Cholera outbreak in Zimbabwe l Dr Dominique Legros l Coordinator, Disease Control in Emergencies l WHO
Background l Context of a severely deteriorated health care and civil environment – shortages of treatment materials – scarcity of health care providers – poor access to health care l Control measures to go along with some reinforcement of the health system l Cholera outbreaks in Zimbabwe since 1998, but never reached the current scale
History of the current outbreak l Started on 20 th August in Chitungwiza (south of Harare) l September : limited to Mashonaland West l October : explosive outbreaks started in Harare city l First half of November : epidemic swept through Zimbabwe l As of 16 December 2008 – 9 out of the 10 provinces in the country – at least 57 of 84 districts – 19, 133 suspected cases and 926 deaths reported to WHO (CFR = 4. 8%)
New cholera cases by time period, Zimbabwe, 18 Aug-14 Dec 2008
New cholera cases by time period, Harare city (Budiriro and BRIDH CTCs), 3 Oct-14 Dec
New cholera cases per day, Chegutu city, 23 November-12 December
Main limitations of the national response capacity (1) l Surveillance – lack sensitivity – too complex system for early alert and quick reactivity l Case management – lack of stock of drugs supplies, weak lab capacity, lack of personnel & material resources – organization of some CTCs or CTUs inadequate
Main limitations of the national response capacity (2) l Social mobilization – community mobilization and hygiene promotion weak in coverage and intensity – no standardized messages l Environment – lack of financial and technical resources – water and sewerage systems lack maintenance – no access to safe water in many areas
Organization of the Response l Strong willingness and commitment of NGOs and UN partners to support through Health and Wash clusters l Multi-sectoral support to the Mo. HCW by: WHO, UNICEF, OCHA, ICRC, IFRC, IOM, MDM, MSF-Spain/ Holland/ Luxembourg, Oxfam, SCF, World Vision, etc. and donors l Strong collaboration between Health and Wash clusters and within each cluster l Cholera Command Control Center as a technical reference group of experts in surveillance, case management, wat san / infection control, logistics
Objectives of the response l Strengthening health and wash sector leadership and coordination l Reducing the spread of the epidemic – – Strengthening epidemiological and laboratory surveillance Ensuring access to safe water and sanitation Ensuring safe isolation and infection control practices in health care facilities Strengthening community mobilization and standardizing prevention messages l Decreasing mortality – Ensuring early detection of cases – Ensuring easy access to health care, including availability of ORS at community level – Ensuring appropriate case management (training, treatment and prevention materials, infection control practices, waste & dead bodies management)
Cholera Command Control Center WHO Representative Ministry of Health Cluster Cholera Command Control Center Log Cluster Wash Cluster Provincial staff
Cholera Command Control Center Assessment – Evaluation – Recommendations Surveillance, case management, wat san / infection control, logistics Monitoring Completion of recommendations Recommendations Watsan cluster Recommendations Health cluster Technical and operational review of recommendations Validation reco / WES plan Design project if any Funding Technical and operational review of recommendations Validation reco / Health plan Design project if any Funding Implementation recommendations Government / local authorities Bilateral UN NGO Private
Main challenges l Coordination of multiple partners l Difficulties of controlling nationwide outbreaks of cholera – – The outbreak is NOT under control yet Population movements during holiday period Rainy season Access to safe water l Context of the intervention – Collapse of the health care system – Staff absenteeism – Multiple health priorities
Conclusion l Nationwide cholera outbreaks, varying in intensity and duration, situated in either rural, semi-urban or urban environment with huge consequences in term of morbidity and mortality l Require a sensitive alert system, an extremely reactive response mechanism and the capacity to quickly organize standardized patients care on a temporary basis, with strong social mobilization l To be done in a collaborative manner among all implementing partners from the health and wash cluster l In a context of a long lasting and highly politicized crisis with major public health consequences
Thank you!
Скачать презентацию Cholera outbreak in Zimbabwe l Dr Dominique Legros
46b6eea72d732d37b5aa105d8936fa49.ppt