India, Orissa: cholera-diarrhoea epidemic claims 140 lives

At least 140 people have died from cholera and diarrhoeal diseases in the Indian state of Orissa. Worst hit is Rayagada district, where 39 deaths have ocurred and 784 affected persons have received medical attention since first week of August 2010. After fierce criticism from opposition parties, accusing the state government for failing to contain the outbreak, Health Minister Prasanna Acharya and the Secretary of the Rural Development Department, which oversees drinking water facilities, rushed to the Rayagada district on 14 September 2010 to take stock of the situation. One opposition leader (Tara Prasad Bahinipati, Congress) claimed that over 600 people had already died in undivided Koraput district.

In Rayagada district, according to official sources, 39 deaths have occurred till date, while unofficial figures put the mark at over 65. Regional Medical Research Centre, Bhubaneswar, has confirmed the prevalence of cholera in the district. [...] To assist the existing medical teams, 70 more personnel, comprising 30 doctors and 40 paramedics, are being sent to the district.

Back in 2007, a cholera and diarrhoea epidemic in Rayagada district had claimed over 100 lives.

Non-availability of clean drinking water, faecal contamination of drinking water sources, lack of awareness about sanitation among tribals living in remote pockets and slow progress of the Total Sanitation Campaign are the reasons behind the recurring cholera and diarrhoea outbreaks in this district during monsoon, said Chief District Medical Officer of Rayagada, B.D. Nayak.

Lack of doctors and communication facilities in remote areas adds to the problem. Fifty-nine posts of doctors are vacant in Rayagada district.

Source: Sib Kuma Das, The Hindu, 15 Sep 2010 ; The Hindu, 14 Sep 2010

Afghanistan: chlorination drive to avert water-borne diseases

Health workers in flood-affected parts of Afghanistan are trying to prevent water-borne disease outbreaks by chlorinating drinking water and promptly delivering health services.

Dozens of small health teams have been sent to areas mainly in northern and eastern Afghanistan hit by flash floods [at the end of July 2010], Health Ministry officials said.

Nepal: specialists call for stronger measures to combat diarrhoea

Aid agencies are urging Nepal to implement stronger water and sanitation measures to prevent diarrhoea outbreaks, which claim hundreds of lives each year.

Ahead of next month’s monsoon season – the four- to five-month period when there is a spike in diarrhoea-related deaths – aid workers have been calling on the government to prepare for a deluge of cases.

“This is the period of water-borne disease, and there is a lack of effective awareness programmes, which has to be stressed a lot to reduce the outbreak,” said Richard Ragan, country representative of the UN World Food Programme, which is involved in public health education about safe drinking water and sanitation practices.

In 2009, there were more than 370 diarrhoea deaths, mostly in western Nepal, according to figures from the government’s Epidemiology and Disease Control Division (EDCD). There were more than 67,000 diarrhoea cases reported last year, most of them in 18 of the country’s 75 districts.

The east of the country is also vulnerable, with the number of children five and under who fell ill with diarrhoea increasing from 241 cases per 1,000 children in 2007, to 550 in 2009, the regional health directorate said.

Even before the monsoon has started, 15 people have died from diarrhoea-related causes in the last two months in five districts of western Nepal, according to the government.

Better preparation needed

The Nepal Red Cross Society (NRCS), the country’s largest humanitarian organization, is concerned that the mistakes of last year might be repeated: improper distribution of medicines, untimely reporting of cases and poor coordination with remote districts.

“Preparedness measures are the top priority of the government, but it needs to do a lot in terms of action in the field or we will be faced with a major disaster like last year,” said Pitamber Acharya, NRCS disaster director.

Acharya said the government needs to invest more in hygiene, water purification and safe drinking water supplies – the lack of which are the main causes of diarrhoea outbreaks every year.

“Simply giving health education and providing emergency response are not enough,” he said.

According to the latest UN Millennium Development Goal statistics, 89 percent of the population has access to improved drinking water sources – such as piped water into a home, a dug well, rainwater or bottled water – and 27 percent have access to clean sanitation.

