Afghanistan

One new cases of wild poliovirus type 1 (WPV1) were reported in the past week, in Nawzad district of Hilmand province, with onset of paralysis on 23 January. The total number of WPV1 cases for 2016 remains 2, compared to 1 reported for 2015 at this point last year.

No new WPV1 environmental positive samples were reported in the past week. The most recent environmental positive samples were collected on 27 December 2015 - one in Jalalabad in Nangarhar province and the second in the city of Kabul.

Sub-National Immunization Days (SNIDs) are planned from 19 to 22 April, prior to the switch. Read more about the switch here.

Pakistan

One new wild poliovirus type 1 (WPV1) case was reported in the last week, in Shikarpur district of Sindh province, with onset of paralysis on 5 March. The total number of WPV1 cases for 2016 is now 7, compared to 20 reported at the same date last year.

One new WPV1 environmental positive sample was reported in the past week, in Peshawar district with collection date on 2 March.

Sub-National Immunization Days (NIDs) are planned in April using bOPV.

Lao People's Democratic Republic

No new cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) were reported in the past week. The most recent case was reported in Fuang district of Vientiane province, with onset of paralysis on 11 January 2016. The total number of cVDPV1 cases in 2015 remains 8 and in 2016 remains 3.

Outbreaks of cVDPVs can arise in areas with low population immunity, emphasizing the importance of maintaining strong vaccination coverage. Learn more about VDPVs.

An emergency outbreak response is continuing in the country, with particular focus on three high-risk provinces.

Efforts continue to further strengthen surveillance activities in all provinces of the country, to ensure that no cVPDV1 transmission is missed anywhere.

Madagascar

No new cases of circulating vaccine-derived poliovirus type 1 (cVDPV1) were reported in the past week. The most recent case had onset of paralysis on 22 August from Sud-Ouest region. The total number of cVDPV1 cases for 2015 remains 10.

The 2015 cases are genetically linked to the case with onset of paralysis in September 2014, indicating prolonged and widespread circulation of the virus. Learn more about vaccine derived polioviruses here.

The emergency outbreak response continues to be intensified. National Immunization Days (NIDs) are planned from 14 to 18 March and 11 to 15 April using tOPV.

Myanmar

No new cases of circulating vaccine-derived poliovirus type 2 (cVDPV2) have been reported in the past week. The most recent case was isolated from a 16-month old child in Maungdaw, Rakhine, with onset of paralysis on 05 October. The total number of cVDPV2 cases in 2015 remains 2.

The case was genetically linked to a VDPV isolated in the same township in April 2015, which has now been reclassified as a cVDPV type 2. The genetic changes in the isolate suggest the cVDPV2 has been circulating for more than a year. Learn more about vaccine derived polioviruses here.

Significant immunization gaps remain in Myanmar, with an estimated 24% of children un- or under-immunized (source: WHO-UNICEF best estimates, 8 January 2016). Vaccination coverage remains particularly low among special at-risk populations. AFP surveillance quality indicators are acceptable at the national level, but subnational gaps persist.

While WHO assesses the risk of international spread from Myanmar to be low, surveillance and immunization activities are being strengthened in neighbouring countries.

Nigeria

No new wild poliovirus type 1 (WPV1) cases were reported in the past week. No cases were reported in 2015. The most recent case had onset of paralysis on 24 July 2014 in Sumaila Local Government Area (LGA), southern Kano state.

No new cases of type 2 circulating vaccine-derived poliovirus (cVDPV2) were reported in the past week. The most recent case had onset of paralysis in Kwali Local Government Area (LGA), Federal Capital Territory (FCT) Abuja, with onset of paralysis on 16 May 2015; this is the only cVDPV2 case reported in Nigeria in 2015.

Vigilance must be maintained to ensure that all children are reached with polio vaccines and that surveillance systems remains alert to polioviruses.

Sub-National Immunization Days (NIDs) are planned from 14 to 17 May using bivalent oral polio vaccine (bOPV).

Ukraine

No new circulating vaccine-derived poliovirus type 1 (cVDPV1) cases have been reported in the past week. The most recent case had onset of paralysis on 7 July 2015 in the Zakarpatskaya oblast, in south-western Ukraine, bordering Romania, Hungary, Slovakia and Poland. The number of cVDPV1 cases reported in 2015 remains 2.

Ukraine had been at particular risk of emergence of a cVDPV, due to very low vaccination coverage. Learn more about vaccine derived polioviruses here.

West Africa

No new circulating vaccine-derived poliovirus type 2 (cVDPV2) cases were reported from Guinea in the past week. The most recent was reported from Kankan district, with onset of paralysis on 14 December. The total number of cVDPV2 cases for 2015 remains 7. The 2015 cases are genetically linked to the case with onset in August 2014.

