MSF in Nigeria: 2017 Medical Report

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Š Maro Verli Š Maro Verli

Doctors Without Borders (MSF) operational centre Paris

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JAHUN PROJECT

Jigawa state

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­ ( ) ­ ( ) ­ ( ) ­ ­ ­ ­ ( ) ­ ­

© Maro Verli © Maro Verli

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• ( ) • ( ) • / / • ( ) • ( ) • ­ • ­ ( ) • / • / • / / • • ( ) • ­ ) / ( ) ( ) ( ) ) ( ) ) ­ % ) ( ) ) % ) / / /

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%

%

%

%

%

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%

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%

(%)

%

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• % ­ (

­ ­) ­ • ­ ­ • ­ % ­­ ( % %) ­ /

Admission trends , MSF Jahun maternity:2009-2017 1400 2011

1200

2012 Number of admission

1000

2013

800

2014 2015

600

2016 400

2017

200 0 J

F

M

A

M

J

J

A

S

O

N

D

% ­ % ­ % ­ % % ­ % ­ ­ %

% ­ ­ ( ) ­ ­ ­ % % % % % % ­

© Maro Verli

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• 8,301 women delivered in Jahun Maternity in 2017 compared to 7,138 in 2016, 16% of the increase. This number represents a monthly average of 692 deliveries per month in 2017 versus 595 in 2016 and 653 in 2015. • 1,801 C/S were performed in Jahun in 2017 (proportion of C/S is 22 %) compared to 20% in 2016 and 19% seen in 2015. Indications of C/S: 22% due to cephalopelvic disproportion; 20% to antepartum haemorrhage and 16% prompt delivery of pregnancy. • The stillbirth rate remains very high: 1,379 in 2017 (16%) compared to 17.1 % in 2016 and to 17.2 % in 2015. This year we recorded 109 intrapartum deaths while FHR was present at admission. This means that one over six women delivering in Jahun will give a stillborn baby.

• 1,406 admissions recorded in ICU in 2017 (average of 117 admissions/month); compared to 1,141 in 2016 and 1,238 in 2015. • 1,227 exits recorded in 2017 of which 96 deaths, 76 referrals and 4 defaulters. • The mortality rate in the unit was 6.8% compared to 5.5% in 2016 and 5.7% in 2015). • The major morbidities seen in the ICU remains hypertensive disorders (eclampsia & severe pre-eclampsia) with 31% of cases; hemorrhage (APH + PPH) with 17% of cases, Anemia with 13 % of cases; sepsis with 7 % of cases; Ruptured uterus with 5% of cases and pulmonary edema with 4 % of cases.

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• 1,894 newborns were admitted to NBU in 2017 (46% of increase) compared to 1,293 in 2016. Average of 158 admissions /month in 2017 versus 108 admissions/month • 1,814 exits recorded in 2017 compared to 1224 in 2016: 82.5 % were discharged home, 6.2% defaulted, and 1.4% newborns were referred to the tertiary facility. • In 2017 the mortality rate in NBU was 10 %. Compared to 13.1% in 2016, to 17% in 2015 and 22% in 2014. The decrease in the mortality rate is due, to the proper follow up of admission criteria, the training received from the neonatologist paediatrician, also the international training for some neonate staffs. The average length of stay was 4.9 days and bed occupation rate of 98 %.

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Jan 141

Admission <2500gr (<1500 gr) Total Exit 125 Defaulter 7 Deceased 14

Feb 148

Mar 215

Apr 146

May 136

37(0)

56 (3)

34 (3)

127

221

144

139

6

15

18

13

24

Jun 163

Jul 118

Aug 138

33(6)

44(6) 90 (16) 52(4)

161

110

132

191

161

159

171

8

7

6

11

23

6

5

2

10

23

19

11

7

21

14

13

15

40 (7) 67(10)

Sept 201

Oct 160

Nov 178

Dec 186

96 (6) 82(14)

Mortality rate (%)

11.2

10.2

10.9

6.9

16.5

11.8

10

5.3

11

8.7

8.2

8.8

BOR (%)

68

103.4

121.8

118.8

115.4

101.8

86.1

82.7

101.9

95.9

75.7

102.1

ALOS (days)

