Education Level and Income of Participants

In this study, more than 20% of participants and their partners had graduated from high school. The National Demographic and Health Survey in 2017 (NDHS) reported 8.8% of males and 11.3% of females who were parents of families of 6 or more from the lowest wealth quintile had completed high school.²⁷ Therefore, the current study participants had relatively higher education levels than those reported in the NDHS in 2017.

From the current study, more than 95% of participants and their families lived under the absolute poverty line According to the Philippine Statistic Authority, a family of 5 needed no less than PHP 10,481 (US$ 209.62) monthly, on average. This amount was essential to meet the basic food and other needs in a month during 2018.²⁸ It means at least PHP 69.43 (US$1.39) were necessary to fulfill the basic needs per person per day in the Philippines. The national poverty²⁹ line in the Philippines was lower than absolute poverty. Even if the national poverty line in the Philippines was considered, more than 80% of the participants could not get enough money to fulfil their basic needs in this study. Such poverty circumstances might thereby explain the fact that more than half of participants’ partners were engaged in temporary jobs. To determine whether the percentage of temporary jobs was a consequence of Typhoon Yolanda, the occupation status before Typhoon Yolanda needs to be determined in the future research.

Child Health Condition

The results of the National Nutrition Survey (NNS) in Eastern Visayas on Leyte Island revealed that the prevalence of stunted growth in children less than 5 y old had fallen from 44.5% in 1989 to 33.7% in 2011, and the prevalence for children less than 5 y old to be underweight had also fallen from 27.3% in 1998 to 20.2% in 2011. Compared with data on stunted growth from 2011, 2013, and to the current study, our data were the least favorable; the rates were 30.3% for the 2013 NNS and 42.3% in this study. For underweight, all scores were similar; however, the data in this study were the least favorable, ie, 20% in NNS 2013 and 22.9% in this study. First, the existence of a certain relationship between malnutrition and poverty is obvious. Because most of our participants lived beneath the absolute poverty line, sampling bias and the fact of low observed variation may have affected the results. Second, the prevalence of stunting was more common than underweight for the entire period. There is a possibility that genetic factors played a role in the children’s height because both NNS and this study followed the WHO standard.³⁰ Finally, there is a possibility that height measurements were distorted by sloped ground surfaces and the common tendency of the children of not remaining still; the children often cried and tried to escape while recording the measurements. However, underweight, an indication of acute malnutrition, revealed only a slight increase. This great achievement might be owing to the fact that the GO/NGO efforts had been successful in maintaining and even improving child health in the area.^{Reference Bernardo, Zamora and Guzman31} No relationship was found between mothers with provisional PTSD and child sleeping disturbances or child eating problems, which differed with the results of an earlier study in Indonesia.^{Reference Juth, Silver and Seyle14} However, a relationship was found between mothers who had perceived a life threat and the child height Z-scores. Although the present study was unable to determine causality, this finding could support Stewart’s theory^{Reference Stewart32} that a mother’s distress affects children’s growth.

Disaster Circumstances and Preparedness

Multiple regression analysis revealed that people who lived in their own house had lower life-threatening experiences, and people who lived in a multistory house and had delivered their baby in a health facility had lower loss-disruption experiences. Regarding house ownership, living in their own houses led to taking more precautions and kept people away from life-threating experiences. Additionally, people who had greater life-threatening and loss-disruption experiences felt more anxiety about their own disaster preparedness and had not prepared an evacuation plan. Despite the tragedy brought to Leyte Island by Typhoon Yolanda, 21% of the participants had made no preparations for the next disaster, and 43.5% had no evacuation plan. Previous studies have also highlighted a lack of household disaster preparedness,^{Reference Levac, Toal-Sullivan and O’Sullivan15,Reference Kohn, Eaton and Feroz16,Reference Wakui, Agree and Saito24} even when the people know its importance. These contradictory phenomena might also explain the presence of unrealistic optimism, a state that is characterized by the belief that one will experience fewer negative life events than others.^{Reference Sattler, Kaiser and Hittner33,Reference Burger and Palmer34} It was found that respondents who lived in multistory houses and had had problems during pregnancy were more likely to have an evacuation plan, with odds between 2.30 and 3.38, respectively (Table 4), which suggests that mothers who faced problems during pregnancy might feel a greater responsibility toward their unborn child and, therefore, be more motivated to prepare for a future disaster; this finding is consistent with the findings of Levac et al., a study in the United States,^{Reference Levac, Toal-Sullivan and O’Sullivan15,Reference Olympia, Rivera and Heverley35} who found that caregiving responsibilities toward children or older adults became a motivation for disaster preparedness.

This tendency was seen in the results of the multiple regression analysis for the factors affecting the range of loss-disruption experiences (Table 3) and disaster preparedness anxiety (Table 5). Mothers who faced experiences associated with their child’s health might take action to reduce the damage from the disaster and be more cautious regarding disaster preparedness.

Mother’s Provisional PTSD

There was a 53.3% provisional PTSD prevalence in the current study, which was higher than in previous studies even conducted after Typhoon Yolanda, in which the highest score was 48.1%.^{Reference Alderman, Turner and Tong2,Reference Galea, Nandi and Vlahov3,Reference Chan, Tang and Hall36-Reference Wang, Wu and Dai38} This may have been because of the participant characteristics, such as being female, having more than 1 child, and living under the absolute poverty line; all of which have been found to be significant risk factors for PTSD.^{Reference Alderman, Turner and Tong2,Reference Galea, Nandi and Vlahov3,Reference Moreno-Walton and Koenig6} Furthermore, differences were observed in disaster magnitude and diagnosed measurements. On the contrary, over half of the participants expressed doubt of the possibility of having PTSD. It is essential to support those victims with expert-approved methods, as well as by conducting follow-ups and further study.

Different from previous studies,^{Reference Galea, Nandi and Vlahov3,Reference Xiong, Harville and Mattison9} the total PCL-5 score, however, was found to be significantly associated with only anxiety over disaster preparedness in the multiple regression analysis. In other words, no other risk factors for the development of PTSD were found in this study (Table 6). As mentioned above, the participants in this study had quite similar backgrounds, ie, there was little variance leading to minor overall differences.