Date: Wed, 7 Mar 2018 04:20:53 +0100
By Daniel GARELO PENSADOR

Luanda, March 7, 2018 (AFP) - Heavy rains, filthy conditions, medicine shortages and endemic corruption have combined to make a lethal malarial cocktail for Angola.   Since the start of the year more than 300,000 cases of the disease have been reported across the country, leading to at least a thousand deaths.   The toll, say experts, is a clear sign of the poverty and failings of governance in a country which, paradoxically, is one of Africa's top oil producers.   "The number is frightening," said Jose Antonio, the director of public health in Kilamba Kiaxi, a poor neighbourhood of the capital.  

Luanda province, which includes the capital, has been the hardest hit with more than 75,225 cases and 117 deaths followed by Benguela in the west of the country where 43,751 cases and 213 deaths have been reported.   In 2017, 7,000 people died from the disease.   Sub-Saharan Africa accounts for 90 percent of malaria cases worldwide and 92 percent of deaths caused by the condition that is spread by infected mosquitoes. Malaria remains one of the leading causes of premature death in Angola and every year public hospitals are deluged with patients battling the disease.

- 'She is dead' -
In the Cajueiros clinic, in the heart of the densely populated Cazenga neighbourhood in Luanda, dozens of mothers and their children queued for medical consultations.   "Every day we record at least 15 to 20 cases of malaria in our hospital," said paediatrician Miguel Sebastiao. That compared to just one or two in the dry season.   "They don't give us any medicine here. You can have a free consultation but they just give you a prescription to go and buy drugs at a pharmacy," complained Rosa Eduarte, who had come to seek a diagnosis for her five-year-old daughter.

Because of her precarious financial position, she had no other choice than to visit a public hospital, which typically lacks even basic supplies like cotton wool, syringes, latex gloves and, crucially, medicines.   "We don't have any tablets here," said Marcelina Paulina, a nurse at the Palanca Dona Paulina hospital in Luanda.   Ana Joaquina lost her sister at the end of February.   "The doctors diagnosed malaria. The hospital didn't have any money to buy medicines. She is dead," said Joaquina matter-of-factly.

Like all of Angola's other public services, health care has been starved of resources by the economic crisis that has plagued the country since oil prices collapsed in 2014.   In 2016 an outbreak of yellow fever killed almost 400 people and shone a light on the risible state of government-run healthcare.   The system has also suffered from chronic corruption, according to doctors and opposition politicians.

- 'Easier to buy luxury cars' -
"It's easier to buy luxury cars for the hospital managers than it is to buy medical supplies," said Maurilio Luyele, a medical doctor who is also a lawmaker for the opposition Unita party.   Last month, three senior officials were sentenced to eight years imprisonment after embezzling $2 million (1.6 million euros) that was intended for the fight against malaria.   Even if Angola had the "best medicine in the world," the issue of malaria will persist "while we don't resolve the problem of rubbish piling up in the streets, of stagnant water and a lack of hygiene," said Sebastiao, the paediatrician.   Refuse collectors have not visited some parts of Luanda for months, another service that is also afflicted by corruption.

Some quarters of Luanda have been transformed into open-air dumps as local authorities grapple with limited budgets and the small number of companies providing refuse services.   During the rainy season from September to May, roads and public spaces are transformed into marshes with floating detritus -- a paradise for mosquitoes.    Faced with a growing crisis, the government of new president Joao Lourenco who took office in September last month launched an emergency plan to fight the malaria epidemic with mass insect fumigation and the distribution of mosquito nets.
Date: Sat 14 Oct 2017
Source: Angola Online [in Portuguese, machine trans., edited]
<http://angola-online.net/noticias/surto-de-colera-mata-mais-de-14-pessoas-no-zaire>

According to information from the health authorities of Zaire, of the more than 60 islands inhabited in the province, of a total of 120, most are affected by the outbreak of cholera that has killed at least 15 people out of 214 registered cases.

The lack of clean water on the islands and poor housing conditions are pointed out by the health authorities of the province of Zaire as the causes of the outbreak, so last week campaigned for mobilization and awareness, and distributed filters to purify water.
====================
[Maps of the West African country of Angola can be seen at
<http://www.un.org/Depts/Cartographic/map/profile/angola.pdf> and
<http://healthmap.org/promed/p/23901>. Zaire province is located in the extreme northwest of the country.