4.6

5.5

4.6

5.5

5.8

5.5

5.5

4.4

4.7

4.2

4

5.2

­

•

• ( ) . Admission

Jan 47

Feb 38

Mar 43

Apr 38

May 47

Jun 29

Jul 31

Aug 21

Sept 32

Oct 56

Nov 29

Dec 29

Tot 440

Exit

53

38

36

44

43

31

22

39

19

37

32

27

421

BOR* (%)

83

87

85

81

74

77

78

71

50

82

82

78

77

ALOS** days)

29.5

35.3

33.6

26.6

30.3

34.9

51.7

26.7

38.5

41.8

39.5

44.6

34.8

• • • • • ( • ( ) % % % %

© Maro Verli

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VVF Repair

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sept

Oct

Nov

Dec

Number of discharge

41

33

23

24

21

19

21

30

14

14

24

21

Closure rate (%)

80

75

80

59

72

84

75

74

95

100

90

74

Continence rate (%)

80

63

59

49

36

84

47

74

91

87

74

74

Total Cases

8

1

0

2

3

2

1

2

0

0

0

3

Closure rate (%)

88

0

N/A

100

75

100

100

50

N/A

N/A

N/A

100

Continence rate (%)

88

0

N/A

100

75

100

100

50

N/A

N/A

N/A

100

RVF Repair

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VVF Repair

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sept

Oct

Nov

Dec

Number of discharge

18

7

23

24

18

14

22

9

11

28

18

9

Closure rate (%)

100

100

100

80

100

100

100

100

90.9

92.8

100

100

Continence rate (%)

88.89

85.71

100

60

94.44

100

100

100

90.9

71.4

88.8

100

Total Cases

2

0

3

0

2

2

0

0

2

0

1

1

Closure rate (%)

100

N/A

100

N/A

100

100

N/A

N/A

100

N/A

0

100

Continence rate (%)

100

N/A

100

N/A

100

100

N/A

N/A

100

N/A

0

100

RVF Repair

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ƒ % Manual Vacuum Aspiration 13% versus 20% last year

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• • ­ • % ­ % % % • ­

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Screening test

No- of donors tested

Positive results

HIV 1

10,872

991 (9%)

HIV 2

10,872

280 (3%)

Hep. B

10,872

1152 (11%)

Hep. C

10,872

101 (1%)

Syphilis

10,872

287 (3%)

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MSF doctor in BEMONC in Aujara city

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% ­ ( % ) ­ ­ ­ ( % % ­ % ) Monthly trend: 1st ANC, deliveries Aujara PHC 2017 700

Number of delivery

600 500 400 300 200

Number of delivery First ANC

100 0

J

F

M

A

M

J

J

A

S

O

N

D

­ ­ ­ ­ ­ ­­ ­­ %

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MSF Emergency preparedness and response team trained Jahun Medical Activity Manager on epidemic surveillance system. No response to epidemics in 2017 in Jigawa State

Š Maro Verli

Patients are preparing for the physiotherapy session

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PORT HARCOURT PROJECT Rivers state

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Indicators

2015 (from June)

2016

2017

New cases

190

643

876

New cases per month

28

54

73

Number of Consultations

N/A

2491

4099

Number of Referrals

8

19

56

( ) %

( %, © Maro Verli ) / ( % ) % %

% (< ) % % %

%

%

%

%

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/ Age distrubution of survivors by age group (year) in Orogbum clinic 2017 0% 10%

 Â€ Â?Â? Â? ˆ  Â€ ‘ € ­   Â€ ˆ € Â?ƒ Â?‰ ˆ  Â€

12% 0 -5 y.o

13%

23%

6 to 10 y.o 11 to 14 y.o 15 to 17 y.o 18 to 25 y.o 26 to 45 y.o

28%

14%

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ELIOZU

Jan

Feb

Mar

Apr

May

Jun

Jul

Aug

Sept

Oct

Nov

Dec

2017

Number of New Case

56

63

71

42

69

92

71

70

71

57

58

48

768

% of Minor <18y.o

64

62

66

57

62

62

58

68

65

60.8

57

60.5

61.9

% of Male survivors

7.1

1.6

5.6

4.8

2.9

3.3

7

0

0

3.5

3.4

0

3.3

Patient coming < 72 hrs commenced on PEP (%)

85

81

90.5

83

97

91

94

92

91

71

80

82.1

87

Previous Sexual Assault (%)

36

47

39

40.5

38

31

44

39

47

45.6

31

41.7

39.5

Multiple Assailants (%)

