Increased injuries resulted from both child abuse and accidents, University of North Carolina at Chapel Hill researchers say. Parental stress, weakened social supports and other factors also may have taken a toll.
"Inflicted traumatic brain injury in the most affected counties increased dramatically in the six months following the disaster when compared with the same areas before the hurricane," said Dr. Heather T. Keenan, research assistant professor of social medicine at the UNC School of Medicine.
"The same was true for brain injuries resulting from various accidents," she said. "We found no corresponding increased incidence in North Carolina counties less affected or unaffected by the storm."
Overall, child abuse brain injuries were five times more common in the hardest-hit counties in the half-year after the hurricane than before and such injuries attributable to accidents were more than 10 times as common, Keenan said.
A report on the findings appears in the April issue of the American Journal of Preventive Medicine. Besides Keenan, authors are Drs. Stephen W. Marshall, assistant professor of epidemiology and orthopedics, and Desmond K. Runyan, professor and chair of social medicine. Mary Alice Nocera, project manager at the UNC Injury Prevention Research Center, also contributed to the study.
Hurricane Floyd, which dropped 20 inches of rain in eastern North Carolina, affected an estimated 2.1 million people, with 52 deaths -- most from drowning, Keenan said. Damage was estimated at $6 billion dollars, and federal officials designated 66 counties as disaster areas.
"The incidence of child abuse following natural disaster has not been thoroughly studied, and an examination of it following hurricanes Hugo in South Carolina and Andrew in Louisiana and the Loma Prieta Earthquake in California had mixed results," she said. "We hypothesized that the flooding and subsequent loss of -- and disruption to -- lives, property and community ties in our state may have contributed to an increase in parental stress and depression and thus contributed to an increase in child maltreatment."
Keenan and colleagues concentrated on head injuries rather than all forms of child abuse since such cases were more likely to be severe, require treatment and be reported.
Data used in the UNC study came from the N.C. Office of the Chief Medical Examiner and extensive review of cases of children under age 2 admitted to pediatric intensive care units at the state's largest medical centers, she said. Among those helping identify cases were charge nurses at the units whom researchers contacted regularly.
"We identified 245 children as having suffered a traumatic brain injury or death during the entire 40-month study period from September 1998 through December 2001," Keenan said. "Thirty-seven, or 15 percent, occurred in the 16 severely affected counties. Of those, we identified 20 child abuse injuries. In the other 84 counties, 108 were inflicted."
The rate of child abuse brain injuries returned to close to "normal" in the hardest-hit counties six months after the hurricane while the rate of other brain injuries remained elevated for the entire post-disaster study period, she said. Seventy-three percent of the injured children in the worst-hit counties were non-whites as compared to less than 49 percent in other counties. That suggests that non-whites suffered more economic and other stresses following the disaster than whites did.
Besides stress, possible factors in abuse injuries were poverty and depression, the scientist said. Potential additional reasons for non-abuse injuries included higher risk of car crashes and injuries from disaster-related environmental hazards, less adult supervision of infants and dangers associated with living away from home in temporary housing.
"While our study can't prove specific causes, Hurricane Floyd was likely to have produced both an increase in psychiatric symptoms as seen after other large-scale disasters, as well as financial hardship and loss of social ties for families caught in the worst of the flooding," she said.
"Our conclusion was that families are vulnerable to an elevated risk of inflicted and non-inflicted child traumatic brain injury following a disaster," Keenan said. "This information may be useful in future disaster planning. To the extent possible, vulnerable families should receive additional support -- both immediately after a disaster and during the recovery period."
The project was supported by a grant from the National Center for Injury Prevention and Control to the UNC Injury Prevention Research Center.
Journal
American Journal of Preventive Medicine