Health Action in

Health Newsletter Ministry of Health and Population, Department of Health Services, Epidemiology and Disease Control Division World Health Organization-Emergency and Humanitarian Action - Issue IV, December 2005

N Headlines IO N G NEPAL E M R ID N - · Nepal and Vaccine Preventable R W E H U MLA E T ST S E KATH MAN DU E D AR C HU LA R N Diseases W R BA JHA N G E PU R R G KTA A I BHA F BA ITA DI O B AJU RA MUGU N RA HU D W EL JU MLA E D K K DA D OT I ALI S LA LITP UR A AC H HA M K O DOLP A T N T E Highlights C R H N A MU S TAN G N R P D AILE KH E U R JA JA R KOT G KA ILAL I IO N · Training on Public Health in RU KU M MAN AN G C SU RK H ET EN TR B AR DI YA MY AGD I A Emergencies for District Rapid SA LYA N BA L GL GOR KH A R OLPA U T K ASK I R NG A EG LA MJUN G B IO R RA SU W A N PY UT HA N A Response Team BA NK E GU LMI P JA G EASTE G I N RN RE AN GI ON Y T AN AH U D DAN G S A H SI ND H U D N UW A KOT PA LCH OK PA LPA HA S OL U TU SI A K A S I A L SA NK HU W A · Assessment of Impact of ILB E H AR DO P K HU MB U P AP ND L H A SA BH A K A A C HI TWA N H TAP LEJU NG U P AW MA KW A NP U R KAV RE C R N E M conflict on health Service A R OKH AL A

R S S IND H ULI DH U NGA G N U A R A A T OT P R R A H H A K J E R A I T M H P U T O H delivery in rural Nepal A H H I H T C B A A H N R A T L A U D H AN A B TE RAI D P U R S A T Y U A K UT A A A T P I LA M S N U R O R I HILL A H SIR AH A R H · AES case including JE during A A D M S

MO UNTAIN N S AP TAR I JH AP A U 2005 in Nepal S MORA N G

EDCD News update · Avian Influenza and Influenza Training on Public Health in Emergencies for Pandemic Task Force Meeting in December 2005 District Rapid Response Team (RRT) · Malaria Quarterly Review The training on Public Health in Emergencies for Rapid Response Team of 6 districts, Meeting in in the including 5 districts from the Central Region (i.e. Dhanusha, Sarlahi, Mahottari, Sindhuli Central Region from 5-6 and Rauthat) and 1 district from the Eastern Region (i.e. Siraha) held at in the December 2005 Central Region of Nepal on 21-22 December 2005. This training was conducted by MOHP/DHS/ Epidemiology and Disease Control Division with the technical and · Training on Malaria Related financial assistance of the Emergency and Humanitarian Action Programme of World Information, Diagnosis and Health Organization Nepal. 29 participants attended the training. They were Senior Management of the Malaria to Public Health Officers from the office of the Regional Health Directorate, members of District Disaster Relief Committee, District Health Officers, Medical Officers, Public all the Health Personnel in the Specific Malaria Prone Health Officers, Medical Officer of Primary Health Centers, and Senior Representatives of the district chapters of Nepal Red Cross Society (NRCS). Districts The main objective of this training was to enhance the knowledge of emergency · Kalazar Quarterly Review preparedness and the disaster response capacity of district RRTs. This training program Meeting in Hetauda in the was helpful to initiate a coordinated emergency preparedness in close cooperation with Central Region from 5-6 the District Disaster Relief Committee and Nepal Red Cross Society.

December 2005 The main contents of the two-day training were: 1) disaster concepts, disaster · Two Day Orientation Training management cycle and health effects of various hazards; 2) policy context and Cum Workshop on Prevention implementation aspects; 3) health sector disaster management; 4) introduction of the Guidelines on best public health practices in emergencies and functional mechanism of and Control of Zoonoses rapid response teams; 5) communicable disease surveillance, EWARS and reporting including Rabies for Health system in disasters; 6) control of communicable diseases in disasters; 7) health sector Professionals damage assessment and needs analysis; 8) lessons learnt from Nepal Red Cross's community based disaster preparedness; 9) lessons from Asian Tsunami Disaster · Lymphatic Filariasis Mapping Response in Sri Lanka; and 10) group discussions on preparedness for responding to in 13 districts of Nepal earthquakes and floods. The training programme was a combination of theory presentations, group discussions and interactions among all the participants.

