The aim of this thesis was to examine the spatial and the temporal patterns of anxiety and chest pain resulting from the Canterbury, New Zealand earthquaeks. Three research objectives were identified: examine any spatial or termporal clusters of anxiety and chest pain; examine the associations between anxiety, chest pain and damage to neighbourhood; and determine any statistically significant difference in counts of anxiety and chest pain after each earthquake or aftershock which resulted in severe damage. Measures of the extent of liquefaction the location of CERA red-zones were used as proxy measures for earthquake damage. Cases of those who presented to Christchurch Public Hospital Emergency Department with either anxiety or chest pain between May 2010 and April 2012 were aggregated to census area unit (CAU) level for analysis. This thesis has taken a unique approach to examining the spatial and spatio-temporal variations of anxiety and chest pain after an earthquake and offers unique results. This is the first study of its kind to use a GIS approach when examining Canterbury specific earthquake damage and health variables at a CAU level after the earthquakes. Through the use of spatio-termporal scan modelling, negative and linear regression modelling and temporal linear modelling with dummy variables this research was able to conclude there are significant spatial and temporal variations in anxiety and chest pain resulting from the earthquakes. The spatio-termporal scan modelling identified a hot cluster of both anxiety and chest pain within Christchurch at the same time the earthquakes occurred. The negative binomial model found liquefaction to be a stronger predictor of anxiety than the Canterbury Earthquake Recovery Authority's (CERA) land zones. The linear regression model foun chest pain to be positively associated with all measures of earthquake damage with the exception of being in the red-zone. The temporal modelling identified a significant increase in anxiety cases one month after a major earthquake, and chest pain cases spiked two weeks after an earthquake and gradually decreased over the following five weeks. This research was limited by lack of control period data, limited measures of earthquake damage, ethical restrictions, and the need for population tracking data. The findings of this research will be useful in the planning and allocation of mental wellbeing resources should another similar event like the Canterbury Earthquakes occur in New Zealand.
The potential for a gastroenteritis outbreak in a post-earthquake environment may increase because of compromised infrastructure services, contaminated liquefaction (lateral spreading and surface ejecta), and the presence of gastroenteritis agents in the drinking water network. A population in a post-earthquake environment might be seriously affected by gastroenteritis because it has a short incubation period (about 10 hours). The potential for a gastroenteritis outbreak in a post-earthquake environment may increase because of compromised infrastructure services, contaminated liquefaction (lateral spreading and surface ejecta), and the presence of gastroenteritis agents in the drinking water network. A population in a post-earthquake environment might be seriously affected by gastroenteritis because it has a short incubation period (about 10 hours). The aim of this multidisciplinary research was to retrospectively analyse the gastroenteritis prevalence following the February 22, 2011 earthquake in Christchurch. The first focus was to assess whether earthquake-induced infrastructure damage, liquefaction, and gastroenteritis agents spatially explained the recorded gastroenteritis cases over the period of 35 days following the February 22, 2011 earthquake in Christchurch. The gastroenteritis agents considered in this study were Escherichia coli found in the drinking water supply (MPN/100mL) and Non-Compliant Free Associated Chlorine (FAC-NC) (less than <0.02mg/L). The second focus was the protocols that averted a gastroenteritis outbreak at three Emergency Centres (ECs): Burnside High School Emergency Centre (BEC); Cowles Stadium Emergency Centre (CEC); and Linwood High School Emergency Centre (LEC). Using a mixed-method approach, gastroenteritis point prevalence and the considered factors were quantitatively analysed. The qualitative analysis involved interviewing 30 EC staff members. The data was evaluated by adopting the Grounded Theory (GT) approach. Spatial analysis of considered factors showed that highly damaged CAUs were statistically clustered as demonstrated by Moran’s I statistic and hot spot analysis. Further modelling showed that gastroenteritis point prevalence clustering could not be fully explained by infrastructure damage alone, and other factors influenced the recorded gastroenteritis point prevalence. However, the