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- 02/25/16--08:37: _Sierra Leone: Empow...
- 02/25/16--09:11: _Nigeria: West and C...
- 02/25/16--18:50: _Sierra Leone: In Si...
- 02/25/16--21:32: _Sierra Leone: Post-...
- 02/26/16--05:29: _Nigeria: UNOWA News...
- 02/26/16--05:34: _Nigeria: UNOWA News...
- 02/29/16--01:20: _Syrian Arab Republi...
- 03/01/16--00:14: _Mali: Afrique de l’...
- 03/01/16--04:19: _Chad: Sécurité Alim...
- 03/01/16--11:50: _World: Polio this w...
- 03/01/16--21:46: _Sierra Leone: UNHRD...
- 03/02/16--09:12: _Sierra Leone: WHO E...
- 03/02/16--10:24: _Cameroon: West and ...
- 03/02/16--10:54: _Cameroon: Région de...
- 03/03/16--07:45: _World: Polio this w...
- 03/03/16--14:07: _Sierra Leone: Expel...
- 03/03/16--21:32: _Sierra Leone: Morbi...
- 03/04/16--08:22: _World: Food Assista...
- 03/04/16--08:37: _Sierra Leone: Sierr...
- 03/07/16--13:24: _Guinea: La résilien...
- 02/25/16--08:37: Sierra Leone: Empowering Koinadugu women farmers in Sierra Leone
Cameroon, Chad, Niger and Nigeria seek US$531 million to assist 5.2 million people.
El Niño limited impact to date in West and Central Africa, but region remains at risk.
Rising food insecurity and new LRA-related displacement in CAR.
Lassa fever outbreak kills 120 in Nigeria and Benin.
Upcoming elections in West and Central Africa.
- 02/25/16--21:32: Sierra Leone: Post-Ebola Syndrome, Sierra Leone
Stage 1: influenza-like illness (i.e., fever, myalgia. lethargy, fatigue, headache, sore throat, conjunctival injection).
Stage 2: multisystem features, including “wet” gastrointestinal symptoms (vomiting, diarrhea), neurologic symptoms (headaches, confusion), vascular symptoms and signs (capillary leak, respiratory distress, hypotension), rash.
Stage 3: internal and external bleeding, multiorgan failure.
National Ebola Response Center [cited 2015 Oct 20]. http://www.nerc.sl
Bwaka MA, Bonnet M-J, Calain P, Colebunders R, De Roo A, Guimard Y, Ebola hemorrhagic fever in Kikwit, Democratic Republic of the Congo: clinical observations in 103 patients.J Infect Dis. 1999;179(Suppl 1):S1–7. DOIPubMed
Kibadi K, Mupapa K, Kuvula K, Massamba M, Ndaberey D, Muyembe-Tamfum JJ, Late ophthalmologic manifestations in survivors of the 1995 Ebola virus epidemic in Kikwit, Democratic Republic of the Congo.J Infect Dis. 1999;179:S13–4. DOIPubMed
Rowe AK, Bertolli J, Khan AS, Mukunu R, Muyembe-Tamfum JJ, Bressler D, Clinical, virologic, and immunologic follow-up of convalescent Ebola hemorrhagic fever patients and their household contacts, Kikwit, Democratic Republic of the Congo.J Infect Dis. 1999;179:S28–35. DOIPubMed
World Health Organization. Report of a WHOIST. Ebola haemorrhagic fever in Sudan, 1976.Bull World Health Organ. 1978;56:247–70 .PubMed
World Health Organization. Clinical management of patients with viral haemorrhagic fever: a pocket guide for the front-line health worker. Geneva; The Organization; 2014.
Rollin PE, Bausch DG, Sanchez A. Blood chemistry measurements and D-dimer levels associated with fatal and nonfatal outcomes in humans infected with sudan Ebola virus.J Infect Dis. 2007;196:S364–71. DOIPubMed
Deen GF, Knust B, Broutet N, Sesay FR, Formenty P, Ross C, Ebola RNA persistence in semen of Ebola virus disease survivors—preliminary report. N Engl J Med. 2015. [Epub ahead of print]
Figure 1. Age distribution of patients at Ebola survivors clinic at the 34th Regimental Military Hospital, Wilberforce Barracks, Freetown, Sierra Leone. Cycle threshold levels at hospital admission by age are shown...(http://wwwnc.cdc.gov/eid/article/22/4/15-1302-f1)
[**Figure 2**. Comparison of the most common post-Ebola syndrome symptoms with admission C
- Figure 3. Scale Venn diagram illustrating the overlap between the 3 main symptom groups among persons with post-Ebola syndrome seen at the Ebola survivors clinic at the 34th Regimental Military Hospital,...(http://wwwnc.cdc.gov/eid/article/22/4/15-1302-f3)
- 02/26/16--05:29: Nigeria: UNOWA Newsletter#3 [FR]
- Interview de M. Mohamed Ibn Chambas sur : la Coopération avec la CEDEAO, les élections, l’extrémisme violent, le changement climatique, les Objectifs de Développement…
- L’Afrique de l’Ouest, face à la recrudescence du terrorisme 2016, une année électorale en Afrique de l’Ouest
- L’ONU appuie la CEDEAO dans la lutte contre le trafic de drogue et la criminalité
- UNOWA renforce sa coopération avec la CEDEAO dans la prévention des conflits et la médiation
- Les femmes appelées à jouer un rôle plus important en Afrique de l’Ouest
- 02/26/16--05:34: Nigeria: UNOWA Newsletter - N° 3/February 2016
- 03/01/16--00:14: Mali: Afrique de l’Ouest Bulletin Mensuel des Prix - Février 2016
Confirmation des niveaux satisfaisants des productions agropastorales en Afrique de l’Ouest et au Sahel : augmentation de 12 pour cent de la production céréalière par rapport à la moyenne des cinq dernières années.
Confirmation de la baisse de 12 pour cent de la production céréalière au Tchad.
La situation sécuritaire dans le bassin du Lac Tchad, qui continue d’impacter négativement sur les personnes déplacées et les populations hôtes mérite une attention particulière.
L’amélioration de l’offre intérieure fait fléchir les prix des céréales.
- 03/01/16--11:50: World: Polio this week as of 24 February 2016
GPEI have published six new videos on ‘Securing a Polio Free World’ covering topics including the polio vaccines, circulating vaccine-derived polioviruses and the upcoming ‘Switch’. The videos are available in both English and French.
There are eight weeks to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine, an important milestone in achieving a polio-free world. Read more about the reasons behind the switch here. Read more ongoing preparation for the switch here.
UNHRD continues to dispatch operational equipment for its Partners, most recently supporting WHO by sending protective coveralls, gloves and gowns to Guinea and Sierra Leone.
During the worst of the crisis, UNHRD facilities in Accra and Las Palmas served as regional staging areas and the Accra depot hosted UNMEER headquarters.
On behalf of WFP, UNHRD procured and dispatched construction material and equipment for remote logistics hubs, Ebola Treatment Units (ETU) and Community Care Centres. In collaboration with WHO, UNHRD also procured and dispatched equipment to establish camps for teams tracing EVD. Members of the Rapid Response Team (RRT) set-up supply hubs, an ambulance decontamination bay and ETUs.
- 03/02/16--09:12: Sierra Leone: WHO Ebola Situation Report - 2 March 2016
Human-to-human transmission directly linked to the 2014 Ebola virus disease (EVD) outbreak in West Africa was declared to have ended in Sierra Leone on 7 November 2015. The country then entered a 90-day period of enhanced surveillance to ensure the rapid detection of any further cases that might arise as a result of a missed transmission chain, reintroduction from an animal reservoir, or re-emergence of virus that had persisted in a survivor. On 14 January, 68 days into the 90-day surveillance period, a new confirmed case of EVD was reported after a post-mortem swab collected from a deceased 22-year-old woman tested positive for Ebola virus. On 20 January, the aunt of the index case developed symptoms and tested positive for Ebola virus. No further cases were reported, and the aunt was discharged from treatment on 4 February after providing a second consecutive negative blood sample (RT-PCR) and was discharged. All contacts linked to the two cases had completed follow-up by 11 February 2016. If no further cases are detected, transmission linked to this cluster of cases will be declared to have ended on 17 March.
Human-to-human transmission linked to the most recent cluster of cases in Liberia was declared to have ended on 14 January 2016. Guinea was declared free of Ebola transmission on 29 December 2015, and is approximately halfway through a 90-day period of enhanced surveillance that is due to end on 27 March 2016.
With guidance from WHO and other partners, ministries of health in Guinea, Liberia, and Sierra Leone have plans to deliver a package of essential services to safeguard the health of the estimated more than 10 000 survivors of EVD, and enable those individuals to take any necessary precautions to prevent infection of their close contacts. Over 300 male survivors in Liberia have accessed semen screening and counselling services. In addition, over 2600 survivors in Sierra Leone have accessed a general health assessment and eye exam.
