Northeast Nigeria Response: Health Sector Bulletin #36, 30 November 2017

Situation Report
Originally published



  • The cumulative number of cholera cases and deaths are 5,357 and 61 respectively (CFR: 1.1%). Of the total reported cases, 2,692 were from Jere, 1,758 were from Monguno, 736 were from Dikwa, 93 were from Guzamala, 58 were from MMC, and 20 were from Mafa. Of the 431 samples tested by RDT, 354 (82%) were RDT positive and of the 381 samples cultured, 175 (46%) were culture positive.

  • Hepatitis E outbreak, 63 new cases were reported from Rann, Kala/Balge (62) and Mobbar (1) in week 47. No cases were reported from the other LGAs involved in the outbreak and there were no reports from any new area. The cumulative number of cases and deaths are 1,376 and 8 respectively (CFR: 0.6%).

  • Nigeria, which has the second highest burden of Human Immunodeficiency Virus (HIV) infection in the world. Stakeholders who converged at the Banquet Hall of the Aso Rock Villa in Abuja on 28 November, to commemorate the 2017 World AIDS Day, were unanimous that the fight against the scourge needs combined investments from all tiers of government, civil society, and development partners and organized private sector. This year, Nigeria is marking the annual event, with the theme: 'Right to Health, Making it Happen', earlier than the commemorative date (01 December 2017).

  • 55 cases of cutaneous Leishmaniosis have been confirmed in Lekko Ward, Jada LGA of Adamawa State.

Situation update

The health sector response strategy’ will continue to focus on providing humanitarian life-saving and lifesustaining health services to the most vulnerable populations, while also supporting the strengthening of health sector coordination and health information systems, with an emphasis on enhancing protection and increasing access to health services.
The provision of life-saving and life-sustaining health services will be driven by a combination of minimal and comprehensive packages, including maternal and child health services, services for gender-based violence, management of malnutrition with medical complications, management of non-communicable diseases, mental health and psychosocial support, support for people living with HIV/AIDS, and the strengthening of referral services. There will be a particular focus on active detection of malnutrition, referral to appropriate services (out and in-patient facilities) and capacity building of health workers to manage SAM with medical complications. Health sector partners will continue their support to the national immunization and vaccination campaigns for Vaccine Preventable Diseases (VPD) as well as supplementary and/or reactive vaccination activities (e.g. measles, cholera, meningitis, hepatitis) in IDPs camps and known high-risk epidemic prone areas.
The 2017 cholera outbreak in Borno state clearly demonstrated the need for further strengthening the coordination between WASH and health partners. This is especially relevant at LGA level and in IDPs camps where the population is living in congested and unfavourable conditions with limited access to clean drinking water and limited access to emergency health care services. To mitigate against these risks, Oral Cholera Vaccination (OCV) campaigns will be launch before the rainy season in epidemic-prone LGAs as identified by the epidemiological data and potential risk.
A recent WHO preliminary analysis suggests that seasonal mass chemoprevention (SMC), consisting of four rounds of monthly prophylactic antimalarial medication delivered through house-to-house visits, is expected to significantly reduce malaria morbidity and mortality among in children under five. Furthermore, the impact of malaria can be mitigated through a combination of preventive measures (indoor residual spray, using insecticide-treated nets) and effective case management. The sector will therefore target the highest risk group (children under five years of age) with SMC during the rainy season to reduce morbidity and mortality in this emergency setting.
The sector’s Reproductive Health (RH) Working Group will coordinate partners to ensure that RH related needs such as maternal and neonatal health, including basic emergency obstetric care, HIV and GBV-related health issues are addressed in a timely manner.
The health sector will support improvements in the health system by strengthening institutional and response capacity and empowering the health authorities and the national health workforce. To ensure adequate health assistance, the provision of primary and secondary health care will be expanded beyond the urban areas. This approach has been chosen in part because it caters to the widespread mental health needs and can be adapted to the country context, for which specialized care is currently only available in Maiduguri.
Critical gaps in mental health services will be met through the introduction of outreach services from the Federal Neuropsychiatry Hospital in Maiduguri to selected PHC in six LGAs of Borno state. Outreach teams and PHC staff will be able to refer diagnosed/threated patients from PHCs to the Neuropsychiatry Hospital.
More broadly, the sector will work to strengthen mental health (psychiatric and psychosocial), trauma care, reproductive health services, rehabilitation services and referral systems, and ensure availability of essential medicines, medical supplies and equipment.
Health partners will work through the Rapid Response Mechanism (RRM) to provide an array of quick impact services and supplies to populations affected by a disease outbreak, natural disaster or medium to large-scale population movement (both IDPs and returnees) in areas where partners are not present or where the needs exceed existing capacities. Partners will use RRM-dedicated or flexible funds to deliver RRM response, which may include, depending on the context, distribution of life-saving drugs and medical supplies, deployment of health RRM teams for outbreak risk assessment and surveillance supported by Hard to Reach (H2R) teams, mobile emergency health intervention package (including measles and polio immunization, health screening and treatment), putting a referrals system in place, establishing an isolation area, ORS point or setting up an emergency structure with tent, spraying and disinfection of the medical facility.