Lesson learnt from diarrheal outbreak edcd


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Lesson learnt from diarrheal outbreak edcd

  1. 1. Ministry of Health Population Department of Health Services Epidemiology and Disease Control Division DR GD THAKUR Director Lesson Learnt from Acute Watery Diarrhea Response in the West
  2. 2. <ul><li>Every year outbreak of diarrhea occurs through out the country. E.g. </li></ul><ul><ul><li>3137 persons affected (37 deaths) in 2005 </li></ul></ul><ul><ul><li>3136 persons affected (23 deaths) in 2006 </li></ul></ul><ul><ul><li>33746 persons affected (247 deaths) in 2007 (cholera in Kalikot and Rautahat) </li></ul></ul><ul><ul><li>6515 persons affected (38 deaths) in 2008 </li></ul></ul><ul><li>Case fatality rate of about 1 % is usually observed </li></ul><ul><li>Rapid response teams are mobilized during outbreak </li></ul>
  3. 5. <ul><li>Diarrhoeal outbreak started in the month of May 2009 (Baisakh 2066) </li></ul><ul><li>Immediate response was provided by the District Health Office </li></ul><ul><li>Rapid Response team was mobilized to the VDC </li></ul><ul><li>Outbreak was controlled </li></ul>
  4. 6. <ul><li>At the start of July 2009 (Asar 2066), the outbreak was active again. </li></ul><ul><li>Jajarkot and Rukum have been highly affected </li></ul><ul><li>Initial Response through the DHO </li></ul><ul><li>Response from Regional Health Directorate through mobilization of Response team and drugs </li></ul><ul><li>Centre aware of the outbreak and homework initiated to respond to it </li></ul><ul><li>A central team was mobilized on Asar 18 to Jajarkot district </li></ul>
  5. 7. <ul><li>Honourable Minister for Health and Population Mr. Umakant Chaudhary visited the districts on 23 Asar 2066. </li></ul><ul><li>Instruction was given to high level officials for adequate response </li></ul><ul><li>A high level meeting was held on 28 Asar chaired by Rt. Hon'able Prime Minister Mr. Madhav Kumar Nepal which took major decisions for responding to the outbreak </li></ul><ul><li>Right Honorable Preseident Dr. Ram Varan Yadav was briefed about the responses on 1 Shrawan (14 July 2009) </li></ul>
  6. 8. <ul><li>A High level meeting was called at MOHP for effective response, which decided to: </li></ul><ul><ul><li>Strengthen the Control Room at EDCD </li></ul></ul><ul><ul><li>Locate the regional response coordinator in Surkhet led by Dr. L. R. Pathak, Director </li></ul></ul><ul><ul><li>Local district response coordinators in Jajarkot and Rukum, namely Dr. P. B. Chand and Dr. G. D. Thakur </li></ul></ul><ul><li>Adequate drugs and supplies were sent to the districts as well as human resources </li></ul>
  7. 10. <ul><li>52% of tested stool samples have Vibrio cholera (O1 El Tor Ogawa) positive (n=107). </li></ul><ul><li>Adult population are mostly affected. </li></ul><ul><li>Cases progressed to Severity within few hours. </li></ul><ul><li>10-15 % of cases have severe dehydration. </li></ul><ul><li>Death toll is high, although CFR is 0.6%. </li></ul><ul><li>Cholera is endemic in Nepal. High case fatality and severity in past also have cholera outbreaks (Eg- Kalikot, Rautahat). </li></ul><ul><li>Polluted water is the main source of disease transmission. </li></ul><ul><li>Hygiene and sanitation and poor socioeconomic conditions are predisposing factors. </li></ul><ul><li>Tetracycline is sensitive in all cases and co-trim is resistant </li></ul>
  8. 11. <ul><li>At central level: Central Control Room at EDCD </li></ul><ul><li>At regional level: Located in Surkhet and Dipayal </li></ul><ul><li>At District level: Jajakot and Rukum </li></ul><ul><li>Responsible Persons: </li></ul><ul><ul><li>Surkhet: Dr. L. R. Pathak/Dr. S.S. Tiwari </li></ul></ul><ul><ul><li>Dipayal: Dr. S.S. Mishra </li></ul></ul><ul><ul><li>Jajarkot: Dr. Padam B. Chand/Dr. Bhim Acharya </li></ul></ul><ul><ul><li>Rukum: Dr. G. D. Thakur/ Mr. Arjun B. Singh </li></ul></ul>
  9. 12. <ul><li>Nepal Army </li></ul><ul><li>Nepal Police </li></ul><ul><li>Armed Police </li></ul><ul><li>Nepal Medical Association </li></ul><ul><li>HELBITAS Nepal </li></ul><ul><li>Nepalgunj Medical College </li></ul><ul><li>Nepal Health Research Council </li></ul><ul><li>INF Nepal </li></ul><ul><li>SMNF </li></ul><ul><li>CWIN/SCF </li></ul><ul><li>Water Aid </li></ul><ul><li>AMDA </li></ul><ul><li>CWIN/SCF </li></ul><ul><li>CARE Nepal </li></ul><ul><li>Concern worldwide Nepal </li></ul><ul><li>TUTH </li></ul><ul><li>NAMS </li></ul><ul><li>Medicare Hospital </li></ul><ul><li>Nepal Red-cross </li></ul><ul><li>UNICEF </li></ul><ul><li>WHO Nepal </li></ul><ul><li>WHO/IPD </li></ul><ul><li>WHO/SEARO </li></ul><ul><li>Deprocs Nepal </li></ul><ul><li>ADRA Nepal </li></ul><ul><li>MSF Holland </li></ul><ul><li>NEWAH </li></ul><ul><li>Health workers from UNCPM </li></ul><ul><li>Hill development </li></ul><ul><li>ENPHO/Paschim paila </li></ul><ul><li>Alka Hospital </li></ul><ul><li>NRN </li></ul><ul><li>National Medical College </li></ul><ul><li>NCCI </li></ul><ul><li>GRACE hospital </li></ul>
