WHO Angola Update

WHO Angola Update June-July 2001

already become operational within the Provincial Delegations of Luanda, Benguela, Malange, Moxico and Huíla. In order to The World Health Organization has been in support the national efforts against Polio and the frontline mobilizing technical and financial the other potentially endemic diseases at the resources to empower the health sector and in provincial level, WHO appointed 15 national doing so, to address health problems at the health technicians who have been posted in community level. Improvement in health the remaining 13 provincial delegations. service provision is the targeted and expected result of these efforts. In the first phase of the Central Africa Synchronized NIDs, Angola reached a Polio Furthermore, we have to emphasize the efforts coverage rate equivalent to 94% of the made by the Government of Angola in making children under 5 years. It is planned for this available financial resources for health both for year that Angola will synchronise its efforts primary and tertiary care. This reverts in more with Democratic Republic of Congo, Gabon engagement and assistance of the and Congo Brazzaville to vaccinate against international community to the country. Polio 16 millions of children from 0 to 4 year A survey carried recently out by the European old. It is of utmost importance to underline that Union concerning fields of cooperation WHO/AFRO Program Director, Dr Luis Gomes indicates that in Angola more than 30% of Sambo visited Angola on July 6 to launch on external grants are devoted to the health behalf of all involved partners the sector. Synchronized NIDs. New partnerships formed by WHO in the last Aiming at an increased response capacity in two months have been created in the following the humanitarian and emergency field, WHO areas: has appointed since the end of July 2001, a paediatrician with public health background to ► Polio Eradication Initiative for the year be based in Luanda. He will support the 2001:Contribution of approximately 5.5 million international and national efforts in the USD from different partners such as USA, UK, prevention of and response to emergency the Netherlands, Rotary, CDC, etc; health situations. ► Strengthening of the National Malaria The IDPs are still considered by the partners Control Program and activities to reduce infant as the main vulnerable group in Angola. They and maternal mortality in the provinces of need a full and constant involvement of all Luanda, Malange and Huambo: Contribution of partners in a coordinated approach. We do 5 million USD from USA for the next five years. think that WHO can play a major role in bringing together efforts and synergizing ► The Leprosy Eradication Initiative: more activities. than 500,000 USD from WHO/HQs; In comparison to the year 2000, WHO has ► HIV/AIDS project for surveillance and increased its staff from 20 to 70 units, and has Voluntary Counselling & Testing: 550,000 USD shifted from a centralized presencein the for the next 18 months from the Government of capital to the provincial level. By doing so, Italy. WHO is responding to the request from the MoH and the Angolan Government to create ► Surveillance and early response against conditions for a more effective response to the epidemics: 200,000 USD from Norway. health problems faced by the country. In this first semester of 2001, WHO/Angola WHO/Angola continues advocating for a expanded its activities in the field through the greater assistance from all partners, in order to opening of five epidemiological coordination increase the country response capacity. “antennas” managed by 4 international public health experts and 1. These antennas have

