ZIMBABWE HEALTHCLUSTER MEETING

Harare, Zimbabwe

Date:9 April 2013 Venue: WHO Annex Boardroom, Parirenyatwa Hospital Grounds

Chair:Dr L Charimari – Health Cluster Coordinatorai Time: 2.30 p.m.

Agenda Item / Discussion / Follow up Actions
Welcome and Introductions
Welcome Remarks
Minutes of the Last Meeting /
  1. The Chair welcomed all to the April 2013 Health Cluster meeting.
  2. Apologies were received from Dr D Okello, WR, WHO Zimbabwe , Dr P Manangazira – Director, EDC- MoHCW.
  3. Introductions round the table were done.
  1. Since the last meeting there have been reports of cholera cases in Beitbridge and Chiredzidistricts as well as suspected cases in Harare. More on this topic to come under the Epidemiological Update.
  2. Our South African counterparts have had no new cases since the last cases reported.
  3. Emphasis on surveillance and preparedness on any disease outbreak was stressed.
1.Corrections: Page 8 – List of attendance. Dr Isaac Phiri’scellphone number should read 0772810580.
2.Follow up issues – Page 3, Point number 12 – The National RRT went to Beitbridge to give support. They responded to cholera in Shashe and attended to some suspected cholera cases in Beitbridge. MSF was said to be giving a lot of support in the area.
3.Page 4 – ERF proposals were being coordinated by the HC Lead.
4.Page 5 & 6–More on malaria outbreak response by partners to be reported under item no. 4 on the agenda.
EPI Update
By Dr I Phiri – EDC (MoHCW) /
  1. Highlights for Week 13 were:
24 new suspected typhoid cases
3 new suspected cholera cases
10 diarrhoea deaths
4 suspected anthrax cases
21 malaria deaths
1 suspected AFP case
  1. Typhoid–Of the 24 new suspected typhoid cases reported in week 13 - 14 were from Chegutu district, Mashonaland West province; 6 from Chitungwiza Central Hospital and 4 from Parirenyatwa Group of Hospitals. The cumulative figure for typhoid since October 2011 was 6,883 suspected cases, 267 confirmed cases and 7 deaths.
  2. Cholera – Three new suspected cholera cases were reported this week (week 13). 1 case was reported from Harare Central Hospital 2 from Bulawayo City. Investigations to establish whether they were positive or not still underway. The cumulative figure for cholera was 4 confirmed cases and 3 suspected cases. Cholera cases in Chiredzi now 4 with 1 confirmed and 1 in Beitbridge and 2 suspected cases in Harare. The two tested in Harare tested negative.
  3. Common diarrhoea - Total cases reported this week were 7,949 cases and 10 deaths. 3,931 (49.4%) and 4 deaths were from the under five years of age. The deaths were reported from Buhera district (2); Chimanimani district (1); Chipinge district (1) all in Manicaland province. Harare Central hospital (3); Chitungwiza Hospital (1); Mpilo Hospital (1); and United Bulawayo Hospitals (1). Provinces with the highest number of diarrhea cases were Manicaland (1,331) and Mashonaland Central (998). The cumulative figure for diarrhea was 130,876 and 93 deaths (CFR 0.07%).
  4. Dysentery –Clinical dysentery cases for this week were 664 and one death. 208 (31.3%) and no deaths were from the under five years of age. The death was reported from Mutasa district in Manicaland province. Manicaland (116) and Mashonaland Central (131) had the highest number of dysentery cases. The cumulative figure for dysentery was 14,744 and 11 deaths (CFR 0.07%).
Malaria – A total of 19,536 malaria cases and 21 deaths were reported this week. Of the cases reported 3,417 (17.5%) and 5 deaths were under the age of five years. The deaths came from Harare Hospital (1); Parirenyatwa Hospital (1); Mutoko district (2) in Mashonaland East province; Makonde district (2) in Mashonaland West province; Mwenezidistrict(1), Chiredzi district (1) both in Masvingo province; Buhera district (2), Chimanimani district (3), Mutare district (6) all in Manicaland province; Chirumanzu district (1) in Midalands province and Bindura district (1) in Mashonaland Central province. Manicaland (8,393) and Mashonaland Central (4,409) reported the highest number of cases. The cumulative figure for malaria was 199,697 and 111 deaths (CFR 0.05%).
  1. Anthrax –4 suspected cases of anthrax were reported this week. Cases from Buhera district (3) and Chipinge district (1) both in Manicaland province. The cumulative figure was 68 and 1 death.
  2. Dog Bites - A total of 377 dog bites cases reported this week. Of these 27 cases were inflicted by vaccinated dogs. Vaccination status of 350 dogs was unknown. Manicaland (70 and Midlands (59) reported the highest number of dog bites. Cumulative figure for dog bites was 5,680.
  3. Rabies – No new suspected rabies cases this week. Cumulative figure for rabies was 4 cases and 4 deaths.
  4. Snake bites – Total snake bites this week was 77 and no deaths. Cumulative figure was 1,475 and 7 deaths.
  5. Influenza –Total of 6,815 influenza cases were reported this week. Cumulative figure was 75,770. No cases of pandemic influenza A (H1N1) reported since week 44 of 2010.
  6. Measles – 8 new suspected cases of measles were reported this week through the Weekly Disease Surveillance System (WDSS). Cumulative figure was 67. One Igm positive case of measles was reported from Marondera district through the Case Based Surveillance System (CBSS). Cumulative figure for suspected measles was 158.
  7. AFP/Poliomyelitis – One new suspected case of AFP was reported this week through the (EDSS). Cumulative figure was 4. 35 new suspected cases of AFP were reported this week through the Case Based Surveillance System (CBSS) . Cumulative figure was 57.
  8. Meningococcal Meningitis – No suspected cases were reported this week. Cumulative figure was 1.
  9. NNT – No new suspected cases reported this week through the WDSS, Cumulative figure was 1. No news cases reported this week through the CBSS. Cumulative figure was 2.
  10. National Completeness – for week 13 marginally decreased from 85% to 84% and timeliness also dropped from 85% to 84%. All provinces and Central hospitals reported.
  1. Points to Note:
  • Harare City was still testing cases of typhoid. This was also being done in Chitungwiza although not all cases are tested as is the practice in an outbreak situation – this was in response to a question asked by one of the members.
  • It was pointed out that CDC assisted Harare City in the collection of samples for lab testing. However their concern was the collection of incorrect quantities of sample fluids.. This would impact negatively on the outcome of the results. This, it was pointed out was as a result of the inadequacy of trained staff in case management, hence the need to train more health staff.. Support from partners was being sought in this regard.
  • It was however noted that weekly Typhoid Preparedness and Response Taskforce meetings take place in Chitungwiza.ChitungwizaCity Health were provided with clear guidelines on how to collect samples for laboratory testing. What was needed was to follow up on whether these guidelines were being followed.
  • It was also noted that if the right size syringe was provided to collect samples it would be easy to do so.
  • Also noted that in Chitungwiza a number of on the job case management trainings were carried out by partners in the area.
  • Over the past 3 years WHO and MoHCW have been carrying out case management trainings for health workers in the country. There are however still some gaps as in some cases the trained staff leave for greener pastures, leaving behind untrained staff.
  • The Department of Epidemiology and Disease Control (EDC) in the Ministry of Health & Child Welfare have plans to train health personnel in IDSR as well as case management. They were working on the budget and will be glad to receive assistance from partners.
  • OCHA was ready to support in Case management trainings if a proposal were submitted.
  • It was noted cumulative figure on typhoid dates back to October 2011, and this was misleading. A question was raised on whether this was one continuous outbreak or there were several outbreaks. The response was typhoid has been going on although in some areas it was going down, but the outbreaks continued since October 2011.It would be more informative if cases were separated for 2011, 2012 and 2013.
  • The house sought to know if there were malaria outbreaks in in the country? It was highlighted that there weredefinitely malaria outbreaks in some districts of Manicaland, Mashonaland Central and mashonaland West provinces. The provinces was in crisis considering the numbers of malaria deaths.
  • Daily reports from affected provinces are received if there is a disease outbreak. The EDC was in touch with some provinces on a daily basis e.gMasvingo. Dr Charimari will get in touch with Save the Children to get information on what is happening in Masvingo and this information will be shared.
  • It was pointed out that if the media is denied information on disease outbreaks, they go ahead and get it from unreliable sources and publish incorrect stories on the outbreaks. . To avoid incorrect information being published a special update for the media should be prepared regularly for their information. This would also help to educate the public.

