DPR Korea: Situation bulletin - Feb - Mar 2005
The first reported outbreak in DPR Korea of Avian Influenza ("Bird Flu") occurred in rural Pyongyang province on three poultry farms. The Government made the announcement on 27th March and stated that the outbreak began on 25th February. The Ministry of Agriculture and the Ministry of Public Health responded promptly to the outbreak and quickly established an anti-epidemic cordon around the affected farms. No human cases have been reported, and no clinical cases have been noted in cullers and health workers either.
At the farm level, this outbreak has had a devastating effect for the fledgling poultry industry, and resulted in the culling of at least 219,000 birds. Poultry production has expanded in DPR Korea in recent years, doubling the production rate between 1997 and 2004 to approximately 25 million birds. Plans to begin exporting significant quantities of poultry to South Korea have been put on hold.
The authorities asked for international assistance and the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) both provided support. Both organisations sent Avian Influenza experts to the DPR Korea, who visited the farms, and supplied technical expertise to support the investigation and identify the virus strain. FAO also provided support to the Ministry of Agriculture's Veterinary and Quarantine Services through a regional project (laboratory testing and diagnosis, and a workshop) and collaborated on a daily basis with the WHO. Ministry of Public Health medical and laboratory personnel were also invited and duly participated in the same workshop.
WHO supplied laboratory equipment and reagents for diagnosis, technical guidelines, support for strengthening epidemic preparedness and response, logistical support with the provision of Personal Protection Equipment (PPE) and antivirals, and emergency diagnostic kits.
The strain was identified as the H7N7 strain which can cause influenza type symptoms. However, it is the H5N1 strain which has proved so fatal in Cambodia, Thailand and Vietnam. Among the immediate H7 Issues for DPRK, there is the need to find out how the virus entered what are considered 'normally bio-secure farms' - and the need to enhance surveillance capacity and develop plans to determine how much Avian Flu is present, and where. H7 had previously been reported in Canada, the Netherlands and some parts of Asia . Investigations continue as to how the virus reached DPRK, though there is unconfirmed speculation that migratory birds may have infected the local poultry.
Special Feature - Press Release from Caritas
CARITAS CELEBRATES 10 YEARS OF ACTIVITY IN THE DPRK
On his second visit to the Democratic People's Republic of Korea (DPRK), Caritas Internationalis Secretary General, Duncan MacLaren, said that, after ten years of activity in the country, the needs were still great. He said:-
"In the five years since my last visit, there have been some positive changes - there is movement in the economy after the July 2002 reforms, there is more visible trading and more bikes on the road, for example. However, there are also growing gaps between the haves and have nots. While it was satisfying to note the positive impact of aid from Caritas, it was also obvious that there were still many needs."
Mr MacLaren was accompanied by Ms Kaethi Zellweger of Caritas Hong Kong. Ms Zellweger, who has visited the DPRK many times since 1995, is in charge of the Caritas Internationalis programme in the country. They visited officials of their main partner, the Flood Damage Rehabilitation Committee (FDRC), both at national and local level, and visited projects in Hamgyong Province on the east coast. Caritas assists with food aid to hundreds of thousands of children, particularly orphans and pregnant and nursing women, provides inputs to cooperative farms to increase production and supports projects in the health sector.
Ms Zellweger said that one of the main problems was the energy crisis. "This", she said, "has a substantial impact on industrial output, harvests and the daily lives of the people struggling to survive in a climate that is often harsh. While in Hamhung, we experienced snowfalls of 30cms and witnessed people carrying brushwood for fuel and putting plastic sheeting in the windows to protect them from the cold."
Mr MacLaren continued: "While the 2004 harvest was the best in ten years, there was still a shortfall making 6.5 million people vulnerable and in need of food assistance. I was horrified at the state of the equipment in hospitals that would be better off in a medical museum. In one county hospital serving 60,000 people, the only drugs were the ones supplied by Caritas. I was impressed by the attempts of the doctors to serve their patients despite their outdated equipment. All this adds up to the need to continue the Caritas programme which also serves to engage the DPRK with the outside world. The Caritas programme is a good example of humanitarian engagement devoid of political manipulation. I am grateful to the 30 members of the Caritas Confederation and the many other organisations, Catholic, ecumenical and secular, who contribute funds to the programme and will be encouraging more to become involved."
The last Caritas appeal in 2004 amounted to $2.5 million and a similar one will be launched in April 2005.
HEALTH AND NUTRITION
UNICEF & WFP- Nutrition Assessment 2004
The Nutrition Assessment 2004 report was finalized and endorsed by the Government in the last week of February 2005. According to the report, the prevalence of stunting is 37 percent, underweight 23 percent and wasting 7 percent. Since 2002, there has been some improvement in the nutritional status of young children less than three years old. This indicates the better utilization of humanitarian aid and the government's efforts for the reduction of malnutrition. Despite the improvement in the nutritional status of young children, the rates of stunting (37 per cent) and underweight (23 per cent) are still high according to WHO criteria.