National Immunization Days (NIDs) will be carried out in Benin, Burkina Faso, Liberia, Mali, Mauritania, Sierra Leone, Guinea, Cote d’Ivoire and Niger at the start of April. All campaigns are using trivalent oral polio vaccine (tOPV).

• See more at: http://www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx#sthash.8MvcqTDa.dpuf

L'essentiel

• Détérioration continue de la situation alimentaire des populations déplacées dans le bassin du lac Tchad.

• Augmentation du nombre de populations déplacées au Nigeria et au Mali.

• Poursuite des activités de cultures de décrue et de contre-saison dans la majeure partie des zones de la région.

• Les approvisionnements en céréales sont jugés globalement satisfaisants dans la région.

Les activités agricoles de décrue et de contre-saison permettront de générer des revenus pour les ménages pratiquant ces modes de production. La situation pastorale reste dans l’ensemble assez bonne malgré le début de la dégradation des conditions d’abreuvement au niveau des points d’eau et du tapis herbacé.

Dans le bassin du lac Tchad, la situation alimentaire des populations sur les sites des sous-préfectures de Liwa et Daboua (Tchad) est préoccupante. Les déplacés ont perdu une grande partie de leurs ressources, car ils ont dû abandonner leur champs, bétail ou matériel de pêche durant leur fuite. Les communautés d’accueil sont également en situation de vulnérabilité partageant leurs stocks de nourriture (issus de la pêche, agriculture ou élevage), et parfois leurs terres avec les déplacés. De plus, les prix des denrées sur le marché ont augmenté avec l’arrivée des déplacés.

Les résultats des missions conjointes d’évaluation des marchés conduites au mois de février 2016 montrent que les niveaux d’approvisionnement en céréales sont jugés globalement satisfaisants dans tous les bassins de la région et se sont améliorés par rapport à l’année dernière. Les prix des céréales ont en général baissé en particulier le maïs tandis que ceux des autres produits vivriers ont fluctué différemment suivant les types de produits ou suivant les pays. La demande est en général en baisse par rapport à l’année précédente et aussi par rapport à son niveau habituel. La disponibilité actuelle au niveau des ménages et des commerçants laisse présager un approvisionnement régulier et constant jusqu’à la période de soudure. Cependant, avec la réduction progressive des stocks des ménages, la demande sera plus importante sur les marchés à partir du mois d’avril sans pour autant perturber le fonctionnement des marchés.

Dans les trois pays affectés par Ebola, il y a eu une réelle relance et l’approvisionnement des marchés est en nette amélioration par rapport à la période d’Ebola, mais l’animation des marchés reste encore faible par rapport à la période pré-crise.

HIGHLIGHTS

• Following the January event in Tonkolili, the WHO declared the end of the outbreak in Sierra Leone on 17 March 2016. However, cases in neighbouring Guinea and Liberia are again a testament that flare-ups are likely to occur; hence the need for the country to remain on high alert and ready to respond. Enhanced surveillance and sustained social mobilization efforts are therefore key over the next few months. In this context, UNICEF as pillar lead is supporting the government on its 10-24 months recovery plan to build on the lessons learned during the epidemic and better prepare the country to respond to health emergencies.

• In response to the EVD flare-up in Guinea, Child Protection, WASH and social mobilization pillars in Kailahun district have been re-activated and put on alert. Essential stocks of Infection Prevention and Control supplies have been prepositioned in Kenema and two Community Care Centre kits deployed to Kailahun.

• In Kambia, social mobilization efforts were sustained through the continued deployment of nine integrated surveillance and social mobilization teams and 77 dedicated section and chiefdom level mobilizers.

• A secondary negative impact of the EVD epidemic in Sierra Leone is a more severe measles outbreak than otherwise likely, due to decreased measles vaccination coverage and virtually non-functional Vaccine Preventable Diseases (VPD) surveillance systems during Ebola outbreak. UNICEF continues to support the response to the Measles outbreak.

SITUATION IN NUMBERS

As of 30 March 2016

8,706 Confirmed cases of Ebola

3,590 Confirmed deaths from Ebola

1,459 Confirmed cases of infected children under age 18 registered by MSWGCA

8,624 Registered children who lost one or both parents due to Ebola

UNICEF funding needs to March 2016 USD 5 million

In this issue - 181: A review of the role of training in WHO Ebola emergency response - 186: Yellow fever urban outbreak in Angola and the risk of extension - 192: Monthly report on dracunculiasis cases, January–February 2016

Dans ce numéro - 181: Examen du rôle des formations dispensées dans le cadre de la réponse de l’OMS à la crise Ebola - 186: Flambée urbaine de fièvre jaune en Angola et risque d’extension - 192: Rapport mensuel des cas de dracunculose, janvier-février 2016

• The third Outbreak Response Assessment in Madagascar found that the surveillance system is not yet strong enough to conclude that polio transmission has been interrupted. Thirty-nine high-risk districts have been identified to receive focused attention.

