Angola Update - DOC

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					                       WHO Angola Update
                      Nr. 05 – October 2001. 1st year

WHO Country                  Cooperation                control efforts, reinforce AFP epidemiological
                                                        surveillance        and     use       inter-personal
Strategy ( CCS )                                        communication as a tool for social
        A     mission      from     the   WHO                     WHO Angola technical staff, including
headquarters in Geneva and WHO/AFRO was                 the       14      epidemiological       surveillance
in the country from 1 – 7 October 2001 to               technicians recently posted to the Provinces
begin the preparation of the WHO Cooperation            and officials from various MoH Departments,
Strategy with Angola. The aim of this first             reviewed the current state of polio eradication
mission was to start a dialogue with the                activities in the country. To this end a seminar
government and all the partners in health               was held in Luanda on 25 and 26 October, as
development, evaluate the situation of the              part of the recent WHO retreat, with the aim of
health sector and draw up an initial draft              identifying the implementation constraints of
cooperation strategy, as well as the initial            the antennas set up in the 18 Provinces and
administrative      implications      on     the        reinforcing technical assistance to health
Organization.                                           programmes in Angola.
        WHO started this process, which shall                     Also present at the meeting were Dr.
cut across all countries in the six different           Babanyi, Coordinator of the Polio Eradication
regions, in order to consolidate its cooperation        Initiative in the WHO African Region, Dr.
and technical assistance policy. Angola was             Rigobert Adegbini of WHO/AFRO, Dr. René
one of the first 8 countries selected for the           Van der Werd of WHO Geneva and Dr. Steven
implementation of the process.                          MacLaughlin of CDC (Center for Diseases
        The strategy-drafting period is 20              Control), USA. Under specific discussion was
weeks. The second mission to Angola is                  the integration of the technicians at Provincial
scheduled for February 2002.                            level as well as the role that they have been
                                                        performing in supporting the Polio Eradication
Vaccine-Preventable Diseases                                      In the conclusions approved at the
                                                        end of the meeting, the delegates noted
         Angola participated in an assessment           improvements in the surveillance indicators in
meeting of experts from the 5 countries of              the last six months, as well as a better
Central Africa that are carrying out joint polio        performance in the organization of polio NIDs.
eradication activities, which was held from 11                    The implementation of “Kick Polio Out
– 13 October in Kinshasa, DRC. The meeting              of Africa” initiative, has started in 1995 with the
was to assess the outcome of the last joint             support of WHO, UNICEF, USAID, Rotary
cross-border NIDs during which about 17                 international, DFID/GB, CDC/Atlanta, CORE,
million children of 0 – 5 years in Angola, DRC,         the governments of Holland and Portugal,
Congo       Brazzaville   and     Gabon     were        Odebrecht, among other partners.
         The Angolan delegation to this
meeting included Dr. Fátima Valente, WHO                         Disease Prevention
Angola Head of Polio team, Dr. Rui Gama                             and Control
Vaz, EPI experts and polio initiative partners.
         The meeting also helped to define              Malaria Control
coordination mechanisms for the NIDs
planned for 2002.                                               Angola was part of a committee of 8
         With the assistance of the bordering           African experts appointed to draft a study
countries, NGOs and the FAA (Angolan Armed              protocol on the economic impact of Malaria in
Forces) in the coverage of inaccessible areas,          Africa. Dr. Basílio Cassoma, National Malaria
3.9 million children were immunized during the          Control Program (NMCP) expert and Angolan
last NIDs in Angola.                                    representative in the committee, informed that
         In    Kinshasa,     the    participating       the country already has its own protocol, which
countries were encouraged to continue quality           shall be implemented by WHO/AFRO in 2002.

According to data available from a study                        Angola received a 20 thousand
carried out by two Angolan experts, Dr. Raúl           Dollars worth free batch of DFMO, a medicine
Feio and Dr. Filomeno Fortes, the annual cost          applied on patients at the critical stage of the
implication of malaria in Angola is 125 million        disease, in October.
Dollars.                                                       Furthermore, as part of the Leprosy
          The special joint RBM and IMCI group         Elimination     Initiative, MoH        promoted
met in Harare on 25 – 28 October 2001, as              awareness campaigns for the implementation
recommended at the first meeting of the group          of a project for the coverage of 80% leprosy
in 2000. Multilateral and Bilateral Cooperation        patients in the country, using the therapy
bodies, NGOs, private sector and research              recommended by WHO. MoH, WHO and ILEP
institutions participated in the meeting. Angola       NGO held workshops on capacity building and
was represented by 3 MoH technical staff. The          planning actions for increased geographical
meeting served as a forum for information              coverage with the MDT (Multi Drug Therapy).
sharing between countries and to evaluate              MoH technicians from different Provinces
progress made in the implementation, as well           converged in Luanda and Lubango.
as review the achievements and consider
challenges faced in the general application of             Emergency Preparedness
the strategies.
          An AFRO/SAMC technical mission                        Two inter-country epidemiologists for
supported the National Malaria Program from            Southern Africa and the Great Lakes Region,
18 – 02 November 2001. Activities to be                Dr. A. Mammo and Dr. N. Ndayimirije,
carried in the next months include provincial          respectively, undertook a technical mission
working missions for the preparation of                from 21 September to 03 October 2001 to
provincial malaria epidemic control plans and          assess the meningitis epidemic that occurred
technical capacity building workshops for the          in Benguela, Cunene, Kuando Kubango and
prevention, preparation and early detection            Luanda Provinces, as well as to propose
and response to the epidemic.                          solutions for it. In Luanda, the mission
                                                       participated in a special review session of the
                                                       epidemic that was chaired by the National
Trypanosomiasis and Leprosy                            Public Health Director, Dr. Adelaide de
         Control                                       Carvalho. The outcome of the review of the
                                                       epidemic from 1994 – 2001 and the meningitis
         A new form of oral treatment of               control statistics were presented at this event.
trypanosomiasis based on a new Pentamidine             The meeting also witnessed the participation
molecule “DB289”, has been undergoing tests            of the officials from Hospitals, MoH, FAA
in Angola, since October 2001, on 30 patients          health sector, health-related UN agencies,
at the first stage of the disease admitted in a        NGOs and Churches. The WHO team
referral center of Viana Municipality. Apart           recommended at this meeting that the national
from the oral application, the new treatment           epidemiological surveillance system be
has the advantage of being applied in just five        reinforced and that studies on the
days, as against a minimum of seven and                characterization of the meningitis situation be
maximum of 10 days required by the                     continued.
intramuscular method hitherto in use. The                       WHO/AFRO consultants also visited
study is being carried out together with the           some Municipalities in Luanda, as well as in
Swiss Tropical Institute of Basileia and North         the Province of Cunene, one of those affected
Carolina University, USA. Angola has reported          by the epidemic, where they gathered data on
42 thousand sleeping disease cases in the last         the illness. During the campaign that involved
ten years. Treatment for sleeping disease is           WHO, MSF/F, MoH and the Provincial
free and the government with WHO takes care            government, more than 70 thousand people
of all medicine procurement costs.                     between 2 – 40 years were immunized against
          WHO is developing international              meningitis.
efforts      to    help      countries   where                  MoH reported 41 new cases and two
trypanosomiasis is endemic, as is the case of          meningitis-related deaths in the six Provinces
Angola, and has got a guaranty of 25 million           between 14 – 20 October. Between May and
Dollars      from    Adventis,      a   German         October this year, Angola had a cumulative
pharmaceutical company. Adventis has                   figure of 1219 cases and 277 meningitis-
accepted to supply medicines free of charge to         related deaths. The six affected Provinces are
countries where the disease is endemic for the         Benguela, Cunene, Kuando Kubango, Bié and
next five years, such as Pentamidine,                  Zaire.
Melarsoprol and DFMO. Also, support for the                     With aim at facing this situation, the
production of new pharmaceutical products              Provincial Committee on Potential Epidemic
and research on medicine combination and               Disease decided to embark on a meningitis
field surveillance shall be guaranteed.                immunization in Menongue Municipality of
                                                       Kuando Kubango Province. MSF/S together
                                                       with MoH, WHO, ACF and INTERSOS

