Northeast Nigeria Response Health Sector Bulletin #30 16 th 31 st August 2017

Transcription

1 BORNO STATE GOVERNMENT Northeast Nigeria Response Health Sector Bulletin #30 16 th 31 st August MILLION PEOPLE IN NEED OF HEALTH CARE IN; ADAMAWA, BORNO AND YOBE STATES HIGHLIGHTS 5.9 MILLION TARGET BY THE HEALTH SECTOR; ADAMAWA, BORNO AND YOBE STATES 1,496,995* IDPS IN BORNO STATE HEALTH SECTOR 2,060,394 POLIO VACCINATED CHILDREN As of 30 August 105 cases of cholera including 8 deaths have been reported in / around Maiduguri. All suspected cases live in Muna Garage IDPs camp except for two in Bolori II. The Borno State MoH, MSF, UNICEF and WHO are responding along with support from WASH sector partners. - Infection control and case management centres have been set up in Muna Garage and Dala; - BSMOH/WHO has strengthened case investigation, active case search and surveillance in Muna Garage IDPs camp and surrounding communities and health facilities; - In addition to surveillance, IEC materials including television documentary and live community drama in Jere and Maiduguri LGAs is ongoing. - Discussion with ICG about releasing oral cholera vaccine for use in a mass vaccination campaign. To reduce the number of acute watery diarrhea cases, and with the rainy season in full force, a stronger partnership is required with other sectors especially water/sanitation partners - to improve the quality of the drinking water, sanitation conditions and community awareness in camps for displaced persons. A multisectoral integrated approach is also instrumental in preventing potential cholera outbreaks. To this end, health partners and WASH sector are taking part in the LGA-Level coordination forums and are also supporting camp-specific approaches. 22 HEALTH SECTOR PARTNERS HEALTH FACILITIES** 288 FUNCTIONING** (OF TOTAL 749 ASSESSED HEALTH FACILITIES) 262 FULLY DESTROYED 215 PARTIALLY DAMAGED 67 REHAB/RENOVATED IDP CAMPS CUMULATIVE CONSULTATIONS 562,026 MEDICAL CONSULTATIONS*** EPIDEMIOLOGICAL WEEK 30: EARLY WARNING & ALERT RESPONSE 104 EWARS SENTINEL SITES 239 REPORTING SENTINEL SITES 81 TOTAL ALERTS RAISED**** SECTOR FUNDING, HRP 2017 HRP 2017 REQUIREMENTS: 93.8M US 16.8 M US$ FUNDED (17.9%) 2016 UNMET REQUIREMENTS 11.8 MILLION USD FUNDED (22%) 53.1 MILLION USD REQUESTED * Total number of IDPs in Borno State by IOM DTM XV April ** MoH/WHO HeRAMS December *** Cumulative number of medical consultations at the IDP camps from 2017 Epidemiological Week **** The number of alerts change from week to week. *****Number of Polio vaccinated children in the Outbreak and Response campaign as April

2 Situation update As of 29 August, the security situation continues to worsen and is deteriorating. Between January - August, there have been 60 suicide attacks in Borno State, involving 200 deaths. This is the highest number of attacks since The number of attacks in Maiduguri alone has doubled over the previous year. LGAs such as Damboa, Jere, Konduga and Maiduguri metro have shown a marked increase in insurgent attacks and other security incidents. Analysts say, This increase in attacks indicates a clear change in Boko Haram s tactics, moving from one of occupation to a more disruption-focused insurgency. This shift is seen as a strong indication of Boko Haram s reduced ability from fighting to capture territory to guerrilla-style hit and run attacks. This includes increasing its campaign of suicide bombings against soft targets. Civilians continue to withstand the worst of these attacks. Cholera Outbreak Response: With the peak of the rainy season, 58% of the population is at risk of disease outbreaks with limited access to health care. The Health Sector partners are trying to ensure that all children in accessible parts of northeastern Nigeria are protected from childhood diseases including polio, measles, as well as responding to the threat posed by malaria and diarrheal diseases like cholera. As of the105 suspected and confirmed cases of cholera reported, with eight deaths have been reported with case fatality ratio of 7.6%. Cases have been confirmed by the laboratory in Lagos. A cholera treatment center has been set up in Dala by the MOH with support from