trea HealthEritrea Update Health Update Issue 2 No.10 11th to 24th June, 2007

PROFILES Outbreak Monitoring: Week 22 (28th May to 3rd June, 2007) Population: ) 3,447,060 - (1997 Report Cerebro-Spinal Projection) Completeness and Meningitis (CSM) Timeliness Zoba Northern Red Sea Number of Zobas reported 3 new cases of (Regions): 6 he national average meningococcal meningitis health facility to caused by N. meningitidis Humanitarian TZoba weekly report type A in the last 2 weeks Target population: completeness has slightly bringing the total cases for the year to 10 with 1 2.3 Million fallen from 96.3% in the last report to 95.2%. The death. average weekly report Although both epidemic Main Sources of timeliness also fallen from and alert thresholds have humanitarian 85.2% to 82.4%. The slight not been crossed, the funding: decline was noticed in continuous reporting of • UN CERF Anseba and Debub Zobas. sporadic cases is alarming in view of the low • ECHO This could be attributed to the on going community population immunity and sensitization and training the fact that the height of HIGHLIGHTS activities that are taking the hot season has not ƒ Outbreak monitoring place in these Zobas and been reached in the area. ƒ Addressing Maternal may be occupying the Strong surveillance will mortality in the coastal health workers. therefore be mounted. and IDP re-settled areas ƒ Results of CBTF Table 1: Average Health facility to Zoba weekly report completeness and timeliness as at week 20 activities in Gash Barka (14th – 20th May, 2007) with ECHO funding Zoba Total Population No. of HFs Timeliness Completeness support ƒ Events: Anseba 554552 34 97.3 100.0 Debub 916467 60 97.1 99.6 Gash Barka 684972 65 69.0 87.9 Maekel 653639 31 100.0 100.0 NRS 556952 37 79.1 89.8 ERITREA HEALTH UPDATE SRS 80481 15 26.7 100.0 3,447,060 242 82.4 95.2 c/o WHO, Adi Yakob street N. 173, Total House N. 88/89, Geza Banda, P.O.BOX 5561 , Eritrea. Tel. 291 1 200634, Fax 291125155 1 trea Health Update

Eritrea Health Update

Malaria could be the same as for above. As observed in figure 1, the weekly The weekly number of cases has not number of cases of malaria in Zoba Anseba crossed the 3rd quartile threshold level at has reached the 3rd quartile threshold level. National level. The cause could be improvement in reporting as a result of community No outbreaks of other diarrhoeal diseases sensitization. The possibility of foci of were reported. outbreak is also being investigated. The Zoba has been informed to investigate Other Outbreaks: accordingly. No outbreaks of other diseases have been This increase in numbers of cases in reported in the reporting week. Anseba has not affected the trends at national level (Figure 2). Situation: The total suspected measles cases for the Diarrhoea and Bloody year has reached 24. These have been Diarrhoea: reported from 4 Zobas with Debub and The weekly number of cases of bloody Northern Red Sea remaining silent. diarrhoea (shigellosis) in Zoba Anseba as All the suspected measles cases tested seen in figure 3 is also approaching the 3rd negative for measles IgM. Three cases quartile threshold level. The explanation tested positive for Rubella.

Figure 1

Anseba Zoba: Malaria weekly trend in 2007 3rd Quartile Yr 2007 140

120

es 100

cas 80 of r 60

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1 4 7 0 3 6 9 2 5 8 1 4 7 0 3 6 9 2 1 1 1 1 2 2 2 3 3 3 4 4 4 4 5 Week number

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Eritrea Health Update

Figure 2

Eritrea: Malaria weekly trend in 2007

3rd Quartile Yr 2007

3000

2500

2000 cases

of 1500

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1 5 9 3 7 5 9 1 1 21 25 29 33 37 41 4 4 week number

Figure 3

Anseba Zoba: Bloody Diarroea weekly trend in 2007

3rd Quartile Yr 2007 140

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C 80 of 60 mber

u 40 N

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Eritrea Health Update

Addressing Maternal Mortality in the Coastal and IDP re-settled areas of Eritrea:

