Health Services Committee 10th July, 2018 REPUBLIC OF KENYA COUNTY ASSEMBLY OF KWALE SECOND ASSEMBLY – SECOND SESSION REPORT OF THE COMMITTEE ON HEALTH SERVICES On The Question by Hon Hanifa Badi Aware that Health is a function of the County Government as devolved in the Constitution of Kenya, further aware there has been reported and confirmed cases of cholera in Kwale County and in the neighbouring County of Mombasa, Concerned there are also reported death cases and hospitalization of 15 MCAs from Migori County among others instances; What is the Kwale County Government’s preparedness status in handling the Cholera outbreak and other related water borne diseases in the County? 10 TH JULY, 2018 Kwale County Assembly Page 1 Health Services Committee 10th July, 2018 Table of Contents LIST OF ACRONYMS AND ABBREVIATIONS ................................................................................ 3 PREFACE ............................................................................................................................................... 4 ACKNOWLEDGEMENTS .................................................................................................................... 4 BACKGROUND .................................................................................................................................... 4 COMMITTEE MEMBERSHIP .............................................................................................................. 5 OBJECTIVES ......................................................................................................................................... 7 METHODOLOGY ................................................................................................................................. 7 COMMITTEE REPORT ........................................................................................................................ 7 COMMITTEE OBSERVATIONS ....................................................................................................... 15 COMMITTEE RECOMMENDATIONS ............................................................................................. 15 Kwale County Assembly Page 2 Health Services Committee 10th July, 2018 LIST OF ACRONYMS AND ABBREVIATIONS 1. CEC – County Executive Committee 2. HON – Honourable Kwale County Assembly Page 3 Health Services Committee 10th July, 2018 PREFACE Mr. Speaker sir, the Committee on Health Services is one of the sectorial committees under the second schedule of the standing order mandated to investigate, inquire into and report all matters related to county health services including, in particular county health facilities and pharmacies, ambulance services, promotion of primary health care, licensing and control of undertakings that sell food to the public, veterinary services (excluding regulation of the profession), cemeteries, funeral parlours and crematoria and refuse removal, refuse dumps and solid waste disposal, water and sanitation services. ACKNOWLEDGEMENTS Mr. Speaker Sir, I want to sincerely thank the members of Committee on Health Services for their commitment and dedication throughout the exercise. The Office of the Clerk and the Speaker for their support and adequate facilitation not forgetting the Honorable Members for their valuable input. BACKGROUND Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae . Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhoea that lasts a few days. Vomiting and muscle cramps may also occur. Diarrhoea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance. This may result in sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet. Dehydration can cause the skin to turn bluish. Symptoms start two hours to five days after exposure. Cholera is caused by a number of types of Vibrio cholerae , with some types producing more severe disease than others. It is spread mostly by unsafe water and unsafe food that has been contaminated with human faeces containing the bacteria. Undercooked seafood is a common source. Humans are the only animal affected. Risk factors for the disease include poor sanitation, not enough clean drinking water, and poverty. There are concerns that rising sea levels will increase rates of disease. Cholera can be diagnosed by a stool test. A rapid dipstick test is available but is not as accurate. Prevention methods against cholera include improved sanitation and access to clean water. Cholera vaccines that are given by mouth provide reasonable protection for about six months. They have the added benefit of protecting against another type of diarrhoea caused Kwale County Assembly Page 4 Health Services Committee 10th July, 2018 by E. coli . The