situation report on cyclone idai issue 0015€¦ · cyclone idai health sector response sitrep 1...

Cyclone Idai Health Sector Response Sitrep 1

SITUATION REPORT ON CYCLONE IDAI ISSUE 0015 Disaster Name Cyclone Idai Province affected Manicaland, Chimanimani, Chipinge

Date & Time of report 12.04.2019 1700hrs Response start date 16.03.2019

Prepared by MOHCC

1. HIGHLIGHTS

Early warning system daily reporting of facilities is 69% (23/33)

Training of OCV for district and provincial managers on 13 April followed by training implementers on 14 April 2019

The cumulative number of OPD consultations are 9,353 (3,212 Male and 6,141 Female) patients who have received care at the different health facilities since the health interventions for the cyclone were started

Significant cases of acute respiratory infection are reported daily

Supply of inhalers for asthma low and need to be beefed up, considering the setting in of the winter

2. BACKGROUND

Zimbabwe experienced torrential rainfall caused by Cyclone Idai from the 15th of March 2019 to the 17th of March 2019.Tropical Cyclone Idai which was downgraded to a tropical depression on the 16th of March 2019 caused high winds and heavy precipitation in Chimanimani, Chipinge, Buhera, Nyanga, Makoni, Mutare Rural, Mutasa and parts of Mutare Urban districts among other districts, causing riverine and flash flooding and subsequent deaths, destruction of livelihoods and properties. Chimanimani district was the most affected with two main centres having received the brunt of the cyclone, Ngangu Township of Chimanimani which experienced landslides and Ngangu growth point which experienced flooding. The immediate impact of the cyclone resulted in deaths of 181 people, with another 347 still missing. Those injured were 183, and they received immediate surgical care in the different health facilities across Manicaland Province. The Ministry of Health and Child Care is leading the health response to the effects of cyclone Idai with support from partners with overall guidance by the Civil Protection Unit at all levels. Focus has now shifted to ensuring continuity of health care, restoration of services and the prevention of outbreaks.

2.1 Coordination

Daily health coordination meetings are being held at PMD’s office and its being attended by all health partners.

The Ministry of Health and Child Care has developed a six month health response plan and is currently being implemented.

Three Midwifes from ZiCOM, deployed to Mutambara Mission Hospital

Development of OCV micro-plans at both Chimanimani and Chipinge with assistance from PNO, PHPO, Provincial EPI Officer, WHO, MSF and UNICEF representatives

3. EPIDEMIOLOGICAL OVERVIEW

3.1 Early warning alert and response Network.

Completeness of Reporting: Since the Early warning system was launched in the first week of April, 33 sites have been trained of which 23 are the existing health facilities and 10 are new satellite sites. Today 22 sites reported giving a completeness of 69%. Efforts are on-going to address challenges with the technology to enable all facilities to report. The trend of reporting is showing in figure below:


Figure 1: Daily Completeness of Reporting from Early Warning Sites in Chimanimani District

Acute Respiratory Infection (ARI), malaria, dysentery and diarrhoeal were 5 diseases/conditions that were managed on the 12th of April 2019 out of the 9 that are being monitored on a daily basis. A total of 79 ARI cases were reported by 19 out of the 22 health facilities which submitted their daily surveillance data in Chimanimani District. The incidence of ARI continues to be high in cyclone Idai affected areas where people lost their homes(Chimanimani Hospital, ARDA Rusitu, Mhakwe and Mutsvangwa ) as shown on the map (Figure 2 & 3). . Currently, there are no cholera, typhoid, AFP, measles and rubella cases reported.

