23juin2017

Cholera Platform

Against cholera

National strategies & plans

National strategies and plans - Sierra Leonne

Multi-sectoral multi-year cholera preparedness and response plan 2013 – 2017

Cholera epidemiological trends in Sierra Leone

According to Ministry of Health and Sanitation (MOHS), Cholera ranks among the five most important epidemic-prone diseases in Sierra Leone. Cholera cases have occurred regularly in particular communities in Sierra Leone. There is a serious threat of spread from such communities to other areas in the country.The prevailing strain is El-Tor which Sierra Leone experienced as its first epidemic in 1970. It was nationwide and met the country ill prepared leading to a fairly high attack rates and case fatality. Since then, the country has experienced three huge epidemics in 1985, 1994, 1995. There were several epidemics during the period 1998-2008 that caused major concern among public health authorities, healthcare workers, relief agencies and Non-Governmental Organizations (NGOs.) However, a significant reduction in case fatality rate from 8.6% in 1985 to 2.3% in 1995 was observed during these outbreaks (Table 4). Proper case management has contributed to low case fatality during the most recent outbreaks.Districts sharing international boundaries with Sierra Leone were at risk of contracting the disease during the 1998-2008 outbreaks

.Sierra Leone cholera outbreak in 2012

November 2011, the Ministry of Health and Sanitation, through the weekly surveillance reporting system noted an increase in number of diarrhoea and vomiting (D & V) cases. The MoHS did not have the capacity to conduct bacteriological analysis of faecal samples at that time. With support from WHO, samples collected were tested in Dakar Regional Laboratory and revealed the causative organism as E. coli.

In February 2012, the situation worsened and joint assessments were conducted by MoHS and WHO. Samples collected from Kambia, Port Loko and Pujehun confirmed Vibrio cholera 01 El-tor Ogawa. The Government of Sierra Leone then declared an outbreak of cholera on the 27 February 2012. With the onset of the rainy season further increase in the number of diarrhoea cases was reported in Western Area in week 25. Samples collected from Mabella Community Health Centre (CHC) in Western area were analysed at the Regional Laboratory in Ouagadougou and confirmed Vibrio cholera O1 Ogawa on 17 July 2012.

During the period July to August, the epidemic rapidly spread to eight other districts (Bo, Kenema, Tonkolili, Kono, Koinadugu, Bonthe, Moyamba and Bombali). As of 31 December 2012, 12 out of 13 districts were affected with a cumulative of 22, 971 cases and 299 deaths (CFR = 1.3%). Western Area which is the most populated district where the capital city is situated reported the highest (above 50%) number of cases.

Prior to the outbreak, MoHS established a National Taskforce on cholera in April 2011 (comprised of WHO, UNICEF, MSF and Urban WASH Consortium), which developed a preparedness and response plan. The activities of the Urban WASH Consortium were mainly concentrated in Western Urban Area during that time. Following the outbreak the MoHS led the response with the support of partners. This called for a concerted effort to address the epidemic and prevent its spread through effective coordination, surveillance, good case management, prevention, hygiene promotion, communication and social mobilization activities, as well as access to safe water. As the outbreak progressed, MoHS with support from partners developed intensified scale-up plans of interventions for the outbreak control. On 16 August 2012, the Government of Sierra Leone declared the cholera outbreak as a public health emergency and created a high level Multi-sectoral Taskforce. A Cholera Control and Command Centre (C4) was established on the 27 August 2012 to provide coordination and technical advice.

The magnitude of this epidemic and the limited resources resulted in many partners contributing to the response during the initial stages. The cholera lessons learnt and post epidemic evaluation was conducted to assess the response so as to identify the strengths, weaknesses and gaps that would guide the development of this multi-sectoral, multi-year cholera preparedness and response plan.