MSF. A second CTC is being established in Muna Garage Camp by the MOH, tents were provided by UNICEF and further technical support by MSF. Regarding the management of dead bodies, special group of undertakers were trained by MSF and allowed to wash with chlorine, use body bags and transport the body to the graveyard. On WASH interventions, 52 hygiene promoter are providing HP messages through either door-to-door session or mass campaign at water points including 20 from ICRC/NRC, 7 UNICEF, 18 CIDAR, and 7 DRC. In order to ensure a proper chlorination stakeholders commits to either use dosing pump (2 for ICRC) or bucket chlorination methodology for chlorination of water point (as soon as they can). In close collaboration with MSF, Solidarity International has three spraying teams in charge of disinfecting (with chlorine) shelters of suspected cases, any area where patients could have put some fluids and neighborhoods of suspected cases (latrines used, garbage pit etc.). Hygiene Replenishment Kits distribution started 27-Aug-2017 by CIDAR for 1,500 households. Desludging of latrines is ongoing in Muna Garage camp by UNICEF/BOSEPA for at least 16 blocks. In the most needed location, MSF will decommission two block of latrines and build two new ones. As soon as dislodgement will be done, CRS will provide emergency rehabilitation on seven blocks of latrines (near the recorded cases). A request for Oral Cholera Vaccine (OCV) to the International Coordination Group (ICG) on vaccine provision for cholera is under discussion by the Nigerian Government with technical support from WHO to ensure that vaccine is timely provided. Active monitoring of cholera at 16 health facilities around the affected area is ongoing, including active case finding and reporting by the DSNOs and community informants. Public Health Risks and Needs Imminent risk of cholera outbreak due to poor water and sanitation conditions, poor nutrition status, population mobility and the weakened immune system through the state has increased. The lack of safe or limited access to safe water, latrines and shelter facilities increases the risks of communicable diseases including cholera especially among under five. Continuous influx of returnees and overcrowding of camps due to limited availability of shelter and WASH services continue to increase the risk of outbreaks. Diarrhea and malaria cases are in the raised. Although the HEV cases are decreasing, there still a risk of Hepatitis E spread cross-border to Cameroon. Geographical access remains a challenge and continues to be worsen by the rainy season. Health partners prepositioning supplies and drugs in high-risk LGA and health facilities to prepare for mitigation of deterioration of the health situation during the rainy season is ongoing. There is a serious shortage of skilled health care workers, particularly doctors and midwives, and their reluctance to work in recently accessible areas is a major challenge for the provision of health assistance. 2

3 W W W W W W W W W W W W W W W W W W W W W W W W W W Number of cases Surveillance and communicable disease control Early Warning Alert and Response System (EWARS): In Epidemiological Week , a total of 16 out of 25 LGAs and 104 out of 239 reporting sites (including 20 IDP camps) submitted their weekly reports. Timeliness and completeness of reporting were 72% and 56% respectively at LGA level (target 80% respectively). Of the 81 indicator-based alerts received, 83% were verified. Malaria: In Epidemiological Week 33, 4,030 cases of confirmed malaria cases were reported representing 16.1% of reported morbidities. Of the reported cases, 498 were from 250 Housing Estate (Kofa) camp clinic in Konduga, 271 were from General Hospital Bama IDP camp clinic, and 241 were from EYN (CAN) center IDP camp clinic in MMC. Two deaths among children under five years were reported from Dikwa General Hospital (1) and Guwal clinic in Kwaya Kusar (1) Cases under 5 years Cases 5 years and above Figure 2: Number of confirmed Malaria cases, Week Week , Borno State Measles: In Epidemiological Week 33, 25 cases of measles were reported through EWARS with 84% occurring in children below 5 years. No