Professional Documents
Culture Documents
: 47191813
Module: MPHDHM9/101/2010
Assignment: Assignment 02
1.26 Reporting
1.28 Treatment
1.29Epidemic Preparedness
1.31 Training
References
1.1 Four epidemiological questions from the demographic data.
1. Why are there more women than males who are affected by cholera
2. Why are there more children between the age of 0 -15 years infected with cholera
than adults?
3. Why are there more males than females between the age 0-19 infected with
cholera?
4. Why is the highest rate of cholera is between the age 5-9 than any other age?
1.2 Recommendations to the district manager on cholera preventive and health
promotion
Actively inform and educate health care workers and the community about the extent
and severity of the outbreak and the effectiveness and simplicity of current treatment
methods, and benefits of reporting cholera cases promptly. The free flow of
information would prevent panic spreading through the community. Communities
should also be involved in educating themselves through the use of various
communication strategies. Street food-vendors and restaurants may contribute in the
spread of the disease. Therefore, Environmental Health Officers need to be vigilant
in inspecting food-handling practices, and should be authorised to stop street sales
or close restaurants if insanitary practices are revealed.
Health education activities for food handlers in areas under the threat of cholera
should stress the following:
It is very important to liaise with local media such as press, radio and television to
ensure that correct health education messages are passed on to the general public
(Steinberg and Greene ,2001).
An organised programme for the control of diarrhea diseases is the best preparation
for a cholera outbreak. The best control measures are the early detection and
effective treatment of infected persons allied to health education. The mortality is
likely to be high among severe cases (up to 50%) in an unprepared community.
All proven cases must be reported immediately through the line listing form to the
local authority who must report to the Provincial Communicable Disease Control
Officer and the National Department of Health. An attempt must be made to
establish a bacteriological diagnosis from rectal swabs or stool specimens in cases
of gastro-enteritis suspected of being due to or possibly due to cholera, presenting at
hospitals/peripheral clinics or observed by mobile health teams and field workers in
cholera designated areas.
Environmental surveillance forms one of the most important part in the control and
preparedness of the cholera epidemic. The following are to be taken into
consideration when conducting an environmental surveillance.
When such changes in the pattern of diarrhea illness occur the notification process
should be activated immediately. When this information comes from an area where
cholera has.not previously been confirmed, bacteriological and epidemiological
investigations should be arranged promptly to establish the cause of the outbreak
and epidemic control measures instituted www.health24.com.
1.26 Reporting
When suspected cases of cholera are detected at a health facility, the nearest
referral facility or designated local health officer should be notified immediately. The
Provincial Department of Health should then be notified to investigate and confirm
the diagnosis. Upon confirmation, the National Department of Health should be
notified since cholera is a notifiable disease.
Either the Provincial or National Department of Health should proactively inform the
community via the media, of the cholera threat and measures to be taken to prevent
the outbreak from spreading.
The National Communicable Disease Officer should then inform the Senior
Management of the outbreak of the disease and the steps being taken to contain and
control the outbreak. The opportunity should be used to motivate for improved water
and sanitation through provision of safe water supplies and the building of toilets or
latrines.
1.27 Notification According to International Health Regulations
According to these regulations National Health Authorities should report the first
suspected cases of cholera to the World Health Organisation as rapidly as possible.
Laboratory confirmation should be obtained at the earliest opportunity and also
reported to WHO. Weekly reporting is required where cholera is confirmed.
Reports should include the number of new cases and deaths since the previous
report plus the cumulative totals for the current year by province or other applicable
geographic division (Colwell R ,1996).
1.28 Treatment
Hospitalisation with enteric precautions is desirable for severely ill patients but strict
isolation is not necessary. Less severe cases can be managed on an outpatient
basis with oral rehydration. Crowded cholera wards can be operated without hazard
to staff and visitors when effective hand washing and basic procedures of
cleanliness are practiced. The only treatment needed is rehydration as soon as
possible. It is essential that all cases presenting clinically as cholera cases, must be
treated as such immediately (Medecins, 1997).
A strong programme for the control of diarrhoeal diseases is the best preparation for
a cholera epidemic. In the long term, improvements of safe water supply and
adequate sanitation are the best means of preventing cholera. In an outbreak, the
best control measures are the early detection of cases and treatment of patients;
coupled with health education. In order to respond quickly to the cholera epidemic
and to prevent deaths, health facilities must have access to adequate quantities of
essential supplies, particularly oral rehydration solution and intravenous fluids.
During the outbreak of cholera, these supplies are needed in greater quantities than
normal. To prepare for an outbreak, it is essential to maintain additional stocks at
appropriate points in the drug delivery system. Small 'buffer stocks" should be placed
at local health facilities, larger buffer stocks at district or provincial levels, and an
adequate emergency stock at a central distribution point.
Recognition of cholera cases "rice water stools" is very important, and health
workers need to start treatment as early as possible to reduce potential
contamination of the environment and death.
1.31Training
Since case fatality is largely determined by the urgency and adequacy of diarrhoeal
management practices, prior training and continual supervision of health workers in
the assessment of diarrhea cases and the promotion and use of ORT and continued
feeding during diarrhea illness are essential.
Effective rehydration practices cannot be assumed during an outbreak if they are not
part of established daily routine practice. Such practice is the cornerstone of diarrhea
disease control in the conditions that prevail throughout much of South Africa and
each province should pay due attention to training in, and supervision of the practice
of ORT at primary care.
It is therefore essential to educate all health workers regarding cholera and to create
an awareness of possible cholera cases. All hospitals, clinics, mobile health teams
and other field workers such as Health Inspectors and Health Assistants must be
equipped http://www.who.int/cholera/publications/cholera_outbreak/en/print.html.
If a cholera outbreak occurs in an area where the peripheral health services are
inadequate or have no experience in controlling the disease, mobile teams from
national or provincial level may be called upon for assistance. These outbreak
response teams should have intersectoral representation including members from
the Department of Water Affairs and Forestry, the South African National Defence
Force, Provincial and Local Government and provincial and national communicable
disease officers, environmental health officers, communications and laboratory
services. The members of each team should be brought together for briefing on
emergency activities and their individual responsibilities. The far-reaching effect of
cholera outbreak often calls for an immediate action from the national co-ordinating
committee, reinforced by senior members from relevant ministries. This control
committee is responsible for:
• epidemic preparedness;
• inter-sectoral co-ordination;
• national and international collaboration;
• collection and reporting of cases and deaths;
• organisation of special training;
• procurement, storage and distribution of required supplies; as well as
• implementation, monitoring and evaluation of control activities.
References
Colwell RR (1996). "Global climate and infectious disease: the cholera paradigm".
Science 274 (5295): 2025–31. PMID 8953.
Joubert ,GE (ed) 2007.Epidemiology: a research manual for South Africa , with
contributing editors J Katzenellenbogen and SA Karim. 2ND edition.Cape Town.
Oxford Univeristy Press.
Gilbert, Pamela K. (2008), Cholera and Nation: Doctoring the Social Body in
Victorian England, SUNY Press. p. 231.
Mintz ED, Guerrant RL (2009). "A lion in our village--the unconscionable tragedy of
cholera in Africa". N. Engl. J. Med. 360 (11): 1060–3.
Ryan, Kenneth J.; Ray, C. George, eds. (2003), Sherris medical microbiology: an
introduction to infectious diseases (4th ed.),
Steinberg EB, Greene KD, Bopp CA, Cameron DN, Wells JG, Mintz ED (2001).
"Cholera in the United States, 1995-2000: trends at the end of the twentieth century".
J. Infect. Dis. 184 (6): 799–802
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