Figure 2: Distribution of Priority Disease on 11 April 2019 (reported sites)

0%

20%

40%

60%

80%

100%

3-Apr 4-Apr 5-Apr 6-Apr 7-Apr 8-Apr 9-Apr 10-Apr 11-Apr 12-Apr 13-Apr 14-Apr

Co

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rtin

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Date

Daily completeness of Reporting from Early warning sites in Chimanimani District

Completeness(%) Target(85%)

79

36

19

8 62 0 0 0

0

10

20

30

40

50

60

70

80

90

ARI Diarrhoea Injuries MeaslesRubella

Malaria Dysentery Cholera Typhoid AFP

Total of Cases


Figure 3: Chimanimani District Map – Epidemic Prone Diseases

3.2 Diarrhoea Surveillance

The Province is on high for cholera, given the outbreak of cholera in Mozambique following the cyclone. The

interruption in the water and hygiene infrastructure in the most affected districts presents another risk for diarrheal

diseases As shown in the graph below, as of week 14 the trend of diarrheal diseases in Chimanimani district is

normal ( similar to the same period in 2017 and 2018) . There has been no report of death due to diarrhoea and

dehydration among the affected communities. Follow up of cases and active case finding amongst contacts is on-

going with 8 at Beta, 12 at Kaneta temporary clinic and 4 cases at Ngorima Clinic on 11 April followed up making a

cumulative 86 cases followed up thus far.


Figure 4: Chimanimani District Diarrhoea Cases by Week, 2017, 2018, 2019

Source: DHIS2

3.3 Malaria Surveillance

Malaria threshold level value (TLVs) graphs for week 14 for 2019 show that in Chimanimani District Mutambara

Hospital (24) and Mutsvangwa are above alert line, whilst in Chipinge only Musani (5) is above action line/level. A

comparison of the weekly malaria cases by year for Chimanimani shows that the cases from week 11 to now are less

than for the same period in 2017 and at same with 2018 as shown in figure 4 below. The province has receive in

excess of 160 000 LLINs with distribution currently under way.

Figure 5: Chimanimani Malaria Cases by Week, 2017 – 2019

Source: DHIS2

W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14

2019 52 137 96 128 145 103 101 124 131 127 89 114 151 163

2018 112 116 159 162 128 130 154 128 125 127 124 149 121 135

2017 112 121 132 115 171 146 142 183 135 155 104 110 103 91

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350

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27

CA

SES

Week

Chimanimani Malaria Cases by Week 2017, 2018, 2019

2019

2017

2018


4. PUBLIC HEALTH ACTION/RESPONSE INTERVENTIONS

4.1 Clinical Services

Health facilities functionality: 12 health facilities (7 in Chimanimani and 5 in Chipinge) were partially damaged by the cyclone. So far all the health facilities in Chipinge are functioning normally. In Chimanimani road access to health facilities is gradually being restored as the Public Works continues to repair bridges.

OCV Vaccination is set to set on the 15th of April 2019 in both Chimanimani and Chipinge Districts. In Chimanimani a two phased approach will be used started with the accessible areas in the first three days and moving to the inaccessible areas using Helicopters to deliver vaccines. Training of Trainers from the DHE and PHE will take place on the 13th of April in Mutare, cascade training for the vaccination teams will happen on Sunday 14th April in both districts

Figure 6: Chipinge, Manicaland, Zimbabwe. Distribution of OCV Campaign Teams

Curative services

Eleven satellite clinics that were established are continuing to provide emergency health services to populations that cannot access the pre-existing health facilities.


The cumulative number of OPD consultations are 9,353 (3,212 Male and 6,141 Female) patients who have received care at the different health facilities since the health interventions for the cyclone were started.

Mental Health services

The Deputy Director Child Rights and Mental health services has been visited the districts assessing the provision of mental health services. The team is developing a coordination mechanism for all mental health services, to ensure that all interventions are of the same quality and there is proper follow up of the clients. Skilled Health workers are also being mobilized to support provision of care.

Maternal and Child Health Across Chimanimani district 65 women attended antenatal care (ANC) clinics on the 12th of April 2019. There were 9 institutional deliveries reported. Figure 7: Maternal surveillance for 11 April 2019

Source: Health Facilities Daily Surveillance Data

4.2 WASH (Prevention of epidemic prone disease/conditions)

To guide provision of safe water, Water quality monitoring is being conducted. The cumulative number of water samples collected is 80.

