Giuseppe
Emeritus
[Source: ICDDR,B, full pate: (LINK). Edited.]
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icddr,b experts recommend scaling up of ORS to prevent fatalities in cholera stricken Sierra Leone
icddr,b?s emergency team of experts have recommended that nationwide scaling-up of Oral Rehydration Solution (ORS) as a life saving treatment for diarrhoeal diseases amidst the recent cholera outbreak in Sierra Leone.
The recommendation was one of several made to the World Health Organization (WHO) by the team after spending three weeks in the west African country where they assisted WHO through the Global Outbreak Alert and Response Network to manage the deadly outbreak. The team returned to Bangladesh from Sierra Leone on 30 September. Since its discovery in the 1960s, ORS have been effectively used in treating children with cholera, and adults and children with non-cholera diarrheal diseases.
The icddr,b team in Sierra Leone consisted of Dr. Pradip K. Bardhan, Chief Physician of the Dhaka Hospital, Dr. Azharul Islam Khan, Chief Physician and Head of the Diarrhoeal Diseases Unit and Dr. Md. Sirajul Islam, Environmental Microbiologist and Head of Environmental Microbiology Lab with icddrb?s Centre for Food and Waterborne Diseases. During their assignment in Sierra Leone, the team worked closely with international experts and Sierra Leone?s ministry of health to develop early detection programmes and train local health care providers in case management and reporting.
In August 2012 , the cholera outbreak spread rapidly through most of Sierra Leone and by the end of September WHO reported the outbreak has killed 271 people, and a total of 18,508 cholera cases have been recorded in 12 out of Sierra Leone?s 13 districts. 60 percent of all recent cases have been reported in the western part of the country, where the capital city of Freetown is located.
Some of the key recommendations put forth by icddr,b to WHO includes:
Building capacity and instiling confidence
Dr. Azharul Islam Khan and Dr. Pradip K. Bardhan travelled to various parts of the country to undertake supply and clinical assessments. They also provided support training to health professionals working in the affected areas. The icddr,b team shared their technical experiences in the Control of Diarrhoeal Diseases, focusing specially on cholera in selected areas of Sierra Leone and based on WHO guidelines. They assessed the cholera outbreaks in the country and organised training programmes to build capacity of health professionals on Case Management through clinical meetings.
While the health professionals showed much enthusiasm to learn during the training sessions, the icddr,b team observed that many of the case fatalities were due to inconsistent definition of diarrhoea and the inappropriate use of ORS and intravenous saline and antibiotics. The icddr,b experts provided hands on training and orientation on diarrhoea case management, including triage criteria, infection control and treatment guidelines to selected category of health care staff.
A Training of Trainers was organised in Freetown from 25 to 28 September. The training aimed at building the capacity and confidence of the health professionals to cascade the training at the district levels.
Building laboratory capacity
icddr,b?s scientist and expert microbiologist, Dr. Md. Sirajul Islam, was based in Freetown. From 10 to 14 September he facilitated a training organised by WHO at the Sierra Leone National Central Public Health Reference Laboratory (CPHRL) on theoretical and bench training of laboratory scientists and technologists on identification of bacterial pathogens, Participants at the training included staff of CPHRL, main referral hospitals and regional laboratories in the country. Dr. Islam trained participants on laboratory isolation, identification and characterisation of causative agents of bacterial meningitis and enteric diseases, and to conduct antimicrobial susceptibility testing. The training was aimed at ensuring that the bacteriology laboratory is fully functional and also to build the capacity of the participants. icddr,b and WHO donated a consignment of reagents and supplies for the diagnosis and antibiogram of meningitis and enteric diseases including cholera the Ministry of Health and Sanitation.
During his stay in Freetown, Dr. Islam also provided technical assistance to the CPHRL to develop a Standard Operating Procedures for meningitis and enteric diseases and a long term plan for bacteriology laboratory.
Sierra Leone is one of the many countries where icddr,b experts have been rapidly dispatched to assist with diarrheal diseases outbreaks. Over the past two decades, and with growing expertise, icddr,b has extended assistance to help manage cholera outbreaks in the past to other countries.
Since 1994, icddr,b teams have travelled widely to help fight the disease, from Rwandan refugee camps in what is now the Democratic Republic of the Congo, to Pakistan and Zimbabwe. In November 2010 a team of experts from icddr,b travelled to Haiti to help manage the fatal cholera epidemic that had broken out there. During 2011 and 2012 icddr,b teams have travelled to Kenya, Somalia and the Philippines to assist with the management of cholera outbreaks.
For details contact Nasmeen Ahmed
-icddr,b?s emergency team of experts have recommended that nationwide scaling-up of Oral Rehydration Solution (ORS) as a life saving treatment for diarrhoeal diseases amidst the recent cholera outbreak in Sierra Leone.