Health Action in Nepal (Monthly Health News Letter, Issue IV, December 2005) Page # 1 of 6

Existing AEFI Surveillance Sites in Nepal Nepal and Vaccine •Bir Hospital Preventable Diseases •Kanti - Children • Tri - Chandra Military H Source: Dr. J. N. Giri • Institute of Medicine TUHA Immunization Coordinator, IPD/WHO • Medical College, J • Medical College, Kathmandu Nepal's National Immunization Programme (NIP) is privileged with an extensive immunization network. There are almost 16,000-immunization •KZH sessions and about 8,000 vaccinators. They are • DZH • NZH supported by more than 48,000 Female Community • NMC •PMH Health Volunteers. On top of that almost 200 • BHC • CMCS • NSRH immunization related health workers (like EPI • NMC •BPKIHS • JNH • Patan H • SZH supervisors, Refrigerator Technicians and Cold • PRH • KRH Chain Assistants) are working. On average, one • PMC •SMH •LZH • HRDC • DMI • MZH •AMDA health facility (2 vaccinators in each health facility) • OMH • AMDA Hospital Source: Immunization Section, WHO/IPD •SMC has to vaccinate 96 kids in a year for complete vaccination and 8 kids in a month. Though it is not Districts Categorized with Problems and Priority, Immunization true for each vaccinator because there is very Nepal-2004/2005 sparse population in high hill and dense population Priority 1 Priority 2 Priority 3 in . However, in some areas the average is more or less because of the spare population.

The trend of immunization coverage for the last few years is very encouraging. National immunization coverage remained about 80% for DPT3. In supplementary immunization Measles and Maternal and Neonatal tetanus (MNT), the districts have always reported more than 95% Categories coverage. This led Nepal to a status of polio-free 1 Low drop - out (<10%), High Coverage (>80%) country for about 4 years. Measles, Diphtheria and 2 High drop-out (>10%), High Coverage (>80%) Pertusis cases have dropped dramatically and NT is Low drop-out (<10%), Low Coverage (<80%) 3 in the stage of elimination. This status is achieved 4 High drop - out (>10%), Low Coverage (<80%) through constant efforts of health workers involved in immunization and supported by the beneficiaries WHO/Polio, Immunization Section Data Source: MoH/DoHS, HMIS, Electronic Data who have internalized the NIP. But it is rightly said Re emergence of Vaccine preventable Disease that when you climb “Mount Everest” the initial climb is easy but when you are about to reach the Re-emergence of the immunization preventable diseases is only possible peak you have to struggle a lot. if the immunization does not reach, at least its 80% target population uniformly , and if the information on coverage collected through the NIP is struggling to stop the importation of vaccine periphery (VDC) is not utilized at local and district level for intervention. preventable diseases through extensive and Nepal borders with Bihar and of India where wild polio sensitive surveillance network. NIP with the transmission has not stopped. There is a lot of similarity between both support of WHO/IPD carries integrated VPD sides of the country boarder in the day-to-day life, cultures, and rituals surveillance on Acute Flacid Paralysis (AFP), including sanitation. People visit either side of border frequently and Measles, Neonatal Tetanus (NT) and Acute poliovirus has every chance to travel with them. The only possible means Encephalitis Syndrome (AES) through 408 weekly to stop this transmission is to create an immunological border where we reporting units and 81 active surveillance sites. have not secured 100% susceptible population through vaccinating against Besides, information is collected through Early Polio. Nepal, after 4 years of its polio free status saw one imported wild Warning Reporting System (EWARS) and the polio case in Siraha district in the Eastern Region in 2004 and 3 wild polio Health Management Information System (HMIS). cases in Sarlahi and Rautahat in the Central Region of Nepal in 2005. In response the National Immunization Program is looking closely at each The National Public Health Laboratory (NPHL) and NIP with strong technical support of IPD has district and VDC using different immunization tools for quality routine and supplementary immunization program to avert any such happening in initiated laboratory surveillance on Hib the future. Regarding other vaccine preventable diseases, NIP has (Haemophilus Influenza), AES, and Measles, introduced a school immunization program with tetanus toxoid to sustain which will be a great support for making NT elimination, and the plan is in place to include other vaccines like decision ’s on the incorporation of Hib vaccine in measles. In its Multi Year Plan of Action (2005/06 - 2010/11) NIP plans to the National immunization program in coming introduce new and under used vaccines including JE by 2006 and MMR days. The quality of immunization is monitored (Measles, Mumps and Rubella) , and Hib by 2008 where as expansion of through 31 Adverse Effect Following HepB vaccine in all 75 districts is already in place.