• There is one week to go until the globally synchronized switch from the trivalent to bivalent oral polio vaccine, the first stage of objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018. Learn more about preparations for the switch here. Learn more about the rationale for the switch through this series of videos.

Key Points

• Continued deterioration of the food situation of displaced populations in the Lake Chad basin.

• Increased number of displaced people in Nigeria and Mali.

• Continuation of the recession and off-season crops activities in most areas of the region.

• Cereal supplies are deemed generally satisfactory in the region.

Recession and off-season agricultural activities will generate income for households practicing these modes of production. The pastoral situation remains generally favorable despite the beginning of the deterioration of water levels and reduced grass cover.

In the Lake Chad Basin, the food situation of the population in the sub-prefectures of Liwa and Daboua (Chad) is concerning. The displaced have lost much of their resources because they were forced to abandon their farms, livestock and fishing equipment when fleeing. Host communities are also vulnerable, sharing their food stocks (from fishing, agriculture or livestock), and sometimes their land with the displaced. Moreover, the price of commodities in the market have increased with the arrival of the displaced.

The results of the joint assessment of markets conducted in the month of February 2016 show that the grain supply levels are deemed generally satisfactory in all basins of the region and have improved compared to last year.

Grain prices have generally fallen, particularly corn, while other food products have fluctuated differently depending on the product or the country. Demand is still low compared to the previous years. The current availability at the household and trader levels suggest a regular and constant supply until the lean season.

However, with the gradual reduction of household stocks, demand will be higher in markets from April, though this will not disrupt the functioning of markets.

In the three Ebola-affected countries, market supply has improved compared to the Ebola period, but the market activity is still low compared to the pre – crisis period.

(MissionNewswire) 

Salesian missionaries are assisting the small village of Kumbrabai, 100 kilometers from the capital city of Freetown in Sierra Leone, which has been severely impacted by the Ebola virus. The village once had 270 residents but 82 villagers succumbed to Ebola and 65 more who were infected fled the village. Entire families were lost and some are left with only one member. Those who remained in the village were shunned by their own people who were afraid to enter homes where someone had died. The community was stigmatized and isolated by other villages out of fear.

Real concerns remain about how the village with so few members will survive. When the village had 270 residents, it was already a challenge to sustain the community working together under challenging weather conditions, frequent water shortages and other threats to growing crops and raising animals. Recently, there has been growing concern about how to work the fields to gather enough to eat with so few people as well as concern about prevention methods to stop another Ebola outbreak.

Having first visited Kumbrabai during the Ebola outbreak to distribute food, water and other aid, Salesian missionaries are now bringing hope to the village by starting projects to improve residents’ health, hygiene and sanitation practices and enhance agricultural capacity for the long-term sustainability of the community.

“Salesian missionaries in the region developed a fondness for the people of Kumbrabai as they helped them cope with the effects of the Ebola epidemic,” says Father Mark Hyde, executive director of Salesian Missions, the U.S. development arm of the Salesians of Don Bosco “From the start, they resolved to support concrete, sustainable projects that could help villagers become more self-sufficient and hopeful for the future. The first project, a newly installed water well, is just one small step toward that overall vision.”

Kumbrabai is only accessible via poorly constructed country roads and is surrounded by dense vegetation that during the rainy season turns into soggy marshland. Villagers used a small swamp of dirty water for drinking, washing, watering their animals and even as a toilet. The new water well will provide safe drinking water and water for agriculture as well as opportunities for people to learn healthy habits like hand washing, that can help protect against many diseases. Before the well, nearly two-thirds of Kumbrabai’s crops were lost to weather conditions, including drought, annually.

The new water well is the result of a renewed focus on clean water initiatives by Salesian Missions. According to Water.org, more than 750 million people do not have access to clean water and almost 2.5 billion do not have access to adequate sanitation. The lack of clean water causes more than 3.4 million deaths each year from water, sanitation and hygiene-related causes.

In response to this crisis, Salesian Missions has made building wells and supplying fresh, clean water a top priority for every community in every country in which Salesian missionaries work.

Looking ahead, missionaries plan to further expand agricultural expertise among the villagers of Kumbrabai by teaching new farming techniques and animal management practices and distributing seeds. And, they intend to create a local school where children can, for the very first time, begin their primary education.

Sources:

Salesian Missions- In Sierra Leone, a Village is Reborn

Water.org

4th April 2016 - Governance issues exposed during the Ebola response came under the spotlight at a high-level discussion at the African Union Commission (AUC) in Addis Ababa, Ethiopia today.

Hosted by the AUC’s Department of Social Affairs, the Roundtable on Governance Issues in the Multi-Stakeholder Responses to the Ebola Virus Disease (EVD) in West Africa brought together key national, regional and continental stakeholders to share good practices and lessons learnt in the Ebola response, to inform appropriate government structures needed for sustainable and resilient health systems.

