The Following report is compiled by the the Ministère de la Sante Publique et de la Population (MSPP) and PAHO, the Regional Office of the World Health Organization (WHO) for the Americas, coordinate the Health Cluster. MSPP Cluster Contacts: Dr. Claude Surena; Dr. Jean Hugues Henrys; PAHO/WHO Contacts: Dr. Dana van Alphen.
The security situation has presently improved in all regions of the country, but may deteriorate again, as the problems associated with last elections remain unresolved. The celebration of Carnival, which begins o Sunday in some cities, could potentially lead to an escalation of violence, but also may provide an opportunity for community mobilization for cholera prevention and to fight cholera-related stigma and discrimination.
As people are being moved from camps, UNDP has proposed an interagency plan to find housing solutions, access to healthcare, water and sanitation for the thousands of families who will be located.
SURVEILLANCE AND ALERTS
On 24 January, 2011, the MSPP has reported a total of 209,034 cases of cholera, with 4,030 deaths.Based on the surveillance data, the epidemic in Haiti appears to be stabilizing. The number ofnew cases reported daily is sometimes smaller than those reported in previous days.
In rural areas, where access to health care and cholera prevention information is poor, health partners continue to report an increased number of cases. Surveillance reporting from rural areas remains poor. This could lead to a misinterpretation of the current trend of the cholera epidemic in Haiti.
Over the past two weeks, the average number of new hospital admissions was about 7,000 per week. MSPP, PAHO/WHO and CDC (US Centers for Disease Control) continue the investigation of four paralysis cases in cholera patients that occurred in the coastal city of Port-de-Paix. It is likely that polio will be dismissed as the cause of these cases. A final diagnosis depends on laboratory results. Experts are investigating the possibility that contamination has occurred in hospitals or in the patient‟s homes and may originate from medicines, food, or other sources. As a precaution, vaccine against polio was included in the vaccination campaign against diphtheria and measles in the department of the North West.
At the meeting of national epidemiologists held on 20 and 21 January, participants and members of a working group composed of MSPP, PAHO/WHO, Cuban Brigade, MSF, and CDC produced a new set of recommendations: health partners need to ensure the decentralization of collection and analysis of epidemiological data to the departmental level and help enhance the quality of information collected at the community level.
MONITORING THE CHOLERA RESPONSE
MSPP and PAHO/WHO will evaluate the operation of CTCs and CTUs. The initiative aims to better understand the disparity in the outcomes of various establishments, such as the differences in death rates among hospitalized patients, length of hospitalizations, percentage of patients treated with IV infusion and the proportion of severe cases.
The purpose of the evaluation is to assess the knowledge of cholera case management and adequate use of treatment and sanitation protocols. Any deviation from the recommended standard of care will be addressed quickly through staff training, clinical management, inventory management, waste management and sanitation.
The reports of 27 visits to health establishments in the West department were already sent to PAHO/WHO for analysis. Not all of them provide comprehensive information, such as the total number of beds, occupancy rates, average consumption of ORS sachets and IV fluids per patient, death rate, and number of deaths.
The majority of establishments seem to use proper treatment protocols and have procedures for organization, sanitation and hygiene. Inventories are generally enough for 30 days, with the exception of the ones experiencing stock-outs of ORS sachets. Community actions developed in the surrounding area, however, are not routinely linked with the establishments providing cholera care. The evaluation visits already helped to correct anomalies and improve patient care.
The roll-out of evaluations in other departments is underway, as part of an effort of MSPP teams at the central and departmental levels, PAHO/WHO, and the volunteer physicians from the Haitian Medical Association.
The description of the quality standards used o evaluate CTCs and CTUs and schedule of future assessments can be found on the following links: http://haiti.humanitarianresponse.info/LinkClick.aspx?link=Health+Cluster/Concept+de+surveillance+de+la+qualite+CTC.doc·&tabid=77&mid=757
Following the announcement of reduction of activities related to cholera by the humanitarian community (particularly NGOs), including the closure of some CTCs and CTUs, the MSPP and Health Cluster partners initiated a discussion about the handover of CTCs and CTUs to other partners or to the MSPP and local level health authorities. In the medium and long term, the strategy is to prioritize the establishment of “diarrhea units” in every primary health center and the training of health workers for the treatment of cholera.
Health partners were reminded last week about the critical importance of screening for severe acute malnutrition in children with cholera. A protocol is available in the Haiti Humanitarian Response website
Only USD 78,252,600 is yet available of the USD 906,961,206 requested through the 2011 Consolidated Appeal for Haiti. This represents 9% of the total amount asked from donor organizations.
HAITI HEALTH CLUSTER BULLETIN #16 –
An USD 20 million agreement for will be signed between Haiti, the Inter-American Development Bank and UNICEF, with the objective to lower the mortality rate from 2% to 1%. The project will focus on the Northwest, and Northeast departments.
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