title: Health Care Access and Utilization after the 2010 Pakistan Floods.
abstract: Introduction The 2010 floods submerged more than one-fifth of Pakistan's land area and affected more than 20 million people. Over 1.6 million homes were damaged or destroyed and 2,946 direct injuries and 1,985 deaths were reported. Infrastructure damage was widespread, including critical disruptions to the power and transportation networks. Hypothesis Damage and loss of critical infrastructure will affect the population's ability to seek and access adequate health care for years to come. This study sought to evaluate factors associated with access to health care in the aftermath of the 2010 Pakistan floods.
  
  
  METHODS
  A population-proportional, randomized cluster-sampling survey method with 80 clusters of 20 (1,600) households of the flood-affected population was used. Heads of households were surveyed approximately six months after flood onset. Multivariate analysis was used to determine significance.
  
  
  RESULTS
  A total of 77.8% of households reported needing health services within the first month after the floods. Household characteristics, including rural residence location, large household size, and lower pre- and post-flood income, were significantly associated (P<.05) with inadequate access to health care after the disaster. Households with inadequate access to health care were more likely to have a death or injury in the household. Significantly higher odds of inadequate access to health care were observed in rural populations (adjusted OR 4.26; 95% CI, 1.89-9.61).
  
  
  CONCLUSIONS
  Adequate health care access after the 2010 Pakistani floods was associated with urban residence location, suggesting that locating health care providers in rural areas may be difficult. Access to health services also was associated with post-flood income level, suggesting health resources are not readily available to households suffering great income losses. Jacquet GA , Kirsch T , Durrani A , Sauer L , Doocy S . Health care access and utilization after the 2010 Pakistan floods. Prehosp Disaster Med. 2016;31(5):485-491.
authors: 1Johns Hopkins University School of Medicine,Baltimore,MarylandUSA.
authors: Gabrielle A
authors: http://orcid.org/0000-0001-9486-5512
authors: GA
authors: Jacquet
authors: 1Johns Hopkins University School of Medicine,Baltimore,MarylandUSA.
authors: Thomas
authors: T
authors: Kirsch
authors: 5University of Pennsylvania School of Medicine,Philadelphia,PennsylvaniaUSA.
authors: Aqsa
authors: A
authors: Durrani
authors: 1Johns Hopkins University School of Medicine,Baltimore,MarylandUSA.
authors: Lauren
authors: L
authors: Sauer
authors: 2Johns Hopkins Bloomberg School of Public Health,Baltimore,MarylandUSA.
authors: Shannon
authors: S
authors: Doocy
mesh_terms: D016000:Cluster Analysis; D005260:Female; D055868:Floods; D019538:Health Care Surveys; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010154:Pakistan
keywords: GPS Global Positioning System; Pakistan; USD United States dollar; catastrophic flooding; health services accessibility; natural disaster