Twenty-six districts across the country remain at risk from diarrhoea outbreaks, according to the EDCD. Some impoverished, food-insecure districts, where people survive on less than US$1 a day, endure the worst water and sanitation conditions, and health services.

Thir Bahadur, head of the Home Ministry’s disaster risk management unit, said the government has stocked medicines and formed rapid response teams in vulnerable districts to prepare for the monsoon.

Source: IRIN, 14 May 2010

Nepal: Sanitation finally a priority

The diarrhoea that spread earlier in 2009 in 18 districts across Nepal killed nearly 300 people; nearly six months after the initial outbreak, four ministries have finally made a joint commitment to launch a massive water and sanitation campaign to meet the state’s target of providing complete sanitation to all by 2017.

“We were not able to launch all components of water and sanitation in a comprehensive manner earlier, which is why we had diarrhea-related deaths every year,” said Dr. Babu Ram Marasini, chief of health sector reform unit at the Ministry of Health.

The programme was launched on Global Handwashing Day on 15 October 2009 as a comprehensive and combined effort by the Ministries of Health, Education, Physical Planning and Works, and Local Development. The programme will see extension of the construction of latrines in all 75 districts, awareness programmes, establishment of a national sanitation fund among others, according to Kamal Adhikari, an official at the Department of Water Supply and Sewerage. Adhikari also said that the ministries have planned to review the existing policies to provide complete sanitation to all by 2017.

According to a report by WaterAid, about 14.2 million people do not have access to sanitation and 7.1 million lack access to safe drinking water and sanitation in the country; similarly, according to the Ministry of Health, 54 percent of the country does not have access to latrines. Likewise, only 37 percent wash their hands, and only 12 percent use soap. Also, 45 percent of deaths caused by avoidable diseases is because of unsafe drinking water and lack of sanitation. “Earlier, we used to implement programmes related to water and sanitation separately but we are now planning to go ahead in a joint and comprehensive manner,” said Adhikari.

Source: The Kathmandu Post; The Rising Nepal; Gorkhapatra; Naya Patrika; Annapurna Post; Kantipur; Nepal Samacharpatra / NGO Forum, 15 Oct 2009

South-East Asia: diarrhoea is a leading cause of child deaths

Fifty children under-five die every hour in South-East Asia due to diarrhoea. It is a leading cause of child mortality in the Region, second only to pneumonia.

“Diarrhoea and acute respiratory infections are the biggest killers of children under five in South-East Asia. Diarrhoea is also seriously under reported in the Region. There is a need to focus on dirrahoea and pneumonia in national health programs”, said Dr Samlee Plianbangchang, WHO Regional Director for South-East Asia. He was speaking to journalists at WHO’s Regional Committee session in Kathmandu, Nepal [on 8 September 2009].

In South-East Asia, the average incidence of acute diarrhoea among children under five years of age is around three episodes per child per year. In some South-East Asian countries, it could be as high as 12 episodes per child per year. Lack of safe water, sanitation, proper nutrition, essential health services and awareness about effective interventions make the poor especially vulnerable to acute diarrhoeal diseases. Large outbreaks of acute watery diarrhoea and deaths in the South-East Asia Region in the recent past have affected both children and adults.

Simple, safe and relatively inexpensive interventions are available, which can greatly reduce the deaths due to diarrhoea in this Region. Exclusive breastfeeding up to six months of age, frequent hand-washing, nutritional interventions, timely immunizations and improved case management with early oral rehydration therapy and zinc at both community and facility levels. An adequate supply of safe water and improved sanitation as well as community, household and good personal hygiene practices can tangibly reduce the disease burden in this Region.

Control of diarrhoea and acute respiratory infections requires an integrated and comprehensive approach for prevention and case management with full involvement of the community. The WHO Regional Office for South-East Asia is supporting countries in their efforts to control these diseases by developing a regional strategy, guidelines and protocols, and training materials.

Source: WHO Regional Office for South-East Asia, 8 Sep 2009

Nepal, Surkhet: no toilet, no passport

A remote region of Nepal is hoping to improve local sanitation by asking everyone who applies for a citizenship card or passport whether they have a toilet at home, an official said Thursday.

