Chad: Hepatitis E Outbreak - Sep 2016Ongoing
From 1 September 2016 until 13 January 2017, a total of 693 cases including 11 deaths of acute jaundice syndrome (AJS) have been reported from Am Timan, Chad. Based on the available information, there appears to be a plateau in the number of cases reported in the past 5 weeks from the affected area with an average of 70 cases reported weekly where only a minor proportion (7.2%) requires hospitalization. The infectious risk seems confined to Am Timan and immediate surroundings. However, the event remains under close monitoring at all levels of WHO. (WHO, 24 Jan 2017)
As part of the UNICEF response to the Hepatitis E suspected epidemic, WASH supplies for disinfection and water treatment were made available to the Amtiman Health District. (UNICEF, 31 Dec 2016) MSF, in addition to providing medical care, has also implemented hygiene and sanitation activities since this virus is primarily transmitted from one person to another through contaminated water and in areas where access to quality water is limited. More than 600 MSF staff have been working to test for new cases, treat patients and improve water supplies and sanitation in the city of Am Timan, including chlorination of the city’s water towers. (MSF, 9 Feb 2017)
The outbreak of hepatitis E in the Salamat region of Chad continues to evolve, with one new district being affected. The potential of the outbreak to escalate is high given the prevailing predisposing factors. Only 25% of the 63,000 people in Am Timan, the epicenter of the outbreak, have access to clean and safe water. Meanwhile, about 30% of the 13,000 people in Aboudeïa have access to safe water. The local community continues to fetch and drink water from rain pools (ponds), sharing with animals and birds. The affected communities also have poor sanitation, commonly practicing free range open defecation. With these factors, in addition to the onset of rainy season expected soon, the risk of further spread of hepatitis E, as well as of cholera, remains very high. (WHO, 14 Apr 2017)
Since September 2016, 1,684 suspected cases of Hepatitis E (77 in July) have been reported in the 3 health districts of Salamat, of which 230 cases were tested and 130 of these confirmed positive (positive rate of 52.2%); 16 deaths have so far been reported (no death this month). As the Ministry of Public Health officially declared a Hepatitis E epidemic in the region of Salamat, the epidemiologic surveillance has been extended to the region’s 3 health districts and the 42 areas of responsibility (12 in Aboudeia, 18 in Am Timan, and 12 in Haraze health districts). (UNICEF, 31 Jul 2017)
Outbreaks occurred in the Salamat Region, predominantly affecting North and South Am Timan, Amsinéné, Mouraye, Foulonga, and Aboudeia. The number of cases decreased since week 39. Of the 64 cases in pregnant women, five died (CFR: 7.8%) and 20 were hospitalized. Water chlorination activities were stopped at the end of September 2017 due to a lack of partners and financial means. No cases have been reported since week 48 of 2017 and the outbreak was declared over by the Ministry of Health on 14 February 2018. (WHO, 02 Mar 2018)
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More than 120 sites and displacement locations are scattered around this remote region, making humanitarian assistance a logistical challenge.
Despite incidents reported in Kaiga-Kindjiria area, the security situation remains relatively calm in the Lake region. A decrease in incidents has coincided with the surrender of elements associated with armed groups in recent weeks.
Results from the most recent national SMART survey indicate an 11.2% prevalence of global acute malnutrition (GAM). 153,738 children with severe acute malnutrition (SAM) have been admitted and treated in nutritional units so far in 2016, reaching 79% of the annual target.
Heavily pregnant, Miriam rests on the bed as an MSF gynaecologist performs an ultrasound of her growing belly. She seems surprised when, unexpectedly, the outline of a baby appears on the monitor, and her expression quickly turns to relief as the translator confirms that Miriam’s unborn child is progressing well.
Miriam is one of 44 patients with hepatitis E who have been admitted to Am Timan hospital in Chad since September. More than 320 other potential cases have been identified.
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Selon l’enquête nutritionnelle SMART de novembre 2016, 10 régions ont enregistré des taux de malnutrition aigüe sévère (MAS) au-dessus du seuil d’urgence de l’OMS (2%).
Le Tchad perd chaque année environ 9,5 pour cent de son Produit intérieur brut (PIB), soit plus de 578 milliards de FCFA à cause de la sous-nutrition.
PROLONGED STRIKE HURTING EDUCATION
A teachers strike since September due to non-payment of salaries continues to affect access to education throughout the country. In the eastern Ouaddai region, for instance, only around a quarter of the 365 schools are currently functioning. However, 90 per cent of them are private. As a result, parents in some localities have mobilized to recruit community teachers, but there are concerns about the quality of education provided by these teachers.
LA GRÈVE PROLONGÉE NUIT À L’ÉDUCATION
31 October 2016
• As of end of October 2016, there are 123,293 people displaced by the Nigerian crisis in Chad’s Lac region. Three additional sites were discovered this month.
• A Hepatitis E outbreak has been reported in the Salamat Region. A total of 128 cases, including 20 positive cases (16% positivity rate) and 2 deaths (1.6% case-fatality) were registered in Amtiman, the main city of Salamat Region.
DANS CE NUMERO
P1 MSF répond en urgence aux cas suspects d’Hépatite E à Am Timam dans la région de Salamat
Qui sont les Médecins Sans Frontières?
P2 Nos activités au Tchad
Interview: Une psychologue panaméenne dans la zone du Lac
Les enfants de Dr. Uli
P3 Les déplacés du Lac
P4 Lutter contre la malnutrition à Bokoro
P5 Interview Dr Rony Brauman: On soignait tout le monde, civils comme combattants
P6 MSF au Tchad en chiffres