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The fight against cholera and other diarrheic diseases in West and Central Africa (Dakar, 14-16 May 2008)

Young girl being treated for cholera in Pointe Noire, Congo (2007)
© UNICEF/Brigitte Helali

Workshop: Towards an integrated risk reduction strategy in the fight against cholera and other diarrheic diseases in West and Central Africa
Dakar, Senegal, 14-16 May 2008

Organized jointly by WHO & UNICEF, the workshop flows from the Cholera & Diarrheic Disease Initiative conducted by UNICEF at the West and Central African regional level in 2006 and the regional workshop organized last November 2007 by IRC and CREPA related to Governance, transparency and responsibility in water, hygiene and sanitation.  The objective is to develop integrated and concerted strategies against cholera and diarrheic diseases in the region.  Outcomes should help to define a framework for prevention, responses and preparedness strategies.  It will draw a first methodological guideline to help develop cholera reduction national plans and to support regional countries in the elaboration and implementation of such programs.  It will also support enlarged collaboration between partners.

Since the first cases in 1971 in West and Central Africa, cholera has become endemic in many regions.  Since 2000, governmental and humanitarian actors have faced outbreaks in most countries in the region.  In 2006 only, more than 230,000 cases were reported, corresponding to an 87% increase compared with 2005.  This represents almost 99% of total cases officially notified by WHO.

In order to maximize the prevention, response & preparedness programs in the context of resource scarcity, targeting the most vulnerable populations is required.  Cholera risk reduction programs should be supported by an efficient surveillance system and by a solid strategy of risk factor identification. Outcomes of risks management can be efficient if programs combine multidisciplinary and concerted approaches, including the participation of implicated population and the coordination of national programs.  Programs should be embedded into national strategies for drinking water supply, sanitation and hygiene promotion, as well as addressing specific cross-border dynamics.  Additionally, risks reduction programs should demystify and rationalize the cholera image for governments, public health stake holders, as well as media and the population.

There is numerous and complex questions to be solved before the implementation of efficient programs:  how to prevent cholera outbreaks?  What are the main risks factors? Which zones to prioritize?  What are the best actions to undertake?  How to measure the impact?  How to include cholera risks reduction program into current national programs?  How to insure the coherence between different geographical levels, i.e., regional, national, community, especially in the context of decentralisation? Those questions will be addressed during the workshop in three steps, devoted to three distinct themes: 

  1. Identification of risks factors
  2. Strategies of risks reduction
  3. Risks management and partnership.

For each theme, presentations will be given and working groups will be formed to work on essential issues to define risks reduction strategies.  Three working groups will be formed along distinct geographical zones will be treated by the working groups:  Sahelian, coastal, and lake.

  1. Identification of risks factors: Elaboration of risks reduction program should be supported by accurate identification of: 1) risks factors - environmental, socio-demographic, political and socio-economical factors, 2) trigger and propagation factors, 3) infection risk zones, and 4) most vulnerable groups.  This identification will be based on multifactor, historical, epidemiological analyses including cross-border dynamics.  It should help to develop priorities (group work 1) and to highlight limits and constraints of surveillance systems (group work 2)
  2. Strategies of risks reduction:  Elaboration of a risk reduction program should be supported by efficient activities targeting diarrheic diseases reduction: individual and food hygiene, sanitation, access to potable water, domestic storage and treatment of water, etc  Presentations will focus on examples of programs and on an anthropological study.  Working groups will first prepare a general frame of cholera risks reduction strategies (group work 3) and adapt it to each of the 3 regions (group work 4).
  3. Risks management and partnership: Local actors involved in risks reduction programs will present their experiences defining and coordinating national programs establishing functioning partnerships.  Role play will then be used to help imagine ways to improve actual institutional partnerships.



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