Nepal: Mid Western Region diarrhoea outbreak - Situation update until 12 Jul 2009

Situation Report
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- District Public Health Office confirms 96 diarrhoea related deaths in Jajarkot District from 1 May to 12 July 2009

- 19 unconfirmed diarrhoea related deaths reported in Rukum District and two deaths in Dailekh District, currently under investigation

- District Line Agencies are coordinating response to outbreak

- Difficult access to remote affected areas delays response of medical staff and delivery of supplies

I. Situation Overview

1. The hilly districts of the Mid Western Region have been affected by a diarrhoea outbreak, in particular Jajarkot and Rukum Districts1. Jajarkot District was initially affected, with 96 diarrhoea related deaths as of 12 July, according to the District Public Health Office (DPHO). Media reports indicate diarrhoea related deaths are increasing in Jajarkot and neighbouring Districts, WHO is working with the DPHOs to investigate the cause of the outbreak and verify the epidemiological data.

2. Jajarkot is the worst affected District, which is attributed to poor sanitation and hygiene by local health workers. The winter drought, delayed monsoon rains and dried up water sources increased the risk of consuming contaminated water. Water quality and availability and latrine coverage figures are unknown at this time. The DPHO stated that the latrine coverage is very low and open defecation is a common practice. In early May 2009, DPHO responded to the initial diarrhoea outbreak in remote communities in southern Jajarkot District, which was difficult due to lack of logistical access and locally available resources. On 14 May, the Minister for Health and Population (MoHP) including a team of Doctors assessed the diarrhoea affected communities in the Mid Western Region. The number of diarrhoea related deaths continued to rise. On 24 June, DPHO mobilized available medicine and health teams and requested additional support from the Regional Health Directorate and MoHP.

3. There are additional reports of diarrhoea related deaths in Rukum, Dailekh, Salyan and Dolpa Districts. In Rukum District, unconfirmed reports indicate an estimated 15 diarrhoea related deaths, with about ten VDCs adjoining to Jajarkot and Dolpa Districts affected by the diarrhoea outbreak. In Dailekh District, the DPHO confirmed two diarrhoea related deaths in VDCs bordering Jajarkot District on 25 June and 4 July. In Salyan District, the DPHO stated that there were two diarrhoea related deaths in the District on 2 and 3 July, however, the situation is under control. According to sources at the regional medical store, in Dolpa District headquarters 25 police affected by the diarrhoea are under going treatment and dozens of people are affected in the villages bordering to the Jajarkot.

4. Due to the logistic difficulties DPHOs are facing challenges to provide the medical aid to the diarrhoea affected population in the remote villages. There were also shortages of the health workers and medicine in some of the diarrhoea affected Village Development Committees (VDC) in Jajarkot and Rukum Districts, which is being addressed by the DPHOs.

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