liberia 2003.ppt [Read-Only]apps.who.int/disasters/repo/10867.pdf · • 22 latrines in the SKD...

WORLD HEALTH ORGANIZATION September 2003

LIBERIA

Health Crisisand WHO’s actions

Dr Michelle Gayer Programme on Communicable Diseases in Complex Emergencies

Dr Sylvie BriandGlobal Task Force on Cholera Control

Ms Melanie ZippererMedia and Communications, Emergency and Humanitarian Action


Displacement of population with conflict


Water and Sanitation in Monrovia• Only 32% of Liberia’s population has access to

clean drinking water

• Less than 30% of the people have access to latrines

• Most people depend on wells and many of these are polluted. Garbage can easily be washed down the wells and contaminate them.

• In Monrovia there is no regular garbage collection since 1996. In March 2003, garbage collection completely collapsed


IDP Camps in Monrovia

• Over 90 camps in Monrovia provide shelter to at least 250,000 displaced people

• People in the camps receive a maximum of 3 liters of water per day for drinking, cooking , washing and personal hygiene

• They receive a bowl of rice and high energy biscuits through WFP

• Daily heavy rainfalls make living conditions in the camps very difficult


IDP Camps in Monrovia

• 22 latrines in the SKD stadium have to serve the needs of 45,000 people

• In the Masonic Temple, there are tenlatrines for 10,000 people

• The health center of the SKD footballstadium is completely overwhelmed,up to 500 patients come every day to see six nurses


Situation Outside Monrovia

• Access to basic health services is very limited. Most health facilities have been looted and destroyed

• In the few remaining clinics, staff is notwell trained and have not been paid for years

• Significant shortage of medicines

• Food available in local market but most people do not have the money to buy anything


Health problems

Population


Surveillance

• To know the health problems• To follow trends in disease • To assess magnitude and location• To detect epidemics• To calculate the resources needed• To target interventions


Health Problems

• Cholera• Malnutrition• Measles• Malaria• Anaemia

• Severe Cholera outbreak due to highpopulation density in camps and poorhygiene. Between 25.8. and 1.9., 2035 new cases have been reported

• Up to 40% of children in Liberia suffer from acute malnutrition

• National Immunization Programscollapsed, measles coverage < 40%

•Malaria is endemic throughout the country - up to 35% of consultations

•Anaemia major cause of hospitalization in children, requiring transfusion


Surveillance: Morbidity Form County: ……………………… District/Zone: …………………………

Community/Settlement/Camp:……………………………….Healthfacility:…………………………………

Agency: ……………………………………

Reporting period: From Monday ……/……/…….. To Sunday ……/……/……….

Total population covered: ………………………. Under 5 population: ………………………

NEW CASESDISEASE / SYNDROME Under 5 years 5 years and

Acute watery diarrhoea (incl. suspected*cholera)

Acute bloody diarrhoea (incl. suspected*shigellosis)

* Acute flaccid paralysis (suspectedpoliomyelitis)

* Acute haemorrhagic fever syndrome

* Acute jaundice syndrome (including *YellowFever)

* Measles

* Meningitis – suspected

* Neonatal tetanus

Acute lower respiratory infection/pneumonia

Malaria

– suspected

– confirmed (rapid test/smear)

Fever of unknown origin

Sexually Transmitted Infections

Tuberculosis – suspected

Severe malnutrition

Trauma/injury:

War-related injury

Road traffic accident/Other injury

Others

TOTAL NUMBER OF CONSULTATIONS


Cholera cases by epidemiological weeks- Monrovia-2003

0

200

400

600

800

1000

1200

1400

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Epidemiological weeks

Nu

mb

ero

f cases

309

426

935

376

1203

727

874

891

First attack,week 23

Second attack,week 26

Third attack,week 29

Cease-fireweek 32

Surveillance: Cholera trend


Living conditions•sanitation•water supply•unsafe food

External conditions•gatherings•forced migrations•crowded places

Climatic conditions•rain•floods•dry season

Cultural factors•Burial practices•Hygiene behaviour

Cholera outbreak: risk factors

outbreak


Cholera: high risk areasJune

July

August

Cholera outbreak and internal migration

Monrovia 2003

PaynesvilleGardnersville

• Central Monrovia

Congo TownSinkor


Partners

Population

Health problems

Co-ordination


Co-ordination: Health Sector Matrix1. PRIMARY CURATIVE/PREVENTIVE SERVICES

OPD + EPI ReproductiveHealth

HealthEducation/HIV/AIDS

Central MonroviaWest Point (Catholic Mission) –only preventive services currently

MSFB MSFB

Soniwein Clinic MSFB MSFBMamba Point OPD MSFF MSFFWorld Wide Mission IRC IRCGreystone MERLIN MERLINMasonic Temple MERLIN MERLINNewport High School MERLIN (OPD)

