• Although decreased rains are expected in West Africa, high ground moisture sustains the risk for floods.
  
• Poorly distributed rains strengthen seasonal deficits over parts of central Ethiopia, South Sudan and Uganda

1) While a recent increase in August precipitation is expected to lead to more favorable ground moisture, a delayed onset and uneven rainfall distribution observed during the June-September season may negatively impact cropping and pastoral conditions in the region.

2) Despite recent increase in rainfall, the much delayed start to the rainfall season has resulted in drought, which has severely impacted ground conditions and already led to livestock death across parts of north-central and eastern Ethiopia.

3) Heavy August rainfall has led to a saturation of ground conditions and localized flooding in several regions of West Africa. The continuation of heavy rainfall remains forecast across the region for the upcoming outlook.

4) Well below-average rainfall during August has led to a strengthening of moisture deficits throughout several provinces in southern South Sudan and northern Uganda. Below-average rainfall is expected in the region for the upcoming outlook period.

In numbers

To date, in Guinea, Liberia and Sierra Leone:

• More than 3.7 million people assisted with food, cash and nutrition support under the EMOP;

• 24,966 responders transported by UNHAS;

• Over 112,000 m3 of cargo transported since September 2014.

• Over 2,200 mt of relief items dispatched to the region by the UN Humanitarian Response Depot since March 2014.

WFP response adjusts to the outbreak

At the request of WHO, WFP is extending its Emergency Operation until 31 December 2015 to continue the provision of support to the health response, in case of new micro-out breaks across Guinea,
Liberia and Sierra Leone.

The Special Operation was revised to decrease the requirements by USD 67.1 million, maintaining the timeframe up to 31 December 2015. WFP has reviewed its operational needs and is adjusting the common logistics services to reflect the evolution of the outbreak, while maintaining the capacity to support the efforts of the humanitarian community to reach and maintain zero ebola cases.

HIGHLIGHTS

• Schools reopened nationwide on 31 August 2015 with the Ministry of Education, Science and Technology, supported by UNICEF, verifying availability of hygiene safety supplies in schools, and, where necessary, replenished. UNICEF took advantage of the summer recess to train 10,000 teachers in psychosocial support so that the teachers have the skills to address the psychosocial needs of children impacted by Ebola.

• The week to 30 August 2015 saw the reporting of the first new Ebola case in Sierra Leone since 7 August 2015, with a positive swab test made following the death of a woman in Sella Kafta (Tonko Limba chiefdom, Kambia district). The twinned villages are both now under quarantine with 223 households (970 people).

• Following the new case of EVD, UNICEF supported the rapid mobilisation of operations in the district, including through UNICEF social mobilization partners Restless Development, the Health For All Coalition and the Sierra Leone Red Cross. Through implementing partners, UNICEF supported deployment of 1,772 social mobilizers in Port Loko and Kambia districts. An additional 21 social mobilizers were trained in a half-day orientation by a joint-team from the District Health Management Team, UNICEF, WHO, and Restless Development.

• UNICEF child protection teams also conducted assessments in the quarantined villages and reached 365 children and 362 adults with psychosocial support, and also provided 50 kits of household items, 100 recreation kits, and 100 mattresses for children in quarantine houses

• UNICEF, working through the Sierra Leone Water Company (SALWACO) and implementing NGO CAWEC, started the construction of 29 out of the planned 53 latrines for the quarantined villages in Kambia. Preparations are being made to distribute hygiene kits to the affected communities and households. UNICEF also provided around 30,000 litres of water to six check points in Kambia district through SALWACO.

• In Western Area (in and around Freetown), the last people currently in quarantine were discharged from the Voluntary Quarantine Facility (VQF) on 29 August 2015. All 14 quarantined children received recreational materials from the UNICEF-supported protection desk.

Overview

There is no evidence to show that women who survive Ebola virus disease (EVD) and subsequently become pregnant pose a risk for Ebola virus transmission. However, pregnant women with active EVD and pregnant women who survive EVD without pregnancy loss may transmit the virus during delivery and/or management of obstetric complications. Pregnant women who are contacts of confirmed Ebola cases pose a potential risk.

