Sierra Leone mudslide raises fear of spike in waterborne diseases

ABIDJAN — One week after heavy rains induced a massive mudslide in Sierra Leone, public health experts are focusing on preventative messaging to mitigate the possibility of a disease outbreak. Hundreds are still presumed missing from the disaster, and a highly coordinated emergency response effort is underway.

Rainy season is expected to last until October, increasing the likelihood not only of another mudslide, but also a spike in water- and mosquito-borne diseases, including malaria and cholera. Local health facilities are already reporting an increase in malaria cases, UNICEF’s development communication chief Kshitij Joshi told Devex.

Sierra Leone saw its last major cholera outbreak in 2012, when more than 19,000 cases were reported and more than 250 people died. The country also has one of the world’s highest malaria burdens. The World Health Organization has previously warned that the entire population is at risk.

Pools of standing water and clogged waterways following the mudslide increase the likelihood of these diseases surging. So far, two suspected cholera cases are undergoing testing but have not yet been confirmed, Joshi said.

For now, it’s still too early to tell if the mudslide is triggering health concerns, WHO’s Sierra Leone Spokesperson Laura Keenan told Devex. “It’s possible, though, with people living in temporary sites and not having access to preventative measures, and with the amounts of standing water.”

WHO has led surveillance efforts within health facilities to ensure that health workers know how to identify a potential case of a high-risk disease, how to use rapid testing materials, and when to refer patients to health facilities.  

To ensure that essential health services remain uninterrupted — such as child vaccinations and prenatal care — 20 volunteer doctors have come from other government posts and have been trained to support affected areas.

Ongoing efforts post-Ebola

Following the Ebola crisis, partners including WHO, UNICEF, Sierra Leone Red Cross and Concern Worldwide jointly prepared key messages with the Ministry of Health and Sanitation for potential hazards, including for floods and cholera outbreaks. These ready-to-use guidelines, collected in a messaging book, became the first reference for humanitarian, health and community workers after the mudslide.

“We retained the functionality of these pillars beyond Ebola response so the fact that meetings were happening regularly with partners involved and informed made it far easier to roll out behavior change messages and mobilize community health workers,” Joshi said.

Roughly 150 community health workers who were incorporated into the public health system after Ebola serve as frontline volunteers. UNICEF, in conjunction with the health education division of the Ministry of Health and Sanitation, conducted a one-day refresher training last week on key messages around cholera and malaria, such as the importance of handwashing and bed net use. Health workers are also targeting mothers of children under age 5 to ensure that any water storage — where mosquitoes tend to breed — is removed from nearby living quarters.

“Consistency in messaging across communities is a big shift” in how the response has unfolded, compared with pre-Ebola relief, Joshi explained. Previously, disparate messages from aid groups “sometimes caused confusion,” he said.

Also this year, before the start of rainy season, Sierra Leone saw one of its largest government-led bed net distributions to date — with the U.N., NGOs and community partners giving away more than 4 million in total.

Mitigating risks

Immediate attention is now focused on short-term provisions such as access to pure drinking water and toilet installations. Meanwhile, UNICEF is using the media to share messages about the importance of hygiene.

Joshi pointed to radio spots as a key way to reach people with messaging about how to prevent malaria and cholera. Some spots are using discussion groups where people can phone in with questions about the services provided. A general public health line (117) maintained by the Ministry of Health Emergency Operations Center is also available to mobile phone users.

Certain mobile technologies are resurfacing, after their initial use during the Ebola response. RapidPro, an SMS-based platform, is being used by affected populations and field agents for daily reporting. It is available for basic mobile phones and the SMS is free to send. U-Report, a mobile platform mostly used by youth, allows for real-time community participation and gathering of information about community perceptions.

Starting this week, response efforts have also relied on the support of Muslim and Christian faith leaders, who were tasked by the social mobilization emergency response pillar with relaying messages promoting key behaviors, as well as providing counseling at mosques and churches.

Other responses such as “fogging,” or fumigation — a process by which a mosquito-killing spray is dispersed through the air — are also being considered, after rains have ceased for the first time this week.

“The gaps that still exist are a concern but the systems in place are quite robust,” Keenan said. “They can still be enhanced, but now we are also quite confident that alert systems are working quite well.”

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