BURKINA FASO: CEREBRO SPINAL MENINGITIS EPIDEMIC appeal no: 07/96 19 April 1996 THIS APPEAL SEEKS CHF 1,155,000 IN CASH, KIND AND SERVICES TO ASSIST 900,000 BENEFICIARIES FOR 3 MONTHS Summary Since the beginning of the year a cerebro spinal meningitis (CSM) epidemic has afflicted the Sahel region of Africa, causing terrible loss of life. The Federation has already launched an Appeal to combat the effects of the disease in Nigeria (04/96, 4 March), and on 3 April issued a Preliminary Appeal for Burkina Faso after official statistics from the government showed that a CSM epidemic was raging at unprecedented levels through its population, too. By 7 April, 24,749 cases had been reported in all of the country s provinces, causing 2,439 deaths. Compared with figures from the last major epidemic in Burkina Faso in 1984 when 20,000 cases were reported the current figures seem even more alarming, as the epidemic could continue until the onset of the rainy season, expected at the beginning of June. Several provinces in the central, northern and eastern parts of the country are particularly affected, with 200 new cases per 100,000 inhabitants appearing each week and a mortality rate which is now surpassing 14%. The Intended Operation The International Federation and the Burkina Be Red Cross plan to implement a health education and CSM awareness campaign in all of the country s provinces; institute a vaccination campaign in Namentenga, one of the most-affected provinces; whilst continuing its immunisation activities from the National Society dispensaries in Ouagadougou, Bobo-Diolasso and a centre in Djibo (Soum). Medicines for those already afflicted by the disease in Namentenga will also be provided. This three-month operation will require antibiotics and other essential drugs to treat CSM patients, as well as 200,000 doses of type A + C cerebro spinal meningitis vaccine to protect up to 70% of the population in Namentenga. The country-wide prevention campaign, using brochures and leaflets that have already been produced, will utilise the National Society s extensive volunteer network. In addition to medical supplies, the Federation will provide the Burkina Be Red Cross with logistical and financial support as well as expatriate delegates.
The Disaster The first cases of cerebro spinal meningitis in Burkina Faso were already reported at the beginning of the year. Since then, fresh cases have appeared in all provinces of the country. The epidemiology data reveals that there was a significant upsurge at the end of February which peaked in mid-march. By 7 April, 24,749 cases had been reported with 2,439 deaths. Compared with figures from the last major epidemic in the country in 1984 when 20,000 cases were reported the current figures seem even more alarming, as the epidemic could continue until the onset of the rainy season, expected at the beginning of June. In the first week of April, another 4,191 cases (with 408 deaths) were reported, proof that the epidemic continues to be sweeping across the country (see Annex II for details). Several provinces in the central, northern and eastern parts of the country are particularly affected, with a weekly rate of 200 new cases per 100,000 inhabitants and a mortality rate which is now surpassing 14%. The Response so far Government Action By 4 April, the Ministry of Health had distributed 1,591,650 doses of vaccines and 62,000 vials of chloramphenicol to all provinces to vaccinate and care for the affected population. Health information is being given on the radio and in the press. Public health workers are working in co-operation with the Red Cross provincial committees all over the country. The government asked its partners in Burkina Faso to help provide the huge amounts of medicines, vaccines and supplies required. Support teams have been sent to the worst-affected provinces and vaccination campaigns launched but, given the scope of the epidemic, the logistics and personnel capacities of the provincial health authorities have to be built up. Red Cross/Red Crescent Action The lack of health information and CSM awareness is one of the key problems in combating the meningitis epidemic. The Burkina Be Red Cross has therefore focused its efforts on preventive measures (information and health education) in the affected provinces. The National Society is one of the best structured in West Africa, with a large network of volunteers and first aiders, and has a clear understanding of the vital role it can play in a nationwide information and awareness campaign. In addition, the National Society has set up vaccination centres at Ouagadougou and Bobo Dioulasso, where it runs two dispensaries. No sooner was the epidemic declared than 30,000 doses of vaccines (made available by the Belgian Red Cross) were distributed among the 30 provincial Red Cross committees. As an initial response to the Burkina Be Red Cross s appeal, the Federation sent a delegate from the Regional Delegation and one of its doctors to consolidate the details of the Red Cross plan of action. Other Agencies Action Various partners such as the EU and WHO donated vaccines and medicine to the government. MSF Belgium has also launched a vaccination campaign in Tapoa province. Red Cross Objectives To help reduce the current mortality rate of the epidemic by providing treatment and medicine for the most needy, including those in hospital. 2