This document provides guidance for:

• screening and triage of pregnant women in the context of an Ebola outbreak;
  
• infection prevention and control (IPC) precautions for pregnant women at risk of EVD transmission during childbirth and complication management;
  
• management of pregnant EVD cases, contacts and survivors;
  
• lactation and Ebola virus disease.

LES POINTS MARQUANTS

• Les progrès de l’Afrique de l’Ouest sur le plan de la croissance économique, de la démocratisation ou de la coopération régionale sont impressionnants.

• Aujourd’hui, alors que la recrudescence des violences, des conflits, des narcotrafics et de la piraterie, ainsi que la montée des extrémismes, suscitent des inquiétudes quant aux perspectives de développement, les initiatives de renforcement de la résilience marquent des points.

• Une nouvelle étude tire les enseignements de l’évolution de la sous-région et souligne l’importance des politiques de développement pour étayer la stabilité et réduire durablement les conflits et les violences.

Quel est le point commun entre la Sierra Leone, le Libéria et la Côte d’Ivoire ? Ces trois pays sont situés en Afrique de l’Ouest et ils sont parvenus à mettre un terme à des guerres civiles et des conflits de grande envergure, ce qui en fait de précieux exemples de résilience aux violences.

Si l’épidémie récente d’Ebola est venue rappeler les conséquences tragiques et durables des conflits dans la sous-région, l’Afrique de l’Ouest a néanmoins déploré moins de victimes de conflits au cours des 60 dernières années que les autres pays d’Afrique subsaharienne.

En plus du rôle central de dirigeants déterminés, sa trajectoire souligne l’importance des organisations de développement pour la reconstruction des institutions et le règlement des différends au lendemain d’un conflit ou d’une crise politique.

« Plus que jamais, les gouvernements et leurs partenaires de développement doivent s’inspirer des pays d’Afrique de l’Ouest et tirer des enseignements de leur expérience de la résilience face aux violences et aux conflits », estime Alexandre Marc, spécialiste en chef de la Banque mondiale pour les questions de fragilité, de conflit et de violence.

Afin d’appuyer ces efforts, une nouvelle étude intitulée en anglais The Challenge of Stability and Security in West Africa (a) analyse les dynamiques du conflit et de la violence pour proposer des recommandations sur la manière d’améliorer l’appui des partenaires de développement à un retour durable de la stabilité.

Ce travail paraît à un moment décisif pour l’Afrique de l’Ouest qui, depuis plusieurs décennies, a fait d’immenses progrès sur le plan de la consolidation démocratique, de la croissance économique et de la coopération régionale, et peut se targuer d’abriter certains des pays les plus stables du continent. Mais les avancées futures pourraient achopper sur l’absence de politiques de développement résolument orientées vers la stabilité.

Selon cette étude, tandis que les conflits et les guerres de grande envergure sont de moins en moins fréquents en Afrique de l’Ouest, de nouvelles menaces apparaissent depuis quelques années (du trafic de drogues à l’extrémisme en passant par la piraterie), signe que les violences changent de nature.

Ainsi, le mouvement de démocratisation engagé dans les années 90 a certes favorisé les alternances politiques pacifiques, mais a induit une hausse des violences électorales, sur fond de concurrence exacerbée pour le pouvoir entre groupes ethniques ou religieux. Les pays de la région s’efforcent de lutter contre ce problème, aidés notamment par les organisations de la société civile qui déploient des observateurs lors des scrutins et contribuent au traitement des litiges électoraux.

L’étude identifie plusieurs domaines critiques pour installer durablement la paix et la stabilité :

1) diriger les efforts de développement vers les régions en retard ;

2) renforcer la gouvernance locale, notamment dans le cadre de politiques de décentralisation ;

3) améliorer la gestion foncière ;

4) mieux traiter les doléances liées à la gestion des ressources extractives ;

5) renforcer la gestion des migrations et les droits des migrants ;

6) ouvrir des débouchés pour la jeunesse, notamment en l’impliquant davantage dans la société ;

7) appuyer la réforme du secteur de la sécurité et renforcer la justice et l’État de droit.

