WHO Angola Update
June-July 2001
health experts and 1. These antennas have
already become operational within the
Provincial Delegations of Luanda, Benguela,
Malange, Moxico and Huíla. In order to
support the national efforts against Polio and
the other potentially endemic diseases at the
provincial level, WHO appointed 15 national
health technicians who have been posted in
the remaining 13 provincial delegations.
The World Health Organization has been in
the frontline mobilizing technical and financial
resources to empower the health sector and in
doing so, to address health problems at the
community level. Improvement in health
service provision is the targeted and expected
result of these efforts.
In the first phase of the Central Africa
Synchronized NIDs, Angola reached a Polio
coverage rate equivalent to 94% of the
children under 5 years. It is planned for this
year that Angola will synchronise its efforts
with Democratic Republic of Congo, Gabon
and Congo Brazzaville to vaccinate against
Polio 16 millions of children from 0 to 4 year
old. It is of utmost importance to underline that
WHO/AFRO Program Director, Dr Luis Gomes
Sambo visited Angola on July 6 to launch on
behalf
of
all involved
partners
the
Synchronized NIDs.
Furthermore, we have to emphasize the efforts
made by the Government of Angola in making
available financial resources for health both for
primary and tertiary care. This reverts in more
engagement
and
assistance
of
the
international community to the country.
A survey carried recently out by the European
Union concerning fields of cooperation
indicates that in Angola more than 30% of
external grants are devoted to the health
sector.
New partnerships formed by WHO in the last
two months have been created in the following
areas:
Aiming at an increased response capacity in
the humanitarian and emergency field, WHO
has appointed since the end of July 2001, a
paediatrician with public health background to
be based in Luanda. He will support the
international and national efforts in the
prevention of and response to emergency
health situations.
► Polio Eradication Initiative for the year
2001:Contribution of approximately 5.5 million
USD from different partners such as USA, UK,
the Netherlands, Rotary, CDC, etc;
► Strengthening of the National Malaria
Control Program and activities to reduce infant
and maternal mortality in the provinces of
Luanda, Malange and Huambo: Contribution
of 5 million USD from USA for the next five
years.
The IDPs are still considered by the partners
as the main vulnerable group in Angola. They
need a full and constant involvement of all
partners in a coordinated approach. We do
think that WHO can play a major role in
bringing together efforts and synergizing
activities.
► The Leprosy Eradication Initiative: more
than 500,000 USD from WHO/HQs;
In comparison to the year 2000, WHO has
increased its staff from 20 to 70 units, and has
shifted from a centralized presencein the
capital to the provincial level. By doing so,
WHO is responding to the request from the
MoH and the Angolan Government to create
conditions for a more effective response to the
health problems faced by the country.
► HIV/AIDS project for surveillance and
Voluntary Counselling & Testing: 550,000
USD for the next 18 months from the
Government of Italy.
► Surveillance and early response against
epidemics: 200,000 USD from Norway.
In this first semester of 2001, WHO/Angola
expanded its activities in the field through the
opening of five epidemiological coordination
“antennas” managed by 4 international public
WHO/Angola continues advocating for a
greater assistance from all partners, in order to
increase the country response capacity.
1
Integrated Management of
Illnesses (IMCI)
Chloramphenicol (oil) and vaccines had been
requested by WHO and the Health Delegation
of Benguela Province to address this situation.
An emergency health kit was also sent to
Balombo, also in Benguela Province, to assist
10 thousand persons suffering from various
diseases and at risk of meningitis.
Childhood
Provincial workshops were held in July 2001 in
the provinces of Benguela and Huíla within the
framework of the new IMCI approach. The aim
of these workshops was to give information
and orientation about the objectives of the
National Program for Integrated Management
of Childhood Illnesses to 60 technicians
belonging to a number of NGOs engaged in
the health sector. Among them, in the
Benguela province, UNICEF, CRS and the
‘Pastoral da Criança’.
Following the recommendation of a WHO/MoH
multidisciplinary team, which assessed malaria
from 12 to 18 June in the Namibe province,
WHO sent a provision of supplies composed
of anti-malaria drugs and impregnated bed
nets in order to control the outbreak caused by
the floods of April 2001. Approximately 6,000
families have been affected by that natural
disaster. Main strategy for reducing mortality
due to malaria consists of:
Angola participated in the IMCI training for the
Portuguese speaking countries held in Maputo
from 2 to 13 of July. The key aim of the
Angolan participation was to constitute a task
force of national facilitators capable of training
personnel of institutions involved in providing
care to children. During the training in Maputo
two Angolan experts acted as facilitators.
Emergency Response
-
improving diagnostic equipment and
staff skills;
-
providing a timely (less than 24 hours
from the onset of the symptoms)
adequate treatment;
-
promoting the use of bed nets as well
as ensuring use of insecticides.
