Health Action in Nepal 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 D K JU MLA E 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 E LA MJUN G G B IO R RA SU W A N PY UT HA N A Response Team BA NK E GU LMI P A G E G J ASTERN N I N REGI ON YA D DAN G S T AN AH U 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 TE RAI A D B 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 Hetauda 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 Janakpur 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 all the Health Personnel in the District Disaster Relief Committee, District Health Officers, Medical Officers, Public 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 Nepal and Vaccine Existing AEFI Surveillance Sites in Nepal •Bir Hospital Preventable Diseases •Kanti - Children • Tri - Chandra Military H Source: Dr. J. N. Giri • Institute of Medicine TUHA Immunization Coordinator, IPD/WHO • Kathmandu 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 Nepal-2004/2005 true for each vaccinator because there is very sparse population in high hill and dense population Priority 1 Priority 2 Priority 3 in terai. 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 3 Low drop-out (<10%), Low Coverage (<80%) 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 Uttar Pradesh 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.