Complexes, ces questions exigent une coordination et un engagement durables.

« Les politiques de développement sont au cœur des efforts de construction de la paix et de stabilité, étant donné que le développement économique et social est la clé pour réduire les tensions et les frustrations face à l’exclusion ou un accès inégal aux ressources », analyse Alexandre Marc, auteur principal de cette étude. « En mettant l’accent sur la stabilité dans les politiques de développement, nous contribuerons à réduire les conflits et les violences à long terme. »

9 September 2015 – The United Nations health agency’s special envoy on Ebola response today said the outbreak in West Africa has a “very nasty sting in its tail,” but projected that the goal of zero transmission in the human population remains “very possible within 2015.”

Dr. Bruce Aylward, Special Representative on Ebola Response for the World Health Organization (WHO), made those remarks at a press conference in Geneva, following his return from the “hot spots” of the epidemic in Guinea and Sierra Leone.

He said that despite the “ferocious rainy season” in West Africa, the number of Ebola cases has remained in the single digits for six consecutive weeks in Guinea and Sierra Leone. In addition, there are only three active chains of transmission in those countries, a development he described as a “major milestone in all three countries [Liberia being the third] in the march towards zero” cases.

“Our goal is zero transmission in the human population and that remains very possible within 2015,” he said.

The senior WHO official said that the focus of the current Ebola response was what he called Phase 3 aimed at ensuring that the residual risks are managed and guarding against the re-emergence of the disease, which has claimed more than 11,000 lives, mostly in West Africa.

Dr. Aylward described the remaining challenges as residual risk surveillance, sustaining rapid response teams, and survivor engagement and care, which includes the risks of transmission through semen by male survivors of Ebola.

Testing for the status of semen is underway, he said, but other precautions are also being looked into such as the vaccination of sexual partners or family members to reduce the risk if someone tests positive.

“This virus has a very nasty sting in its tail,” he said.

Separately, WHO released guidance on the care of pregnant women with Ebola. The agency said that there is no evidence to show that women who survive Ebola and subsequently become pregnant pose a risk for Ebola virus transmission. However, pregnant women with active Ebola, pregnant women who survive the disease with an ongoing pregnancy and pregnant women who are contacts of confirmed Ebola cases pose a potential risk.

WHO’s latest weekly update on Ebola showed there were 2 confirmed cases of the disease reported in the week to 6 September: 1 in Guinea and 1 in Sierra Leone.

• A case of vaccine-derived poliovirus type 2 (VDPV2) has been reported with onset of paralysis on 20 July 2015 in Bamako city, Mali. The virus was isolated from a 19-month old boy of Guinean nationality. The closest genetic match to this case is from a case from Kankan, Guinea, with onset of paralysis on 30 August 2014. The genetic changes suggest that the cVDPV2 has been circulating for more than 12 months. Discussions are currently ongoing with national health authorities to plan and implement an urgent outbreak response. More

• The Global Polio Eradication Initiative is proud to partner with the Global Citizen Festival on 26 September, featuring Ed Sheeran, Pearl Jam and other headliners to help fight extreme poverty and inequality around the world, and support approaches that will make life more sustainable for people and the planet

1. The present letter on the work of the United Nations in response to the Ebola outbreak in West Africa covers developments from 1 to 31 July 2015, the 300-day mark since the establishment of the United Nations Mission for Ebola Emergency Response (UNMEER). It records activities carried out by my Special Envoy on Ebola and UNMEER and provides an update on progress made in the Ebola response pursuant to General Assembly resolution 69/1 since my letter of 24 July 2015 (A/69/992).

Way forward

1. The people and nations affected by Ebola looked to the United Nations system for support and assistance in the face of the outbreak. A number of United Nations system entities have offered sustained support in responding to the outbreak, supporting the restoration of essential services and recovery efforts and building preparedness in the region. They have done so under the stewardship of national leaders, engaging with local communities and supporting local and national response efforts. They have coordinated closely with national and international non-governmental organizations, regional organizations and the assistance, operations and medical teams deployed by foreign Governments.