death was reported. Malnutrition: In Epi week 33, 1,580 cases of severe acute malnutrition were reported. Of the reported malnutrition cases, 235 were from Giwa Barracks clinic in Jere, 115 were from Dikwa MCH, 98 were from Gunda CHC in Biu, and 77 were from Kaka Mallam Yale MCH in Konduga. Two deaths were recorded in Mbalala MCH in Chibok. Acute respiratory infection: In Epi week 33, 2,315 cases of acute respiratory infection were reported. Of the reported cases, 161 were from 250 Housing Estate (Kofa) IDP camp clinic in Konduga, 150 were from EYN (CAN) centre IDP camp clinic in MMC, 117 were from 505 Housing Estate clinic in Jere, 116 were from Bakassi Gwoza IDP camp clinic in MMC, 115 were from Dikwa MCH, 112 were from Dalaram PHC in Jere, 105 were from Biu MCH, and 101 were from NYSC IDP camp clinic in MMC. No death was reported. 3

4 Acute watery diarrhea: In Epi Week 33, 2,330 cases of acute watery diarrhea were reported through EWARS with 65% of cases occurring in children below 5years. Of the reported cases, 393 were from Dikwa general Hospital, 211 were from Muna Garage Camp Clinic A in Jere, 112 from 505 Housing Estate in Jere, and 100 from Town dispensary in Kwaya Kusar. No death was reported. Figure 3: Trend in number of acute watery diarrhoea cases, Week Week , Borno State Neonatal death: No neonatal death was reported. Maternal death: One maternal death was reported from Alheri clinic in Askira Uba. Health Sector Coordination The Health Sector Coordination meetings are held bi-weekly in each of the three states. The MoH has initiated daily task-force meetings for the cholera response, attended by all partners who are actively involved and including representation by the WASH sector. The meetings are held at the PHEOC at the Eye Hospital in Maiduguri at 4:00 pm. Local health sector coordination in the LGAs is being encouraged and partners have been identified in several of the LGAs to take the lead. The coming meetings can focus on cholera preparedness and capacity to respond within the LGA, and any request for support can be communicated back to the Health Sector. -Monguno: ALIMA -Dikwa: FHI360 -Ngala: UNICEF -Rann: UNICEF -Banki/Bama: UNICEF -Gwoza: IRC Health Sector Action International Rescue Committee (IRC) Across all its sites, the IRC attended to 4,403 patients (38% children under 5, 55% female) at its mobile health & nutrition clinics and at supported health facilities in MMC, Jere, Konduga, Monguno, Gwoza, and Askira Uba LGAs in Borno State. As cases of diarrhoea and malaria were gradually increasing, the health sensitization sessions at the sites and in the communities through community volunteers have focused on hygiene promotion, use of ORS, and malaria prevention, reaching 11,675 people (73% female). The IRC in collaboration with the SPHCDA trained 43 health staff from both MoH and the IRC on clinical care of sexual assault survivors in Maiduguri, and a similar training was held in Mubi for 15 participants from Askira Uba and Michika LGAs. The Comprehensive Women Centre in Gwoza was completed and daily services have commenced, consisting of reproductive health care and psychosocial services and case management of survivors of GBV. 4

5 FHI360: Banki Town After two weeks of preparation, FHI 360 opened Banki Primary Healthcare Centre on August 24 th in the IDP camp. Through the USAID Office of Foreign Disaster Assistance Integrated Humanitarian Assistance to Northern Nigeria (IHANN) project, FHI 360 is expanding coverage in WASH, Health, Protection and Nutrition to Banki IDP Camp. FHI 360 has completed renovations and delivered critical medical equipment, consumables and medications over the past weeks in preparation for opening the clinic. Since the opening, the clinic has been seeing more than 100 patients per day who are seeking consultations for communicable and non-communicable disease as well as FHI360 nurse assessing patient at Banki Clinic reproductive healthcare. FHI 360 s current team of a doctor, two nurses, a midwife, a laboratory technician and a pharmacist are able to provide care and services that have been limited and unable to meet the needs of the growing IDP population. As the clinic