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Diffa Region, Niger Health Assessment 21-26 November 2013

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Diffa Region, Niger Health Assessment 21-26 November 2013 HUMANITARIAN HEALTH ASSESSMENT IN DIFFA REGION DR FATOU F R A N C E S C A MBOW , SAVE THE CHILDREN 26.11.13 ASSESSMENT TEAM • Dr Fatou Francesca Mbow, Save the Children WCA Regional Humanitarian Health Adviser [email protected] +221 777406701 Dakar-Niamey-Dakar: 18-27 Nov. 13 Niamey-Diffa-Niamey: 21-26 Nov.13 • Anda Oumarou, Save the Children Health and Nutrition Program Manager , Diffa Excused -sick leave -(Diffa): Aicha Taybi (UNHCR) METHODOLOGY 1. Literature review 2. Face-to-face discussions with key informants: Ministry of Health (Direction Régionale de la Santé, Health Facilities’ staff), Diffa Health District Head, Diffa Urban Health Centre Head, Mental Health Co. Diffa Regional Hospital*, NGOs (Save the Children, IRC) UN agencies (UNHCR), patients in health facilities *phone conversation 3. Direct observation: Bosso health centre, Kablewa health centre, Diffa’s regional hospital (paediatric ward including CRENI), Maine Soroa district hospital (paediatric ward and CRENI), Maine Soroa health center Limitations: -MoH and Save the Children staff very engaged in “Journées Nationales de Vaccination” - SAM/MAM Save the Children program not evaluated quantitatively Niger 17 million DIFFA Diffa REGION 600,000 http://www.stat- • 6 departments niger.org/statistique/file/rgph2 • 3 health 012.pdf districts Diffa 48% below age 15 http://www.snis.cermes.net/downl oad/Annuaire_%20statistique_2 011.pdf CARTE SANITAIRE DIFFA REGION AND DEPARTMENTS Diffa REGION 600,000 people 157,000 km² 50 CSI 127 cases de santé N’Guigmi: 83,100 people Maine Soroa: 135,000 km² 216,600 1 District Hospi. people 12 CSI 15,000 km² 27 cases de 1 District santé Hospi. Diffa: 20 CSI 224,000 people 43 cases de 7,000 km² santé 1 regional hospital 17 CSI 57 cases de santé HUMANITARIAN CHALLENGES IN DIFFA OVERVIEW http://reliefweb.int/report/niger/sahel-operation-diffa-situation-niger- november-2013 TRANS-BORDER MOVEMENTS DIFFA HEALTH DISTRICTS: 37,000 PEOPLE, ¼ NIGERIAN (UNHCR) HEALTH # %NIGERI DISTRICT HEALTH FACILITY SITE NAME # MOBILE POP. NIGERIA A Health Centre (urban) BOSSO 10913 1863 17% MAMOURI 1582 277 18% GARIN AMADOU 1294 420 32% BOULAGANA 991 164 17% GAMGARA 1 250 250 100% GAMGARA 2 644 27 4% BOULABRINE 162 162 100% ABADAM 2218 1117 50% TCHOUKOUJANI 1936 588 30% Health Centre (rural) BAROUA 1247 381 31% NGUELKOLO 1252 117 9% Health Centre (urban) DIFFA 4638 963 21% Health Centre (rural) TOUMOUR 837 47 6% Diffa TOTAL Diffa 27964 6376 23% Health Centre (rural) KABLEWA 5225 790 15% N'Guigmi TOTAL N'Guigmi 5225 790 15% Health Centre (urban) MAINE-SOROA 2890 1013 35% ABASSARI 304 47 15% YABAL 58 75 129% Health Centre (rural) TAM 443 68 15% ABOUNGA 24 16 67% TOTAL