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Health Impact of Drought: Communicable Disease Control
Public Private Health Forum Meeting
23 February 2018
Charlene A. Jacobs
Introduction✓ Drought poses many health implications
Some health effects occur in the short-term and can be directly observed and measured
Slow rise or chronic nature of drought also can result in longer term, indirect health implications that are not easy to anticipate or monitor
✓ Drought can affect areas/communities differently depending on several additional variables e.g. structure and capacity of existing water systems, local governance
of water use, economic development, and the at-risk populations living within the affected
Health Impacts ✓ Compromised quantity and quality of drinking water
✓ Increased recreational risks
✓ Effects on air quality
✓ Diminished living conditions related to energy, air quality, and sanitation and hygiene
✓ Compromised food and nutrition
✓ Increased incidence of illness and disease
Increased incidence of illness and disease (1)• Infectious Diseases
– Viruses, protozoa, and bacteria can pollute both groundwater and surface water when rainfall decreases.
– Acute respiratory and gastrointestinal illnesses are more easily spread from person to person when hand washing is compromised by a perceived or real lack of available water.
– E. coli and Salmonella are examples of bacteria that during drought can more readily contaminate food and cause infectious disease.
– Persons exposed to contaminated recreational waters are more likely to become infected with pathogens that thrive in the shallow warm waters that exist during drought conditions.
Increased incidence of illness and disease (2)
✓ Diseases transmitted by vectors and animals
In periods of limited rainfall, both human & animal behaviour can change in ways that increase the likelihood of other vector-borne diseases ▪ E.g. during dry periods, wild animals are more likely to seek water in areas
where humans live. These behaviours increase the likelihood of human contact with wildlife, the insects they host, and the diseases they carry
Drought reduces the size of water bodies - and become stagnant. This provides additional breeding grounds for certain types of mosquitoes.
Adaptation and Mitigation Measures (1)
✓Must be implemented by public health officials, public and private healthcare providers and health practitioners.
✓ Effective adaptive strategies requires multi-discipline and sector collaboration among diverse government, research sectors and communities.
Adaptation and Mitigation Measures (2)
1. Strengthen epidemic preparedness & response teams at provincial /district /sub-district levels
2. Intensify disease surveillance, early detection, reporting, and adequate case management
3. Identify and report all suspected communicable disease outbreaks (early warning systems)
4. Provide adequate health care facilities and services, able to manage any surge or increase in cases of communicable diseases
5. Coordinate key activities towards preparedness, prevention & control of diarrhoeal, waterborne and vector/rodent borne diseases
Key aspects and CDC activities
Resources
Surveillance,
M&E, Research
Training
Legislation , Acts,
Policies
& Guidelines
Multi-sectoral
Collaboration
Outbreak Response,
Mass Gathering,
Public Health
Emergencies
Programme
Coordination
Communication
Strengthen epidemic preparedness & response teams (1)
✓ The Provincial CDC Stakeholders Committee/Outbreak Response Team is
activated when a provincial public health response is required
The Provincial CDC Manager coordinates the plan when an outbreak is
confirmed i.e. the strategy, communication, interventions, role-players, roles
and functions, meetings etc.
Provincial CDC Resource Directory
✓ District / sub-district Outbreak response teams must be on alert and
respond rapidly when an outbreak is suspected or confirmed.
✓ District Outbreak Response Teams must include multi-discipline and sector
individuals in the team/committee depending on the disease / condition
under investigation.
Rapid response teams at sub-district levels respond at local level.
Strengthen epidemic preparedness & response teams (2)
✓ Healthcare workers (HCW) must be vigilant and maintain a high index of
suspicion when evaluating all patients
Travel, occupation, exposure histories of suspected emerging and re-emerging
pathogens
✓ In the event of an outbreak the Provincial and District Outbreak
response Teams will implement the following actions:
Laboratory confirmation of the outbreak
Ensuring adequate clinical management of cases
Intensifying surveillance and reporting / notification of suspected cases
Assessing the risk of a large outbreak with high morbidity and mortality
Investigating the outbreak
Implementing control and prevention measures
Ensuring effective community involvement and public awareness.
Intensify disease surveillance, early detection and reporting, and adequate case management (1)
✓ Surveillance Systems to detect diseases
Notifiable Medical Conditions (NMC) System
Laboratory Surveillance
EPI Active Disease Surveillance
Integrated Disease Surveillance and Response (IDSR)
Sentinel Surveillance e.g. Flu Watch
Community based surveillance – rumours, school, ECD centres
Media
✓ Legislation, Guidelines and SOPs
Existing protocols for the reporting of notifiable medical conditions, disease surveillance,
weekly priority conditions reporting from hospitals, and reporting of suspected/confirmed
outbreaks are in place
Refer to and ensure all health facilities have the appropriate disease-specific guidelines for
laboratory confirmation, case management and the appropriate response activities.
