Eritrea Health Update Issue 2 No.20

Transcription

1 Issue No. th November st December, PROFILES Eritrea Population:,,6 - (99 Projection) Number of Zobas (Regions): 6 Humanitarian Target population:. Million Main Sources of humanitarian funding: UN CERF ECHO DFID HIGHLIGHTS Editorial Notes Diarrhoeal Disease Outbreaks WASH rapid assessment report Events: o CBTF o Health cluster meeting. o IDSR/malaria joint review meeting o Trachoma strategic planning workshop ERITREA HEALTH UPDATE c/o WHO, Adi Yakob street N., House N. 88/89, Geza Banda, P.O.BOX 556 Asmara, Eritrea. Tel. 9 6, Fax 9555 ) Editorial Notes: This will probably be the last edition of the Eritrea health bulletin for the year. The break will allow the editorial team to consolidate other things for the end of the year. We have also slightly modified the format in this edition to focus on some issues we consider to be major priorities that should receive attention in 8. In our view, capacity for early detection, response and prevention of outbreaks of diarrhoeal including capacity for WASH is number one priority. Thus we focussed on highlighting this issue. Of course other priority humanitarian interventions for nutrition, improving access to vital health services for hard to reach populations, nomadic groups (using the mapping tool), IDPs resettled areas and the refugees also constitute high priority. And there is another threat expansion of the meningitis belt eastward, with increasing involvement of other serogroups (W5, X, Y) and new sero-subgroups, antibiotic resistance and issues of access to vaccines in the presence of poor surveillance. We hope the readers have enjoyed reading the previous issues. Let us try to make it a true health bulletin in 8 by contributing articles. Compliments of the season Diarrhoeal Disease Outbreaks: Eritrea has been experiencing outbreaks of diarrhoea over the years mainly due to poor access to drinking water and poor sanitation. A rapid assessment on Water, Sanitation and Hygiene (WASH) carried out in 6 showed only minimal improvement from the DHS findings. The assessment results revealed a rural water supply coverage with improved drinking water sources of 58% and rural sanitation coverage of.5%.

2 Among the 58% of villages with improved drinking water sources, 5% were unprotected sources, while % are a mixture of protected and unprotected. Out of the total,5 villages in the country, only 5 (9%) had toilets of any kind, making open defecation a very common practice. This fact predisposes people to various communicable diseases transmitted by faeco-oral contamination including diarrhoeal diseases. Thus it is not surprising that, diarrhoea is consistently reported as the second major cause of morbidity and mortality in all Zobas especially among children under 5. Diarrhoea with blood (suspected shigellosis), is one of the outbreak prone diseases monitored weekly. A rd quartile threshold has been developed at health facility, sub Zoba and Zoba levels using data from the last 5 years. The weekly numbers of cases at each level are charted against the rd quartile threshold value for that level for that week. If the cases reach. Figure or exceed the threshold for that week, an alert is triggered and the possibility of an outbreak is investigated. When this trend is noticed at national level (Figure ), the Zoba trends are observed to see which Zoba(s) is contributing to the high figures at national level. The Zoba (s) is alerted accordingly. As presented in figures to 5, several Zobas experienced the crossing of the threshold at a certain stage. Investigation has always revealed a focus of outbreak within the Zoba at that period of time. There were also major outbreaks of acute diarrhoeal disease in Asseb and Tio in Southern Red Sea Zoba and as presented in Figure 6, there was another outbreak in Bada, Gelalo sub Zoba of Northern Red Sea. One of the major focuses for humanitarian response in 8 should be on strengthening capacity to detect early, respond and prevent diarrhoeal disease outbreaks Number of cases Eritrea: Bloody diarrhoea weekly trend in rd Quartile Yr week Number

3 Figure Anseba Zoba: Bloody Diarroea weekly trend in 5 rd Quartile Yr Number of Cases Week Number Figure Number of weeks Gash Barka Zoba: Bloody diarroea weekly trend in rd Quartile Yr week Number

4 Figure SRS Zoba: Bloody Diarroea weekly trend in rd Quartile Yr Number of cases week number Figure 5 NRS Zoba: Bloody diarroea weekly trend in rd Quartile Yr Number of cases week number

5 Figure 6 Epid Curve of Outbreak of Acute Diarrhoea in Bada, Northern Red Sea, Eritrea Number of Cases 8 6 Wk 8 Wk 9 Wk Wk Wk Wk Cases 9 6 Deaths Epidemiological Week () Number of Deaths The following manuals both available at the WHO website in UN languages and useful as reference for response to diarrhoeal disease outbreaks:. Cholera Outbreak: Assessing the Outbreak Response and Improving Preparedness. First steps for managing an outbreak of acute diarrhoea Excerpts from the documents are presented in the boxes below 5