Maine Maine Soroa Soroa 3719 1219 33% TOTAL Diffa Region 36908 8385 23% FLOODS http://reliefweb.int/report/niger/flash-update-no1-du-15- novembre-2013-inondations-diffa-suite-la-crue-de-la- komadougou FOOD INSECURITY http://www.fews.net/pages/country.aspx?gb=ne HUMANITARIAN HEALTH CHALLENGES IN DIFFA OVERVIEW SAM PREVALENCE THE HIGHEST IN THE COUNTRY AND INCREASING SINCE 2011 5 Prevalence of SAM per Niger Region, SMART 2007-2013 4,5 4 3,5 Agadez Diffa 3 Dosso 2,5 Maradi Axis Axis Title Tahoua 2 Tillabery Zinder 1,5 Niamey 1 Niger 0,5 0 2007 2008 2009 2010 2011 2012 2013 GAM PREVALENCE DECREASING HIV PREVALENCE POSSIBLY THE HIGHEST IN THE COUNTRY DHS 2006* *HAVE NOT BEEN ABLE TO GET SENTINEL SURVEILLANCE DATA BUT IT APPARENTLY EXISTS AND CONFIRMS THE ABOVE • DHS 2006 http://www.measuredhs.com/pubs/pdf/HF16/Niger_HIV_F actSheet.pdf ENQUÊTE SOCIO COMPORTEMENTALE ET DE PRÉVALENCE DES IST ET DU VIH/SIDA DANS LE BASSIN DU LAC TCHAD A DIFFA AU NIGER, JUL. 2011 Hommes Femmes Ensemble Intervalle de confiance à Intervalle de confiance Intervalle de confiance à 95% HIV-1 95% Effectif HIV-1 Effectif HIV-1 à 95% Effectif Inf Sup Inf Sup Inf Sup Milieu de résidence Urbain 0,0% 0,0% 1,5% 321 3,00% 1,3% 6,3% 236 1,3% 0,5% 2,7% 560 Rural 2,00% 0,7% 4,8% 254 3,70% 1,6% 7,8% 189 2,7% 1,5% 4,8% 447 Age 15 - 19 0,0% 0,0% 6,7% 68 0% 0,0% 4,5% 103 0,0% 0,0% 2,7% 171 20 - 24 0,0% 0,0% 5,3% 87 5,70% 2,1% 13,5% 87 2,9% 1,1% 6,9% 174 25 - 29 1,1% 0,1% 6,9% 90 1,10% 0,1% 7,1% 88 1,1% 0,2% 4,4% 178 30 - 34 2,2% 0,4% 8,4% 92 3,70% 0,6% 13,8% 54 2,7% 0,9% 7,3% 146 35 - 39 0,0% 0,0% 5,8% 79 6,80% 1,8% 19,7% 44 2,4% 0,6% 7,5% 123 40 - 44 2,8% 0,5% 10,7% 71 8,10% 2,1% 23,0% 37 4,6% 1,7% 11,0% 108 45 -49 0,0% 0,0% 10,9% 40 0,0% 0,0% 30,1% 12 0,0% 0,0% 8,6% 52 50 - 54 0,0% 0,0% 14,6% 29 - - - - 0,0% 0,0% 14,6% 29 55 - 59 0,0% 0,0% 20,9% 19 - - - - 0,0% 0,0% 20,9% 19 ND - - - - 0,0% 0,0% 43,9% 7 Niveau d’instruction Aucun 3,10% 1,2% 7,6% 159 4,70% 2,4% 8,7% 214 4,0% 2,4% 6,7% 373 Primaire 0,0% 0,0% 5,1% 90 2,90% 0,2% 16,6% 35 0,8% 0,0% 5,0% 125 Secondaire 1er cycle 0,0% 0,0% 5,3% 86 1,60% 0,1% 9,5% 64 0,7% 0,0% 4,2% 150 Secondaire 2nd cycle 0,0% 0,0% 9,1% 49 9,10% 0,5% 42,9% 11 1,7% 0,1% 10,3% 60 Supérieur 0,0% 0,0% 32,1% 11 0,0% 69,0% 3 0,0% 0,0% 26,8% 14 Autres 0,0% 0,0% 2,6% 180 1,00% 0,1% 6,4% 98 0,4% 0,0% 2,3% 278 ND 0,0% 0,0% 43,9% 7 HIV IN DIFFA REGION Diffa Regional Hospital • 2013: 198 on ART, 11 of them caseload 2008-2013 children (Diffa regional 500 hospital is the only ART site in 450 the region) 400 350 • We don’t know how many on 300 ART are lost to follow-up since 250 HIV+ Northern Nigeria crisis 200 ART 150 • Assoc. of PLWHA: at least 300 100 people in Diffa Health District 50 (>50% from Nigeria) 0 2008 2009 2010 2011 2012 2013 • HIV+ in SAM seems to be overlooked issue MENTAL HEALTH IN DIFFA REGION • 323 mental health patients in Diffa’s regional hospital Jan.