Zimbabwe Health Cluster bulletin Bulletin No 9 15-23 March 2009 Highlights: Cholera outbreak situational update • About 92,037 cases and From the beginning of the cholera out- 4050 deaths, CFR 4.4% break in August 2008 to date, all prov- and I-CFR 1.8% inces and 56 districts have been af- fected. By 21 March, a total of 92, 037 • Outbreak appears to be on the decrease cases and 4,105 deaths had been re- ported, giving a crude Case Fatality Ratio • Cholera hotspots now in (CFR) of 4.4%. This week, 51% of all 62 Harare and Chitungwiza districts have reported. cities Preliminary results from an ongoing • Cholera Command & analysis of the cholera outbreak by WHO Control Centre continue with provincial sup- epidemiologists indicate that the out- port and monitoring visits break is indeed slowing down. While this is good news, some areas remain hot- spots especially Chitungwiza and Harare city, which are affected by water short- ages and poor waste disposal systems. Chitungwiza is of particular interest be- cause it was the initial focus of the out- Inside this issue: break in August 2008. A further risk analysis in Chitungwiza and Cholera situation 1 Harare is being carried out by a monitor- ing and evaluation team from the cholera Missions to Zimbabwe 2 command and control centre. Coordination updates 2 Mashonaland west province has also re- ported, Kadoma district specifically, is C4 weekly meetings 2 experiencing an upsurge in cases. A team from the C4 has been dispatched Who, what, where, 3 this week to investigate this. when Areas within Harare city that required Who, what, where, 4 targeted interventions include Budiriro and BRIDH, which have consistently re- ported over 30 cases of cholera per day for the last two weeks. Water and sani- tation (WASH) interventions including distribution of soap, hand washing facili- ties and water treatment tablets at household level are underway in these areas. So far, 31 boreholes have been constructed in Harare city and are currently being tested after which they shall be handed over to the communities. Water trucking, a short term solution to the shortages in severely affected areas, shall be stopped when the bore- holes are handed over. Social mobilization and health promotion continue alongside case management and WASH interventions in those areas. The rest of the bulletin contains more details of current cholera interventions. Zimbabwe Health Cluster bulletin Missions to Zimbabwe Guidelines and Norms • A World Bank Mission visited Zimbabwe last week The WASH cluster Strategic Advisory Group (SAG) in col- (16-21 March) to carry out assessments on the laboration with the health cluster, has finalised the current rural and urban water situation which ‘Recommended mechanisms for targeted allocations of they would base a $10 million emergency fund ORS in the current context’ . The guidelines advise that; program on. The team indicated that it planned • Trained and active community level health volun- to carry out a pilot project n a rural town teers, who generally act as ORS holders at community level, would provide ORS to suspected cholera cases on • Recommendations from the high level Inter- the basis of need, whilst undertaking house-to-house dis- agency mission that visited Zimbabwe from 21-25 tributions in the event of a localised outbreak. February 2009 to the humanitar- • Oral Rehydration Points ian community are: (ORPs) will be set up to provide • Revision of the CAP 2009 to in- first line treatment for suspected clude more clearly defined cholera cases with ORS at a cen- ‘humanitarian plus’ activities tralised community level, prior that will link emergency and to referral to a treatment centre recovery phases. In Cholera Treatment Centres • Build capacity and work closely (CTCs), ORS will be administered with the government, provincial to patients by direct treatment and district structures as well as as well as provided to them as cluster focal points in order to supplies for recovery upon dis- better coordinate humanitarian Environmental health team assessing CTC in- charge. action in the country. fection control measures Photo credit: J. Souquet The mission included the UN Assis- The Case management and tant Secretary-General for Humani- Environmental health working tarian Affairs and Deputy Emergency Relief Coor- groups of the C4 are in the process of finalising infection dinator, as well as representatives from WHO, control guidelines for CTCs. A team from ICDDR, B are UNICEF and WFP. working on case management guidelines, flow charts for Assessments: CTCs as well as contributing to the revision of national Multi-disciplinary teams consisting of epidemiolo- Cholera control guidelines. gists, social mobilization experts and case manage- The logistics working group