1 Integrated Management of Childhood of Benguela Province to address this situation. Illnesses (IMCI) An emergency health kit was also sent to Balombo, also in Benguela Province, to assist Provincial workshops were held in July 2001 in 10 thousand persons suffering from various the provinces of Benguela and Huíla within the diseases and at risk of meningitis. framework of the new IMCI approach. The aim of these workshops was to give information Following the recommendation of a WHO/MoH and orientation about the objectives of the multidisciplinary team, which assessed malaria National Program for Integrated Management from 12 to 18 June in the Namibe province, of Childhood Illnesses to 60 technicians WHO sent a provision of supplies composed of belonging to a number of NGOs engaged in anti-malaria drugs and impregnated bed nets the health sector. Among them, in the in order to control the outbreak caused by the Benguela province, UNICEF, CRS and the floods of April 2001. Approximately 6,000 ‘Pastoral da Criança’. families have been affected by that natural disaster. Main strategy for reducing mortality Angola participated in the IMCI training for the due to malaria consists of: Portuguese speaking countries held in Maputo from 2 to 13 of July. The key aim of the - improving diagnostic equipment and Angolan participation was to constitute a task staff skills; force of national facilitators capable of training personnel of institutions involved in providing - providing a timely (less than 24 hours care to children. During the training in Maputo from the onset of the symptoms) two Angolan experts acted as facilitators. adequate treatment; - promoting the use of bed nets as well as ensuring use of insecticides. Emergency Response The Health and nutrition sub-Group held a In Kuito, Bié Province, a new pellagra disease special session on 5 of July 2001 in Luanda in outbreak has been declared. Pellagra is order to become more response-oriented, and, related to deficit in micro- nutrients. In the year as such, more effective in a timely manner 2000, the number of notified pellagra patients addressing acute needs. increased from May until the end of October, reaching its peak at the end of August. In Camacupa, Bíe Province, with to the newly Malaria Control accessible areas, MSF/B reported treatment of The “ Roll Back Malaria” initiative received a 14 pellagra cases in week 25 and 15 cases in new impulse with the joint technical mission week 26. from WHO/HQs, WHO/AFRO and USAID, This Belgian/NGO opened a therapeutic UNICEF. The mission linked up with other nutritional center in Camacupa to implement partners and a workshop was organized by nutritional treatment of undernourished MoH and WHO in Luanda on 17 July to children, referred from Cuemba municipality. discuss the National Strategic Plan. Assistance to undernourished children is done Government Members, Members of the locally with exception of the serious cases who National Assembly, Cooperation Agencies and need to be transferred to Kuito. NGOs attended the workshop. By July 2001, 340,000 cases of Malaria with 2,000 deaths The nutritional situation in Mussende, Kwanza have been notified by MoH for this year . Sul Province, has been reported as very worrying; however a deep assessment of the The joint mission also analysed the situation of situation is to be repeated soon. MoH and this complex emergency and formulated WHO are discussing with the FAA how to specific strategies to combat malaria in difficult overcome constraints in term of access. areas. The mission, led by the Vice Minister of According to the survey carried out in May Health, Dr José Van-Dúnem visited the 2001 by the MoH, acute malnutrition rate was provinces of Moxico and Namibe. In Moxico 16,1%. The undernourished people were the involvement of all partners during the reported to the MSF therapeutic nutritional mission made it possible to recognize that center in Cangandala, Malange Province. further assistance for diagnosis, training, medical supplies and social marketing of In the first semester of 2001 about 22 impregnated bed nets is needed for that suspected cases of Meningitis were reported province. In Namibe, the strong involvement with 12 deaths in Benguela. In the first three from the Provincial Government in the health weeks of July 22 more cases with 5 deaths sector is showing how helpful this can be in have been claimed to be meningitis. terms of creating hopes for decrease in Chloramphenicol (oil) and vaccines had been mortality from malaria. The already mentioned requested by WHO and the Health Delegation contribution of 5 Million USD from the

