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Lesson learnt from diarrheal outbreak edcd
 

Lesson learnt from diarrheal outbreak edcd

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    Lesson learnt from diarrheal outbreak edcd Lesson learnt from diarrheal outbreak edcd Presentation Transcript

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