continues to expand and receive more staff and equipment, the number of patients seen per day is expected to grow. FHI 360 is currently on-boarding staff to start its Community-based Management of Acute Malnutrition (CMAM) program. Premiere Urgence Internationale (PUI): At Herwa Peace PHC, 4,631 patients were attended to, an increase of 1,150 compared to the previous two-week period. In the three mobile sites, Bayan Texaco, Jajeri Kantudua and Fillin Bayan Makaranta, 4,278 consultations were done, with 140 referrals to the PHC. On 29 August, PUI received one adult patient from Umamari suspected of cholera, who was transferred to the CTC at Dala, and later passed away. The case was RDT positive, while culture results are pending. No further suspected cholera cases were received. PUI has called for a coordination meeting with all actors working in the camp for further action. Other communicable diseases seen were 519 confirmed cases of malaria, 112 cases of typhoid fever (clinical diagnosis) and 6 cases of measles. 3,492 vaccination doses were administered to children, and those who completed Penta 3 and measles were rewarded with a mosquito net. This has contributed to an increase in children who come for measles vaccination. At the mobile sites, 165 tetanus toxoid vaccinations were provided. At the OTP, 283 children are currently admitted, increased by 56 children compared to the previous reporting period. Among them, 18 children with medical complications were transferred to other facilities for stabilization. MUAC screening at the PHC and three mobile sites reached 5,200 children 6-59 months; 2.7% children were found to be severely malnourished and referred to OTP. In maternal health, 611 ANC visits were reported from Herwa PHC, and 42 postnatal visits were made. There were 106 family planning consultations (73 new, 33 revisit), which is constantly increasing after implementation of health talks at the waiting area. Delivery services were initiated this week, and so far, skilled birth attendants assisted seven deliveries. At the mobile sites, 308 ANC consultations were held. The SRH officer trained the health staff of the PHC on GBV. The SRH officer with first baby delivered at Herwa PHC UNICEF cholera outbreak response: Since the report of an alert of 2 RDT positive cases of cholera in Muna Garage IDP camp in Borno State, UNICEF Health and WaSH teams have been working closely with Government Authorities and other health and WaSH partners to quickly contain the disease. UNICEF health section supported the SMOH with seven tents to set up a cholera treatment center in Muna Garage, the epicenter of the cholera outbreak and oriented all the doctors on proper cholera case management. The doctor in charge conducted further on job training for the health staff on cholera case management and VCMs on 5

6 preparation of homemade ORS and door-to-door active case search. Thereafter, they were given ORS sachets and zinc to distribute to the households in need specifically during night. UNICEF Polio/C4D team, using its VCM network in Muna Garage as well as the religious and traditional leaders, has been conducting community sensitization activities on cholera. 31 traditional and religious leaders living at Muna Camp and representing sectors, LGAs and tribes residing at the camp were oriented on cholera key messages to be disseminated. They were given pictorial IEC materials on cholera to be distributed in the 80 mosques of Muna Garage during the Friday (Eid Kabir) prayer. They were explained the importance of early health seeking behavior and how to prepare and start homemade ORS. UNICEF hygiene promotion in Muna Camp UNICEF WaSH response to the cholera outbreak focused on the sustainability of WASH services that are being provided especially in camps to ensure good quality: - Water systems are being attended to by operators and are being regularly chlorinated and dosing pumps provided to automate chlorination. - Camps are being cleaned from garbage and latrines cleaned on regular basis. - NFIs are being replenished with Aqua Tabs included for HH water treatment; all coupled with HP activities. - Latrine pits are being dislodged when full. - Urban water systems are now beginning to use chlorine from UNICEF for blanket chlorination. WASH hopes that all these preventive measures would mitigate risks of the spread of the virus and other pathogens causing diarrhea. Integrated emergency PHC services During the reporting period, a total of 98,787 women and children and their families were reached with integrated PHC in all the UNICEF supported health facilities in the IDP camps and host communities in Borno and Yobe States. 