Health Update Issue 3 No. 3 10th March – 16th March, 2008

Outbreak Monitoring: Week 11 (10th March – 16th March, 2008) PROFILES ) Eritrea Population: Report on Completeness is maintained at an 3,543,580 - (1997 and Timeliness appreciable level, there is an Projection) unprecedented delay in the ll six Zobas/Regions submission of weekly Number of Zobas submitted reports up reports from the (Regions): 6 Ato week 11. The zoba/regional health offices Southern to the central Ministry of Humanitarian and Gash Baka Health. A mechanism Zobas/Regions continue to therefore has to be put in Target population: record the lowest place to facilitate the timely 2.3 Million percentages in terms of submission of reports from timeliness of reporting. the zoba/regional level to Sources of There is a need to work with the central Ministry of humanitarian these two regional health Health. funding: offices to improve the • UN CERF timeliness of reporting. Cerebro-Spinal Meningitis • EU-ECHO (CSM) Although the average To date, there has been no • DFID timeliness of reporting from newly suspected case of the health facilities to the meningitis recorded in 2008 HIGHLIGHTS zoba/regional health offices from any of the zones.

Table 1: Average Health facility to Zoba weekly report completeness and ƒ Outbreak monitoring timeliness as at week 11(10th – 16th March, 2008) for week 11 ƒ Measles and AFP Zoba Total Population Number of HFs Timeliness Completeness Surveillance Anseba 570079 34 Indicators for the First 97.79 100 Quarter in 2008 Debub 942128 60 98.66 99.25 ƒ Rapid Assessment Gash Barka 704151 65 57.30 92.70 Mission Report to the Maekel 671941 31 Southern Red Sea 97.66 100 Zone NRS 572546 37 75.42 92.14 SRS 82735 15 38.79 87.88 ERITREA HEALTH Total 3,543,580 242 96.79 80.27 UPDATE Eritrea Health Update c/o WHO, Adi Yakob street N. 173, House N. 88/89, Geza Banda, P.O.BOX 5561 , Eritrea. Tel. 291 1 200634, Fax 291125155 trea Health Update

Eritrea Health Update

Other Outbreaks: investigation revealed that 10 of the 19 cases Malaria of AFP were non- polio AFP. A total of 9 Generally, the cases of malaria were cases of AFP are pending classification. maintained below the third quartile threshold level during the period under The annualized non-polio AFP rate review. There was no noticeable crossing of was 5.9 per 100,000 children under the threshold in all the regions. The number the age of 15 years (target > 2) of malaria cases was also well maintained while adequate stool collection below the third quartile threshold level at the within 14 days of the on-set of national level during the period under paralysis was 100% (target > 80%) review. at the national level during the first quarter in 2008, 1st January 2008 to Bloody and Other Diarrhoeas: 31st March 2008. There was no reported outbreak of bloody diarrhoea (shigellosis) from any of the zones At the zonal level, certification during the period under review. At the standard for AFP surveillance national level, the number of bloody indicators was achieved with diarrhoea cases was maintained below the optimal AFP detection and stool third quartile threshold level during the adequacy rates in five of the six period under review regions of the country during the first quarter in 2008. Measles and AFP Situation: During the period, 1st January 2008 to 31st However, Debub Region did not March 2008, a total of 10 suspected cases of achieve certification standard for measles were reported to the national level. AFP surveillance indicators during All the suspected measles cases were the first quarter in 2008, 1st January sporadic and were reported from three of the 2008 to 31st March 2008, as the six regions of the country – annualized non-polio AFP rate was reported a total of 6 cases, Debub Region less than 2 per 100,000 children less reported a total of 3 cases while Gash Baka than 15 years of age. Region reported 1 case. Laboratory investigation revealed that all 10 suspected cases of measles were negative.

During the same period, 1st January 2008 to 31st March 2008, a total of 19 cases of AFP were detected and documented. Laboratory

Eritrea Health Update

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Table 2: Measles Case Load and Classification by Region, 1st January – 31st March 2008

Zoba/Regio Total Confirmed by Discarded Compatible* n repor lab epidemiological by lab ted linkage Central 0 0 0 0 0 Debub 3 0 0 3 0 Anseba 6 0 0 6 0 G. Barka 1 0 0 1 0 NRS 0 0 0 0 0 SRS 0 0 0 0 0 Total 10 0 0 10 0

Table 3: AFP Surveillance Indicators by Region, 1st January – 31st March 2008 No. of cases N0. with Zoba detected adequate stool NP-AFP Rate % adequate stool Central 3 3 3.0 100% Debub 1 1 1.2 100% Anseba 8 8 10.0 100% Gash Barka 3 3 2.0 100% NRS 3 3 3.8 100% SRS 1 1 10.8 100% National 19 19 5.9 100%

