Adapting Response Efforts to Stop the Spread of Acute Watery Diarrhoea 

By Rebecca Beauregard

SOMALI Region, 20 April 2017 – When Basazin Minda was requested to support the acute watery diarrhoea (AWD) response in Somali region, he did not hesitate. In fact, within one week, he handed over his duties to colleagues in UNICEF Oromia team and was in Jigjiga office.

Complex emergencies are not new to him. He was in Gambella when a South Sudanese refugee influx necessitated immediate WASH response. And when an AWD outbreak threatened lives in the southern cross-border town of Moyale, Basazin led the AWD WASH response and coordinated joint Kenya and Ethiopia control mechanisms. This is part of why he loves working with UNICEF – there is full support and resources to take quick action as well as the flexibility to respond where needed when communities are facing crisis, such as the AWD outbreak.

One lesson he learned from those past emergencies was that to have an impact, it required extensive human resources in the affected areas. Recently hired WASH Information Management Officers (IMOs) were available to support his team and he soon learned about UNICEF Health section’s C4D (Communication for Development) consultants, which could help spread the critical WASH messages to stop the spread of AWD.

Adapting Response Efforts to Stop the Spread of Acute Watery Diarrhoea
On site community mobilization concerning poor drainage and optimal water collection methods. Lasoaano kebele, Shilabo woreda ©UNICEF/2017/Mualid

AWD describes infections that can result in easily transmitted and potentially deadly diseases. The spread of such disease is very high in areas with water scarcity and can have a devastating impact on children who may already be undernourished. Additionally, those living in crowded spaces with poor access to WASH facilities, like the many temporarily displaced families, also face a higher risk.

The recent AWD outbreak peaked in Somali region in February 2017 and now more than 50 per cent of the woredas (districts) are reporting active cases. Particularly due to the current Horn of Africa drought, there are refugees coming from neighbouring Somalia, as well as temporarily displaced Ethiopian Somalis, as people move in search of water, food and pasture for their livestock. The predominately pastoralist Somali region is the worst drought-affected area in Ethiopia with over 30 per cent of the region’s population requiring food assistance in 2017. Living conditions of these temporarily displaced people are often inadequate and widespread open defecation poses a risk of the spread of AWD, among other disease outbreaks.

Upon arrival, Basazin began a series of discussions with people from UNICEF, the Regional Water Bureau (RWB) and the zonal command post. What he learned immediately on the ground was a little different than he had prepared himself for. He came for mass chlorination of boreholes to stop the spread of AWD. However, he identified that boreholes are protected. “This is what can be so interesting about emergencies. You go in with one mind set and task and immediately are faced with a reality that may differ. The problem was not the water sources, so the contamination had to be happening at some point after water is collected, either during collection or storage,” Basazin explains.

Like detectives, Basazin and the newly formed team began contacting local water office staff and meeting with various community members to pinpoint where this contamination was coming from. The team concluded that contamination was occurring from water trucking, during the transport of water (usually by donkey cart) and at the household level, where dirty jerry cans were utilized repeatedly. Now the task has shifted to a multi-effort approach including mass chlorination of water trucks, community awareness campaigns to ensure clean jerry cans and training sessions for local water staff on chlorination standards.

The RWB staff know about chlorination, however at this critical time of drought and AWD, with a mobile team equipped with testing kits, jerry cans and barrels of HTH chlorine solution, everyone was eager to learn more from practical demonstrations. A key lesson that was missing before now was how to calculate correct measurements of chlorine according to the container size to ensure disinfection. Referencing UNICEF WASH guidelines, Basazin prepared a guideline of chlorination and turbid water purification with these specific calculations included and it was subsequently distributed to all water offices in the region.

Adapting Response Efforts to Stop the Spread of Acute Watery Diarrhoea
Basazin demonstrating residual chlorine with technical staff and community mobilizers at the Lasooano kebele health centre in Shilabo woreda ©UNICEF/2017/Mead

The feedback was positive after the training and RWB staff proliferated the learning by sharing demonstration photos through their Viber group, a mobile messaging application utilized by all Somali RWB staff.

One water office participant commented after a demonstration, “Assistance has come through here and sometimes guidance is offered, but not like this. Receiving evidence-based participatory training makes a big difference.”

Basazin did not always explain the calculations and guidelines. Another lesson his work has taught him is to tailor his WASH messages according to the audience. “AWD bugs will attack the water if it finds it without chlorine and consequently the attack will reach to human beings.” There was laughter when Basazin used this metaphor.

The team is working through Good Friday, the big Easter holiday and weekends to curb the outbreak and spirits remain high. Basazin’s energy and commitment to ensuring his work has impact is easily detected as he speaks. “I like to learn today and implement for tomorrow,” he says. “Perhaps another idea coming from this mission is that we should highlight a jerry can and water truck washing day, just as we promote handwashing day.” He is also quick to admit this is not a one-man show. With the UNICEF Jijiga and Addis team and the community, mass chlorination is taking place exactly where needed to curb the AWD outbreak.

“Everything has a solution,” Basazin declares.

 

New EU funding will provide essential nutrition treatment for 130,000 children under the age of five in Ethiopia

03 May 2017, ADDIS ABABA – The European Union (EU) has given €3 million in humanitarian funds to support UNICEF’s emergency interventions in Ethiopia. The new grant will provide life-saving nutrition treatment for severely malnourished children living in drought-affected areas of the country.

In Ethiopia, below-average rainfall has worsened the situation in Somali, Afar, and parts of Oromia and Southern Nations, Nationalities, and People’s (SNNP) regions, already severely affected by protracted drought. Access to water, sanitation and health services in these areas is critically low. In addition, livestock deaths have further reduced communities’ capacity to cope, resulting in food and nutrition insecurity. An estimated 303,000 children under the age of five are at risk of severe acute malnutrition (SAM) in 2017.

A boy is being treated for a severe malnutrition at a UNICEF supported stabilization centre“We are grateful for EU’s continuous and generous assistance for life-saving interventions addressing malnutrition at this critical time,” said Ms Gillian Mellsop, UNICEF Representative to Ethiopia. “We believe that the funding will significantly improve the health condition of children affected by the current drought and reduce the long term impact of malnutrition including life-long cognitive impairments.”

The EU humanitarian funding will support UNICEF to reduce child mortality and morbidity associated with SAM. In order to reach vulnerable children in remote areas, UNICEF will support the Government to expand existing healthcare services and provide treatment supplies – including ready-to-use-therapeutic food (RUTF), therapeutic milk, and medicines. The intervention will also aim at mobilizing communities’ awareness on preventing malnutrition.

“As devastating drought hits pastoral communities in the south and south-east of Ethiopia, bringing in its wake Acute Watery Diarrhoea (AWD) , food and water shortages, the EU is scaling up funding to provide children with vital nutrition care,” said Ségolène de Beco, Ethiopia Head of Office for EU Civil Protection and Humanitarian Aid (ECHO). “Infants and young children are extremely vulnerable to a combination of malnutrition and diseases. To avoid unnecessary deaths and suffering, we need to respond to the needs of these children in time with appropriate treatment and care.”

The concerted efforts of UNICEF with the EU, the Government of Ethiopia and other partners, will relieve the suffering of children while continuing to build long term resilience and strengthening the Government’s capacity to respond to future nutrition emergencies.

Volunteers Blast Hygiene Message to Halt Acute Watery Diarrhea

By Bethlehem Kiros

ADDIS ABABA, 30 September 2016 – Mickias Fikre, a taxi driver keeps soap in his car and makes sure to wash his hands thoroughly before he eats. According to him, it is a new habit he developed after he saw his friend suffer from Acute Watery Diarrhea (AWD). “He was so sick that I thought he would not recover,” he remembers. His friend got better after few days and Mickias learned from the local health centre how to protect himself from the disease. Mickias adds, “It is really helpful that volunteers are travelling throughout our community on trucks, spreading the message on how to stay safe.”

UNICEF and partners response to Acute Watery Diarrhoea outbreak in Ethiopia
ERCS volunteers in Akaki/Kaliti sub-city perform a traditional dance to draw the attention of the community and raise awareness on AWD prevention. © UNICEF Ethiopia/2016/Ayene

Ayantu Dadi, 20, is one of the volunteers who is helping communities protect themselves from AWD. A recent college graduate and an Ethiopian Red Cross Society (ERCS) volunteer of over five years, she has been spending the last three months on the UNICEF and ERCS-supported audio truck that drives around the Nefasilk Lafto sub-city.   Since July 2016, UNICEF and ERCS have been conducting mass public awareness campaigns using 10 audio trucks deployed in each of the 10 sub-cities of Addis Ababa.

