Eritrea Health Update Issue 3 No. 4

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1 Issue 3 No. 2 th 3 th March, 8 PROFILES ) Eritrea Population: 3,53,58 - (99 Projection) Number of Zobas (Regions): 6 Humanitarian Target population: 2.3 Million Sources of humanitarian funding: UN CERF EU-ECHO DFID HIGHLIGHTS Outbreak monitoring for week 3 Status Report on Health Related Millennium Development Goals(MDGs) Outbreak Monitoring: Week 3 (2 th 3 th March 8) Report Completeness and Timeliness All six Zobas have submitted reports up to week 3. The Southern Red Sea and Gash Baka Zobas/Regions continue to record the lowest percentages in terms of timeliness of reporting. There is a need to work with these two regional health offices to improve the timeliness of reporting. Cerebro-Spinal Meningitis (CSM) Ten suspected cases of meningitis have been documented. Nine (9) cases were reported from the Paediatric Referral Hospital in Meakel Zoba while one case was reported from the Northern Red Sea Zoba. Laboratory investigation revealed that five ( from the Paediatric Referral Hospital and the one case from the Northern Red Sea Zoba) of the suspected cases of meningitis were positive. Table : Average Health facility to Zoba weekly report of completeness and timeliness as at week 3(2 th 3 th March, 8) Zoba Total Population Number of HFs Timeliness Completeness Anseba Debub Gash Barka Maekel NRS SRS Total 3,53, ERITREA HEALTH UPDATE c/o WHO, Adi Yakob street N. 3, House N. 88/89, Geza Banda, P.O.BOX 556 Asmara, Eritrea. Tel , Fax 2955 Eritrea Health update

2 Other Outbreaks: Malaria Generally, the cases of malaria have been maintained below the third quartile threshold level during the period under review. There was no noticeable crossing of the threshold in all the regions. The number of malaria cases was also well maintained below the third quartile threshold level at the national level during the period under review. Bloody and Other Diarrhoeas: There was no reported outbreak of bloody diarrhoea (shigellosis) from any of the zones during the period under review. However, in the Southern Red Sea Zoba, there were two sharp increases in the number of bloody diarrhoea cases beyond the third quartile threshold level, during week and week 3, which were followed by a sharp falls. At the national level, the number of bloody diarrhoea cases was maintained below the third quartile threshold level during the period under review Measles and AFP Situation: To date, a total of 2 cases of AFP and suspected cases of measles have been documented. Investigations revealed that all suspected cases of measles were negative while of the 2 cases of AFP were non polio AFP. A total of cases of AFP are still pending classification. Figure Anseba Zoba: Malaria weekly trend in rd Quartile Yr Week number 2

3 Figure 2 Debub Zoba: Malaria weekly trend in 8 3rd Quartile Yr Week number Figure 3 Maekel Zoba: Malaria weekly trend in 8 3rd Quartile Yr Week No 3

4 Figure Gash Barka Zoba: Malaria weekly trend in 8 Number Cases 3rd Quartile Yr Week number Figure 5 NRS Zoba: Malaria weekly trend in rd Quartile Yr Week number

5 Figure 6 SRS Zoba: Malaria weekly Trend in 8 3rd Quartile Yr Week number Figure Eritrea Health Upda Eritrea Health Anseba Zoba: Bloody Diarroea weekly trend in 8 Number of Cases 3rd Quartile Week Number Yr8 5

6 Figure 8 Debub Zoba: Bloody Diarroea weekly trend in NUmber of cases 3rd Quartile Yr Week Number Figure 9 Number of weeks 5 5 Gash Barka Zoba: Bloody diarroea weekly trend in 8 3rd Quartile Yr week Number Update Eritrea Health 6

7 Figure Maekel Zoba: Bloody Diarroea weekly trend in rd Quartile Yr Week Number Figure Health NRS Zoba: Bloody diarroea weekly trend in 8 3rd Quartile Yr week number

8 Figure 2 SRS Zoba: Bloody Diarroea weekly trend in 8 5 3rd Quartile Yr week number Figure 3 Eritrea: Bloody diarrhoea weekly trend in 8 3rd Quartile Yr week Number Update Eritrea Health 8

9 Figure Eritrea: Malaria weekly trend in 8 3rd Quartile Yr week number 9

10 Status Report on Health Related Millennium Development Goals (MDGs) Introduction The Government of Eritrea, in collaboration with its development partners, has been making significant strife towards achieving the Millennium Development Goals (MDGs). Realizing that economic growth is crucial for poverty reduction, the Government pursued policies, which resulted in rapid growth, until the border conflict with neighboring Ethiopia. Similarly, the Government embarked on a comprehensive malaria control program, ahead of the launching of the MDGs and the Global Roll Back Malaria Program. The state of no-peace no-war and the consequent high level of mobilization of the productive labour force for military service, in particular, have reduced considerably the scope for economic growth. In addition, Eritrea has had to cope with five years of recurrent severe droughts from -5. In any case, because of its arid climate, the country suffers from chronic food deficits. Even in years of good rainfall, it has normally not been able to produce more than 6- percent of the domestic consumption requirements. From the country own experience as documented in the 2 Demographic Health Survey (DHS) and from experiences of other countries, there are numerous synergies between and within sectors. Access to safe drinking water and improved sanitation in schools is not just a matter for the Ministry of Education but also for Ministry of Health and other Government agencies. Similarly, child nutrition is not just a matter for Ministry of Health but also the Ministry of Education, Ministry of Agriculture and other agencies. To capitalize on the existing synergies, the Government of Eritrea is finalizing a medium term development plan. Progress To Date Towards Achieving The Health Related MDGs Targets In order to ascertain the progress that Eritrea has made towards the MDG targets, it is necessary to establish a base year and benchmarks for the indicators. Based on a review of the available data, 3 has been chosen as the base period. Progress towards achieving the MDG targets is therefore assessed by comparing the status of various indicators during the period 8 with that of 3, drawing on a number of surveys and other sources. The choice of a three-year period is dictated by the fact that data on all the major indicators are not available for any single year. In some cases data are not available for the base period. However, on the whole, the data presented below are adequate to assess, with some degree of certainty, Eritrea s progress towards achieving the MDGs targets. They include the 2 DHS, the 3 Poverty Assessment comprising the Living Standards Measurement Survey (LSMS) and the Participatory Poverty Assessment (PPA), the 3 Rural Livelihood Security Assessment, and the 3 Food Security Strategy (FSS).

