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AFRO-NETS> Central African Republic, Chad, Niger: Meningitis Epidemic Appeal
- Subject: AFRO-NETS> Central African Republic, Chad, Niger: Meningitis Epidemic Appeal
- From: Holly Ladd <Hladd@usa.healthnet.org>
- Date: Thu, 20 Apr 2000 14:39:38 -0400 (EDT)
Central African Republic, Chad, Niger: Meningitis Epidemic Appeal
THIS APPEAL SEEKS CHF 503,644 CASH AND KIND TO VACCINATE AND PROVIDE
TREATMENT FOR 615,000 BENEFICIARIES AGAINST MENINGITIS FOR 3 MONTHS
Cases of meningitis which have been occurring since mid December have
dramatically increased and the Central African Republic (CAR), Chad
and Niger are now tackling a full epidemic. An evaluation mission
carried out in March by a member of the Federation's Epidemics Sur-
veillance Team for West Africa confirms the need for urgent action on
the part of the National Societies and Federation in order to avoid
further loss of life. The Red Cross volunteer network is already
working in the affected communities, and will reinforce its action in
order to ensure a wider dissemination of messages to prevent the fur-
ther spread of meningitis. The Red Cross, as auxiliary to the govern-
ment authorities, is also called upon to assist with the provision of
vaccines which are desperately needed.
Since mid December 1999, cases of cerebro-spinal (meningococcal) men-
ingitis have been reported in Cameroon, Chad, the CAR and Niger, and
the number of victims are now increasing at an alarming rate. In Cam-
eroon, meningitis is recurrent in the northern regions, and the cur-
rent epidemic has particularly affected the north-west and south-west
areas of the country. Initial cases were seen in a remote region near
the border with Nigeria which explains the very high mortality rate
of 22 deaths, out of a total of 87 cases. Since a mass vaccination
campaign was undertaken by the Ministry of Health at the outset of
the dry season, funding for Cameroon is not requested in this Appeal.
In the CAR, the north-west and central areas of the country are the
most affected, but meningitis is also now present in numerous pockets
throughout the country. In the capital, Bangui, located towards the
south, many cases have been recorded, particularly among children.
With the arrival of rain in the south, the epidemic may be halted in
Bangui. Unfortunately, this will not be the case for the other areas
of the country which remain dry. In the CAR, as of 28th March there
had been 1,111 cases of the illness, resulting in 205 deaths (a mor-
tality rate of 18.4%). In Chad, the affected regions are in the
south-west of the country, with West Logone and East Logone the first
areas where cases were recorded. The epidemic then spread into Moyen
Chari and Mayo-Kebi. As of April 4th, 4,365 cases had been recorded,
resulting in 551 deaths (a mortality rate of 12.6%).
According to technicians from the Ministry of Health in Chad, the
CAR, and Cameroon, the official statistics represent a small percent-
age of actual cases. In remote villages, the illness is detected at a
much later stage. In fact, the villagers often do not recognise the
disease as such.
In Niger, outbreaks of meningitis occur on an annual basis. In 1995,
the illness resulted in 4,000 victims of a total of 42,000 offi-
cially-recorded cases. This year, as of 4 April, 2,815 cases of men-
ingitis have been recorded in Niger, which have lead to 250 deaths.
The epidemic has been particularly virulent in the capital, Niamey,
where, to date, 1,072 cases have occurred and 75 people have died (a
mortality rate of 8.8%). The epidemic is also taking its toll in the
regions of Birni N'Konni in the east near the border with Nigeria and
in T ?ra in the West, which is close to the border with Burkina-Faso.
Stocks of vaccines are diminishing rapidly since the government
launched a vaccination campaign in Niamey and in the other towns
which are affected by the epidemic.
The Response so far
In the CAR, the Ministry of Health has set up an epidemiological sur-
veillance cell which includes representatives of the Red Cross and
international governmental and non-governmental organisations. The
mandate of the surveillance cell is to draw up an intervention plan,
and to identify potential partners to assist in halting the spread of
the epidemic. Vaccination has already begun in certain areas, but the
health authorities are faced with shortages of vaccines. Data collec-
tion has also posed problems over the last two weeks. Two teams made
up of health agents from the Ministry of Health and the NGO MSF, un-
dertook an evaluation in the affected areas. As a result, the Red
Cross has been requested to be responsible for working in two of the
four most affected regions of the country (Ombella-Mpoko and Mamb?r?