The recommendation was one of several made to the World Health Organization (WHO) by the team after spending three weeks in the west African country where they assisted WHO through the Global Outbreak Alert and Response Network to manage the deadly outbreak. The team returned to Bangladesh from Sierra Leone on 30 September. Since its discovery in the 1960s, ORS have been effectively used in treating children with cholera, and adults and children with non-cholera diarrheal diseases.
The icddr,b team in Sierra Leone consisted of Dr. Pradip K. Bardhan, Chief Physician of the Dhaka Hospital, Dr. Azharul Islam Khan, Chief Physician and Head of the Diarrhoeal Diseases Unit and Dr. Md. Sirajul Islam, Environmental Microbiologist and Head of Environmental Microbiology Lab with icddrb?s Centre for Food and Waterborne Diseases. During their assignment in Sierra Leone, the team worked closely with international experts and Sierra Leone?s ministry of health to develop early detection programmes and train local health care providers in case management and reporting.
In August 2012 , the cholera outbreak spread rapidly through most of Sierra Leone and by the end of September WHO reported the outbreak has killed 271 people, and a total of 18,508 cholera cases have been recorded in 12 out of Sierra Leone?s 13 districts. 60 percent of all recent cases have been reported in the western part of the country, where the capital city of Freetown is located.
Some of the key recommendations put forth by icddr,b to WHO includes:
- Nationwide scaling-up of Oral Rehydration Solution (ORS).
- Chlorination of all wells and fixing of all non-functioning pumps as part of a country wide emergency preparedness programme including hard-to-reach areas.
- Proper application of case definition to enable isolation of cholera cases.
- Documentation, evaluation and appropriate management of complications of cholera/diarrheal diseases.
- Deaths in the facilities can mostly be averted by continuous monitoring and supervision of admitted cases for management of complications and associated co morbidities.
- Following ToT cascading of the training in the districts need immediate planning and implementation in phases.
- Hard-to-reach areas need special attention because of special circumstances. Provision of some additional incentives should be created for people working for these areas.
Building capacity and instiling confidence
Dr. Azharul Islam Khan and Dr. Pradip K. Bardhan travelled to various parts of the country to undertake supply and clinical assessments. They also provided support training to health professionals working in the affected areas. The icddr,b team shared their technical experiences in the Control of Diarrhoeal Diseases, focusing specially on cholera in selected areas of Sierra Leone and based on WHO guidelines. They assessed the cholera outbreaks in the country and organised training programmes to build capacity of health professionals on Case Management through clinical meetings.
While the health professionals showed much enthusiasm to learn during the training sessions, the icddr,b team observed that many of the case fatalities were due to inconsistent definition of diarrhoea and the inappropriate use of ORS and intravenous saline and antibiotics. The icddr,b experts provided hands on training and orientation on diarrhoea case management, including triage criteria, infection control and treatment guidelines to selected category of health care staff.
A Training of Trainers was organised in Freetown from 25 to 28 September. The training aimed at building the capacity and confidence of the health professionals to cascade the training at the district levels.
Building laboratory capacity
icddr,b?s scientist and expert microbiologist, Dr. Md. Sirajul Islam, was based in Freetown. From 10 to 14 September he facilitated a training organised by WHO at the Sierra Leone National Central Public Health Reference Laboratory (CPHRL) on theoretical and bench training of laboratory scientists and technologists on identification of bacterial pathogens, Participants at the training included staff of CPHRL, main referral hospitals and regional laboratories in the country. Dr. Islam trained participants on laboratory isolation, identification and characterisation of causative agents of bacterial meningitis and enteric diseases, and to conduct antimicrobial susceptibility testing. The training was aimed at ensuring that the bacteriology laboratory is fully functional and also to build the capacity of the participants. icddr,b and WHO donated a consignment of reagents and supplies for the diagnosis and antibiogram of meningitis and enteric diseases including cholera the Ministry of Health and Sanitation.
During his stay in Freetown, Dr. Islam also provided technical assistance to the CPHRL to develop a Standard Operating Procedures for meningitis and enteric diseases and a long term plan for bacteriology laboratory.
Sierra Leone is one of the many countries where icddr,b experts have been rapidly dispatched to assist with diarrheal diseases outbreaks. Over the past two decades, and with growing expertise, icddr,b has extended assistance to help manage cholera outbreaks in the past to other countries.
Since 1994, icddr,b teams have travelled widely to help fight the disease, from Rwandan refugee camps in what is now the Democratic Republic of the Congo, to Pakistan and Zimbabwe. In November 2010 a team of experts from icddr,b travelled to Haiti to help manage the fatal cholera epidemic that had broken out there. During 2011 and 2012 icddr,b teams have travelled to Kenya, Somalia and the Philippines to assist with the management of cholera outbreaks.
For details contact Nasmeen Ahmed
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