The mortality from cholera and most diarrheal illnesses is related to non-replacement of fluid and electrolytes from the diarrheal illness.

As stated in Lutwick LI, Preis J, Choi P: Cholera. In: Chronic illness and disability: the pediatric gastrointestinal tract. Greydanus DE, Atay O, Merrick J (eds). NY: Nova Bioscience, 2017 (in press), oral rehydration therapy can be life-saving in outbreaks of cholera and other forms of diarrhea:

"As reviewed by Richard Guerrant et al (1), it was in 1831 that cholera treatment could be accomplished by intravenous replacement, and, although this therapy could produce dramatic improvements, not until 1960 was it 1st recognized that there was no true destruction of  the intestinal mucosa, and gastrointestinal rehydration therapy could be effective, and the therapy could dramatically reduce the intravenous needs for rehydration. Indeed, that this rehydration could be just as effective given orally as through an orogastric tube (for example, refs 2 and 3) made it possible for oral rehydration therapy (ORT) to be used in rural remote areas and truly impact on the morbidity and mortality of cholera. Indeed, Guerrant et al (1) highlights the use of oral glucose-salt packets in war-torn Bangladeshi refugees, which reduced the mortality rate from 30 percent to 3.6 percent (4) and quotes sources referring to ORT as "potentially the most important medical advance" of the 20th century. A variety of formulations of ORT exist, generally glucose or rice powder-based, which contain a variety of micronutrients, especially zinc (5).

"The assessment of the degree of volume loss in those with diarrhea to approximate volume and fluid losses can be found in ref 6 below. Those with severe hypovolemia should be initially rehydrated intravenously with a fluid bolus of normal saline or Ringer's lactate solution of 20-30 ml/kg followed by 100 ml/kg in the 1st 4 hours and 100 ml/kg over the next 18 hours with regular reassessment. Those with lesser degrees of hypovolemia can be rehydrated orally with a glucose or rice-derived formula with up to 4 liters in the 1st 4 hours, and those with no hypovolemia can be given ORT after each liquid stool with frequent reevaluation."

References
----------
1. Guerrant RL, Carneiro-Filho BA, Dillingham RA. Cholera, diarrhea, and oral rehydration therapy: triumph and indictment. Clin Infect Dis. 2003; 37(3): 398-405; available at
<http://cid.oxfordjournals.org/content/37/3/398.long>
2. Gregorio GV, Gonzales ML, Dans LF, Martinez EG. Polymer-based oral rehydration solution for treating acute watery diarrhoea. Cochrane Database Syst Rev. 2009; (2): CD006519. doi: 10.1002/14651858.CD006519.pub2; available at
<http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006519.pub3/full>
3. Gore SM, Fontaine O, Pierce NF. Impact of rice based oral rehydration solution on stool output and duration of diarrhoea: meta-analysis of 13 clinical trials. BMJ 1992; 304(6822): 287-91;
available at <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1881081/>
4. Mahalanabis D, Choudhuri AB, Bagchi NG, et al. Oral fluid therapy of cholera among Bangladesh refugees. Johns Hopkins Med 1973; 132(4): 197-205; available at
<http://www.searo.who.int/publications/journals/seajph/media/2012/seajph_v1n1/whoseajphv1i1p105.pdf>
5. Atia AN, Buchman AL. Oral rehydration solutions in non-cholera diarrhea: a review. Am J Gastroenterol 2009; 104(10): 2596-604;
abstract available at <http://www.ncbi.nlm.nih.gov/pubmed/19550407>
6. WHO. The treatment of diarrhoea, a manual for physicians and other senior health workers. 4th ed. 2005; available at
<http://whqlibdoc.who.int/publications/2005/9241593180.pdf>. - ProMED Mod.LL]
Date: Thu 28 Sep 2017
From: Neida Ramos neydaneto@gmail.com
[Portuguese, transl ProMED Mod.RNA, summarised, edited]

A total of 11 people died in the province of Cuanza Norte during the 1st half of this year [2017], victims of rabies, after having been attacked by infected dogs. This means 10 more [than the number of rabies cases] during the same [period during] 2016, informed the supervisor of the epidemiological surveillance area in the Provincial Health Department, Kende Alfredo.