of the C4 is also working on ment experts, on recommendation from the C4, visited Cholera Treatment Centres preparedness plans for provinces and districts while pre- CTCs) in Harare and positioning emergency cholera stocks at provincial level. Chitungwiza cities. Interviews with patients revealed The social mobilization working that some of them used inappropri- group carried out a national ori- ately prepared home made ORS for entation workshop for health treatment of diarrhoea. Inappro- promotion focal points of north- priate case management proce- ern provinces and partners n 19- dures for example, initiating anti- 20 March. The workshop for the biotic therapy after two to three southern provinces and partners days were found in use. Anecdotal will be carried out on 26th and information from the CTC staff in- 27 March. Among the materials disseminated include; new Social dicated that co-morbidities were a Patients in Beatrice Road Hospital CTC mobilization guidelines. possible contributing factor to the Photo Credit: Dr Ramendra, ICDDR, B deaths among cholera patients. Recommendations included: Schedule of meetings: targeted health promotion, appropriate use of ORS C4 has bi-weekly meetings on Mondays and Fridays. and IV fluids and early use of antibiotics in severely Joint health-WASH cluster meetings are held on a bi- dehydrated patients. monthly basis, the next shall be held on 1 April. Health cluster meetings are held on a monthly basis. Page 2 Zimbabwe Health Cluster bulletin Who is doing what where: Partnerships for health n Chipinge, Manicaland province, this week, ACF Medicin du Monde (MDM) continues to provide support I (Action Against Hunger) is carrying out cholera non to case management, hygiene promotion, surveillance food item (NFI) kit distribution at household level and provision of medical supplies to CTCs in Chipinge along with targeted health promotion activities in prison and Tongorara refugee settlement. wards 3, 16 and 20. 32 schools have been reached through their school cholera NFI kit distribution and This week, Plan Zimbabwe is carrying out the following health promotion program which is expected to ex- activities: tend to Chimanimani later this week. The kits consist of hand washing facilities, soap and • Provision of support to 13 posters. CTCs in Mutare, giving medical sup- plies that include Intravenous Venous German Agro Association (GAA) and (IV) fluids, IV fluids giving sets, latex Merlin are supporting case manage- gloves, oral rehydration sachets ment, provision of medical supplies, (ORS), sodium hypochlorite, cotton set up of 36 community oral treatment wool, refuse bags, strapping and points and training of community menthylated spirit. health workers in Harare Urban, Ka- • Support to the Ministry of doma, Chinhoyi (Mashonaland West) Health with a vehicle for daily Gokwe North and South (Midlands). Hygiene and health promotion for fisher- awareness campaigns targeting high men at Kariba, Photo credit: GOAL risk areas and populations at risk. In GOAL is providing health support, train- partnership with other organisa- ing and hygiene promotion in Hurungwe, tions, Plan Zimbabwe has also contributed Makoni and Nyanga. GOAL has distributed The cholera response in to the payments of daily allowances to 11,000 household cholera prevention kits most districts and health workers. which consist of a bucket with lid and tap, 30 • In Mutare, Plan has partnered with a water purification tablets, three Oral Rehydra- provinces of Zimbabwe team of 10 medical students from the Uni- tion Salts (ORS) sachets, 1 bar soap and In- versity of Zimbabwe who are members of was successful because formation Education and Communication the AIDS Free Generation Trust. These medi- (IEC) materials . of partnerships between cal students have beefed up the awareness campaign teams in Mutare and are conduct- The International Organization for Migra- NGOs, UN agencies and ing a Knowledge, Attitude, Perception and tion (IOM) has carried out rapid health and the different authorities Practice (KAPP) study for cholera in 18 chol- WASH assessments at 18 border points of era affected communities. Beitbridge, Hurungwe, Hwange, Mudzi, Logistical supplies for the cholera Mbire, Chimanimani, Kariba, Chipinge, UNICEF is carrying out the following Bulilima, Mutare, Mangwe, Chiredzi and response Photo credit: World Vision program activities; Mt Darwin. IOM is providing support to Mobile Vulnerable Populations (MVPs). Procurement and distribution of Other interventions include: • Emergency Obstetric and Neonatal • Provision of cholera supplies, support Care kits to 56 districts in the coun- to surveillance and provision of CTC try and they include sphygmoma- staff and staff incentives. nometers, midwifery kits, obstetric