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Figure 1

Anseba Zoba: Malaria weekly trend in 2008

3rd Quartile Yr 2008 120 100 80 60 40 20 Number of cases 0

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

Figure 2

Debub Zoba: Malaria weekly trend in 2008

3rd Quartile Yr 2008

500 450 400 350 cases

f 300

o 250 200 150

mber 100 50 Nu 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

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Eritrea Health Update

Figure 3 Maekel Zoba: Malaria weekly trend in 2008 3rd Quartile Yr 2008 120

100

80 cases

f 60 er o b m u

N 40

20

0

1 4 7 6 9 1 4 6 9 10 13 1 1 22 Week25 number28 3 3 37 40 43 4 4 52

Update

Figure 4 Gash Barka Zoba: Malaria weekly trend in 2008

3rd Quartile Yr 2008 1800 1600 1400 1200 1000 Cases

er 800 b 600

Num 400 200 0

1 4 7 9 1 3 10 13 16 1 22 25 28 3 34 37 40 4 46 49 52 Week number

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Figure 5

NRS Zoba: Malaria weekly trend in 2008

3rd Quartile Yr 2008 120 100 80 cases 60 er of

b 40

Num 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

Figure 6

SRS Zoba: Malaria weekly Trend in 2008

3rd Quartile Yr 2008

25

20 cases

f 15

er o 10 mb 5 Nu 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

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Figure 7

Anseba Zoba: Bloody Diarroea weekly trend in 2008

3rd Quartile Yr2008 160 140 120

ases 100 C f 80 er o

b 60 m

u 40 N 20 0

1 4 7 4 7 0 3 10 13 16 19 22 25 28 31 3 3 4 4 46 49 52 Week Number

Eritrea Health update Figure 8

Debub Zoba: Bloody Diarroea weekly trend in 2007

3rd Quartile Yr 2008

400 350 300 250 200 150 ber of cases 100 50 NUm 0

1 4 7 4 7 0 3 10 13 16 19 22 25 28 31 3 3 4 4 46 49 52 Week Number

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Figure 9

Gash Barka Zoba: Bloody diarroea weekly trend in 2008 3rd Quartile Yr 2008

250

eks 200

150 er of we

b 100 m 50 Nu 0

1 4 7 0 3 6 9 1 1 1 1 22 25 28 31 34 37 40 43 46 49 52 week Number

Eritrea Health Update Figure 10

Maekel Zoba: Bloody Diarroea weekly trend in 2008

3rd Quartile Yr 2008 200 180 160 140

cases 120 f 100

er o 80

mb 60

Nu 40 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

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Figure11

NRS Zoba: Bloody diarroea weekly trend in 2008

3rd Quartile Yr 2008

80 70 60 50 40

er of cases 30 b 20 10 Num 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

Figure 12

SRS Zoba: Bloody Diarroea weekly trend in 2008

3rd Quartile Yr2008 50

40

cases 30

er of 20 b

10 Num 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

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Eritrea Health Update

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Figure 13

Eritrea: Bloody diarrhoea weekly trend in 2008

3rd Quartile Yr 2008

1000 900 800 700

cases 600 f 500 er o

b 400

m 300 Nu 200 100 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

Figure 14

Eritrea: Malaria weekly trend in 2008

3rd Quartile Yr 2008

2500 2000 1500

er of cases 1000 b 500 Num 0

1 5 9 1 3 5 13 17 2 25 29 3 37 41 4 49 week number

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Eritrea Health Update

Rapid Assessment Mission Report to the Southern Red Sea Zone

Diarrhea, Acute Respiratory Infections (ARI), Malnutrition, Tuberculosis and various skin diseases are among the major causes of morbidity in the zone.

The Southern Red Sea Zone is one of targeted regions in Eritrea for the implementation of earmarked activities under the EU/ECHO and DFID Projects. The 4 sub zobas in the zone have been targeted for the implementation of specified activities under the EU/ECHO Project while a total of 8 kebabis, 2 selected from each of the 4 sub zobas, have been targeted for the implementation of specified activities under Background the DFID Project.

The Southern Red Sea Zone is one of the six In an effort to collect baseline information administrative zones in Eritrea which is prior to the implementation of specified bordered by Djibouti on the south-eastern, activities, a joint MOH/WHO Team by on the south and south-western, conducted rapid assessment mission to the Southern Red Sea Zone from 29th February by the Northern Red Sea Zone on the north th and by Red Sea on the east. The total 2008 to 7 March 2008. population is estimated at 63,179 with about 89% of inhabitants living in the rural areas. Objectives Farming, animal husbandry and fishery are the main sources of livelihood for the The main objective of the rapid assessment inhabitants of this zone. was to determine baseline health indicators prior to the implementation of specified The sources of drinking water for a activities. The specific objectives were as significant proportion of the population are follows: unprotected wells, river beds or shallow „ To acquire information on the socio- hand dug water points. The environmental demographic parameters sanitation in the urban as well as the rural areas is substandard. As a direct result of „ To determine the type and scope of the decreased access to safe drinking water basic services provided by the and the poor environmental sanitation, the health facility and community population has increased susceptibility to communicable diseases, including diarrhea. „ To determine the training/logistics needs.