2 Government of the United States will allow Vaccine-Preventable Disease WHO and the country to implement a Malaria control project with two components. On one In Angola, no wild polio virus was isolated in hand, the National level will be strengthened 2001. This represents a success story for the so as to increase its operationally, on the other Polio Eradication Initiative. 60 cases of Acute hand the project aims at improving the Flaccid Paralysis (AFP) have been reported laboratories and treatment in the provinces of from January to June 2001; 2 cases due to Huambo, Luanda, Malange. In Luanda, the vaccine; 4 cases clinically compatible with project will link up with another initiative to Polio; 24 discarded; 15 waiting for the follow protect mother and child health funded by up visit and 15 waiting for laboratory results. USAID as well. The provinces of Cabinda, Bengo, Namibe and In June 2001, a workshop funded by WHO Lunda-Sul have not reported in a timely was held in Luanda to train a group of 20 manner the occurrence of APF cases. In order health staff. Laboratory technicians and nurses to strengthen the information system and from hospitals and health centres learnt about quickly report on data regarding the national diagnostic of malaria. The workshop was epidemiological situation, WHO and the MoH organized by the MoH and the Provincial have established a radio-communication Health Delegation. system. The rational is that health centres can promptly respond to pre-epidemics situation if provincial sentinel sites are in place. For that reason, 18 WHO epidemiological units are Trypanosomiasis Control now assisting the provincial Health Delegation. On 30 July, in Viana municipality, Luanda the In Angola, 3,657,210 children out of 3,8 million Institute working on Trypanosomiasis was have been vaccinated in the first NID of 2001. visited by the Health Vice Minister province. This is equivalent to an estimated coverage of Angola reported 42,000 cases of patients with 94%. 11% of the children were vaccinated for sleeping sickness over the past 10 years. MoH the first time. The two provinces in need of and WHO estimate that around 100 thousand more support turned out to be Cunene where people are affected in the country. only 21% were vaccinated and Kuando- Population at risk of contracting this disease Kubango with a coverage of 27%. are those residing in the Provinces of Luanda, Findings from a survey carried out during the Bengo, Malange, Uíge, Zaíre, Kwanza Norte e first NID showed that around 96% of the Kwanza Sul. The Institute to Combat houses questioned had been visited by the Trypanosomiasis (ICCT) has been recently vaccinators and 88% of the mothers knew in renovated. The new service of ICCT, whose advance about the campaign. staff is comprising of 8 nurses, can provide hospitalisation to 27 patients. The total In the Luanda province the vaccination investment for the new wing was of 500,000 campaign reached a coverage of 94% with 7% USD which have been disbursed by the corresponding to children with zero doses. A Governments of Angola, Belgium and Norway. total of 54 AFP cases out of 68 expected According to the Institute Director, Dr. cases annually have been notified since the Theophile Josenando, the ICCT is currently beginning of the year. That corresponds to a operating with 10 Angolan MDs and 27 nurses. rate of 0.80 per 100,000 which is below the This Institution carries its activities in planned target of 1 case in each 100 thousand partnership with WHO, the Portuguese children. Institute for Preventive Medicine, APN/Norway, MSF, Caritas and FUNDANGA. The Second Coordination Committee Meeting for the Synchronized NIDs in the Central Africa A team from ICCT carried out a mission in was held on 14 and 15 June in Luanda. The June to supervise activities in Mbanza Congo meeting was attended by representatives from Zaire province. The aim was to assess the the host country, and from DRC, RoC, Gabon, implementation of the national norms WHO/AFRO, WHO/HQs, UNICEF and the concerning diagnosis and treatment of other partners. sleeping sickness. The four countries previously mentioned are A mobile team from Calulu, Kwanza Norte planning to vaccinate 16 million children under province attended in Luanda a training course five years during the synchronized campaigns. regarding the diagnosis and treatment of sleeping sickness. One week after, another meeting was organized in Lusaka for the preparation of the synchronized NIDs in the borders with Zambia and Namibia. It was an opportunity to elaborate the micro-plans for the vaccination.

3 The health professionals from Cabinda and are collaborating in this project. In a few the North of Angola met with their Congolese months, this initiative will provide the country counterparts in order to finalize the details of with a better understanding of the prevalence the vaccination campaign. of the disease which is estimated officially to be currently 3,4%. Other components of the Both the Luanda and Lusaka meetings project include behaviour surveillance and demonstrate the effort made by all of these counselling -voluntary testing. countries engaged and committed to the common objective to stop polio transmission 185 participants, including military experts, by the end of 2002 and to be certified as part NGOs and the private sector, attended the of the polio free world by end of 2005. In order Second National Forum on AIDS which was to reach this target, WHO and others partners held in Luanda from 18 to 20 of June. The are implementing activities that include Forum recommended among other measures, capacity building for coordinators of the creation of a multi-sectoral National municipalities, strengthening of the Commission under the chairmanship of the surveillance system and country mapping. President of the Republic. WHO Representative presented in this meeting projections indicating that Angola would be Nutrition able to control prevalence reaching in 2009 6.39% if serious control programs against From 26 to 28 July 2001, two officers from the AIDS are implemented. Thus saving 275 Nutrition and the Reproductive Health Million US dollars in terms of expenditures on Departments of MoH attended in Harare the treatment without considering the even larger Regional Meeting on the Global Nutrition indirect cost which would be avoided. Strategy for Newborns and children. A Technical Meeting on this issue had been organized by WHO/UNICEF and others Human Resources partners in March 2000 in Geneva. WHO/UNICEF together with others partners WHO provided 5 internal scholarships and are committed to update the Nutrition Global computers equipment for the paediatric Strategy of the newborn and children committee of the Post Graduate Medical elaborated 10 years ago. The Harare Meeting School, for a training course for paediatricians allowed the adaptation of the above-mentioned to be held in the Lubango Paediatric Hospital. global strategy to the African Regions. This support will allow the provision of the first two years of paediatrics internship. To accomplish the above-mentioned training, Disease Control and Prevention three teachers are going to be transferred to Lubango. This initiative got also a strong WHO financed two supervisory missions to support from the Provincial Government in four provinces for collecting data on the Huila. incidence of tuberculosis. During the first rd quarter of 2001, cases of tuberculosis were For the 3 year students at the Higher College reported in barely 45% of Angola's of Nursing ‘Instituto Superior de Enfermagem’ municipalities. Comparative data indicates that (ISE) 6 internal fellowships were also provided. 3900 new cases have been notified in the first Furthermore, support to 25 students following trimester of 2001 against 590 reported in the the midwifery course in Luanda has been fourth trimester of the last year. No information agreed with ISE. is available from Huíla, Kuando-Kubango, In the Bengo Province, 20 nursing technicians Cunene, Luanda, Lunda Sul and Namibe are receiving in childbirth assistance. The provinces. Luanda midwifery school is responsible for this AN HIV/AIDS seroprevalence study of 148 training. preliminary samples from TB patients at Two MoH technicians attended the advanced ‘Divina Providência’ Hospital, located in workshop in health management technology Kilamba Kiaxi municipality, in Luanda, showed held in San Paulo, Brazil from 3 to 7 June 17 (11.5%) positive cases and 131 (88.5%) 2001, where issues concerning politic and negative cases. strategic planning for hospital technologies A project for the establishment of an were analysed and discussed. epidemiological surveillance system for HIV/AIDS financed by Italy began on 2nd of July in Angola. Through 6 sentinel sites in the Safe blood provinces of Cabinda, Benguela, Huíla, Luanda, Malange and Moxico, 25 National Two technicians from the National Blood NGOs, Italian NGOs, UNICEF, and UNFPA Centre (MoH) attended a course in Abidjan,

