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
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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) Eritrea 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 Outbreak monitoring place in these Zobas and been reached in the area. Addressing Maternal may be occupying the Strong surveillance will mortality in the coastal health workers. therefore be mounted. and IDP re-settled areas 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 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 Asmara, Eritrea. Tel. 291 1 200634, Fax 291125155 1 trea Health Update Eritrea Health Update Malaria could be the same as for malaria 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). Measles 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 40 Numbe 20 0 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 2 trea Health Update Eritrea Health Update Figure 2 Eritrea: Malaria weekly trend in 2007 3rd Quartile Yr 2007 3000 2500 2000 cases of 1500 1000 Number 500 0 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 140 120 100 ases C 80 of 60 mber u 40 N 20 0 1 4 7 0 3 6 9 2 1 1 1 19 22 25 28 31 34 37 40 43 46 4 5 Week Number 3 trea Health Update 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 health care 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 Health in Eritrea, October 28-30, 2004 4 trea Health Update Eritrea Health Update 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. 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 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 5 trea Health Update 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.