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Health Cluster Bulletin 13

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Health Cluster Bulletin 13 Zimbabwe Health Cluster bulletin Bulletin No 13 01-15 May 2009 Highlights: Cholera outbreak situation update • 98, 234 cases and 4, By 16 May, the cumulative number of reported cholera cases was 98, 234 and 4, 277 deaths 277 deaths reported by (since August 2008). The trend continues to decline, with Harare and Midlands provinces 16 May reporting 78% of all cases during week 20. • Sustained decline of The cumulative crude cases case fatality stands at 4.4% and the weekly • Cholera hotspots re- ported in Midlands and crude case fatality rate Harare provinces (week 20) stands at 3%, with all deaths reported occurring at community level. The deaths oc- curred in Midlands (5 in Gokwe south) and Manica- land (1 in Mutare urban) provinces. There was a 28% reduction in reported cases com- pared to week 19 (201 compared to 281.The highest (weekly) case loads were observed in Harare (95) and Midlands (61) provinces. Matabeleland North and Matabeleland South re- ported no cases for the sixth cumulative week. Bulawayo also continued to report zero Inside this issue: cases this week. There was a decline in reported cases in all districts except for Gokwe South district where Cholera situation up- 1 an increase was experienced (6 cases in week 19 to 61 cases this week), resulting in Mid- date lands province reporting the highest weekly caseload. Chitungwiza reported 50 new cases Update on social mobi- 2 and Harare City, 45, among the highest district case loads for six cumulative weeks. Other lization working group districts affected by cholera this week include; Makonde, Chipinge, Mwenedzi, Masvingo and activities Makoni. The average weekly reporting rate dropped from 85% in week 19 to 76% this week, with suboptimal reporting observed in Masvingo province. 86 cases reported in Mutare rural Stories from the field 4 were established as a case of batch reporting. Meetings and events 5 Response and recommendations • Concerted efforts are still required in the identified areas (hot spots) which continue to Donor response to 6 report high numbers of cases and deaths. There is a need to work with the leaders of the cholera Apostolic faith churches to find ways to prevent the spread of cholera in their communi- ties as many of the cases reported in the last few weeks have been due to religious gath- erings. As a major annual apostolic gathering of 100, 000 or more is planned during July in Manicaland, there is an urgent need to initiate a partnership with the community to find a way to prevent unnecessary morbidity and mortality. • Laboratory testing is ongoing in Gokwe and Kadoma to verify that reported cases are in- deed cholera. A test on stool samples collected by GAA-Merlin at an Oral Rehydration Point (ORP) recently indicated the possibility of a rotavirus outbreak. • Rotavirus is a winter virus that is transmitted by the faecal-oral route. It causes severe diarrhea, abdominal pain, vomiting and fever for 3-8 days (incubation of a few hours to 2 days). Globally, the virus causes up to 527,000 annual deaths among children below 5 years old, most among children between 6 and 24 months. By age 3, most have devel- oped antibodies that make repeat episodes less severe. Mothers and caregivers of chil- dren are being encouraged to practice proper hand washing as well as to ensure that children’s nappies are properly covered to prevent the spread of the virus to other chil- dren. Health education is ongoing at ORPs, more community education shall be carried out during the national immunization days. Zimbabwe Health Cluster bulletin Update on activities of the joint health and those who can be persuaded to seek treatment are discouraged by high mortality rates in institutions. WASH social mobilization working group On 19/20 (Harare) and 26/27 March (Bulawayo), na- tional health promotion trainer of trainers’ workshops A Participatory were carried out by the joint health-WASH social mo- Health and bilization working group of the cholera command and Hygiene Educa- control centre. The participants were health promo- tion session tion resource persons at national and provincial level . during the The aim of the workshops was to; Masvingo train- ing Photo • Orient health promotion resource persons on har- credit: N. monized a health promotion message and Ngwenya, WHO • Set up structures at community level to support epidemic preparedness and response The methods used included; • Poor health seeking behaviour among many mem- • Pre and post tests bers of the community also caused a delay in seek- • Presentations by resource persons and discussions ing treatment and resulted in deaths at both com- with participants munity and in health facilities (many institutional deaths are also attributed to delays in treatment • Group work and plenary seeking). Focus group discussions in some communi- The trainers were then expected