WHO Angola Update
Nr. 06 – November-December 2001. Year 1
Angola records improvement
in Polio Eradication
international experts and 18 local technicians
and their subsequent deployment to 16
Provinces, as part of the operation of the
epidemiological antennas. There are now six
antenna
coordination
centres
with
headquarters in Luanda, Benguela, Huambo,
Huíla and Malanje. Another antenna will be
soon established in Cabinda.
Angola recorded significant reduction in the
spread of the wild poliovirus in 2001, when
compared to the previous year. Although the
virus is still circulating, its rate of transmission
has dropped due to the improvement of the
Polio Eradication programme in Angola.
Significant strengthening in planning, mapping,
training of immunisation brigades and social
mobilisation for the NIDs and Sub NIDs
(National and Sub National Immunization
Days).
One of the major concerns still remain how
to create mechanisms to reach out to
children living in areas of difficult access in
order to vaccinate each child, as well as the
extension of the AFP epidemiological
surveillance system to these areas.
These data were presented by the ViceMinister of Health of Angola, Dr José VanDúnem, in Addis Ababa, in occasion of the 9th
Meeting of the Task Force for Immunisation
(TFI), held from 4 to 7 December; as well as at
the 8th meeting of the African Region Interagency Coordination Committee (ARICC). Dr
José Van-Dúnem was the head of the Angolan
delegation composed of EPI technicians from
MoH, WHO, UNICEF, Rotary, USAID and
partners from the CORE group.
Emphasis was laid in Addis Ababa on the
need to improve on routine Polio, BCG,
Measles, Tetanus, Yellow Fever and DPT
immunisation, especially in the more densely
populated Provinces and Municipalities. It
was decided that measles immunisation be
given special attention, as it is one of the
main causes of child morbidity and mortality.
Furthermore,
EPI
held
its
11th
Methodological Meeting in Luanda, 11 - 14
December, to “review the activities carried
out during 2001 and identify priority activities
for 2002”. Apart from Central EPI
Technicians and partners such as WHO,
UNICEF, Rotary and Centre for Disease
Control (CDC/Atlanta) that participated at the
meeting, also attending the meeting were the
epidemiological surveillance technicians, the
social mobilisation officials and the Provincial
EPI supervisors from all the Provinces.
It was reported at this meeting that as at the
end of 2001 only 11 countries are still
endemic with a total of 502 cases, as against
an approximate 350 thousand polio cases
reported in 1988 in 125 countries. In Africa,
only 6 countries are still endemic to the wild
poliovirus, with Nigeria having the highest
transmission rate, followed by Southern
Niger and Sierra Leone. Compared with a
total of 55 wild poliovirus cases diagnosed in
Angola in 2000, only 2 cases were
diagnosed in the country in 2001. This
reduction
was
accompanied
by an
improvement
in
the
epidemiological
surveillance system, which allowed early
detection of AFP nation-wide. To date, 134
AFP cases have been reported, when the
target was 64, which is an evidence of the
enhanced efficiency of the epidemiological
surveillance system.
Emergencies
Regarding emergency preparedness, Angola
has been provided with emergency medicine
kits for IDPs and for the prevention of
possible epidemic outbreaks, such as
malaria. The batch includes 24 boxes of
malaria drugs, consumables and hospital
equipment that will be dispatched, at this
initial phase, to Huila, Huambo, Malanje,
Cunene, Namibe and Luanda. WHO and
MoH drafted norms on the use of such kits
Chief among the factors that facilitated the
AFP epidemiological surveillance system
was the recruitment by WHO of 4
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and disseminated them to all provinces.
food diet, which might result in an increased
malnutrition rate and other communicable
diseases among the IDPs. It was further
noted that the community health services
were not functional due to a dearth of
qualified
personnel
(Technicians
and
Doctors), medicines and consumables. In the
hospital of Wacu-Kungo Municipality, blood
transfusion is done without haemoclassification, HIV and other tests. According
to local estimates, the government
anticipates the provision of these services to
an influx of 15000 IDPs at the end of
December 2001.
