Nutrition Components of the Cholera response in Haiti

Coordination du ‘CLUSTER’ Nutrition-HAITI Nutrition Cluster Coordination-HAITI

Very fertile Ground for a Cholera EpidemicExtreme poverty, Weak governance Weak Healthcare systemPoor access to safe water, hygiene and sanitationPolitical violence and unrest Still recovering from Earthquake of January 2010Vulnerable to other natural disasters

Temporal-spatial evolution of cholera from 19/10/10 to 20/11/10

Centre d’Operation d’Urgence Nationale (COUN)

From Epidemic to Endemic: No population immunity. Highly virulent Vibrio Cholerae strain. First reports of 40 diarrhoeal deaths on 20th October,

by 29th 4714 cases and 330 deaths and within 5 weeks (21st November) 61,825 cases and 1426 deaths.

Cholera rapidly became endemic and is likely to have further peaks during the next cyclonic season.

As of 1st March 252,640 cases, 136,275 hospitalisations and 4,672 deaths with still 7000 new cases a week.

Approximately 10% of cases are under 5. Estimated that only 60% of cases get reported.

Initial difficulties of Cholera Response: The Haiti Cholera Treatment protocol did not make

provision for severely malnourished children, breastfeeding or use of Zinc with RO ORS.

Initial key messages issued by MoH did not include nutrition.

Heath system including external support overwhelmed for many weeks.

Not always good implication of sectors besides Health and Wash in the response coordination.

More initial difficulties…

Impossibility to assist with safe water and sanitation at such a large scale.

Initial delay by MoH in approval of Zinc with RO ORS for cholera.

Difficulty in adopting the Nutrition components of cholera response in a Health setting.

Several nutrition centres were converted to CTCs and stigmatisation of all health/nutrition facilities.

Key messages developed and diffused: Development of key IYCF messages for diffusion. Poster on use of Zinc and RO ORS for under 5. Poster on breastfeeding and cholera. Decisional Flowchart of breastfeeding in a CTC context. Posters of screening of SAM in children with cholera and

rehydration protocol Addendum to National Nutrition Protocol to include SAM

rehydration in a cholera context. Guidelines for management of SAM and IYCF in CTC and

IYCF in the community.

Key Nutrition components of cholera care more easily implemented:

To be included in revised National Cholera Protocol:Rapid screening of SAM children on admission for application of rehydration protocol for SAM children with cholera.Use of Zinc with RO ORS for U5.Then:Food provision once a patient is able to eat.Supplementary or therapeutic feeding (mainly in CTCs run by Nutrition partners).MAM/SAM take home ration of RUSF/RUTF upon discharge (mainly in CTCs run by Nutrition partners).

Coverage of Nutrition components in CTC/CTUs

Key activities Partners Centers

Screening of children < 5 yrsZinc administration with ORSFood rations Therapeutic food Referral to PTA/PNS/USN

12/ 1612 / 1611 / 167/ 16

16 / 16

62 / 6758 / 6742 / 6737 / 6767 / 67

By February 2011, 101 CTCs, 165CTUs and 786 ORPs, # keep changing according to needs and NGO presence.

Only 16 partners have reported on Nutrition activities covering 67 CTC/CTUs: WVI, SC, MDM-F, MDM-Ch, MDM-E, Gheskio, Healing Art Mission, Merlin, ALIMA, IMC, MSF-F, MSF-E, MSF-Ch, Jap. RC, FSB, MDM-Can

Components care more difficult to implement: Record of nutrition activities in CTC. Screening on discharge and referral for SAM/MAM

or IYCF follow up (coverage low). Identification of breastfeeding mothers with cholera

separated from their children and reunification. No requests of RUIF from CTC/CTUs. Plumpy Doz on discharge to assist recovery of non-

malnourished. Advice on adequate IYCF after discharge to assist

recovery.

lessons learned: Need for advocacy at all levels for inclusion of

Nutrition Components in cholera treatment protocols.

Rapid and early response at scale is essential Better Preparedness (scenarios, protocols and

messages) Easier to change the health approach if it is not

seen as a Nutrition action Better Surveillance and M&E Is a MUAC of 115mm the best SAM threshold for a

young child with cholera? Breastfeeding promoted as an effective cholera

prevention strategy.

Mesi Anpil