Kade?). In Chad, the Ministry of Public Health has provided FCFA 19
million (CHF 47,400) in order to fight the epidemic. The Ministry is
working in close co-operation with the WHO, MSF and the Red Cross.
However, vaccination campaigns have not yet begun in certain areas
since the official threshold which calls for emergency action of 15
cases for 100,000 inhabitants has not yet been reached. In Niger, the
government has begun an emergency vaccination campaign.
Red Cross/Red Crescent Action
The Federation issued an Information Bulletin on 20 March to alert
donors and the international community of the severity of the situa-
tion, the Red Cross and Red Crescent action taken, and the planned
strategy. In the affected countries, Red Cross volunteers are at the
forefront of initiatives to halt the epidemic. Moreover, in the CAR
and in Chad, Red Cross volunteers were responsible for drawing the
authorities' attention to the outbreak of an epidemic. The CAR Red
Cross Society has been entrusted by the Ministry of Health with the
translation into local languages of messages addressed to the target
population. First aid trainers have also been requested to organise
refresher courses on meningitis. Red Cross branches relay information
gathered in the field by radio or other means on a regular basis. In
Chad, the Red Cross is committed to working in awareness-raising and
in mobilising the population to participate in the vaccination cam-
paign. In Niger, the Red Cross is working actively alongside the
health authorities in order to ensure that those suffering from men-
ingitis are offered appropriate treatment and to implement a vaccina-
tion campaign in the affected areas.
This meningitis programme and the African Red Cross Red Crescent
Health Initiative (ARCHI 2010) are mutually complementary. ARCHI is a
programme which reflects a strong commitment to improving the impact
on health by better focusing activities on real priorities as defined
by Ministries of Health and beneficiaries, using approaches that
build on the Red Cross/Red Crescent strengths while supporting poli-
cies and best practices that have been identified by major health ac-
Other Agencies? Action
In Chad, MSF has donated 500,000 doses of vaccine and is working in
West Logone to treat those with meningitis. MSF is also working in
the centre of the country as well as the CAR, undertaking vaccination
sessions in those villages where cases have been detected. In Chad,
the Central African Republic and in Niger, the WHO is working in
close collaboration with the Ministry of Health.
The IFRC is a member of the International Coordinating Group (ICG)
who are responsible for assuring that responses to meningitis epidem-
ics avoids duplication of effort and ensures that an adequate and ap-
propriate intervention is implemented. The planning of this appeal
and the amount of vaccines specified was carried out by the Federa-
tion's Health Department, in close collaboration with other members
of the ICG.
The Intended Operation
Assessment of Needs
The Federation has carried out a needs assessment by the Regional
Epidemics Surveillance Team for West Africa, with visits undertaken
to both the CAR and Chad during the month of March in order to col-
lect information relating to the epidemic and to ensure co-ordination
with the Ministry of Health, with WHO, MSF and other organisations
working in the area of health. National Societies were also assisted
to draw up an appropriate plan of action and budget and to assess
training needs for its volunteers. In order to carry out these pre-
liminary needs assessments, CHF 21,000 was allocated from the Federa-
tion's Disaster Relief Emergency Fund (DREF). The assessment reports
underline the need for rapid intervention on the part of the Red
Cross Societies and the Federation. In Niger, the Red Cross Society
has worked in close collaboration with the government in the assess-
ment of needs.
The immediate need is for appropriate vaccines to halt the spread of
the epidemic through vaccination of the population in affected areas,
and for oily chloramphenicol in order to treat those who have con-
tracted meningitis. The governments of the CAR, Chad and Niger have
appealed for a total of 2,235,035, 1,500,000 and 4,700,000 doses of
vaccine respectively. The Federation, through the IGC, is providing
200,000 doses per country in addition to a total of 15,000 vials of
oily chloramphenicol. Furthermore, Swiss Co-operation has pledged an
additional provision of 250,000 doses of vaccine for the campaign in
Niger. Information and awareness-building materials are also urgently
required in order for the Red Cross volunteers to mobilise the popu-
lation and spread messages relating to prevention and recognition of
initial signs of meningitis. In Niger, materials are required in or-
der to carry out a hygiene initiative at the hospital to which menin-
gitis cases are referred in Niamey. In addition, the Society intends
to put up an additional temporary shelter in order to accommodate
greater numbers of patients.