Immunization (AEFI) surveillance sentinel sites, In conclusion, Nepal believes that through its strong immunization service which will be expanded in other districts very soon. network, it will be able to achieve and sustain the target of 90% coverage This will help NIP to know the status of quality of Nationally and 85% at VDC level by 2010 and fulfill the aspiration of the immunization services. MDG in reducing child mortality by two third’s.

Health Action in Nepal (Monthly Health News Letter, Issue IV, December 2005) Page # 2 of 6 An Assessment of Impact of The main findings of an assessment of Impact of Conflict on Conflict on Health Service Health Service Delivery System for the Rural Population of delivery system for the rural Nepal study are as follows: population of Nepal, 2005 Impact on health infrastructure: Health facilities had not been directly targeted by the insurgents. Nevertheless, some facilities housed in Government building

such as Village Development Committee (VDC) offices had sustained damage or Nepal has been affected by a violent destruction during attacks on the VDC offices. insurgency since 1996 when the Maoists declared a “People’s War”. The intensity of Impact on service provision: The outlook of insurgents towards health programs the conflict has increased over the years, and and health workers was reported to be relatively positive as compared to other to date more than 12,000 people have been sectors. Special national campaigns such as National immunization days for polio killed. Vital infrastructure has been destroyed and Measles immunization, biannual Vitamin A supplementation & de -worming and in many areas, developmental efforts and programs as well as family planning sterilization camps were not much affected. It Governmental reform has been significantly was also reported that insurgents supported such events by participating in the affected. advocacy efforts and making allowances for the vehicles to move unhindered.

Nepal has made significant improvements in Impact on health workers:The insurgency had affected health services due to a large number of undesirable factors noted in the field as: intimidation, harassment, the health outcomes over the past 15 years, but extortion and threats. Most of the health workers reported that they were compelled the direct and indirect impact of the conflict to pay levy and donations to the insurgents. Health workers reported that they were on the health system delivery is a cause for also facing problems by security forces who would pressure the health workers not concern. Although the health sector is to treat the insurgents. comparatively less directly targeted than for instance the education sector, the indirect Impact on management of quality health services at district level: Technical impact of the unstable security situation has support visits and supervision had been confined to safe and accessible areas. not been well documented. The World Bank Frequent and unpredictable general strikes necessitated adjustment of Health commissioned a study in 2005 to assess the programs planning and implementation. The strikes also badly affected the supply impact of the current conflict situation on the and distribution of commodities, drugs and vaccines as shown in the study. delivery of essential health care services for Furthermore, in the absence of locally elected bodies, the Local Health the rural population of six districts (two in the Management Committees (LHMC) was not functioning effectively. INGOs and Mid Western Region and four in the Central donor agencies were also not implementing activities directly at the field level at the Region) of Nepal and to recommend remedial time of the study, but through governmental systems (District Public Health Offices measures. (DPHOs), and District Health Offices (DHOs).

