BORNO STATE GOVERNMENT UNICEF’s C4D teams conducted trainings on meningitis social mobilization (Photo: UNICEF) Northeast Nigeria Response BORNO State Health Sector Bulletin #24 16th to 30th April 2017 6.9 MILLION 5.9 MILLION 1,428,947* PEOPLE IN NEED OF TARGET BY THE HEALTH 1,976,644 IDPS IN HEALTH CARE IN; SECTOR; ADAMAWA, POLIO VACCINATED CHILDREN ADAMAWA, BORNO AND BORNO AND YOBE BORNO STATE YOBE STATES STATES HIGHLIGHTS HEALTH SECTOR The Borno State Ministry of Health (SMoH)’s Rapid Response Team 21 HEALTH SECTOR PARTNERS (RRT) mechanism has been re-activated under the umbrella of the Health Sector Coordination, and with the support of WHO, UNICEF HEALTH FACILITIES** and partners. The mechanism aims to respond to the looming threat 288 of Cerebro-Spinal Meningitis (CSM) epidemic that has already FUNCTIONING** (OF TOTAL 749 affected at least five states in Nigeria. A series of trainings for ASSESSED HEALTH FACILITIES) clinicians, nurses and laboratory scientists of secondary health-care 262 FULLY DESTROYED facilities is taken place in Maiduguri and Biu LGAs in Borno State. 215 PARTIALLY DAMAGED Health sector is supporting the State MoH of Adamawa, Borno and IDP CAMPS CUMULATIVE CONSULTATIONS Yobe states on preparedness and response planning for cerebro- spinal meningitis epidemic prevention and control in the north-east 217,335 MEDICAL CONSULTATIONS*** region. A draft epidemic preparedness and response plan has been prepared for north-east Nigeria. A one-day workshop was organized EARLY WARNING & ALERT RESPONSE in Maiduguri on Wednesday 19th April to discuss the preparedness 149 EWARS SENTINEL SITES 91 REPORTING SENTINEL SITES and response plan under the lead of Borno State Ministry of Health supported by WHO, UNICEF and Health Sector Partners 21 TOTAL ALERTS RAISED**** In Yobe, state Ministry of Health and partners are on high alert while VACCINATION undertaking preparedness and response interventions for containment of cerebro spinal meningitis (CSM) outbreak. The key 1,976,644 POLIO interventions include social mobilization, strong surveillance, IPV & OPV***** investigation and case management, improved diagnostic, trainings and reactive vaccination in the high risk LGAs of the state. SECTOR FUNDING, HRP 2017 Under the NGO co-lead arrangement for the health sector, IRC was elected unopposed in the health sector meeting on 27 April in 93.8M US$ – HRP 2017 REQUIREMENTS Maiduguri to support the health sector coordination mechanism 6.3 MILLION USD FUNDED (6.7%) especially at operational level in the field. The NGO co-lead support will strengthen coordination, improve quality of service delivery and 2016 UNMET REQUIREMENTS promotion of better community engagement. 11.8 MILLION USD FUNDED (22%) 53.1 MILLION USD REQUESTED * Total number of IDPs in Borno State by IOM DTM XV April 2017. ** MoH/WHO HeRAMS December 2016. 1 *** Cumulative number of medical consultations at the IDP camps from 2017 Epidemiological Week 1- 14. **** The number of alerts change from week to week. *****Number of Polio vaccinated children in the Outbreak and Response campaign (IPV Inactivated Polio Vaccine & OPV Oral Polio Vaccine) as April 2017 Situation update: During the reporting period, Boko Haram insurgent activity continued in the vicinity of Maiduguri Metro and Jere LGA in the form of suicide bombings (PBIEDs). This has resulted in civilian fatalities and to Civilian Joint Task Force (CJTF) personnel. Nigerian Armed forces have continued clearance operations in the Sambisa Forest South of Maiduguri in Konduga LGA. This has been complemented by clearance operations being carried out in Damboa LGA in Southern Borno State and in Gujba LGA in Yobe State. This has resulted in the arrest of numerous Boko Haram fighters and the seizure of equipment and materiel. Military personnel and Boko Haram fighters have incurred fatalities. On Thursday 27 April, Boko Haram carried out a SVBIED attack on advancing troops in Damboa LGA. This resulted in five (05) troop fatalities and circa 40 troops being injured. Limited access to these areas remains in place for humanitarian actors due to ongoing operations. Health sector is supporting the State Ministry of Health and State Primary Health Care Agency in Adamawa, Borno and Yobe states to lead the preparedness process for cerebro-spinal meningitis epidemic, which is a looming threat in the region. A draft epidemic preparedness and response plan has been prepared for North-East Nigeria. A one-day consultative workshop was organized in Maiduguri on Wednesday 19th April to discuss the preparedness and response plan under the lead of State Ministry of Health supported by WHO, UNICEF and Health Sector Partners. The ongoing Cerebro- spinal meningitis (CSM) outbreak in Nigeria has affected 25 Local Government Areas (LGAs) across six states— Niger, Katsina, Kebbi, Sokoto, and Zamfara and Yobe. As of April 13, 2017, a total of 5,695 suspected cases have been reported; included 221 (4%) laboratory confirmed cases; and 611 deaths (10.9%) (Source: Sitrep/NCDC/FMoH). Health sector