To achieve the second key phase 3 response framework objective of managing residual Ebola risks, WHO has supported the implementation of enhanced surveillance systems in Guinea, Liberia, and Sierra Leone to enable health workers and members of the public to report any case of febrile illness or death that they suspect may be related to EVD. In the week to 28 February, 1474 alerts were reported in Guinea from all of the country’s 34 prefectures. The vast majority of alerts (1467) were reports of community deaths. Over the same period, 9 operational laboratories in Guinea tested a total of 392 new and repeat samples (14 samples from live patients and 378 from community deaths) from 20 of the country’s 34 prefectures. In Liberia, 1062 alerts were reported from all of the country’s 15 counties, most of which (925) were related to live patients. The country’s 5 operational laboratories tested 815 new and repeat samples (657 from live patients and 158 from community deaths) for Ebola virus over the same period. In Sierra Leone 1865 alerts were reported from the country’s 14 districts. The majority of alerts (1479) were for community deaths. 1114 new and repeat samples (34 from live patients and 1080 from community deaths) were tested for Ebola virus by the country’s 7 operational laboratories over the same period. The overall trend in 2016 is one of an increase in the number of alerts reported, suggesting a continuing improvement in disease surveillance capacity throughout the three countries. The number of new samples tested has remained stable week on week, but with an average of 330 samples tested per week Guinea tests around one-third the volume of samples as do Liberia and Sierra Leone. However, the geographical distribution of sampling is improving, with an increased number of prefectures submitting samples for testing.
- 03/03/16--07:45: World: Polio this week as of 2 March 2016
The Director General of WHO, Dr Margaret Chan, upon the advice of the Emergency Committee, concluded that poliovirus continues to constitute a Public Health Emergency of International Concern (PHEIC). Read the statement here.
The Journal of Infectious Diseases has published a supplemental journal on Nigeria’s polio eradication effort. Read more here.
A new method to administer the inactivated poliovirus vaccine (IPV), developed by a collaboration of Australian institutions, has had promising results in animal trials. The Nanopatch may enable unprecedented levels of dose reduction.
There are seven weeks to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine
- 03/03/16--14:07: Sierra Leone: Expelled pregnant girls back at school in S.Leone
- 03/04/16--08:22: World: Food Assistance Outlook Brief, February 2016
- 03/04/16--08:37: Sierra Leone: Sierra Leone Trader Survey Report February 29, 2016
This report provides a summary of findings from a FEWS NET trader survey using a SMS-based platform through GeoPoll during the week of January 18th, 2016 (seventeenth round of data collection). The sample includes 455 small to large-scale traders across 14 districts in Sierra Leone (Figure 1).
Thirty-five percent of respondents were local rice traders and 26 percent were imported rice traders, followed by palm oil (21 percent), and cassava (18 percent).
During the week of January 18th, 23 percent of survey respondents reported that the most important market in their area operated at reduced levels (Figures 2 and 3), and less than one percent of traders reported market closures.
Twenty-six percent of traders indicated that market supplies of main commodities were lower than the previous month (Figure 4).
High transport costs was the most frequently cited reason for reduced market supplies since the previous month (Figure 5).
Sixty-two percent of respondents indicated that the current primary agricultural activity is harvesting (Figure 10). Fifty percent of respondents reported normal and on-time agricultural activities (Figure 9).
Forty percent of respondents reported reduced agricultural wage opportunities compared to normal at this time (Figure 8). Twenty-three percent of traders reported that their cash crop sales were lower than the previous month (Figure 7).
In the framework of its support to **Ebola recovery**, the Food and Agriculture Organization of the United Nations (FAO) donated a 45 KVA **generator** worth USD 15 000 to the Koinadugu Women Vegetable Farmers’ Cooperative. The generator will be used to power the Cooperative’s 40 feet long refrigerator which can load up to 500 bags of **vegetables**.
The generator was procured with financial support from the **African Solidarity Trust Fund** (ASTF) as part of its engagement to help farmers recover from the devastation caused by the Ebola disease epidemic in Sierra Leone. This assistance complements other ASTF-funded activities to boost the cooperative’s activities. In particular, cash transfers enabled them to purchase quality vegetable seeds and replenish their depleted funds following the Ebola outbreak, for a total amount of USD 29 000. The project is being implemented by FAO in partnership with the Ministry of Agriculture, Forestry and Food Security.
The **Koinadugu Women Vegetable Farmers’ Cooperative** comprises seven hundred women engaged in **vegetable farming** as a major source of livelihood, from over ten communities in the Koinadugu District.
On 7 February 2016, handing over the generator kit, the FAO Representative, Dr Gabriel Rugalema, told the women farmers that the ASTF support is meant to wipe the bitter experiences caused by the **Ebola outbreak** and enable them to revive their activities with increased productivity. “We provided you this generator to enable you preserve your commodities until transportation to market so that you can get better prices from them, which can quickly elevate your profits.” he stated.
Dr Rugalema congratulated the **women farmers** for being resilient and for continuing their activities amidst the devastation caused by the epidemic. He admonished them to properly manage the generator so that it can last longer and help them maximize their benefits in the medium and long term. The Chairlady of the cooperative, Haja Sundu Marah, expressed gratitude to FAO and ASTF for this support. She stated that the possession of the generator is a realisation of a decade dream and will play a key role in improving the value chain in their business.
Ms Sundu Marah recounted that her membership had long been suffering huge post-harvest losses and price volatility because of the lack of electricity. “Even the Ebola disease devastation would not have been that huge if we had **electricity** to refrigerate, stock and preserve our goods until the movement restriction and quarantine measures were minimised” she lamented. She described the generator donation to be very timely and crucial to their **livelihoods**, especially now that they are gradually recovering from Ebola’s impact on their activities.
The Speaker of Wara Wara Yagala Chiefdom, Chief Tortor Kargbo, described the assistance as perfectly seized to reduce a major burden for the entire community in the district, as that was a responsibility that the chiefdom authorities had always pondered about, but never fulfilled because they lacked the means to so. He described the women farmers as major engine in the development and sustainability of many households in the district. He led the women farmers to dress the FAO Representative in an honorary fashion for been very supportive to them over the years.
The ASTF Ebola recovery support has directly benefitted 2 900 **farming households** in Sierra Leone mainly through agricultural inputs distributions, replenishing depleted funds, rehabilitation of farming equipment, and refresher training on the use and management of agricultural machinery. It is expected that the support will have a multiplier effect on other communities.
Lake Chad Basin: nine million people need assistance
In the Lake Chad Basin, Africa’s fastest growing displacement crisis is unfolding, threatening the lives and livelihoods of some 20 million people in Cameroon, Chad, Niger and Nigeria. A year-long surge in violence has forced thousands of families from their homes and deepened destitution among the displaced and the communities hosting them. Around 9.2 million people are already in need of humanitarian assistance.
The protracted violence by Boko Haram and military operations against the armed group have displaced some 2.7 million people in the four countries. North-east Nigeria alone accounts for 2.2 million of the displaced. Around 4.4 million people in the conflict-affected region are severely food insecure with an estimated 223,000 severely acutely malnourished children.
In recent weeks, around 100,000 people in Niger’s south-east Diffa region fled their homes in fear of attacks and sought shelter alongside the highway linking the capital Niamey to the east of the country.
A recent needs assessment identified tens of thousands of IDPs in Liwa and Daboua localities of Chad’s eastern Lac region. The IDPs had not been registered before due to insecurity, limiting access to the host communities where they found refuge. The figures are currently being verified and are likely to double the current IDP population in the region, which stood at around 50,000.
The four Lake Chad Basin countries have upped military offensives against Boko Haram since early 2015. In north-eastern Nigeria, the armed group has lost much of the territory it held. However, it remains resilient and continues to carry out suicide attacks and armed raids.
Since the start of 2016, Cameroon’s Far North region has been hit by more than 30 suicide attacks. Similarly in north-east Nigeria, the group continues to raid villages, target markets, mosques and towns with suicide bombings. Chad and Niger maintain a state of emergency in their respective conflict-affected regions.
Humanitarian access is restricted in certain localities of north-east Nigeria and the Far North region of Cameroon. In Chad, humanitarian organizations are able to deliver assistance on the axis between Baga Sola and Bol, which hosts the majority of registered IDPs. At the same time population movement, access to basic services as well as trade, farming and other daily livelihood activities have been constrained.
Niger on 31 January extended the state of emergency in Diffa, pointing out that the ongoing insecurity warranted the measure. Insecurity remains a major impediment to population movement, daily activities as well as humanitarian access.
