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Situation report 29

Disease surveillance continues to be strengthened. Virtually all areas throughout the region are endemic for dengue fever and malaria. With the rainy season now starting, particularly in Indonesia and Sri Lanka, a rise in cases can be expected at this time of year. As many governments shift focus from relief to rehabilitation, and as more people return to their villages, the top priorities are the provision of safe drinking water, proper disposal of excreta, prevention of waterborne and vector-borne diseases, psychosocial rehabilitation, and restoration of damaged infrastructure.

Summary

• No outbreaks have been reported
• Health coordination in Aceh remains an issue as there are over 50 NGOs providing services in the area.
• Providing support to countries to implement vector control strategies, including establishment of a proper drainage system and engineering methods, are key components of WHO's long-term strategy to rehabilitate the damaged or destroyed public health infrastructure.
• Psycho-social services remain a priority. Thailand reports that it has strengthened its services available and that more people are using them.

Health Priorities

Communicable Diseases

• Indonesia: WHO/Global Outbreak Alert & Response Network International team in Aceh is now receiving communicable disease surveillance reports from 18 agencies working in the field. As of Week 3 (ending 23 January 2005), 90 cases of malaria and 8 cases of measles were reported. Between 31 December 2004 and 25 January 2005, 91 cases of tetanus were hospitalized in Banda Aceh, Meulaboh and Sigli. No new tetanus admissions have been reported since 22 January. One laboratory confirmed dengue fever case was reported from Banda Aceh.
  The Ministry of Health reported that measles vaccination covered a total of 65,343 children as of 25 January 2005 in the tsunami-affected area (45.9% of the targeted population).Another measles vaccination campaign is scheduled to begin on 27 January in the entire district of Aceh Besar..
• Maldives: No outbreaks have been reported.
• Sri Lanka: No unusual cluster of communicable diseases has been reported. Currently, the WHO field office in Ampara has only traced approximately 50% of registered tuberculosis patients under treatment.
• Thailand: No outbreaks or epidemics have been reported.
  "To reduce the risk of dengue fever or malaria cases, WHO is strengthening its support to national authorities to implement effective vector-borne disease prevention and control activities. WHO is working with national authorities and international teams in the region to conduct entomological sampling, expand entomological surveillance in affected districts with local staff being trained on the job. WHO is also making accessible insecticide-treated bed-nets, vector control supplies, and equipment for larviciding and fogging with insecticides as a stopgap measure. In addition, health workers are starting to involve the community to clean up the Aedes mosquito breeding sites in the open water containers and debris around camps and homes."
  -- Dr Samlee Plianbangchang
  WHO Regional Director for South-East Asia Region.

Environmental Health (access to safe water and hygiene, sanitation situation)

• Indonesia: A joint WHO - UNICEF assessment of 50 priority Internally Displaced Person (IDP) camps in Banda Aceh revealed no immediate health issues. Access to clean water, sanitation and food is still a major problem. Large numbers of displaced people are constantly on the move.

Other health issues (Mother and child health, mental health)

• Maldives: Psycho-social programmes are needed to address a range of needs including those of relief workers. Training new counselors is needed to replace volunteers returning to their normal work.
• Thailand: WHO is supporting the Department of Mental Health in developing a programme of long term mental health programme in the most affected areas. A rehabilitation center will be set up in Khao Lak, Phangnga to provide people with psychosocial treatment and counseling for up to two years. The center will be staffed by psychiatrists and nurses from around the country working in rotation. The six affected provinces report an increase in mental health services delivered including psychiatric drugs, counselling sessions, physical treatement and referrals.

Health system and infrastructure (functioning health facilities, access)

• Indonesia: WHO’s work is underway in Meulaboh to establish a public health laboratory with the arrival of a lab specialist and much of the necessary equipment. More materials and staff are expected soon.
• Maldives: Tenders will soon be issued for the repair of health facilities that were destroyed and a list of needed equipment will be presented to potential donors. The Ministry of Health (MoH) has announced plans to distribute free essential medicines on a limited basis in affected areas.

MAP: Number of deaths in Sri Lanka

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Contributions/pledges to WHO for the Indian Ocean Tsunami response 25 January 2005

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