to cascade the train- ties revealed that a loss of faith in the formal ing to district and ward level, based on work plans health services due to lack of human resources and drawn at the workshops. As of 29 May, a total of 8 even drugs discouraged people from going to health provinces had carried out cascade training to district facilities for treatment. level (see the table below for details). • In addition, lack of sugar due to the economic crisis Based on discussions at the workshops, the following prevented the making of salt sugar solution (SSS), and Oral Rehydration Salts (ORS) was only available Province No of districts covered within institutions. Deaths in health institutions have been attributed to; Manicaland 7 • Other underlying causes such as malaria, HIV/AIDS, Masvingo 7 diabetes, high blood pressure among others; Mashonaland Central 8 • geographical access to CTCs • human resource challenges resulting in low staff to Mashonaland East 8 patient ratios (3:100 reported in Manicaland) result- ing in deaths especially at night Mashonaland West 8 • Lack of skills/training as cholera was a ‘new’ disease Matabeleland North 7 • limited treatment supplies, particularly antibiotics for treatment of patients with co-morbidities Matabeleland South 7 2. Aquatabs and other household water treatment Midlands 8 chemicals face continued resistance due to the smell and taste of the water. There is a need for Total: 8 provinces 60 districts continued education on the importance of water treatment and boiling of all drinking water. The pro- vision of aquatabs on the retail market was strongly lessons have been drawn for future outbreak re- advocated for. In addition, there is a request from sponses; districts for provision of aquatabs as part of the 1. Explanations for high case fatality rates emergency response stockpile for use at facility level. At community level: 3.Hygiene practices: During pre and post workshop • Religious beliefs among predominant apostolic faith tests among participants, there was limited percep- (in Manicaland and Midlands) played a big role in tion of the fact that hand washing is meant to kill the high number of community deaths. This is be- germs, rather than merely remove dirt. This should cause they generally discourage medical treatment be addressed in the review of information education and discussions with the community indicate that & communication materials on hand hygiene. Page 2 Zimbabwe Health Cluster bulletin 4. The importance of village health workers in com- formed with the church to improve immunization munity preparedness and response was acknowl- coverage. Interviews with members of the sect in edged; there was a recommendation for the ur- other areas indicate that they have not been in- gent revitalization of the program in all areas. As cluded in other health activities and resent the fact MoHCW is currently updating the VHW training that they have only been approached during a crisis. module and overall program, the working group They also feel stigmatized by attitudes expressed has made suggestions for additional areas to be towards them. As such, it has been agreed that per- included in the training including but not limited suasion as a strategy for health promotion is the only to community outbreak response, the VHW kit and option as enforcement of the public health act (for harmonization of incentives. A number of partners outbreaks) drove away the very people that it was are interested in working towards the revitaliza- meant to be protecting in the past. tion of the program and proper coordination will 11. There is a need to agree on strategies for communi- go a long way in making it successful. cation with vulnerable and/or hard to reach groups. 5. Importance of synergistic partnerships and coordi- In Manicaland and Mashonaland Central, gold pan- nation in management of cholera. Some areas ners were identified as an at risk community because reported conflict between partners and the dis- many are illegal and are therefore hesitant to pre- trict MoHCW staff. There is a need for clear infor- sent for treatment. The other vulnerable groups mation on C4 roll out down to district level as identified were prisoners, the elderly, children below there seems to be a dearth of knowledge on how 2 years, people with no fixed abode and people with to use it as a platform for coordination. There is disabilities. It was agreed that for health promotion also a need to strengthen leadership among ‘one size does not fit all’. MoHCW to support coordination, with clear roles 12. In order to strengthen health promotion, the joint and responsibilities drawn out for both MoHCW and health-WASH social mobilization working group have partners to avoid conflict. agreed that a shared annual work plan be made un- 6.Lack of personal protective equipment (PPEs)-many der the leadership of the Ministry of Health and Child health facilities were forced to improvise in ways Welfare.
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