partners are expanding services to the newly accessible areas like Damasak, Rann, Ngala and Banki in Borno state as the security conditions and access is improving and more returnees are arriving in their areas of origin from within Borno state as well as from Niger, Cameroon and Chad. The Ministry of Health Niger on 19 April declared an outbreak of Hepatitis E in the border areas of Diffa with Damasak in Mobbar LGA that has killed 25 among 86 infected people. Medical assistance and preventive measures are ongoing to curb the disease, which is mostly transmitted through contaminated water. Separately, 2,100 meningitis cases, including 120 deaths, were recorded as of 16 April. The districts of Niamey 2 and Madarounfa (in the southern Maradi region) have reached the epidemic level. A vaccination campaign is ongoing. (Source: OCHA, 24 Apr 2017). Public Health Risks and Needs As the rainy season is approaching, partners need to preposition medicines stock and supplies to control the deterioration of the health situation. Cross border collaboration between partners, working in Nigeria and in Cameroon is the utmost priority during the rainy season. Inter country or cross border collaboration will be needed in high priority area at the border with Cameroon (Rann, Ngala and Banki) as well as at the border with Niger (Damasak/Mobbar); The health aspects of the crisis do not receive the required attention, and funds remain limited for the immediate health sector humanitarian response and longer term early recovery; There is a serious shortage of skilled health care workers, particularly doctors and midwives, and their reluctance to work in recently accessible areas is also a major challenge; 2 Significant areas in Madagali LGA, Adamawa State, are still inaccessible; Nutrition support needs to be enhanced along with food distribution to keep the malnutrition cases under control from further deterioration. For malnourished children plumpy nut and other nutrition supplements are needed; WASH support is needed specially for health and hygiene awareness as well as community mobilization for mitigating risk of outbreaks, especially in IDPs camps; Referral services need to be strengthened, especially ambulances support in priority areas. Surveillance and communicable disease control . Polio: No new cases of polio have been reported. As part of the innovative strategies to reach every child with oral polio vaccine during the April 2017 polio campaign, WHO in collaboration with the Borno state ministry of health partnered with the Nigerian Army to ensure that all eligible children were vaccinated in hard-to-reach areas especially in Damasak, Mobbar LGA. Military personnel were trained on OPV administration, house marking and data capturing to enable them vaccinate eligible children in security- compromised locations where civilian health workers and volunteers could not reach. IDPs camps: The epidemiological data collected from 33 IDPs camps across Borno state shows cases total consultations of 217,335 out of this 2,911 for malaria, 2,767 for respiratory tract infection, 1,088 for diarrhea and 43 cases of measles during week 14. Early Warning Alert and Response System (EWARS): In Epidemiological Week 14 - 2017, 91 out of the 149 reporting sites (including 20 IDP camps) in 13 LGAs submitted their weekly reports. Completeness of reporting was 58% and timeliness was 71% (target 80% respectively). Twenty-one indicator-based alerts were received and 81% were verified. Meningitis: a total number of 44-suspected Cerebro-Spinal Meningitis cases were reported in Borno from September to March 2017, including 23 cases since January. In Yobe, a total number of 168 CSM cases were reported as of 23 April 2017. Weekly trend of Meningitis cases reported through EWARS from week 34-2016 to Week 14-2017 3 Distribution of CSM cases reported in Yobe from January-March 2017 Malaria: In Epidemiological Week 14, 3327 cases of confirmed malaria were reported with one malaria death. The number of confirmed Malaria cases has remained below 4000 cases since January 2017. Measles: Between Epi Weeks 34-2016 and Week 14-2017, 2,890 suspected cases of measles were reported from EWARS reporting sites in 13 LGAs. In Epi Week 14, 71 suspected cases were reported. Weekly trend of Measles cases reported through EWARS from Week 34-2016 to Week 14-2017 Health Sector Coordination Preparedness and response plan for CSM: The health sector coordination has facilitated regular meetings in Borno State for the planning of meningitis vaccination using vaccines stockpiles of meningitis serotype A. A micro plan was developed and an immunization campaign conducted in April 2017 in Monguno and Dikwa with in collaboration with MSF and Alima. The Rapid Response Team mechanism has been operating in Yobe State for the investigation and response to outbreaks of Meningitis in Nguru LGA (February) and Fika LGA (March 2017). A total of 168 cases were reported from January to 23 April 2017, including 24 deaths. Nineteen (out of 22) samples tested positive.