WVI (EPI)MERLIN

Demonstration School MERLIN MERLINGW Gibson High School SCF SCFGreater Refuge Temple SCFYWCA WVI

Bushrod IslandClara Town Community Clinic MSFB MSFBNew Kru Town Clinic MSFB MSFBCatholic Mission Clinic Private (St Joseph’s) INTERSOS IntersosBoatswain School IRC IRCCharles G Taylor School IRC IRC

GardnersvilleNew Georgia Clinic (Somalia dr.) MSFB MSFBTopor village (Somalia dr.) MERLIN MERLINOxygen Factory (Somalia dr.) MERLIN MERLINChicken Soup Factory OPD(Somalia dr.)

MSFF MSFF

Fumba Compound PMU PMUGold Medal Factory PMU PMUFatima Cottage and Orphanage(OPD to open?)

WVI WVI

PaynesvilleSKD Stadium MSFF (OPD + EPI)

MERLIN (OPD + EPI)WVI (OPD + EPI)

MSFF + WVI WVI

Paynesville MSFF OPD MSFF MSFFDuport Road Clinic MSFB MSFBPaynesville Town Hall MERLIN MERLINSalvation Army (Soul Clinic) IRC IRCPaynesville Community School IRC IRCKendeja Village MERLIN MERLINNeezoe Community (not yet open)for Calvery Temple, PaynesvilleAcademy, Liberian People’sAcademy and Kissi CommunityIDP sites.

IRC IRC

2. REFERRAL SERVICESSurgery/ Obstetrics/ Internal Medicine/ Paediatrics/Blood Transfusion

Location NGO

MSFB Hospital (all) Mamba Point MSFBMSFF Hospital (Internal Medicine/ Paediatrics/Blood Transfusion)

Mamba Point MSFF

JFK Hospital (surgery/obstetrics) Sinkor ICRCSt Joseph’s Catholic Hospital (all) Paynesville Private/INTERSOSELWA Hospital (all) Paynesville Private

Ambulance(Central Monrovia/ Tubman Bvd/ Congo Town/Sinkor)

MERLIN/MERCI

3. CHOLERA TREATMENT CENTRESGreystone Central Monrovia MERLINJFK Hospital Sinkor MSFBUN drive Central Monrovia MSFBSKD Stadium Paynesville MSFFGobachop Market Paynesville MSFFChicken Soup Factory Gardnersville MSFF

4. ORT CORNERSCWA Central Monrovia MSFFGibson Street Central Monrovia MSFFWest Point Central Monrovia MSFFWells-Hairston High School Central Monrovia MSFFClara Town (ORT corner + educators) Bushrod Island MSFFChicken Soup Factory Gardnersville MSFFRed Light/Pipeline Paynesville MSFF

5. NUTRITIONAL SERVICESNutritional Screening

WVI: Global malnutrition Severe Malnutrition11 IDP sites in Monrovia (which ones?)2112 children 6-59mo (7/2003)

39.9% 11.1% (of which2.2% oedema)

MSFH:Greystone Camp (8/20 03) 627 children 6-59mo

12.8% 1.8%

Masonic Temple (8/2003) 362 children 6-59mo 23.2% 4.1%Masonic Temple (8/2003) 302 adults >=55 yrs 36% (BMI <18.1) 9.2% (BMI <16)ACF:11 IDP sites (4-14/8/2003) Final report awaited

Therapeutic Feeding Centres (TFCs) Location NGOMamba Point – 150 beds Central Monrovia ACFMSFF Hospital/Clinic (TFC+Medical) Central Monrovia MSFFSinkor – 180-190 beds Sinkor ACFSKD Stadium – 50 beds now (planning for150)

Paynesville ACF

Bushrod Island north of Somalia Drive(planned)

Bushrod Island MSFH


Co-ordination: Epidemic Committee

• Epidemic preparedness

• Co-ordination among sectors and information sharing (Matrix)

• Local, regional and international collaboration

• Collection and reporting of cases and deaths

• Organisation of any relevant training

• Procurement, storage and distribution of required supplies

• Implementation , supervision, monitoring and evaluation of control activities (including Laboratory)