41,905 consultations were reported with malaria being the major cause of morbidity [Malaria (12,965), ARI (8,251), AWD (4,833), Measles (51) and other medical conditions (15,805)]. A total of 31,928 children and pregnant women were reached with various antigens (including 3,839 children 6months- 15 years vaccinated against measles). Vitamin A supplementation (8,223), Albendazole for deworming (10,313), ANC visits (5,555); delivery (531), Post Natal Care (432) were also recorded in the UNICEF supported health facilities in Adamawa, Borno and Yobe States. Yobe State during the outreach interventions, 110 LLITNs were distributed while in Adamawa 8,010 LLITNs. UNICEF donated 165 Nigeria Health Kits to Borno SMOH to support integrated emergency PHC interventions in the health facilities in the IDP camps and host communities. UNICEF donated 100 NHK to WHO to support their Hard to Reach Team (HTR) outreach health interventions. A total of 35 HTR teams are providing health services in 16 out of the 17 LGAs in Yobe state. In addition, 20 NHK were donated to PUI to support integrated emergency PHC services in four health facilities (3 mobiles and 1 fixed) serving a population of 80,000 including 25,000 IDPs in MMC LGA of Borno State. UNFPA UNFPA continues to support the humanitarian response in Borno through provision of quality and timely live saving SRH interventions. During the Period above, UNFPA in collaboration with Red Cross and SMOH completed the distribution of 747 cartons of RH kits to facilities in MMC, Jere, Biu, Konduga, Monguno, Kaga, Gwoza, Mobbar, Ngala, Chibok, Kala Balge, Dikwa and Mafa LGAs. Additional RH Kits have been prepositioned and contingency stock plans made to respond to emerging needs. 3,300 Dignity kits were distributed to support mothers in the Post Natal Care period in facilities in the LGAs above, it s anticipated these kits will enhance facility based deliveries. UNFPA in partnership with the SMOH and Action Health Incorporated, completed a MISP training of 30 health workers drawn from MMC, Jere, Konduga and Monguno LGA facilities from the 24th-28th July 2017 in Maiduguri. The training was facilitated by UNFPA and SMOH staff. This training was phase 2 of the training making it a total of 60 health care workers trained. 6

7 UNFPA in collaboration with the SMOH provided equipment (hospital beds, delivery beds and kits) to Muna Garage Maternity Clinic, the facility is now able to conduct deliveries and will help address the SRH gaps in this populated IDP camp. Engaged 18 medical outreach team and they provided MNCH services in the 16 most affected communities of Yobe State with support from UNFPA. 2,136 IDP women and 3,198 IDP girls, and 14,104 children were provided with MNCH medical services and referrals in the last 6 months. 1,756 girls and 2,376 women were provided with EmONC services and referrals by the medical outreach team. Supported the SMOH to distribute contraceptives to 123 service delivery point; and also supported training and engagement of 7 community volunteers to mobilize and sensitize women on FP, increasing uptake and creating demand. This was done in 4 IDP camps In Yobe State; held Family Planning Commodities review, resupply and redistribution meeting with Health Facility Managers, LGA MCH Coordinators, and a representation from the National Primary Health Care Development Agency with support from UNFPA. 