A cholera epidemic in the Katanga province Application of spatial analysis to surveillance system Democratic Republic of Congo Katanga province, Lubumbashi 2002 Participants copy Objectives 1) To represent data from surveillance on electronic maps 2) To use the most common GIS for data representation 3) To import data in a GIS from external database 4) To produce thematic maps 5) To develop specific maps according to administrative and geographical representation 6) To understand the basic format of a database structure 7) To relate spreadsheets 8) To collect points using GPS 9) To represent polygons, points and lines using GPS 10) To represent points on satellite images 11) To Geo-reference Images 12) To develop hypothesis from spatial representation The case study is not intended to teach about the use of a specific software however it will allow the participants to use .shp files that can be represented in ArcView, ArcGIS, in HealthMapper and with Epiinfo. Through the practical application the participants will learn how to apply GIS to represent spatially the data produced by a surveillance system. 1/15
Introduction General information on Lubumbashi and Katanga province Katanga is one of the 11 provinces of democratic Republic of Congo. The province is placed in the South-East part of the country and is limited to East by the Tanganyika Lake, to South by the Zambia, to North by the provinces of Kivu and Maniema, to West by Angola and to North-West by the provinces of Kasai Its population is estimated around 7 millions of inhabitants. Almost one million and half are living in the capital Lubumbashi. After 1997, six district of North of Katanga are affected by a civil war between rebel groups and the DRC army. This war has already caused hundred of thousands victims among the civil population especially due to an internal massive migration and to a drastic reduction of the economic activities in the area. During the last year R.D.C. several thousands of civilians migrated from the north of the province to Lubumbashi crossing the Zambian state. This population is living today in a rural area, at the periphery of Lubumbashi, in some very critical hygienic conditions. The population of the town is estimated at 1.413.869 inhabitants (WHO 2002). The town is organized administratively in 5 Health zones. Tableau 1 : population o f Lubumbashi district Kampemba 383,757 Ken ya Kamalon do 236,707 Lubumbashi 277,375 Rwashi 245,990 Katuba 270,040 T he province is crossed from the South to the North by the Congo river that is also used as the most important communication system. The majority of towns and villages are located on river border where the economic life is ruled out. The city of Ankoro is considered as the crossing point of all economic activities of the province and the principal river harbor from where fish is sent out by truck to the capital of the province Lubumbashi. 2/15
Katanga is very reach in lakes and rivers that allow to the population to have a food subsistence source through the fishing activity. The river Luapula leave the Mwero Lake going to join the River Lualaba, which is the upper part of the Congo river. The junction between Luapula and Lualaba is located at Ankoro. In fectious diseases surveillance system in Katanga province The surveillance of infectious diseases is organized by the department of surveillance e pidemiology of the ministry of Health in the Katanga province. The system is organized in 40 health zones. One district is comp osed by one or more h ealth zones. After 1997 only 34 health zones out of the 40 make a report on infectious diseases, the other 6 hea lth zones, situated in the North of the province, because affected by a long civil war, since several years they don’t report any more. 14 diseases are under surveillance in the present system as showed in Annex 1. Cases are detected and reported by nurses or doctors from the health centers, hospitals and health posts. In each health zone, data are compiled by the medical officer in charge and sent weekly to the provincial health department in Lubumbashi. Data transmission is done by radio or by hand, fax and e-mail are utilized only in few zones. Communications are very difficult, especially in the zones faraway from Lubumbashi. At provincial level the fourth direction of the MoH (epidemiology surveillance) is th carried out by the 4 health direction but does not have any computerized database. Data are collected on spreadsheet forms using MS Execel using the computers provided by WHO. Reports are not produced in a standardized format. Feed back is not provided regularly. As WHO health officer in cha rge with the surveillance system in Katanga, based in L ubumbashi you have to prepare an electronic map to be utilized for your surveillance system. Question 1 W hat kind of features do you think to represent on your maps? What kind o f administrative level you want to represent on your maps? What kind of data do you think to insert in your database? 3/15
Is the first November 2000. As WHO epidemiologist in ch arge to support the 4th health provincial office you are p lanning a meeting with the district epidemiologists to give them the regular quarterly feed back meeting on infectious diseases and you are thinking to introduce the district epidemiologists to the application of GIS to the surveillance system During the workshop the medical officer in charge with the 4th provincial health d irection present some data on cholera, shigelloses, Typhoid fever and meningitis during the year 2000 in your province Evolution des cas et decès de choléra par semaine, Province du Katanga, RDC, année 2000. Source: REH des Zones de Santé, Antenne de l'OMS au Katanga. Données disponibles pour les semaines n° 1 à 37 350 300 250 Nombre de cas et décès 200 Cas Decès 150 100 50 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Semaines 4/15
Evolution des cas et décès de Shigellose par semaine, Province du Katanga, RDC, année 2000. Source: REH des Zones de Santé, Antenne de l'OMS au Katanga. Données disponibles pour les semaines n° 1 à 37. 160 140 120 Nombre de cas et décès 100 Cas 80 Décès 60 40 20 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Semaines Evolution des cas et décès de F. Typhoïde par semaine, Province du Katanga, RDC, année 2000. Source: REH des Zones de Santé, Antenne de l'OMS au Katanga. Données disponibles pour les semaines n° 1 à 37. 100 90 80 70 Nombre de cas et décès 60 Cas 50 Décès 40 30 20 10 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Semaines 5/15
Evolution des cas et décès de Méningite par semaine, Province du Katanga, RDC, année 2000. Source: REH des Zones de Santé, Antenne de l'OMS au Katanga. Données disponibles pour les semaines n° 1 à 37. 45 40 35 Nombre de cas et décès 30 25 Cas Décès 20 15 10 5 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Semaines Question 2 How do you think to represent data about the diseases in term of place? End of the first part 6/15
Second part During the year 2001 the 4 th Direction of Katanga province receives several alert about cholera outbreak from different districts. The director of the 4th direction is a bit worried for the information coming from the north of the province and specifically from the district de Kongolo et Kabalo. Unfortunately the data that arrive from these districts are a little limited for security reasons and arrive late. Is seems however that MSF Belgium that is operating in these districts is talking about a cholera outbreak in June. The only data that the 4th direction has are coming from Kabalo, however no actions are taken from the provincial direction. Cas de cholera dans le district de Kabalo dans les semaines 1-23 2001 35 30 25 20 15 10 5 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 semaines During the 40 th week of 2001 , from 01 to 07 October, MSF France and MSF Belgium have alerted about an epidemic of cholera in the district of Ankoro in the North center of the province. The surveillance system of the province confirms with its reporting system the occurrence of an epidemic as showed in this retrospective analysis of the data collected by the surveillance system. 7/15
Ankoro cas de choléra depuis la semaine 40, 2001 300 250 200 150 100 50 0 1 3 5 7 9 1 3 5 7 9 1 3 5 7 9 1 3 5 7 9 1 3 5 7 9 1 1 3 5 7 9 1 3 5 7 1 1 1 1 1 2 2 2 2 2 3 3 3 3 3 4 4 4 4 4 5 1 1 1 1 semaines 2001-2002 Is the end of the 2001, last week of December. At this point, even if it seems a bit late, you suggest to your national counterpart to organize the data collection in a way to facilitate their export in your GIS to represent them spatially and see the progression by time and by space. Question 3 What counseling would you give to the provincial data manager to facilitate the relation between the data collected in Excel files and your GIS database? End of second part 8/15
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