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F Situation Update Mid and Far Western Region Diarrhoea Outbreak This report was issued by UN OCHA Nepal and covers the period until 3 August 2009. Highlights: • 233 total diarrhoea related deaths reported in 16 affected districts in Mid and Far Western Regions, from 5 May to 3 August 2009. • 142 diarrhoea related deaths recorded in Jajarkot District, as of 3 August 2009. • Health situation remains a concern in Rukum and Dailekh Districts. • Access to diarrhoea affected areas and communication remain a constraint for the delivery of emergency medical services. • GoN announced a Short Term Plan and Long Term Plan for the diarrhoea affected areas in Mid and Far Western Regions. I. Situation Overview 1. The Districts of the Mid Western Region and Far Western Region are affected by an outbreak of Acute Watery Diarrhoea (AWD). Diarrhoea related deaths continue to be reported in the western regions despite targeted attempts by government, non government organizations and international relief community to curb the outbreak. The main challenges remain logistics and access to remote affected communities in Village Development Committees (VDCs). 2. According to the Ministry of Health and Population (MoHP), the cumulative death toll from diarrhoea related causes is 233 deaths in 115 VDCs of 16 diarrhoea affected districts, between 5 May and 3 August 2009. This data is based on data recorded by health camps, Health Posts and District Hospitals and sent to MoHP through District Public Health Offices (DPHOs). The highest death toll was recorded in Jajarkot, with 142 deaths and 43 deaths in Rukum and 12 deaths in Dailekh district. ( The Health Cluster Situation Update on 4 August will provide a district breakdown for diarrhoea treated patients and deaths). 3. The trend in health records in Jajarkot and Rukum indicate a decrease in the number of deaths, according to WHO. Nevertheless, the risk of further infection remains. Therefore, the implementation of prevention activities is important, including continued mass hygiene information campaigns in the vulnerable districts. 4. According to National Public Health Laboratory, out of 13 samples collected from Jajarkot, 3-4 samples tested positive for Vibrio Cholerae and the remainder indicate mixed results. 5. DPHOs continue to face challenges in the provision of medical aid to the diarrhoea affected population in the remote areas due to logistical constraints and difficult terrain. The Government of Nepal (GoN) stated that there is sufficient medicine and medical staff in the affected areas, however, requested continued technical support from the international community to address the gaps on 25 July. 6. The Prime Minister, Health Minister and senior government officials visited the diarrhoea affected areas in Rukum and Jajarkot districts to assess the situation on 20 July and announced a relief package of NPR 10- 15,000 to the families who lost their kin in diarrhoea outbreak in Jajarkot, Rukum and other districts in the Mid Western Region. The Prime Minister also urged local Political Parties, civil society members and representatives of local organizations to support the government in responding to the diarrhoea outbreak. On 31 July and 1 August, the Minister for Health and Population visited the local health facility in Majhkot, Khagenkot and Nayakwada of Jajarkot. 7. The Government of Nepal announced a Short Term Plan and Long Term Plan to coordinate the response and preventative measures this week. The Short Term Plan, coordinated by the MoHP, includes a response to control the outbreak; supply of adequate drugs and human resources and the active surveillance in other districts; and promotion of health education and promotion (IEC) and post diarrhoeal malnutrition activities. MoHP has requested relevant Ministries including security Officials and UN Agencies, External Development Partners (EDPs), I/NGOs and other organizations to support these activities. The Long Term Plan, coordinated by the Prime Minister’s Office, includes the Water Sanitation and Hygiene and Food Safety and security programme to address the post-diarrhoeal malnutrition, chronic malnutrition and to improve overall nutritional status of the affected population. The government also requested support for the Long Term Plan. Situation Update 4: Mid and Far Western Region Diarrhoea Outbreak, 03 August 2009 1 II. Humanitarian Needs Health Response: 1. The MoHP/Epidemiology and Disease Control Division (EDCD) is leading the response from the central level. The District Public Health Offices (DPHOs) in the various Districts are leading the response to the diarrhoea outbreak at the district level. 2. The MoHP is coordinating the Short-Term Plan, which includes approaches to surveillance, case management, outbreak confirmation, prevention and control, and immediate response. 