Scaling up the response
Humanitarian partners have increased their presence in the affected areas, including Cameroon’s Far North region, the Lac region in Chad, Diffa province in Niger, and northeastern Nigeria.
In January, the four countries finalized their Humanitarian Response Plans seeking a total of US$531 million to assist 5.2 million people in the areas affected by Boko Haram violence.
The Humanitarian Response Plans give priority to addressing food insecurity and malnutrition, providing refugees, internally displaced persons (IDPs) and local communities with protection assistance, shelter as well as improving access to basic services.
The Nigeria Regional Refugee Response Plan (RRRP), also launched in January, aims to provide assistance to 230,000 Nigerian refugees and their host communities in the region.
The UN Central Emergency Response Fund has allocated US$31 million to bolster humanitarian response in the four Lake Chad Basin countries, with Nigeria receiving around US$10 million, while Cameroon, Chad and Niger received some US$7 million each.
Nina de Vries
FREETOWN— In an attempt to deal with a rise in sexual violence and teenage pregnancies in Sierra Leone during the Ebola crisis, the country’s government has moved to address the issue through an alternative education initiative.
Under a program started in October, many pregnant girls previously barred from attending school now have classes available to them. The classes are also available to lactating mothers.
Elizabeth Issa, 17, is just one of thousands of young girls across the country taking alternative classes being offered under the new program. She has a seven-month-old daughter, who is watched by her parents when she is in school.
She prefers this kind of classroom setting because often shame is brought on girls who get pregnant while still in school, she explains in her native Krio dialect.
Elizabeth says that when she was pregnant she felt a bit embarrassed and stayed inside her house, but she says she feels better being in school with girls sharing the same experience.
The alternative schools have been successful, according to Olive Musa, the head of non-formal education at Sierra-Leone’s Ministry of Education, Science and Technology.
She says an estimated 11,000 girls have registered for the schools. Originally, the classes were offered only to those who got pregnant during the Ebola crisis, but others were so eager participate that the program was expanded.
But not everyone is on board with the new concept.
Human rights group Amnesty International says even though there are alternative classes, students are still not allowed to take exams to get into senior secondary school or college if they are visibly pregnant, and there are no alternative options for that.
In an email to VOA, West African Amnesty researcher Sabrina Mahtani said "The government must act to protect girls' right to non-discrimination and education, and this means protecting their right to continue on in mainstream schools and sit exams equally with others, should they wish to do so," she said.
Mahtani also said the schools' alternative curriculum must be monitored to determine the quality of education. Currently, classes are held just three times a week for a couple of hours.
But Musa says the attitudes cannot change overnight.
“I do not think it is morally right, and considering the culture we have, we are yet to reach that point for accepting that if you are visibly pregnant, you can take exams with those who are not. Of course in college, universities, no one cares, but at that tender age, people will want to frown on it,” Musa said.
She added that the government is looking at methods to ensure student pregnancies are reduced.
“That is why we have to intensify the family planning, the sexual reproductive health programs, so that at least we teach them about prevention.”
For now, the only option is the alternative classes.
Elizabeth Issa, who wants to be a banker, says she feels she is learning enough, but admits some of her peers wanted to attend the mainstream schools, even while pregnant.
Janet T. Scott(http://wwwnc.cdc.gov/eid/article/22/4/15-1302_article#comment) , Foday R. Sesay, Thomas A. Massaquoi, Baimba R. Idriss, Foday Sahr, and Malcolm G. Semple
Author affiliations: University of Liverpool Institute of Translational Medicine & NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, UK (J.T. Scott, M.G. Semple); 34th Regimental Military Hospital, Freetown, Sierra Leone (F.R. Sesay, T.A. Massaquoi, B.R. Idriss, F. Sahr)
Thousands of persons have survived Ebola virus disease. Almost all survivors describe symptoms that persist or develop after hospital discharge. A cross-sectional survey of the symptoms of all survivors from the Ebola treatment unit (ETU) at 34th Regimental Military Hospital, Freetown, Sierra Leone (MH34), was conducted after discharge at their initial follow-up appointment within 3 weeks after their second negative PCR result. From its opening on December 1, 2014, through March 31, 2015, the MH34 ETU treated 84 persons (8–70 years of age) with PCR-confirmed Ebola virus disease, of whom 44 survived. Survivors reported musculoskeletal pain (70%), headache (48%), and ocular problems (14%). Those who reported headache had had lower admission cycle threshold Ebola PCR than did those who did not (p<0.03). This complete survivor cohort from 1 ETU enables analysis of the proportion of symptoms of post-Ebola syndrome. The Ebola epidemic is waning, but the effects of the disease will remain.
Thousands of persons have now survived Ebola virus disease (EVD). During efforts to control the current Ebola-Zaire outbreak, attention has focused on containing spread of infection and improving survival. In Sierra Leone, 4,051–5,115 persons are confirmed to have survived from among 8,704 confirmed cases and 3,589 confirmed deaths (1).
Survivors report a range of sequelae loosely described as post-Ebola syndrome (PES). Follow-up clinics were not always planned as part of the emergency response. However, survivors from the Ebola treatment unit (ETU) at the 34th Regimental Military Hospital, (MH34), Wilberforce Barracks, Freetown, Sierra Leone, were all followed up in an outpatient clinic within 2 weeks after discharge. Although resources to care for survivors, including basic equipment (e.g., adequate stethoscopes), were scarce, each survivor was seen by a physician who made contemporaneous structured notes, which afforded an opportunity to document PES during these first weeks.
What proportion of Ebola survivors have sequelae is not clear. Little is known about PES or whether it is an entity distinct from an appropriate response to the traumatic events of EVD. Abdominal pain, vision loss, hearing loss, impotence, bleeding, psychological problems, and general weakness were listed qualitatively as symptoms of PES after the Ebola-Sudan outbreak in Uganda in 2000 (2). Arthralgia and ocular diseases were noted in 19 survivors (selected according to availability) who were followed up after the 1995 Ebola-Zaire outbreak in Kikwit (3,4); in the same outbreak, arthralgia, myalgia, abdominal pain, extreme fatigue, and anorexia were more common in Ebola survivors than in their household contacts (5). From the current outbreak, survivors reported arthralgia and anorexia (which in this context includes loss of appetite without weight loss) in a telephone-administered questionnaire in Guinea several months after discharge (6). Because none of these studies comprised an unselected cohort of survivors, interpretation of proportions was difficult. Other reports referred to anecdotes of pain, weakness, difficulty hearing, and mental disturbances (7,8). These observations suggest complaints that might be expected. Descriptions of the proportions of survivors needing care for the most common problems are needed to plan health care for the thousands of survivors. We report the symptoms described by all EVD survivors from 1 ETU in the initial weeks after discharge.
The MH34 ETU can accommodate 30 persons with confirmed EVD plus 20 persons with suspected EVD; it also contains a doffing area. MH34 opened on December 1, 2014, with 115 staff, including 3 physicians and catered to patients who fell ill in western Freetown and surrounding areas. The ETU admitted 355 patients (84 PCR-positive patients) and discharged 44 survivors during December 2014–March 2015. The area for persons with confirmed EVD is a permanent building with several 1–4-bed rooms that have electric lighting and ceiling fans. Three hot meals per day are provided, generally rice with protein, such as fish or chicken; each meal is provided with 2 bags of water, and more water is freely available. Staff members of this small ETU are all permanent Sierra Leonean healthcare workers.
Patients were admitted to the confirmed Ebola ward when Ebola virus (EBOV) infection was confirmed by real-time PCR. For some patients, a cycle threshold (Ct) result also was available. Although Ct results were not standardized between PCR platforms or between laboratories, a low Ct reflects a high viral load. Patients were staged on arrival to the ETU, as follows:
Patients were treated for Ebola with supportive care (9). Antimicrobial drugs were administered empirically, and artesunate, paracetamol, and 500 mL intravenous Ringer’s lactate were administered on arrival. Ongoing treatment included further boluses of intravenous fluid; antiemetic medication and proton pump inhibitors were administered in accordance with clinical need. Some patients participated in a compassionate use open nonrandomized study of a single unit of convalescent whole blood (CWB), results of which are pending.
Discharge criteria were as follows: 2 consecutive negative PCR results for Ebola virus on separate days; medical fitness, in the opinion of his/her physician; and adequate social provisions, including release of the house and household members from quarantine. During the convalescent period, many patients ate >1 serving of each meal, 3 time per day. Although they were not routinely weighed, most patients visibly gained weight.
On leaving the ETU, all survivors were issued a survivor’s certificate and invited to a follow-up appointment within 2 weeks after discharge. Some survivors were seen before this appointment because of clinical need.