Intensify disease surveillance, early detection and reporting, and adequate case management (2)
✓ The following conditions are prioritized during droughts (but are not
confined to):
Bacterial: Cholera, Typhoid fever
Vector-borne: Malaria (not endemic in our province), Viral Haemorrhagic Fever
Viral: Viral hepatitis, Enteroviruses
Multiple causes: Food-borne illnesses, other diarrhoeal diseases
Identify and report all suspected outbreaks of communicable disease (early warning systems)
✓ All suspected clusters/outbreaks of communicable diseases must be
reported to the local health authorities or next level (sub-district, district
and provincial level).
✓ The District Outbreak Response Team and /or a Rapid Response Team are
responsible for the investigation and control of outbreaks.
This is dependent on the specific condition/disease – and will always be done in liaison
with the provincial CDC programme, experts and members of the Provincial CDC
Stakeholders Committee / Response Team.
Outbreak Investigation Steps✓
Prepare for fieldwork
Establish the existence of an outbreak
Verify the diagnosis
Construct a working case definition
Find cases systematically and record information
Perform descriptive epidemiology
Develop hypothesis
Evaluate hypotheses epidemiologically
As necessary, reconsider, refine, and re-evaluate hypotheses
Compare and reconcile with laboratory and/or environmental studies
Initiate or maintain surveillance
Communicate findings
Imp
lem
en
t c
on
tro
l a
nd
pre
ve
ntio
n
me
asu
res
Provide adequate health care facilities & services, able to manage any surge or increase in cases of communicable disease
.
✓ Improve facilities for handling increased patient volume resulting from
extreme weather events and ensure adequate stocks of vaccine etc.
✓ Anticipate necessary surge capacity (e.g., for major heat waves, fires,
epidemics/outbreaks).
✓ Coordinate with emergency-services agencies and ambulance facilities
and consider morgue capacity.
✓ Reinforce and extend public health programs to provide a foundation for
dealing with most types of climate-related health effects
Environmental Health
Expanded Programme on Immunisation
Health Promotion
Infection Prevention and Control
Increase community awareness and involvement on priority communicable diseases
✓ Promote basic hygiene, hand washing, food safety and the use of oral
rehydration solutions etc.
✓ District and sub-districts should ensure that Information, Education
and Communication (IEC) material are available, and that appropriate
communication materials and methods are used in the event of an
outbreak and response activities.
✓ Public Health officials should ensure general prevention and control
activities in communities and in healthcare facilities.
Coordinate key activities towards preparedness, prevention & control of communicable diseases (1)
✓ Outbreak prevention and control activities can involve the following:
Strengthening case management
Ensure emergency stock of drugs and supplies e.g. vaccine stock
Update health staff skills (e.g. one-on-one in urgent situations) and training on
standard precautions, barrier nursing and use of protective clothing, isolation
precautions, treatment protocols e.g. oral rehydration salts (ORS)
Conduct emergency immunisation if indicated
Inform and educate the community (risk communication)
Promoting good personal hygiene e.g. hand washing
Improve food-handling practices (food safety) by educating the community and
those in the food industry
Coordinate key activities towards preparedness, prevention & control of communicable diseases (2)
Vector control activities
Reduce exposure to mosquitoes – how to avoid bites etc.
Improve access to safe water (if no water available during an emergency) – water supply may need to be brought in by trucks. Educate the community on safe drinking water storage etc.
Ensure safe disposal of human waste (sanitation)
Pest control measures against flies, cockroaches, rodents etc.
Improve infection control practices for airborne infections e.g. educate about cough hygiene and etiquette etc.
Management of contacts / family of cases of infectious disease
Conclusion
The province has been able to manage and control communicable
disease outbreaks and respond effectively
A multi-sector and discipline participation and partnership is essential
to prevent and control disease outbreaks:
Disease surveillance, early detection, and reporting of communicable
disease needs to be enhanced
Ensuring public health interventions are conducted e.g. immunisation,
vector control, testing of water, health promotion, etc.
Rapid response and mobilisation of resources to outbreaks
Thank you
Charlene Jacobs forCommunicable Disease Control (CDC) Sub-directorateMPH (Field Epidemiology) Deputy Director: Facility-based Programme, Health Programmes [email protected]: 021-483-9964/3156
