Person: Leaning, Jennifer
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Leaning
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Jennifer
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Leaning, Jennifer
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Publication Urban disaster preparedness of Hong Kong residents: A territory-wide survey(Elsevier BV, 2017-08) Lam, Rex Pui Kin; Leung, Ling Pong; Balsari, Satchit; Hsiao, Kai-hsun; Newnham, Elizabeth; Patrick, Kaylie; Pham, Phuong; Leaning, JenniferObjective: To assess the state of community disaster preparedness of Hong Kong residents and to identify factors associated with adequate preparedness behaviors. Design: A cross-sectional survey using random Global Positioning System (GPS) spatial sampling conducted from the 8 August 2015 to 6 September 2015. Participants: Hong Kong residents aged 18 years or more. Method: A 19-item questionnaire was developed to assess respondents’ preparedness information acquisition, communication plan, evacuation strategies, first-aid and disaster knowledge, financial resilience, and preparedness behaviors. In total, 1023 residents were interviewed at 516 GPS locations. Multiple logistic regression was used to identify factors associated with preparedness behaviors, defined as having an evacuation kit in our study. Results: Television remains the key information source, both before and during disaster, with young respondents also favoring social media and the internet and elder residents preferring television and radio. Many respondents did not have adequate first-aid knowledge and few showed correct responses to a typhoon warning signal. Only 39.4% had an evacuation kit. In logistic regression, correct responses to first aid questions and a typhoon warning signal were significantly associated with kit preparation (OR 2.023, 95% CI 1.233−3.318, p=0.005). Residents with elderly household member(s) were significantly less likely to do so (OR 0.554, 95% CI 0.333−0.922, p=0.023). Conclusions: Community resilience-building programs should tailor information provision to different age groups with a focus on the family caregivers of elderly residents. There is a need to promulgate first-aid training and disaster education in the community.Publication Mortality in Puerto Rico after Hurricane Maria(New England Journal of Medicine (NEJM/MMS), 2018) Kishore, Nishant; Marqués, Domingo; Mahmud, Ayesha; Kiang, Mathew; Rodriguez, Irmary; Fuller, Arlan; Ebner, Peggy; Sorensen, Cecilia; Racy, Fabio De Castro Jorge; Lemery, Jay; Maas, Leslie; Leaning, Jennifer; Irizarry, Rafael; Balsari, Satchit; Buckee, CarolineBACKGROUND Quantifying the effect of natural disasters on society is critical for recovery of public health services and infrastructure. The death toll can be difficult to assess in the aftermath of a major disaster. In September 2017, Hurricane Maria caused massive infrastructural damage to Puerto Rico, but its effect on mortality remains contentious. The official death count is 64. METHODS Using a representative, stratified sample, we surveyed 3299 randomly chosen households across Puerto Rico to produce an independent estimate of all-cause mortality after the hurricane. Respondents were asked about displacement, infrastructure loss, and causes of death. We calculated excess deaths by comparing our estimated post-hurricane mortality rate with official rates for the same period in 2016. RESULTS From the survey data, we estimated a mortality rate of 14.3 deaths (95% confidence interval [CI], 9.8 to 18.9) per 1000 persons from September 20 through December 31, 2017. This rate yielded a total of 4645 excess deaths during this period (95% CI, 793 to 8498), equivalent to a 62% increase in the mortality rate as compared with the same period in 2016. However, this number is likely to be an underestimate because of survivor bias. The mortality rate remained high through the end of December 2017, and one third of the deaths were attributed to delayed or interrupted health care. Hurricane-related migration was substantial. CONCLUSIONS This household-based survey suggests that the number of excess deaths related to Hurricane Maria in Puerto Rico is more than 70 times the official estimate. (Funded by the Harvard T.H. Chan School of Public Health and others.)Publication Costs of Inaction on Maternal Mortality: Qualitative Evidence of the Impacts of Maternal Deaths on Living Children in Tanzania(Public Library of Science, 2013) Yamin, Alicia; Boulanger, Vanessa; Falb, Kathryn L.; Shuma, Jane; Leaning, JenniferBackground: Little is known about the interconnectedness of maternal