Maternal mortality in Eritrea is among the identified as avoidable factors of maternal highest in the world. According to Eritrean mortality in Eritrea. Demographic and Health Survey (EDHS) of 1995, maternal mortality Rate (MMR) in The Zobas with the highest maternal Eritrea was 998/100,000 Live Births. The mortality ratio in Eritrea are Southern Red subsequent study conducted in 2003 Sea Zoba followed by Anseba and Gash showed MMR in Eritrea to be 752/100,000 Barka Zobas. Community transportation, Live Births and WHO/UNFPA/UNICEF communication and referral are poor in all estimation of MMR in Eritrea is the Zobas. The linkage between the 630/100,000 LB. Majority of maternal communities and the delivery deaths in Eritrea occur at home, before system in relation to maternal and seeking medical care. Close to half of the newborn care is poor, except for specific maternal deaths occur during childbirth, programs like malaria, where the malaria and therefore care during childbirth is most agents report maternal and newborn critical in Eritrea. Poor quality of medical problems related to malaria to the nearest care, poor access to health service, poor health facilities. transportation and poor knowledge were

Maternal Mortality Ratio by Zoba Maternal Deaths per 100,000 Live Births

46 1,083 747

1,040 696 1,261

The Road Map to Improve Maternal and Newborn , October 28-30, 2004

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The major causes of maternal mortality are barriers to access service including haemorrhage, infection, and eclampsia, physical, cultural and financial barriers, obstructed labour and unsafe abortions etc.) and which account for more than 70% of the 3. Delay in receiving care (due to lack of total maternal deaths in the world. But why skilled personnel, supplies, equipments, do women die? Basically there are three blood transfusion services, etc.). delays that predispose pregnant women to die. These are: One of the areas the humanitarian 1. Delay in decision-making to seek care interventions is addressing with funding (due to lack of understanding of from ECHO and UN CERF was the high complications, lack of trust in the health maternal death especially among the care delivery system, acceptance of coastal mobile nomadic communities and maternal death as norm, low status of the IDP resettled areas of Gash Barka. women, socio-cultural barriers to This problem was being addressed from 2 seeking care etc.) angles: Community and Health facilities 2. Delay in reaching care (due to lack of where the mothers are being referred to. transportation & communication,

The Community Approach: The community approach included providing outreach antenatal and post • Assessment of training needs natal care integrated with immunization for which has been completed children and other services. • Upgrading of training manuals The second community approach was the and training training and equipping of Traditional Birth • Procurement of equipment which Attendants (TBAs), which includes: was done centrally.

TBA Assessment and re-positioning:

Evidence shows that traditional birth pregnancy and refer mothers to the health attendants have a key role in improving care system they can contribute to the maternal health as advocators and links reduction of maternal and neonatal between the community and the health morbidities and mortalities. system. The major causes of maternal mortality are An assessment of the TBAs was carried out hemorrhage, infection, eclampsia, with the following objectives: obstructed labour and unsafe abortions. ƒ To elucidate the role of TBAs in With the level of training and the providing maternal and neonatal equipment that the traditional birth health services attendants have it is less likely to expect ƒ Based on the results of the them to avoid deaths due to the above assessment, to redefine the role of causes. TBAs in provision of maternal and But if they are trained to prepare mothers neonatal health care services for delivery, advice on family planning and nutrition, detect complications of

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Eritrea Health Update

A questionnaire was developed in English, the highest maternal mortality ratio in the pre-tested and used to collect data. A total country. of 12 data collectors were trained in how The data collected will reveal practices, to administer the questionnaire and training gaps and current roles of the TBAs dispatched to four Zobas. The assessment and will provide the basis for re-positioning was conducted in the period May 02-12, them and re-training/re-equipping them. 2007 and a total of 310 TBAs from the four The data entry, cleaning and report writing Zobas, namely Gash Barka, Anseba, process is in progress and will be available Northern and Southern Red Sea Zobas in a book form to be circulated to the were enrolled. These Zobas are Zobas with Ministry of Health officials, all partners and Zobas for future action.

