The spread of Acute Watery Diarrhoea (AWD) across nine districts of mid- and far western Nepal has affected over 5,000 people and so far claimed over 200 lives. The National Public Health Laboratory has confirmed that three out of the seven samples brought to it carried the Vibiro Cholerae bacterium, the causative pathogen for cholera.
As an ex-officio member of the government's disaster management set-up, the Nepal Red Cross Society is part of the coordination mechanism in the country's capital, Kathmandu, as well as in the field. Red Cross volunteers have been mobilized to assist in the raising awareness in the remote villages while also providing care to the ailing.
This bulletin is being issued for information only, and reflects the current situation and details available at this time. The International Federation is not seeking funding or other assistance from donors for this operation. The Nepal Red Cross Society however, is accepting direct assistance from in-country partners to provide support to the affected population.
The Situation
Beginning May 2009, cases of acute watery diarrhoea were first observed in three village development committees (VDCs) of Jajarkot district in Nepal's mid-western region. The diarrhoea outbreak spread rapidly across all of the 30 VDCs (look at map, provided by UNOCHA). Since then, the infection has spread to adjoining districts (Rukum, Salyan, Surkhet, Rolpa, Dailekh and Dang) in the mid-western region and in Bajura and Dadeldhura of the far-west region. The government's health department predicts that the cases of diarrhoea could be of similar nature and origin.
So far, over 200 people are estimated to have lost their lives and over 5,000 thousand have been affected. Of the seven samples collected from Jajarkot, three were found to have Vibrio Cholerae and others, mixed infection. The government's health authorities have decided to follow the protocols for treatment of cholera.
Nepal was free of cholera for 10 years until 1997, when the disease first showed up in Saptari district bordering India in the country's south east. Since then, there have been a number of reported cases, the last being in 1997 in the Kathmandu valley.
Between 15 May and 17 July, 11 of Jajarkot district's 30 VDCs reported 2,190 cases with 61 deaths; in community health parlance, a case fatality ratio (CFR) of 2.8 per cent. In the Majarkot VDC alone, there were 15 deaths of the 250 cases reported, giving a CFR of 10 per cent.
The affected region of the country is difficult to reach due to its geographical remoteness. Communication, including telecommunication, is a major challenge in this region, with police radio sets being the only means of communication to gather information on infection and mortality. Thus, confirming the exact number of deaths remains a challenge. As the region is very underdeveloped, most of the menfolk are away from the village working elsewhere as migrant labourers. This has meant that women and children are the most affected and those from disadvantaged sections of the communities, more so. It is expected that the situation will take a few more months to stabilize.
Safe drinking water is difficult to access as most people live far above the river or other sources of water. Whatever sources of water could be accessed have also been scarce because of the demand for water upstream due to the paddy transplanting season which demands a high volume of water. The health situation has been further exacerbated by the food insecurity in the region which has been suffering from a drought.
The Nepal government's Ministry of Health and Population is leading the response with the support of the World Health Organization. Coordination focal points are in place for human resource coordination, logistics and communication. The Ministry of Health and Population, supported by the Nepal Medical Association (NMA), has deployed health teams to health posts, sub-health posts and primary health centres in the most affected districts. Each team comprises of a doctor and three paramedics.
At the district level, authorities are intensively involved in rendering services to affected populations. The World Health Organization, together with the Ministry of Health and Population, district public health offices, epidemiology and disease control division has been conducting surveillance in the affected districts. Various agencies are supplying medicines to the affected areas. However, due to the remoteness and scattered settlements (in many cases, health personnel face a one-day trek to reach a single household) access to the affected area, delivery of supplies as well as promotion of awareness raising activities are complicated.
Patients are being brought from distant places and the limited health infrastructure of the affected region is being stretched to its limits. Police stations are doubling as health posts and the conditions for treating the patients are far from acceptable.
The immediate needs identified are both clinical (to treat the patients) as well as preventive (involving disseminating information on water, sanitation and hygiene practices). In some cases, the issues are very basic as people prefer to defecate in the open and the number of toilets or latrines at the household level is very low. Soap is not available in most communities either.
Another concern is that many children are being orphaned due to their parents dying – 94 per cent of those affected are above five years of age.
Map - Nepal: Diarrhoea Outbreak in Jajarkot District - Location of Health Camps (as of 20 Jul 2009)