“There is no doubt that governance issues had a significant impact on the fight against EVD,” said AU Commissioner of Social Affairs Dr Mustapha Sidiki Kaloko. “For example, why did the health workers in the affected countries initially have difficulties in mobilizing an immediate and adequate response to the EVD?”

Commissioner Kaloko noted other governance-related issues observed during the epidemic, including, in some instances, accountability of the state, effective consultation, erosion of trust and social contract between state and society; participation and engagement of citizens in state public affairs; access to and effective delivery of public services, amongst other challenges.

The roundtable was convened in partnership with the Institute for Peace and Security Studies, Addis Ababa University; the African Peace Building Network Program of the Social Science Research Council; the Oxfam International Liaison Office with the AU; and the United Nations Development Programme (UNDP).

Commissioner Kaloko also highlighted the extraordinary efforts of member states and the African private sector in their support to the African Union’s efforts toward fighting Ebola.

“The continental response to the Ebola epidemic included high-level advocacy, mobilization of financial resources and the deployment of health workers and other personnel to the affected countries by member states and the private sector. The African Union support to Ebola Outbreak in West Africa (ASEOWA) mission deployed 855 volunteers between September 2014 and February 2015,” Dr Kaloko said.

The roundtable participants engaged in frank exchanges on the lessons learned; what accounted for the varied responses to Ebola by various stakeholders; the remedial or containment measures that should be in place as well as their availability; and what lessons can be learnt from the Ebola response about existing early warning systems and early actions.

Participants also discussed the appropriate government structure and systems required to establish sustainable and resilient health systems to shocks, and that would ensure that the current arrangements do not collapse in times of national emergencies.

Having recently declared that all known chains of transmission have been stopped in West Africa, the World Health Organization (WHO) warned that more flare-ups were expected and that sustained monitoring and response systems would be critical. The most recent case of Ebola was reported on 1 April in Liberia.

Contact Information In Addis Ababa: Sandra Macharia, Communications, Advisor, sandra.macharia@undp.org

Freetown, Sierra Leone | AFP | dimanche 10/04/2016 - 15:29 GMT

Seule la vigilance, mais pas la fermeture des frontières, permettra d'empêcher la propagation d'Ebola, a affirmé dimanche le ministre sierra-léonais de la Santé, alors que l'OMS vient d'établir que les nouveaux cas en Guinée et au Liberia voisins sont directement liés.

Une femme est décédée d'Ebola le 31 mars à Monrovia, la capitale libérienne, après avoir franchi la frontière guinéenne avec ses enfants pendant les quelques jours où celle-ci a été fermée après l'annonce le 17 mars de la réapparition du virus en Guinée, où l'épidémie avait été déclarée finie le 29 décembre.

Cette femme et ses trois enfants, dont deux, âgés de 5 et 2 ans, ont été depuis testés positifs au virus, étaient la famille d'un homme décédé d'Ebola le 21 mars dans la préfecture de Macenta, dans le sud de la Guinée, a révélé en fin de semaine l'Organisation mondiale de la Santé (OMS).

"La fermeture des frontières entre les trois pays n'est pas la bonne réponse à la menace d'Ebola", a déclaré dimanche à l'AFP le ministre sierra-léonais de la Santé Abubakarr Fofanah, de retour d'une tournée d'inspection avec des responsables sanitaires à la frontière avec la Guinée.

"Nous avons constaté que tout était en place et nous maintenons une surveillance sanitaire constante sur l'entrée et la sortie de véhicules et de piétons sur notre territoire", a assuré le ministre, appelant les populations frontalières à la vigilance.

Selon un communiqué de l'OMS daté de jeudi, des équipes de l'organisation et des ministères de la Santé guinéen et libérien "ont établi des liens épidémiologiques entre les nouveaux cas d'Ebola au Liberia et un épisode en cours en Guinée".

D'après les premiers résultats de l'enquête sur l'origine de ces cas et leurs "contacts", notamment ceux de l'homme décédé à Macenta, "la femme serait partie pour le Liberia avec ses trois enfants après la mort de son mari pour rejoindre des parents vivant à Monrovia, la capitale. C'est là qu'elle est présumée avoir développé les symptômes".

Une centaine de "contacts", personnes identifiées comme exposées à une contamination lors de contacts avec les cas enregistrés au Liberia, ont été placés sous surveillance médicale et doivent être vaccinés pour prévenir la propagation du virus, comme cela a déjà été le cas en Guinée pour quelque 1.400 autres, a indiqué l'OMS.

Parmi elles figurent "15 personnels de santé qui ont été en contact avec la première victime", la femme décédée, a précisé à l'AFP George Sorbor, un porte-parole du ministère libérien de la Santé.