A MoH and MSF/F team visited Cunene
Province from 10 – 18 November, to
investigate rumours on the occurrence of
new meningitis cases. In Cahama, Ombadja
and Xangongo Municipalities, the team
visited the municipal hospitals of Cahama,
Chiulo, Caconda, Changalala and Cuamato
health centres, as well as the Humbe Health
Post. At the time of the visit no meningitis
clinical case was detected among the
patients while 1 – 2 suspected cases of
meningitis per day had been reported in
Ombadja Municipality, Cunene Province,
between the epidemiological weeks 36 and
45, making a total of 61 cases and 16 deaths
detected. The same reports indicate that 24
of these cases occurred in Xagongo
commune and 13 in Mucope commune.
The WHO/OCHA/WFP team that initially
visited Waku-Kungo had recommended the
following measures:
The team recommended to immunize 90% of
the local population from 2 – 45 years old
against meningitis and to train for
immunisation brigades in Xagongo and
Mucope communes considered to be at risk
for future outbreaks. 75,000 doses of vaccine
were released for the immunisation
campaigns and one thousand ampoules of
oil chloramphenicol for the treatment of the
cases, while MSF/F provided Slidex for the
laboratory confirmation of meningococcal
meningitis.

Urgent intervention and mobilisation of
other partners, such as NGOs working in
Waku-Kungo, in order to prevent a
catastrophe;

Maintenance of roads and bridges to
facilitate movement by road during the
rainy season;

Deployment of NGOs and UN agencies
to the field.
Acting on these recommendations, a team of
NGOs such as AFRICARE, SCF-UK,
MOLISV and ACM/YMCA, carried out a
more specific assessment of the new IDPs at
Waku-Kungo, consisting of 720 families
(2733 people) living in four registration and
receptions centres.
About 110 new meningitis cases were
reported in July 2001, 100 of which in
Ondjiva, Capital of Cunene Province. In
order to bring this meningitis epidemic under
control, MoH immunised about 85,555
people, with the support of WHO and NGOs
working in Ondjiva, thereby attaining 95%
coverage of the local target population.
In two of the settlements, the mortality rates
were estimated at 2.76/10000/day and
3.8/10000/day during the week prior to the
visit. In spite of the non-availability of a case
recording system, the team identified
malaria, diarrhoea and respiratory diseases,
scabies, worms and schistosomiasis, as the
most frequent diseases in the settlements. A
measles case had been diagnosed three
days earlier.
WHO, in collaboration with MoH and other
partners, is preparing a health services
package to attend to new IDPs during the
first six months; beginning from January
2002.
According to WHO emergency experts, this
health package will help cushion the
suffering of the IDPs, including people to be
resettled.
The MoH team carried out a screening of
122 children and found out that 8.8% of them
suffered from malnutrition. A measles
immunisation campaign was also held for
children under 15 and polio campaign for
children under 5, in accordance with recent
EPI/MoH guidelines.
It was decided to provide an health package
for the IDPs after a technical team of WHO,
OCHA and WFP visited Wacu-Kungo
Municipality, Kwanza-Sul Province, in
November 2001, and assessed the situation
of thousands of people from Bailundo,
Huambo Province.
Apart from other
difficulties, the team took note of the lack of
equipment and materials for safe blood
transfusion; lack of clean water, poor
environmental sanitation and unbalanced
At the end of the mission, four of the above
NGOs prepared an action plan to address
the health problems among the IDPs, under
the direct responsibility of the local
technicians.
In order to improve quality epidemiological
surveillance data and the organisation of
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emergency preparedness, WHO delivered a
number of computers to MoH provincial
directorate in Huíla, Kwanza Sul, KuandoKubango, Namíbe, Uíge and Zaire
Provinces. This was the second delivery in a
plan aimed at reinforcing the institutional
capacity of MoH at the Provincial level.
