Nwamaka Osakwe, FWACP, MBBS
Heavy rainfalls, excessive ocean waves, and dam breaks cause floods. Over the years, several African countries have been hit by floods. But unfortunately, the “worst floods in a decade” recently swept through several African countries, killing hundreds and forcing millions out of their homes.
Flood-related health risks are enormous. These health risks may be directly or indirectly related to flooding. They include drowning or near drowning, damage to infrastructures, loss of food and medicine, problems with clean water supply, sanitation, or even loss of social support system.
This article explores seven health-related consequences of floods that healthcare workers should look out for and how to manage them.
Seven health risks associated with floods
- Drowning and near drowning: This is the commonest immediate cause of death. “Drowning is a huge risk, and it can be hard to know how bad flooding will be,” said Dr. Nsisong Asanga, a public health physician. The risk of drowning is higher for rapidly developing floods like flash floods.
Management: Patients with a near-drowning experience often require oxygen. So, it is crucial to monitor oxygen saturation with a pulse oximeter. In addition, patients with respiratory distress, altered sensorium, or severe hypoxemia may require intubation. Therefore, patients with hypoxemia are best treated in a facility with an intensive care unit where they can get rapid access to respiratory support.
It is also appropriate to monitor blood glucose and temperature in these patients.
- Trauma/Injuries: Flood water often contains debris and other items (such as sharp objects) able to injure people caught in the flood. Dr. Nsisong said, “injuries and accidents occur because of mobility problems, debris, and damage to existing structures.”
Floods may also contain hazardous waste, chemicals, and biological waste.
Additionally, there’s a risk of being bitten by displaced animals such as snakes and crocodiles, said Dr. Nsisong. For example, one report documented that 14 crocodiles were washed up in one flood in South Africa.
Management: All wounds following exposure to flood waters should be inspected, and the degree of injury assessed. It is best to remove all devitalized tissues that can slow the wound-healing process. Then the wounds can be irrigated and cleaned with normal saline. Primary closure of the damage may be done for injuries with a low risk of infection. It is also best to administer the tetanus vaccine to people not adequately immunized.
For people with snake bites, avoid using a tourniquet. An antivenom for snakes endemic to the region should be used as it is unlikely the healthcare professional would be able to identify the snake responsible for the snake bite. Antibiotics should also be considered, given the risk of secondary infection.
Patients exposed to chemicals should be decontaminated as quickly as possible.
- Hypothermia: In this state, a person’s temperature-regulating mechanism is dysregulated due to very low external temperature, and the body’s core temperature falls below 35oC.
During floods, a person submerged in water loses heat from the body through conduction. The problem with being submerged in water is that water conducts heat thirty times more than air. So, the body loses heat faster in cold water. Mechanisms that conserve heat, like shivering and vasoconstrictions, can get overwhelmed when a person is immersed in water.
Patients with hypothermia may present with chills, confusion, dizziness, slurred speech, and ataxia. In addition, the central nervous system function is compromised at moderate to severe hypothermia, and arrhythmias may develop.
Management: Remove all wet clothes when managing patients with hypothermia. Dry blankets and warm packs/bottles are helpful. Warm drinks and skin-to-skin can also help warm the patient. However, the CDC discourages the use of alcoholic beverages in this setting.
- Electrical injuries: This may occur from fallen power lines or the power supply in the submerged home. It is best to turn off the fuse during a flood. And in floods, the power company may need to shut down power lines. Electrical hazards may persist even after the floods have begun to recede.
Some electrical injuries kill instantly. In other cases, people with electrical injuries may have a minimal external injury or sustain severe burns. Individuals thrown by electricity may break their bones or sustain neck injuries.
Management: This depends on the degree of injury. The clinician should pay close attention to the airway, breathing, and circulation. It is essential to examine for entry and exit wounds. Furthermore, unconscious patients may require radiologic examination. An ECG is necessary because of the risk of arrhythmia. It is also essential to hydrate and monitor urine output because of the risk of myoglobinuria.
- Infections: The risk of infection is high in flood conditions, and several body systems can be affected.
- Skin infections, old and new injuries may get infected from being submerged in flood waters. Staphylococcus and Streptococcus species are the most implicated organisms.
Management: Skin infections containing pus should be drained. If there are dead tissues, they should be debrided and all foreign bodies removed.
Beta-lactamase antibiotics (like flucloxacillin, amoxicillin/clavulanic acid, and cefalexin) and clindamycin are effective agents.
- Respiratory tract infections have been observed in flood situations. For example, flood-associated pneumonia may occur following near drowning, and implicated organisms are often polymicrobial. Viral respiratory tract infections are also common, particularly in crowded spaces often seen in camps and other temporary housing for displaced persons.
Management: It is mainly supportive for viral infections. Bacterial infections require the use of broad-spectrum antibiotics.
- Gastrointestinal infections are high, especially in areas with poor water supply. Faecal contamination is common. Ensuring safe drinking water is the best preventive action, according to WHO. Boiling and chlorination are effective ways of purifying water.
Examples of gastrointestinal infections that may come to the physician’s attention are cholera by Vibrio cholera, typhoid fever from Salmonella typhi, hepatitis E, and hepatitis A.
Management: Rehydration is vital when managing gastroenteritis. Children are particularly vulnerable to dehydration.
The therapy goals are to rehydrate orally or intravenously, identify complications and prevent the spread of infections.
These infections can spread rapidly if appropriate actions are not taken. Education is essential. Victims of flood disasters should wash their hands frequently and treat all water used for drinking and cooking.
Cooked foods should be kept separate from raw foods to minimize the risk of infection and transmission.
- Malnutrition: Food shortages often follow flooding. Dr. Nsisong talked about how communities could lose their farm produce and livelihood, leading to undernutrition and malnutrition. Children are particularly vulnerable to malnutrition.
Patients with undernutrition may present with protein, energy, and micronutrient deficits. Undernutrition impacts growth and development in the pediatric population. Similarly, pregnancies may be complicated by intrauterine growth restriction and low birth weight. Furthermore, lactating mothers may develop problems with breastfeeding.
Children with undernutrition are weak and emaciated, and their skin may hang loosely from the loss of subcutaneous fat.
Interventions and relief aid by the government, non-governmental organizations, and philanthropic individuals are essential to help curb the risk of malnutrition after a flood.
Management: Malnutrition can be managed in the community, but patients with severe complications like hypothermia and pneumonia require hospitalization.
- Mental disorders: Flooding and associated displacement with loss of lives and property are significant sources of stress. Anxiety, depression, post-traumatic stress disorder, and insomnia are some mental health issues related to flooding.
How can flood-related health hazards be prevented?
Some communities experience floods from time to time, especially during the rainy seasons. For people living in such places, it’s crucial to stay informed and have an evacuation plan. Sometimes, the government announces an impending flood before it hits.
Dr. Nsisong encouraged evacuating as soon as possible. However, power lines and gas sources should be turned off before evacuating. Then, only leave with essential materials.
Furthermore, Dr. Nsisong emphasized the government’s vital role, including providing early evacuation warnings, food, and healthcare support.
The government should also pay attention to water supply and waste management. Infections are often rampant in camps due to overcrowding and contamination of food and water.
Final words
Floods carry a significant health risk to the community. Healthcare professionals play a critical role in treating and educating the community. Implementing key strategies like the supply of clean water, frequent hand washing, and proper waste disposal will go a long way in curbing the health impact of floods.
Nwamaka Osakwe, FWACP, MBBS, is an award-winning physician who loves writing about health and wellness. You can reach her here.
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