Angola Records Improvement

WHO Angola Update Nr. 06 – November-December 2001. Year 1

Angola records improvement international experts and 18 local technicians in Polio Eradication and their subsequent deployment to 16 Provinces, as part of the operation of the Angola recorded significant reduction in the epidemiological antennas. There are now six spread of the wild poliovirus in 2001, when antenna coordination centres with compared to the previous year. Although the headquarters in Luanda, Benguela, Huambo, virus is still circulating, its rate of transmission Huíla and Malanje. Another antenna will be has dropped due to the improvement of the soon established in Cabinda. Polio Eradication programme in Angola. Significant strengthening in planning, mapping, One of the major concerns still remain how to training of immunisation brigades and social create mechanisms to reach out to children mobilisation for the NIDs and Sub NIDs living in areas of difficult access in order to (National and Sub National Immunization vaccinate each child, as well as the Days). extension of the AFP epidemiological surveillance system to these areas. These data were presented by the Vice- Minister of Health of Angola, Dr José Van- Emphasis was laid in Addis Ababa on the Dúnem, in Addis Ababa, in occasion of the 9th need to improve on routine Polio, BCG, Meeting of the Task Force for Immunisation Measles, Tetanus, Yellow Fever and DPT (TFI), held from 4 to 7 December; as well as at immunisation, especially in the more densely the 8th meeting of the African Region Inter- populated Provinces and Municipalities. It agency Coordination Committee (ARICC). Dr was decided that measles immunisation be José Van-Dúnem was the head of the Angolan given special attention, as it is one of the delegation composed of EPI technicians from main causes of child morbidity and mortality. MoH, WHO, UNICEF, Rotary, USAID and partners from the CORE group. Furthermore, EPI held its 11th Methodological Meeting in Luanda, 11 - 14 December, to It was reported at this meeting that as at the “review the activities carried out during 2001 end of 2001 only 11 countries are still and identify priority activities for 2002”. Apart endemic with a total of 502 cases, as against from Central EPI Technicians and partners an approximate 350 thousand polio cases such as WHO, UNICEF, Rotary and Centre reported in 1988 in 125 countries. In Africa, for Disease Control (CDC/Atlanta) that only 6 countries are still endemic to the wild participated at the meeting, also attending poliovirus, with Nigeria having the highest the meeting were the epidemiological transmission rate, followed by Southern surveillance technicians, the social Niger and Sierra Leone. Compared with a mobilisation officials and the Provincial EPI total of 55 wild poliovirus cases diagnosed in supervisors from all the Provinces. Angola in 2000, only 2 cases were diagnosed in the country in 2001. This reduction was accompanied by an Emergencies improvement in the epidemiological surveillance system, which allowed early Regarding emergency preparedness, Angola detection of AFP nation-wide. To date, 134 has been provided with emergency medicine AFP cases have been reported, when the kits for IDPs and for the prevention of target was 64, which is an evidence of the possible epidemic outbreaks, such as enhanced efficiency of the epidemiological malaria. The batch includes 24 boxes of surveillance system. malaria drugs, consumables and hospital equipment that will be dispatched, at this Chief among the factors that facilitated the initial phase, to Huila, Huambo, Malanje, AFP epidemiological surveillance system Cunene, Namibe and Luanda. WHO and was the recruitment by WHO of 4 MoH drafted norms on the use of such kits