7,021 different Family Planning Options were distributed to 179 health facilities (HF) of Yobe State. MPDRS data review and validation from 10 HF was conducted by the Primary Health Care Management with support from UNFPA. Maternal and perinatal death trend was ascertained and Commissioner of Health will present during MPDRS state level meeting. Procure MNCH drugs, consumables and supplies worth 1.2 Million Naira to support medical outreach team. (1,000 Doses of oxytocin injection, 430 doses of misoprostol, 1,000 doses of magnesium sulphate injection, 4 cartons of 500ml of normal saline). Conducted community sensitization in Bakassi camp and Farm Center camp on SRH and GBV as part of activities to mark the International Youth Day in conjunction with the State Government, youth groups and media. Continued to support the SMOH to coordinate the RH response through the SRH Sub Technical Working group monthly meetings and strengthening the linkages to the GBV Sub Working group. Two quarterly and 6 monthly RH Coordination meetings were conducted. 17 MCH Coordinators, Director PHC, State M&E Officer, Red Cross officer were sensitized on the need to come together to support the state MNCH data status. WHO: For the first time, a joint review of mobile health teams (hard-to-reach) and Community Oriented Persons activities was conducted in southern Borno state. The objective of the review was to synchronize and strengthen collaboration between the two initiatives, which provide home/community-based healthcare services to people with limited access. The second round of the Seasonal Malaria Chemotherapy (SMC) campaign for children aged 3-59 months in Borno state has been concluded in Jere, Maiduguri Municipal Council, Konduga, Monguno and Mafa LGAs. WHO estimates up to 10,000 lives could be saved by November through malaria prevention and control, if more funds are secured. WHO has trained community health workers to always on the lookout for signs of malaria. They offer rapid diagnostic tests to determine if people have malaria, provide treatment, and advice on prevention. In addition, with more funding, WHO plans to reach more areas in Borno state with antimalarial drugs and support overall malaria control interventions. Gaps in response Secondary health care and referral services is a big challenge population facing in the remote areas due to lack of secondary care facilities, ambulance services and specialized health care providers. Most of the secondary health care facilities at LGAs are non-functional and referrals must be done to Maiduguri or cross borders to Niger and Cameroon. Mental health and psychosocial support need more efforts to help the population affected by the insurgency and the detrimental conditions as displaced populations. Low vaccination coverage due to access and security issues as well as challenges ongoing polio outbreak, Hepatitis E and other vaccine preventable diseases. Insufficient number of skilled and appropriately trained health care staff. NGOs medicines importation continue to hampers their programme implementation and timely health service delivery. 7

8 Nutrition screening is not regularly conducted in all the catchment areas to timely detect severe acute malnourished children with complications. Resource mobilization The latest funding overview of the 2017 HRP reports shows that Health Sector is currently 16.8 M US$ (17.9%) funded of the required appeal of 93.8 M US$ ( Health Sector Partners - Federal Ministry of Health and Adamawa, Borno and Yobe State Ministries of Health - UN Agencies: IOM, OCHA, UNFPA, UNICEF, UNDP, WHO, OCHA - National and International Partners: ALIMA, Action Against Hunger, Action Health Incorporated, MSF (France, Belgium, Spain and Switzerland), ICRC, Medicines du Monde, Premiere Urgence Internationale, International Rescue Committee, FHI-360, International Medical Corps, Catholic Caritas Foundation of Nigeria, SIPD, Nigeria Centre for Disease Control, BOSEPA, BOSACAM, WASH & Nutrition Sectors, Nigerian Armed Forces, Nigerian Air Force & others. -Health sector bulletins, updates and reports are now available at For more information, please contact: Dr. Haruna Mshelia Dr. Abubakar Hassan Commissionner for Borno State Ministry of Health Permanent Secretary, BSMOH harrymshelia@gmail.com abubakarhassan60@gmail.com Mobile: Mobile Dr. Jorge Martinez Mr. Muhammad Shafiq Health Sector Coordinator-NE Nigeria Technical Officer- Health Sector martinezj@who.int shafiqm@who.int Mobile Mobile: