Health Workers Reduce Diarrhoea Cases in Remote Areas

IN THE remote village of Ongengo-Olukonda, a month has passed since 29-year-old Paulina Sem last paid Amalia Johannes (21) and her one-year-old son Vicky Kambau a visit for a health check-up.

Now she is back. Sitting in her hut with Kambau on her lap, Johannes gently measures her son’s upper arm with a coloured plastic tape. The tape is marked in three sections with red, yellow and green to determine whether a person is malnourished or not.

Helped by a nurse who also monitors health extension workers, Sem uses a baby scale to weigh Kambau after the malnourishment examination. She also looks for other vital signs such as the breath rate and heartbeat. When she is finished, she cheerfully gives Kambau a clean bill of health.

Despite dramatic declines in deaths due to diarrhoea and malaria among infants and children in the country, these preventable diseases still remain a cause of morbidity and mortality in the Ongengo-Olukondo village in the Oshana region.

Sem said while conducting census visits she recorded high cases of diarrhoea in the village. About 10 households have had someone suffering from the stomach bug. As a newly qualified health extension worker, Sem is now at the forefront of ensuring that people in her village, especially children under the age of five, will not die of the disease.

She had gone to great lengths to aise members of the community how to stop diarrhoea. She taught them hygiene and how to make simple home remedies to fight infection. She also encouraged villagers to take their children to the clinics to receive immunisation.

“The diarrhoea cases were very high during the time of the census. After combative hygiene promotion the cases went down. Last month I only recorded one, while this month I recorded two,” she explained.

Sem said although diarrhoea cases declined in recent months, she is still hesitant that the preventable disease might come back.

According to the Namibian Demographic and Health Survey of 2013, around 12% of children with diarrhoea do not receive any type of treatment.

With help from health extension workers like Sem, who are dispatched at various remote areas in 11 regions across the country, 59% of children with fever and 64% under the age of five with diarrhoea, are taken to a health facility for treatment.

Although significant progress has been made in child mortality, previous reports highlighted the country may not achieve the UN Millennium Development Goal of reducing child mortality, mainly due to neonatal causes and preventable diseases such as pneumonia, diarrhoea, measles and malnutrition, as well as HIV-AIDS.

UNICEF country representative Micaela de Sousa said: “Namibia has now developed and launched a child survival strategy with a scorecard to track progress.”

She said this strategy highlights the significant role to be played by health extension workers in bringing down child mortality rates in the country to desired levels in 2-3 years time.

In 2013 the Ministry of Health and Social Services, with the support of development partners such as the World Health Organisation and the United Nations Children’s Fund, developed a comprehensive child survival strategy – a monitoring tool to accelerate reduction of under-five morbidity and mortality towards achieving child survival goals, and link to the global commitment “A Promise Renewed”.

The Namibia Child Survival Strategy 2014 -2018 objective is to increase and sustain the integrated delivery of high impact and cost-effective maternal, newborn and child health and nutrition interventions. It aims to reduce the under-five mortality rates from 54 in 2013 to 39 by 2015, and to 24 by 2018 and below 20 by 2035, as part of Namibia’s regional and global commitment in child survival initiatives.

Ministry of health permanent secretary Andrew Ndishishi said with extended health services provided through the health extension programme, the child survival strategy will save the lives of children and mothers.

“All concerned partners can overcome the child survival challenges in Namibia when there is a concerted effort,” he said.

Oshana regional health director Sakaria Taapopi said health extension workers have taken up the important role of being health surveillance agents in communities in Oshana.

“They are mindful of disease prevalence in their communities and can connect with the health facilities to ensure relevant support is given to prevent disease spreading and also to give curative support,” said Taapopi.

The health extension workers programme was started in 2010 by the health ministry, with technical support from UNICEF, USAID, WHO and other stakeholders. It was introduced not only to improve the links between the health facilities and the communities, but will also increase the demand for child survival interventions, particularly in remote areas.

Hygiene promotion through tippy taps and latrine coverage.

About 20 kilometres away, another health worker, 29-year-old Ester Jasfati, has also experienced some cases of diarrhoea.

According to Jasfati she realised that the spread of the disease was caused by the fact that some households did not have facilities for adults and children to wash their hands after using the latrine or after playing outside.

The number of cases reduced, however, with the use of tippy taps, a simple and highly economical technology used to encourage hand-washing in the villages. She said households have installed taps in their homesteads and close to latrines.

The tippy-tap primarily consists of a container that releases a small amount of water each time it is tipped. This low-cost gadget is hands-free and reduces the transmission of bacteria as the user touches only the soap.

“The use of tippy-taps inside households certainly helped reduce the infections a great deal. Households that were most hit by the infection were very cooperative,” said Jasfati with a smile.

“So far this month about five families installed tippy-taps. I think it is safe to say that there are more than 20 houses that have done so. I made sure that they all knew about the tap system and the different ways of installing them.”

In the event of households not having soap, they can use ash as an alternative detergent to kill germs.

Health worker Asteria Shaanika who serves the Emgombe village in the Uuvudhya constituency, said she encouraged community members to build toilets to promote personal hygiene.

“It is common for some households to not have toilets, as most of them use the bush to answer the call of nature. When they return, they mostly forget to wash their hands,” she said. “As a result, preventable bacterial diseases surface and cause substantial mortality.”

Source : The Namibian