Cholera outbreak management amongst a Sudanese refugee population, Uganda' - PowerPoint PPT Presentation

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Cholera outbreak management amongst a Sudanese refugee population, Uganda'

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Title: Cholera outbreak management amongst a Sudanese refugee population, Uganda'


1
Cholera outbreak management amongst a Sudanese
refugee population, Uganda.
  • Nasur Mwonge Lubega
  • Ann Burton
  • International Rescue Committee Uganda Program
  • Interagency Environmental Health Conference,
    London 8-9th January 2004

2
Objectives
  • Appreciate the importance of factors other than
    the provision of clean water in the transmission
    of cholera.
  • Have a greater understanding of the multiple
    factors involved in cholera prevention.

3
Background
  • Approximately 200,000 Sudanese refugees in Uganda
    in over 20 camps.
  • Most camps are in the care and maintenance phase.
  • Kiryandongo was the exception to this.

4
Background
  • August 2002 LRA attacked the Achol-pii camp in
    northern Uganda.
  • 24,000 refugees fled and 16,000 were relocated to
    Kiryandongo.
  • Kiryandongo was already home to 14,000 refugees.
  • Two distinct caseloads.
  • From the beginning the government had planned to
    relocate the 16,000 Achol-pii refugees.

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Background
  • Conditions in Kiryandongo were highly conducive
    to a cholera outbreak.
  • Average of 4.5m2 of land per person in new
    caseload.
  • 6.75L/person/day of water.
  • Latrine coverage 55 persons per stance
  • Cholera reported in another Sudanese camp in
    January 2003.

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Preparation
  • Surveillance
  • Laboratory and medical supplies
  • Chlorination
  • Health education

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Despite these measures3 suspect cases of
cholera were identified on the 10th of June 2003.
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Response
  • Notification
  • Confirmation
  • Mobilisation and sensitisation
  • Active case finding
  • Water and sanitation activities.
  • Case management
  • Data collection

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Notification
  • Relevant district health authorities
  • Camp administration
  • UNHCR

13
Confirmation
  • Stool specimens taken from seven patients.
  • Three cultured Vibrio cholerae O1 Ogawa
  • Sensitivities reported.

14
Mobilisation and sensitisation
  • Inter-sectoral task force formed.
  • World Refugee Day meal and school feeding
    cancelled.
  • Community health education using CHWs and
    community volunteers.
  • Market food stalls targeted for education on safe
    food preparation techniques.
  • MoH film van showed films every night attended
    by 1000-2000 people for four nights.

15
Active case finding
  • Case definition broadened to
  • A patient aged gt 5 years develops acute watery
    diarrhoea ( or vomiting).
  • CHWs referred cases from the community.

16
Water and sanitation related activities
  • Chlorination of jerry cans extended to all 35
    water points
  • All water points tested coliforms found to be
    lt10/100ml
  • Water bladder constructed in high density area
  • Latrine construction expedited.

17
Case management
  • Temporary cholera ward opened in a tent.
  • Followed WHO recommendations
  • Emphasis on rehydration
  • Antibiotics for severe cases only.
  • Vitamin A to children.

18
Data collection
  • Line listing of all cases started.
  • Outbreak described in Person, Place and Time.
  • demographics (age, sex).
  • area of residence.
  • date of onset.
  • risk factors (latrine access, water source,
    chlorination of drinking water).
  • outcome.

19
Epidemiology
  • 92 cases reported over 12 weeks.
  • 3 deaths - CFR of 3.3 (2.2 in treatment centre)
  • 5 cases nationals
  • 63 female
  • Most cases came from highly congested areas of
    the camp where latrine access and water supply
    were poor.
  • First ten cases came from neighbouring houses.
  • 8.6 (8 ) of cases were acquired from the health
    centre.

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Factors favouring cholera transmission.
  • Inadequate water supply
  • Poor latrine coverage
  • Firewood shortage
  • Lack of non-food items

27
Inadequate water supply
  • An average of 6.75L/per person per day in the new
    caseload.
  • Proper hygiene measures such as hand-washing and
    utensil washing not able to be practiced.
  • Improving water supply very challenging in this
    caseload.

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Poor latrine coverage
  • The more people sharing a latrine the greater the
    risk of contamination.
  • Using a latrine may have been a risk factor for
    transmission.
  • Latrine coverage problematic due to population
    density and uncertainty over the move.

30
Firewood shortage
  • 35,000 people competing for firewood
  • Stoves were not fuel efficient- firewood used
    very quickly.
  • Reheating food difficult
  • Mozambican refugees- shown that the greater the
    number of times households cooked per day the
    less the risk of cholera.

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Lack of non-food items
  • No non-food items (jerry cans, plates, cups,
    cooking pots) distributed.
  • Soap only distributed once the outbreak started.
  • Major contributing factor to poor food-handling
    and water storage practices.

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Key lessons
  • Heightened surveillance meant that cases were
    detected early.
  • Chlorination probably limited the extent of this
    outbreak.
  • Hygiene promotion also includes creating an
    environment conducive to behaviour change.
  • Water quantity vs water quality.

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