Table 1: Water Supply Up Date

BH rehab/repair BH flushing DW rehab/repair DW flushing Piped water

schemes

Springs

Target achieved Target achieved Target achieved Target achieved Target achieved Target achieved

Chimanimani 55 41.8% 22 77.2% 14 0% 7 0% 19 0% 56 16.1%

Chipinge 35 65.7% 8 75% 0 0 0 0 0 0 35 0%

Chipinge Urban 16 93.8%

65

9

0 0 00

10

20

30

40

50

60

70

Women receiving ANC Institutional deliveries Maternal deaths Neonatal deaths Still births

Total of Cases


Progress in Chimanimani is hindered by inaccessibility of some areas such as Vimba, Muchadziya and Rusitu. Mutsvangwa is now accessible

Six 6 samples were found without adequate residual chlorine. Business community are under dosing water as reviewed by results, they highlighted that clients are complaining of 7npalatable taste and smell caused by water purifiers. EHPs advised people to treat water as per guidelines as a public health preventive method.

Cumulative food quantities inspected o Solid is 143 377,35 kgs o Liquid is 34 941,55 litres

Cumulative Total temporary toilets constructed in Chimanimani are 202 (56.1% of target).

NFI distribution is progressing with the following having been distributed to affected communities (Table 3).

Table 2: NFI Distributions

Toilet

Sanitizers

Jerry

cans

Buckets Soap Aqua

tabs

Water

Guard

Slates Blankets Hampers IEC Mosquito

Nets

Cumulative

NFIs

Distributed

33 4572 4552 7871 36787 3967 149 40 661 2,781 34,277

82 LLINs were distributed to members of ZRP relief team in Ngorima.

144 members of ZNA relief team in Ngorima were registered to benefit LLINs. Distribution of hygiene kits has benefited 37% of the targeted population (20572/55617*100)

5.1 Nutrition Update

Malnutrition cases have already started increasing with average of 5 cases of acute malnutrition identified per day

This week about 1531 children under 5 years of age were screened for malnutrition

Active screening on going at food distribution points, feeding points and health facility level Weekly nutrition coordination meeting are being held with participation from NAZ, World Vision, Plan International,

Save the Children, UNICEF and MoHCC.

4.3 Social mobilization

A total of 28 665 people were reached with health promotion and OCV mobilization campaign.

Table 3: Health Promotion as at 09 April 2019

Activity Male Female Total

Provision of health education during NFI, mosquito nets and food distribution

and Mobilize communities for vaccination catch-up campaign and OCV

1810

3755 5565

Source: Health Promotion Data

Health and Hygiene Education: A total of 43,182 people have been reached with health education in Chimanimani and Chipinge with the support from the health partners as detailed on the table below. The Topics covered include Hand Hygiene, water treatment, cholera prevention and Oral cholera vaccination

Table 4: WASH Sector Distributions by Partners

Mercy Corps World vision Goal Care IRC Plan Oxfam

Total Population

reached

19,325 1,500 2,110 1,747 2,000 25,000 1,000


Source: WASH Cluster

5. LOGISTICS

5.1 Medical Supplies

The following medicines were reported to be on low levels/stock out are shown in table 5 below:

Low stock levels of inhalers and needs beefing up considering the onset of winter season

Table 5: Medical supplies at low levels/stock out for 11 April 2019

Name of reporting Site Anti-Hypertension Anti-diabetics ART Anti-Asthma Anti-Mental IV Antibiotics Family Planning

ARDA Rusitu HCT N/A N/A N/A Carbamezapine N/A Depo provera

Mhakwe Clinic N/A N/A N/A Salbutamol inhaler CPZ Gentamycin N/A

Biriwiri Hospital Metformin N/A AZT, 3TC Salbutamol inhaler FD Ceftriaxone N/A

Skyline Atenolol N/A N/A N/A N/A Benzylpenicilin Jadelle

Chayamiti RHC HCT N/A N/A N/A N/A N/A N/A

Chimanimani Rural N/A N/A N/A Prednisolone N/A N/A N/A

Chimanimani Urban Nifedipine Glibenclamide N/A Salbutamol inhaler CPZ Ceftriaxone Control Pill