A Study Conducted Recommendations: in 6 Districts of HUMLA

DARCHULA Based on the findings of the study, the following remedial measures were

BAJHANG MUGU Nepal in 2005 BAITADI BAJURA KATHMANDU recommended to increase access, availability and utilization of health DADEL- JUMLA BHAK DHURA DOTI ACHHAM KALIKOT DOLPA

MUSTANG KANCHAN- LALIT PUR DAILEKH JAJARKOT KAILALI services as envisioned in the National Health Policy. RUKUM MANANG

SURKHET

SALYAN MYAGDI BARDIYA GORKHA ROLPA BA KASKI GL UN LAMJUNG G PARBAT RASUWA PYUT- BANKE HAN GULMI DANG ARGHAK SYANGJA TANAHU SINDHU- § Improving the confidence of health workers is an urgent priority. There HACHI NUWAKOT PALCHOK PALPA DHADING KATHM DOLAKHA KAPIL- NAWAL BHAK SULUK- BASTU RUPAN- DEHI PARASI HUMBU SANKHUWA- P TAPLEJUNG CHITWAN MAKAWAN- LALIT KAVRE H A SABA H PUR E C M R A OKHAL- is a need to assess the impact on the quality of health services to DHUNGA PARSA SINDHULI KHOTANG TERHA- AR BHOJ- THUM T H BARA RAUT- E PUR C H AHAT UDAYAPUR DHAN - P A SARLAHI MAHO- KUTA Central Region TARI DHA ILAM NUSA SIRAHA enhance quality of care and maintain staff motivation. SUNSARI MORANG SAPTARI JHAPA Mid Western Region § Improvement in technical support and supervision in innovative modality by introducing a third party continuing technical and The six districts of Nepal were purposively managerial supervision system in partnership with capable and selected based on the level of insurgency and experienced NGOs and private institutions. from different ecological zones. Both qualitative and quantitative methodologies § Local health management committees (LHMCs) are to be empowered and were applied to collect information. made more autonomous. Altogether 38 group discussions were § Central level authorities to monitor continuously conflict and health conducted with 215 participants. The management system by developing a conflict and health monitoring interviews were conducted at the center and approach and indicators in coordination with district officials and the district level focused on impact of conflict External Donor Project s. on health infrastructure, service provision, health workers, management of quality health § A feed back to security forces to extend appropriate behavior with services and experiences in dealing with health workers be conveyed from central health authorities that helps security personnel in districts. development of right kind of interpersonal communication skills, respect for human values and human rights. The study shows that the community level workers and volunteers like Female Orientation of security forces at front lines level on Geneva Convention Community Health Volunteer (FCHV) and other international resolutions and practices governing the rights and continue to provide basic essential health care duties of health workers and other civilians. services but the delivery of health services in rural areas by the existing public health Source: The World Bank, Health, Nutrition and Population (HNP), Nepal Country Office system remains fragile and uncertain for assuring quality of care.

Health Action in Nepal (Monthly Health News Letter, Issue IV, December 2005) Page # 3 of 6 Acute Encephalitis Distribution of Anti JE IgM Positive Syndrome (AES) case Cases by districts, Nepal, including Japanese Encephalitis (JE) during

2005 in Nepal

Seasonal outbreak of Japanese Encephalitis usually occurs every year from July to late October with the peak period in August and September. As Total = 657 JE cases from 40 districts reported to Ministry of Health and 1 dot = 1 case Population (MOHP), Department of Health Services (DHS), Epidemiology 3000 and Disease Control Division (EDCD) till Acute Encephalitis Syndrome the end of November 2005, there were 2500 2824 1729 1908 altogether 2784 AES cases including 2000 Japanese Encephalitis . At the end of 1543 December 2005, a total of 2824 AES 1500 cases including JE were reported to No. of cases 842 931 EDCD from 40 districts from Jhapa 1000 district in the Eastern Region to 500 Kanchanpur district in the Far-Western Region of Nepal. 0 2000 2001 2002 2003 2004 2005 Regular surveillance of AES cases for Year

