CHOLERA FACT SHEET #6

CHOLERA FACT SHEET #6
(ReliefWeb) - Source: United States Agency for International Development (USAID)

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KEY DEVELOPMENTS

- The Pan American Health Organization (PAHO)/U.N. World Health Organization (WHO)highlight a decreasing case fatality rate (CFR) since the outbreak began in late October, noting that the CFR for hospitalized patients has decreased from up to 9 percent to 3.5 percent, with an overall CFR for both hospitalized and non-hospitalized cases of 2.2 percent.

- On December 1 and 2, USAID Office of U.S. Foreign Disaster Assistance (USAID/OFDA) flights transported 300,000 sachets of oral rehydration salts (ORS) to Haiti, bringing the total number of sachets delivered by USAID/OFDA to more than 1.6 million―sufficient to help 82 percent of individuals PAHO forecasts to have cholera in the first three months of the outbreak.

- On December 3, USAID/OFDA delivered 25 cholera treatment kits―which include medical supplies, gloves, soap, and Ringers lactate, an intravenous saline solution―for placement at critical sites in each of Haiti's 10 departments; 20 of the kits will be transported through USAID/Haiti's supply chain management system (SCMS) to USAID- and U.S. Centers for Disease Control and Prevention (CDC)-supported health facilities to augment treatment capacity at the facilities. In total, the kits will help treat 10,000 severe or moderate cholera cases.

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** the detailed full report follows below **

NUMBERS AT A GLANCE SOURCE

Overall Cholera Caseload - 84,391 (MSPP1 – November 30, 2010)

Hospitalized Cases - 39,010

Deaths Due to Cholera - 1,882

Overall Case Fatality Rate - 2.2 percent

CONTEXT
On October 22, U.S. Ambassador Kenneth H. Merten issued a disaster declaration due to the cholera outbreak. On October 26, USAID deployed a Disaster Assistance Response Team (DART) to work closely with staff from USAID/Haiti, USAID/OTI, and CDC to coordinate emergency response efforts, technical assistance to the MSPP, and support to longer-term health systems. USAID also stood up a Response Management Team in Washington, D.C., to support the USAID/DART in Haiti and coordinate with the USAID Haiti Task Team (HTT) in Washington, D.C.

USAID/OFDA’s response plan focuses on preventing cholera cases, reducing the number of cases requiring hospitalization, and reducing the case fatality rate. The plan outlines four elements: provision of chlorine to increase availability of safe drinking water; expansion of national hygiene education outreach; provision of ORS and medical supplies; and increase in the number of cholera treatment centers (CTCs) and units (CTUs), particularly in underserved and rural areas.

USAID/Haiti continues to work with the MSPP and PAHO to plan and respond to the cholera outbreak. USAID/Haiti grantees are distributing educational materials, conducting hygiene trainings, and broadcasting prevention messages. In addition, USAID/Haiti grantees have procured and consigned commodities—including ORS, water purification materials, intravenous sets, Ringer’s lactate, and bleach—to USAID-supported health sites and other sites treating cholera cases.

In response to the outbreak, USAID/OTI is conducting direct cholera prevention activities; all ongoing and new USAID/OTI activities in response to the earthquake now also include cholera prevention and education elements.

In addition to ongoing work to strengthen and rebuild Haiti’s basic public health infrastructure, CDC is contributing scientific leadership and technical guidance in response to the outbreak in four key areas: preventing deaths in health facilities; preventing illness and deaths in communities; monitoring the spread of disease; and improving laboratory and diagnostic capacity. CDC currently has a total of 185 staff providing support to the MSPP cholera response, including 28 staff members deployed to Haiti specifically for the cholera response and 40 additional staff in Haiti normally assigned to CDC’s Global AIDS Program. Among those involved in the cholera response are medical officers, epidemiologists, laboratory scientists, environmental health specialists, communication specialists, public health advisors, planners, information technology specialists, and support staff.

The MSPP’s approach to the cholera outbreak has focused on community-level primary response to provide rehydration, disinfect affected areas, and promote good health practices; CTUs at health service sites, where patients can receive oral rehydration and basic intravenous therapy; and CTCs for treatment of severe cases.

Health
Health Cluster members note an increasing number of cholera cases in Northwest Department and the need for additional cholera treatment interventions in the department. The U.N. Office for the Coordination of Humanitarian Affairs (OCHA) reports that several health partners have met to assess needs and coordinate response planning in the department, highlighting the need to increase treatment capacity in St. Louis de Nord, Baie de Henne, Anse-a-Foleur, and Tortue Island. At present, USAID/OFDA is funding grantees International Medical Corps (IMC) and International Organization for Migration (IOM) for water, sanitation, and hygiene (WASH) and health interventions in the department, as well as distribution of relief commodities and logistical support. IMC plans to establish four CTCs in the four identified priority areas.

