Humanitarian Health Action

Zimbabwe Health Cluster Bulletin No.16 1 - 15 July 2009

Latest information on health partners and health needs in the current crisis in Zimbabwe

Highlights:

Mothers and Caregivers queuing at Murara Outreach Site in Mutare
WHO/Zimbabwe
Mothers and Caregivers queuing at Murara Outreach Site in Mutare
  • 98 592 cases and 4288 deaths reported by 15 July 2009.
  • Tail end of the epidemic.

Cholera outbreak situation update

By 15 July 2009, the cumulative number of cases reported with cholera stood at 98 592 and 4288 deaths*. On the whole the epidemic seems to have reached its tail end. The cumulative crude case fatality rate now down to 4.3%. Of the deaths reported, 2631 occurred outside health facilities. 89% of the districts and all 10 provinces have reported cholera cases.

During the last two weeks, one case of cholera was reported in UMP. No cholera deaths were reported.

The number of districts submitting daily reports has improved overtime, with 100% reporting during the last two weeks.

A number of cholera cases were denotified by districts during the last month, including Chimanimani (Manicaland) due to double reporting.

Visit to the John Marange annual convention-Chipiro (Mufararikwa ward)

by P.Mathenge and R. Shanzi, UNICEF

From 07-08 July, a UNICEF team (WASH and Hygiene promotion consultants) carried out an assessment visit to the site of the John Marange Apostolic sect annual convention. The purpose of the visit was to;

  • To assess the water, sanitation and hygiene situation at Chipiro village where there is an ongoing annual gathering for the apostolic faith sect.
  • To deliver supplies for use in case of an outbreak of diarrhoeal diseases and especially cholera.
Background

Chipiro village is located about one hundred kilometres from Mutare town in Chief Marange area. It is the centre for major John Marange Apostolic church gatherings and attracts followers from all parts of Zimbabwe as well as from other SADC countries. The village has over 11 000 people, 90% of whom are part of the sect. It was hard hit by the cholera epidemic resulting in the Ministry of Health setting up a cholera treatment centre there.

The ongoing meeting started on the 1st of July and will end on the 20th of July. The gathering is expected to attract up to 100 000 people.

Findings

On the day of the assessment visit was when all other members were arriving as prior days were for church leadership. About 10 000 people had already gathered with women and children constituting about 70% of the group. The church venue covers a stretch of between two and three kilometres.

Health and Water, Sanitation & Hygiene (WASH)

It was reported that there are eight motorized boreholes at the site but only one was seen by the team. The borehole water is pumped into a water tank whose capacity is estimated to be 100 000 litres and five other 5000 litre tanks. Water then flows by gravity to seven places (having from one to eleven taps) where there are stand pipes. Some of the stand pipes are not yet in use as connection work still has to be completed. Long queues of mothers and children were seen at some stand pipes signifying a high demand for water. Some mothers were seen washing clothes and bathing children at the nearby river which is also a source of water for other communities down stream.

Single, double and multi-compartment Blair latrines are provided at the temporary homestead and at the church assembly point. There are people from the congregation who are responsible for cleaning the toilets every day as well as monitoring their use. No hand washing facilities were seen there.

Various committees had been formed within the congregation to take care of various portfolios including Health and hygiene, Water and sanitation, Security, Slaughter pole and Disease surveillance.

Eight Environmental Health Technicians (EHTs) from the Provincial Medical Director’s office in Manicaland are on the site and are also part of the committees. The EHTs carry out water quality monitoring, carry out hygiene promotion activities, meat hygiene and disease surveillance activities. They reported maximum cooperation in all areas except in disease surveillance. The sect members were found to be secretive about getting sick for fear of being referred for medical attention.

General hygiene and feeding practices

At the time of the assessment there was a lot of movement of people into the camp such that it was difficult to get a clear picture of the situation. Each family (wife) prepares food on their own and take turns to send food to the husbands who stay at a separate place. It was noted that the run to waste method of hand washing is practiced before meals. Household waste is disposed of in hand dug pits.

There is a slaughter pole at site where animals an average of twenty cattle are slaughtered per day and meat inspection services are provided by the Environmental Health Staff.

There were clear indicators that people were not washing their hands with soap, for example whilst eating with the leaders, water for hand washing was offered without soap. This observation was confirmed by the EHTs.

Other Issues
Ministry of Health & Child Welfare meeting with the Apostolic Faith Mission Leaders

A closed door meeting between the Minister for health and Apostolic leaders was held recently. During the meeting, the minister explained his concern about their resistance to health interventions, notably cholera treatment and response which may have led to high case fatalities. He indicated that the government has a right to enforce the public health act by all means. By all indications, the leaders were receptive to the minister’s call and agreed to work closely with the ministry of health and to have some of their followers work at community level. The religious leaders however expressed the concern that they are not involved in planning of programmes for their communities and urged the government and others to consult them at all stages.