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Methodology Structured questionnaire was developed. The questionnaire was used by the MOH and WHO staff to collect the required data by interviewing heads of health facilities, community leaders and administrators.

Health Management Information System (HMIS) and other record and reporting forms were reviewed for the appropriate data. Additionally, data on display at the health facilities were cross checked and there was keen observation of the Health Management Information System (HMIS) and other records reviewed 2008 environment to confirm some of the information received. Findings

Interview of health workers, community leaders and administrators revealed very important health and management information in the areas visited.

The health workers, administrators and community members welcomed the proposed interventions – Maternity Waiting Homes, Community Based Therapeutic (CBTF) Feeding and integrated Sustainable Outreach Services (SOS) – and were very supportive in providing the required information.

Direct observation revealed that the health A questionnaire being administered in Abo workers were knowledgeable about their Health Station SRS zone March 2008 catchment population as well the health indicators; the waste management system was substandard, and some residents had access to only unprotected sources of water.

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Discussion on Health and Nutrition Issues with Rahayta Kebabi Administrator Mach 2008 Unprotected drinking water source in one of the areas visited March 2008 Most of the basic essential drugs were available in the health facilities during the The availability of Maternity Waiting assessment team visit. Homes facilitated an increase in the number of deliveries attended by skilled health workers.

The implementation of the integrated Sustainable Outreach Services (SOS) in February and August 2007 were the primary means of providing basic health services, including immunization, to the traditionally un-reached population.

Conclusion

The total population of the is 63,197 while the total number of children less than one year of age is Poor waste management system in one of the 2,528; the total number of children less than health facilities visited March 2008 five years of age is 9,480; and the total number of pregnant women is 3,161.

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A tent erected to manage diarrhea cases in Tio Health facilities know their target population Health Center, on the verge of collapse and health indicators in the area.

There was no functional community IMCI For the 8 selected kebabis/communities and no functional community IDSR in the 4 from the 4 sub zobas in the Southern Red sub zobas of the Southern Red Sea Region. Sea Region, the total population is 4,796 while total number of children less than one year of age is 193; the total number of children less than five years of age is 718; and the total number of pregnant women is 239.

There are 13 health facilities and 110 health workers in the 4 sub zobas of the Southern Red Sea Region.

There was adequate number of trained health workers at the health facilities to conduct the integrated Sustainable Outreach Edi Health Station, with Maternity Waiting Home (Tent) beside it March 2008 Services (SOS) but the required logistical support was non-availability to implement The proportion of deliveries attended by this activity. skilled health workers ranged from 2.7% to 24%. Although there are Maternity Waiting Homes in 62% of the 8 targeted Less than 10% of the population had access kebabis/communities in the 4 sub zobas of to safe water supply. the Southern Red Sea Region, the non- availability of essential supplies is a critical A significant proportion of the population limiting factor to the operations of these used the open field for excreta and solid maternity waiting homes. waste disposal.

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Maternity waiting home in Edi with old bed provided by the health station March 2008

Training is needed in nutritional intervention, Life Saving Skills (LSS), IMCI enabling conditions for more women to and IDSR. readily use them with subsequent increase in the proportion of delivery attended by Water testing and treatment chemicals are skilled health workers, there is a need to required to improve access to safe water supply. provide the essential supplies and Data were available at all levels of the health equipment. care delivery system. However, data analysis, interpretation and use for decision Targeted capacity building interventions in making at the lower level was weak. the areas of Life Saving Skills (LSS), Therefore, there is a need to strengthen the therapeutic feeding practices, community capacity to analyze, interpret and make IMCI, IDSR and the use of data for decision to improve program performance informed decision making at the lower level based on available data at the lower level. should be provided to health workers and community health ambassadors, including Recommendations traditional birth attendants in order to improve service delivery and subsequently There is an urgent need to provide the improve program performance. required logistical support to the heath facilities to facilitate the implementation of The initiation of community IMCI as well as the integrated Sustainable Outreach Services community and facility based therapeutic (SOS) to ensure that basic health services feeding interventions is very crucial for reach the traditionally un-reached. improving the health status of children less than five years of age in the Southern Red In order to improve the operations of the Sea Region. Maternity Waiting Homes and create the

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The required chemicals needed for water Community transportation should be testing and treatment should be procured in initiated with locally available and order to increase the population access to technically appropriate system to promote safe water supply in the Southern Red Sea prompt and early referrals. Region with a subsequent decrease in the susceptibility to water borne diseases, Feed back and supportive supervision including diarrhoea. should be promoted at all levels of the health

care delivery system in order to increase

capacity and improve program performance.

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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