Ayantu and seven other volunteers meet early in the morning at the Nefasilk Lafto ERCS branch office, then visit the sub-city health office to obtain instructions on the exact locations they need to cover for the day. These locations are selected based on reported cases of AWD, as well as observed risk factors such as poor hygiene and sanitation practices. The volunteers spend about eight hours reaching out the public with awareness-raising messages on how to prevent AWD and recognize its symptoms. “We play music for few minutes to attract people’s attention and then we broadcast the Public Service Announcements on hygiene and sanitation,” she elaborates.

They also stop at designated priority locations, such as crowded locations where they can reach a large number of people, to distribute flyers, put up posters and have one-on-one talks with people who have questions about AWD. “We especially take time to talk with street food vendors and people in economically impoverished communities where the problem seems to be most prevalent,” she explains. According to Ayantu, the outreach helps prevent new cases of AWD as well as identify existing cases. “It is quite satisfying when you find out that your actions actually impact people’s lives. It is what encourages me to keep passing this message every day,” she says.

UNICEF and partners response to Acute Watery Diarrhoea outbreak in Ethiopia
Ayantu Dadi, 20, an ERCS volunteer, teaches a street vendor about AWD. “I only graduated last month so this is what I do full time.” ©UNICEF Ethiopia/2016/Ayene

Since the AWD outbreak was reported in November last year, 7,769 cases have been identified in Addis Ababa alone.

The coordinated response by the Federal Ministry of Health (FMOH) and partners including UNICEF, cases have now continued to decline however, we should not let our guard down.

UNICEF and partners response to Acute Watery Diarrhoea outbreak in Ethiopia
Sintayehu Tsegaye, who had AWD and has recovered, washes the hands of her son Michael, 3, before she gives him orange. “I always keep soap next to the tap so that I wash my hands when I come from outside or from the toilet. I also try my best to drink boiled water and make the rest of my family do the same.” ©UNICEF Ethiopia/2016/Ayene

Sintayehu Tsegaye 45, is among the thousands affected by AWD and was treated for a week in the local AWD case treatment centre (CTC). A mother of two, she has a small business selling potato chips, flowers and grass that is used in Ethiopian coffee ceremonies. “It is hard to be clean all the time when you touch grass all day, use community latrines and live with a big family that does not have the same hygiene practices as you,” she explains, adding that after her recovery from AWD, she has become more careful about practicing proper hygiene measures such as handwashing with soap.

“People in the community don’t always take the information seriously unless they are personally affected by it, but with repeated teaching, I believe many will listen,” says Sintayehu. “Is especially important to spread the message in communities like mine that use shared latrines.”

In addition to public outreach, UNICEF is also supporting the Government of Ethiopia’s efforts to contain and prevent the spread of AWD  by providing supplies for case treatment centres, technical support for case management and infection prevention, and water treatment supplies to safeguard drinking water for households and communities.

አጣዳፊ ተቅማጥና እና ትውከት /አተት/ በሽታን እንከላከል

የአጣዳፊ ተቅማጥና ትውከት በሽታ በተለያዩ በጥቃቅን በዓይን በማይታዩ ተዋህሲያን አማካይነት አማካይነት የሚከሰት በሽታ ሲሆን ከንጽህና መጓደል በተለይም በተህዋሲያን በተበከሉ ምግቦች፣ የመጠጥ ውሃ እና በሌሎች መተላለፊያ መንገዶች ከሰው ወደ ሰው በከፍተኛ ፍጥነት የሚተላለፍ ነዉ፡፡

በሀገራችን ነባራዊ ሁኔታ በአንዳንድ አካባቢዎች የንጹህ መጠጥ ውሃ አቅርቦት በቂ ያለመሆንና በዓለም ላይ በተከሰተዉ የኢሊኖ አየር መዛባት ምክንያት የዉሃ እጥረትና በሌላዉ በኩል የጎርፍ ችግር መኖር እንዲሁም ፣ ከሕብረተሰቡ የአከባቢ፣ የግል፣ የውሃና የምግብ ንጽህና አያያዝና አጠቃቀም ልማድ አለመዳበር ጋር ተያይዞ የተቅማጥ በሽታዎች ስርጭት በየጊዜው እንዲከሰት አስተዋጽዖ አድርጓል፡፡ በተለይም በጎርፍ ምክንያት ምንጮች፣ ወንዞች፣ የውሃ ጉድጓዶች ስለሚበከሉ በአጣዳፊ ተቅማጥና ትውከት የሚያዙ ሰዎች ቁጥር ይጨምራል፡፡

የአተት ምልክቶች ምንድናቸው ?