6 First Steps in managing outbreak of diarrhoea: Two very important questions need to be answered:. Is this the beginning of an outbreak?. Is the patient suffering from cholera or shigella? Is this the beginning of an outbreak? You might be facing an outbreak very soon if you have seen an unusual number of acute diarrhoeal cases this week and the patients have the following points in common: They have similar clinical symptoms (watery or bloody diarrhoea) They are living in the same area or location They have eaten the same food (at a burial ceremony for example) They are sharing the same water source There is an outbreak in the neighbouring community Or You have seen an adult suffering from acute watery diarrhoea with severe dehydration and vomiting If you have some statistical information from previous years or weeks verify if the actual increase of cases is unusual over the same period of time (The threshold is crossed). Is the patient suffering from cholera or shigella? Acute diarrhoea could be a common symptom. Therefore it is important to differentiate between shigella or cholera in order to improve case management and to estimate needed supplies Establish a clinical diagnosis for the patient you have seen (Table) Do the same for the other family members who are suffering from acute diarrhoea Try to take stool samples and send them for immediate analysis. If it is not possible to send the samples immediately, collect stool specimens in Cary Blair or TCBS transport medium and refrigerate. Table : Symptoms Stool Differential Diagnosis of Cholera and Shigellosis: Cholera: Acute watery Shigella: Acute bloody diarrhoea diarrhoea > loose stools/day, watery like rice water Fever No Yes Abdominal Cramps Yes Yes Vomiting Yes No Rectal Pain No Yes > loose stools/day, with blood or mucous 6

7 Cholera - Some Basic Facts:. Cholera is a diarrhoeal disease caused by infection of the intestine with the bacterium Vibrio cholerae, either type O or O9.. Both children and adults can be infected.. About % of those who are infected develop acute, watery diarrhoea % of these individuals develop severe watery diarrhoea with vomiting.. If these patients are not promptly and adequately treated, the loss of such large amounts of fluid and salts can lead to severe dehydration and death within hours. 5. The case-fatality rate in untreated cases may reach 5%. 6. Treatment is straightforward (basically rehydration) and, if applied appropriately, should keep case-fatality rate below %.. Cholera is usually transmitted through faecally contaminated water or food and remains an ever-present risk in many countries. 8. New outbreaks can occur sporadically in any part of the world where water supply, sanitation, food safety, and hygiene are inadequate. 9. The greatest risk occurs in over-populated communities and refugee settings characterized by poor sanitation, unsafe drinking-water, and increased personto-person transmission.. Because the incubation period is very short ( hours to 5 days), the number of cases can rise extremely quickly. It is impossible to prevent cholera from being introduced into an area but spread of the disease within an area can be prevented through early detection and confirmation of cases, followed by appropriate response.. Because cholera can be an acute public health problem with the potential to cause many deaths, to spread quickly and eventually internationally, and to seriously affect travel and trade a well coordinated, timely, and effective response to outbreaks is paramount. Case definition According to the WHO case definition, a case of cholera should be suspected when: In an area where the disease is not known to be present, a patient aged 5 years or more develops severe dehydration or dies from acute watery diarrhoea; In an area where there is a cholera epidemic, a patient aged 5 years or more develops acute watery diarrhoea, with or without vomiting. A case of cholera is confirmed when Vibrio cholerae O or O9 is isolated from any patient with diarrhoea. In children under 5 years of age, a number of pathogens can produce symptoms similar to those of cholera, such as rice water diarrhoea. To maintain specificity, therefore, children under 5 are not included in the case definition of cholera.

8 Most important key messages:. Wash your hands after taking care of patients touching them, their stools, their vomits, or their clothes.. Beware of contaminating the water source by washing patients clothes in the water.. Come to the health care facility as soon as possible in case of acute watery diarrhoea.. Start drinking ORS at home and during travel to the health care facility. 5. Wash your hands before cooking, before eating, and after using the toilet. 6. Cook food.. Drink safe water. Water, sanitation and Hygiene (WASH) Rapid Assessments in Northern and Southern Red Sea Zobas: Acute watery diarrhoea outbreaks occurred in North and Southern Red Sea regions in an extended period of time, since mid July of in different locations and scale. Two previous high level support missions have been conducted and ensured control measures were taken. Based on the outcome of the previous missions to the outbreak areas and decisions made during follow-up meetings with Water Resources Department and UN agencies, the Ministry of Health commissioned a six person team comprising of staff members from Ministry of Health, WRD, UNICEF and WHO to conduct quick assessment with focus on the WASH situation. The overall objective of the mission was to determine further intervention needs especially in the area of water supply sanitation and hygiene and propose possible action points for decision making. Below is a summary of the mission report: 8

9 Map showing Areas at High Risk & Distribution of Detected Cases in NRS and SRS sub zones Gelalo Bada Adaieto Tio Arata Ethiopia Makel Denkalia Edi Be rasole Asseb Harsile Abo Debub Denkalia Kelom a 5 kilometers Djibouti Main Findings: The outbreak in Bada has been effectively controlled and no new cases have been reported since October,. Sporadic cases continue to be reported in Tio, Hamerti, Egroli and Aytus areas of Southern Red Sea. Despite the large number of cases in SRS the death case fatality rate reported was less than one percent while in NRS it was.8 percent. Shortages of laboratory materials were also observed (Carry-Blair transport media). Supplies of essential drugs, ORS, IV fluids and disinfectants for routine health services were available. However these are not adequate to provide effective control for outbreaks of such magnitude Access to safe and adequate water is a priority issue in the communities. Currently the community of Bada is relaying on two types of water sources, spring water and shallow unprotected dug wells and neither of them is safe. Rapid hydrogen sulfide test confirmed that the existing water sources are bacteriological contaminated in most areas, The water collection and storage methods are unsafe The communities practice open defecation. Even when they are admitted in the health facilities; they do not use the health facility latrines. There are huge knowledge, attitude and behaviour gaps in the communities specifically in the areas of safe Hygiene and sanitation practices. The report proposed a number of recommendations and action points especially on WASH and future outbreak prevention and response. The detailed report is available with the Ministry of Health, Water Resources Department, WHO and UNICEF. 9