confirmation of JE is carried out by WHO, Immunization Preventable 25 20 Diseases (IPD), Field and Central Offices 19.4 in collaboration with EDCD, Child Health 20 Division (CHD), and National Public 14.5 Health Laboratory (NPHL) of DHS, 15 MOHP. 9.8 11.18 10 8 Out of 2824 AES cases reported, 657 No. of cases Case Fatality Rate cases were confirmed for JE by laboratory 5 (elevated levels of Anti JE IgM). Case Fatality Rate (CFR) for AES was 11.18 0 whereas CFR for confirmed JE cases was 6.54. Most of the confirmed cases were 2000 2001 2002 2003 2004 2005 from four districts, namely Bankey, Year Bardiya, and Dang in the Mid Western Region and Kailai in the Far Western 3000 2824 AES including JE cases Region. during 2005 in Nepal 2500 < 1 yr Ministry of Health and Population, 1-4 yrs 2000 Department of Health Services has 1862 5-9 yrs planned interventions on Japanese 10-14 yrs 1500 15+ yrs Encepha litis mass vaccination campaign 1274 Total in high endemic district during the Fiscal 1000 Year 2006/07. In addition, awareness 803 657 558 campaigns, and immunization of children 481

397 500 385 323 316

266 280

will be carried out as usual for the 186 158

114 95 113 85

40 48 43 35 28

7 11 3 7 0 5 reduction of AES including JE outbreak 0 during the fiscal year 2006/07. Cases Deaths Lab Tested Cases Deaths AES Anti IgM Positive (JE)

Health Action in Nepal (Monthly Health News Letter, Issue IV, December 2005) Page # 4 of 6

News update in December 2005 News update in December 2005

National Malaria Quarterly . National Workshop with District Malaria

Review Meeting in the Programme Managers from 13-14 December Central Region from 5-6 2005

December 2005 The 2-day national workshop was held in Dhulikhel in the Central Region of

The 2-day quarterly review meeting of Nepal from 13-14 December 2005 for district malaria program managers. Malaria was held in Hetauda in the Central Altogether 45 participants from 15 districts (Physicians from Janakpur Region of Nepal from 5-6 December 2005 Zonal Hospital - Janakpur, Mahakali Zonal Hospital - Mahendranagar, for Vector Control Assistants and Malaria Teaching Hospital - Maharaqjgunj and BPKIHS, (B.P. Koirala Inspectors. Institute of Health and Sciences), National Public Health Laboratory , and VBDRTC (Vector Borne Diseases Research Training Centre) participated Altogether 21 participants participated in the national workshop. including representatives from VBDRTC 1.To update the understanding of district program managers on global and (Vector Borne Diseases Research Training national malaria situation. Centre) in the quarterly review meeting 2.To solicit commitment of district health managers toward the use and especially from 17 districts with high practice of national guidelines of malaria control and Ploasmodium Falciparum (PF) Pr evalance 3.To share experience of the district health managers in the field of malaria rate compared to other Malaria endemic control. districts. Recommendations from group were discussed as follows: 1. Malaria prevention and control measure: discussed on what changes Representatives from Bankey and Bardiya need to be done with new technology for the prevention and control of in the Mid-Western Region, Nawalparasi malaria; and Kaski in the Western Region, Jhapa, 2. What are the new techniques used in the severe and complicated Morong, Sunsari, Saptari, Udayapur, and malaria causes; Ilam in the Eastern Region and 3. What steps need to be taken for the community based approach to Sindhupalchowk, Makwanpur, Bara, malaria prevention. Rauthat, Mahottari, and Dhanusha in the Central Region of Nepal participated in this News update in December 2005 meeting. Training on Malaria Related Information, Diagnosis and Malaria Quarterly Review Management of the Malaria to all the Health Personnel Meeting HUMLA in the Specific Malaria Prone Districts DARCHULA from 5-6 Dec 2005 BAJHANG MUGU BAITADI BAJURA KATHMANDU

BHAK DADEL- JUMLA DHURA DOTI ACHHAM KALIKOT DOLPA A wide range of trainings to all the health personnel in the specific malaria