Authorities in the rural midwestern district of Surkhet say only one in three households there has a toilet, below the national average of 45 percent, while the district headquarters has only one public toilet for 44,000 people.

They say there is a lack of awareness of the health risks related to open defecation, and are hoping the proposed scheme will help to eradicate the practice.

“We decided we have to motivate and put pressure on people to build toilets in their houses,” regional sanitation engineer for Surkhet, Prem Krishna Shrestha, told AFP.

“Of course, we cannot deny them their right to citizenship. The idea of the programme is to make sure that people understand the value of having a toilet in their houses.

“So when someone comes to get a passport or citizenship card, the officials will ask if they have a toilet in their house.”

The proposal comes as Nepal is struggling to deal with a diarrhoea outbreak that has reportedly killed around 150 people in a remote western region.

Disease outbreaks are common during the monsoon, when floods mean water sources can easily become contaminated.

The government has promised to eradicate open defecation by 2017, but Shrestha said it was well behind schedule on the building of new toilets.

“Nepal should be building 320,000 toilets a year and records show only around 100,000 to 125,000 toilets are being built. We have a lot of catching up to do,” he said.

Source: AFP / Straits Times, 23 Jul 2009

Nepal: Government failing to curtail rural diarrhoea deaths – health workers

Neglect of the rural health system and poor preparedness result in thousands of avoidable diarrhoea-related deaths annually in Nepal, health analysts warn. “The diarrhoea epidemic has repeated again due to the government’s lack of effective preventive measures which we have been reminding the officials of every monsoon,” said Prakash Amatya, director of NGO Forum for Urban Water and Sanitation.

Most deaths occurred in remote villages in the mid-west region where a large percentage of the population remains vulnerable due to poor sanitation, unsafe drinking water and illiteracy. Many are uneducated about basic hygiene and healthcare.

In addition, there are issues of access [impassable roads] and logistics [lack of electricity].

[...] While much of the mid-west was affected, worst hit was Jajarkot district (400km northwest of the capital), where 106 people have reportedly died since 1 May [2009], according to the District Public Health Office, followed by Rukum, about 300km northwest of Kathmandu, where 25 people died between 29 June and 13 July [2009]. Deaths have also been reported from the region’s remote Dailekh, Salyan, Dang and Doti districts.

Nearly 14 percent of the country’s 27 million people live [in mid-west region], despite limited access to health, education, roads, telephones, electricity, water supply and sanitation services. The region has long been isolated from development initiatives, held back by a decade-long armed conflict and political instability.

According to UNICEF, about 13,000 children under five die annually from diarrhoea because of poor hygiene and sanitation. A government report, Nepal Country Plan for International Year of Sanitation 2008 estimated that only 46 percent of the population had access to basic sanitation. More than 14 million people, mainly in rural areas, do not have access to latrines, states the report, while over 30 percent do not have access to potable water, according to the Department of Water Induced Disaster Prevention.

“This problem would have never existed if more attention was paid to improving health hygiene and sanitation situation in the rural areas,” Pitamber Sharma, director of the disaster department of the Nepal Red Cross Society (NRCS), said.

[...] But according to the UN: “It doesn’t help to blame but to look at what needs to be strengthened, what could have been done in terms of prevention and to make this a priority for our development partners,” said Wendy Cue, head of the UN Office for the Coordination of Humanitarian Affairs (OCHA)

Source: IRIN, 17 Jul 2009

Bangladesh: Cyclone leaves trail of contaminated water sources

One week after Cyclone Aila struck southern Bangladesh [and West Bengal and Orissa in India], survivors in some areas are facing acute shortages of drinking water after many water sources were contaminated.

“The dire situation has yet to improve,” Mohammad Badi Akhter, Oxfam’s acting chief of operations in Dhaka, told IRIN, noting the government was calling on NGOs to beef up their operations, particularly for water, sanitation and hygiene (WASH).

Despite relief efforts by the government, NGOs, the UN and international agencies, thousands of people on islands had yet to receive any kind of relief assistance. Even on the mainland, scores of people were still trapped in their homes, surrounded by stagnant floodwater.