Les nouveaux cas en Guinée - neuf, dont huit morts, selon le dernier bilan - ont été découverts à Koropara (sud), près de la frontière avec le Liberia, après le décès le 27 février d'une femme qui a commencé à présenter des symptômes vers le 15 février, selon l'OMS.

rmj-zd-sst/dom

© 1994-2016 Agence France-Presse

Freetown, Sierra Leone | AFP | Sunday 4/10/2016 - 16:31 GMT

Sierra Leone called Sunday for increased vigilance to prevent a resurgence of the Ebola virus after new cases in neighbouring Liberia and Guinea, but cautioned against shutting off borders between the west African states.

The alert came after the World Health Organization (WHO) confirmed a link between a fatality in Liberia, months after it was declared Ebola-free, and new cases in its neighbour Guinea.

A woman died of Ebola in the Liberian capital Monrovia on March 31, after arriving from Guinea, where a fresh Ebola outbreak has killed eight of the nine cases registered since mid-March.

Two of her three children, aged five and two, have since tested positive for the virus.

Liberian Health Minister Abu Bakarr Fofanah told AFP Sunday that closure of the borders between the three countries "is not the right answer to the existing Ebola threats".

"Our findings were that everything was in place and we are keeping a constant health watch on both pedestrian and vehicular traffic entering and leaving," he said after returning from a visit to the Guinea border.

The WHO said on Thursday it had "established epidemiological links between new Ebola cases in Liberia and a current flare-up of Ebola in neighbouring Guinea following intensified case investigations and contact tracing".

Liberia was the country worst hit by the outbreak of the disease which has claimed 11,300 lives since December 2013, the vast majority in Liberia, Guinea and Sierra Leone.

burs/mt/txw

© 1994-2016 Agence France-Presse

After 16 months supporting the fight against Ebola, the ETC operation has come to a close.

In July 2014, this sign was posted on the wall of a Monrovia radio station, advising people not to shake hands. It was known then that the virus was around and that human-to-human contact needed to be reduced, but the full impact of the deadly Ebola outbreak in West Africa was completely unprecedented.

Since the initial outbreak in March 2014, 28,603 cases of Ebola were reported across Guinea, Liberia, and Sierra Leone. Shockingly, more than 40% of those cases proved fatal*. In July 2014, this sign was posted on the wall of a Monrovia radio station, advising people not to shake hands. It was known then that the virus was around and that human-to-human contact needed to be reduced, but the full impact of the deadly Ebola outbreak in West Africa was completely unprecedented.

Although the World Health Organization (WHO) has not yet declared the end of the epidemic, the number of new confirmed cases of Ebola has significantly decreased and health care facilities are closing. After 16 months, the Emergency Telecommunications Cluster (ETC) was able to demobilise services in West Africa at the end of January 2016, handing service provision back to local, commercial providers.

The Ebola operation brought a number of ‘firsts’ for the ETC which has since influenced the cluster’s strategic direction. The West Africa Ebola response was considered one operation, but spread across three countries; each with its own government-lead approach; one with a different language to the others (Guinea); and then managed from a fourth country (Ghana). Voice and internet connectivity were required far beyond common operating areas, down to tens of community level centres – never before has the ETC provided services to so many sites, in one operation. The ETC even had to take on the acronym ‘ET Cluster’ for the duration of the operation so as not to be confused with ‘Ebola Treatment Centre’!

The West Africa response was also the first large-scale health emergency and the first time a dedicated UN body was established for a non-conflict emergency, the UN Mission for Ebola Emergency Response (UNMEER).

For the ETC responders on the ground, what made this emergency so extraordinary was that they were working almost alongside health workers. All responders, whether treating patients or setting up internet connectivity, risked exposure to the deadly virus on daily basis.

"It's more a personal challenge rather than a technical challenge to set-up equipment in facilities like a treatment unit,” said Martin Falebrand from Ericsson Response, deployed as part of the ETC response team to Sierra Leone. “It's a very special feeling to go into an Ebola Treatment Unit (ETU). You smell all the chlorine and you see the doctors working in the ‘red zone'. You are close enough to actually look across into the red zone of an ETU and see the people that are being treated inside. It's not far away – it's very close to Ebola."

The success of the ETC Ebola operation, the ability to rapidly expand and adjust to meet the constantly changing needs, was only possible due to strong partnerships and collaboration across the ETC network. "In the effort to provide internet services to humanitarians and medical personnel across West Africa, the role of partnerships cannot be overestimated," said Mark Phillips, ETC Emergency Coordinator for Sierra Leone. "From equipment to expertise, collaboration and contribution from our partners are what has allowed us to support so many medical facilities with essential services.”

From August 2014 to December 2015, the ETC network of partners provided vital communications services to over 3,000 responders at 91 sites across the three affected countries.

The ETC was not officially activated in West Africa, however UNMEER mandated WFP, as global lead of the ETC, to respond as if the Cluster was activated.

User of ETC services included: Ebola Treatment Units and Community Care Centres for treating patients; National and District Ebola Response Centres, responsible for coordination, case management, surveillance, safe burials and social mobilisation; Logistics bases where equipment ranging from medical protective equipment to electricity generators were warehoused; and offices and accommodations of various UN agencies and NGOs responding to the Ebola Outbreak.

