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F2c88118db1ee7e7c12575f6 Situation Update Mid and Far Western Region Diarrhoea Outbreak This report was issued by UN OCHA Nepal. It covers the period until 14 July 2009. The next report will be issued by 16 July. Highlights: • 103 diarrhoea related deaths in Jajarkot District DPHO confirmed, from 1 May to 13 July 2009 • 25 diarrhoea related deaths in Rukum District DPHO confirmed, from 29 June to 13 July, currently under investigation • Number of affected population increasing in neighbouring Districts • Ministry of Health and Population and District Line Agencies are coordinating response to outbreak • Access to remote affected areas delay response of medical staff and delivery of supplies • Public awareness campaigns on sanitation and hygiene underway I. Situation Overview 1. The hilly Districts of the Mid Western Region have been affected by a diarrhoea outbreak. Jajarkot District was initially affected, with 103 diarrhoea related deaths as of 13 July, according to the District Public Health Office (DPHO) 1. Medical teams are mobilised to the affected areas and mass information hygiene awareness activities are underway. The Ministry of Health and Population (MoHP) is coordinating the response, with the support of WHO to investigate the cause of the outbreak and verify the epidemiological data and UNICEF supporting drinking water supplies and sanitation and hygiene awareness raising campaigns. 2. Jajarkot is the worst affected District, which local health workers attribute to lack of clean drinking water, poor sanitation and hygiene. The winter drought, delayed monsoon rains and dried up water sources increased the risk of consuming contaminated water. Water quality, availability and latrine coverage figures are unknown at this time. The DPHO stated that the latrine coverage is very low and open defecation is a common practice. The seasonal economic migration is high in Jajarkot, with the majority of men and male youth in India for employment. 3. In Rukum District, the diarrhoea related death toll has reached 25 dead from 29 June to 13 July, according to the DPHO Rukum. The highest diarrhoea affected populations are in Aathbiskot and Gotamkot Village Development Committees (VDCs), adjoining affected VDCs in Jajarkot District, according to WHO 2. 4. Diarrhoea related deaths are also reported in a growing number of neighbouring Districts. Any link between these cases is unconfirmed and under investigation by MoHP and WHO health teams. ▪ Dailekh : DPHO confirmed two diarrhoea related deaths in VDCs bordering Jajarkot District. ▪ Salyan : DPHO stated that there were two diarrhoea related deaths on 2 and 3 July. Situation is under control with sufficient medicine stock and health workers, according to the DPHO. ▪ Dang : One child died of diarrhoea in Lalmatiaya VDC. The number of patients with diarrhoea symptoms is increasing. 25 police affected by the diarrhoea are under going treatment, according to unconfirmed reports. Local clubs mobilized volunteers to promote hygiene practices. Situation is under control. ▪ Doti : Diarrhoea cases are increasing. The DPHO confirmed two deaths from diarrhoea on 12 July. DPHO has sufficient medicine and is able to respond the current situation. ▪ Dadeldhura : DPHO deployed a health team to Belabur VDC, where there are reportedly ten families affected by diarrhoea and two unconfirmed deaths due to diarrhoea. ▪ Mugu : DPHO stated that the situation is normal. NRCS will conduct a hygiene awareness campaign through its community-based volunteer’s network. 5. Due to logistic constraints, DPHOs face challenges in the provision of medical aid to the diarrhoea affected population in the remote areas. There were also shortages of the health workers and medicine in some of the diarrhoea affected VDC in Jajarkot and Rukum Districts, which is being addressed by the DPHOs. 1 Jajarkot District a Human Development Index (HDI) ranked 71 out of 75 Districts in Nepal. The projected population of Jajarkot District is 151,551 people. Rukum District HDI ranked 64, with a projected population 215, 270. Dailekh HDI is 66 with a projected population of 255, 858. Salyan HDI is ranked 61 with a projected population of 610,000. 2 WHO Health Post data: Aathbiskot VDC: On 13 July 2009, 42 admitted diarrheal cases, 67 severe diarrheal cases and 380 general cases were treated and returned their home with medicine; Gotamkot VDC: On 13 July 2009, 62 admitted diarrheal cases, 120 severe diarrheal cases and 450 general cases were treated and returned their home with medicine. Situation Update: Mid and Far Western Region Diarrhoea Outbreak, 14 July 2009 1 II. Humanitarian Needs Health ▪ Central Response : 1. The MoHP is leading the response from the central level, with staff located in Jajarkot and Rukum Districts. Coordination focal points were identified from MoHP and Epidemiology and Disease Control Division (EDCD) for human resource mobilization, logistic coordination and communications. MoHP logistics coordinator is also located at the Chourjahari airstrip. The DPHOs in the various Districts are leading the response to the diarrhoea outbreak. 