To help prevent the spread of cerebro spinal meningitis through immunisation campaigns of the most vulnerable groups. To help reduce the present and future vulnerability of the population by organising information and health education activities. To strengthen the Burkina Be Red Cross s capacity to cope with disasters by linking the operation with its community-based first aid programme. National Society/Federation Plan of Action The plan of action comprises four major elements: To inform the population and increase its awareness of the meningitis epidemic in all of the country s provinces. To institute a vaccination campaign in Namentenga, one of the most-affected provinces. To continue to pursue the immunisation activities in the Ouagadougou and Bobo- Diolasso dispensaries, whilst opening another centre in the premises of the Red Cross of Djibo (Soum) dispensary. To provide medicine for the most vulnerable, in parallel with the immunisation campaign in the hospital centres. Informing the Population and Increasing its Awareness of the Meningitis Epidemic in all 30 Provinces With its many volunteers all over the country, the Burkina Be Red Cross (BRC) has ideal structures for a vast campaign to inform the population on how to prevent meningitis and to increase awareness of the importance of vaccination. More general health education messages will be incorporated into the campaign. It is expected that this will have both an immediate and long-term effect on the epidemic and will strengthen the BRC s structures. This programme initiative will comprise four phases. Phase 1 The production of teaching material on how to prevent meningitis, in French and in three national languages. This phase is now over. Phase 2 The training of trainers (three participants per province) at the BRC headquarters in Ouagadougou. Trainers already trained in community-based first aid will be given priority over other potential candidates. Training will include the issuing of prophylactics for cerebro spinal meningitis and the rudiments of general health education. Phase 3 Refresher training for volunteers (20-30 per province) by provincial trainers trained in phase two of the programme. Phase 4 The conduct of awareness/prevention campaigns in the provinces, especially where people gather (in market places, at funerals, etc.). Some of the groups of volunteers trained will join government vaccination teams in order to spread the message. Vaccination Campaign in Namentenga Province 3
In agreement with the Ministry of Health, Namentenga province (with a population of 245,907) was identified as the target province for a Red Cross vaccination campaign. This province was chosen for the following reasons: The spread of the epidemic in the province is still occurring at a rapid and still rising pace, with a mortality rate of 14%. The absence of other organisations involved in activities to combat meningitis in the province. The vulnerability of the region due to its poor infrastructure and consequently limited ability to cope with the epidemic. The objective is to achieve 70% vaccination coverage in the province, in line with the Ministry of Health s strategy. The principle to be followed will be to strengthen the existing EPV (Expanded Programme on Vaccination) structures using the staff and volunteers, vaccines and medicines, and logistical, structural and organisational support provided by the BRC and Federation. The campaign will be run by the provincial health director in co-operation with the Federation s medical co-ordinator and the BRC co-ordinator. It will consist of seven phases: Phase 1 In co-operation with the provincial health authorities and using or including the already existing EPV structures, ten mobile and other stationary vaccination teams will be set up comprising EPV staff and BRC volunteers as well as first-aid volunteers. Phase 2 The training of volunteers in the principles of hygiene and the specific tasks they will have to undertake during the vaccination campaign. Phase 3 The strategic organisation of the campaign based on epidemiological and geographical data. The existing EPV logistics means as well as those of the BRC will be used. Phase 4 and 5 Running of the campaign and evaluation. Phase 6 and 7 All volunteers who took part in the campaign will be trained in community-based first aid and special information on meningitis will be included in future BRC training. Caring for the Sick At this stage of the crisis, the many people sick with meningitis must receive urgent care. In parallel with the vaccination campaign, health training will be given with the medicines provided in Namentenga. Treatment will be free of charge. Timeframe Training of trainers at Ouagadougou and Bobo Dioulasso. 15-21 April Planning and logistical organisation of the vaccination campaign at Namentenga. Training of volunteers at Namentenga. 4
22-28 April 29 April - 5 May Training of volunteers in all provinces. Launching of awareness campaigns in the provinces. Vaccination campaign in Namentenga. Continuation of awareness campaigns. Continuation of vaccination campaign. 6-12 May Continuation of awareness campaigns. Evaluation and possible continuation of vaccination campaign. From 13 May Final evaluation phase. Capacity of the Burkina Be Red Cross The National Society has one medical co-ordinator, one nurse, three assistant nurses and one logistics expert working on its programmes in Ougadougou to combat the epidemic. In addition, in Namentenga it has two doctors, 20 nurses/health auxiliaries, 50 Red Cross volunteers and five members of the provincial supervision committee. Present Capacity of the Federation The Federation has installed one medical co-ordinator and the regional finance/ administration delegate in Burkina Faso, but urgently needs to send an experienced relief co-ordinator and a public health nurse to reinforce Red Cross operations there. Immediate needs The immediate needs which must be sent to Burkina Faso urgently are as follows: A + C meningococcus vaccines (if possible, 10 dose bottles) 200,000 doses Four-wheel-drive Toyota Landcruiser vehicles 1 ml syringes with needles 300,000 Computer with Printer 1 10 ml syringes 10,000 A, B, C meningitis test kits 5 18g needles 20,000 Non-sterile gloves 2,000 Oily chloramphenicol, 500 mg vials Watery chloramphenicol, 1g bottles 10,000 Tents, capacity 20 persons 5 3,000 Drips 2,000 1g ampicillin injections 3,000 Lumbar punction needles 800 5% glucose serum (500 ml) 2,000 0.9% salty serum (500 ml) 2,000 Budget summary See Annex 1 for details. Conclusion The Federation would like to thank those donors who reacted quickly to its Preliminary Appeal of 3 April. However, we would urge these and other donors to respond quickly with cash donations in order to allow the Federation to cover in-kind needs as well as the 2 5
running operational costs. The first results of the Red Cross action are already being seen in the field, but given the magnitude of the crisis and local expectations much more needs to be done to enable the Burkina Be Red Cross to fulfil its humanitarian mission. Margareta Wahlström Under-Secretary General, Disaster Response Operations Coordination George Weber Secretary General 6
Annex II Evolution of the Cerebro Spinal Meningitis Epidemic in Burkina Faso 7