2. On 17 September 2014, at the height of the Ebola crisis, I wrote to the President of the General Assembly and the President of the Security Council, indicating that I intended to establish the first-ever United Nations emergency health mission to harness the capabilities of all the relevant United Nations actors under one crisis management system to reinforce unity of purpose among responders and to ensure a rapid and effective response to the crisis (see A/69/389-S/2014/679). My decision, which followed a joint request from the Presidents of Guinea, Liberia and Sierra Leone for the United Nations to coordinate international support to nationally led response efforts, was heralded by the international community. UNMEER was established on 19 September 2014 following the adoption by the General Assembly of resolution 69/1.

by Dan Stewart

Around a year ago I arrived in Sierra Leone for the first time. The Ebola epidemic seemed to be spiralling out of control, deadly and poorly understood. A few weeks later the outbreak reached its peak, with more than 500 cases recorded in a single week.

Sometimes I felt like I was looking at the country through a glass screen. It was right there but distant. Movement was restricted, crowds were avoided, everyone was cautious.

Today the situation is different. The governments of the affected counties, NGOs and, most crucially, Ebola-stricken communities have worked together in a concerted effort to fight the disease.

We’ve come a long way, but we aren’t there yet. A few days ago Ebola claimed another life in Sierra Leone, just as hope was growing that we’d seen the last case there. The fight to get to zero goes on.

But alongside that we face the equally urgent task of helping children affected by the disease to rebuild their lives. Schools were closed for six months. Businesses and livelihoods suffered. Thousands of children in Sierra Leone lost parents and loved ones.

Joshua and Ibrahim

I met Joshua* and his cousin Ibrahim* about 10 minutes’ drive from the site of the Save the Children-managed Ebola Treatment Centre in Kerry Town, which closed in April as the number of cases dropped.

Both are 14 years old. Both are Ebola survivors. But survival was just the start of their struggle to recover.

Ibrahim lives nearby with his grandmother but they tell me he’s more or less always here at Joshua’s house.

“I came to stay with my uncle and aunt as my mother and father passed away when I was a very small boy,” he tells me.

Ibrahim’s uncle Abu* supported the entire family by working to build latrines. “After school we would go to the site and help him fetch water, and get him ‘kola nuts’ to chew. I liked helping him,” Ibrahim continues.

Abu was the first person in the family to get Ebola. “When my uncle was sick two of us children cared for him – myself and Joshua. We tried our best but he couldn’t recover. After he passed away we were also infected.”

By the time Joshua and Ibrahim managed to pull through with the help of the team at the treatment centre, Ebola had coursed through their family and taken the lives of Abu and 12 other relatives, including Joshua’s younger brother.

“When my brother died I felt bad. I could not speak,” he remembers.

A long road

Joshua was given the all clear and returned home, but his own fight for life wasn’t over yet. Due to complications he remained very ill, slipping in and out of consciousness.

Ibrahim says, “It was difficult when I saw Joshua again and he was in an ambulance on a stretcher. I thought that was the end of his life. I was totally discouraged after we had the same struggle.”

Joshua shows me a photo (right). In it he sits on a chair, visibly thin and weak, surrounded by his remaining family. “I stayed in my room when I couldn’t walk for one month. I was very sick. This is the day I left. On that day, that was the first time I thought I would make it,” he says.

With the support of his mother, Ibrahim and Save the Children, Joshua has slowly returned to something approaching his full strength.

Our team provided a package of support including rice, oil, a mattress and money to help him get the medical treatment he needed. Our child protection team visit regularly to provide psychosocial support.

Many challenges

Living with their loss wasn’t the only obstacle on their path though. Even returning to school was to prove a challenge.

When the family was hit by Ebola, the majority of their possessions were taken away and burnt in an attempt to stop further transmission, leaving them with almost nothing to return to.

When they returned to school, they were forced to start from scratch, with Abu no longer alive to support them.