“I don’t see any possibility of the waters receding before the end of the monsoon,” said a water engineer from the Sharankhola area of Bagerhat District. This translates into the end of September [ 2009]: the consequences of the storm may turn out worse than expected.

[...] Lack of drinking water was forcing many to go hungry as they were unable to cook the food they had received from relief agencies.

Over 1,400km of flood protection embankments were washed away by Aila, exposing thousands of villages just as the monsoon is beginning, the country’s Disaster Management Bureau reported.

[...]

The main sources of drinking water in coastal areas are ponds, wells and tube wells, but many have been contaminated. “I had to walk five miles [8km] to get one pitcher of drinking water. All the sweet water ponds and tube wells were flooded by sea water,” said Motia Banu, a resident of Burirchar Union, Borguna District. [In week of 1-7 June 2009, the ICCDR,B estimated that 2000 to 3000 patients suffered from diarrhoea every day in the affected areas, of whom 20-30 patients were severely affected, and three people has died - ICDDR,B, 09 Jun 2009].

Meanwhile, the UN Children’s Fund and the government’s Department of Public Health Engineering are working with Action contre la Faim, ActionAid, BRAC, CARE, CARITAS, Catholic Relief Services, NGO Forum, Islamic Relief, Muslim Aid, Save the Children USA, Solidarites, Oxfam GB and Water Aid to improve the WASH situation.

UNICEF is procuring 70,000 bags of oral rehydration salts and pre-positioning 12.5 million water purification tablets, essential drugs and 135.7 tons of high-energy BP-5 biscuits.

“We have mobilised volunteers throughout the affected region. They are providing dry food, water purification tablets and oral rehydration solutions,” Mohamad Abul Quasem, an officer of the Bangladesh Red Crescent Society (BDRCS), told IRIN.

Source: IRIN, 02 Jun 2009

As of 10 June 2009, the death toll from Cyclone Aila according to the government was 190 and over 3.9 million people has been affected.

The WASH cluster/ working group [were carrying out an assessment for further assistance regarding water and sanitation. A rough estimate indicates about 500,000 to 750,000 people are seeking immediate water supply and sanitation supports. Most of the ponds have saline water contamination making them unfit to support drinking and other domestic water supply for the communities. Water purification is carried out by agencies such as CARE/Oxfam GB, DPHE, Save the Children USA, WVI. Bangladesh Army is also supporting water trucking to the locations [that] are difficult to reach by other agencies. Beside providing pure water many WASH working group agencies are working on restoration of potable water sources by dewatering/disinfecting ponds and tube-wells.

Source: Govt of Bangladesh / Reliefweb, 11 Jun 2009

For the latest updates on Cyclone Aiila water and sanitation relief efforts in Bangladesh see ReliefWeb.

Across the border in “over 5.1 million people have been affected in 16 districts of West Bengal, and over 500,000 houses either damaged or destroyed”, according to a release by the OPEC Fund for International Development (OPIC) on 8 June 2009. A week after the cyclone hit West Bengal, the Indian Express (02 Jun 2009) reports how the people on the islands of Sunderban had still not received any government relief. “Nine-year-old Sandeepa Gharami survived Cyclone Aila, but succumbed in its aftermath. She died on an embankment near Lahiripur on Friday after several days of continuous vomiting and diarrhoea. She received no medical care. Her parents buried her by the river”.

Bhutan: water shortage problem hits (PM’s) home

The failure of the country’s rural water supply scheme (RWSS) has the prime minister himself facing [a] serious drinking water shortage at his residence in Chang gewog [block], Thimphu. [...] And, along with him, enduring the scarcity are about 60 households of the same gewog.

This has led to residents resorting to stealing from each other’s water supply and even the prime minister’s water pipes have not been spared – [the] prime minister’s drinking water tank is never full and his security and other staff drink water from an irrigation channel.

Meanwhile, villagers claim they are forced to drink water from the Ngabi Rongchu stream, polluted often by dog waste from the Serbithang dog pound and also human waste from labour camps below it.