Contact with survivors was maintained by mobile phone. Confirmation of identification has not proved problematic because the survivors and healthcare workers had come to know each other well. Appointments are made by mobile phone and unscheduled visits by patients to the hospital. All survivors attended their follow-up visits. Patients were examined by 1 of 3 experienced physicians.
A follow-up appointment was established as a standard of care in this ETU from the outset at the height of the epidemic. Handwritten clinical notes documented presenting complaints, symptoms, and signs. These notes were subsequently used to develop appropriate preprinted clinical documentation. Age, sex, presenting complaints, and history of transfusion with CWB were noted for each patient. Preexisting conditions were rare in this cohort of patients and not included in this data extraction. At that time, facilities and equipment for survivors were limited; for example, all stethoscopes had been incinerated; blood pressure cuffs, ophthalmoscopes, and specialist opinions were not available.
We determined 95% CIs and conducted hypothesis testing of binomial outcomes (binomial frequency test) continuous outcomes (Mann-Whitney U) and analyzed them using Stata version 9 (StataCorp LP, College Station, TX, USA). Graphics were produced by using Stata version 9 and R version 3.1.1 (R Foundation for Statistical Computing, Vienna, Austria).
Figure 1(http://wwwnc.cdc.gov/eid/article/22/4/15-1302-f1). Age distribution of patients at Ebola survivors clinic at the 34th Regimental Military Hospital, Wilberforce Barracks, Freetown, Sierra Leone. Cycle threshold levels at hospital admission by age are shown in <>
During December 1, 2014–March 30, 2015, the MH34 ETU treated 84 persons with PCR-confirmed EVD. Of these, 44 (52%) survived; 23 were female, and patient ages were 8–70 years (median 35 years; interquartile range [IQR] 20–37 years); age was not documented for 1 patient (Figure 1; Table 1(http://wwwnc.cdc.gov/eid/article/22/4/15-1302-t1)).
Acute EVD Episode
Information about the acute EVD episode was available for 12 (27%) of the 44 survivors. Sex and ages of these 12 survivors did not differ significantly from those of the full set. For these 12 persons, median length of ETU stay was 15.5 days (range 9–17 days, IQR 13.5–16.6 days). For the 11 survivors for whom Ct results were available, median Ct at ETU admission (admission Ct) was 28 (range 23–37, IQR 23–31). Two patients were admitted in clinical stage 1 and 9 in clinical stage 2.
Twenty-three (52%) survivors received CWB. Ages of survivors receiving transfusions did not differ significantly from those of survivors who did not (p = 0.8). The frequencies of symptoms did not differ significantly between survivors who received CWB and those who did not (p = 0.5). Our study was not designed to assess efficacy or toxicity of CWB.
At the time of data extraction, each survivor had attended at least 2 appointments. All survivors had >1 post-Ebola complaint (median 2, maximum 5). A total of 117 separate complaints were reported: 31 (70% [95% CI 55%–83%]) patients had musculoskeletal pain, 21 (48% [95% CI 32%–63%]) had headaches, and 6 (14% [95% CI 5%–27%]) had ocular problems.
Figure 2(http://wwwnc.cdc.gov/eid/article/22/4/15-1302-f2). Comparison of the most common post-Ebola syndrome symptoms with admission C
t results, 34th Regimental Military Hospital, Wilberforce Barracks, Freetown, Sierra Leone. A) Headache, B) musculoskeletal pain, C) ocular problems. Specific Ct...
In their initial follow-up appointment, patients who reported headache had had admission Ct results that were significantly lower (correlating to a higher viral load) than those who did not subsequently report headache (with headache: n = 6, median Ct 24 [IQR 23–28]; without headache: n = 5, median Ct 31 [IQR 30–31]; p<0.03 by Mann-Whitney U test) (Table 2(http://wwwnc.cdc.gov/eid/article/22/4/15-1302-t2); Figure 2). There was no significant difference in admission Ct or clinical stage, or length of stay in the ETU for acute Ebola or clinical stage, between patients who had ocular problems or musculoskeletal pain and those who did not (Table 2(http://wwwnc.cdc.gov/eid/article/22/4/15-1302-t2); Figure 2).
One patient died after deteriorating respiratory symptoms and left-sided pleural effusion. He was a 25-year-old man in whom EVD was diagnosed on January 26; he received supportive care and 1 unit of CWB. His first negative PCR result was on February 8 and his confirmatory negative test on February 11; he was discharged home. At his 14-day follow-up visit, he had weight loss, cough, and dyspnea on exertion. At his second outpatient appointment, he was admitted to the general medical ward of MH34 on March 3 with left-sided pleural effusion. A pleural tap yielded only a small quantity of blood-stained fluid that was insufficient for analysis. He died on March 8, 2015, one month after his recovery from acute EVD. In adherence to safe-burial policy, a postmortem examination was not performed. His diagnosis remains unclear, but postviral effusion is possible, with tuberculosis pleural effusion a differential diagnosis.
Because in our experience and in the local context the distinction between myalgia and arthralgia can be physician-dependent, we merged these complaints. However, for the purpose of comparisons with other studies, we determined that 12 (27% [95% CI 15%–42%]) of the 44 survivors had arthralgia, 15 (34% [95% CI 20%–50%]) had myalgia, and 4 (9% [95% CI 3%–22%]) had both (Table 3(http://wwwnc.cdc.gov/eid/article/22/4/15-1302-t3)). We found no significant differences between the proportion of male and female survivors, or between children (<18 years of age) and adults, who had musculoskeletal pain.
Patients described musculoskeletal pain variously as problems with walking or moving or pain specific to 1 area (such as knees, thighs, or back) or generalized musculoskeletal pain. (21%–52%). Most often, patients characterized their musculoskeletal pain as a general pain rather than pain in a specific joint or area, as reflected in the recorded symptoms. Unspecified joint pain accounted for 14 of the 19 times joint pain was recorded (73% [95% CI 49%–90%]) and generalized body pain for 8 of the 19 times body pain was recorded (42% [95% CI 20%–67%]). Some patients recorded >1 symptom.
Examination indicated no joint inflammation or effusion, such as might be expected in a reactive condition, and patients retained full range of movement. Functional disability ranged from mild to moderate. For example, 1 man in his 20s continues to play football but now takes acetaminophen to facilitate this activity. A woman in her 40s requires assistance to step into a bath and cannot continue normal household work; she walked unaided into the clinic but needed assistance to step up into the clinic room and to sit and stand. Most of her musculoskeletal symptoms are relieved by simple analgesics.
Of the 21 (48% [95% CI 32%–63%]) survivors who reported having headache, 2 (10% [95% CI 1%–30%]) were girls 8 and 11 years of age. The proportion of male and female survivors reporting headaches did not differ significantly (p = 1 by χ2 test). Headache was generally described as affecting the full head, with no diurnal pattern and being constant. Ocular symptoms might coincide, but no visual phenomena, such as might be found in migraines, were reported.
Among the 6 (14% [95% CI 5%–27%]) survivors who reported ocular problems, symptoms were eye pain, clear discharge, red eyes, and blurred vision (Table 4(http://wwwnc.cdc.gov/eid/article/22/4/15-1302-t4)). These symptoms appeared within 2 weeks after discharge and were not present at or before ETU discharge. Eye discharge was treated with topical chloramphenicol. Ophthalmology services for survivors are currently under development.
Combinations of Musculoskeletal Pain, Headache, and Ocular Problems
Figure 3(http://wwwnc.cdc.gov/eid/article/22/4/15-1302-f3). Scale Venn diagram illustrating the overlap between the 3 main symptom groups among persons with post-Ebola syndrome seen at the Ebola survivors clinic at the 34th Regimental Military Hospital, Wilberforce Barracks,...
Musculoskeletal pain and headache overlapped substantially. Eighteen (58% [95% CI 40%–75%]) of the 31 survivors with musculoskeletal pain reported headache, and 18 (86% [95% CI 64%–97%]) of the 21 survivors with headache reported musculoskeletal pain. Two (6% [95% CI 1%–21%]) survivors with musculoskeletal pain reported ocular problems, and 2 (33% [95% CI 4%–78%]) with ocular problems reported musculoskeletal pain. Two (6 % [95% CI 1%–30%]) survivors with headache reported ocular problems. One survivor had all 3 complaints (i.e., 3% [95% CI 1%–17%] of survivors with musculoskeletal pain; 5% [95% CI 0%–24%] of those with headache, and 17% [95% CI 0%–64%] with of those with ocular problems) (Figure 3).