The lack of simple but vital things like books and pens could have crushed their dreams of returning to education and making up for lost time.

Joshua tells me, “We had financial challenges. I wanted to go. I could see my colleagues going. I knew they were all going to sit together and take exams. I was very keen to go back to school. I missed my friends.”

Save the Children helped provide school bags, pens, books, radios and money for lunch, and both Joshua and Ibrahim have been able to restart their education.

“I want to be a doctor,” Joshua says. “If I become the doctor I’ll be giving treatment to my family and community. There will be no need to take them to other doctors. I’ll be taking care of them.”

More than an education

Getting back to school isn’t just about the chance to learn. Education is protection.

Earlier this year Save the Children helped interview more than 1,100 children in Sierra Leone about the impact of the Ebola crisis on their lives.

They reported a direct link between being out of school and increases in child labour and exploitation, exposure to violence in the home and community, and teenage pregnancy.

Although they are now in school Ibrahim leaves me in no doubt that they will continue to need all their strength, and all our support, to carry on.

He says, “I feel bad because of my family that has passed away. I always think of them, especially my uncle. When he was alive and difficulties came my way, I would go to him and ask him and he provided for me.

“Now food is hard because my uncle is not alive. Every time we go to sleep hungry I think of my uncle and that this is not the way we lived before. I often sleep hungry.”

Children affected by Ebola need food, education, emotional and psychosocial support. These are the challenges we must face if Ebola is to take not just their friends and family, but their futures as well.

Over the next year, the EU Humanitarian Aid and Civil Protection department (ECHO) will be supporting Save the Children to help more children in Sierra Leone return to school safely and increase their resilience to future emergencies.

• Names changed to protect identity

Conflict, instability and disasters continued to take an immense toll on development in 2014. However, as this report shows, UNDP continued to help countries prevent and respond to disasters, protect justice, uphold security and the rule of law, promote inclusive governance and build peace. Active in over 170 countries and territories, UNDP is there before and after a crisis.

UNDP is often the first to be called after a crisis to lead the transition to peace and stability, or support early recovery efforts following disasters. In many cases, UNDP is best placed to prevent crises from recurring.

In 2014, UNDP’s new Strategic Plan took effect, geared towards making the organization more efficient, and deepening its focus on helping countries build resilience. Resilience reduces the risks of conflict and disasters, and means that even if they do strike, people will have capacities to blunt the impacts and recover quickly. Better employment opportunities, equitable access to resources, transparent and accountable governments, and the systematic resolution of disputes are among the key ingredients to achieving resilient societies.

Throughout 2014, UNDP helped national authorities around the world to build peace and recover from disasters. In the wake of the devastation wrought by Typhoon Haiyan in the Philippines, UNDP assisted communities to rebuild, including by restoring livelihoods for over 40,000 people. After the declaration of a humanitarian emergency in Gaza, UNDP supported the rebuilding of homes and provided thousands of people with emergency employment.

When violence exploded in the Central African Republic, rendering half the population in need of humanitarian assistance, UNDP launched an emergency programme of support to the transitional government to help reactivate core government systems and ensure essential services would function.
By the end of 2014 the country had achieved some key milestones, including a cessation of hostilities agreement between warring factions.

After the Ebola outbreak struck Guinea, Liberia and Sierra Leone, UNDP immediately joined partner organizations to stop its spread, such as through supporting governments to ensure the timely payment of nearly 50,000 Ebola response workers, assisting communities to identify new cases, educating people on avoiding transmission, and making life-saving welfare payments to the most vulnerable people and communities.

Beyond efforts to respond to crises, UNDP continued its commitment to conflict prevention and risk reduction. Support and training was provided to Parliament as Fiji, after eight years of a military-led government, successfully transitioned to an elected government. Tunisia became the first ‘Arab Spring’ country to formally establish and consolidate a democratic political system, with a key actor being the Tunisian General Labour Union, consistently supported by UNDP.