Co-ordination: Cholera Response

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1Planzone 1 2

Plan zone 2 3

Plan zone 3 4

Planzone4 5

Planzone 5

ActivitiesCase management

ORT corner

*MSF/B*Merlin*Save Children*IRC*MSF/F

ECOMILYAED

MSF/BIRCMSF/F

MerlinSave Children MSF/B

MerlinSave Children

*MSF/B*W. Vision*Merlin*Save Children*IRC*MSF/F Merlin W. Vision

OPD clinics

*MSF/B*Merlin*Save The Children*IRC*MSF/F

ECOMILYAED IRC

MerlinSave Children MSF/B

MerlinSave Children

*MSF/B*W. Vision*Merlin*Save Children*IRC*MSF/F

W.VisionMerlin

Cholera treatment centerMSF/B ECOMIL

YAED MSF/F MSF/B

ORS provision

*Merlin*Save Children*IRC*MSF/F

ECOMILYAED

IRCMSF/F

MerlinSave Children Merlin

*W. Vision*Merlin*Save Children*IRC*MSF/F

W. VisionMerlin

active case findingMerlinMSF/F

ECOMILYAED MSF/F Merlin MSF/F

Save Children


SKD stadium MSF/F cholera treatment centre

•Guidelines• Staff

• Trained staff• Available 24 h

•Cholera Treatment Units•ORS Corner• Supplies

•infusions •ORS •chlorine•disinfectant

•Active case finding•“baby minders”

Cholera : Case Management


Standardisation


Standardisation: Measles vaccination6. MEASLES VACCINATION COMPLETED July-Aug 2003

SITE LOCATION POPN est. # Vaccinated(6mo-15yrs)

ORG

Indian Community School Centr. Monr. 2000 143 MSFFMosque Site Centr. Monr. 500 80 MSFFUNHCR building Centr. Monr. 1027 190 MSFFUNOMIL Centr. Monr. ? 275 MSFFBuilding next to UNOMIL Centr. Monr. ? 158 MSFFLebanese Community School Centr. Monr. 2203 153 MSFFWells-Hairston High School Centr. Monr. 1000 217 MSFFOld Ambassador Hotel Centr. Monr. 1600 255 MSFFNewport High School Centr. Monr. 8000 220 MSFFWorld Wide Mission School Centr. Monr. 3482 362 MSFFJW Gibson High School Centr. Monr. 9000 533 MSFFNewport Primary School Centr. Monr. ? 315 MSFFHousing Bank Centr. Monr. ? 533 MSFFCWA Centr. Monr. ? 293 MSFFMSFF Mamba Pt Hospital Centr. Monr. ? 526 MSFFOld Govt Hospital, Fraint st Centr. Monr. ? 602 MSFFATS Centr. Monr. ? 520 MSFFSlipway Centr. Monr. ? 167 MSFFAME Zion High School Centr. Monr. ? 270 MSFFAME University Centr. Monr. ? 614 MSFFGreystone Centr. Monr. 13000 518 (6-59mo) MSFHMasonic Temple Centr. Monr. 11200 368 (6-59mo) MSFHSKD Stadium Paynsville 40000 18000 WVIPaynesville Community School Paynsville 3500 ? IRCSalvation Army Paynsville 6153 ? IRCHarbel Firestone 23445 5200+ Merlin


Standardisation: Nutritional ScreeningWVI (July 2003): Global malnutrition

(W/H < 80%)Severe Malnutrition

(W/H < 70%)

1. 11 IDP sitesN = 2112 6-59mo 39.9% 11.1%

MSFH (Aug 2003):

2. Greystone CampN = 627 6-59mo

12.8% 1.8%

3. Masonic TempleN = 362 6-59mo

23.2% 4.1%

4. Masonic TempleN = 302 adults>=55 yrs

36%

(BMI < 18.1)

9.2%

(BMI < 16)


Standardisation: Chlorination of Wells

65 % purechlorine

1% chlorinesolution

How to prepare 1 gallon of 1% chlorine solution

The quantities are calculated with an average wellvolume of 8m3 (1m diameter and 10m watercolumn), a level of 5ppm of chlorine in the well and11 grams per soup spoon.

1 gallonjerry-can

1 – Take 6big spoons

of purechlorine

2 - Empty the 6spoons into the1 gallon jerry-can filled withwater

1 gallonjerry-can

1 gallonjerry-can

3 – Shake thejerry-can todissolve the purechlorine

4 – Emptyslowly thejerry-can intothe well

• Priority setting:– Areas where high incidence of cholera

• Strategy: – Wells to be chlorinated vs– Wells to be closed– Methodology to be used

• Supervision and monitoring : – Water quality control– Residual chlorine levels


WHO action• QUALITY ESSENTIAL

HEALTH CARE SERVICESPrimary and Referral Services– Standard setting– Guidelines– Training and Supervision– Medications and Material

• CO-ORDINATION– of over 50 NGOs to ensure

rapid, effective, well-targeted health sector response


WHO action• OUTBREAK PREVENTION AND

CONTROL – Surveillance system– Strengthen laboratory capacity– Vaccination– Chlorination of wells– Health education

• NATIONAL CAPACITY STRENGTHENING– support rehabilitation of hospitals– restart MOH programmes

liberia 2003.ppt [Read-Only]apps.who.int/disasters/repo/10867.pdf · • 22 latrines in the SKD...

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