On [Thu 28 Sep 2017], World Rabies Day, the official said that the reported cases occurred among a total of 768 people bitten by dogs, cats and monkeys in the province. He made it known that the Cazengo municipality (the county capital of the province) leads the statistics with 8 deaths related to rabies among 370 cases of dog bites.

Compared to the same period of 2016, Kende Alfredo said that there was an increase of 431 cases of animal bites, justifying this increase with the high number of stray dogs that circulate in the streets of different localities of the province.
-----------------------------------
Neida Ramos, MD, Ministry of Health, Angola
neydaneto@gmail.com
===================
[The above report was originally submitted by Dr Neida Ramos to ProMED-PORT (in Portuguese). The ProMED moderator, RNA, acknowledged the sender and included, in the commentary, request for additional information on canine rabies control strategies in Angola as well as on the prevailing and applied pre-and post-exposure prevention strategies for humans. He asked if the reported cases received any kind of post-exposure care, including serovaccination and if the post-exposure treatment was complete and timely.

According to the most recent available annual report of Angola to the OIE, the number of dogs vaccinated against rabies during 2015 was 429 165; 85 cases of rabies in (dead) dogs were reported. The number of officially reported human cases, countrywide, during recent years was: 2013 - 111; 2014 - 91; 2015 - 69. The data for 2016 are not yet available. - ProMED Mod.AS]
Date: Fri 8 Sep 2017
From: Dr Neida Ramos <neydaneto@gmail.com> [edited]

In Ondjiva city, Cunene province, 33,100 malaria cases including 91 deaths were diagnosed by the health authorities of Cunene province, during the 2nd trimester of this year (2017), 5297 cases more than the total reported during 2016. ‎ In announcing this today, [Fri 8 Sep 2017], Angop, the head of the department of public Health and endemic disease control, Felix Belarmino Satyohamba, said that 9797 cases were reported in the Ombadja municipality, 9371 in Cuanhama, 6618 in Cuvelai, 5233 in Cahama, 1080 in Namacunde and 466 in Curoca.

It should be noted that in relation to the deaths, there was a decrease of 28 deaths, due to the increase in the awareness of the people and by the health sector, and that hospital services for treatment is available. Felix Belarmino Satyohamba stressed that measures to prevent malaria and the importance of waste disposal continued to prevent deaths from this disease, especially in children and pregnant women.
========================= 
[Cunene province is bordering Namibia and is not usually regarded as a malaria high risk area. However, there has been several reports of increased malaria risk over the past few months from Botswana and South Africa (see ProMED reports listed below). Malaria is highly endemic in Angola.

According to the WHO World Malaria Report 2016 (<http://www.who.int/malaria/publications/world-malaria-report-2016/report/en/>), there was an estimated 3.1 million malaria cases in 2015 with 14 000 fatal outcomes. Less than 50 percent of the population sleep under insecticide impregnated bed nets. - ProMED Mod.EP]

[A HealthMap/ProMED-mail map can be accessed at: <http://healthmap.org/promed/p/165>.]
Date: Tue 4 Jul 2017
Source: Releif Web [edited]
<http://reliefweb.int/report/angola/huila-over-8000-people-vaccinated-against-yellow-fever>

Over 8000 people were vaccinated against yellow fever during a campaign held in the last 15 days in Mulondo commune, Matala Municipality of the southern Huila Province. According to the chief nurse of the Mulondo health centre, Joso Pintal Gonçalves, the vaccination campaign covered adults and children, representing 82 percent of the predicted target.  Yellow fever is a dangerous infectious disease caused by a virus transmitted by mosquitoes.
====================== 
[The yellow ever (YF) outbreak, which was 1st detected in Angola in December 2015, caused 965 confirmed cases across the 2 countries, with thousands more cases suspected. The last case detected in Angola was on 23 June 2016. Huila province was a very early site at the beginning of the YF outbreak in Angola. It seems likely that this province was included in the massive YF vaccination campaigns carried out in Angola.

There is no indication in the above report that the current vaccination campaign is in response to concern about new cases or of potential spill-over from the sylvan (forest) endemic transmission cycle of YF virus. - ProMED Mod.TY]

[A HealthMap/ProMED-mail map showing the location of Angola can be accessed at:
<http://healthmap.org/promed/p/165>

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/promed/p/32978>.]
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