Diarrhoea Outbreak
JULY 30, 2009
(12/2009) Nepal Diarrhoea Outbreak
DETAILS OF THE EMERGENCY
A diarrhoea outbreak has badly affected some hill districts in the mid- and far-western regions of Nepal. The first case of diarrhoea was reported in Rokaya Goan of Jajarkot district on 3 May 2009. The epidemic has now spread to 18 hill districts – Achham, Baitadi, Bajura, Bhajang, Dadeldhura, Dailekh, Dang, Dolpa, Doti, Jajarkot, Jumla, Kalikot, Kanchanpur, Pyuthan, Rolpa, Rukum, Salyan and Surkhet. According to a UNICEF report around 100,000 families of 100 Village Development Committees (VDCs) are affected.
It is estimated that 16,407 people are suffering from diarrhoea in the nine most affected districts of mid- and far- western Nepal. According to the media reports, the death toll has reached over 200. The death toll in Jajarkot alone, which is a neighbouring district of LWF Nepal working area, has reached 143. The deaths are mainly attributed to lack of clean drinking water, poor sanitation and hygiene, lack of medicine, nutrition and health personnel. Availability of water and latrine coverage is low in the affected areas.
Access to all affected areas remains a challenge, as most of the areas are remote and only accessible by 1-3 days walk. This has hindered access for distribution of supplies to the households and medical assistance, with many patients dying before getting any treatment. According to reports, the majority of the population in affected villages are suffering from diarrhoea.
ACTIONS TO DATE AND EMERGENCY NEEDS
The Epidemiology and Disease Control Division (EDCD) of the Government of Nepal, the Nepalese Army, WHO, UNICEF and some international and national NGOs are providing relief supplies and education materials to the affected districts. Some of them have also deployed medical teams to the affected districts.
Local organizations, clubs, I/NGOs, UN agencies and Government officials have started distribution of personal hygiene kits and information, Education Communication (IEC) materials. These IEC materials focus on personal hygiene and public health. These activities are mostly concentrated in Jajarkot and Rukum districts. Responses in other districts are minimal. In the coordination meetings at local and central level attended by ACT/LWF Nepal confirmed that the gap between the need and the supply is enormous.
There have been reports in the media that health personnel have fled sub-health posts in Majhakot VDC of Jajarkot district after becoming affected with diarrhoea. Similar incidents were also reported from other districts. According to local correspondents, members of satellite medical teams have also fled the villages for fear of getting infected.
PROPOSED EMERGENCY RESPONSE
The proposed rapid response is to meet the immediate medical and personal hygiene needs of the diarrhoea affected and at risk communities of Dadeldhura, Dailekh and Surkhet districts of mid and far west Nepal.
- OBJECTIVE(S) OF THE EMERGENCY RESPONSE:
Goal: the goal is to contribute to controlling the spread of diarrhoea through meeting health and personal hygiene needs of the most vulnerable communities.
- TARGET POPULATION:
Target Locations and number of families: ACT/LWF Nepal plans to assist 2,400 diarrhoea affected and vulnerable families. Out of the 2,400 families, 1,200 diarrhoea patients will receive diarrhoea medical kits along with a hygiene kit for the family members. The remaining 1,200 hygiene kits will be distributed to 1,200 vulnerable families in three hill districts of mid and far west Nepal.
ACT/LWF Nepal plans to intervene in Dadeldhura, Dailekh, and Surkhet districts. Dadeldhura and Dailekh are the ACT/LWF Nepal operational districts and Surkhet is the neighbouring district of Dailekh. The number of beneficiaries may differ based on the decision of IASC cluster, coordination meetings and ground needs.
Criteria for beneficiary selection: Poor and marginalized communities will be prioritised. Dalits (lower casts and untouchables) along with Haliya (ex-bonded labourers) are the focus groups among the population. However, women, children, the elderly and people with disabilities will be given due priority.