Partner Response to Malaria Outbreaks / 1.United Methodist Church
Contacting PMD Mashonaland Central to get threshold for Mt Darwin
Submitted proposal for training of Village Health Workers and Village Heads in malaria case management in Mt Darwin district.
United Methodist Health Board
Had a meeting with other partners regarding malaria control. Will give hot spots in Manicaland. Plan International on the ground in the province.
To train Village Health Workers in malaria case management.
2.Plan International
Had a meeting with other partners. Also met with the provincial team to identify their malaria hot spots and requirements for emergency response interventions..
Mutare district noticed high number of malaria cases and deaths beginning week 3 of 2013. The whole district is affected.
Most burdened areas are Burma Valley, Gutaurare, Chitora, Mutanda, St Andrews, Marange, Nyagundi, Chipendeke, Chitakatira and Bwizi. These had threshold values exceeded for weeks 5,6 and 7. The peak period of malaria outbreak was reached in week 6 though some centres are still reporting increasing number of cases.
Factors contributing to the malaria outbreak
  • Abundance of breeding sites after the recent heavy rains
  • Late health seeking behaviour resulting in complicated cases which leads to death
  • Use of multiple treatment regiments for malaria in Vumba area where there isillegallvending of anti-malarial medicines from Mozambique with instructions written in a foreign language not understood by locals. Resulted in irregular and inappropriate administration of dosages
  • Population movements from non-malaria transmission to endemic malaria transmission areas (Marange community)
  • Increased outdoor activities in some communities especially irrigation areas
  • Low Long Lasting Insecticide Treated Nets (LLINs) utilization.
  • Low Indoor Residual Household Spraying (IRS) coverage in some districts.
  • Heavy rains in some parts affecting accessibility to problem areas e.g. Chivhanga, Sagambe and Nyamukwarara.
Gaps
  • Ambulance services. In some districts no ambulance services running. Would need help in servicing the vehicles.
  • Critical staff shortage to cover all areas. Some staff have not been trained in IDSR and Case management
  • Weak community disease surveillance systems
  • High rate of untrained School Health Coordinators
  • Mobile communication systems poor in some areas
  • Inequitable distribution of malaria commodities – RDTs and ACTs are running low in some areas.
Interventions needed
  • Sensitization of the community focusing on need for early treatment. Most affected areas to be targeted.
  • IEC materials reproduction and distribution to schools and community
  • On the-job training of Village Health Workers on malaria case management very vital in order to reach every household. A large number of VHWs still to be trained. Plan International developed a proposal for ERF funding for this project.
  • School Health Coordinators’ training in malaria case management to cater for children falling ill while at school. A large number still to be trained.
  • Assist health facilities to calculate malaria thresholds for those with adequate data.
  • Redistribution of ACTs and RDTs from over stocked facilities to needy facilities and procurement/distribution of quinine. Procurement and distribution of Quinine, Clindamycin, Fansidar.
  • LLINs distribution as a personal protection measure for all households. Plan International distributed LLINs in Mutasa district. Managed to reach all wards except Nyamukwarara. Might distribute this week.
  • IDSR training for health workers to appreciate importance of data collection and use at local levels including use of thresholds for early detection.
  • Transmission verification in Mutare City and consideration for IRS implementation – vector surveillance.
  • Improvement in communication systems for RDN.
In a programme funded by CIDA clusters were formed in each village consisting 10 households each. These clusters are led by fathers/mothers who have regular meetings with VHWs to give updates.
IRC was going to do IDSR training in Manicaland. Partners wishing to do similar trainings should get in touch with them.
Vector Control assessment last done in 1982. There was need to carry out another assessment.
It was noted that the distribution of LLINs should be done before the rains rather than wait until the onset of rains. This, it was pointed out was attributed to the late arrival of the product. Also the household listing was not yet done to determine how many are needed.
Village Health Worker training materials should be standardized. It was pointed out that the VHW training manual was revised towards the end of last year to include all kinds of skills they will need. WHO supported the Ministry of Health in coming up with a complete VHW kit.
Draft manual on malaria is also available. Will look for it and make it available to partners.
Targetted IRS – there was a hitch on financial support for allowances of the spray operators. / To share with members updated VHW training manual as well as draft manual on malaria. – HC Lead
OCHA Update / 1.ERF received project proposals from (1) UMCOR (2) IOM; (3) Plan International and (4) Save the Children – (to address malaria outbreaks in the most affected districts).
2.Would discuss with the Health Cluster Lead the possibility of submitting one consolidated proposal.
3.Humanitarian Appeal – normally done in May – July. Deferred to now start in July.
4.80% funding is for the food sector.
5.Humanitarian Appeal funded a total of 59% most of it for food. 20% was for health. ($4,990m) of which 1 million funded for a health project under UNICEF. In the coming weeks health percentage will increase.
Any Other Business /
  1. There was need for partners to be vigilant especially on malaria, typhoid and cholera.
  2. The next Health Cluster meeting will take place on Tuesday 14thMay 2013.
  3. The meeting adjourned at 16.15hours.