results of this research suggest that there was a tenuous, indirect relationship between recorded gastroenteritis point prevalence and the considered factors: earthquake-induced infrastructure damage, liquefaction and FAC-NC. Two ECs were opened as part of the post-earthquake response in areas with severe infrastructure damage and liquefaction (BEC and CEC). The third EC (CEC) provided important lessons that were learnt from the previous September 4, 2010 earthquake, and implemented after the February 22, 2011 earthquake. Two types of interwoven themes identified: direct and indirect. The direct themes were preventive protocols and indirect themes included type of EC building (school or a sports stadium), and EC staff. The main limitations of the research were Modifiable Areal Units (MAUP), data detection, and memory loss. This research provides a practical method that can be adapted to assess gastroenteritis risk in a post-earthquake environment. Thus, this mixed method approach can be used in other disaster contexts to study gastroenteritis prevalence, and can serve as an appendage to the existing framework for assessing infectious diseases. Furthermore, the lessons learnt from qualitative analysis can inform the current infectious disease management plans, designed for a post-disaster response in New Zealand and internationally Using a mixed-method approach, gastroenteritis point prevalence and the considered factors were quantitatively analysed. A damage profile was created by amalgamating different types of damage for the considered factors for each Census Area Unit (CAU) in Christchurch. The damage profile enabled the application of a variety of statistical methods which included Moran’s I , Hot Spot (HS) analysis, Spearman’s Rho, and Besag–York–Mollié Model using a range of software. The qualitative analysis involved interviewing 30 EC staff members. The data was evaluated by adopting the Grounded Theory (GT) approach. Spatial analysis of considered factors showed that highly damaged CAUs were statistically clustered as demonstrated by Moran’s I statistic and hot spot analysis. Further modelling showed that gastroenteritis point prevalence clustering could not be fully explained by infrastructure damage alone, and other factors influenced the recorded gastroenteritis point prevalence. However, the results of this research suggest that there was a tenuous, indirect relationship between recorded gastroenteritis point prevalence and the considered factors: earthquake-induced infrastructure damage, liquefaction and FAC-NC. Two ECs were opened as part of the post-earthquake response in areas with severe infrastructure damage and liquefaction (BEC and CEC). The third EC (CEC) provided important lessons that were learnt from the previous September 4, 2010 earthquake, and implemented after the February 22, 2011 earthquake. The ECs were selected to represent the Christchurch area, and were situated where potential for gastroenteritis was high. BEC represented the western side of Christchurch; whilst, CEC and LEC represented the eastern side, where the potential for gastroenteritis was high according to the outputs of the quantitative spatial modelling. Qualitative analysis from the interviews at the ECs revealed that evacuees were arriving at the ECs with gastroenteritis-like symptoms. Participants believed that those symptoms did not originate at the ECs. Two types of interwoven themes identified: direct and indirect. The direct themes were preventive protocols that included prolific use of hand sanitisers; surveillance; and the services offered. Indirect themes included the EC layout, type of EC building (school or a sports stadium), and EC staff. Indirect themes governed the quality and sustainability of the direct themes implemented, which in turn averted gastroenteritis outbreaks at the ECs. The main limitations of the research were Modifiable Areal Units (MAUP), data detection, and memory loss. It was concluded that gastroenteritis point prevalence following the February 22, 2011 earthquake could not be solely explained by earthquake-induced infrastructure damage, liquefaction, and gastroenteritis causative agents alone. However, this research provides a practical method that can be adapted to assess gastroenteritis risk in a post-earthquake environment. Creating a damage profile for each CAU and using spatial data analysis can isolate vulnerable areas, and qualitative data analysis provides localised information. Thus, this mixed method approach can be used in other disaster contexts to study gastroenteritis prevalence, and can serve as an appendage to the existing framework for assessing infectious diseases. Furthermore, the lessons learnt from qualitative analysis can inform the current infectious disease management plans, designed for a post-disaster response in New Zealand and internationally.
