Nigeria

Northeast Nigeria Response (Borno State): Health Sector Bulletin #8, 20 November 2016

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20 November 2016

3.7 MILLION
IN NEED OF HEALTH ASSISTANCE 2016
1.8 MILLION
INTERNALLY DISPLACED PERSONS
2.6 MILLION
2016 TARGET BY HEALTH SECTOR
1,799,506
BORNO STATE POLIO VACCINATED CHILDREN

Highlights

  • On 17 November 2016 following harmonization of the data available from the following sources: EWARS, IDP camp surveillance data from SPHCDA, Health sector partners and IDSR, it was concluded that there is an ongoing measles outbreak in Borno State.
     The Borno State Ministry of Health is already conducting a reactive vaccination campaign with the support of partners targeting 18 locations/IDP camps. So far, 35,742 children have been vaccinated in six camps.
  • Children under the age of five are at highest risk of malaria morbidity with up to seven-disease episode per year and of malaria mortality. Malaria mortality is exceedingly high in the presence of concomitant severe acute malnutrition (SAM) which is prevalent at around 20%. The combination of malaria morbidity with SAM is reported to be able to reach case fatality rates of up to 50% as compared with 3% for uncomplicated malaria.
  • The upcoming measles catch up campaign would be an ideal opportunity to reach the identical target age group for malaria < 15 years also with malaria MDA.

Situation Update:

The humanitarian crisis caused by insurgency in Borno State has resulted in more than 1.4 million IDPs living in more than 100 camps freely mingling with a host population of about 4.3 million people. With an estimated population of 2.36 million children between 6 months to 15 years of age, it has led to massive disruption of the health care delivery system with interruption of such services as Routine Immunization (RI), as seen with the polio outbreak, measles and reported suspected diphtheria cases.

As for the reports in measles cases, following the harmonization of the available data from the following sources: Early Warning and Response System (EWARS), IDP camp surveillance data from State Primary Health Care Development Agency (SPHCDA), Health sector partners and Integrated Diseases Surveillance and Response (ISDR), it was concluded that there is an ongoing measles outbreak in Borno State afflicting camp and non-camp populations.

The Borno State Ministry of Health is already conducting a reactive vaccination campaign with the support of partners targeting 18 IDP camps. So far, 35,742 children have been vaccinated in six camps. This campaign however is inadequate to interrupt the transmission of measles across the state, as it does not involve the host communities nor other settlements and IDP camps where measles cases have also been reported. As the BSMOH is expanding the present campaign to include all accessible estimated 2.3 million children aged 6 months – 15 years in the state without prejudice to the national measles campaign, a request for support (including vaccines and logistics) have been communicated to the Federal MoH. This expanded campaign is planned to take place from 27 – 30 November 2016.

The targeted children who did survive the years without RI, did not as well received adequate access to malaria prevention and treatment and are most likely mostly malaria parasite carriers. Therefore, any other infection be it ARI, diarrhoea, or measles, is likely to spark an acute increase in parasitaemia and a concomitant clinical malaria episode among those already parasitized. Children under the age of five are at highest risk of malaria morbidity with up to seven-disease episode per year and of malaria mortality.

Malaria mortality is exceedingly high in the presence of concomitant severe acute malnutrition (SAM) which is prevalent at around 20%i. The combination of malaria morbidity with SAM is reported to be able to reach case fatality rates of up to 50% as compared with 3% for uncomplicated malaria.

Among the currently reachable target population, it can be expected than children under 15 years be infected with malaria at least once during the ongoing peak transmissions season. If there is no treatment available uncomplicated malaria episodes can be expected to have a 10% case fatality rate, which could rise to 50% among the 20% of children under 5 with and to 30% for the children between five to under 15 years old the untreated association of SAM and malaria. Therefore, a total of 18% of children under 5 or 14% of children between 5 to less than 15 years of age are at are at high risk of dying of malaria between now and the end of this year unless urgent action to alleviate the acute lack of access to antimalarial drugs is taken. It can be expected that adults will have developed semi-immunity in a hyper-endemic area but in face of the widespread prevalence of malnutrition, also among adults, it is recommended to administer one curative dose of antimalarial to all those receiving iron supplementation due to anaemia.

Given the above, WHO and the Global Malaria Programme (GMP) recommends that urgent action be focused on the rapid reduction of malaria mortality among the children under the age of 15, giving first priority to children under the age of five. The upcoming measles catch up campaign would be an ideal opportunity to reach the identical target age group for malaria < 15 also with malaria Mass Drug Administration (MDA). For the 15% of the total population reachable in IDP camps, age-targeted MDA for malaria also could be carried out as a standalone campaign. A written decision in this approach is being awaited from the National Malaria Elimination Programme (NMEP).

Security incidents of the past week indicate the continued fluidity and unpredictability of the general situation in the area. These continued to impact on the humanitarian movements and activities.