Minutes compiled by: Mrs Regina Chipo Mutanhaurwa – WHO
Distribution: All Health Cluster members

List of participants – Health Cluster Meeting – 9 April 2013

NAME / ORGANISATION / EMAIL ADDRESS / TELEPHONE
1 / Dr Lincoln Charimari / WHO / / 0772277893
2 / Regis Magauzi / USAID/PMI / / 0772134104
3 / PanganayiDhliwayo / CDC/Zimbabwe / / 0772129119
4 / Dr Isaac Phiri / MoHCW/ HQ / / 0772810580/0774368240
5 / Florian Vogt / MSF Spain / / 0778912865
6 / Forster Matyatya / The Johanniter International / / 0772154183
7 / Hannah Mafunda / United Methodist Church Health Board / / 0774186750
8 / Patience Panganai / MCHIP / / 0772140950
9 / Benoit Pylyser / OCHA / / 0772125282
10 / Stephen Maphosa / WHO / / 0772279259
11 / SiyengiweSibanda / Help from Germany / / 0712877472
12 / Wilson Chauke / Plan International / / 0779809824
13 / Tinashe Dhobbie / MoHCW/EDC / / 0772328175
14 / Blessing Muchemwa / ECHO / / 0772720198
15 / RatidzaiMachwira / ZCBC Health Commission / / 0772312868
16 / Never Dodzo / Sysmed International / / 0774040396

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