The Health and nutrition sub-Group held a
special session on 5 of July 2001 in Luanda in
order to become more response-oriented, and,
as such, more effective in a timely manner
addressing acute needs.
In Kuito, Bié Province, a new pellagra disease
outbreak has been declared. Pellagra is
related to deficit in micro- nutrients. In the year
2000, the number of notified pellagra patients
increased from May until the end of October,
reaching its peak at the end of August.
Malaria Control
In Camacupa, Bíe Province, with to the newly
accessible areas, MSF/B reported treatment of
14 pellagra cases in week 25 and 15 cases in
week 26.
The “ Roll Back Malaria” initiative received a
new impulse with the joint technical mission
from WHO/HQs, WHO/AFRO and USAID,
UNICEF. The mission linked up with other
partners and a workshop was organized by
MoH and WHO in Luanda on 17 July to
discuss
the
National
Strategic
Plan.
Government Members, Members of the
National Assembly, Cooperation Agencies and
NGOs attended the workshop. By July 2001,
340,000 cases of Malaria with 2,000 deaths
have been notified by MoH for this year .
This Belgian/NGO opened a therapeutic
nutritional center in Camacupa to implement
nutritional treatment of undernourished
children, referred from Cuemba municipality.
Assistance to undernourished children is done
locally with exception of the serious cases who
need to be transferred to Kuito.
The nutritional situation in Mussende, Kwanza
Sul Province, has been reported as very
worrying; however a deep assessment of the
situation is to be repeated soon. MoH and
WHO are discussing with the FAA how to
overcome constraints in term of access.
According to the survey carried out in May
2001 by the MoH, acute malnutrition rate was
16,1%. The undernourished people were
reported to the MSF therapeutic nutritional
center in Cangandala, Malange Province.
The joint mission also analysed the situation of
this complex emergency and formulated
specific strategies to combat malaria in difficult
areas. The mission, led by the Vice Minister of
Health, Dr José Van-Dúnem visited the
provinces of Moxico and Namibe. In Moxico
the involvement of all partners during the
mission made it possible to recognize that
further assistance for diagnosis, training,
medical supplies and social marketing of
impregnated bed nets is needed for that
province. In Namibe, the strong involvement
from the Provincial Government in the health
sector is showing how helpful this can be in
terms of creating hopes for decrease in
In the first semester of 2001 about 22
suspected cases of Meningitis were reported
with 12 deaths in Benguela. In the first three
weeks of July 22 more cases with 5 deaths
have been claimed to be meningitis.
2
Vaccine-Preventable Disease
mortality from malaria. The already mentioned
contribution of 5 Million USD from the
Government of the United States will allow
WHO and the country to implement a Malaria
control project with two components. On one
hand, the National level will be strengthened
so as to increase its operationally, on the other
hand the project aims at improving the
laboratories and treatment in the provinces of
Huambo, Luanda, Malange. In Luanda, the
project will link up with another initiative to
protect mother and child health funded by
USAID as well.
In Angola, no wild polio virus was isolated in
2001. This represents a success story for the
Polio Eradication Initiative. 60 cases of Acute
Flaccid Paralysis (AFP) have been reported
from January to June 2001; 2 cases due to
vaccine; 4 cases clinically compatible with
Polio; 24 discarded; 15 waiting for the follow
up visit and 15 waiting for laboratory results.
The provinces of Cabinda, Bengo, Namibe
and Lunda-Sul have not reported in a timely
manner the occurrence of APF cases. In order
to strengthen the information system and
quickly report on data regarding the national
epidemiological situation, WHO and the MoH
have established a radio-communication
system. The rational is that health centres can
promptly respond to pre-epidemics situation if
provincial sentinel sites are in place. For that
reason, 18 WHO epidemiological units are
now assisting the provincial Health Delegation.
In June 2001, a workshop funded by WHO
was held in Luanda to train a group of 20
health staff. Laboratory technicians and nurses
from hospitals and health centres learnt about
diagnostic of malaria. The workshop was
organized by the MoH and the Provincial
Health Delegation.
Trypanosomiasis Control
In Angola, 3,657,210 children out of 3,8 million
have been vaccinated in the first NID of 2001.
This is equivalent to an estimated coverage of
94%. 11% of the children were vaccinated for
the first time. The two provinces in need of
more support turned out to be Cunene where
only 21% were vaccinated and KuandoKubango with a coverage of 27%.
On 30 July, in Viana municipality, Luanda the
Institute working on Trypanosomiasis was
visited by the Health Vice Minister province.
Angola reported 42,000 cases of patients with
sleeping sickness over the past 10 years. MoH
and WHO estimate that around 100 thousand
people are affected in the country.