The Assessment reported that 32 percent of women are malnourished, using the Mid Upper Arm Circumference (MUAC) measurement technique. The reported prevalence rate is almost the same as in 2002. About 35 percent of women were reported to be anaemic in 2004, a similar figure to 2002. The report showed an association between maternal and child nutritional status, which indicates the need to focus on maternal nutritional status to further reduce child malnutrition. The higher the consumption level of rice and rice products, poultry or meat, red or yellow vegetables, and oils and fats, the greater the reduction in child malnutrition.
On 7 March, the report was released jointly by UNICEF and WFP in Beijing, China. The major findings of the report were also presented to donors in Beijing. The report was well received by the donor community. On 9 March, the findings of the report were presented to the donors in Pyongyang, DPRK, and on 10 March, the findings were shared with UN agencies and NGOs working in DPRK. The main results were also shared with members of the interagency Health and Nutrition group in the regular sector meetings. The major findings of the reports are being incorporated into orientation and training packages for caregivers and provincial authorities. The Ministry of Public Health plans to disseminate the findings to senior officials in the near future.
UNICEF - Prevention and Control of Micronutrients
The distribution of fortified food to young children, and pregnant and lactating women, which is a joint project with WFP, is ongoing. Supplementary activities giving multi-micronutrients to pregnant women and iron/folic acid to non-pregnant women continue.
UNICEF - Immunization Plus
Currently two different government departments, the Anti-Epidemic Stations and the Central Medical Warehouse, are responsible for the distribution of vaccine and vaccine equipment including different types of syringes and safety boxes. Discussions have been held with the Ministry of Public Health (MoPH) on how best to harmonize and coordinate the two distribution systems. UNICEF's proposal was endorsed and a directive has been sent by the MoPH to Provincial Medical Warehouses instructing that "vaccine devices can be released only upon receipt of a vaccine distribution plan from the Anti Epidemic stations". This is a very important decision made by the MoPH, which will increase programme effectiveness and efficiency, as well as avoiding shortages or surpluses of vaccine equipment in different locations.
UNICEF - Safe motherhood
A new package on safe motherhood for distribution to focus counties and respective Ri hospitals/clinics is being developed and endorsed by the MoPH. The Reproductive Health taskforce is developing a Reproductive Health strategy for DPRK. A first draft is expected to be made available by the end of April.
300,000 sheets of partograph and 300,000 ante-natal cards have been printed and will be distributed to health facilities in April.
A total of 120 Ri, five county and 2 provincial maternity hospitals in North and South Hwanghea provinces have received Emergency Obstetric Care (EmOC) and safe delivery kits.
UNICEF - Essential medicines
A coordination meeting was recently held with the aim of harmonizing the list of essential drugs provided by different agencies to health facilities. Concerned agencies re -confirmed that all items provided to health facilities will be taken from the main essential drug list.
UNICEF - Medic al Deliveries (ECHO-funded)
In February the Central Medical Warehouse (CMW) distributed medicine kits to 448 Ri clinics and 39 provincial and county hospitals in N. Pyongan, S. Hamgyong and N. Hwanghae provinces, while in March, the CMW distributed medicine kits to 1258 Ri clinics and 52 provincial and county hospitals in S. Pyongan, Kangwon, Ryanggang and S. Hwanghae provinces.
UNICEF- Equipment Distribution (Government of Japan-funded)
The CMW distributed midwifery kits to 32 Ri clinics in Kwail county, 24 in Jangyon county and Emergency Obstetric kits to Haejiu Provincial Maternity Hospital, Kwail and Jangyon County Hospitals in S. Hwanghae province. Midwifery kits also went to 20 Ri clinics in Thosan county, 20 in Kumchon county, 24 in Yonsan county and Emergency Obstetric kits to Sariwan Provincial Maternity Hospital, Thosan, Kumchon and Jangyon County Hospitals in N. Hwanghae province. The CMW distributed section doctors' bags to 1,036 section doctors in Ryanggang province (covering 100% of the province) and to 4,450 section doctors in N. Hamgyong province (covering 94% of the province).
UNICEF - F100 Delivery (ECHO-funded)
In January 2005, the CMW distributed the 1st and 2nd quarter's quota of F100 and the April distribution, will cover the quota for the third quarter. Rehabilitation of the CMW started in mid-March and procurement of metal racks, trucks and calculators, printing of ledgers and logistic forms has been partially completed. A consultant follow-up visit is expected in May/June 2005. All activities are coordinated with UNFPA.
UNICEF - Integrated Management of Childhood Illnesses (IMCI)
After the successful implementation of the first phase in 2004, UNICEF will work with the MoPH and WHO in 2005 on the second phase for early implementation in two pilot counties. Training will take place in June with the help of an external consultant from the WHO regional office (SEARO).
The report of the Reproductive Health (RH) survey in South Pyongan, Kangwon and South Hamgyong supported by UNFPA in 2004 will be finalized in April 2005. The survey focuses on assessing reproductive health knowledge, reproduction and related RH services, and contraceptive use in the three provinces. It was noted in the survey that
knowledge on different methods of HIV/AIDS prevention needs to be increased; the taking of iron and folic acid tablets for 90 days during pregnancy to address anaemia among pregnant women should be promoted and implemented; and the satisfaction rate of clients for Reproductive Health services including family planning should be improved.
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