1 and disseminated them to all provinces. food diet, which might result in an increased malnutrition rate and other communicable A MoH and MSF/F team visited Cunene diseases among the IDPs. It was further Province from 10 – 18 November, to noted that the community health services investigate rumours on the occurrence of were not functional due to a dearth of new meningitis cases. In Cahama, Ombadja qualified personnel (Technicians and and Xangongo Municipalities, the team Doctors), medicines and consumables. In the visited the municipal hospitals of Cahama, hospital of Wacu-Kungo Municipality, blood Chiulo, Caconda, Changalala and Cuamato transfusion is done without haemo- health centres, as well as the Humbe Health classification, HIV and other tests. According Post. At the time of the visit no meningitis to local estimates, the government clinical case was detected among the anticipates the provision of these services to patients while 1 – 2 suspected cases of an influx of 15000 IDPs at the end of meningitis per day had been reported in December 2001. Ombadja Municipality, Cunene Province, between the epidemiological weeks 36 and The WHO/OCHA/WFP team that initially 45, making a total of 61 cases and 16 deaths visited Waku-Kungo had recommended the detected. The same reports indicate that 24 following measures: of these cases occurred in Xagongo commune and 13 in Mucope commune.  Urgent intervention and mobilisation of other partners, such as NGOs working in The team recommended to immunize 90% of Waku-Kungo, in order to prevent a the local population from 2 – 45 years old catastrophe; against meningitis and to train for  Maintenance of roads and bridges to immunisation brigades in Xagongo and facilitate movement by road during the Mucope communes considered to be at risk rainy season; for future outbreaks. 75,000 doses of vaccine were released for the immunisation  Deployment of NGOs and UN agencies campaigns and one thousand ampoules of to the field. oil chloramphenicol for the treatment of the cases, while MSF/F provided Slidex for the Acting on these recommendations, a team of laboratory confirmation of meningococcal NGOs such as AFRICARE, SCF-UK, meningitis. MOLISV and ACM/YMCA, carried out a more specific assessment of the new IDPs at About 110 new meningitis cases were Waku-Kungo, consisting of 720 families reported in July 2001, 100 of which in (2733 people) living in four registration and Ondjiva, Capital of Cunene Province. In receptions centres. order to bring this meningitis epidemic under control, MoH immunised about 85,555 In two of the settlements, the mortality rates people, with the support of WHO and NGOs were estimated at 2.76/10000/day and working in Ondjiva, thereby attaining 95% 3.8/10000/day during the week prior to the coverage of the local target population. visit. In spite of the non-availability of a case recording system, the team identified WHO, in collaboration with MoH and other malaria, diarrhoea and respiratory diseases, partners, is preparing a health services scabies, worms and schistosomiasis, as the package to attend to new IDPs during the most frequent diseases in the settlements. A first six months; beginning from January measles case had been diagnosed three 2002. days earlier.

According to WHO emergency experts, this The MoH team carried out a screening of health package will help cushion the 122 children and found out that 8.8% of them suffering of the IDPs, including people to be suffered from malnutrition. A measles resettled. immunisation campaign was also held for children under 15 and polio campaign for It was decided to provide an health package children under 5, in accordance with recent for the IDPs after a technical team of WHO, EPI/MoH guidelines. OCHA and WFP visited Wacu-Kungo Municipality, Kwanza-Sul Province, in At the end of the mission, four of the above November 2001, and assessed the situation NGOs prepared an action plan to address of thousands of people from Bailundo, the health problems among the IDPs, under Huambo Province. Apart from other the direct responsibility of the local difficulties, the team took note of the lack of technicians. equipment and materials for safe blood transfusion; lack of clean water, poor In order to improve quality epidemiological environmental sanitation and unbalanced surveillance data and the organisation of