-Nov. 2013 (no data trends*). This is the only health facility with mental health capacity (1 “licencie en sante mentale”)in the Diffa region. • 1 in 10 patients is displaced from Nigeria (no data stratified by age nor sex*) • “majority” suffers from depression linked to husbands, children, other family members brutally killed (beheaded) in front of patient prior to fleeing Northern Nigeria. • No info. on treatment* *very short phone conversation HEALTH IN DIFFA LITERATURE REVIEW DHS 2012 PRELIMINARY REPORT: DIFFA • Vaccination: 12-23 months who received all vaccines: Diffa lowest (42%) after Zinder (41%). Country is 52% • Monitoring and evaluation: Data on ARTI, fever and diarrhoea treatment for Diffa is incomplete • SAM and under-nutrition -3ET weight/height: Diffa 21% (Niger 6.2%) – worst of all regions. Similarly worst of all regions for -3ET weight for age and height for age • HIV Men knowledge on condoms’ protection against HIV is the worst in the country DHS 2012 PRELIMINARY REPORT: NIGER • Fertility index 7.6 children/woman (rural 8.1, urban 5.6) has increased since 2006. Adolescents contribute 15% to fertility index in rural areas.>80% women want another child “soon” or “later” regardless of number of living children already had. 86% women no contraception (usage has increased from 11% to 14% since 2006) • 83% ANC but then only 30% delivery in health facility/assisted by health professional (Anthropo. Study French Red Cross 2012: no knowledge of danger signs/symptoms – neither health staff nor pregnant women) • 6 months exclusive breastfeeding: 13% (with water added, 52%) • 60% households owns an insecticide treated bed net yet ¾ children do not sleep under one • 73% anaemia in children (43% severe), 46% anaemia in women (1/3 mild) • U5MR declined since 2006 from 198 to 127 per 1,000 live births ANNUAIRE STATISTIQUE 2011: DIFFA • Diffa worst region for: o % assisted deliveries (12% versus country 24.75%) o % maternal deaths (0.66% versus country 0.13%) o % Diffa regional hospital higher number of consultancies compared with all other regional hospitals (including Niamey) • Transfusion not in hospitals but in “centres régionaux de transfusion sanguine” in Diffa, Tahoua, Dosso, Niamey HEALTH IN DIFFA DATA FROM HEALTH FACILITIES UNEVEN DISTRIBUTION OF HEALTH FACILITIES AND STAFFS ALTHOUGH SPHERE STANDARDS BROADLY RESPECTED Ce Ho CSI CSI Cas Tot Health Staff Diffa ntre p. 2 1 e al Public Private Hos de de Region p. dist san Reg rict té # Drs 18 (13 4 (3 urbain) urbain) Diff 1 0 2 15 57 75 a # Nurses 213 (109 33 (26 urbain) urbain) MS 0 1 2 18 43 64 NG 0 1 2 11 27 41 # Midwives 32 (24 5 (4 urbain) urbain) Tot 1 2 6 44 127 180 Effectif total du al personnel 263 42 HEALTH STAFF MOBILITY AND RETENTION CHALLENGES - Out of 17 CSI in Diffa Health District, 9 are staffed by 1 single person only – a nurse.
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