Twenty-six (59% [95% CI 43%–74%]) of the 44 survivors reported other symptoms. Five (11% [95% CI 4%–25%]) reported cough; 4 (9% [95% CI 3%–22%]) each reported abdominal pain, chest pain, or itching; 3 (7% [95% CI 1%–19%]) each reported insomnia, fever, or loss of appetite; 2 (5% [95% CI 1%–15%]) each reported labored speech, epigastric pain, or rash; and 1 (2% [95% CI 0%–12%]) reported weight loss, hiccups, increased appetite, chest pain, sneezing, diarrhea, vomiting, left sided weakness with facial nerve palsy, breathlessness, rash, dry flaky skin, earache, fever blister/cold sore, left scrotal swelling, nasal congestion, and tremors (Table 5(http://wwwnc.cdc.gov/eid/article/22/4/15-1302-t5)).
We documented symptoms of EVD survivors in the initial 3 weeks after negative Ebola virus PCR results and 2 weeks after ETU discharge. The dominant clinical features of this survivor cohort were musculoskeletal pain, headache, and ocular problems. Symptoms did not differ by survivor sex or age. Symptoms did not appear to be affected by use of CWB to manage acute EVD; however, this finding should be interpreted with caution because this report is not a prospective study and not designed to consider the effect of CWB on PES. Whether this collection of signs and symptoms after acute EVD constitutes a separate syndrome might be semantic. Because experience of survivors in the weeks after EVD, although varied, has common features, we propose that the term post-Ebola syndrome is useful to describe these phenomena.
Our findings are consistent with some aspects of previous reports (2,5) but vary from others. For example, the prevalence of extreme fatigue and anorexia reported in Kikwit and Guinea (5,6) was not dominant in the cohort reported here. This finding might be due to the period of inpatient convalescence of survivors at MH34 with substantial nutritional support.
We hypothesize that the pathogenesis of pain, particularly muscle pain, is a sequelae of widespread myositis or rhabdomyolysis during acute EVD. This hypothesis would be consistent with laboratory data reporting raised transaminases and disseminated intravascular coagulation from a previous outbreak of Ebola (10) in Sudan. Future research would benefit from a comparison of a survivor cohort with a matched group who had not had Ebola and, if this pain is more common in Ebola survivors (as was found in Kikwit ), further elucidation of its etiology would be useful in determining treatment strategies.
PES includes, but is not restricted to, musculoskeletal pain, headache, and ocular problems. Because some complications occur weeks or months after acute onset of EVD, some symptoms might be underestimated in this cohort (2,5). Since these data were extracted, clinical facilities and documentation has improved, so future information is likely to be more detailed in terms of specific diagnosis, and scope, particularly in regard to psychosocial health and ophthalmology. Previous outbreaks have reported psychosocial problems (2), although they are not included in all reports (5). Psychosocial problems also were evident in the survivors in our study but not captured in the documentation. Improved collaboration with MH34’s mental health team should improve both the care and documentation. Anecdotal evidence from the survivors’ clinic suggests that more subtle neurologic problems, such as specific nerve palsies, might feature more heavily in a follow-up study.
Survivors who reported headache had had lower Ct results than did those who did not. Although patients with higher initial viral loads might be more likely to have central nervous system involvement, and then have a higher probability of headache as a post-Ebola sequelae; Ct values are not standardized among platforms or laboratories. This intertest variability, together with the small sample sizes in this data extraction, suggests any association should be interpreted with caution. We propose that this association warrants further investigation. Headaches could also represent ongoing tension headaches or might result from underlying undiagnosed changes in vision.
We would expect the criteria and definition of PES to continue to develop and that the survivors will continue to face fresh challenges. During the height of the Ebola epidemic, when these consultations took place, resources and equipment for assessing survivors were limited. Our survey documents symptoms only in the first 2 weeks after ETU discharge. Subsequent follow-up might be more detailed and benefit from increased resources, and symptoms continue to develop with time. Indeed, Ebola virus can cross the blood–brain barrier during the acute illness (11) and persists in some compartments for several months (12). Areas for development include comparison of symptoms to community controls, psychosocial problems, causes of ocular problems and musculoskeletal pain, and longitudinal description of the clinical picture.
Because musculoskeletal pain is a common complaint in the general population in Sierra Leone, a community-controlled comparison is needed. In survivors of the Kikwit Ebola-Zaire outbreak in 1995, Rowe et al. reported that their key features—arthralgia, myalgia, abdominal pain, fatigue, and anorexia—were more common in survivors than in household contacts, whereas fever, headache, diarrhea, dyspnea, hiccups, and hemorrhage were the same in both groups (5). A topic for future research is the longitudinal course of recovery. Wendo et al. (2) reported that 1 year after the Ebola-Zaire outbreak in Uganda, 25% of patients were still reporting to clinic. Therefore, we can expect some survivors to have long-term clinical needs. The epidemic is waning but the effects of the disease it caused will remain.
Dr. Scott is a clinical lecturer in pharmacology and infectious diseases at the Institute of Translational Medicine, University of Liverpool. Her primary research interests include characterizing PES and other emerging infectious diseases, clinical trials of EVD candidate therapeutics, and optimizing therapeutic regimens, including passive immunotherapy for EVD.
J.T.S. is supported by the Wellcome Trust. M.G.S. is supported by the UK National Institute for Health Research Health Protection Research Unit in Emerging and Zoonotic Infections. The authors have been awarded a grant from the Enhancing Research Activity in Epidemic Situations (ERAES) program funded by the Wellcome Trust to support further research into the sequelae of Ebola virus disease.
t results, 34th Regimental Military Hospital, Wilberforce Barracks, Freetown, Sierra Leone. A) Headache, B) musculoskeletal pain, C) ocular problems....(http://wwwnc.cdc.gov/eid/article/22/4/15-1302-f2)](http://wwwnc.cdc.gov/eid/article/22/4/15-1302-f2)
Suggested citation for this article: Scott JT, Sesay FR, Massaquoi TA, Idriss BR, Sahr F, Semple MG. Post-Ebola syndrome, Sierra Leone. Emerg Infect Dis. 2016 Apr [_date cited_]. http://dx.doi.org/10.32032/eid2204.151302
Dans ce UNOWA Newsletter#3 :
In This Issue
West Africa: upsurge in terrorism - P 2
2016, an election year in West Africa - P 3
The UN supports ECOWAS in the fight
against drug trafficking and organised crime - P 4
UNOWA strengthens its cooperation with ECOWAS in the areas of conflict prevention and mediation - P 5
Women have to play a greater role in West Africa - P 8
With Mohamed Ibn Chambas, Special Representative of the UN Secretary General for West Africa
YOKOHAMA – The United Nations World Food Programme (WFP) has welcomed a US$120.7 million cash contribution from the Government of Japan to provide vital food and nutrition assistance to the most vulnerable people affected by conflicts and natural disasters in 32 countries in Africa, the Middle East, Asia and Eastern Europe.
“WFP highly appreciates this significant contribution from Japan, which could not have been more timely,” said Stephen Anderson, Director of WFP’s Japan Office. “WFP is responding to critical food needs in four of the world’s largest and most complex, conflict-induced humanitarian emergencies in Syria, Iraq, Yemen, and South Sudan. WFP is also providing emergency humanitarian support to countries severely affected by natural disasters including those hit by one of the strongest El Nino events on record. As chair of the G7 summit to be held in Ise-shima in May, this generous donation reaffirms Japan’s steadfast commitment to humanitarian assistance and proactive leadership in peace building and human security.”
In the lead up to the sixth Tokyo International Conference on African Development (TICAD VI) being held in Kenya in August, with Japan as one of the co-organisers, it is fitting that the largest portion - US$56 million - will assist millions of people on the continent who are affected by natural disasters and conflict in 20 countries. In Ethiopia, where El Niño is responsible for what could be the worst drought-related emergency in 50 years, Japan’s funds will provide emergency food rations to 472,000 people who are already suffering its effects. In Malawi, the funds will be spent on four projects including relief assistance for people hit by floods and dry spells, as well as recovery and school feeding programmes, to ensure seamless support from relief to development. The latter is a priority issue to be discussed at the upcoming World Humanitarian Summit in Istanbul. Recovery activities will be implemented in partnership with Japan International Cooperation Agency (JICA), which will provide technical assistance in agriculture.
US$49 million will be allocated to support those affected by conflict in the Middle East. As the protracted conflict in Syria approaches its sixth anniversary, the Japanese contribution will enable WFP to continue provision of desperately-needed life-saving food and vouchers to nearly 6 million Syrians who are displaced inside Syria and in neighbouring countries. In Yemen, the funds will help WFP provide vital assistance to 2 million internally-displaced persons, including nutrition support to mothers and children.
In Asia, the channelling of funds to support food assistance in Afghanistan and Pakistan reflect Japan’s desire to promote peace and human security in the sub-region.
WFP’s logistics operations will also benefit from Japan’s donation in five countries, including South Sudan and Guinea, where the agency runs the United Nations Humanitarian Air Service, providing critical air transport and cargo services for the entire humanitarian community.