  10. 13. <ul><li>Topography </li></ul><ul><li>Scattered settlement </li></ul><ul><li>Difficult Terrain </li></ul><ul><li>Transport /Communication </li></ul><ul><li>Traditional practices and beliefs </li></ul><ul><li>Low level of awareness </li></ul><ul><li>Poor hygiene and sanitation </li></ul>
  11. 14. Lessons Learnt <ul><li>Strengthening of Surveillance System </li></ul><ul><li>Strengthening of Case Management Capacity at sub-national levels </li></ul><ul><ul><ul><li>How to set up a Diarrhea Treatment Unit </li></ul></ul></ul><ul><ul><ul><li>Use of standard diarrhea treatment for Cholera and Shigella </li></ul></ul></ul><ul><ul><ul><li>How to collect rectal swabs for laboratory confirmation </li></ul></ul></ul><ul><ul><ul><li>How to use Cholera rapid test if provided </li></ul></ul></ul><ul><ul><ul><li>Basic health education messages for the affected population </li></ul></ul></ul>
  12. 15. Lessons Learnt <ul><li>Strengthening of Laboratory Capacity </li></ul><ul><li>Vacant posts must be fulfilled </li></ul><ul><li>Buffer stock of medicines should be prepositioned prior to monsoon </li></ul><ul><ul><li>Ensure logistics for epidemic prone diseases </li></ul></ul><ul><ul><li>Strengthen the supply chain management </li></ul></ul><ul><ul><li>Maintenance of logistic management information system </li></ul></ul>
  13. 16. Response Capacity <ul><li>Strengthen the Rapid Response team at all level (district, region and centre) </li></ul><ul><li>Make the rooster of experts and RRT members for immediate mobilization and regularly update them </li></ul><ul><li>Develop the Disease specific response plan for all possible outbreaks. </li></ul><ul><ul><li>Case management guidelines </li></ul></ul><ul><ul><li>Logistic management </li></ul></ul><ul><ul><li>Monitoring and Evaluation </li></ul></ul><ul><li>Develop the plan for transportation of human and other logistics </li></ul><ul><li>Ensure the financial resources </li></ul><ul><li>MOHP has to ensure sustainability of medical team deployed in an outbreak area. The sustainability should include: Incentives, guarantee foods and tabs for water purification and help in find shelters. Medical team need to have a turnover depending on nature of outbreaks to avoid psychological and physical breakdown. </li></ul>
  14. 17. Response Capacity Cont <ul><li>Train the medical team in the following critical aspect: </li></ul><ul><ul><li>How to set up a Treatment Unit for different outbreaks </li></ul></ul><ul><ul><li>Use of standard treatment guideline for different outbreak </li></ul></ul><ul><ul><li>How to collect sample on different outbreaks </li></ul></ul><ul><ul><li>How to use rapid test if provided </li></ul></ul><ul><ul><li>Basic health education messages for the affected population </li></ul></ul><ul><li>Enforce the rational use of antibiotics for cholera patients and rigorous patient monitoring </li></ul>
  15. 18. Prevention and environmental control (particular to diarrheal diseases) <ul><li>Safe water supply </li></ul><ul><li>Good hygiene and sanitation practices </li></ul><ul><ul><li>Hand washing practices </li></ul></ul><ul><ul><li>Use of Latrines </li></ul></ul><ul><ul><li>Availability of Soap </li></ul></ul><ul><ul><li>Communication Messages </li></ul></ul><ul><li>The place where safe water supply cannot be guaranteed : </li></ul><ul><li>Coordinate with HEALTH and WASH cluster for health education messages and distribution of chlorine and aquatab at household level </li></ul><ul><li>Organize community mobilization to boil the water. </li></ul>
  16. 19. Lessons Learnt <ul><li>Coordination and Collaboration </li></ul><ul><ul><li>Between ministries </li></ul></ul><ul><ul><li>Between national and international partners </li></ul></ul><ul><ul><li>Between security forces </li></ul></ul><ul><ul><li>With political parties </li></ul></ul><ul><ul><li>With Media </li></ul></ul>
  17. 20. “ Prevention is better than cure” Need to work on Decreasing level of ignorance Strengthening of safe water supply Improve hygiene & Sanitation Strengthening of Timely detection and response capacity Could prevent these kind of disaster with multi-sectoral approach
  18. 21. <ul><li>Thank you. </li></ul>