Earlier, beneficiary-Provinces were Bié,
Huambo, Malanje, Moxico and Luanda.
HIV/AIDS emergency package in Angola,
together with all the partners in the health
sector. The definition of the minimum
package is the initiative of UN Agencies and
some NGOs, while WHO heads the “Inter
Agency Committee”
In Africa, Angola, DRC and Sierra Leone were
selected for the implementation and initial
testing of the minimum package.
Dr Paolo Balladelli, WHO Representative in
Angola, visited Bengo Province on 5
December,
on
technical
mission,
in
collaboration with MoH, the Local Government
and the Provincial Directorate of Bengo,
COSV, INTERSOS, Acção Agrária Alemã,
UNICEF and OCHA. This mission was carried
out as a result of an SOS sent to Luanda on
the health conditions of the 37 thousand IDPs
of the Boa Esperança Camp, Porto Quipiri.
Disease Prevention and Control
Tuberculosis: MoH formed a technical group
to prepare a Strategic Plan to fight
Tuberculosis in Angola. The group is headed
by the Director of the National Tuberculosis
and Leprosy Control, Dr. Conceição Palma,
and is composed of the following members:
Dr. Marilla Afonso, in charge of Infectology
Services at Josina Machel Hospital, Dr.
Joseph Nsuka, Coordinator of Tuberculosis
Project (Cooperazione Italiana), Dr. Abel Silva,
Health Delegate of Rangel Municipality and
Dr. Adolfo Sampaio, WHO/Angola TB control
official. As at 30 June 2001, MoH reported
9,398 TB cases with 357 deaths.
The mission got the following data: 37,044
IDPs in the Boa Vista Camp, 1910 Patients
assisted at the health centre in November,
with 266 pregnant women, 965 children, no
MDs, 2 Health Technicians, 12 nurses and 26
health promoters involved in the services
(available health staff among the IDPs are
144); 108 deaths in October and 51 in
November 2001; 13 patients referred to Caxito
and 3 to Luanda; malaria is a major cause of
death, followed by diarrhoea and measles; the
central water system can only supply one litre
of potable water per day per person.
The group embarked on a survey of all the
health units that screen, diagnose and treat TB
cases in the country.
MoH held a TB Control Workshop in Luanda
from 19 – 24 November, with the participation
of 22 nurses, including Provincial Supervisors,
from 14 Provinces. A visit was scheduled for
Benguela to learn on the Coopération
Française TB Project and study the
replicability of the project actions based upon
the DOTS strategy in other Provinces.
The major concern remains the lack of
latrines, which is factor causing increased
child mortality. This problem might be source
of outbreaks during the heavy rain season.
The malaria epidemic might also severely hit
the IDPs during the rainy season. Acute
malnutrition had been assessed and detected
in 2% of the children. A package of measures
was analysed with the Governor. Among other
recommendations, it included: the immediate
building of latrines; the treatment and
expansion of the water system; the hiring of an
MD and a laboratory technician for activities in
the camp; the supply of malaria drugs, deworming medicine and other pharmaceutical
products for the treatment of infectious
diseases; the immunisation against measles
for children from 6 months to 14 years and the
provision of adequate supplementary feeding.
Meningitis: Between 18 – 26 meningitis cases
and 3 deaths were reported in Huambo,
Kwanza Norte and Sul, Huíla, K-Kubango,
Luanda and Malanje Provinces. From
May/2001, a cumulative number of 1443
cases, 306 deaths and 21.2% lethality rate has
been recorded.
Measles: During the same period, measles
cases and relative deaths has been informed
in all the Provinces the worse outbreaks being
registered in Huíla (107 cases and 23 deaths,
21% lethality), K-Sul (754 cases, 9 deaths and
1.19% lethality) and Uíge (74 cases and 2
deaths). A cumulative total of 5783 cases and
263 deaths has been reached from midSeptember 2001.
A WHO/Geneva mission composed of two
experts in HIV/AIDS and Emergency, was in
Luanda from 10 – 14 December, and hold
meetings with MoH, UN agencies, local and
international NGOs and some bilateral
cooperation agencies.