In 2014, UNDP helped advance disaster preparedness in 20 countries in the Caribbean and Central America to rapidly assess and respond to post-disaster needs. Other assistance helped Honduras integrate gender provisions across local disaster risk management strategies for the disaster-prone Choluteca river basin, as well as across national disaster risk management policies and plans.

These examples highlight the range of needs that UNDP responds to through the Crisis Prevention and Recovery Thematic Trust Fund. This fast, flexible funding mechanism permits quick responses to disasters or conflicts as well as scope for seizing unique opportunities to reduce disaster risks or prevent conflicts. In 2014, the Fund mobilized US$ 88 million and disbursed funds to more than 90 countries.

The report chronicles results achieved with CPR TTF assistance in four broad categories, tied to the outcomes of the UNDP Strategic Plan:1) countries are able to reduce the likelihood of conflict and lower the risk of natural disasters, including from climate change, 2) early recovery and rapid return to sustainable development pathways are achieved in post-conflict and postdisaster settings’, 3) countries have strengthened institutions to progressively deliver universal access to basic services, and 4) faster progress is achieved in reducing gender inequality and promoting women’s empowerment. The report is structured to address the first three results areas, with the fourth (gender) being integrated throughout the document.

UNDP supports interventions across the full spectrum of development and crisis issues, recognizing the integral links among them. These interventions are predicated on the reality that development gaps leave people vulnerable to crisis, and that crisis in turn, can strip away development gains, particularly for those with limited resilience and marginal capacities to recover.

Dry conditions forecast for areas of Central America already in severe drought

Africa Weather Hazards

1. Heavy rainfall in August has led to saturated ground conditions and localized flooding in several regions of West Africa. Heavy rainfall is forecast to continue across the region during the next week.

2. While the recent increase in precipitation in August is expected to lead to more favorable ground conditions, a delayed onset and uneven rainfall distribution observed during the June-September season may negatively impact cropping and pastoral conditions in the region.

3. Despite a recent increase in rainfall, the much delayed start to the rainfall season has resulted in drought, which has severely impacted ground conditions and led to livestock death across parts of north-central and eastern Ethiopia.

4. Significantly below-average rainfall during August has led to increased moisture deficits throughout several provinces in southern South Sudan and northern Uganda. Below-average rainfall is forecast in the region during the next week

DISCHARGED CASES

• Total Survived and Discharged Cases = 4,047

NEW CASES

• New Confirmed cases = 1 as follows:
  Kailahun = 0, Kenema = 0, Kono = 0 Bombali = 0, Kambia = 1, Koinadugu = 0, Port Loko =0, Tonkolili = 0 Bo = 0, Bonthe = 0, Moyamba = 0 Pujehun = 0 Western Area Urban = 0, Western Area Rural = 0, Missing = 0

Hot Spots:

District Chiefdom Community History of Positive Case
Kambia Tonko Limba Sella Kafta(1) From Quarantined

CUMULATIVE CASES

• Cumulative confirmed cases = 8,703 as follows:
  456 Kailahun = 565, Kenema = 503, Kono = 253 Bombali = 1,049, Kambia = 259, Koinadugu = 109, Port Loko = 1,484, Tonkolili = Bo = 314, Bonthe = 5, Moyamba = 209, Pujehun = 31 Western Area Urban = 2,285, Western Area Rural = 1,164, Missing = 14

CUMULATIVE DEATHS

• Total cumulative confirmed death is 3,587

• Probable cases = 287

• Probable deaths = 208

• Suspected cases = 4,711

• Suspected deaths = 158

Ebola Virus Disease Situation Report

PROVIDED BY:

The Ministry of Health and Sanitation

For more information, please contact:
District level: District Health Management Team
National level: Directorate of Disease Prevention and Control, E.mail: dpcsurveillance@gmail.com Website: www.nerc.sl or www.health.gov.sl Mobile: 117 (Toll free)

A. Situation Analysis

Description of the disaster

Ebola in West Africa has infected more than 28,000 people, and killed more than 11,000. It is a tragic manifestation of a region susceptible to epidemics. The spread of epidemics (Ebola, cholera) in West and Central Africa has been fuelled by limited health infrastructure, poor hygiene practices, the inability to control population movements across borders, the lack of adequate community involvement in the definition of communication and information and consequent suspicion and mistrust towards health authorities. The IFRC has been supporting response and preparedness activities in affected countries through allocations from the Disaster Relief Emergency Fund (DREF), Partner National Society (PNS) interventions and through deployment of technical human resources through the Regional Disaster Response Team (RDRT) tool.

