Скачать презентацию Cholera outbreak in Zimbabwe l Dr Dominique Legros Скачать презентацию Cholera outbreak in Zimbabwe l Dr Dominique Legros

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Cholera outbreak in Zimbabwe l Dr Dominique Legros l Coordinator, Disease Control in Emergencies 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 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 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, Zimbabwe, 18 Aug-14 Dec 2008

New cholera cases by time period, Harare city (Budiriro and BRIDH CTCs), 3 Oct-14 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 New cholera cases per day, Chegutu city, 23 November-12 December

Main limitations of the national response capacity (1) l Surveillance – lack sensitivity – 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 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 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 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 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 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 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, 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

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