AFP: 27 cases and 0 deaths were recorded
across the Provinces of Benguela, Bengo,
Cabinda, Huíla, Kuando-Kubango, Kwanza
Norte, Kwanza-Sul, Luanda, Lunda Norte,
Malange, Namíbe and Uíge).
The aim of the mission was to present and
analyse the implementation of minimum
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Tétanus: 10 cases and 8 deaths across
Kwanza-Sul (8 cases and 8 deaths), Cabinda
(1 case) and Moxico (1 case).
Schistossomiasis and intestinal worms:
With the technical assistance of WHO and
funding of Cooperazione Italiana, patients
detected during the first stage Schistosomiasis
and Helmentiasis prevalence study held in
selected schools in Bengo and Luanda
Provinces, were treated. Results obtained
from samples of 495 children between 5 and
15 years old, indicated the following:
HIV/AIDS: About two thousand people, among
whom are Health workers, MPs, religious
leaders, soldiers, youths and workers of
international organisations, participated on 1
December, in Luanda, at the World AIDS Day
March. WHO/Angola Representative, Dr Paolo
Balladelli, marched alongside the Minister of
Health, Dr, Albertina Hamukwaya, as well as
other partners such as Dr. Anthony
Bloomberg, UNICEF Representative and
Chairman of UNAIDS thematic group, the
USAID Representative, members of women’s
associations,
the
FAA
and
youth
organisations.


The Instituto Português de Medicina Preventiva
(IPMP), continues to successfully implement the
HIV/AIDS Counselling, Testing and Treatment
Project in the Cajueiros hospital in Luanda. In
October, the IPMP attended to 117 patients with
the following data: 33.3% had urinary infections,
29.9% - Syphilis, 12.8 – Gonorrhoea, 5.1% - HIV+,
3.4% - Trychomonas, 0.85% - Candidiasis and
0.85% S. Kaposi. It is important to mention that
52.1% of the patients were male while 47.8% were
female. Also the proportion of HIV positive
patients with STDs is higher than observed in
previous studies (1999).
Schistossomiasis: 8.7% of positive,
where 5% had strains of hematuria
during the study and 20.4% during the
last 6 months.
Helmetiasis: 29.5% with Ascaris
Lumbricoides, 14.9% with Trichuris
trichuria,
1.4%
Duodenal
Ancylostomas.
The study shall be presented by a group of
local experts at an International Workshop to
be held in Abidjan, Côte d’Ivoire from 12 – 14
December 2001. The event is the initiative of
WFP/Angola and is funded by the Italian
Government.
Leprosy Elimination: 18 technicians from
Bengo, Bié, Cabinda, Kwanza Sul, Huambo,
Huíla and Luanda Provinces, underwent a 3day training in Benguela on the prevention and
treatment of 1st and 2nd degree disabilities of
leprosy patients. The technicians learnt how to
assess the patients, recognise and treat
complications, teach on how to avoid disabilities
and organise self-care groups.
Angola participated with two experts at the
International
Conference
on
Sexually
Transmitted Diseases (STDs) and HIV/AIDS in
Africa, which took place in Burkina Faso, with
the aim of reviewing the major achievements
recorded in the control of this pandemic, put
forward new strategies and identify priority
areas for the reduction of its impact.
WHO/Angola funded the participation of the
two Angolan experts, namely a Representative
of the Presidency and a Representative of a
local company. Dr Alberto Stella, UNAIDS
Country Programme Adviser, also participated
at this event. Between 1985 and 30
September 2001, Angola reported a total of
8,149 HIV/AIDS cases; i.e. 2,665 men, 3,3174
women and 2,110 unspecified.