11 Goal : Reduce Child Mortality The under-five mortality rate fell from 93 deaths per live births in 3 to deaths per live births in 8. The infant mortality rate declined from 8 deaths per live births to 3 deaths per live births during the same period. These figures show that progress has been made towards reducing child mortality. Hard to reach area (Kebabi Ruba-Hadas) The main constraints to improving child health include: Increased prevalence of malnutrition with subsequent increase in the susceptibility of children to infections; and The inadequate number of all cadres of professionally trained health personnel doctors, nurses, health assistants, laboratory technicians, etc. Community based therapeutic feeding in Goluj

12 In spite of the above mentioned constraints, there are opportunities for reducing child mortality further. These include: The continuing increase in the proportion of children 2 to 23 months who are receiving all their immunizations thus decreasing the likelihood of outbreaks of vaccine preventable diseases; The adoption of the IMCI guideline for the management of childhood illnesses; The continuation of the comprehensive malaria control program; and The periodic monitoring of the nutritional status of children along with the provision of supplementary feeding, where necessary, to improve the nutritional status. Goal 5: Improve Maternal Health Although the 2 DHS did not collect data on maternal mortality, it was estimated to be 58 per, live births during the period 3. Most births occur at home, where the risks to the health of the mother and child are greater. This point was reinforced by DHS data which revealed that the proportion of births attended by skilled health personnel was very low. The proportion of births attended by skilled health personnel increased from 2 percent during the period to percent during the period 3. With the increase in the proportion of births attended by skilled health personnel, there is an improvement in the maternal mortality ratio. The proportion of births attended by skilled personnel in 8 is estimated to be 9 percent while the maternal mortality ratio is estimated to be 32 per, live births. 2

13 Maternity waiting home in Edi with old bed provided by the health station The challenges to improving maternal health include: The increased prevalence of malnutrition, especially among the vulnerable population; The high adult female illiteracy rate; The inadequate number of professionally trained health personnel; The low contraceptive prevalence rate; The preference for home delivery due to cultural and religious reasons; and The decreased access to health facilities by disadvantaged population primarily because of the long distances. Goal 6: Combat HIV/AIDS, Malaria and Other Diseases For the period 3, the adult prevalence rate for HIV, based on expanded antenatal surveillance sites, was estimated at 2. percent. For the period 8, the adult prevalence rate for HIV is estimated at 2.38 percent. The recent data show that prevalence rates are much higher among certain occupational categories, namely: bar, hotel and teashop workers (.9 percent), domestic servants (9.5 percent) and military personnel (6 percent). 3

14 Available data revealed that there has been a decline in morbidity and mortality due to malaria. There has been more than 55% decline in health facility based malaria mortality from 3 to. Available data also revealed that there has been an increase in the detection and cure rates of tuberculosis. According to the 3 health facility based data, the smear positive detection rate was percent while the cure rate was 85 percent. The main constraints to further progress in combating HIV/AIDS Malaria and other diseases are as follows: Slow behaviour change. According to the 2 DHS, virtually all women interviewed had heard about HIV/AIDS and, without prompting, 5 percent stated that HIV/AIDS could be avoided by using condoms. However, condom use remains very low, less than one percent among currently married women, according to the 2 DHS There is still widespread stigma associated with HIV/AIDS, discouraging people from undergoing testing Lack of opportunities for treatment discourages people from wanting to know their HIV status Inadequate access to mosquito nets. The 2 DHS showed that the proportion of households with at least one mosquito net was 3 percent. It also revealed that only 2 percent of children slept under a mosquito net the night before the survey Weak institutional capacity. Institutional capacity is being built but more remains to be done, especially with respect to STD and TB control. However, opportunities exist for making further progress in combating HIV/AIDS, Malaria and other diseases. These include: Availability of resources for HIV/AIDS prevention and treatment National high-level leadership to combat the stigma associated with HIV/AIDS Continued focus of National Government on communicable and preventable diseases in terms of resource allocation Expansion of the physical infrastructure to facilitate improved diagnosis, treatment and prevention of Malaria and Tuberculosis Provision of more mosquito nets to further reduce the incidence of malaria.

15 Eritrea has made significant progress towards the attainment of the Millennium Development Goals. The country is therefore on the path towards achieving the health related MDGs targets in 5. Eritrea He ERITREA HEALTH UPDATE c/o WHO, Adi Yakob street N. 3, House N. 88/89, Geza Banda, P.O.BOX 556 Asmara, Eritrea. Tel , Fax

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