The breakdown of the contribution is as follows:
Middle East: Yemen (US$10 million), Jordan (US$8 million), Turkey (US$7.5 million), Lebanon (US$6.6 million), Syria (US$6.2 million), Iraq (US$6 million), Sudan (US$2.7 million), Palestine (US$1.3 million), Egypt (US$1 million)
Africa: Ethiopia (US$5.35 million), Central African Republic (US$5 million), Malawi (US$5 million), Niger (US$3.5 million), Uganda (US$3.5 million), Democratic Republic of the Congo (US$4.5 million), Somalia (US$3.1 million), Cameroon (US$3 million), Burundi (US$2.65 million), South Sudan (US$3.2 million), Sierra Leone (US$2.2 million), Guinea (US$3 million), Mauritania (US$2 million), Kenya (US$2 million), Tanzania (US$1.8 million), Chad (US$1.75 million), Mali (US$1.5 million), Republic of Congo (US$1.4 million), Liberia (US$1 million), Burkina Faso (US$1 million)
Asia: Afghanistan (US$8 million), Pakistan (US$6 million)
Eastern Europe: Ukraine (US$1 million)
WFP is the world's largest humanitarian agency fighting hunger worldwide, delivering food assistance in emergencies and working with communities to improve nutrition and build resilience. Each year, WFP assists some 80 million people in around 80 countries.
Follow us on Twitter @wfp_media For more information please contact (email address: email@example.com):
Yuko Yasuda, WFP/Yokohama, Tel. +81 (0)3 5766 5364, Mob. +81 (0)90 9844 9990
L'Afrique de l’Ouest peut être divisée en trois zones agro-écologiques ou en trois bassins commerciaux (bassins de l’ouest, bassin du centre, bassin de l’est). Les deux sont importants pour l'interprétation du comportement et de la dynamique du marché.
Les trois principales zones agro-écologiques incluent la zone Sahélienne, la zone Soudanaise et la zone Côtière où la production et la consommation peuvent être facilement classifiées. (1) Dans la zone Sahélienne, le mil constitue le principal produit alimentaire cultivé et consommé en particulier dans les zones rurales et de plus en plus par certaines populations qui y ont accès en milieux urbains. Des exceptions sont faites pour le Cap Vert où le maïs et le riz sont les produits les plus importants, la Mauritanie où le blé et le sorgho et le Sénégal où le riz constituent des aliments de base. Les principaux produits de substitution dans le Sahel sont le sorgho, le riz, et la farine de manioc (Gari), avec les deux derniers en période de crise. (2) Dans la zone Soudanienne (le sud du Tchad, le centre du Nigéria, du Bénin, du Ghana, du Togo, de la Côte d'Ivoire, le sud du Burkina Faso, du Mali, du Sénégal, la Guinée Bissau, la Serra Leone, le Libéria) le maïs et le sorgho constituent les principales céréales consommées par la majorité de la population. Suivent après le riz et les tubercules particulièrement le manioc et l’igname. (3) Dans la zone côtière, avec deux saisons de pluie, l’igname et le maïs constituent les principaux produits alimentaires. Ils sont complétés par le niébé, qui est une source très significative de protéines.
Les trois bassins commerciaux sont simplement connus sous les noms de bassin Ouest, Centre, et Est. En plus du mouvement du sud vers le nord des produits, les flux de certaines céréales se font aussi horizontalement. (1) Le bassin Ouest comprend la Mauritanie, le Sénégal, l’ouest du Mali, la Sierra Leone, la Guinée, le Libéria, et la Gambie où le riz est le plus commercialisé. (2) Le bassin central se compose de la Côte d'Ivoire, le centre et l’est du Mali, le Burkina Faso, le Ghana, et le Togo où le maïs est généralement commercialisé. (3) Le bassin Est se rapporte au Niger, Nigéria, Tchad, et Bénin où le millet est le plus fréquemment commercialisé. Ces trois bassins commerciaux sont distingués sur la carte ci-dessus.
ARMY SAYS RESCUES HUNDREDS OF HOSTAGES
The Government said on 26 February that it had rescued 850 villagers from Boko Haram during a joint military operation with Nigeria in which 92 members of the armed group were also killed. The operation was carried out in the Nigerian village of Kumshe near the border with Cameroon. Cameroon’s Far North region has repeatedly been hit by suicide attacks suspected to be perpetrated by Boko Haram.
CENTRAL AFRICAN REPUBLIC
FIRE LEAVES OVER 700 IDPS HOMELESS
On 25 February, fire destroyed 85 huts at the Catholic Mission site for the displaced in the northern Batangafo town, leaving 758 people homeless. They have sought refuge at the Mission’s hall, schools, temporary classrooms and at the town hall. It is the third fire outbreak on the site since January.
Meanwhile, humanitarian organizations are providing assistance to hundreds of IDPs following multiple fire outbreaks over the past month on various sites in Bambari, Batangafo and Kaga-Bandoro regions.
OVER 8,000 IVORIAN REFUGEES REPATRIATED
On 23 and 25 February, UNHCR repatriated 536 Ivorian refugees from Liberia, with the UN mission (ONUCI) providing escorts on the Ivorian side. Most returnees are reintegrating well in their communities, according to UNHCR in Côte d’Ivoire. However, there have been reports of land disputes and difficulties in obtaining birth certificates and IDs. Since the resumption of the voluntary repatriation on 18 December 2015, 8,521 Ivorian refugees have returned home. UNHCR aims to repatriate 25,000 refugees by December 2016.
PRESIDENTIAL ELECTION GOES FOR SECOND ROUND
Run-off presidential vote will be held on 20 March between incumbent President Mahamadou Issoufou and detained former parliament speaker Hama Amadou.
President Issoufou won 48.41 per cent of the vote while Amadou received 17.79 per cent of votes according to results announced by the electoral commission on 26 February. No major incidents were reported in the first round of voting on 21 February.
EBOLA VIRUS DISEASE (EVD)
FOUR SIERRA LEONE CONTACTS STILL MISSING
No new cases were reported in the week ending on 28 February. In Sierra Leone, many of the missing contacts have been identified, leaving only four at large in Kambia district. Meanwhile, the inter-agency operation in the district ended on 25 February. All the reported deaths are being swabbed, however death alerts are still below the expected level and therefore not all deaths are being screened. In Guinea, notification of deaths remains active. Of the reported deaths across the country in the last week of February, 54 per cent were within communities. Monitoring of survivors, lab tests, cross-border surveillance and infection prevention measures are also ongoing.
DES CENTAINES D’OTAGES LIBÉRÉS SELON L’ARMÉE
Le gouvernement a déclaré le 26 février qu'il avait sauvé 850 villageois de Boko Haram au cours d'une opération militaire conjointe avec le Nigeria où 92 membres du groupe armé ont également été tués. L'opération a été effectuée dans le village nigérian de Kumshe, près de la frontière avec le Cameroun. La région de l'Extrême Nord du Cameroun a maintes fois été frappée par des attentats-suicides soupçonnés d'être perpétrés par Boko Haram.
PLUS DE 700 DÉPLACÉS SANSABRI À LA SUITE D’UN INCENDIE
Le 25 février, un incendie a détruit 85 cases sur le site de la Mission Catholique pour les personnes déplacées de la ville de Batangafo, au nord, laissant 758 personnes sans abri.
Elles ont trouvé refuge dans le hall d’accueil de la Mission, des écoles, des salles de classe temporaires et à l'hôtel de ville. Il s’agit du troisième incendie sur le site depuis janvier.
Pendant ce temps, les organisations humanitaires apportent une aide à des centaines de personnes déplacées après plusieurs incendies au cours du mois passé sur différents sites dans les régions de Bambari,
Batangafo et Kaga-Bandoro.
PLUS DE 8 000 RÉFUGIÉS IVOIRIENS RAPATRIÉS
Les 23 et 25 février, le HCR a rapatrié 536 réfugiés ivoiriens du Libéria, avec la mission des Nations Unies (ONUCI) qui a fourni des escortes du côté ivoirien. La plupart des rapatriés sont bien réintégrés dans leurs communautés, selon le HCR en Côte d'Ivoire.
Cependant, des litiges fonciers et des difficultés à obtenir des certificats de naissance et des papiers d’identité ont été rapportés.
Depuis la reprise du rapatriement volontaire le 18 décembre 2015, 8 521 réfugiés ivoiriens sont rentrés chez eux.
Le HCR a pour objectif de rapatrier 25 000 réfugiés d’ici décembre 2016.