2. World Health Organisation (WHO) is supporting the DPHO of affected Districts, as well as the Regional Health Office (RHO) and MoHP. Regional Rapid Response Team (RRT) and District RRTs were mobilized to the affected areas. WHO regional office is deploying a surveillance officer this week. WHO is supporting the MoHP / EDCD at central level in coordination of the response efforts and is investigating the outbreak at the request of MoHP. WHO also has 54,000 aquatabs on standby, to be released upon request from MoHP. 3. The Nepal Army sent stool and water samples to Kathmandu, which are being tested. Walter Reed / AFRIMS Research Unit Nepal (WARUN) sent sample collection kits to Jajarkot and Rukum for virology testing. 4. Nepal Red Cross Society (NRCS) will provide 100 blankets, 100 tarpaulins and 50 stretchers, information, education and communication (IEC) materials to the affected Districts. The Red Cross volunteers will be mobilised for public awareness, as will the central Response Team for coordination, if required. The NRCS supplies will be transported to the Districts with the support of Nepal Army. ▪ Jajarkot District Level Response : 1. DPHO Jajarkot mobilised 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, including the Maoist health workers are supporting affected communities. The Maoist People’s Liberation Army (PLA) health workers from the 6th Cantonment Site are administering treatment to affected communities. Six mobile health teams were deployed from Chourjahari airstrip (four hours walk from District Headquarters) on 14 July 3. 2. Epidemiology and Disease Control Division (EDCD) deployed 20 health workers on 13 July. An additional 26 health workers will be deployed from Nepalgunj. Department of Health Services sent nine health workers, including two Doctors to Jajarkot District. 3. WHO provided the DPHO one diarrheal disease kit, which can treat 100 severe cases and 4-500 mild cases of diarrhoea. (WHO positioned 12 diarrheal disease kit at various strategic locations throughout, which can be mobilized be required). A WHO Surveillance Medical officer (SMO) and a National Public Health Laboratory (NPHL) officer will reach Jajarkot on 11 July with Packing of medicines at Chourjahari, Rukum medicine and reagents to test for sources of infection. (Photo Credit - OCHA) 4. International Nepal Fellowship (INF) deployed a 6-member response team (Doctor, health assistant, nurse, team coordinator and support staff) to Bhur and Karkigaun VDCs to administer treatment for 15 days from 10 July. As of 13 July, the medical team treated 98 patients, with a growing number of patients visiting the health clinic. 5. Helvetas sent a medical team (2 Doctors and 4 health workers) including NPR 300,000 of medicine from Surkhet to Jajarkot on 13 July. The health team will establish the mobile health clinic from 14 -18 July. ▪ Rukum District Level Response : 1. DPHO Rukum mobilised medicine and health workers to control the diarrhoea outbreak and established four treatment camps were established at Gotam Kot, Arbiskot, Bankekot and Garaila. NRCS, Nepal Army, I/NGOs and UN Agencies are supporting the distribution of medical supplies. 2. A WHO Surveillance medical officer is supporting the outbreak investigation. 3. ADRA Nepal supported medicine equivalent to NPR 40,000 to the DPHO Rukum. 4. Safe Motherhood Network Federation (SMNF) is supporting health education in the diarrhoea affected VDCs of Rukum District. 5. Save the Children is working with NRCS and Child Workers in Nepal (CWIN) to provide coordination support to the DPHO and DDRC. 3 Medical teams were deployed to: Bhagawatitol VDC: MoHP medical team 1; Khagenakot VDC: Armed Police Force (APF) team 1; Garkhakot VDC: Nepal Medical College team; Kortang VDC: APF team 2; Majkot VDC: MoHP medical team 2; Sakla VDC: Nepal Police Situation Update: Mid and Far Western Region Diarrhoea Outbreak, 14 July 2009 2 ▪ Other Districts Response : 1. The DPHO Dailekh mobilized the 6 member health team to recent diarrhoea affected areas and directed all the Health Post and Sub-Health Post to remain on high alert. District and the local health institutions are to maintain a maximum of medicine stock. 2. In Salyan, the DPHO reported that the situation is under control and there is no epidemic in the area. The DPHO immediately mobilized health teams and medicine to the reported affected area. Salyan health facilities have sufficient medicine stock and health workers and are on high alert. 3. In Dolpa, the DPHO is assessing the situation, with the support of KIRDAC, a local NGO. ▪ Key gaps : 1. Confirmed information on number of deaths, affected population and linkages with other Districts, which MoHP and WHO is investigating. 2. Mapping of in-coming supplies and health workers, areas of deployment and information mechanisms to capture findings and measure gaps in response. 3. Information on the cause of the outbreak and the epidemiological breakdown, which WHO is conducting 4.
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