primary treatment is oral rehydration therapy; the replacement of fluids with slightly sweet and salty solutions. Rice-based solutions are preferred while Zinc supplementation is useful in children. In severe cases, intravenous fluids, such as Ringer's lactate, may be required, and antibiotics may be beneficial. Testing to see which antibiotic the cholera is susceptible to can help guide the choice. Mr Speaker sir, This is a report of the investigation of this committee after deliberations on the cholera cases subsequent to a question asked on the floor of the house, by Honourable Hanifa Badi on 6th December, 2017 That Aware that Health is a function of the County Government as devolved in the Constitution of Kenya, further aware there has been reported and confirmed cases of cholera in Kwale County and in the neighbouring County of Mombasa, Concerned there are also reported death cases and hospitalization of 15 MCAs from Migori County among others instances; What is the Kwale County Government’s preparedness status in handling the Cholera outbreak and other related water borne diseases in the County? COMMITTEE MEMBERSHIP Mr. Speaker sir, the Committee on Health Services of the County Assembly of Kwale as currently constituted, comprises of the following members: 1. Hon. Mwinyi Khalfan Mwassera Chairperson 2. Hon. Hanifa Badi Mwajirani V/Chairperson 3. Hon. Chirema Josephat Kombo Member 4. Hon. Suleiman Nzala Member 5. Hon. Juma Masudi Ngando Member 6. Hon. Patrick Mangale Member 7. Hon. Mwanauba Mwaphatsa Member 8. Hon. Yusuf Mubwana Member 9. Hon. Alfred Ruwa Bavu Member Kwale County Assembly Page 5 Health Services Committee 10th July, 2018 Pursuant to Standing Order 191(5) (a, g) the questions were then given to the Committee on Health Services to inquire into the matters raised and to report to the house. Mr. Speaker sir, the committee on Health Services has compiled a report on the questions by Hon Hanifa. Mr. Speaker Sir, on behalf of the Committee on Health Services, I now have the honour and pleasure of presenting the Report of the Committee on the question asked by Hon Hanifa Badi. Thank you Signed ……………………………………………… Hon. Mwinyi Khalfan Mwassera, MCA Chairperson Committee on Health Services Date …………………2018 Kwale County Assembly Page 6 Health Services Committee 10th July, 2018 OBJECTIVES i. To determine if there is a cholera outbreak in Kwale County ii. To determine if the Kwale County Government is prepared in handling the Cholera outbreak and other related water borne diseases in the County METHODOLOGY The committee collected the information through: i. Engaging with the CEC Water Services COMMITTEE REPORT This report provides: 1. Submissions by the CEC Water 2. The committee observations 3. The committee recommendations The population affected by suspected cholera infection cases were detected from Kinango (3), Matuga (3) and Msambweni (2) Sub Counties. The point source of the infection was suspected from the faecal contaminated drinking water sources and importation from Mombasa County which is carrying the heavy burden of the outbreak since January 2017. Kwale County has experienced sporadic cholera cases between 19th November and 7th December 2017. Eight (8) cases were admitted and discharged alive at Portreiz, Kinango, Kwale and Msambweni Hospital (still in the ward). Vibrio cholera was isolated from 7 cases. All the 4 clusters are not epidemiologically linked. Cholera Epidemiology Trend The first 2 cases were confirmed on 20th November 2017 admitted at Portreiz Hospital. They were managed and discharged on 22nd November stable. Other 2 cases were admitted at Kinango Hospital on 22nd and 24th November 2017 from Mgamani (Vigurungani) and Miatsani (Kizibe) villages in Kinango and Matuga sub counties respectively. Patients were all discharged home stable on 4th December 2017. On 3rd December, 2 cases from Denyenye were admitted at Kwale Hospital and discharged home in stable condition on 7th December. By date 13th December, 2017, Msambweni Hospital had two patients still admitted in the Kwale County Assembly Page 7 Health Services Committee 10th July, 2018 Amenity ward. The patients are continuing with the treatment protocol and barrier nursing care in the ward. Both patients' general condition is fair. These two cases were from Nyumba Sita Village. One case, Mr Bakari Swalehe Mwambewe 60 years of age from Nyumba Sita Vingujini in Msambweni Sub County had been admitted as a cholera case but later patient presented with dyspnoea (difficult breathing), distended abdomen and restlessness. On examination and investigation, hepatomegaly and PTB were diagnosed. Laboratory tests indicated impending renal failure as the keratin levels