[Cholera in Nicaragua: a rapid evaluation of the countrys preparation]

This report describes a rapid evaluation of the written plan of the Commission for prevention and Control of Cholera in Nicaragua and the level of preparedness within the country in the event that a cholera outbreak occurs. Chapters are included on the cholera epidemic in Latin America and the aims of the evaluation; general recommendations for case management environmental sanitation and social communication; the plan for cholera prevention; the state of preparation of the health services for providing cholera treatment; infrastructure and actions concerning potable water and environmental sanitation; and social communication for cholera control by the Ministry of Health. The written plan was found to be an extensive and careful presentation of all aspects of cholera treatment including the steps necessary to prepare for a possible epidemic. Treatment of cholera cases is described in detail including laboratory diagnosis record keeping and patient management. Although the plan was excellent visits to health facilities revealed various levels of preparation with some installations ready to treat cases immediately and others unprepared. The Ministry of Health Plan clearly established that cholera is a form of acute diarrhea. 80-90% of cholera cases should be suitable for treatment by oral rehydration therapy but health personnel apparently expect that iv rehydration will be required in all cases. The plan was not designed to be an educational manual and an accompanying educational guide should be prepared for health centers. Home and community therapy using oral rehydration solution and education and preparation of the public in general require greater emphasis. The importance of prevention and prompt rehydration should also be stressed. The Ministry of Health with the assistance of the Pan American Health Organization and UNICEF should be capable of handling a possible epidemic. The Ministry of Health may need assistance in the areas of supplies training of health personnel health education for the general public and improvement of water supplies and environmental sanitation. Although improvements in the water supply and sanitation are the only longterm means of preventing cholera several shortterm actions should be taken to reduce chances of a serious outbreak. Interministerial collaboration should be improved and responsibilities should be assigned to specific agencies techniques of rapid evaluation including epidemiological studies should be improved an educational campaign for cholera prevention should be reinforced and water supplies and waste disposal measures should be reviewed and corrected if necessary in all hospitals and dispensaries.