20

17.5

27

40.5

23

26

21

26

16

22.8

29

18.8

23.6

ToP provided/ Requested

5/5

1/1

1/1

0/1

1/1

1/2

1/1

3/4

2/4

2/2

6/7

3/3

26/32

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/ OROGBUM

Aug

Sept

Oct

Nov

Dec

2017

Number of New Case

18

19

20

26

25

108

% of Minor <18y.o

50

63

50

58

56

55.7

% of Male survivors

5.6

0

5

11.5

0

4.6

Patient coming < 72 hrs commenced on PEP (%)

100

100

83.3

81

91.7

89.8

Previous Sexual Assault (%)

33.3

31.6

35

53.8

48

41.7

Multiple Assailants (%)

27.8

15.8

25

26.9

20

23.1

ToP provided/ Requested

0/0

01-Feb 02-Mar 02-Feb 01-Jan

… % „ † ‚ ‡ � ‚ �

06-Aug

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Š Maro Verli

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Š Maro Verli

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A patient and victim of sexual violence is sending her message for the victims to speak out and let the shame and the anger go. Š Maro Verli

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EMERGENCY PREPAREDNESS & RESPONSE TEAM

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•

­ ( )

–

• • /

• •

• •

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•

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PHARMACY

( ) ­ ­ • ­

• • ­ • ­ •

Order Number

Total Cost (Euro) Jahun Project

17/017/FR/NG116

359,215.63

17/029/FR/NG116

40,462.00

17/041/FR/NG/116

30,991.38

17/042/FR/NG116

5,930.36

17/043/FR/NG116

403.34

17/046/FR/NG116

208,585.13

17/051/FR/NG116

163.54

17/055/FR/NG116

5,534,43

17/061/FR/NG116

27,593.20

17/065/FR/NG116

3,245.81

17/067/FR/NG116

502,954.74

17/067/FR/NG116-2

232,007.32

17/068/FR/NG116

293.8

­

Port Harcourt Project 17/016/FR/NG117

10,019.75 21,484.06 23,851,46

17/057/FR/NG117 17/070/FR/NG117

EPREP 17/028/FR/NG149 17/047/FR/NG149

Total

13,318.59 12,937.92 1,498,992.26

Table 7: International order made in 2017

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ATFC

Ambulatory therapeutic feeding program

NFI

Non-food items

ALOS

Average Length of Stay

NGO

Nongovernmental organization

APH

Antepartum hemorrhage

NICU

Neonatal intensive care unit

ANC

Ante natal care

NYSC

National youth service corps

BEmONC Basic Emergency Obstetrics and Newborn Care

ORP

Oral rehydration points

BOR

ORS

Oral rehydration solution

CEmONC Comprehensive Emergency Obstetrics and Newborn Care

OT –

Operation theatre

CFR

Case fatality rate

OCA–

Operational Center Amsterdam (MSF Holland)

CP & D

Complicated pregnancy and delivery

OCBA

Operational Center Barcelona – Athens (MSF Spain)

C/S

Caesarean section

OCB

Operational Center Brussels (MSF Belgium)

CSM

Cerebrospinal meningitis

OCG

Operational Center Geneva (MSF Switzerland)

CTC

Cholera treatment Centre

OCP

Operational Center Paris (MSF France)

EPI

Expanded Program on Immunization

PEP

Post exposure prophylaxis

Eprep

Emergency preparedness

PEV

Post election violence

ER

Emergency room

PHC

Primary healthcare

FMOH

Federal Ministry of Health

PMTCT

prevention of mother to child transmission

Hep B

Hepatitis B

PPH

Postpartum hemorrhage

Hep C

Hepatitis C

RIN

Residual incontinence

HIV

Human immunodeficiency Virus

RVF

Recto vaginal fistula

HR

Human resources

SGBV

Sexual gender based violence

ICU

Intensive care unit

SMOH

State Ministry of Health

IDPs

Internally displaced persons

STI

Sexually transmitted infection

ITFC

Inpatient therapeutic feeding center

TFP

Therapeutic feeding program

LAMA

Leave against medical advice

ToP

Termination of pregnancy

LGA

Local government area

USH

Umaru shehu hospital

MAM

Moderate acute malnutrition

VVF

Vesico-vaginal fistula

MCH

Maternal and child health

MOH

Ministry of Health

MSF

MÊdecins sans frontières.

MVA

Manual Vacuum aspiration

Bed occupancy rate

WATSAN Water and sanitation WFP

World food program

WHO

World health organisation

7 28

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