Ethiopia Technical support feedback report on acute watery diarrhea outbreak Reporting period: 06-16/08/2006 Area: Guji zone, Oromia regional state Prepared by: Dr Desta Abunu Private consultant 0
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Table of contents Introduction 3 Background situation of Guji zone 4 Water and sanitation 0 Gaps identified and technical support provided 0 Stakeholders involved in the epidemic prevention and control interventions 1 Challenges encountered 1 Cross cutting issues that needs consideration in subsequent assignment 2 Opportunities 2 Conclusion 2 Recommendations and next steps 3 Appendix 4 2
Introduction Outbreak of acute watery diarrhea established itself in West Arusi zone of Oromia regional state around the middle of June. Soon it affected south regional state and showed itself up in Guji zone of Oromia regional state in space of less than one month. The first index case of Guji zone was from Adola woreda of Guji zone who visited treatment centre in adjacent woreda (Arbegona) of south regional state on 20th of July. Immediately south regional state health bureau communicated the case to Guji zone and Oromia regional state health bureau. As the investigation and diagnosis of AWD epidemic was already established in south regional state, mobilization of emergency response in area of case management, water and sanitation and public education on one hand and revitalizing emergency response teams at different levels initiated in Guji zone shortly with available resources. Geographic inaccessibility, shortage of human resource and supplies, low health coverage and poor water and sanitation situation started to challenge the interventions from the very outset. The Guji zone health department and administration requested official assistance from stakeholders. Oromia regional health bureau and government officials paid high level visit to assess the situation in Arusi zone and Guji with stakeholders like WHO, UNICEF and others. During the visit working assessment of the overall situation and intervention gaps appreciated. Accordingly gaps in areas of supply, human resource, community mobilization, coordination and water and sanitation identified and stakeholders' resource and technical support called for. This report tries to summarize activities carried out to redress these shortfalls. 3
Background situation of Guji zone Woreda 12 Kebele 317 Household 228,387 Total Population 1141936 Male 576784 Female 600326 Rural 1059399 Urban 117711 Under Five 91355 Health Coverage 46 Health Centres 6 Hospital 1 Health Posts 53 DPT3 Coverage 40.8% Sanitation Coverage 17 Potable Water Coverage 16% Bank present in Bore, Kibremengist, Shakiso, Negele towns All weather road Network in Km 510km Minimum number of cases anticipated in Guji zone with assumption that case fatality rate is 0.5%: 5700 Guji zone population profile by Woreda 1998 S.no Woreda Total Population Kebele 1 Adola and Girja 149941 66 2988 2 Bore 162987 61 32597 3 Kercha and Hamballaa Wamana 207602 4 Liben 161665 5 Negelle Borena 36085 6 Shakiso 154455 7 Uraga and Daamaa 231712 8 Wadera 37489 25 7498 13 Total 1141936 228387 Affected Woredas' are highlighted with the red HH 4
Distribution of affected population by Woreda and kebele in Guji zone until 16/08/2006 S. no. of Woredas' Affected Woreda's and Kebeles' Population 1 Adola Woreda Oda Buta 4778 Dilalesa 2444 Melka Shali 3867 Bechera 3698 Chambe 5412 Michicha 3123 Abulo 3664 Adola Total 26986 2 Bore Woreda Saye chichu 1375 Boltu Girisa 1727 Rovele 3718 Anole wate 2407 Bore T. 9227 3 Wadera Kune Anu 1423 Kune Ulaulu 3038 Borema Gaeso 1927 Wadera Total 6388
4 Girja Kabanawa 3930 Wole megado 2033 Genale Korcha 4341 Herenfema 425 Girja Total 10729 Guji zone Total 53330 Index case is reported from treatment centre situated in south region (adjacent region to Oromia regional state) A week (06-13/08/2006) trend of cumulative cases, deaths and case fatality rate of AWD in Guji zone of Oromia regional state cumulative number cumulative number case fatality rate Remark of cases of deaths Guji zone 1650 44 2.67% due to inaccessibility of most affected areas flow of information is erratic 1
Spot map of AWD cases in Guji zone during the reporting period Almost of all cases are clustered along the river bank The name of the river is called Genale and majority of population along the bank depend on it and its tributary as their source drinking water
Water and sanitation Potable water coverage of Guji zone is just 16% Latrine coverage of Guji zone is just 17% The remaining members of the community depend on river water and open field defecation Gaps identified and technical support provided Management and coordination of epidemic intervention was ad hoc type at the beginning o Facilitated establishment of two layers of working team with administrative and technical responsibility respectively Lack of simplified field guide for planning and intervention o adapted technical field guide for managerial and technical frontline staff to facilitate action oriented intervention (see appendix 1) Action plan was not developed to streamline intervention and mobilize resource based on priority needs and actions o facilitated preparation of action plan for resource mobilization and intervention (see appendix 2) Irregular and inconsistent flow of information o conducted a series of field visits to identify gaps and give technical advice o provided them with recording and reporting formats adopted from surveillance guidelines o initiated monitoring and supervision checklist to encourage checklist based supportive supervision) Exhaustive and less focused daily review meetings o designed review meeting format to increase efficiency and effectiveness of review meetings
