Disease surveillance data have been forwarded to UN agencies by Kupang Provincial Health Office and Medecins Sans Frontieres--Belgium. The Kupang Provincial Health Office provided daily death reporting from Tuapukan Camp in Kupang District. MSF-B submitted case mix data from 1352 presentations to their mobile clinics in Belu district during 10-30 November. No district-wide mortality data have been forwarded by district or provincial health authorities since the last sitrep of 1/12/99.
Kupang District health authorities have acknowledged the need for epidemiologic surveillance to include other district camps. This effort to provide timely information in Kupang District and throughout the province will require additional outside resources. WHO is intensifying its health information activities with local health authorities.
Mortality in Tuapukan Camp of NTT remains elevated at an estimated crude mortality rate of 2.1 deaths/10,000 population/day and under five mortality rate of 9.2 deaths/10,000 population/day. Unspecified diarrheas and clinical malaria were reported as leading causes of camp deaths. The Kupang district health authorities have completed home visits in two thirds of the camp confirming under five population at 19%, and presence of untreated diarrheal disease burden of 2%--none dehydrating. Environmental health conditions remain inadequate though remedies are underway in chlorination of water supply and construction of new latrines.
UN agencies and NGOs have expressed concerns about health needs in other camps. Quantitative health data remain unavailable.
Morbidity and Epidemic Potential
MSF-B data from Belu district reveal a preponderance of upper respiratory tract infections. There were 8 cases of diarrhea with severe dehydration and 32 cases of bloody diarrhea with fever. No culture information was submitted. There were no mobile clinic reports of diseases of epidemic potential of dengue, hepatitis, or meningitis.
Provincial health authorities reported two unrelated deaths (1 adult, 1 pediatric) of unclear causes involving hemorrhage and shock prompting investigation for possible links to seasonal outbreaks of dengue.
Disease Specific Issues
Pursuant to the measles campaign in Kupang District, local health providers have undertaken to confirm vaccination status with families bringing children for consultation and to verify immunization status with the immunization card.
WHO assessment last week of malaria control in NTT and particularly Belu district revealed a control program weakened by inadequate surveillance, insufficient clinical training for case management, and unavailability of medications. Ministry of Health has requested outside assistance for shipment of bednets and larvaecides.
Food Working Group, upon review of CRS and ICRC monitoring activities expressed concern for presence of malnutrition and organized a plan of action to start next week. Activities will include supplementary feeding and micronutrient provision.
Compiled by D Bradt, S Collins, S Pareira, and S Baswedan
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