2 emergency preparedness, WHO delivered a HIV/AIDS emergency package in Angola, number of computers to MoH provincial together with all the partners in the health directorate in Huíla, Kwanza Sul, Kuando- sector. The definition of the minimum Kubango, Namíbe, Uíge and Zaire package is the initiative of UN Agencies and Provinces. This was the second delivery in a some NGOs, while WHO heads the “Inter plan aimed at reinforcing the institutional Agency Committee” capacity of MoH at the Provincial level. Earlier, beneficiary-Provinces were Bié, In Africa, Angola, DRC and Sierra Leone were Huambo, Malanje, Moxico and Luanda. selected for the implementation and initial testing of the minimum package. Dr Paolo Balladelli, WHO Representative in Angola, visited Bengo Province on 5 December, on technical mission, in Disease Prevention and Control collaboration with MoH, the Local Government and the Provincial Directorate of Bengo, Tuberculosis: MoH formed a technical group COSV, INTERSOS, Acção Agrária Alemã, to prepare a Strategic Plan to fight UNICEF and OCHA. This mission was carried Tuberculosis in Angola. The group is headed out as a result of an SOS sent to Luanda on by the Director of the National Tuberculosis the health conditions of the 37 thousand IDPs and Leprosy Control, Dr. Conceição Palma, of the Boa Esperança Camp, Porto Quipiri. and is composed of the following members: Dr. Marilla Afonso, in charge of Infectology The mission got the following data: 37,044 Services at Josina Machel Hospital, Dr. IDPs in the Boa Vista Camp, 1910 Patients Joseph Nsuka, Coordinator of Tuberculosis assisted at the health centre in November, with Project (Cooperazione Italiana), Dr. Abel Silva, 266 pregnant women, 965 children, no MDs, 2 Health Delegate of Rangel Municipality and Dr. Health Technicians, 12 nurses and 26 health Adolfo Sampaio, WHO/Angola TB control promoters involved in the services (available official. As at 30 June 2001, MoH reported health staff among the IDPs are 144); 108 9,398 TB cases with 357 deaths. deaths in October and 51 in November 2001; 13 patients referred to Caxito and 3 to Luanda; The group embarked on a survey of all the malaria is a major cause of death, followed by health units that screen, diagnose and treat TB diarrhoea and measles; the central water cases in the country. system can only supply one litre of potable water per day per person. MoH held a TB Control Workshop in Luanda from 19 – 24 November, with the participation The major concern remains the lack of latrines, of 22 nurses, including Provincial Supervisors, which is factor causing increased child from 14 Provinces. A visit was scheduled for mortality. This problem might be source of Benguela to learn on the Coopération outbreaks during the heavy rain season. The Française TB Project and study the malaria epidemic might also severely hit the replicability of the project actions based upon IDPs during the rainy season. Acute the DOTS strategy in other Provinces. malnutrition had been assessed and detected in 2% of the children. A package of measures Meningitis: Between 18 – 26 meningitis cases was analysed with the Governor. Among other and 3 deaths were reported in Huambo, recommendations, it included: the immediate Kwanza Norte and Sul, Huíla, K-Kubango, building of latrines; the treatment and Luanda and Malanje Provinces. From expansion of the water system; the hiring of an May/2001, a cumulative number of 1443 MD and a laboratory technician for activities in cases, 306 deaths and 21.2% lethality rate has the camp; the supply of malaria drugs, de- been recorded. worming medicine and other pharmaceutical products for the treatment of infectious Measles: During the same period, measles diseases; the immunisation against measles cases and relative deaths has been informed for children from 6 months to 14 years and the in all the Provinces the worse outbreaks being provision of adequate supplementary feeding. registered in Huíla (107 cases and 23 deaths, 21% lethality), K-Sul (754 cases, 9 deaths and 1.19% lethality) and Uíge (74 cases and 2 A WHO/Geneva mission composed of two deaths). A cumulative total of 5783 cases and experts in HIV/AIDS and Emergency, was in 263 deaths has been reached from mid- Luanda from 10 – 14 December, and hold September 2001. meetings with MoH, UN agencies, local and international NGOs and some bilateral AFP: 27 cases and 0 deaths were recorded cooperation agencies. across the Provinces of Benguela, Bengo, Cabinda, Huíla, Kuando-Kubango, Kwanza The aim of the mission was to present and Norte, Kwanza-Sul, Luanda, Lunda Norte, analyse the implementation of minimum Malange, Namíbe and Uíge).