Gudyanga Clinic N/A N/A N/A Salbutamol inhaler N/A N/A N/A

Cashel Valley Nifedipine Metformin N/A N/A N/A N/A Depo provera

Mutsvangwa_clinic Not specified Metformin N/A N/A FD N/A N/A

Ndiyadzo Satelite Nifedipine N/A N/A Prednisolone N/A Cloxacylin, Ceftriaxone N/A

Nyanyadzi Hospital N/A N/A N/A Salbutamol inhaler FD and CPZ N/A N/A

Shinja Clinic Nifedipine Metformin N/A Salbutamol inhaler FD and Carbamezapine Benzylpenicilin N/A

Tilbury Clinic HCT N/A N/A Prednisolone N/A Cloxacylin, Metronidazole

Control Pill

Source: Early Warning System

6. GAPS

Inaccessibility of some of the areas like Chikukwa, and Muchadziya.

There is need for logistics support for the OCV campaign mobilisers (team of HPOs) to move around the district and work with the VHWs in trying to convey the message of the vaccination campaign. Areas which need intensive mobilisation are those in Nyanyadzi Valley and Cashel Valley.

Air lifting for both commodities and personnel to conduct OCV campaign in areas not accessible by road

7. RECOMMENDATIONS & PRIORITY FOLLOW UP ACTIONS

Multi-sectoral collaboration for the Oral cholera vaccination campaign. Given the impact of the Cyclone the Campaign will require more logistical support from partners and other agencies to reach all the vulnerable populations


ANNEX

Annex 1: Cyclone Idai Damaged Facilities

District Name of facility Damaged Area Accessibility

Chipinge

Kopera Water Pump washed away together with concrete slab

Paidamoyo Kitchen for waiting mother’s shelter was destroyed

Gumira Part of roof blown away

Ngaone Part of roof blown away

Nyunga Extent of damage to be established

Chimanimani

Muchadziya 1 staff house roof blown off, 2 rooms (EPI, Male ward) blown off and health records destroyed

Inaccessible by road

Mutsvangwa 1 staff house roof blown (3 rooms) staff toilet destroyed

Accessible by road

Nyahode Water source damaged at clinic and staff fetching water from a borehole 2 km away.

Biriiri Water source damaged Staff houses leaking

Rusitu Water supply system damaged

Sister-In-Charge office, dining hall and kitchen roof- ridges were blown off.

Ngorima Water source washed away

Nyahode Three deep wells were supply destroyed

8 BVIPs collapsed in population serviced by Nyahode Clinic

Roof of Waiting mother’s shelter blown away

No electricity power supply

Annex 2: Costed Health Response Plan

Broad Area Resources Required Available Gap Comments

Coordination 33,230.00 - 33,230.00

Health Information 2,300.00 - 2,300.00

Temporary clinics 54,980.00 - 54,980.00

EPI- vaccinations ( measles, OCV 2,280,750.00 1,850,000.00 430,750.00 Vaccine doses available

Capacity building 32,700.00 - 32,700.00

Referral system 75,000.00 65,000.00 10,000.00 Funds available for pregnant mother referral systems

Medicines and commodities 1,336,238.88 - 1,336,238.88

Malaria prevention and Control 357,480.00 - 357,480.00

Infection Prevention and Control 6,000.00 - 6,000.00

Health Promotion 12,610.00 - 2,610.00

Total 4,191,288.88 1,915,000.00 2,276,288.88

The total amount of budget is $4,191,288.88 of which $2,276,288.88. NB The costing was done using USD$.