MUSTANG KANCHAN- LALIT PUR DAILEKH JAJARKOT st st KAILALI RUKUM MANANG prone districts were conducted from the 21 to 31 of December 2005 on SURKHET MYAGDI SALYAN BARDIYA GORKHA ROLPA BA KASKI G L U N LAMJUNG G PARBAT RASUWA PYUT- BANKE malaria related information, diagnosis and management of malaria. The HAN GULMI DANG ARGHAK SYANGJA TANAHU SINDHU- HACHI NUWAKOT PALCHOK PALPA DHADING DOLAKHA KATHM KAPIL - NAWAL SULUK- RUPAN - BHAK BASTU PARASI HUMBU DEHI P SANKHUWA- TAPLEJUNG training was divided into two categories; one was a 2 day training MAKAWAN- LALIT KAVRE A CHITWAN H H SABA PUR C E A M Western Region R OKHAL- DHUNGA PARSA SINDHULI KHOTANG TERHA- A R BHOJ- THUM T H BARA E RAUT- PUR H AHAT DHAN- A C especially for all the District Supervisors, In-charge of Primary Health SARLAHI MAHO - UDAYAPUR P Central Region KUTA TARI DHA ILAM NUSA SIRAHA SUNSARI MORANG SAPTARI Eastern Region JHAPA Center, Health Post and Sub Health Post. The other one was a 5 day Mid Western Region Total Participants from training for Maternal and Child Health Workers (MCHWs), Village Health 17 districts = 21 Workers (VHWs), and Female Community Health Volunteers (FCHVs) in Nawalparasi in the Western Region and Chitwan and Sindhuli in the Central Region of Nepal. The participants were altogether about 1,000 in MALARIA ENDEMIC DISTRICTS IN NEPAL, 2005 each district (including 800 FCHVs in a district). Kathmandu

The purpose of this training was to make aware all the health personnel Bhaktapur about the seasonal outbreaks of malaria, diagnosis and management of Malaria.

Free Districts (10) News update in December 2005 Endemic Districts (65) Avian Influenza and Influenza Pandemic Task Highly Endemic District (12) Force Meeting in Dec. 05

Following the last Task Force meeting held on 31st October 2005, an The main objectives of this 2 day review Avian Influenza and Influenza Pandemic Task Force meeting was held in meeting were to analyze the progress report the Director General's office, Department of Health Services, Teku, of goals and analytical trends with main Kathmandu on 8th December 2005. health indicators of Malaria, to identify the weaknesses on time for further necessary The purpose of the meeting was to finalize the National Avian Influenza improvement and to do necessary program and Influenza Pandemic Preparedness and Response Plan. The Plan was with the right direction to achieve the goal then sent to Ministry of Health and Population, Ministry of Agriculture of program conducted by Epidemiology and and Cooperatives, National Planning Commission and the Central Disaster Disease Control Division. Relief Committee for endorsement.

Health Action in Nepal (Monthly Health News Letter, Issue IV, December 2005) Page # 5 of 6 News update in December 2005 News update in December 2005

National Kala -azar Quarterly Two Day Orientation Training Cum Workshop Review Meeting on Prevention and Control of Zoonoses in the Central Region including Rabies for Health Professionals in the W estern Region and Mid Western Region from 7-8 December 2005

of Nepal The 2-day quarterly review meeting of Kala-azar was held in Hetauda in the Central Region of Nepal from Two Day Orientation Training Cum Workshop on Prevention and 7-8 December 2005 for Vector Control Ass istants and Control of Zoonoses including Rabies for Health Professionals was Malaria Inspectors. held from 21-22 December in in the Western Region and from 25-26 December 2005 Nepalgunj in the Mid Western Region Altogether 20 participants participated in the of Nepal. These workshops were organized by Ministry of Health quarterly review meeting especially from 12 kala-azar and Population, Department of Health Services, Epidemiology and affected districts like Jhapa, Morong, Sunsari, Disease Control Division (EDCD) and financially supported by the Saptari, Udayapur, and Siraha in the Eastern Region World Health Organization. and Bara, Parsa, Rauthat, Mahottari, Sarlahi and Altogether 32 representatives participated (Medical Officers and Dhanusha in the Central Region of Nepal. Paramedicals, Health Assistants, Staff Nurses, Senior Auxiliary