Stakeholders involved in the epidemic prevention and control interventions Besides, WHO there were several other non governmental and governmental NGOs involved in the different facets of the intervention. UNICEF: providing medical and non-medical supplies MSF: conducting assessment to assist in the preventive and control interventions Oromia regional health bureau: conducted high level official visit to Guji zone with leadership of bureau head. on top of that the bureau assigned three senior staff and three vehicles. Water sector of Oromia regional government along with its zonal counter part were providing technical support Almost all wings of zonal government sector offices involved themselves in the prevention or control efforts. Negele Nursing School hospital participated actively in the intervention. They deployed 89 students by closing the school temporarily. Members of top management of the college also actively participated in allocating vehicle and supervisory support. Through the technical support obtained from the above stakeholders death rate arrested though of incidence of cases is growing with reduced rate. Challenges encountered Inaccessibility of different kebeles with treatment centres by car or motor bike was a critical challenge that hindered flow of information and knowledgeable decision making. Usage of pack animals is being enforced to address the problems. But the problem is still lingering due to the rainy situation. Shortage of manpower at early stage: technical support from Oromia regional health bureau and other stakeholders like WHO, deployment of students from Negele Nursing School somehow resolved it Coordination and management shortfalls: high level official visit from Oromia government and regional health bureau facilitated revitalization of emergency response activity. WHO consultant in collaboration with Oromia regional health 1
bureau and Zonal health department adapted emergency response field guide which tries to format coordination and management approach that identifies duties and responsibilities administrative and technical teams. Medical, non-medical supplies transport and logistics were major problem at the beginning. However transport and supply backup from Oromia regional health, UNICEF and zonal sectoral departments reduced the challenge. Water and sanitation: low coverage of potable water and latrine coverage is inconveniencing prevention and health promotion efforts. Presently the supply of pure water maker is in short and there is no other water treatment intervention in the country side. Community mobilization and public education: absence of IEC material and inaccessibility of affected Kebeles posed unprecedented challenge. However Key message coined from standard AWD guideline is being circulated indifference of affected or unaffected communities through local administration leaders, community health professionals and health professional proper as well. Cross cutting issues that needs consideration in subsequent assignment Transportation: though the driver assigned has been friendly and cooperative, the vehicle rented had several problems related to start up, clutch and speed. Communication and stationary, computer and printer services were not considered at the time of contractual agreement and in the field necessitated expenditure from personal pocket Absence of petty cash: Joint field assessment needs active participation of zonal health officials but they are inconvenienced by shortage of DSA at their treasury. I also could not support their field subsistence needs Opportunities Active and generous financial, material and technical support of different stakeholders Political commitment at regional, zonal and woreda levels in most cases Conclusion The management and coordination, supply and human resource shortfalls encountered in the beginning of the outbreak is being brought under control with stringent involvement of different stakeholders from inside and outside Guji zone. Though it was possible to 2
bring case fatality rate under control in time, incidence of cases continued with reduced incidence rate due to difficult sanitation and water conditions. Public education and community mobilization in the area particularly of safe water, sanitation and food preparation and handling is bearing fruits with progress of intervention. Poor flow of information due to inaccessibility of most affected kebeles is challenging objective and knowledgeable assessment of situations on the ground. Besides that poor potable water and latrine coverage is demanding more resource in the area of public education and water cleaning. Regarding case management reasonably fair supply of drugs and supplies reaching community treatment centres except ampicillin and some camping items indicated in the supply request plan. With objective background situation prevalent in Guji zone, the intervention and attending results are promising. If the technical and material support continued unabated the intervention will contain the outbreak in short time and give momentum to sustainable initiative in water and sanitation area and epidemic preparedness and prevention. Recommendations and next steps Capacity building in area of epidemic preparedness and prevention Inculcation of generic concepts and practical experiences in areas of common epidemic emergency condition and diseases Financial and material support to push through the current crisis is of immediate importance as indicated in the action plan Maintenance of regular follows up of the situation on the ground provides problem solving advices and supports Conducting high level technical review meeting to generate policy ideas and share experience for future preparedness and epidemic prevention Better vehicle rental and consideration of petty cash for stationary and computer service as well as subsistence allowance for zonal staff at government rate could boost field activity with regard to consultancy service 3
Appendix Adapted draft guide for field implementation of prevention and control of AWD epidemic Action plan indicating Guji zone's AWD outbreak resource requirement Map of Guji zone broken into Woredas' showing road networks as well 4