SECOND TOUR DE L’ÉLECTION PRÉSIDENTIELLE
Le second tour de l’élection présidentielle aura lieu le 20 mars entre le Président sortant Mahamadou Issoufou et l'ancien président du parlement détenu, Hama Amadou. Le Président Issoufou a remporté 48,41% des voix tandis qu’Amadou a obtenu 17,79% des voix, selon les résultats annoncés par la commission électorale le 26 février. Aucun incident majeur n'a été signalé lors du premier tour du scrutin le 21 février.
MALADIE À VIRUS EBOLA (MVE)
QUATRES CONTACTS MANQUENT TOUJOURS À L’APPEL EN SIERRA LEONE
Aucun nouveau cas MVE n’a été signalé au cours de la semaine se terminant le 28 février.
En Sierra Leone, la plupart des contacts manquants ont été identifiés dans le district de Kambia, sauf quatre. Pendant ce temps, l'opération inter-agences dans le district a pris fin le 25 février. Des prélèvements sont effectués sur tous les décès signalés, mais les signalements sont encore en dessous du niveau attendu, par conséquent, tous les décès ne sont pas contrôlés. En Guinée, la notification des décès reste active. Parmi les décès signalés à travers le pays dans la dernière semaine de février, 54% étaient au sein des communautés, et non dans des centres hospitaliers. Le suivi des survivants, les tests de laboratoire, la surveillance transfrontalière et les mesures de prévention des infections sont également en cours.
Polio this week as of 2 March 2016
Freetown, Sierra Leone | AFP | Thursday 3/3/2016 - 21:55 GMT
by Rod Mac JOHNSON
A group of 5,000 girls who were expelled from schools in Sierra Leone for getting pregnant during the Ebola crisis have returned to the classroom, the education ministry said on Thursday.
All schools were closed from June 2014 to April 2015 in Sierra Leone as part of government efforts to curb the spread of the Ebola virus, which killed almost 4,000 people in the country.
But when they reopened in April 2015, girls were assessed using invasive methods to check if they were pregnant or had recently given birth.
Kadie, in her third year of secondary school in the south of the country, told AFP: "My breasts were lumped together to find out whether they contained milky substances before I was allowed to continue my tuition."
It pupils were found to be expecting or had become mothers, they were given the choice of attending temporary alternative classes funded by the British and Irish governments.
As a result many girls missed exams to gain entrance to higher secondary school, university or college.
Education Minister Brima Turay said the girls, some of whom were still in the primary system when they became pregnant, were readmitted in January after being banned from mainstream schooling for being a "negative influence" on others.
"They started during the school year in January but we were watching their performance before this disclosure and I am pleased to report that it has been outstanding and over our expectation," he told AFP.
The authorities said last year the girls were expelled "to avoid other girls from following the example of becoming pregnant while attending school", as it "would set a bad precedent which runs alien to the country's cultural values".
An outcry ensued, with the Human Rights Commission of Sierra Leone calling the exclusion of pregnant girls from mainstream educational institutions "discriminatory and stigmatisation".
Sallimatu, 13, who spoke to AFP by phone from Bo, Sierra Leone's second largest city, said she was happy to have returned to school, adding that the stigma attached to teenage pregnancy made her determined to work hard at her studies.
The government will contribute to some of the girls' school fees for two years along with some living costs, the ministry said, partnering with charities to keep class sizes down as the girls re-enter the system.
Some girls, however, will not be returning.
Janet who got pregnant in the capital of Freetown aged just 11, said she had given up on mainstream education.
"I am done with schooling. I fear going back to be harassed by friend and foe alike. I rather nurse my year-old baby and look to what life can do for me," she said.
© 1994-2016 Agence France-Presse
Kathryn G. Curran, PhD1,2; James J. Gibson, ; MD3; Dennis Marke, ; MD4; Victor Caulker4; John Bomeh4; John T. Redd, MD5; Sudhir Bunga, MD6; Joan Brunkard, PhD2; Peter H. Kilmarx, MD7 (View author affiliations)
As of February 17, 2016, a total of 14,122 cases (62% confirmed) of Ebola Virus Disease (Ebola) and 3,955 Ebola-related deaths had been reported in Sierra Leone since the epidemic in West Africa began in 2014 (_1_). A key focus of the Ebola response in Sierra Leone was the promotion and implementation of safe, dignified burials to prevent Ebola transmission by limiting contact with potentially infectious corpses. Traditional funeral practices pose a substantial risk for Ebola transmission through contact with infected bodies, body fluids, contaminated clothing, and other personal items at a time when viral load is high; however, the role of funeral practices in the Sierra Leone epidemic and ongoing Ebola transmission has not been fully characterized (_2_). In September 2014, a sudden increase in the number of reported Ebola cases occurred in Moyamba, a rural and previously low-incidence district with a population of approximately 260,000 (_3_). The Sierra Leone Ministry of Health and Sanitation and CDC investigated and implemented public health interventions to control this cluster of Ebola cases, including community engagement, active surveillance, and close follow-up of contacts. A retrospective analysis of cases that occurred during July 11–October 31, 2014, revealed that 28 persons with confirmed Ebola had attended the funeral of a prominent pharmacist during September 5–7, 2014. Among the 28 attendees with Ebola, 21 (75%) reported touching the man’s corpse, and 16 (57%) reported having direct contact with the pharmacist before he died. Immediate, safe, dignified burials by trained teams with appropriate protective equipment are critical to interrupt transmission and control Ebola during times of active community transmission; these measures remain important during the current response phase.
The Sierra Leone Ministry of Health and Sanitation and CDC conducted a retrospective analysis of laboratory-confirmed Ebola cases in Moyamba during July 11–October 31, to investigate the increase in cases in September 2014, determine the source and risk factors, and recommend prevention and control measures. The Moyamba District Health Management Team (DHMT) received and responded to alerts from health workers, contact tracers, and community members regarding ill persons, possible Ebola cases, and unexplained deaths. Interviewers completed standardized case investigation forms with patients or proxies regarding demographics, symptoms, illness onset, and potential exposures during the month before illness onset, including contact with ill persons, persons with suspected Ebola, and corpses, plus funeral attendance, hospital or traditional healer visits, and travel history. Laboratory technicians collected whole blood from living patients with suspected Ebola and oral swab specimens from corpses and sent the samples to a centralized laboratory for testing.
A suspected case was defined as 1) the occurrence of fever and at least three of 12 symptoms (i.e., vomiting, headache, nausea, diarrhea, difficulty breathing, fatigue, abdominal pain, loss of appetite, muscle or joint pain, unexplained bleeding, difficulty swallowing, and hiccups) in any person; or 2) any sudden, unexplained death. A confirmed case was defined as a suspected case with a positive laboratory test result by reverse transcription–polymerase chain reaction (RT-PCR) test specific for Ebola virus. If RT-PCR results from blood specimens collected <72 hours after symptom onset were negative or indeterminate, additional specimens were collected for repeat diagnostic testing. Paper case investigation forms and laboratory results were entered into the Sierra Leone Viral Hemorrhagic Fever database. Descriptive statistics were calculated using statistical software.
Among 281 suspected Ebola cases in Moyamba District during July 11–October 31, a total of 109 (39%) were confirmed; among these patients, 40 died (case fatality rate = 37%). The median age of patients with suspected Ebola was 30 years (range = 11 months–84 years), and 59% were male. Incidence peaked during the week of September 13–19 at 32 confirmed cases (Figure 1). Overall, during the month before becoming ill, 78 (72%) patients with confirmed Ebola reported having contact with a known or suspected Ebola patient (alive or dead) or ill person. Forty-two (39%) had attended a funeral, 36 (33%) had carried or touched a corpse at a funeral, 10 (9%) had traveled, and eight (7%) had visited a hospital or traditional healer. Among 78 patients with confirmed Ebola who reported contact, 23 (29%) had contact with a corpse, 26 (33%) had contact with a live patient, and 29 (37%) had contact with an Ebola patient both while the patient was alive and after the patient had died.
During September 5–7, 28 persons who were later confirmed to have Ebola attended the 3-day funeral of a prominent pharmacist in Moyamba; patients developed symptoms a median of 9 (interquartile range = 7–12) days after the funeral (Figure 2). The pharmacist was buried by relatives rather than by a district Ebola burial team, and his death was not investigated; consequently, no epidemiologic records exist regarding his exposures and illness, although anecdotal reports suggested he had treated an Ebola patient from a neighboring village. Among the 28 persons who attended the funeral and later developed Ebola, 23 (82%) were family members and 18 (64%) were male. Eight (29%) of these patients, all of whom were male and had touched the corpse, died and were buried by the district Ebola burial team. The case fatality rate among men was 44%; no deaths occurred among women (p = 0.02). Among the 28 Ebola patients who had attended the funeral, 16 (57%) reported having had direct contact with the pharmacist for days (August 25–September 1) before the funeral, and 21 (75%) carried or touched his corpse at the funeral. Subsequent contact with funeral attendees likely led to eight known additional confirmed cases (four in the second generation, including one death, and four in the third generation) (Figure 2).