[...] About 88 percent of houses in Bhutan are supposed to be covered under RWSS, but of that only about 36 percent work without problems. About 31 percent are non-functional. The absolute and relative non functional RWSS rates are 12 percent and 19 percent respectively. The worst hit are Mongar, Tsirang, Haa, Pemagatshel and Samtse, with 44 to 50 percent non-functional water schemes. Others not far behind are Paro, Chukha, Dagana and even rural Thimphu.

“The reasons for the RWSS schemes failing are drying water sources, expansion of beneficiaries, damaged pipes and structures, lack of regular maintenance, inadequate community maintenance and lack of trained water caretaker and tools,” said the health director Dophu Tshering.

Dophu Tshering said: “A major problem is traditional water rights, where villages and communities, even with excess water resources, refuse to share with those suffering from shortages, citing old practices. Another is the lack of dedicated or specialised dzongkhag engineers and, at times, untrained plumbers do the survey work and the pipes are hardly checked.”

Experts feel that RWSS, which started in 1974, had crossed way past its 20-year lifeline and did not take into account the increase in households over the years.

Dophu Tshering said that the Water Act, to be put up in the Assembly for endorsement, would largely address the issue. The government has also committed to give high priority to drinking water, apart from farm roads in the tenth plan.

The recent RWSS report has recommended that a survey should be carried out every three years to assess and improve drinking water programmes in the country. It also suggests that existing programmes be manned through adequate budget allocation and reinstating dedicated engineering staff in the dzongkhags [districts] to look after the drinking water supply.

Source: Tenzing Lamsang, Nima Wangdi, Kuensel Online, 11 Apr 2009

In related news, the latest annual health bulletin (AHB) reports that diarrhoea cases more than doubled in 2008 with 58,537 cases recorded and that skin infections increased from 23,817 to 97,514.

Bangladesh, Dhaka: unusually early outbreak of diarrhoea

As temperatures climb and power outages continue, a lack of safe drinking water has resulted in an unusually early outbreak of diarrhoeal diseases across Dhaka, the capital of Bangladesh.  In [the third week of March 2009]  over 40 patients an hour were seeking admission at the International Centre for Diarrhoeal Diseases and Research, Bangladesh (ICDDR,B) hospital in the city.  Compared with the same period of last year, the number of patients has trebled. At least three tents have been set up in the ICDDR,B car park to cope with the influx.

[...] Since 11 March [2009], an average of 700 patients have been admitted to ICDDR,B each day, and health workers are struggling to cope.  ”Usually we don’t have more than 250 patients admitted at a time. But this season, as the situation worsens every day, we have had to set up temporary wings. We admitted 811 patients on 14 March and 747 on the 18th,” Shahadat Hussein, head of ICDDR,B’s Longer Stay Unit, told IRIN.

“Usually diarrhoea breaks out in late April. But this year, the diarrhoea season seems to have started early. In mid-March, we are admitting more patients than [in] the average April-peak season,” Hussein said.

ICDDR,B sources blame increasing temperatures and chronic power outages as the primary cause. Load shedding is nothing new in this city of 12 million, but with an increase in population and the number of industries, demand for safe drinking water has increased exponentially over the last decade.  Most of the patients are from the slums, areas well known for their inadequate supply of safe drinking water and where residents are largely dependent on groundwater pumped to the surface.

As demand for water rises, the water table continues to fall, and many residents have no choice but to drink contaminated water in the absence of a regular supply.  Hot weather helps bacteria replicate faster, while power outages prevent the smooth distribution of water in the city. The number of diarrhoeal patients is expected to rise in April and May.

[...] Diarrhoea is one of Bangladesh’s main health concerns. It is responsible for about 9 percent of deaths among infants under 12 months old, and 10 percent of deaths among the under-fives, according to the health authorities. Bangladesh has made significant achievements in lowering infant and child mortality rates, but almost 100 children still die every day from diarrhoea, say health experts.

See also: Bangladesh diarrhoea ‘epidemic’, BBC News, 28 Apr 2009

Source: IRIN, 19 Mar 2009