Malaria Partnership Increases
A WHO/AFRO technical mission, headed by
Dr Elizabeth Streat assessed the on-going
study on “The Efficacy of Fansidar and
Chloroquine Treatment” in a total of 135
malaria patients at the Terra Nova Health
Centre and Kilamba kiaxi Municipal Hospital,
in Luanda. The overall objective of the study is
to determine the degree of sensitivity of
plasmodium to those anti-malaric drugs. In
Angola, there is still little knowledge on drug
efficacy. Only two studies were carried out in
the country, one by a local MD in 1984 and the
other by an international NGO in 1996.
Oncocercose (River Blindness): Angola
participated for the first time at the 7th Session
of the Forum of African Programme for
Oncocercose (APOC), held in New York from
9 – 13 December. The major objective of this
programme, with headquarters in Burkina
Faso, is the elimination of “River Blindness” in
Africa, where 99% of River Blindness cases in
the world occurs. WHO is the implementing
agency of a world wide programme financed
by the World Bank. The intervention area is
composed of 19 African countries with about
70 million people vulnerable to this disease.
The RBM movement is still to be reinforced in
Angola. After the partnership entered into with
USAID, Exxom Mobile, an oil company, sealed
its commitment to the fight malaria for the next
years in Soyo Municipality. This commitment
was expressed at a meeting held in Luanda at
the end of November between MoH, WHO and
the Municipal Health Directorate of Soyo.
To this end a mission composed of a Malaria
Programme team, the Municipal Health
Directorate of Soyo, WHO and Exxom, went to
Soyo, Zaire Province, where a preliminary
4
survey of the malaria situation was carried out.
Angola records an upwards of a million
malaria cases per year.
New Heights In IMCI
A strategic assessment mission on IMCI
(Integrated
Management
of
Childhood
Illnesses) was in Luanda to assist Angola to
draft clinical and organisational protocols for
the major paediatric pathologies, including
screening and emergency response. This
mission comes on the heels of the first one,
which took place in November/December
2000, during which a situation analysis and a
paediatric healthcare quality assessment of
the area were carried out, especially in
hospitals. The units involved are the Luanda
paediatric hospital and the municipal hospitals
of Kilamba Kiaxi and Cajueiros.
African Countries United against
Trypanosomiasis
The
fight
against
African
human
trypanosomiasis
(sleeping
sickness),
continues to be of focus of the countries that
are the most affected by this scourge in the
sub-Saharan region, where according to WHO
estimates, 300 - 400 thousand people are
infected. With an average of 10,000 cases
p/year, Angola is the country with the second
highest trypanosomiasis transmission rate in
Africa, after Congo Brazzaville and the Sudan.
The other seven African countries, in which
the sleeping sickness is endemic, are
Cameroon, CAR, Chad, DRC, Côte D’Ivoire,
Guinea-Conakry and Mozambique.
WHO launches initiative to assist street
girls in Luanda
WHO Representative, Dr. Pier Paolo
Balladelli, launched on 18th December in
Luanda a new initiative together with the Vice
Minister of Health, to help about 70 street girls
of the “Centro dos Kandengues Unidos” of
Maianga, a group whose majority are sex
workers, at social risk.
Concerned about the prevalence of this
disease, WHO organised a Conference of
African experts in Bangui, Central African
Republic, from 20 – 23 November, in search of
ways to respond to the calamity, which impact,
in some cases, exceeds HIV/AIDS deaths.
The meeting considered the difficulties and
constraints that African countries encounter
while combating trypanosomiasis; mapped the
endemic and the possibility of holding joint
activities between bordering countries. The
ICCT Director, Dr Theophile Josenando, and
the
Zaire
Provincial
Health
Director,
represented Angola at this event.
The initiative has been studied since several
month ago by MoH and WHO as part of a
policy recommended by Dr. Ebrahim Samba,
the Regional Director for Africa, to have the
organisation more operational in the fight to
poverty though small projects that can
concretely help vulnerable groups such as
street children, orphans of HIV/AIDS,
displaced people, etc. Dr. Balladelli donated
in this occasion, in presence of the Minister of
Youth and Sport, equipment evaluated in 32,
000 USD
to assist the street girls of
“Kandengues Unidos” Centre to find
alternatives to fight poverty and to empower
themselves. The donation includes equipment
for ceramics, kitchen, dress making, literacy
and contracts for occupational teachers.