Findings from a survey carried out during the
first NID showed that around 96% of the
houses questioned had been visited by the
vaccinators and 88% of the mothers knew in
advance about the campaign.
Population at risk of contracting this disease
are those residing in the Provinces of Luanda,
Bengo, Malange, Uíge, Zaíre, Kwanza Norte e
Kwanza Sul. The Institute to Combat
Trypanosomiasis (ICCT) has been recently
renovated. The new service of ICCT, whose
staff is comprising of 8 nurses, can provide
hospitalisation to 27 patients. The total
investment for the new wing was of 500,000
USD which have been disbursed by the
Governments of Angola, Belgium and Norway.
According to the Institute Director, Dr.
Theophile Josenando, the ICCT is currently
operating with 10 Angolan MDs and 27
nurses. This Institution carries its activities in
partnership with WHO,
the Portuguese
Institute
for
Preventive
Medicine,
APN/Norway, MSF, Caritas and FUNDANGA.
In the Luanda province the vaccination
campaign reached a coverage of 94% with 7%
corresponding to children with zero doses. A
total of 54 AFP cases out of 68 expected
cases annually have been notified since the
beginning of the year. That corresponds to a
rate of 0.80 per 100,000 which is below the
planned target of 1 case in each 100 thousand
children.
The Second Coordination Committee Meeting
for the Synchronized NIDs in the Central Africa
was held on 14 and 15 June in Luanda. The
meeting was attended by representatives from
the host country, and from DRC, RoC, Gabon,
WHO/AFRO, WHO/HQs, UNICEF and the
other partners.
A team from ICCT carried out a mission in
June to supervise activities in Mbanza Congo
Zaire province. The aim was to assess the
implementation of
the national norms
concerning diagnosis and treatment of
sleeping sickness.
The four countries previously mentioned are
planning to vaccinate 16 million children under
five years during the synchronized campaigns.
A mobile team from Calulu, Kwanza Norte
province attended in Luanda a training course
regarding the diagnosis and treatment of
sleeping sickness.
One week after, another meeting was
organized in Lusaka for the preparation of the
synchronized NIDs in the borders with Zambia
and Namibia. It was an opportunity to
elaborate the micro-plans for the vaccination.
3
The health professionals from Cabinda and
the North of Angola met with their Congolese
counterparts in order to finalize the details of
the vaccination campaign.
NGOs, Italian NGOs, UNICEF, and UNFPA
are collaborating in this project. In a few
months, this initiative will provide the country
with a better understanding of the prevalence
of the disease which is estimated officially to
be currently 3,4%. Other components of the
project include behaviour surveillance and
counselling -voluntary testing.
Both the Luanda and Lusaka meetings
demonstrate the effort made by all of these
countries engaged and committed to the
common objective to stop polio transmission
by the end of 2002 and to be certified as part
of the polio free world by end of 2005. In order
to reach this target, WHO and others partners
are implementing activities that include
capacity
building
for
coordinators
of
municipalities,
strengthening
of
the
surveillance system and country mapping.
185 participants, including military experts,
NGOs and the private sector, attended the
Second National Forum on AIDS which was
held in Luanda from 18 to 20 of June. The
Forum recommended among other measures,
the creation of a multi-sectoral National
Commission under the chairmanship of the
President
of
the
Republic.
WHO
Representative presented in this meeting
projections indicating that Angola would be
able to control prevalence reaching in 2009
6.39% if serious control programs against
AIDS are implemented. Thus saving 275
Million US dollars in terms of expenditures on
treatment without considering the even larger
indirect cost which would be avoided.
Nutrition
From 26 to 28 July 2001, two officers from the
Nutrition and the Reproductive Health
Departments of MoH attended in Harare the
Regional Meeting on the Global Nutrition
Strategy for Newborns and children. A
Technical Meeting on this issue had been
organized by WHO/UNICEF and others
partners in March 2000 in Geneva.
WHO/UNICEF together with others partners
are committed to update the Nutrition Global
Strategy of the newborn and children
elaborated 10 years ago. The Harare Meeting
allowed the adaptation of the abovementioned global strategy to the African
Regions.
Human Resources
WHO provided 5 internal scholarships and
computers equipment for the paediatric
committee of the Post Graduate Medical
School, for a training course for paediatricians
to be held in the Lubango Paediatric Hospital.
This support will allow the provision of the first
two years of paediatrics internship. To
accomplish the above-mentioned training,
three teachers are going to be transferred to
Lubango. This initiative got also a strong
support from the Provincial Government in
Huila.