Because the pharmacist was suspected to have died from Ebola, Moyamba DHMT engaged the local village chiefs, youth leaders, the community health officer, and others to ensure community support of rapid response measures. Moyamba DHMT conducted case investigations, traced contacts, and established quarantine in the town in mid-September 2014, closing local businesses and providing food support to residents for 21 days. District surveillance officers conducted daily active case finding. A youth leader convened a neighborhood watch, consisting of local, trained youths, who observed contacts of the pharmacist both inside and outside quarantine for Ebola symptoms every day, to support contact tracers and security. DHMT notified the community health officer to be on high alert for Ebola patients at the clinic or in the community; the community health officer notified DHMT soon after when children from the pharmacist’s home became symptomatic. Only two identified contacts of the pharmacist were lost to follow-up.
A single, traditional funeral likely led to a sharp increase in Ebola cases in a previously low-incidence district in Sierra Leone, suggesting a substantially higher rate of secondary transmission from one patient than the basic Ebola virus reproduction number of 2.53 estimated for the outbreak in Sierra Leone (_4_). A high number of secondary cases might be explained by a high viral load in the primary patient, the type of contact, timing of contact (e.g., while a patient was alive or dead), the number of persons exposed, or a combination of these factors. An investigation of the 1995 Ebola outbreak in Kikwit, Democratic Republic of the Congo, identified 38 secondary cases linked to one patient who had many visitors while hospitalized (_5_).
Eight men with confirmed Ebola who attended this funeral died. The high case fatality rate among men might be explained by more intense or prolonged contact with the corpse by the male funeral attendees. According to traditional funeral practices in Sierra Leone, family and friends of the same sex are often responsible for preparing, washing, and clothing the body (_6_). Funerals pose a substantial risk for Ebola transmission for several reasons. First, the risk for transmission might increase with viral load, which is often highest in nonsurvivors, especially during the later stages of disease progression and at death (_7_). Second, the traditional practices of washing, preparing, and touching the body include direct, prolonged contact with the corpse. Finally, funerals attract family, friends, and colleagues from various locations. Attendance is important to demonstrate respect, establish land rights, and determine whether widows will return to their community of origin (_6_). Travelers who are exposed and become infected can establish new chains of transmission when they return to their original communities.
This report highlights the potential for high levels of transmission from a single patient or event and underscores the importance of vigilant Ebola surveillance and response. At least 36 Ebola cases and nine deaths might have been prevented had the pharmacist had a safe, medical burial. The DHMT’s comprehensive and targeted response, including rapid community engagement, quarantine, and active surveillance through daily house-to-house visits and formation of a youth neighborhood watch, likely led to the prompt identification of cases and limited transmission beyond the four cases in the second generation and the four cases in the third generation.
Fear, stigma, and discrimination might lead to underreporting of Ebola cases (_8_), and there was likely underascertainment of Ebola cases, deaths, and exposures. During the time of the investigation, Moyamba DHMT and CDC witnessed and received anecdotal reports of persons who were fleeing the area and hiding from surveillance and contact tracing teams. Self-reported data are limited by patients’ and proxies’ ability to recall exposures and dates, and social desirability bias and fear might have led to underreporting of Ebola symptoms and contact with ill persons or corpses.
To achieve and maintain zero new infections, enhanced community-based surveillance strategies, such as the community event-based surveillance system, which employs community health monitors to detect and report Ebola trigger events (e.g., two or more ill or dead family or household members) (_9_), are critical to the rapid identification of high-risk events to prevent transmission. Safe, dignified burials by trained burial teams using appropriate protective equipment are critical to the interruption of transmission and control of Ebola in both low-incidence and high-incidence settings, as well as in rural and urban settings (_10_). Early identification of Ebola cases along with prompt isolation, testing, and care of patients can limit transmission, improve likelihood of survival, and ensure safe burials of persons who die, ultimately preventing deaths from occurring at home and unsafe burials in the community. Ebola response teams can strengthen community Ebola surveillance.
Moyamba District Health Management Team, including Moyamba District Emergency Operations Committee, surveillance officers, data team, contact tracing team, and clinicians; West Africa Ebola national and international response teams; Ministry of Health and Sanitation, Sierra Leone; World Health Organization; Action Contre la Faim; Médecins Sans Frontieres.
Corresponding author: Kathryn G. Curran, firstname.lastname@example.org, 404-639-4638.
1Epidemic Intelligence Service, CDC; 2Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 3Division of Global Health Protection, Tanzania Country Office, Center for Global Health, CDC; 4Sierra Leone Ministry of Health and Sanitation; 5Office of Public Health Preparedness and Response, CDC; 6Division of Global Health Protection, Center for Global Health, CDC; 7Division of Global HIV/AIDS, Zimbabwe, Center for Global Health, CDC.
PROJECTED FOOD ASSISTANCE NEEDS FOR AUGUST 2016
This brief summarizes FEWS NET’s most forward-looking analysis of projected emergency food assistance needs in FEWS NET coverage countries. The projected size of each country’s acutely food insecure population (IPC Phase 3 and higher) is compared to last year and the recent five-year average and categorized as Higher ( p), Similar ( u), or Lower ( q). Countries where external emergency food assistance needs are anticipated are identified. Projected lean season months highlighted in red indicate either an early start or an extension to the typical lean season. Additional information is provided for countries with large food insecure populations, an expectation of high severity, or where other key issues warrant additional discussion. Analytical confidence is lower in remote monitoring countries, denoted by “RM”.
Between November 2014 and January 2016, FEWS NET worked with Mobile Accord (GeoPoll) to conduct seventeen 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.
La BAD publie un rapport sur l’impact d’Ebola sur les femmes
A l’occasion de la Journée internationale de la femme, le 8 Mars 2016, le Bureau de la vice-présidente et envoyée spéciale pour les Questions du Genre à la Banque africaine de développement, Geraldine Fraser-Moleketi, lance son rapport sur « La résilience des femmes : Intégrer le genre dans la réponse à Ebola. »
La BAD a commandé cette étude pour mettre en lumière un sujet qui a souvent été discuté mais jamais étudié concrètement - la maladie à virus Ebola a-t-elle touché les femmes et les hommes différemment ? La réponse est un oui retentissant. Nous avons pendant longtemps soupçonné que les maladies infectieuses avaient tendance à exacerber les vulnérabilités socioéconomiques qui sévissent avant l’apparition d’un foyer. Cette connaissance se confirme dans le cas de figure présent.
Après avoir visité le Libéria, la Sierra Leone et de la Guinée en Août 2015, au plus fort de l'épidémie, la vice-présidente , Fraser-Moleketi a noté «J'ai rencontré des femmes et des hommes qui travaillent sans relâche pour éradiquer cette maladie. D'innombrables vies ont été perdues dans cette bataille et les répercussions se feront sentir pendant des années à venir en termes de croissance économique. Pour les femmes, il y avait, et il existe encore, un danger de revenir à la façon dont les choses existaient auparavant.
Le rapport examine la futilité d'essayer de renforcer la résistance au virus Ebola et aux futurs chocs de maladies infectieuses dans les ménages et les communautés sans aborder l'inégalité systémique entre les sexes. Les facteurs qui sont ancrés dans la vulnérabilité pour l'ensemble de la population doivent être abordés dans la réponse immédiate, l'atténuation à moyen terme et l’intervention à long terme. Les effets d’Ebola sur le genre dans la région sont influencés par les compétences et les stratégies utilisées avant le déclenchement et les mécanismes particuliers utilisés pour faire face et s'adapter diffèrent.
Le rapport souligne également que le manque de données ventilées par sexe ne devrait pas limiter les interventions, et que tous les efforts doivent être consentis afin de recueillir les informations pertinentes pour lutter contre cette maladie maintenant. Les conclusions de ce rapport peuvent être non seulement de valeur dans le traitement des autres épidémies, mais aussi de prévenir de nouvelles flambées.
L'une des recommandations du rapport était d'établir un fonds d'investissement social. La BAD a depuis investi 33 millions de dollars EU dans le Fonds d'investissement social post-Ebola, dans un projet soutenu par le Département d'Etat américain.
Le niveau d'ambition de la Banque africaine de développement dans l'amélioration de la qualité de vie reste élevé. Il est déterminé à tirer le meilleur parti de ses ressources pour fournir un accès à la santé, la protection sociale et de l'éducation à tous les Africains, hommes et femmes, jeunes et vieux, à travers le continent, pour surmonter un obstacle majeur sur le développement de l'Afrique et de mettre le continent sur le chemin de la croissance inclusive.