3 composed of 19 African countries with about Tétanus: 10 cases and 8 deaths across 70 million people vulnerable to this disease. Kwanza-Sul (8 cases and 8 deaths), Cabinda (1 case) and Moxico (1 case). Schistossomiasis and intestinal worms: With the technical assistance of WHO and HIV/AIDS: About two thousand people, among funding of Cooperazione Italiana, patients whom are Health workers, MPs, religious detected during the first stage Schistosomiasis leaders, soldiers, youths and workers of and Helmentiasis prevalence study held in international organisations, participated on 1 selected schools in Bengo and Luanda December, in Luanda, at the World AIDS Day Provinces, were treated. Results obtained from March. WHO/Angola Representative, Dr Paolo samples of 495 children between 5 and 15 Balladelli, marched alongside the Minister of years old, indicated the following: Health, Dr, Albertina Hamukwaya, as well as other partners such as Dr. Anthony  Schistossomiasis: 8.7% of positive, Bloomberg, UNICEF Representative and where 5% had strains of hematuria Chairman of UNAIDS thematic group, the during the study and 20.4% during the USAID Representative, members of women’s last 6 months. associations, the FAA and youth  Helmetiasis: 29.5% with Ascaris organisations. Lumbricoides, 14.9% with Trichuris trichuria, 1.4% Duodenal The Instituto Português de Medicina Preventiva Ancylostomas. (IPMP), continues to successfully implement the HIV/AIDS Counselling, Testing and The study shall be presented by a group of Treatment Project in the Cajueiros hospital in local experts at an International Workshop to Luanda. In October, the IPMP attended to 117 be held in Abidjan, Côte d’Ivoire from 12 – 14 patients with the following data: 33.3% had December 2001. The event is the initiative of urinary infections, 29.9% - Syphilis, 12.8 – WFP/Angola and is funded by the Italian Gonorrhoea, 5.1% - HIV+, 3.4% - Government. Trychomonas, 0.85% - Candidiasis and 0.85% Leprosy Elimination: 18 technicians from S. Kaposi. It is important to mention that Bengo, Bié, Cabinda, Kwanza Sul, Huambo, 52.1% of the patients were male while 47.8% Huíla and Luanda Provinces, underwent a 3- were female. Also the proportion of HIV day training in Benguela on the prevention and positive patients with STDs is higher than treatment of 1st and 2nd degree disabilities of observed in previous studies (1999). leprosy patients. The technicians learnt how to assess the patients, recognise and treat Angola participated with two experts at the complications, teach on how to avoid disabilities International Conference on Sexually and organise self-care groups. Transmitted Diseases (STDs) and HIV/AIDS in Africa, which took place in Burkina Faso, with Malaria Partnership Increases the aim of reviewing the major achievements recorded in the control of this pandemic, put A WHO/AFRO technical mission, headed by forward new strategies and identify priority Dr Elizabeth Streat assessed the on-going areas for the reduction of its impact. study on “The Efficacy of Fansidar and WHO/Angola funded the participation of the Chloroquine Treatment” in a total of 135 two Angolan experts, namely a Representative malaria patients at the Terra Nova Health of the Presidency and a Representative of a Centre and Kilamba kiaxi Municipal Hospital, local company. Dr Alberto Stella, UNAIDS in Luanda. The overall objective of the study is Country Programme Adviser, also participated to determine the degree of sensitivity of at this event. Between 1985 and 30 plasmodium to those anti-malaric drugs. In September 2001, Angola reported a total of Angola, there is still little knowledge on drug 8,149 HIV/AIDS cases; i.e. 2,665 men, 3,3174 efficacy. Only two studies were carried out in women and 2,110 unspecified. the country, one by a local MD in 1984 and the other by an international NGO in 1996. Oncocercose (River Blindness): Angola participated for the first time at the 7th Session The RBM movement is still to be reinforced in of the Forum of African Programme for Angola. After the partnership entered into with Oncocercose (APOC), held in New York from USAID, Exxom Mobile, an oil company, sealed 9 – 13 December. The major objective of this its commitment to the fight malaria for the next programme, with headquarters in Burkina years in Soyo Municipality. This commitment Faso, is the elimination of “River Blindness” in was expressed at a meeting held in Luanda at Africa, where 99% of River Blindness cases in the end of November between MoH, WHO and the world occurs. WHO is the implementing the Municipal Health Directorate of Soyo. agency of a world wide programme financed by the World Bank. The intervention area is To this end a mission composed of a Malaria Programme team, the Municipal Health