The goal of the program of Kala-azar in Nepal is to Health Workers, Public Health Inspectors, and Auxiliary Health control Kala-azar by the year 2015 by reducing cases Workers) from various institutions (District Public Health Offices, below 1 per 100,000 and no PKDL (Post Kala-azar District Health Offices, Hospitals, Primary health Centers, Health Dermal Leishmaniasis) cases by 2018 . Posts, and Sub Health Posts). They came from 4 districts namely Chitwan in the Central region, and Nawalparasi, Rupandehi, and In order to achieve the goal of the Kala-azar Program Kapilvastu in the Western Region of Nepal. Similarly, another 32 of Epidemiology and Disease Control Division, participants from 6 districts participated in Nepalgunj namely Department of Health Services, the following Kanchanpur, and Kailai in the Far Western Region and Bankey, objectives of this program were discussed during the Bardiya, Surkhet and Dang in the Mid Western Region of Nepal. review meeting. The main objectives of these workshops were to: 1. To reduce morbidity of Kala-azar; 1. reduce morbidity and mortality due to zoonoses in human 2. To prevent mortality from Kala-azar; beings; 3. To strengthen early case detection mechanisms 2. create awareness on zoonoses. and case management ; The specific objectives of these workshops were to: 4. To strengthen case holding and follow -up to 1. describe the epidemiology of zoonoses in human beings; improve cure rate; 2. identify the transmission cycles of zoonoses in human and 5. To reduce vector density with the help of animal; integrated vector control measures. 3. explain the main signs and symptoms of various zoonoses; Based on the objectives of the Prevention and Control 4. identify the specimen to be sent to laboratory properly; of the Kala-azar Program of Nepal, a review was 5. describe the importance of recording and reporting; carried out of achievements of objectives and to 6. explain the principles and measures for prevention and identify weaknesses on time for further necessary control of zoonoses with particular emphasis on improvement. recommended interventions.

Lymphatic Filariasis Mapping in 13 Contacts for further information Districts of Nepal

Lymphatic Filariasis mapping in 13 hilly districts of Ministry of Health and Population Dr. M.B. Bista Nepal started from the month of December 2005. Three Department of Health Services Director teams comprising of health assistants, laboratory Epidemiology and Disease EDCD assistants, motivators and a peon were assigned by the Department of Health Services Epidemiology and Disease Control Division, Control Division (EDCD) Departments of Health Services to carry out the Teku, Kathmandu, Nepal mapping job in the districts. The districts included for Tel: +977-1-4255796/4262268 the mapping are Bajhang, and Bajura in the Far Western Fax: +977-1-4262268 Region, Jajorkot, Salyan and Pyuthan in the Mid Western Region, Myagdi, Baglung, Gulmi, World Health Organization (WHO) Arghakhanchi in the Western Region and Terahathum, Panchthar, Illam and Khotang in the Eastern Region of Dr. Kan Tun Ms. Trine Ladegaard Nepal. The mapping survey employing Immuno- WHO Representative Technical Officer Chromatographic (ICT) card reveals whether the World Health Organization World Health Organization districts are endemic for filariasis or not. This helps in UN House, P.O. Box 108 UN House, P.O. Box 108 planning for mass drug administration in the endemic districts in line with WHO’s given strategy for Pulchowk, Kathmandu, Nepal Pulchowk, Kathmandu, Nepal elimination of lymphatic filariasis in Nepal. WHO has Email: [email protected] Email: [email protected] contributed required ICT cards and funds.

Nepal has put the target for elimination of the disease in the country by the end of 2018.

Health Action in Nepal (Monthly Health News Letter, Issue IV, December 2005) Page # 6 of 6