3. DPHO Jajarkot continues to mobilise Health Posts and Sub-Health Posts, medical staff, including Female Community Health Volunteers (FCHVs) and Maternal Child Health (MCH) workers to provide medical support. Political Party members are also providing support affected to communities, including through health camps. Treatment of diarrhoea patient Khagenkot Health Post, Jajarkot: Credit: Dr. Ravi Kafle 4. As part of surveillance, EDCD, MoHP alerted DPHOs and Regional Health Directorate to enhance the surveillance activities. WHO distributed surveillance forms to the 15 Surveillance Medical Officers (SMO) located in the affected areas, as well as to the case management protocols. Weekly reports will be submitted, based on information collected on a daily basis in the affected VDCs. IFRC activated its internal global system to provide alerts to donor and relief partners. 5. Epidemiology and Disease Control Division (EDCD), WHO, International Nepal Fellowship (INF), Nepal Family Health Programme (NFHP), Helvetas, CARE Nepal, are supporting with health workers. MoHP, EDCD, WHO, NRCS, UNICEF, DEPROSC, NEWAH, Save the Children, MALIN, and ADRA Nepal are providing medical supplies. 6. For detailed information, please refer to the Commodity Tracking Matrix on the Nepal Information Platform (http://un.org.np/resources/diarrhoea-outbreak/ ) Key Gaps : 1. Access to health facilities for affected population in remote areas. 2. Access to affected areas for the health staff. Some areas are only accessible by foot, which prolongs the time to get the supplies to the household level. 3. Health information management system needs to be strengthened. 4. Gathering of medical supplies at road drop-points/plane drop-points needs to be managed. 5. Logistics constraints for the delivery of medical items to remote affected areas. Medicines are delivered by helicopter into the District and transported to affected areas by porters and mules. Water, Sanitation and Hygiene (WASH) Response : 1. The WASH Cluster response in Jajarkot is coordinated by Water Supply and Sanitation Sub Divisional Offices (WSSSDO) and the WASH Cluster meets every three day at District Headquarters. 2. In Jajarkot, the WASH Cluster aims to reach 100% of the households through multiple mobilised volunteers. The WASH Cluster agreed on common messaging for hygiene campaigns. Partners and multiple community volunteers are mobilised with hygiene promotion materials and how to use ORS and water treatment agents. 3. WSSDO, DHO, NRCS, UNICEF, DFID, GTZ, USAID, DEPROSC, HRDC, YARCN, NEWAH supported by Concern Worldwide, ADRA Nepal, Paschim Pailla, and the National Health Education Information and Communication Centre (NHEICC) is supporting hygiene promotion in Jajarkot and Rukum Districts. Similarly responses are ongoing in Surkhet, Dailekh, Rolpa, Dailekh, Doti and Dadeldhura by various agencies; including Oxfam, LWF, youth groups are mobilised for distribution of chlorine tablets, hygiene promotion, cleaning of water sources and villages, chlorination of water system. 4. UNICEF along with DHO, NRCS, WSSDO, DEPROSC and National Health Education Information and Communication Centre (NHEICC) designed and developed additional standard messages disseminate information throughout Jajarkot district through flex IEC materials to raise awareness in WASH; Photo Credit chart and general information booklets. UNICEF Key WASH gaps : 1. Lack of water purification tablets in the affected areas. Chlorine solution remains a gap, with 30,000 households requiring chlorine solution, particularly in Rukum. 2. Logistics of WASH supplies to remote affected areas. Some areas are only accessible by foot, which prolongs the time to get Situation Update 4: Mid and Far Western Region Diarrhoea Outbreak, 03 August 2009 2 the supplies to the household level. 3. Dried Water Source-As the majority of springs and the water sources are dried up due to lack of rainfall during and the winter drought, people are compelled to drink and fetch the contaminated water available elsewhere. 4. Coordination of the response at the local level remains a challenge. Nutrition : Response : Nutrition related information materials were incorporated into the WASH information campaign, including the message on the importance to continue to provide nutritious food to sick children. Nutrition surveillance in Rukum is on-going. Protection : Response : The Protection Cluster developed a child protection and nutrition checklist to assess the impact of the diarrhoea outbreak on children. Needs: 1. Marginalized and low socio-economic status people are the most affected by diarrhoea, according to DPHO data. 2. Health workers and health related organisation are prepared to
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