A lesson learnt from this operation is the importance of a timely and reliable data transmission in public health emergencies. With internet connectivity provided to medical facilities, data transfer took minutes, instead of hours or even days. Whereas before information was often sent by text messages or communicated personally, access to internet enabled quick transmission of data from red to green zones of the ETU, but also from the ETUs in West Africa to medical research institutes worldwide.

The situation is stable now, but Ebola is far being gone from West Africa – the virus still takes it tolls in economic, as well as mental health terms, as many touched by Ebola are struggling to return to normal life. It will no doubt take many years for the countries to recover.

On behalf of the ETC, a smile, a nod, and an enormous thank-you to all the organisations which supported the response. All the best to the development organisations there supporting countries on the road to recovery.

By Katarzyna Chojnacka and Mariko Hall, Global ETC cell

By Indrias G. Kassaye

In Sierra Leone, nearly one third of children under the age of 5 are chronically malnourished. One community is using mothers’ support groups to address child malnutrition.

ROGBONKO, Sierra Leone, 13 April 2016 – It’s eight o’clock on a Saturday morning, and the Rogbonko village centre fills with cheerful song and laughter as women gather around a simple picture book. This is the weekly meeting of the Rogbonko mothers’ support group, where pregnant women, breastfeeding mothers, and mothers with young children from the community come together to learn about nutrition.

“We are here to talk about how we should take care of our children in the best way so that the children can grow up well,” says Rugiatu Kamara, chairwoman of the group.

The danger of child malnutrition

Sierra Leone has one of the highest rates of child mortality in the world with more than 120 children per thousand dying before they reach their fifth birthdays. Poverty and a lack of food can play a part, but most of these deaths are preventable with simple interventions such as proper nutrition. Worldwide, malnutrition is an underlying factor in close to half of under-five deaths, and in Sierra Leone, nearly one third of children under the age of 5 are chronically malnourished.

“The main reason for malnutrition in the community is because some people do not know what kind of food they should give to their children - when and how, and the frequency with which they should be fed,” said Fatou Tarawalie, a nutritionist with the NGO World Hope International (WHI). With UNICEF’ support, WHI is managing the mothers’ support group nutrition programme in the Bombali District.

Colourful solutions

One of the greatest challenges in eliminating malnutrition is disseminating life-saving knowledge in a simple way that can be used in communities throughout Sierra Leone, which has a literacy rate of just 48 per cent for the over-15 population.

To help solve this problem, UNICEF developed an illustrated book, which Rugiatu now uses to lead discussions on nutrition and feeding practices. The picture-filled pages contain information on maternal, infant and child feeding, including what pregnant women, babies and young children should be eating, how often, and in what quantities to ensure optimal health.

After a general discussion with the entire group, Rugiatu makes her way around the circle to check the nutritional status of children aged 6 months to 5 years old. For this assessment, she uses the colour-coded Mid-Upper Arm Circumference (MUAC) tape, which helps to identify if children are malnourished and the level of severity. Green indicates healthy, yellow suggests moderate acute malnutrition (MAM), and red signals severe acute malnutrition (SAM) – a condition that can be deadly if left untreated.

“When I use the MUAC tape and the child falls under the yellow, I will tell the mother that her child is at risk of falling sick and that she should pay attention to what she is feeding the child,” said Rugiatu. “If it is red, it indicates that the child is sick and I will tell the mother to take her child to the hospital.”

On this particular Saturday, all the children have green MUAC readings, except 15-month-old Morlay, whose MUAC measurement is yellow.

Rugiatu explains to Morlay’s mother, Kayima Kaloko, what the yellow MUAC reading means, and proceeds to counsel her on how she should be feeding her child using the nutrition picture pages for children aged 12 to 24 months. The illustrations indicate that she should be complementing breastfeeding with a good mix of fruits, vegetables and cereals. The book also explains how frequently she should be feeding Morlay, and the importance of maintaining good hygiene practices when preparing the food and during feeding.

Kayima promises to follow the advice. “The first thing I will do when I get home is find the right food for my son to eat,” she said.

After finishing with Kayima, Rugiatu turns to the pregnant women in the circle. Using the picture cards depicting optimal feeding during pregnancy and breastfeeding, they discuss the importance of eating properly for the health of both baby and mother.

A bright future

“I am happy because at least now people in the community know what to do,” said Fatou, the WHI nutritionist. “Normally, the rate of malnutrition is high, but with the help of the mothers’ support groups, it is now decreasing.”

Fatou explained how before, when their children were sick, many women would just leave them at home. Now they are referred to the Peripheral Health Unit where there is an Outpatient Therapeutic Program (OTP) and they can get life-saving treatment for severe acute malnutrition. Every Friday, severely acutely malnourished children enrolled at the OTP centres are given UNICEF-supplied Ready-to-Use Therapeutic Food (RUTF). With successful treatment they can be healthy again in 6-8 weeks’ time.