Annex 3: Communication and Accessibility of the affected districts as at 12 April 2019 NAME TELEPHONE/ RADIO Alternative Accessibility Comment


communication

Chimanimani Hosp No Personal Phones Road

Biriwiri Hosp No Tel Personal Phones Road

Nyanyadzi Hosp Tel Road

Mutambara Hosp Tel Road

Rusitu Hosp Tel Air

Changazi RHC No Personal Phones Road

Chikukwa RHC No Personal Phones Air

Muchadziya RHC No Personal Phones Air

Bumba RHC No Personal Phones Road

Chayamiti RCH No Personal Phones Road

Chakohwa Clinic No Personal Phones Road

Chikwakwa Clinic No Personal Phones Air

Gudyanga Clinic No Personal Phones Road

Mutsvangwa Clinic No Personal Phones Road

Shinja Clinic No Personal Phones Road

Ngorima Clinic No Personal Phones Road

Roscommon Clinic No Personal Phones Road

Tilbury Clinic Tel Road

ArdaRusitu Clinic No rad/no Tel Personal Phones Road

Charter Clinic No Personal Phones Air

Nyabamba Clinic No Personal Phones Road

Nyahode Clinic Tel Road

Nhedziwa Clinic No Personal Phones Road

Annex 4: Cyclone Idai Response Partners

AGENCY/Department

ACE ambulances Air lifting patients

CARE International FOOD implementing partner

GOAL WASH -implementation in selected wards

INTERNATIONAL MEDICAL CORPS Donated hygiene kits operating in Bulawayo

IRC (International Rescue Committee) WASH

MERCY CORPS UNICEF-Nutrition and WASH implementing partner

Military (ZNA, Air force, ZPCS, ZRP) Air lifting of patients, staff, logistics

Miracle Missions Paediatrics and general medical support, air lifting

MSF Medicines and commodities, staff, out reaches, tents

NATPHARM Distribution of supplies

OCHA Cyclone IDAI emergency support. Partners Coordination and responsibility Matrix

Operation Orphan Psychosocial support in Chimanimani- 5 doctors

Oxfam WASH

Plan International WASH & food - implementation in selected wards, distribution of LLINs (mosquito nets)

PSMI Ambulances (air and road), medicines and supplies, staff

Red Cross Medical response

UNFPA Maternal and dignity kits- RH

UNICEF WASH, Essential medical supplies, nutrition response, capacity building (community), Logistical support to the vaccination campaigns Welthungerhilfe WASH


WFP Coordinating food sector, air lifting of commodities

WHO Coordination, Capacity building, Medical Logistics, Surveillance and Information Management,

World Vision FOOD implementing partner

ZiMA (National & Manicaland) Staff for medical management of patients

ZINWA, RDC, DDF WASH

Annex 5: EPI fridges Assessment for Facilities Facility Full Gas

Cylinder Empty Clinder

Electricity Vaccine stock Telephone

1 Biriwiri Hosp 1 0 No at Shinja Cellphone

2 Nyanyadzi Hosp 0 0 Zesa Available Cellphone

3 Mutambara Hosp 0 0 Zesa Available Cellphone

4 Changazi RHC 2 0 Solar Available Cellphone

5 Bumba RHC 1 1 Zesa Available Cellphone

6 Chayamiti RCH 1 0 No Available No phone

7 Chakohwa Clinic 1 in use 0 Zesa Available Cellphone

8 Gudyanga Clinic 0 0 Zesa Available Cellphone

9 Shinja Clinic 1 1 No Available not working/personel

11 Nhedziwa Clinic 1 0 Zesa Available not working/personel

12 Cashel 0 0 Zesa Available Cellphone

1. HIGHLIGHTS2. BACKGROUND2.1 Coordination

3. EPIDEMIOLOGICAL OVERVIEW3.2 Diarrhoea Surveillance3.3 Malaria Surveillance

4. PUBLIC HEALTH ACTION/RESPONSE INTERVENTIONS4.1 Clinical Services4.2 WASH (Prevention of epidemic prone disease/conditions)5.1 Nutrition Update4.3 Social mobilization

5. LOGISTICS5.1 Medical Supplies

6. GAPS7. RECOMMENDATIONS & PRIORITY FOLLOW UP ACTIONSANNEXAnnex 1: Cyclone Idai Damaged FacilitiesAnnex 2: Costed Health Response PlanAnnex 3: Communication and Accessibility of the affected districts as at 12 April 2019Annex 4: Cyclone Idai Response PartnersAnnex 5: EPI fridges Assessment for Facilities

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