Disease Control and Prevention
WHO financed two supervisory missions to
four provinces for collecting data on the
incidence of tuberculosis. During the first
quarter of 2001, cases of tuberculosis were
reported in barely 45% of Angola's
municipalities. Comparative data indicates that
3900 new cases have been notified in the first
trimester of 2001 against 590 reported in the
fourth trimester of the last year. No information
is available from Huíla, Kuando-Kubango,
Cunene, Luanda, Lunda Sul and Namibe
provinces.
For the 3rd year students at the Higher College
of Nursing ‘Instituto Superior de Enfermagem’
(ISE) 6 internal fellowships were also
provided. Furthermore, support to 25 students
following the midwifery course in Luanda has
been agreed with ISE.
In the Bengo Province, 20 nursing technicians
are receiving in childbirth assistance. The
Luanda midwifery school is responsible for this
training.
AN HIV/AIDS seroprevalence study of 148
preliminary samples from TB patients at
‘Divina Providência’ Hospital, located in
Kilamba Kiaxi municipality, in Luanda, showed
17 (11.5%) positive cases and 131 (88.5%)
negative cases.
Two MoH technicians attended the advanced
workshop in health management technology
held in San Paulo, Brazil from 3 to 7 June
2001, where issues concerning politic and
strategic planning for hospital technologies
were analysed and discussed.
A project for the establishment of an
epidemiological surveillance system for
HIV/AIDS financed by Italy began on 2nd of
July in Angola. Through 6 sentinel sites in the
provinces of Cabinda, Benguela, Huíla,
Luanda, Malange and Moxico, 25 National
4
elaboration of the Reproductive Health
National Plan. This activity is carried out in
collaboration with UNICEF and UNFPA.
Safe blood
Two technicians from the National Blood
Centre (MoH) attended a course in Abidjan,
Cote d´lvoire on the blood transfusion quality
management from 23 July to 17 August 2001.
After the course, it is hoped that They will
improve methods of assessing the quality of
blood and blood products derivatives as well
as the rational use of blood transfusions.
Epidemiological Surveillance
Constraints exist in Angola when it comes to
reporting of communicable diseases. Data
collection still need to be improved both in
terms of recording and in the flow of data in
order respond in a better and timely manner to
outbreaks of Meningitis, Measles and other
epidemic preventable diseases.
In order to encourage blood donation and
adoption of healthy lifestyles by the
population, WHO organized with MoH and
Ministry of Education a competition among
children for the best drawing on the theme
“Save a life by giving a little of your blood”.
The prizes were given to the winners in a
ceremony conducted in Luanda on 3rd of June
at the Children ´s National Institute. The event
was presided by the First Lady, Mrs. Ana
Paula dos Santos.
Sustainable
Development
Environmental Health
This effort led to the creation of the National
Center
for
the
Epidemiological
Data
Processing. The available data for the months
of May and June 2001 revealed an increase in
the order of 74% of the number of cases and
deaths from meningitis in relation to the month
of May of 2000, in Luanda and Huambo
Provinces.
The health authorities in Luanda are still
analysing the meningitis data in the Prenda,
Paedriatric, Américo Boavida and Josina
Machel Hospitals (see the Chart). A culture of
cerebrospinal fluid needs to be carried out in
the appropriate cases.
and
Throughout June 2001, preparations were
undertaken to ensure the success of the
workshop on the Social Politics for Poverty
Reduction. Aimed at generating concrete
ideas towards governmental strategies for
poverty alleviation, a workshop was organized
by the Ministry of Planning in collaboration
with MoH and Ministry of Education. The WB
and the UN Agencies, NGOs and others
national and international organizations have
been involved as well.
Suspected case of possible Meningitis and
Measles outbreaks have also been reported in
the provinces of Benguela (Balombo and
Bocoio municipalities). Currently a team
constituted
by
technicians
from
the
Epidemiological surveillance teams at Central
and Provincial levels together with WHO are
assessing the situation. Drugs will be
delivered after the assessment is finalized.
WHO assisted in the construction of 5 latrines,
out of which 2 double ones, which were built in
the primary school of Cazenga and
Sambizanga municipalities in Luanda.
In the provinces of Bié, Huambo, Kuando
Kubango, Luanda, Malange and Moxico cases
and deaths caused by rage are still being
reported. In the above-mentioned localities
shortage of anti-rage serum and vaccines was
reported to WHO.
Reproductive Health
A national Ministry of Health technician
attended a Training of Trainers course on
exclusive breastfeeding from 11 to 15 of June
in Sao Tome. This action is in line with the
ongoing exercise led by MoH for the
5
Cases and Deaths caused by Meningitis
Province of Luanda Source: Luanda Hospitals
Elaborated by WHO/MoH - 20 July 2001
Cases of Meningitis
Deaths
Number of cases notified
120
100
80
60
40
20
0
January
February
March
April
Months notified - Year 2001
6
May
June
July