And the mothers’ support groups are helping to improve health in other ways. Following the devastating Ebola outbreak in Sierra Leone, many people were fearful of approaching health clinics. Through their weekly meetings and counselling sessions, mothers’ support groups are rebuilding confidence and encouraging the use of government health facilities.

These low-tech interventions – mothers’ clubs, picture books and colour-coded tape – are leading the battle in these communities against childhood killers like malaria, pneumonia, measles and diarrhoea. By sharing the best advice and catching malnutrition in its early stages, communities have the tools they need to reduce Sierra Leone’s tragic rates of child mortality.

Conakry, Guinea | AFP | Thursday 4/14/2016 - 15:26 GMT

A dedicated Ebola clinic was treating Guinea's only known case of the virus on Thursday after the recovery of a girl diagnosed with the disease, the charity running the facility said.

The Alliance For International Medical Action (ALIMA) runs the country's sole treatment centre in the southern city of Nzerekore, where it has handled six of the 10 confirmed cases recorded since the outbreak was officially declared over in December.

"(Of) six confirmed cases, four have died, one was discharged after recovery and the sixth is still here," said ALIMA emergency co-ordinator Solenne Barbe.

Barbe attributed the high mortality rate to the fact that the recent patients arrived too late to be treated with a good chance of survival.

The newest confirmed case is an elderly man from Macenta prefecture to the north of Nzerekore, she said, thought to be a healer visited by one of the dead while still alive and infected with the virus.

According to health authorities, that deceased man's wife and her children crossed the border into Liberia before she too succumbed to the virus. One son also died while another remains under treatment in Monrovia.

In a rare piece of good news since Ebola's reappearance, an 11-year-old girl left the centre on April 8 after a successful recovery, according to ALIMA.

The World Health Organization was first alerted to the reappearance of Ebola symptoms in a Guinean village near the Liberian border on March 16, the same day it declared a similar flare-up over in Sierra Leone.

Since then eight people have died, all in the same area, while the country's Ebola response unit confirmed Thursday that more than 1,700 people have been vaccinated against the virus.

The WHO has said Ebola no longer constitutes an international emergency, but the announcement of new cases in west Africa has demonstrated the difficulty of managing its aftermath.

The deadliest period in the history of the feared tropical virus wrecked the economies and health systems of the three worst-hit west African nations -- Sierra Leone, Guinea and Liberia -- after it emerged in December 2013.

The virus has since claimed 11,300 lives.

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Conakry, Guinée | AFP | jeudi 14/04/2016 - 14:50 GMT

L'unique centre de traitement d'Ebola (CTE) en activité en Guinée comptait jeudi un cas confirmé, après la guérison d'une fillette et le décès de tous les autres patients, a indiqué à l'AFP l'ONG Alima, qui gère ce centre.

Au total, plus de 1.700 "contacts", personnes identifiées comme susceptibles d'avoir été contaminées lors de contacts avec les malades, ont été vaccinés, a-t-on appris par ailleurs auprès de la Coordination nationale de lutte contre Ebola.

"Nous avons vacciné plus de 1.700 contacts et contacts des contacts", a affirmé à l'AFP un porte-parole de la Coordination, Ibrahima Sylla, citant un "taux de suivi des contacts de 310 sur 355, soit de 87%".

Le CTE de N'Zérékoré, la grande ville du sud de la Guinée, rouvert en urgence après l'annonce officielle le 17 mars de la résurgence d'Ebola, n'accueillait jeudi qu'un vieil homme, venu de la préfecture de Macenta, plus au nord, a précisé à l'AFP Solenne Barbe, coordinatrice d'urgence d'Alima (The Alliance For International Medical Action).

Depuis la réouverture du centre, l'établissement a reçu "six cas confirmés, dont quatre décès, et un sorti guéri et le sixième est encore sur place", a-t-elle détaillé, attribuant la forte mortalité au fait que "les malades arrivent trop tard" pour survivre.

Le patient guéri est une fillette de 11 ans qui a quitté le CTE le 8 avril, selon l'ONG.

Ce dernier bilan porte à dix, dont huit décès, le nombre de cas d'Ebola enregistrés depuis le début de la résurgence en Guinée, où l'épidémie avait été déclarée finie le 29 décembre.

Trois autres cas, une femme et deux de ses enfants, ont été signalés au Liberia voisin. L'enquête a permis d'établir "des liens épidémiologiques entre les nouveaux cas d'Ebola au Liberia et un épisode en cours en Guinée", a annoncé la semaine dernière l'Organisation mondiale de la Santé (OMS).

Cette femme et ses enfants étaient la famille d'un homme décédé d'Ebola le 21 mars dans la préfecture de Macenta, où il avait fui pour consulter des guérisseurs, dont l'un est le patient admis au CTE de N'Zérékoré, selon les autorités sanitaires.

