of the damaged houses which sustained damaged were yet to be repaired due to poor socioeconomic status and nonreceipt of adequate government assistance.

After extensive search, we could not find any study reporting household disaster evacuation readiness plan from India. Disaster preparedness at household level includes necessary arrangement for self-sufficiency for the first 72 h of occurrence of disaster and readiness before relocation to temporary shelter.[13],[18],[19] We could only study the second part of disaster preparedness at household level. All the households in our study reported to have evacuation readiness plan in case disaster such as flood recurs. Studies from other countries reported less proportion of households to be prepared for disaster.[20],[21],[22] A rapid cluster survey from Australia reported that only 42% of households residing in disaster-prone areas were prepared for the disaster.[22]

In our study, all the participants reported easy access to valuables and documents in case of emergency evacuation. Contrary to findings of the present study, only 15% of the participants reported easy access to valuables in a study conducted by Kolen et al.[21] Most of the households reported that they will move to relative house or community hall if flood recurs. Majority of the households reported to secure the ration card if flood recurs. Ration card issued by the government is used in multiple ways and is the basis for availing various government scheme-related benefits including basic amenities such as rice, wheat, sugar, and kerosene in India.[23] Creating awareness and training on disaster preparedness for people residing in flood affected areas are important in minimizing loss of property and life. None of the participants or their family members in our study reported to have attended any disaster preparedness and awareness training program. About 37% of the farmers residing in hurricane-prone area in the US have been reported receiving information on how to prepare them for disaster.[20]

Strength and limitation

This study is first of its kind in India assessing the social support and household evacuation readiness plan in a flood-affected community. A single investigator collected information by face-to-face interview using the semistructured questionnaire and CSS scale. Although nonresponse rate was 14%, mostly due to locked houses during survey time, we believe it would have little impact on the results. Subjective variation due to variation in the age of respondents on response to different items of CSS scale cannot be completely ruled out despite taking adequate precautionary measures. Social support, especially during the flood, needs to be interpreted carefully because of recall bias. Generalization of the results of social support should be context specific as extent of damage inflicted by disaster varies.


  Conclusion and Recommendation Top


Less than a quarter of the flood-affected individuals had adequate social support during flood as well as 8 months after the flood. As reported by the respondents, none of them or family members has been trained on disaster evacuation readiness. However, all of the houses have their own evacuation plan for a disaster such as flood.

Restoring social cohesion after any disaster through restoring communication between the people of the community and keeping the families together are crucial in reducing the suffering of the people and promoting their recovery. Housing development programs need to be carried out in flood-prone areas. People residing in flood-prone areas need to be educated repeatedly on flood preparedness and evacuation readiness strategies. The role of community on preparedness and evacuation for a disaster such as flood need to be emphasized, and community training in this regard should be prioritized by policymakers and government in disaster-prone areas such as Koonimedu.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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