On November 30, USAID/OFDA grantee Samaritan’s Purse opened a CTC in the Cité Soleil neighborhood of Port-au-Prince with a 200 bed capacity. USAID Bureau for Democracy, Conflict, and Humanitarian Assistance Assistant Administrator (DCHA/AA) Nancy Lindborg and USAID/DART and staff visited the facility and observed several admitted patients. Samaritan’s Purse has hired 300 local employees for various tasks in support of the facility.

Water, Sanitation, and Hygiene
Preliminary results from the CDC knowledge, attitudes, and practices survey of Artibonite Department indicate that the percentage of people chlorinating drinking water has increased from 29 percent to 87 percent since the cholera outbreak began—indicating the availability of chlorine and knowledge regarding the need to chlorinate water to prevent cholera. Of survey respondents, 71 percent were aware that hand washing is a cholera prevention method, 97 percent reported washing hands with detergent or soap, and 65 percent reported washing hands before eating and after using the toilet.

On November 30, the Camp Coordination and Camp Management (CCCM) Cluster―the coordinating body for camp management activities―reported ongoing hygiene promotion activities in camps and surrounding communities. According to the CCCM Cluster, camp management operations teams have installed physical facilities for 113 of 250 planned oral rehydration posts in camps and settlements, primarily in Port-au-Prince and Croix-des-Bouquets, West Department, to provide first-line cholera treatment.

As of November 26, the WASH Cluster noted ongoing chlorine residual testing, with results showing the minimum chlorine residual was 72 percent of tank and bladder samples and 52 percent in home samples. The Government of Haiti (GoH) National Direction for Potable Water and Sanitation (DINEPA) reports sufficient chlorination of the water supply system for Cité Soleil, which serves approximately 200,000 people.

Logistics and Relief Commodities
A logistics working group comprising GoH, non-governmental organization, U.N. agency, and donor representatives continues to meet to identify warehousing and supply resources countrywide and determine which agencies are best able to handle additional requests.

In a November 26 meeting with USAID/DART staff, International Federation of Red Cross and Red Crescent Societies (IFRC) staff noted a strong IFRC logistics pipeline, including ORS, Ringer's lactate solution, water purification tablets, and soap, and no major delays due to customs requirements.

To date, USAID/OFDA has provided nearly $2.3 million for relief commodities and logistical support.

USAID HUMANITARIAN ASSISTANCE TO HAITI FOR CHOLERA FY 2011
Grantee -Activity -Location -Amount

Action Against Hunger (ACF) - WASH - Artibonite, North, West Departments -$925,000

American Refugee Committee (ARC) - Health, WASH -West Department - $1,144,166

CDC - Health -Affected Areas -$275,000

Concern - WASH- Center, West Departments - $624,942

U.S. Department of Health and Human Services (HHS) - Logistics and Relief Commodities - Affected Areas - $500,000

IMC - Health, WASH -Artibonite, Center, Northwest, Southeast,West Departments-$1,500,000

IOM - Health, Logistics and Relief Commodities -Artibonite, North, Northeast, Northwest, Southeast, West Departments - $4,600,000

Management Sciences for Health (MSH) - Health -Affected Areas - $825,617

Mercy Corps - WASH - Center Department - $432,438

Partners in Health (PIH) - Health, WASH - Artibonite, Center, and West Departments - $1,500,000

Samaritan’s Purse - Health, Logistics and Relief Commodities, WASH -
West Department - $2,869,431

Save the Children/U.S. (SC/US) - Health, WASH - West Department - $825,000

PAHO/WHO - Health - Affected Areas - $635,580

Logistics and Relief Commodities - Affected Areas - $2,485,924
Administrative Costs ......................................................... $ 87,068
TOTAL USAID/OFDA $19,230,166

USAID/OTI Assistance - Implementing Partners - Health, Logistics and Relief Commodities, WASH - Affected Areas - $318,190

TOTAL USAID/OTI - $318,190

FY 2010
Program - Activity - Location - Amount

USAID/HAITI ASSISTANCE

Community Health and AIDS Mitigation Project (CHAMP) - Community Health Services - Countrywide - $198,000

Leadership, Management, and Sustainability Program (LMS) - Logistics and Relief Commodities - Countrywide - $185,000

PROMARK - Health, Public Outreach - Countrywide - $232,000

Supply Chain Management System (SCMS) - Logistics and Relief Commodities - Countrywide - $600,000

Health for the Development and Stability of Haiti (SDSH) - Essential Health Services - Countrywide - $800,000

TOTAL USAID/HAITI .........................................$2,015,000

TOTAL USAID HUMANITARIAN ASSISTANCE TO HAITI FOR CHOLERA
$21,563,356


USAID/OFDA funding represents anticipated or actual obligated amounts as of December 3, 2010.

USAID/Haiti has pre-existing, long-term health programs that have been an integral part of the cholera response; these programs have also continued normal activities. The USAID/Haiti funding levels represent estimated amounts for one month of FY 2010 resources expended on the cholera response. The funding is based on an estimate of the program spending rate and percentage of resources expended on the cholera response.