Les nouveaux cas en Guinée ont été découverts à Koropara (sud), près de la frontière avec le Liberia, après le décès le 27 février d'une femme qui a commencé à présenter des symptômes vers le 15 février, selon l'OMS.

Partie en décembre 2013 de Guinée forestière (sud), l'épidémie d'Ebola en Afrique de l'Ouest a fait officiellement plus de 11.300 morts sur quelque 28.000 cas recensés, à plus de 99% en Guinée, au Liberia et en Sierra Leone.

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• The World Health Assembly (WHA) Report on Poliomyelitis has been published. The report summarises the status against the Polio Endgame Plan and Resolution WHA68.3, adopted by the WHA in May 2015.

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• The globally synchronized switch from the trivalent to bivalent oral polio vaccine, the first stage of objective 2 of the Polio Eradication and Endgame Strategic Plan 2013-2018 will start on 17 April 2016. Learn more about preparations for the switch here. Learn more about the rationale for the switch through this series of videos.

By Justice Lucy Asuagbor, Commissioner, Special Rapporteur on the Rights of Women in Africa

THE MAPUTO PROTOCOL

The Maputo Protocol guaranteeing comprehensive rights to women was adopted by the AU on 11 July 2003, in Maputo, Mozambique. Following its adoption, AU Member States in the Solemn Declaration on Gender Equality in Africa adopted in July 2004, undertook to sign and ratify the Maputo Protocol by the end of 2004, support the launching of the public campaign aimed at ensuring its entry into force by 2005, and to usher in an era of domestication and implementation of the Protocol, as well as, other national, regional and international instruments on gender equality by all States Parties. In the AU Gender Policy, Member States undertook to achieve full ratification and enforcement of the Maputo Protocol by 2015 and its domestication by 2020.

As of October 2015 however, out of the 54 Member States of the AU, only 37 countries have ratified the Maputo Protocol; Sierra Leone being the last country to have ratified on 30 October 2015. Prior to this ratification the last ratification was that of Cameroon on 13 September 2012. A 3 years gap. 17 countries have not yet ratified the Protocol and these are Algeria, Botswana, Burundi, Central African Republic, Chad, Egypt, Eritrea, Ethiopia, Madagascar, Mauritius, Niger, Sahrawi Arab Democratic Republic, Sao Tome and Principe, Somalia, South Sudan, Sudan and Tunisia.

The President of Sierra Leone on March 31, 2016 formally launched the Provisional Results of the Sierra Leone 2015 Population and Housing Census at the Miatta Conference Hall, Youyi Building, Freetown. President Ernest Bai Koroma said Sierra Leone has come a long way in this journey, in providing the baseline data that will continue to serve as a reference point for the country’s development planning. He described the launch of the provisional results as part of the process of publication and dissemination, and a continuation of a long journey in Sierra Leone’s development trajectories.

‘By all indications, the 2015 Census has been the most comprehensive data collection exercise ever undertaken in our country’s history’, he said. President Koroma commended Statistics Sierra Leone for the hard work and the people of Sierra Leone for the overwhelming interest and extraordinary participation in the process. He applauded all international partners, including, UNFPA, UNDP, DFID, IRISH AID and UK AID for their overwhelming support and participation in the census process. The President said Government whole-heartedly accepts the provisional figures. ‘We believe that the figures give us an indication of the country’s development needs and challenges; we get a pointer to how far we have come, how many of our compatriots are being left behind, in what areas and what we should do to bridge the gaps in order to bring many more on board our unstoppable journey to prosperity’. Making his remarks at the ceremony, the UNFPA Officer-in-Charge, Dr Sennen Hounton expressed delight to be part of the event, as UNFPA has been working closely with SSL and other partners, notably DFID, Irish Aid and UNDP to ensure a very credible and acceptable census outcome. Dr Hounton seized the opportunity to congratulate the President and the Government and People of Sierra Leone and all stakeholders, including development partners, for what he described as a ‘sustainable development investment’. ‘I stand here today as a proud African to participate in the first ever release of the census provisional results conducted during a major and unprecedented Ebola outbreak’, he said.

The process which has been given a pass by international monitors, was commended by the UN Resident Coordinator and other speakers. The results indicate an increase in the overall population by over 42%, with Western Area Urban standing out as the most highly populated administrative district, followed by Port Loko districts.

The data indicates that the population grew from 4,976,871 in 2004 to 7,075,641 in 2015, registering an average annual growth rate of 3.2 percent. Males represented 49.1% of the total population, females 50.9%.

The national census, conducted in December 2015, is the second post-war enumeration exercise conducted by the Government of Sierra Leone with financial and technical support from UNFPA and partners.

The final results of the census will be released in December.

An analysis based on actual persons registered in the UNHCR refugee database (proGres)