With the escalation of the Ebola outbreak in West Africa, the demand for trained technical human resources has increased, and the RDRT system has faced challenges responding to all requests for team members with the necessary technical skills to support Ebola Preparedness measures. The training described herein aims to increase the availability of WatSan RDRT members with appropriate disaster, epidemics response and preparedness skills through specialized training.

EXECUTIVE SUMMARY

Community Event-Based Surveillance (CEBS) was designed in late 2014 as an active, village-level surveillance system for Ebola RECOMMENDATIONS FOR CEBS BASED ON RAPID EVALUATION FINDINGS Virus Disease (EVD). The objective of CEBS is to rapidly identify suspected EVD cases originating from unknown chains of transmission at the village level through using a network of trained Community Health Monitors (CHMs) to detect and report on six “trigger events” which indicate potential EVD transmission. Upon detecting a trigger event, the CHM reports it to his or her Chiefdom Surveillance Supervisor (CSS), who then conducts a preliminary screening of the alert to determine if it should be escalated to the District Ebola Response Center (DERC) for follow up by a case investigation team. Since January 2015, the Ebola Response Consortium (ERC) has been supporting the Ministry of Health and Sanitation (MoHS) through the District Health Management Teams (DHMTs) to implement CEBS in 9 of the 14 districts of Sierra Leone, while the International Federation of the Red Cross (IFRC) is supporting CEBS in an additional three districts. As of June 15, a total of 7,050 CHMs and 137 CSSs have been trained in the ERC-supported districts and have generated over 3,400 alerts.

From April to June 2015, a joint team comprised of members from the ERC, the International Rescue Committee (IRC), and the United States Centers for Disease Control and Prevention (CDC) conducted a rapid evaluation of CEBS in the nine ERCsupported districts. This assessment focused on both functionality (i.e. how well the CEBS structure was working on the ground) and effectiveness (i.e. the sensitivity and timeliness of CEBS in detecting new confirmed cases). To assess functionality, the team interviewed 50 CHMs and 27 CSSs to evaluate their knowledge, skills, and experience, and met with 39 members of the DERCs, DHMTs, and other district partners to gauge their knowledge of and involvement with CEBS. To assess effectiveness, the team used alerts data captured in weekly alert logs kept by CSSs to analyze the quantity and type of alerts being detected through CEBS, as well as to look at issues of sensitivity and timeliness.

The functionality component found that 28% of interviewed CHMs had reported at least one alert in the week prior to the interview and that half of the CHMs recalled at least four of the six trigger events. All CHMs reported that they actively seek information about illnesses and deaths in their villages (as opposed to receiving it passively) and 68% reported community support for their work. The 27 CSSs interviewed supervise an average of 51 CHMs each and recalled an average of five of the seven actions they are expected to take when they receive an alert from a CHM. One of the most common challenges CHMs face is the malfunctioning of the closed user group (CUG) phone system. The CSSs also had CUG issues, but the lack of motorbikes to travel between villages was a more commonly-cited problem. Among the DHMTs and other district partners, knowledge of the system varied, with nearly 60% of representatives understanding the system’s core structure and function. Seventy-four percent of district partners reported that they think CEBS has benefited the districts, though concerns were expressed regarding it financial sustainability, its incomplete coverage of villages, and the need for better coordination with other district partners (e.g. DERCs, DHMTs) and community outreach programs.

