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UNICEF Lake Chad Basin Cholera Study

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Water, Sanitation and Hygiene and Cholera Epidemiology: An Integrated Evaluation in the countries of the Lake Chad Basin Mission Report Pierre-Yves Oger and Bertrand Sudre, UNICEF consultants August 2011 In partnership with: 0 Les appellations employées et la présentation des informations dans ce document ne signifient pas l'expression d'une opinion quelconque de la part du Fond des Nations Unies pour l’enfance quant au statut juridique ou de développement des pays, territoires, villes ou zones, ou de leurs autorités, ni quant au tracé de leurs frontières ou limites. Tous droits réservés. Reproduction et diffusion du matériel et des informations dans ce document ou d'autres fins non commerciales sans autorisation écrite préalable du détenteur des droits d'auteur à condition que la source soit clairement indiquée. La reproduction de matériel de ce produit pour la revente ou d'autres fins commerciales est interdite sans l'autorisation écrite du détenteur des droits d'auteur. Les demandes d'autorisation devront être adressées à au bureau régional Afrique de l'ouest et du centre de l’UNICEF (http://www.unicef.org/wcaro/). Les opinions, analyses et recommandations exprimées dans cette publication sont celles des auteurs et ne reflètent pas nécessairement les vues des Nations Unies pour le Children's Emergency Fund, bien que partagées et discutées avec de nombreux intervenants nationaux et internationaux. Les consultants déclarent ne pas avoir de conflits d'intérêts. The designations employed and the presentation of the material in this information product do not imply the expression of any opinion whatsoever on the part of United Nations of International Children's Emergency Fund concerning the legal or development status of any country, territory, city or area or of its authorities or concerning the delimitation of its frontiers or boundaries. All rights reserved. Reproduction and dissemination of material in this information product for educational or other non-commercial purposes are authorized without any prior written permission from the copyright holders provided the source is fully acknowledged. Reproduction of material in this information product for resale or other commercial purposes is prohibited without written permission of the copyright holders. Applications for such permission should be addressed to the regional office in West and Central Africa of United Nations of International Children's Emergency Fund (http://www.unicef.org/wcaro/) The opinions, analysis and recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the United Nations Children's Emergency Fund, although shared and discussed with many national and international stakeholders. The consultants said they had no conflicts of interest. Study location: Lake Chad Basin (Nigeria, Cameroon, Chad, Niger) Period: October 2010- April 2011 Report Finalization: July 2011 Researchers/Writers: Pierre-Yves Oger Water-Sanitation and Hygiene Engineer Email: [email protected] / Contact Skype: pyoger/ mobile: +33627786214 Bertrand Sudre MD PHD Email: [email protected] / Contact Skype: b.sudre_epidemio / mobile: +46700752105 © Copyright UNICEF WCARO and authors May 2011 ISBN Number XXXX – DOI XXXX to be completed Cover: Villager washing clothes on the edge of Lake Chad at Maga (Nigeria) during the floods of January 2011. 1 2 Acknowledgements This report was prepared in collaboration with the UNICEF West and Central Africa Regional Office (WCARO) in Dakar. We would like to thank: - The UNICEF staff, in particular those responsible for Water, Sanitation and Hygiene issues in each national UNICEF office in the four countries of the study and in the West and Central Africa Regional Office for their support and expertise in the fulfillment of this mission; - All national institutions and ministries, specifically the epidemiological surveillance services of each of the countries as well as the ministries in charge of water, sanitation and hygiene, at both the national and peripheral levels, who contributed to the making of this document with their welcome, their help and their active participation; - Veolia Foundation for their support in the framework of the fight against cholera with the Global Alliance Against Cholera (GAAC); - Action Contre la Faim (France) in Chad for their support of our mission during the cholera epidemics of 2010 and 2011; and - International NGOs including the World Health Organization (WHO), for their welcome and their sharing of information. The authors would like to highlight the respective contributions of all people and institutions contacted and to thank them for their hospitality, availability and support. 3 Abbreviations and acronyms ACF Action Contre la Faim CAM Republic of Cameroon CARE Cooperative for Assistance and Relief Everywhere, Inc. CHD Republic of Chad CTC Cholera Treatment Center DFID Department for International Development GAAC Global Alliance Against Cholera GIS Geographic Information System IDSR Integrated Disease Surveillance and Response IFRC International Federation of Red Cross and Red Crescent Societies IRD Institut de Recherche pour le Développement LGA Local Government Area LCBC Lake Chad Basin Commission NGA Federal Republic of Nigeria NGO Non-governmental Organization NGR Republic of Niger NHMIS National Health Management Information System OFDA Office of U.S. Foreign Disaster Assistance OXFAM Oxford Committee for Famine Relief PO Principal Objective SO Secondary Objective UNICEF United Nations Children’s Fund WASH Water, Sanitation and Hygiene WHO World Health Organization 4 Table of Contents ACKNOWLEDGEMENTS ........................................................................................................................................ 3 ABBREVIATIONS AND ACRONYMS ....................................................................................................................... 4 TABLE OF CONTENTS ........................................................................................................................................... 5 SUMMARY .......................................................................................................................................................... 8 INTRODUCTION ................................................................................................................................................... 9 SECTION I: CHOLERA EPIDEMIOLOGY IN THE FOUR COUNTRIES OF THE LAKE CHAD BASIN ................................. 12 ON THE REGIONAL LEVEL: THE 1970-2003 PERIOD ............................................................................................................. 13 1970-1974: The spread of cholera into West Africa in the direction of Lake Chad ................................................... 13 The 1975-1990 Period: The recurrence of epidemics ............................................................................................... 18 1991-2003: Increased intensity of epidemics ............................................................................................................ 19 ON THE INFRA-NATIONAL SCALE IN THE COUNTRIES OF THE LAKE CHAD BASIN IN THE 2003-2010 PERIOD .................................... 21 DEVELOPMENT OF CHOLERA EPIDEMICS IN 2010 AROUND LAKE CHAD AND INVESTIGATION ELEMENTS .......................................... 24 Period 1 from January to early April (Weeks 1-14): The Inter-Epidemic Period ........................................................ 26 Period 2 from mid-April to early July (Weeks 14-27): Transition and Geographic extension .................................... 27 Period 3 from mid-July to mid-August (Weeks 28-33): The acceleration of the cross-border spread ...................... 27 Period 4 from mid-August to mid-October (Weeks 34-41): The Peak of the Epidemic ............................................. 29 Period 5 from mid-October until December (Weeks 42 to 52): Epidemic decline .................................................... 29 SUMMARY AND RECOMMENDATIONS: CHOLERA EPIDEMIOLOGY IN THE FOUR COUNTRIES OF THE LAKE CHAD BASIN ....................... 31 R-I: Early detection and intervention ................................................................................................................... 33 R-II: Epidemiological analysis and mobility of the response ................................................................................ 34 R-III: Operational Research: Understanding transmission modes and onset to better respond ......................... 35 SECTION II: CHOLERA AND ACCESS TO WATER, SANITATION AND HYGIENE IN THE LAKE CHAD BASIN COUNTRIES .............................................................................................................................................................................. 37 GENERAL DATA ON ACCESS TO WATER, SANITATION AND HYGIENE IN THE COUNTRIES OF THE LAKE CHAD BASIN ............................ 38 CHOLERA AND ACCESS TO WATER AND SANITATION ON THE “MACRO” SCALE ............................................................................ 40 Year of reporting ................................................................................................................................................. 40 Model applied to four countries .............................................................................................................................. 40 Population density factor ...................................................................................................................................
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