4 Directorate of Soyo, WHO and Exxom, went to Soyo, Zaire Province, where a preliminary survey of the malaria situation was carried out. New Heights In IMCI Angola records an upwards of a million malaria cases per year. A strategic assessment mission on IMCI (Integrated Management of Childhood African Countries United against Illnesses) was in Luanda to assist Angola to Trypanosomiasis draft clinical and organisational protocols for the major paediatric pathologies, including The fight against African human screening and emergency response. This trypanosomiasis (sleeping sickness), mission comes on the heels of the first one, continues to be of focus of the countries that which took place in November/December are the most affected by this scourge in the 2000, during which a situation analysis and a sub-Saharan region, where according to WHO paediatric healthcare quality assessment of estimates, 300 - 400 thousand people are the area were carried out, especially in infected. With an average of 10,000 cases hospitals. The units involved are the Luanda p/year, Angola is the country with the second paediatric hospital and the municipal hospitals highest trypanosomiasis transmission rate in of Kilamba Kiaxi and Cajueiros. Africa, after Congo Brazzaville and the Sudan. The other seven African countries, in which the WHO launches initiative to assist street sleeping sickness is endemic, are Cameroon, girls in Luanda CAR, Chad, DRC, Côte D’Ivoire, Guinea- Conakry and Mozambique. WHO Representative, Dr. Pier Paolo Balladelli, launched on 18th December in Luanda a new Concerned about the prevalence of this initiative together with the Vice Minister of disease, WHO organised a Conference of Health, to help about 70 street girls of the African experts in Bangui, Central African “Centro dos Kandengues Unidos” of Maianga, Republic, from 20 – 23 November, in search of a group whose majority are sex workers, at ways to respond to the calamity, which impact, social risk. in some cases, exceeds HIV/AIDS deaths. The meeting considered the difficulties and The initiative has been studied since several constraints that African countries encounter month ago by MoH and WHO as part of a while combating trypanosomiasis; mapped the policy recommended by Dr. Ebrahim Samba, endemic and the possibility of holding joint the Regional Director for Africa, to have the activities between bordering countries. The organisation more operational in the fight to ICCT Director, Dr Theophile Josenando, and poverty though small projects that can the Zaire Provincial Health Director, concretely help vulnerable groups such as represented Angola at this event. street children, orphans of HIV/AIDS, displaced people, etc. Dr. Balladelli donated Mental Health Prepares National Strategic in this occasion, in presence of the Minister of Plan Youth and Sport, equipment evaluated in 32, 000 USD to assist the street girls of Mental Health in Angola took the centre-stage “Kandengues Unidos” Centre to find throughout 2001, on World Health Day, 7 April, alternatives to fight poverty and to empower World Mental Health Day, 10 October, and at themselves. The donation includes equipment the “First National Mental Health Conference”, for ceramics, kitchen, dress making, literacy held in Luanda from 20 – 22 November. The and contracts for occupational teachers. last brought the WHO/AFRO Regional Mental Health Advisor, Dr. Custódia Mandlate, to Angola. At the end of the conference, she Health Human Resources launched the 2001 World Health Report, More Dynamic dedicated to mental health. Present at the ceremony, were members of Government, UN MoH is preparing a draft “Human Resources agencies, NGOs, the Diplomatic Corps and Operational Plan”. The initiative has the donors that have contributed to the support of WHO, the EU and the improvement of the health sector in Angola. Cooperazione Italiana. To this end, Dr. Mark MoH intends to implement a National Mental Beesley, a WHO consultant for in-service Health Strategic Plan for 2002-2006, with the training is contributing since 30 October. support of WHO, in at least 7 Provinces, after having concluded that, “the armed conflict, The Second Meeting of Ministers of the social unrests, natural disasters, poverty, Steering Committee for the Regional Nurse communicable diseases (malaria, meningitis, Training Centre, was held in Luanda from 26 – AIDS, tuberculosis, among others), as well as 27 November. The first meeting was held in malnutrition, have an impact on the occurrence Praia, Republic of Cape Verde, in 1997. of mental disorders”.

5 The Regional Nurse Training Centre, located - The actions underway shall be concluded in Luanda, is funded by the EC to train nurses and a timely response be requested for in management of local health centres and the extension of the funding agreement. provision of nursing services. The beneficiary - Hold a PALOPs Nursing meeting during countries of this programmme are Angola, the first half of 2002. Cape Verde, Guinea Bissau, Maozambique and São Tomé and Príncipe. The project is One of the solemn moments was the signing valued at 2,600 Euros. of the “LUANDA DECLARATION” by the two heads of delegation. The declaration Participating at this meeting were the Ministers expresses “support of the National of Health of Angola and São Tomé and Coordinator for the extension of the funding Príncipe, Representatives of the Ministers of agreement from February 2002 to March Health of Mozambique, Guinea Bissau and 2004”. Cape Verde, Technicians from the various countries, as well as experts from the EU and Increasing dynamism in the area of Health the “PALOP Programme” Secretariat. Human Resources was lastly shown when National Workshop on the development of the The following were the recommendations as sector was held in Luanda from 6 – 8 approved at the meeting: November 2001. The meeting was organised by the National Director, Dr. Evelize Fresta, - Angola shall present a proposal on the with the participation of representatives from sustainability of the project, based on the all the Provinces. One of the suggestions experience from this project. raised at this meeting was to carefully assess the methods and results concerning the The multiplication actions shall be compiled Lubango Technical Health School, and and disseminated in order for them to be more propose the same experience to other readily available. provinces of the country.

Technical Team: Dr. Pier Paolo Balladelli, Representative; Dr. Rui Gama Vaz, Team Leader/Polio; Eng. Gabriela Guerra, Environmental Health; Dr. Balbina Félix, Disease Prevention and Control; Dr. Dalva Barros, Human Resources and Reproductive Health; Dr. Domingos Nsala and Dr. Arturo Silva, Emergency Action; Dr. Nkunku Sebastião, Malaria and Trypanosomiasis; Dr. Michel Kouakou, Administration; Marques Gomes, HIV/AIDS Surveillance Project Coordinator; Adolfo Sampaio, TB Project Coordinator; Bernardino Teixeira, Leprosy Project Coordinator; Mr. José Caetano, Health Information Officer. Address: Rua Major Kanhangulo nr. 197 – 7th Floor, Luanda – Angola E-mail: [email protected] tels: (2 442) 332398, (1 321 ) 956 38 82; Fax: (2442) 332314