10 Trend of suspected cases in Bada kebabis NRS /9/---// IPD cases CASES DEATHS 5 /9/ /9/ 5/9/ 6/9/ /9/ 8/9/ 9/9/ /9/ // // // // 5// 6// // 8// 9// // // // // // 5// 6// // 8// 9// // // // // // 5// 6// // 6 Trend of suspected cases, Tio kebabi SRS /9/- 9// IPD CASES 8 6 /9/ 5 5/9/ /9/ 9/9/ // // 6 6 5// // 6 9// // 8 // 6 5// // 9// // // 5// // cases deaths 9// 5

11 Events: Community Therapeutic Feeding in Goluj Sub Zoba: Community based therapeutic feeding was established in Goluj sub Zoba of Gash Barka bringing to the number of sub Zobas where WHO is implementing the strategy. Goluj is a priority sub Zoba in view of its being an IDP re-settled area. This activity is a joint strategy in which ECHO provides funding support, Ministry of Health and Zoba implement activities, WHO provides technical and logistic support and UNICEF supplies the food items. In this round of ECHO project, the targeted results are being monitored with agreed indicators. The level achieved for some of the indicators so far are: Proportion of severely malnourished children covered by CBTF = 8% (Target 6%) Proportion of severely malnourished children admitted into CBTF died = % (Target 5% and below) Proportion of severely malnourished children admitted into CBTF defaulted = % (Target %) Health Cluster Meeting: Severely malnourished children admitted into CBTF The meeting of the health cluster was held under the chairmanship of WHO Representative, Dr Andrew Kosia on nd November, at the WHO Conference Hall with representation from agencies including Ministry of Health.

12 The meeting arrived at the following resolutions:. Consensus was reached on the cluster objectives and principles. ICRC will adhere to the resolution reached by the organization at international level. The will coordinate with the cluster but will not be part of it. Development of W mapping should be conducted in order to identify gaps. To explore the possibility of bringing cluster Health, nutrition and WASH under one umbrella in Eritrea in order to look at health in a holistic manner 5. OCHA to convey a message to the HC/RC to convene a national meeting of all clusters, have a Government focal point for all the clusters and reach consensus on number of clusters to adopt for Eritrea out of the total number of international clusters 6. To strengthen inter cluster linkages. Ministry of Health to host a meeting next week to prioritize for the areas health response and development of CHAP for 8 8. To develop a strategy and work plan for the cluster At the end of the meeting, the WHO shared the printed version of the migratory route mapping with the members and date of next meeting was set for 5 th December, Trachoma Strategic Plan Development A multisectoral workshop was held in Asmara from 5 th to th November, to develop strategic plan for control of trachoma. The meeting attracted ophthalmologists, public health experts, water engineers and sanitarians from various agencies. A year plan focusing on the strategies proposed by the WHO Surgery, Antibiotics, Facial cleanliness and Environmental hygiene (SAFE) was developed for the Zobas with trachoma problem. All the affected Zobas participated in the exercise. The strategic plan will be the main resource mobilization document including from International Trachoma Initiative (ITI)

13 Quarterly IDRS/Malaria Review Meeting The quarterly joint IDSR/Malaria review meeting for the rd quarter, was held at Asmara on st and nd November, under the leadership of the Director General of health services, Ministry of Health Mr. Berhane Ghebretinsae. All IDSR and malaria officers from the MoH headquarters and the Zobas were in attendance. The meeting reviewed the achievements and constraints recorded in the implementation of IDSR and malaria work plans in the first quarters of the year and the way forward for the time remaining in the year. Major issues discussed included: The threat of malaria resurgence especially in Anseba and the need to further strengthen the national capacity for surveillance and research, especially a resident epidemiologist at the national malaria control program The satisfactory monitoring of malaria trends by IDSR in The improving capacity for early detection and response to outbreaks The strengthening of community surveillance The improving completeness and timeliness of reports in most Zobas and the persistently low achievement of these indicators in Gash Barka The issues of data harmonization with HMIS Way forward including doubling of efforts to sustain achievements in IDSR and malaria control programs, improving preparedness and response capacity to outbreaks especially health workers training as well as propositioning of supplies and doubling efforts in sustaining the certification level surveillance for polio. ERITREA HEALTH UPDATE c/o WHO, Adi Yakob street N., House N. 88/89, Geza Banda, P.O.BOX 556 Asmara, Eritrea. Tel. 9 6, Fax 9555