Cyclones continue to pose a dangerous threat to the coastal populations of Bangladesh, despite improvements in disaster control procedures. After 138,000 persons died in the April 1991 cyclone, we carried out a rapid epidemiological assessment to determine factors associated with cyclone-related mortality and to identify prevention strategies. A nonrandom survey of 45 housing clusters comprising 1123 persons showed that mortality was greatest among under-10-year-olds (26%) and women older than 40 years (31%). Nearly 22% of persons who did not reach a concrete or brick structure died, whereas all persons who sought refuge in such structures survived. Future cyclone-associated mortality in Bangladesh could be prevented by more effective warnings leading to an earlier response, better access to designated cyclone shelters, and improved preparedness in high-risk communities. In particular, deaths among women and under-10-year-olds could be reduced by ensuring that they are given special attention by families, neighbours, local authorities, and especially those in charge of early warnings and emergency evacuation.
PIP: One of the most dangerous cyclone basins of the world is located in the Bay of Bengal and the population most affected lives in coastal areas in Bangladesh. A Bangladesh National Storm Warning Center was set up in 1970 and 311 cyclone shelters were built to accommodate 350,000 people. This paper reports on the rapid assessment of 2 cyclone areas (Chakaria on the mainland and Kutubdia, an offshore island) devastated in the aftermath of the April 29, 1991, cyclone. The aim was to identify factors contributory to survival or death and to improve early warning, shelter building, and preparedness. The hypothesis was that survival was based on the ability of people to reach a reinforced structure in time. Between June 14 and June 21, 1991, 45 clusters comprising 135 households and a total population of 1123 individuals were surveyed. Information was obtained from 45 primary informants for 25-30 neighbors. The results showed that 14% of the survey population died. 26% of children under 10 years of age died and 4% over age 10 died. Almost 40% of unsheltered children were at greatest risk of death. 31% of females older than 40 years died and 40% of those older than 60 years. The risk of dying was related to the type of shelter and the actions taken to seek shelter. 98% of the people were not in "pukka" or safe shelters (made of brick or concrete) during the storm. Although there was 3-6 hours warning, only 4% sought or reached safe shelter. When the storm first hit 10-60 minutes before impact, 13% were in safe shelters and 33% reached safe shelter by impact; none died. The 736 persons at risk drowned in flood waters. Women's and children's mortality was probably due to factors such as physical size, strength, and endurance. Mortality was 39% of the 285 swept away by the storm, 15% of those who clung to objects, 22% of those who found high ground, and 11% of those who sought shelter in trees. The reasons for not seeking shelter were given as misgauging the severity of the storm (45%), difficulty with high winds and flooding (16%), and not understanding 916%). Only 2 of 5 shelters were usable due to flooding. Warnings must state that women and children must seek shelter at the first warning, be more precise about time and place of impact, and the recommended action. Shelters must be made more accessible. The population in general must be better educated about cyclone preparedness and safety.