immunized 55.775 people between 2 – 30                         The “Kitandas on SIDA” is a launching
years old, (65% of the total population).              pad for the commemoration of the WORLD
         12 vaccinators, 24 assistants, 36             AIDS DAY. Taking part in this initiative are 6
registrars, 48 to organize the queue, 6                local NGOs, namely AALSIDA, ANGOBEFA,
supervisors and one cold chain manager                 ANATENO, MAR, RAIO and MAS, as well as
embarked upon this action which last 6 days.           WHO technicians and Municipal authorities.
The immunization achieved 82.1% coverage               During this activity, workshops were held on
or 76.1% in the suburbs and 85.5% in the city          HIV/AIDS and health education materials such
center.                                                as posters, condoms and audio-visual
         Another epidemic that equally drew            materials were promoted.
the attention of the national health authorities               As part of the preparation for the
was measles, which recorded 257 cases and              World AIDS Day, regular meetings have been
17 deaths. The outbreaks occured in Bengo,             held under coordination of the Honourable
Bié, Cabinda, Huambo, Huíla, Kuanza Sul,               Vice-Minister of Health, Dr. José Van-Dúnem.
Kuando Kubango, Luanda, Malange, Moxico,               Local    and     International   NGOs      and
Uíge and Zaire Provinces.                              governmental bodies are participating in these
         The humanitarian crisis was still on          meetings.
focus in Bengo, 60 kilometres from Luanda,
because of the deterioration of the security               Environmental Health and
situation in the Nambuangongo Municipality,
from where thousands of people have been                   Sustainable Development
fleeing to more secure areas since September
this year.
         According to the Local Administration,                 In October, the Environmental Health
about 35101 IDPs, corresponding to 9763                Program of the National Directorate of Public
families, were concentrated in the “Cambambe           Health commenced the building of 6 double
II IDPs Camp” (Porto Kipiri Commune) that is           latrines and water reservoirs in 3 primary
located a few kilometers from Caxito capital of        schools in the Municipalities of Cazenga and
Bengo. Daily arrivals have been informed and           Kilamba Kiax in Launda in collaboration with
more IDPs and more than 20 thousand people             some local NGOs.
are expected from the same area in the                          The Environmental Health Program of
coming days.                                           MoH and the Provincial Directorates of Public
         On 12 October, a multi-disciplinary           Health of Kuanza Norte and Kuanza Sul are
MoH and WHO team visited the “Cambambe II              building latrines for schools and IDPs areas,
IDPs Camp” for a rapid assessment of the               aiming      at    improving    conditions  of
health and nutritional situation of the                environmental hygiene and sanitation.
population hosted there. The team together
with the government and the local partners                              Nutrition
established guidelines for the improvement of
the health situation of the IDPs.                               MoH is carrying out community-based
         In the “Cambambe II IDPs Camp”, the           nutritional rehabilitation programs for children
IDPs are assisted at an improvised tent health         under 5 years belonging to economically
post that is managed by “COSV”. The serious            underprivileged families in Moxico Province.
cases are referred to the Açucararia de Caixão         This project has the participation of MINARS,
Hospital. An unspecified number of cases of            Churches, as well as NGOs, namely “Save the
Measles, Malaria, Scabies and diarrhea have            Children Fund”, LWF, CAPDC and MSF-
also been reported among the IDPs. The                 Belgium. The actions are carried out in the
mission noticed that the environmental health          Intensive Nutritional Centre, at the Nutritional
and hygiene were deficient; most of the people         Feeding Centre and in 27 PICs and
defecate in open air and there are breeding            Community kitchens. High among the
grounds for mosquitoes, plasmodium vectors,            constraints identified by the National Nutrition
around the camp. This situation is expected to         Programme are the lack of potable or pipe
worsen during the rainy season. The water              borne water in the Nutrition Centres and
supplied through water-tanks is insufficient.          community kitchens and non-compliance with
                                                       the national norms for the Intensive Centre by
                HIV / AIDS                             some NGOs.
                                                                A seminar on integrated nutrition was
        ANASO, network of local HIV NGOs,              held in Malange with the participation of 24
organized various “Kitandas on SIDA”, on 13            people including technicians from MoH, NGOs
October 2001 at “Roque Santeiro” the biggest           and journalists. This meeting was held to
market in Luanda, as a way of promoting                analyze the multi-disciplinary nature of
greater awareness on the disease. As at July           nutritional problems. Also discussed were the
2001, MoH had reported 7,607 AIDS cases,               biological aspects of micronutrients as well as
whereas UNAIDS estimates of 1999 indicate              the development of practical activities in health
150 thousand HIV carriers in Angola.

institutions, MoH and other CARITAS and             A national course on nutritional survey was
MINARS centres.                                     held by ACF (Acção Contra Fome) at the
          As part of the framework for the          premises of DNSP in Luanda. Participants at
implementation of WHO Operational Plan for          this course included six technicians including
the African Region, an Inter-country workshop       two from the national nutrition program, two
on Nutrition in Emergency Situation, was held       from the Directorate of Luanda, one from
in Kigali-Rwanda, from 9 – 12 October. Apart        Minars and one from INE (National Statistics
from WHO, other agencies namely UNICEF,             Institute). The duration of the course is six
UNDP, FAO, UNHCR, Save the Children Fund            months and it shall train the six technicians on
and NUTRIPA attended the workshop. The              how to carry out nutritional surveillance survey
aim of the workshop was to reinforce correct        and nutritional data analysis. This course was
local management capacity for nutritional           supported by UNICEF.
problems in situations of emergency. Angola
was represented by Dr. Paulina Semedo,
Director of the National Nutrition Programme.


Technical Team:
Dr Pier Paolo Balladelli, Representative; Dr Rui Gama Vaz, Team Leader/Polio; Eng. Gabriela
Guerra, Environmental Health; Dr Balbina Félix, Disease Prevention and Control; Dr Dalva Barros,
Human Resources and Reproductive Health; Dr Domingos Nsala e Dr Arturo Silva, Emergency
Control; Dr Nkunku Sebastião, Malaria e Tripanossomiasis; Dr. Michel Kouakou, Administration;
Marques Gomes, HIV/AIDS Surveillance Project; Adolfo Sampaio, TB Project Coordinator;
Bernardino Teixeira, Leprosy Project Coordinator; Mr. José Caetano, Health Information Officer.
Address:   Rua      Kanhangulo nr. 197 – 7th floor Luanda – Angola
                  Major                                                                    E-mail:, Tels: (2 442) 332398, (1 321 ) 956 38 82; Fax: (2442) 332314