deaths and impacts on children, beyond infants, or the mechanisms through which this interconnectedness is established. A study was conducted in rural Tanzania to provide qualitative insight regarding how maternal mortality affects index as well as other living children and to identify shared structural and social factors that foster high levels of maternal mortality and child vulnerabilities. Methods and Findings: Adult family members of women who died due to maternal causes (N = 45) and key stakeholders (N = 35) participated in in-depth interviews. Twelve focus group discussions were also conducted (N = 83) among community leaders in three rural regions of Tanzania. Findings highlight the widespread impact of a woman’s death on her children’s health, education, and economic status, and, by inference, the roles that women play within their families in rural Tanzanian communities. Conclusions: The full costs of failing to address preventable maternal mortality include intergenerational impacts on the nutritional status, health, and education of children, as well as the economic capacity of families. When setting priorities in a resource-poor, high maternal mortality country, such as Tanzania, the far-reaching effects that reducing maternal deaths can have on families and communities, as well as women’s own lives, should be considered.Publication Connectedness, social support and internalising emotional and behavioural problems in adolescents displaced by the Chechen conflict(Wiley-Blackwell, 2012) Betancourt, Theresa; Salhi, Carmel; Buka, Stephen; Leaning, Jennifer; Dunn, Gillian; Earls, FeltonThe study investigated factors associated with internalising emotional and behavioural problems among adolescents displaced during the most recent Chechen conflict. A cross-sectional survey (N=183) examined relationships between social support and connectedness with family, peers and community in relation to internalising problems. Levels of internalising were higher in displaced Chechen youth compared to published norms among non-referred youth in the United States and among Russian children not affected by conflict. Girls demonstrated higher problem scores compared to boys. Significant inverse correlations were observed between family, peer and community connectedness and internalising problems. In multivariate analyses, family connectedness was indicated as a significant predictor of internalising problems, independent of age, gender, housing status and other forms of support evaluated. Sub-analyses by gender indicated stronger protective relationships between family connectedness and internalising problems in boys. Results indicate that family connectedness is an important protective factor requiring further exploration by gender in war-affected adolescents.Publication Medical Evidence of Human Rights Violations against Non-Arabic-Speaking Civilians in Darfur: A Cross-Sectional Study(Public Library of Science, 2012) Tsai, Alexander; Eisa, Mohammed A.; Crosby, Sondra S.; Sirkin, Susannah; Heisler, Michele; Leaning, Jennifer; Iacopino, VincentBackground: Ongoing conflict in the Darfur region of Sudan has resulted in a severe humanitarian crisis. We sought to characterize the nature and geographic scope of allegations of human rights violations perpetrated against civilians in Darfur and to evaluate their consistency with medical examinations documented in patients' medical records. Methods and Findings: This was a retrospective review and analysis of medical records from all 325 patients seen for treatment from September 28, 2004, through December 31, 2006, at the Nyala-based Amel Centre for Treatment and Rehabilitation of Victims of Torture, the only dedicated local provider of free clinical and legal services to civilian victims of torture and other human rights violations in Darfur during this time period. Among 325 medical records identified and examined, 292 (89.8%) patients from 12 different non-Arabic-speaking tribes disclosed in the medical notes that they had been attacked by Government of Sudan (GoS) and/or Janjaweed forces. Attacks were reported in 23 different rural council areas throughout Darfur. Nearly all attacks (321 [98.8%]) were described as having occurred in the absence of active armed conflict between Janjaweed/GoS forces and rebel groups. The most common alleged abuses were beatings (161 [49.5%]), gunshot wounds (140 [43.1%]), destruction or theft of property (121 [37.2%]), involuntary detainment (97 [29.9%]), and being bound (64 [19.7%]). Approximately one-half (36 [49.3%]) of all women disclosed that they had been sexually assaulted, and