- PROPOSED ASSISTANCE:
ACT/LWF Nepal intends to address health and personal hygiene needs of the communities affected by the diarrhoea as well as those at risk. Proposed assistance will be reviewed and decided based on the field needs and in coordination with the respective District Disaster Relief Committee (DDRC) and other humanitarian actors on the ground. ACT/LWF Nepal may implement partially or all the proposed assistance based on the ground situation. Items and quantities will be finalized considering the guiding principles of Sphere.
Proposed activities include:
Health Camps: In coordination with District Public Health Office, Health Facility Management Committee, IASC clusters (where they exist), health camps will be organized in remote VDCs in the proposed districts, where an estimated 1,200 patients will receive treatment for diarrhoea. Severely ill patients will be given IV fluids and Antimicrobial agents (Metronidazole, Tetracycline, Amoxycillin) for treatment of specific causes of diarrhoea.
A campaign on personal hygiene and public health awareness will also be organized during the health camps. Various types of IEC materials will be utilized for mass awareness. Demonstrations on the importance of and how to wash ones hands correctly, preparation of Oral Re-hydration Solution (ORS) and chlorination of water will also be organized during the awareness campaign.
Medical personnel in the diarrhoea outbreak districts are minimal as many of them fled the villages fearing they would be infected. ACT/LWF Nepal do not have medical personnel in its existing team. Therefore health related personnel are proposed in this RRF. This team will be responsible for providing medical services and improving public health awareness.
Personnel hygiene needs: Each diarrhoea affected and at risk family will receive a personnel hygiene kit. Each kit comprises bathing soap, laundry soap, ORS, a water treatment agent and IEC materials. The quantities of each item in the kit will be finalized at IASC WASH cluster meetings and will be fully compliant with Sphere standards. Following are the proposed combination in each kit. Hygiene kits will be distributed to 2,400 families.
Average family size 5.5
- Bathing soap - 250 gram per person per month (1.375 kilogram per family)
- Laundry soap- 200 gram per person per month (1.100 kilogram per family)
- ORS- 15 packet per family
- Water treatment agent- 4 bottle per family
Social mobilization: Lack of clean drinking water, poor sanitation, hygiene and minimal access to the health services are the main reasons for the present diarrhoea outbreak. Open air defecation further aggravates the situation. Taking all this into consideration, it is planned to mobilize social volunteers at village level to create awareness related to personal hygiene and public health. The volunteers will also help bring patients to the nearest health centres/health camps. Through regular home visits the volunteers will also educate households on maintaining personnel hygiene, use of water treatment agents and promotion of safe human excreta disposal. These volunteers are residents of the respective districts and will be selected from the Nepal Red Cross and district based NGOs and CBOs.
- IMPLEMENTATION ARRANGEMENTS:
ACT/LWF Nepal will implement this RRF in close cooperation and coordination with respective District Public Health Office and Health Facility Management Committee. District Disaster Relief Committees (DDRCs) will also be consulted for guidance and support. District chapter of Nepal Red Cross and local partners will be mobilized for sound effective social mobilization. If needed, an MoU will be signed with the concerned authorities. ACT/LWF Nepal will activate its Emergency Response Teams (ERTs) in each district. The Health and HIV/AIDS Manager of ACT/LWF Nepal will take full responsibility to provide technical backstopping to this RRF. The Program Coordinator and Emergency Response and DRR Manager will provide support in project Management and the Finance and Admin Coordinator will take care of financial management. The Country Representative will provide guidance and support when required.
- COORDINATION:
Being an active member of the Disaster Preparedness Network, Association of INGOs in Nepal, OCHA contact group and various IASC cluster groups, ACT/LWF Nepal will implement the RRF with full co-ordination with these forums. At the national level, ACT/LWF Nepal will ensure coordination and visibility through the national level coordination forum. At the district and field level, ACT/LWF Nepal will ensure coordination and visibility through the District Public Health Office, Health Facility Management Committee, District Development Committee (DDC), Village Development Committee (VDC), IASC clusters (where exist), and various networks.
- COMMUNICATIONS:
ACT/LWF Nepal Communication and Documentation Manager is the main communicator for the Emergency Response Team as well as for communication and media coverage. ACT/LWF Nepal will ensure compliance with ACT guidelines and procedures for communication.