The effectiveness component found that a total of 3,432 alerts were generated through CEBS across eight districts (Kailahun data not available) from February 19 to June 14, 2015. Of these alerts, 2,937 (86%) were for deaths, 480 (14%) were for sick cases, and only 1 (<1%) was for an unsafe burial or corpse washing. The vast majority of alerts (2,667/3,432, 78%) were for community deaths, which were reported through the “other” trigger. In Kambia, the only ERC-supported district with active transmission when CEBS was rolled out, CHMs were involved in the detection of 7 of the 12 (58%) confirmed EVD cases occurring between April 13 and May 20, including three of the five (60%) cases that originated from unknown chains of transmission. Of the five cases from unknown chains of transmission, the range of time from the onset of symptoms to detection was two to three days if detected by CEBS and five to seven days if detected by other sources. CEBS also detected three suspected measles outbreaks during the study period. Overall, CEBS is serving as a valuable component of the surveillance system through helping to detect new cases in Kambia and confirming zero transmission in the other districts. Based on the evaluation findings, the ERC and CDC developed several recommendations, which are provided in the table on the following page.

DISCHARGED CASES

• Total Survived and Discharged Cases = 4,047

NEW CASES

• New Confirmed cases = 0 as follows:
  Kailahun = 0, Kenema = 0, Kono = 0 Bombali = 0, Kambia = 0, Koinadugu = 0, Port Loko =0, Tonkolili = 0 Bo = 0, Bonthe = 0, Moyamba = 0 Pujehun = 0 Western Area Urban = 0, Western Area Rural = 0, Missing = 0

Between November 2014 and July 2015, FEWS NET worked with Mobile Accord (GeoPoll) to conduct twelve rounds of SMS-based trader surveys in Liberia and Sierra Leone on the status of market activities and operating costs. Liberia and Sierra Leone are FEWS NET remote monitoring countries. In remote monitoring countries, analysts typically work from a regional office, relying on a network of partners for information. As less data may be available, remote monitoring reports may have less detail than FEWS NET presence countries. The SMS-based survey results serve to corroborate key informant and partner reports on market activities and serve as inputs to FEWS NET’s integrated food security analysis on the impacts of the Ebola outbreak. The first round of data collection identified a sample of traders to monitor fundamental market characteristics (Table 1). During the second through sixth rounds, the survey focused on market activities, while the subsequent rounds inquired about both market and agricultural activities. Data was collected on a bi-weekly basis for rounds 2-6 and on a monthly basis thereafter.

• This report provides a summary of findings from a FEWS NET trader survey using a SMS-based platform through GeoPoll during the week of July 24th, 2015 (twelfth round of data collection). The sample includes 313 small to large-scale traders across 14 districts in Sierra Leone (Figure 1).

• Forty percent of respondents were local rice traders and 28 percent were imported rice traders, followed by palm oil (17 percent), and cassava (16 percent).

• During the week of July 24th , 34 percent of survey respondents reported that the most important market in their area operated at reduced levels (Figures 2 and 3), and three percent of traders reported market closures.

• Twenty-eight percent of traders indicated that market supplies of main commodities were lower than normal at this time (Figure 4).

• Reduced availability was the most frequently cited reason for reduced market supplies over the previous 10 days (Figure 5).

• Forty-seven percent of respondents indicated that the current primary agricultural activity is weeding (Figure 10). Thirtyeight percent of respondents reported normal and on-time agricultural activities (Figure 9).

• Fifty-one percent of respondents reported reduced agricultural wage opportunities compared to normal at this time (Figure 8). Twenty-six percent of traders reported that they were not able to sell their cash crops as usual at this time of year (Figure 7).

Some features inside this issue:

• Epidemiological situation overview:
  Since the beginning of the EVD outbreak in West Africa, a total of 28 132 cases including 11 305 have been reported deaths from six West African countries namely Guinea, Liberia, Sierra Leone, Mali, Nigeria and Senegal

• EVD Research Update:
  In Kambia, Sierra Leone, the detection of a new case of Ebola virus disease set in motion the first ‘ring vaccination’ use of the experimental Ebola vaccine in Sierra Leone after the country had marked almost three weeks of zero cases.

• EVD Preparedness:
  WHO leads EVD preparedness efforts in the Region with priority focus in 14 countries that have been identified to be at highest risk.