4 Cote d´lvoire on the blood transfusion quality ongoing exercise led by MoH for the management from 23 July to 17 August 2001. elaboration of the Reproductive Health After the course, it is hoped that They will National Plan. This activity is carried out in improve methods of assessing the quality of collaboration with UNICEF and UNFPA. blood and blood products derivatives as well as the rational use of blood transfusions. In order to encourage blood donation and Epidemiological Surveillance adoption of healthy lifestyles by the Constraints exist in Angola when it comes to population, WHO organized with MoH and reporting of communicable diseases. Data Ministry of Education a competition among collection still need to be improved both in children for the best drawing on the theme terms of recording and in the flow of data in “Save a life by giving a little of your blood”. The order respond in a better and timely manner to prizes were given to the winners in a rd outbreaks of Meningitis, Measles and other ceremony conducted in Luanda on 3 of June epidemic preventable diseases. at the Children ´s National Institute. The event was presided by the First Lady, Mrs. Ana This effort led to the creation of the National Paula dos Santos. Center for the Epidemiological Data Processing. The available data for the months of May and June 2001 revealed an increase in Sustainable Development and the order of 74% of the number of cases and Environmental Health deaths from meningitis in relation to the month of May of 2000, in Luanda and Huambo Throughout June 2001, preparations were Provinces. undertaken to ensure the success of the workshop on The health authorities in Luanda are still the Social Politics for Poverty analysing the meningitis data in the Prenda, Reduction. Aimed at Paedriatric, Américo Boavida and Josina generating concrete ideas Machel Hospitals (see the Chart). A culture of towards governmental cerebrospinal fluid needs to be carried out in strategies for poverty the appropriate cases. alleviation, a workshop was Suspected case of possible Meningitis and organized by the Ministry of Measles outbreaks have also been reported in Planning in collaboration with the provinces of Benguela (Balombo and MoH and Ministry of Bocoio municipalities). Currently a team Education. The WB and the constituted by technicians from the UN Agencies, NGOs and Epidemiological surveillance teams at Central others national and and Provincial levels together with WHO are international organizations assessing the situation. Drugs will be have been involved as well. delivered after the assessment is finalized. WHO assisted in the construction of 5 latrines, In the provinces of Bié, Huambo, Kuando out of which 2 double ones, Kubango, Luanda, Malange and Moxico cases which were built in the primary and deaths caused by rage are still being school of Cazenga and reported. In the above-mentioned localities Sambizanga municipalities in shortage of anti-rage serum and vaccines was Luanda. reported to WHO.

Reproductive Health A national Ministry of Health technician attended a Training of Trainers course on exclusive breastfeeding from 11 to 15 of June in Sao Tome. This action is in line with the

5 Cases and Deaths caused by Meningitis Province of Luanda Source: Luanda Hospitals Elaborated by WHO/MoH - 20 July 2001 C a s e s o f M e n i n g i t i s D e a t h s

120 d e i f

i 100 t o n 80 s e s a 60 c f o 40 r e b 20 m u

N 0 January February March April May June July Months notified - Year 2001