Throughout Africa the impact of disasters and disease outbreaks is particularly severe in areas were people are poor and have few accessible resources during crisis. In addition, the ability of some African countries to cope disasters is impaired,by Poor infrastructure, especially of primary and public health care systems, complicates disaster and outbreak response further. One such outbreak is measles.
Seasonal measles outbreaks occur in some Somali land regions where the national EPI programs, have not yet reached satisfactory levels. Sahil region shares this low EPI ratewith other regions, possibly due to climate and geographical challenges, population mobility, and misinformed beliefs about the immunization in rural communities resulting in immunization refusal. , Measles outbreaks usually occur inSomalilandduring dry seasons when people who live in rural areas are wont to travel, resulting in devastating outbreaks with peculiarly high morbidity and mortality.
The widespread malnutrition in most of rural Somaliland compounded with measles outbreaks during dry seasons results in severe symptom presentation.
Because of the high incidence, most of the population knows the presentation of the disease. Popular understanding is a fever followed by rash that leads to severe disease. Traditional therapeutic practices include use of cold to keep the rash with in the body, covering the child with warm sand and blankets, exposure to sun, and avoiding bathing.
Fortunately about the last two years the quality of health service in Somaliland is increasing day in day out due to educated and motivated Minister of Health, the other MOH staff, and consulting organizations.
On March 27nd there was information coming from one of the elders who live in Ganbaxo village saying most of the people who lived around Ganbaxo and itself complaining a disease presenting with severe cough,vomiting and rash. Acting Regional Medical Officer (Mr.Osman Ibrahim Hayd) informed Sahil Medical Emergency Team (SMET) consisting of a medical doctor, pharmacist, laborotorist and nurse They quickly gathered their medication and samples, then visited the area from Ceeldaraad to Laas-muuse.
Sahil Response Team
The objective of the team was to reduce mortality and morbidity through case treatment and detection. Of the approximately 180 patients, most were between 3 and 15 years old and had not been previously vaccinated. Children who developed measles but had been vaccinated presented with milder cases than those not vaccinated. Other patients were from Ceel-Daraad, Laaqdheer, Dhaxyaal, Karin, Duurdhiil, Ganbaxoand finally Laasmuuse,. Some had clinical features of pertussis because their symptoms started with coryzal symptoms and progressively worsening cough, developing into paroxysms of intractable coughing frequently resulting vomiting. I considered that most of children who live inSomalilandhad incomplete coverage of the scheduled three doses of pertussis vaccination.
The maternal mortality rate in the region reduced after the HPA (Health Poverty Action) started the EPHS program (Essential Package Health Service) In Sahil Region. Still there is increased maternal, perinatal and infant mortality and morbidity rate due to complete absence of health service. Most of these patients die due to poor antenatal care, very severe nutritional anemia both children and pregnancy assessed by checking their conjunctiva Hb(haemoglobin) less than 3mg/dl.When they got sick they use traditional burns on the chest, abdomen and some times the face which causes severe pain and also it can be infected as we met a child in Duur-dhiil, it can also produce future cosmetic problems.
A child is evaluated by the Sahil Response Team
The other strange thing that most of the people who live in the area told me is that the second most common cause of death in these areas after pregnancy related complications is the snake bite by a snake they called (Abeeso).The houses they live in are small huts so they are in high risk for the biting of this snake; even as health staff we were risk. The good news about this snake is that there is the potential to create an anti-venom, or find an existing anti-venom that works.
Assessing a Geriatric Patient
In my conclusion this is our recommendation
1.First and foremost establishment of primary medical care in the rural areas of the Sahil region. As a Ministry of health and other NGOs who provide the health care in Sahil Region, it is disaster not to build even one health post as soon as possible.
2. Regular planned visits so we are aware of outbreaks.
3. To increase EPI coverage by considering population movement and to send suspected areas to confirm the disease.
4. To increase the health education and minimize rumour believes in the rural communities that the vaccination causes infertility. Through planned interventions
5. We have to discuss why there is an outbreak of measles in the country despite vaccination campaigns twice annually
Pharmacist Nagiib supplies patients with medications from the Response Team Vehicle
This post was written by Dr. Bashiir Jaamac, Regional Health Officer
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