Mental Health Prepares National Strategic
Plan
Mental Health in Angola took the centre-stage
throughout 2001, on World Health Day, 7 April,
World Mental Health Day, 10 October, and at
the “First National Mental Health Conference”,
held in Luanda from 20 – 22 November. The
last brought the WHO/AFRO Regional Mental
Health Advisor, Dr. Custódia Mandlate, to
Angola. At the end of the conference, she
launched the 2001 World Health Report,
dedicated to mental health. Present at the
ceremony, were members of Government, UN
agencies, NGOs, the Diplomatic Corps and
donors that have contributed to the
improvement of the health sector in Angola.
MoH intends to implement a National Mental
Health Strategic Plan for 2002-2006, with the
support of WHO, in at least 7 Provinces, after
having concluded that, “the armed conflict,
social unrests, natural disasters, poverty,
communicable diseases (malaria, meningitis,
AIDS, tuberculosis, among others), as well as
malnutrition, have an impact on the occurrence
of mental disorders”.
Health Human Resources
More Dynamic
MoH is preparing a draft “Human Resources
Operational Plan”. The initiative has the
support of WHO, the EU and the
Cooperazione Italiana. To this end, Dr. Mark
Beesley, a WHO consultant for in-service
training is contributing since 30 October.
The Second Meeting of Ministers of the
Steering Committee for the Regional Nurse
Training Centre, was held in Luanda from 26 –
27 November. The first meeting was held in
Praia, Republic of Cape Verde, in 1997.
The Regional Nurse Training Centre, located
in Luanda, is funded by the EC to train nurses
5
in management of local health centres and
provision of nursing services. The beneficiary
countries of this programmme are Angola,
Cape Verde, Guinea Bissau, Maozambique
and São Tomé and Príncipe. The project is
valued at 2,600 Euros.
-
-
The actions underway shall be concluded
and a timely response be requested for
the extension of the funding agreement.
Hold a PALOPs Nursing meeting during
the first half of 2002.
One of the solemn moments was the signing
of the “LUANDA DECLARATION” by the two
heads of delegation. The declaration
expresses “support of the National Coordinator
for the extension of the funding agreement
from February 2002 to March 2004”.
Participating at this meeting were the Ministers
of Health of Angola and São Tomé and
Príncipe, Representatives of the Ministers of
Health of Mozambique, Guinea Bissau and
Cape Verde, Technicians from the various
countries, as well as experts from the EU and
the “PALOP Programme” Secretariat.
Increasing dynamism in the area of Health
Human Resources was lastly shown when
National Workshop on the development of the
sector was held in Luanda from 6 – 8
November 2001. The meeting was organised
by the National Director, Dr. Evelize Fresta,
with the participation of representatives from
all the Provinces. One of the suggestions
raised at this meeting was to carefully assess
the methods and results concerning the
Lubango Technical Health School, and
propose the same experience to other
provinces
of
the
country.
The following were the recommendations as
approved at the meeting:
Angola shall present a proposal on the
sustainability of the project, based on the
experience from this project.
The multiplication actions shall be compiled
and disseminated in order for them to be more
readily available.
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 and Dr. Arturo Silva, Emergency Action; Dr. Nkunku
Sebastião, Malaria and Trypanosomiasis; Dr. Michel Kouakou, Administration; Marques Gomes, HIV/AIDS
Surveillance Project Coordinator; Adolfo Sampaio, TB Project Coordinator; Bernardino Teixeira, Leprosy
Project Coordinator; Mr. José Caetano, Health Information Officer.
Address: Rua Major Kanhangulo nr. 197 – 7th Floor, Luanda – Angola E-mail: whoang@ebonet.net tels: (2
442) 332398, (1 321 ) 956 38 82; Fax: (2442) 332314
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