Data collection process in Northern Red Sea Zoba showing a Women’s Association member and a young mother assisting the team and an old TBA being interview

Health Facility Approach: delivery time. In some areas, the maternity Poor terrain, distance, nomadic life style waiting homes are not available due to and harsh weather conditions prevent the lack of shelter and where they exist, they pregnant women from reaching health were not being utilized because of lack of facility on time to receive skilled care. If essential supplies especially for feeding. emergency is involved, the mothers usually With support from UN CERF, tents were die on the way. procured and erected to serve as shelter One strategy adopted to address this issue for the mothers, while with support from is the use of Maternity Waiting Homes. The ECHO, consumables procured and mothers arrive at the health facility in their supplied in order to encourage mothers to 8th month of pregnancy to wait for their utilize these waiting homes

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Eritrea Health Update

Maternity waiting home being re-enforced with tents procured with UN CERF funding

Supplies and consumables including food items procured for maternity waiting homes with ECHO support

Another major activity under the health • Procurement of emergency facility approach is to ensure that, the obstetrics and cold chain facilities have the capacity to provide the equipment for 25 health facilities. emergency services and to carryout The equipment for emergency obstetrics outreach activities. In order to achieve this, and cold chain strengthening for the 25 the following were carried out: health facilities were procured through the • Life saving skills training WHO central supply

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Eritrea Health Update

Results of Community Based Therapeutic Feeding (CBTF) Activities in Gash Barka with support from ECHO:

Gash Barka Zoba is an IDP re-settled area ECHO, community based therapeutic that has overstretched facilities and high feeding activities were conducted in this incidence of diarrhoea and malnutrition. As area from 24th to 30th April, 2007. This part of the mortality reduction activity was conducted in 2 parts – a humanitarian interventions supported by training of trainers and field activities.

The Training of Trainers (TOT): The training of trainers was conducted in Micronutrients and Underling the Zoba capital of Barentu with the aim of causes of malnutrition. building capacity in the Zoba to tackle - Recognition of malnourished major causes of mortality in children. It was children: Body changes in combined with a training of trainers on the malnutrition; Nutrition assessments community management of diarrhoea (type and techniques); Case finding using IMCI principles. The capacity building and screening for Severe targeted 38 trainees who are health Malnutrition workers selected from 16 sub-Zobas with - Management of malnourished high levels of malnutrition. children: Medical management of severe malnutrition; Supplementary During the training various skills were built feeding programmes; Community using presentations and practical Based Therapeutic Feeding (CBTF) demonstrations. These skills included: programme; Referral, other action and advice for children with - Discussions of the basic theoretical different levels of malnutrition; knowledge of nutrition: Nutrition Community follow up action and situation in Eritrea; Basic nutrition defaulter tracking and reporting of (Breastfeeding and deaths and other malnourished Complementary feeding); children

Trainees at the TOT for CBTF

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The Field Activities: The training was focussed on: • Anthropometric The field activity was the implementation of measurement community based therapeutic feeding • MUAC measurement and program in Haykota, one of the sub-Zobas detecting of Oedema with level of malnutrition. • Sampling and sample size The first stage of the field activity involved • Selection of a household the selection of community volunteers with • Interview techniques help of medical staff and local • Discussion of questionnaire – administrators in Haykota and training all questions them on how to screen and refer children. • Practice on how to fill the screening form

Community volunteers at a training session:

After the training of the volunteers, moderately malnourished and were screening was then conducted in Haikota admitted to supplementary feeding and surrounding villages with support from program, while 10 severely malnourished the village administrators. children and were admitted to therapeutic A total of 1736 from 6 to 59 months of age feeding program with 8 of them were screened by the volunteers using Mid undergoing Outpatient Therapeutic Upper Arm Circumference (MUAC) feeding program (OTP) with community measurement. A total of 302 with MUAC follow up and 2 of them with medical <11.0 cm or from 11.0 - 12.5 cm were complications like pneumonia and suspected of being malnourished and diarrhoea and admitted to facility based were refereed to Haycota health center for therapeutic feeding centre in Haikota height and weight measurement. Health Centre. Out of the 302 children whose weight for height were measured, 102 children were

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MUAC screening of children

Weight and Height Measurement in Haycota

Eritrea Health Update

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Eritrea Health Update

Events:

Various activities funded by ECHO and UN CERF have been undertaken by both WHO and UNICEF. Some of the concluded activities are as follows: • Field visit by ECHO field officer in Tanzania Mr. Yves Horrent. • Community surveillance training and sensitization in Northern red Sea and Anseba

The results of these activities will be presented in details in the subsequent issues.

ERITREA HEALTH UPDATE

c/o WHO, Adi Yakob street N. 173, House N. 88/89, Geza Banda, P.O.BOX 5561 Asmara, Eritrea. Tel. 291 1 200634, Fax 291125155

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