በበሽታው የተያዘ ሰው በተደጋጋሚ አጣዳፊ ተቅማጥና ትውከት ይኖረዋል፡፡ በዚህም የተነሳ የሰውነት ፈሳሽና ጠቃሚ የሆኑትን ንጥረ ነገሮች መጠን ያዛባል፡፡ በተጨማሪም

  • አጣዳፊ መጠነ ብዙ የሆነ ውኃማ ተቅማጥ
  • ትውከትና ቁርጥማት
  • የአይን መስርጐድ
  • የአፍና የምላስ መድረቅ
  • እንባ አልባ መሆን
  • የሽንት መጠን መቀነስ
  • የቆዳ ድርቀትና መሸብሸብ በመጨረሻም ከፍተኛ የሆነ የሰውነት ድርቀት በማስከተል ህመምተኛው በወቅቱ ካልታከመ ለሞት ሊያበቃው ይችላል፡፡

አጣዳፊ ተቅማጥና ትውከት የሚያስከትለው ችግር ምንድነው ?

በአተት የተያዘ ሰው ከሰውነቱ ብዙ ፈሳሽ ስለሚወጣ በሽተኛው የሰውነት ድርቀት /Dehydration/ ያስከትልበታል፡፡ ይህ ሁኔታ ደግሞ በአተት የተያዘው ሰው በአጭር ጊዜ ራሱን እንዲስት ያደርገዋል፡፡ ከዚህ በተጨማሪ አፋጣኝ የሕክምና ዕርዳታ ካላገኘ በበሽታው የመሞት አጋጣሚው ሃምሳ ከመቶ /5%/ ነው፡፡ ነገር ግን አስፈላጊው የሕክምና ዕርዳታ ከተደረገለት የመሞት አጋጣሚው ከአንድ ከመቶ /1%/ ወይም ከዚያ በታች ማድረግ ይቻላል፡፡

በሽታውን መለያ መንገዶች

1. ምልክቶቹን በማየት

2. በላብራቶሪ ሊረጋገጥ ይችላል፡፡

ህክምናው

  • የወጣውን ፈሳሽ መተካት ዋናውና ቅድሚያ የሚሰጠው ነው
  • እንደ ተዋህሲያኑ አይነት በባለሙያ የሚሰጥ ህክምናን ተግባራዊ ማድረግ

መከላከያና መቆጣጠሪያ መንገዶች

AWD message in Amharic

  • መፀዳጃ ቤት መገንባትና በአግባቡ መጠቀም
  • ምግብን በሚገባ አብስሎ መመገብ
  • በውኃ /መድሃኒት/ በውኃ አጋር/ የታከመ ውሃ ለመጠጥ መጠቀም ወይም ውኃ አፍልቶና አቀዝቅዞ መጠጣት
  • እጅን በውኃና በሳሙና /በአመድ በደንብ አጥርቶ መታጠብ
    • ከመጸዳጃ ቤት መልስ
    • ምግብ ከማዘጋጀት በፊት
    • ምግብ ከማቅረብ በፊት
    • ምግብ ከመመገብ በፊት
    • ሕጻናትን ካጸዳዱ በኋላ
    • ህጻናትን ጢት ከማጥባት በፊት
    • በበሽታዉ የተያዙ ሰዎችን እነክብካቤ ካደረጉ በኃላ

ማንኛውም ከቤት የሚወጣ ደረቅ ወይም ፈሳሽ ቆሻሻ አካባቢን ወይንም ውኃን እንዳይበክል በአግባቡ ማስወገድ፡፡ ምልክቱ የታየበት ህመምተኛ ፈጥኖ ወደ ህክምና ተቋም በመምጣት ሊታከም ይገባል፡፡

ይህንን መሰረት በማድረግ ሁሉም ህብረተሰብ በሽታዉን በመከላከል ዙሪያ የተሰጡ መልእክቶችን በመተግበር እያንዳንዱ ግለሰብ እራሱንና ቤተሰቡን እንዲሁም አካባቢዉን ሊከላከል ይገባል፡፡