Anticipated Later Needs
Later needs relate to the necessity of establishing a disaster pre-
paredness plan for epidemics in the Central African region. For this
purpose, an evaluation meeting will be held to draw on lessons
learned throughout this operation and in order to take the first
steps towards putting a preparedness plan in place.
Red Cross Objectives
* To work with respective Ministries of Health to treat those who are
suffering from meningitis in the target areas.
* To collaborate with the respective Ministries of Health in order to
ensure vaccination coverage in affected communities in the CAR, Chad
* To build awareness in the communities of meningitis prevention
methods, and how to recognise the first signs of the illness.
* Given the recurrent nature of epidemics in the three countries, to
draw lessons from the operations following the outbreak of meningitis
in order to work towards setting up a preparedness strategy.
* To reinforce the capacity of the National Societies so that they
may play a more pro-active role in halting the future spread of
National Society/Federation Plan of Action
Emergency Phase: 15th April - 30th April 2000
Target regions will be provided with vaccines, medicines, syringes
and equipment necessary to carry out a 10-day intensive vaccination
campaign in the affected communities.
Red Cross volunteers will assist personnel designated by the Ministry
of Health to ensure appropriate vaccination coverage.
During the 10-day intensive campaign and until the end of the month,
awareness work will by carried out by Red Cross volunteers in the
community. To this effect, volunteers will be trained or offered re-
fresher courses in information, education and communication tech-
niques. In all three countries, volunteers will also be trained in
data collection and record-keeping. In addition, refresher training
is to take place to ensure that volunteers are aware of the symptoms
of meningitis, and are able to immediately refer cases to appropriate
Health messages for the target community will be drawn up for wide
Volunteers will ensure communication regarding the status of the epi-
demic between the Red Cross branches and Headquarters.
The Red Cross Society of Niger will organise a one-day intensive
cleaning operation at the Lazaret hospital in Niamey, set up to re-
spond to the crisis, in order to improve hygiene standards.
Phase Two: 1st May - 15th May 2000
The Red Cross Society of Niger will continue its work with the Laza-
ret Hospital where temporary structures will be established to accom-
modate patients suffering from meningitis. The Red Cross volunteers
will work with the hospital staff in the treatment and care of menin-
Capacity of the National Societies
The Red Cross of Chad has 3,771 active trained first aiders, 930
youth volunteers and 219 trainers. In Bongor and Moundou, two of the
regions in which the Red Cross will concentrate its activities, the
Branches have 50 and 150 active first aiders respectively. The Cen-
tral African Red Cross Society has a total of 3,000 volunteers and
youth members. Volunteers have worked successfully on several occa-
sions such as the National Vaccination Day, during the operations in
response to floods, and an epidemic of cholera. The Red Cross Society
of Niger has 4,800 volunteers, of whom 130 received intensive relief
training from the ICRC in 1997. Each of the National Societies has a
health co-ordinator, responsible for the National Societies health
programme and activities.
Present Capacity of the Federation in Yaounde and Abidjan Regional
Both the Regional Delegation in Yaounde and in Abidjan include Re-
gional Health Delegates.
It is planned to conduct a review of the operation in response to the
meningitis epidemic with the participation of representatives from
each of the National Societies involved. The Health Delegates from
the Regional Delegations and the Regional Disaster Preparedness Dele-
gate for West Africa will facilitate the workshop. This evaluation
will provide an opportunity to work towards setting up early warning
systems and plans for response in the event of future epidemics. The
budget also provides for a visit to Niger by a representative of the
Health Department in Abidjan and visits to the CAR and Chad by the
Regional Health Delegate in Yaounde in order to provide assistance to
the National Societies as they work in the affected communities.
During the dry season, cases of meningitis occur each year in the
CAR, Chad and Niger. Trends show that the disease reaches epidemic
proportions every seven to eight years. Urgent action on the part of
the Red Cross Societies and the Federation is required to save lives,
and the Red Cross is in a position to play a key role in the affected
communities through its effective volunteer network through the dis-
semination of vital messages to the populations at risk. For the fu-
ture, it is essential that the National Societies, as auxiliaries to
the government, put into place an early warning system in order to
track progress of diseases and to monitor potential epidemics. The
evaluation to take place at the close of the vaccination and aware-
ness campaign will examine how such a system may be effectively set
up, and will take advantage of disaster preparedness expertise in the
Didier J. Cherpitel
Acting Under Secretary General,
Disaster Response & Operations Coordination
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