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Nutrition Components of the Cholera response in Haiti

H A I T I. Nutrition Components of the Cholera response in Haiti. Very fertile Ground for a Cholera Epidemic. Extreme poverty, Weak governance Weak Healthcare system Poor access to safe water, hygiene and sanitation Political violence and unrest

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Nutrition Components of the Cholera response in Haiti

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  1. H A I T I Nutrition Components of the Cholera response in Haiti

  2. Very fertile Ground for a Cholera Epidemic • Extreme poverty, • Weak governance • Weak Healthcare system • Poor access to safe water, hygiene and sanitation • Political violence and unrest • Still recovering from Earthquake of January 2010 • Vulnerable to other natural disasters

  3. Temporal-spatial evolution of cholera from 19/10/10 to 20/11/10 Centre d’Operation d’Urgence Nationale (COUN)

  4. From Epidemic to Endemic: • No population immunity. • Highly virulent Vibrio Cholerae strain. • First reports of 40 diarrhoeal deaths on 20th October, by 29th 4714 cases and 330 deaths and within 5 weeks (21st November) 61,825 cases and 1426 deaths. • Cholera rapidly became endemic and is likely to have further peaks during the next cyclonic season. • As of 1st March 252,640 cases, 136,275 hospitalisations and 4,672 deaths with still 7000 new cases a week. • Approximately 10% of cases are under 5. • Estimated that only 60% of cases get reported.

  5. Initial difficulties of Cholera Response: • The Haiti Cholera Treatment protocol did not make provision for severely malnourished children, breastfeeding or use of Zinc with RO ORS. • Initial key messages issued by MoH did not include nutrition. • Heath system including external support overwhelmed for many weeks. • Not always good implication of sectors besides Health and Wash in the response coordination.

  6. More initial difficulties… • Impossibility to assist with safe water and sanitation at such a large scale. • Initial delay by MoH in approval of Zinc with RO ORS for cholera. • Difficulty in adopting the Nutrition components of cholera response in a Health setting. • Several nutrition centres were converted to CTCs and stigmatisation of all health/nutrition facilities.

  7. Key messages developed and diffused: • Development of key IYCF messages for diffusion. • Poster on use of Zinc and RO ORS for under 5. • Poster on breastfeeding and cholera. • Decisional Flowchart of breastfeeding in a CTC context. • Posters of screening of SAM in children with cholera and rehydration protocol • Addendum to National Nutrition Protocol to include SAM rehydration in a cholera context. • Guidelines for management of SAM and IYCF in CTC and IYCF in the community.

  8. Key Nutrition components of cholera care more easily implemented: To be included in revised National Cholera Protocol: • Rapid screening of SAM children on admission for application of rehydration protocol for SAM children with cholera. • Use of Zinc with RO ORS for U5. Then: • Food provision once a patient is able to eat. • Supplementary or therapeutic feeding (mainly in CTCs run by Nutrition partners). • MAM/SAM take home ration of RUSF/RUTF upon discharge (mainly in CTCs run by Nutrition partners).

  9. Coverage of Nutrition components in CTC/CTUs • By February 2011, 101 CTCs, 165CTUs and 786 ORPs, # keep changing according to needs and NGO presence. • Only 16 partners have reported on Nutrition activities covering 67 CTC/CTUs: WVI, SC, MDM-F, MDM-Ch, MDM-E, Gheskio, Healing Art Mission, Merlin, ALIMA, IMC, MSF-F, MSF-E, MSF-Ch, Jap. RC, FSB, MDM-Can

  10. Components care more difficult to implement: • Record of nutrition activities in CTC. • Screening on discharge and referral for SAM/MAM or IYCF follow up (coverage low). • Identification of breastfeeding mothers with cholera separated from their children and reunification. • No requests of RUIF from CTC/CTUs. • Plumpy Doz on discharge to assist recovery of non-malnourished. • Advice on adequate IYCF after discharge to assist recovery.

  11. lessons learned: • Need for advocacy at all levels for inclusion of Nutrition Components in cholera treatment protocols. • Rapid and early response at scale is essential • Better Preparedness (scenarios, protocols and messages) • Easier to change the health approach if it is not seen as a Nutrition action • Better Surveillance and M&E • Is a MUAC of 115mm the best SAM threshold for a young child with cholera? • Breastfeeding promoted as an effective cholera prevention strategy.

  12. Mesi Anpil

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