  • Child health: The team observed a number of children with scabies, ring worms and protruding stomachs indicating possible worm infestation.
  • Education:Children will not attend school this month and will miss final exams for this term.
  • Opportunities: The gathering is an opportunity to request for catch up immunization, Vitamin A supplementation and de-worming for children.
  • Threat: there is a high risk of spread of diseases – if cholera or H1N1 hits the camp, it will be a major disaster with possible spread in the whole country.
Recommendations
  • The leadership needs to work on increasing the number of stand pipes at the camping area. Hand washing facilities need to be put at all the existing toilets.
  • There is need to support the EHTs working at the site with fuel to carry out their activities smoothly.
  • There is need to also send soap for distribution to the members through the leaders and EHTs to promote hand washing and personal hygiene – at least 50 000 bars.
  • Liaise with Plan International, IRC and other NGOs operating in the area to also look at the needs of the community down stream where a lot of dirt is being washed. There is a high risk of spread of infection.
  • Increased advocacy among the community to dispel beliefs that cholera is not caused by poor hygienic habits and unsafe water. In the course of the advocacy, respect for the group’s doctrine must be maintained.
  • Health and WASH clusters need to be prepared for any eventuality.

Report on National Immunisation Days campaign

by R. Matema, Specialist EPI officer, UNICEF and Mary Munyoro, EPI officer, WHO

Zimbabwe conducted a national integrated measles, oral polio vaccination and vitamin A supplementation campaign from the 8th to the 19th of June 2009. The target population and age group was as follows;

  • Measles all children 9 – 59 months population 1 523 312
  • Oral polio all children <5 years population 1 796 973
  • Vitamin A all children 6 – 59 months population 1 614 532

The Honorable Minister of Health and Child Welfare, Dr Madzorera, officiated at the national launch on the 3rd of June 2009. The occasion was also graced by The Permanent Secretary in the Ministry of Health and Child Welfare, WHO and UNICEF country representatives, representatives from agencies such as Helen Keller Internal, World Vision, Rotary International, Private Hospitals, ZACH, Private Practitioners, The press, ZINA,ZIMA,OPHID. The Government of Zimbabwe (GOZ) contributed mostly in kind to the campaign that is provision of transport and all the health personnel, while WHO, UNICEF and other EPI partners provided both technical and financial support.

As routine EPI and outreach services were disrupted in 2008, the country decided to integrate the campaign with routine vaccinations to those children who were due or overdue. During the initial planning, OPV was not part of the campaigns but due to the on-going WPV transmission in Kenya and Uganda, it was found necessary to include OPV.

The national measles campaign coverage of 92% was lower than the 1998 coverage of 93%, and the 2006 coverage of 95%. Provincial/city coverage ranged from 72% to120%. National vitamin A coverage was 100% and provincial/city coverage ranged from 73%- 113%, while National OPV coverage was 93%, higher than the 2007 campaign coverage of 83 and 81% for the two rounds. Provincial/city coverage ranged from 73%-113%. An estimate of 1782 vaccination teams worked during the campaigns. There was an average of 3 trained nurses and 3 volunteers per team. Approximately 9626 health workers were vaccinating and about 5918 volunteers assisted during the campaign. Most of these volunteers were village community workers who moved from house to house inviting care givers to the vaccination posts.

Various strategies (outreach points, house to house visits, negotiations with some religious objectors) were put in place in an endeavor to reach the hard to reach children. A breakthrough was made with an increased number of religious objectors agreeing to have their children vaccinated. Volunteers/Mobilizers such as village health workers were encouraged to go from house to house using village registers to ensure that no children missed vaccinations.

1534 fixed posts were used as one of the vaccination strategies .These included all existing health facilities as well as major hospitals including all private hospitals. Mobile and camping teams visited all existing outreach points (4393) as well as newly established vaccination posts. House to house vaccinations were carried out in selected hard to reach areas and a total of about 5927 vaccination posts were set up nation wide.

Some of the major achievements for this year’s campaign are:

  • High political commitment as evidenced by participation of Minister and other Government officials and good collaboration with EPI partners such as WHO, UNICEF, Plan international, Rotary International, and Helen Keller International
  • Attainment of high coverage of 92% for Measles and 93% for OPV,100% for Vitamin A as a result of good advocacy, social mobilization, communication through production of electronic and print media.
  • Significant number of religious objectors agreed to have their children vaccinated.

News

The health cluster has formed a Strategic Working Group (SWG) to move the agenda of the cluster beyond cholera, to focus on broader issues in health including other communicable diseases, health promotion and health system recovery.

The working group has already agreed on benchmark indicators for the cluster and will agree on a strategy and work plan at its next meeting. It is expected to map partner interventions by both programme and geographical area and use this information to advocate for partner support in underserved areas. The group has a rotating chair and meetings are held every second Thursday of the month. Membership of the working group includes: ECHO, GOAL, IOM, OCHA, UNICEF and WHO.

Dr Chantal Umutoni has joined the Health Cluster as a Coordinator. Dr Olu Olushayo, who was acting Health Cluster Coordinator continues with his main role as Emergency Health Action focal point for East and South Africa. Dr Umutoni is formerly from MSF France.

For more information, please contact:

Dr Custodia Mandlhate,
WHO Representative to Zimbabwe
Tel: +263 4 253 724-30,
email: mandlhatec@zw.afro.who.int

Dr S.M. Midzi,
Director, Epidemiology & Disease Control
Tel: +26311878009
Email: smmidzi@yahoo.com

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