one-half of sexual assaults were described as having occurred in close proximity to a camp for internally displaced persons. Among the 198 (60.9%) medical records that contained sufficient detail to enable the forensic medical reviewers to render an informed judgment, the signs and symptoms in all of the medical records were assessed to be consistent with, highly consistent with, or virtually diagnostic of the alleged abuses. Conclusions: Allegations of widespread and sustained torture and other human rights violations by GoS and/or Janjaweed forces against non-Arabic-speaking civilians were corroborated by medical forensic review of medical records of patients seen at a local non-governmental provider of free clinical and legal services in Darfur. Limitations of this study were that patients seen in this clinic may not have been a representative sample of persons alleging abuse by Janjaweed/GoS forces, and that most delayed presenting for care. The quality of documentation was similar to that available in other conflict/post-conflict, resource-limited settings.Publication Using Mobile Technology to Optimize Disease Surveillance and Healthcare Delivery at Mass Gatherings: A Case Study from India's Kumbh Mela(Oxford University Press (OUP), 2017-09-01) Kazi, Dhruv; Greenough, Paul Gregg; Madhok, Rishi; Heerboth, Aaron; Shaikh, Ahmed; Leaning, Jennifer; Balsari, SatchitBackground: Planning for mass gatherings often includes temporary healthcare systems to address the needs of attendees. However, paper-based record keeping has traditionally precluded the timely application of collected clinical data for epidemic surveillance or optimization of healthcare delivery. We evaluated the feasibility of harnessing ubiquitous mobile technologies for conducting disease surveillance and monitoring resource utilization at the Allahabad Kumbh Mela in India, a 55-day festival attended by over 70 million people. Methods: We developed an inexpensive, tablet-based customized disease surveillance system with real-time analytic capabilities, and piloted it at five field hospitals. Results: The system captured 49 131 outpatient encounters over the 3-week study period. The most common presenting complaints were musculoskeletal pain (19%), fever (17%), cough (17%), coryza (16%) and diarrhoea (5%). The majority of patients received at least one prescription. The most common prescriptions were for antimicrobials, acetaminophen and non-steroidal anti-inflammatory drugs. There was great inter-site variability in caseload with the busiest hospital seeing 650% more patients than the least busy hospital, despite identical staffing. Conclusions: Mobile-based health information solutions developed with a focus on user-centred design can be successfully deployed at mass gatherings in resource-scarce settings to optimize care delivery by providing real-time access to field data.Publication A Rapid Needs Assessment Among the Rohingya and Host Communities in Cox’s Bazar, Bangladesh: A Randomized Survey(Center for Open Science, 2018-04-15) Bhatia, Abhishek; Mahmud, Ayesha; Fuller, Arlen; Shin, Rebecca; Morshed, K.A.M; Rahman, Azad; Shatil, Tanvir; Sultana, Mahmuda; Balsari, Satchit; Leaning, JenniferThe Rohingya people of Myanmar have been subject to human rights violations through governmentsponsored discrimination and violence. Since August 2017, an intensified assault by Myanmar authorities has resulted in a rapid increase of Rohingya pouring into Bangladesh, and the expansion of refugee settlements in the district of Cox’s Bazar has strained humanitarian and government relief efforts. Assessing Rohingya and host community needs is critical for prioritizing resource allocations and for documenting the rights violations suffered by Rohingya refugees. From March 15 to 18, 2018, we conducted a rapid needs assessment of recently arrived Rohingya and host community households. We collected data on demographics, mortality, education, livelihoods, access to food and water, vaccination, and health care. Among other things, our survey found high levels of mortality among young Rohingya men, alarmingly low levels of vaccination among children, poor literacy, and rising poverty. Denied formal refugee status, the Rohingya cannot access due protections and find themselves in a state of insecurity in which they are unsure of their future and unable to formally seek work or send their children to school. While the government of Bangladesh explores the options of repatriation, relocation, and third-country resettlement for these refugees, it is important to ensure that they are not denied a life of dignity.