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close this bookCerebrospinal Meningitis Epidemics and Surveillance Systems in the Sudan, Ethiopia and Chad (Centre for Research on the Epidemiology of Disasters, 1990, 40 p.)
View the document(introduction...)
Open this folder and view contentsI. INTRODUCTION
Open this folder and view contentsII. COUNTRY REPORTS
View the documentIII. CONCLUSIONS
Open this folder and view contentsIV. ANNEXES

III. CONCLUSIONS

Capacities to respond to epidemics and emergencies in these three countries are weak. These countries have not yet developed any Emergency Preparedness and Response structure and, except for the Sudan, there is no such project. The 1987-1988 epidemic country responses are summarized in the table below.

TABLE V: 1988 CSM EPIDEMIC RESPONSE IN SUDAN, ETHIOPIA AND CHAD


ADDIS ABABA

KHARTOUM

N'DJAMENA

Total Population

1489176

+/-5000000

500000

First Reported Cases





- month

November

January

January


- N° Cases

?

1

6

ALARM





- date

December

February 11

February 22


- N° cases

17

27

21


- Criteria

unusual increase

unusual increase

unusual increase

DATE EPIDEMIC DECLARED

January 27

February 16

February 22

CRISIS COMMITTEE





- date first meeting

February

February 16

February 27 (CASU *)


- number of cases

177

53 (106)

116

EVOLUTION





- N° cases month 0

17 (Dec.)

1 (Jan.)

6 (Jan.)


- N° cases month 1

60

387

111


- N° cases month 2

194

7140

1358


- N° cases month 3

104

2882

1386


- N° cases month 4

80

1027

105


- N° cases month 5

138

300

34


- N° cases month 6

117

22

14


- N° cases month 7

36



MEASURES




* Standardized treatment


NO

Yes


- Penicillin

+

+

-


- Ampicillin

+

+

-


- Oily Chloramphenicol

-

+

+


- Chloramphenicol

+

+

-

* Prophylaxis





- Rifampicin

Yes

No

No

* Vaccination





- High risk groups

Yes

No

Yes



- date

April


March 5



- number cases






- duration

3 weeks


11 days



- number

684834


156500


- Mass Campaign

No

Yes

Yes



- date


February, 20

April 5



- duration


4 weeks

7 days



- number


3400000

262738

* General measures

active case detection health education

prohib. of mass meetings

prohib. of mass meetings

STOCKS





- Vaccines

36500

862500

0


- RMP 300 mg. tab

141 boxes

-



- Penicillin

9600 vials

355200 vials



- Chloramphenicol

1000 (IV) vials

19850 vials (IV)

663 vials (oily)

INTERNATIONAL ASSISTANCE




- date of request

February 13

March 1

February 27

- coordination

Crisis committee

Crisis committee

CASU *

* the Comit'Action Sanitaire d'Urgence (CASU) met for the first time on February 27. A special crisis committe in charge of the epidemic response was assigned during the first CASU meeting and since February 28, met daily.

Epidemic response capacities have improved after the last epidemic.

Guidelines for treatment and response strategies have been developed but most of the time there are only some elements for response and only for CSM epidemics.

The improvement of countries capacities for emergency preparednes and response should be integrated. It is not rational to develop in each country as many response structures and strategies as there are different type of disasters.

The first step should be to identify and set-up focal points for development of integrated emergency preparedness and response mechanisms.

The inadequate surveillance system and poor communication capacities as well as the lack of trained personnel are the common weaknesses in all of these countries. High priority should be given to developing effective early warning surveillance systems focused on the different types of disasters each country is prone at. Accordingly, specific training needs should be identified and training programmes implemented.

Strengths and weaknesses of the existing systems have been outline above. The positive elements should be retrieved and adapted in the different countries. The characteristics of each country surveillance and control plan for epidemics are summarized in the following two tables.

TABLE VI: SURVEILLANCE SYSTEMS IN SUDAN, ETHIOPIA AND CHAD


ETHIOPIA

SUDAN

CHAD

ROUTINE SURVEILLANCE SYSTEM




FREQUENCY

week

week

month

REGULARITY

irregular

irregular (50%)

regular (85%)

TYPE

passive

passive

passive

REPORT TO

Health surveillance & Region

Epidemiology & region

Statistics (BSPE)

TYPE OF INFORMATION:




Cases

+

+

+

Deaths

-

+

-

Sex

+

+

+

Age

+

+

- (> 5 years old)

Origin

+

+

-

Vaccination

-

+

-

COMPILATION

partially computerized

by hand

computerized

FEED-BACK INFORMATION

-

+

-



+


TRANSMISSION TO




Other countries

-

-

-

MEANS




Messagers

+

+

+

Mail

+

+

+

DELAYS

up to 3 months

up to 3 months

1 month

RAPID SURVEILLANCE SYSTEM

+

+

-


week
radio/telephone



IN CASE OF EPIDEMIC




Frequency

daily

daily

daily

Means:





- N° radio/telephone

25

12

9 (+2)


- Others

mail/messagers

mail/messagers

mail/messagers

Type:





- passive

+

+

+


- active

+

-

-

TABLE VII: MENINGITIS EPIDEMIC CONTROL PLANS IN SUDAN, ETHIOPIA AND CHAD


ETHIOPIA

SUDAN

CHAD

Define Strategy

+

+

+/-

Warning messages

-

+

-

Systematic Sensitivity monitoring

-

+

-

Early warning Surv. Syst.

-

-

-

Confirmation

Epidemic Control Team



Diagnosis guideline case definition

-



Lumbar Puncture

+/-

+/-

+/-

Treatment guideline

+

+

+

Oily Chloramphenicol

-

+/-

+

Other

+

+

+/-

Vaccination

high risk

mass

high risk


Epidemic Control Team



Surveillance during epidemic




Frequency

daily

daily

daily

communication means/capacities

25 radio or tel

12 radio or tel

9 (+2) radio or tel

active

+

-

-

passive

+

+

+

Coordination




Crisis committee

In Epidemiology dpt. & in regions

in Epidemiology Dpt & in regions

(Prev. Medicine)

International Assistance

Crisis committee

Crisis committee

CASU

NGOs - International agencies

+/-

-

+

There is no formal communication of information between these countries. Information sharing on epidemiologic situation is scarce and rare. Most of the information consists of rumors. The monitoring of simple and standardized indicators for emergencies (including on stocks) and the establishment of communication channels would allow accurate information exchange and hence, the implementation of adequate measures in case of an alert issued by a neighbouring country.