DIARRHOEAL DISEASE CONTROL
The CIDRZ Programme for the Awareness and Elimination of Diarrhoea (PAED) takes a comprehensive approach to tackling diarrhoeal disease in children.
Diarrhoea is the third largest killer of children under the age of 5 in Zambia. Every year, children under 5 experience 10.5 million episodes of diarrhoea; over 60,000 are hospitalised, and it is estimated that 15,000 die due to the disease.
The negative impact of diarrhoea on Zambian children is intensified by the weak health system infrastructure and the lack of human and financial capacity. These include: the low doctor and nurse to population ratio; insufficient vaccine cold chain capacity; erratic access to essential medicines; and poor public awareness of appropriate behaviours for lifesaving measures against diarrhoea.
Aims of the CIDRZ PAED Programme
- To accelerate the nationwide introduction of rotavirus vaccine in Zambia. The World Health Organization recommends rotavirus vaccine as part of a comprehensive public health strategy to combat diarrhoeal disease in children. First, PAED conducted a pilot of rotavirus vaccine; in November 2013 rotavirus vaccine was included as routine part of the standard childhood immunisation package in Zambia.
- To improve the clinical management of diarrhoea in health facilities through identifying and addressing bottlenecks in demand and supply of Oral Rehydration Salts (ORS) and zinc tablets, and enhance healthcare staff skills to appropriately manage childhood diarrhoea through training, mentorship and supportive supervision using a government-led and approved curriculum.
- To provide meaningful behaviour change education to caregivers and the community that promotes prevention of diarrhoea through handwashing with soap, exclusive breastfeeding and appropriate use of ORS and zinc.
Building on Existing Infrastructure
PAED is an innovative example of a successful Public Private Partnership that has tackled a complex health system problem and yielded tangible achievements in a sustainable manner.
The CIDRZ PAED Programme plays a catalytic role by leveraging government leadership and political will to combat diarrhoea, with provision of modest seed funding that attracts other funders and stakeholders. PAED is completely integrated within the Zambian Ministry of Health and Ministry of Community Development Mother and Child Health activities aligning with government priorities. PAED operates within the national Expanded Programme on Immunisations (EPI) and our experts train and work with government frontline health workers. Our overall implementation plan is actively supported by both Ministries.
Community involvement has been one of the cornerstones of PAED with initiatives that involve church leaders and Neighbourhood Health Committee members taking a lead role in educating their communities. PAED has also sought support from multiple donors and diversified to areas of water, sanitation and hygiene through partnering with the UNICEF WASH programme.
We work in 105 public health clinics and catchment areas in Lusaka Province serving a total of 2.1 million Zambians. As of 20th July 2014, over 152,149, Zambian infants have been fully vaccinated against rotavirus-caused diarrhoea.
Water Sanitation & Hygiene (WASH)
The CIDRZ WASH project is working with the Government of Zambia, with support from UNICEF through DFiD, to improve equitable access and coverage of hygiene and sanitation practices. Through the implementation of Community-Led Total Sanitation (CLTS) and School-Led Total Sanitation (SLTS) programmes.
CIDRZ WASH will reach out to 150,633 people including 20,589 children through access to safe water, sanitation and hygiene facilities in Chongwe, Rufunsa, Chilanga and Chongwe Districts.
The aim of the CIDRZ WASH project is for districts to attain Open Defecation Free (ODF) status through a collaboration led by communities and schools to sensitise communities, teachers and students about the hazards of open defecation and through construction of appropriate latrines, along with hand-washing facilities.
CLTS is a community-based, cost-effective way of stimulating community responsibility for the construction of latrines and promotion of good hygiene and sanitation practices. It discourages subsidies and supports and promotes community ownership to help themselves to achieve ODF environments through community leadership, understanding and pressure. CLTS costs are minimal once Champions and Environmental Health Technicians (EHTs) are trained in the process of triggering, follow up and verification.
The Government of Zambia, in its Public Health Regulations requires schools to provide proper and sufficient latrine accommodation for students. As per the Interim WASH in Schools Package guidelines, the satisfactory ratio of students to latrine or toilet is 50:1. CIDRZ WASH will undertake activities to ensure that students attend schools with water, sanitation and hygiene access and facilities. The provision of safe, adequate water, hygiene and sanitation facilities in schools coupled with hygiene education will contribute to better health, improved school enrolment and performance, more equitable girl/boy enrolment ratios and decreased absenteeism. It will also reduce diarrhoea and other hygiene-related disease incidence.
Vaccine Cold Chain Scale-Up
CIDRZ is working with the Ministry of Community Development, Mother and Child Health to strengthen Zambia’s Expanded Programme on Immunisation, by assisting in scale-up of the vaccine cold chain system.
Preventing unnecessary death and disease through vaccines is contingent upon a comprehensive vaccine management system, which includes the “cold chain”. Vaccine management encompasses all aspects of delivering vaccines – appropriate stock management, distribution, temperature, storage, maintenance, equipment and transport – ensuring the viability of vaccines at each step from arrival into Zambia until administration to a child. The assurance of the vaccine cold chain system is even more critical as new vaccines come at a higher price than the historically available ones such as BCG for tuberculosis or the Polio vaccine.
Based on a national assessment and in order to bring in new vaccines, Zambia is in need of a massive scale-up of the vaccine cold chain. Through major advocacy efforts, both the National and Provincial level cold chain equipment gaps have been addressed. While great progress has been made, there are still gaps at the district and health facility levels.
Through the Government, with partnership with other organisations and funding from ELMA Vaccines and Immunization Foundation, CIDRZ aims to reduce under-5 mortality through improved access of all eligible Zambian children to new and under-utilised vaccines, as well as traditional ones, through a strengthened national immunisation programme.
Our cold chain strengthening objectives include:
- Equipment: To strengthen district and health facility level cold chain for the introduction of vaccines.
- Logistics: To ensure the safe and efficacious delivery of vaccines at all levels through appropriately trained health workers and logisticians.
- Advocacy/Sustainability: To advocate for improved EPI delivery and monitoring to ensure the successful provision of vaccines and to prepare Zambia for the introduction of additional vaccines as they become available.