St. Francesco Di Assisi Mariallou Hospital Tonj North County Warrap State, South Sudan

2015 ANNUAL REPORT

Period Covered: 1st January to 31st December 2015

Reported By: Jimmy Kivumbi/Clinician & Nutritionist

Submittal Date: 5th January 2016

Addressee: Dr.Callixte Minani/AAA Health Coordinator

EXECUTIVE SUMMARY

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2015 went through some significant changes as far as service delivery and infrastructural improvement are concerned. Service delivery stalled for the first half of the year due to delay in payment of national staffs by the State Ministry of Health. A contemporary new maternity ward of 16 beds was inaugurated in July by AAA and a new project implemented by CCM was started in the third quarter. The management of the hospital changed from two implementing partners in the first half of the year to three partners from the third quarter of the year.

The management of Mariallou hospital in 2015 was a partnership between Warrap State Ministry of Health (SMoH), Arkangelo Ali Association-International (AAA) and Comitato Collaborazione Medica (CCM). The memorandum of understanding for management of Mariallou hospital was as follows:

1. SMoH owned the hospital and therefore was the host. The SMoH formulated and invoked health policies that the 2 Non Governmental Organizations (NGO) followed to implement hospital activities. In addition SMoH did regulation, monitoring and evaluation of the activities of the two NGO.

2. AAA was tasked with improving hospital infrastructures and spearheading child health service delivery.

3. CCM was the lead agency for service delivery in the hospital, of which, the main task was provision of Comprehensive Emergency Obstetric and Neonatal Care (CEmONC) using funds provided by the Health Pooled Fund (HPF). In addition CCM managed day to day running of the hospital, human resources and health supplies under the HPF project.

Mariallou hospital had both Outpatient (OPD) and Inpatient (IPD) departments. The hospital had a capacity of 93 beds divided into children, adult and maternity wards. Other hospital activities included Antenatal care, Laboratory, Ultrasound imaging, expanded program of immunization (EPI) and provision of safe piped water to the surrounding community using stand taps in the hospital perimeter as fetching points. The OPD attendance increased by 7.7% in comparison to attendance of 2014 where as the IPD bed capacity rose from 86 beds in 2014 to 93 beds in 2015. The bed occupancy rate in 2015 was 33.7%.

The following key achievements were attained in 2015:

Inauguration of new maternity ward of 16 beds. Resumption of construction of new operating theatre and two ward blocks. Excavation of 3 pits for construction of 12 stances of sealed VIP latrines. Strengthening of hospital service delivery owing to boosting of numbers of expatriates

and resumption of payment of national staffs on a regular basis using HPF funds by CCM.

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16,537 patients attended OPD. 3,057 patients were admitted. 182 deliveries of babies were done. 269 surgeries were done. 4,082 women of child bearing age were sensitized about Infant and Young Child Feeding

(IYCF) practices. 2,443 pregnant women attended Antenatal care. 339 pregnant women received the second dose of Intermittent Preventive Treatment

(IPT2) of Malaria. 2,005 children under 5 years old were de-wormed 1,579 children 6-59 months received Vitamin A supplementation. 607 children up to 5 years benefitted from the nutrition program. 2,010 children under 1 year old received EPI services. 503 pregnant women were vaccinated with Tetanus Toxoid. 132 Voluntary Counseling and Testing (VCT) clients were attended. 15 clients tested

positive for HIV. 414 pregnant women were tested for HIV. Only 1 client tested positive for HIV.

1.0 Introduction

ST. Francesco DI’Assisi Mariallou hospital is a public health facility situated in a remote village in Tonj North County Warrap State in the Republic of South Sudan.

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Tonj North County is divided into 10 administrative units officially known as Payams. These Payams are Mariallou in which the hospital is situated, Akop, Alabek, Aliek, Awul, Rualbet, Kirik, Pagol, Warrap and Manlor. The County headquarter (called Warrap) is 87Km to the North of the hospital and was inaccessible during the peak of the wet season experienced in the third quarter.

Tonj North County comprises 18 health facilities i.e 1 hospital, 4 primary health care centres (PHCC) and 13 primary health care units (PHCU). However 14 health facilities were fully functional i.e 1 hospital (Mariallou), 4 Primary Health Care Centres and 9 Primary Health Care Units. The hospital was managed by AAA and CCM. All the other 13 health facilities (4 PHCC and 9 PHCU) were managed by World Vision International.

Mariallou hospital was mandated to serve as Tonj North County referral hospital with a service area population of 165,222 people. However, 3 Payams namely Mariallou, Akop and Rualbet accessed the hospital throughout the year in addition to clients from boardering Tonj East County. The total population of the three Payams was 41,997 people dwelling in 7,748 households, of which, 3,359 were pregnant and lactating women (PLW), 7,378 under five year old (U5) and 1,680 under 1 year old (U1).

The hospital provided free curative and preventive health care services in Outpatient (OPD) and Inpatient (IPD) departments; IPD had a capacity of 93 beds, of which, there were 30 beds in children ward, 47 beds in adult ward and 16 beds in maternity ward.

Arkangelo Ali Association (AAA) is a nonprofit international organization reconstructing and involved in health service delivery at Mariallou hospital since October 2007 up to date. The overall goal of AAA was to improve the quality of life of the people of South Sudan by reducing human suffering and improving their social economic status whereas the mission was to uplift the dignity of the disadvantaged people through provision of social services more so in the health sector. This undertaking by AAA at Mariallou hospital yielded contemporary hospital wards, 24/7 electricity for the hospital from solar generation, safe piped water for the hospital and surrounding community, safe disposal of both liquid and solid waste generated in the hospital and overall improvement of health of the people of Mariallou especially children and women.

The direct management of the hospital was a partnership between AAA and Comitato Collaborazione Medica (CCM), of which, the later came on board in August 2015 to implement the Health Pooled Fund (HPF) project. The HPF project was expected to last for 5 months with a deadline on 31st December 2015 but was extended for further 2 years from April 2016. Bridging

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funding for the first quarter of 2016 was secured by CCM from HPF.

The specific roles and responsibilities of AAA and CCM at Mariallou hospital were as follows:

AAA was responsible for improving the hospital infrastructure using donations given by ERKO, DKA and MISEREOR. The infrastructures undertaken were construction of 2 new ward blocks @ 24 beds, new maternity ward of 16 beds, new operating theatre, central walk way connecting all new premises and sanitary facilities for patients and staffs’ living quarters. AAA was also responsible for spearheading child health service delivery using funds of her benefactors like CAESAR and other individuals.CCM was the lead agency of service delivery at Mariallou hospital using HPF project budget with emphasis on provision of Comprehensive Emergence Obstetric and Neonatal Care (CEmONC) services and day to day management/running of the hospital. Other responsibilities of CCM included recruitment and payment of National staffs (in addition to the expatriate staffs) under the HPF payroll. CCM was also responsible for procurement of medicines and other health supplies.

2.0 Hospital Activities Carried Out In 20152015 was busy and uncomfortable due to delay in payment of national staffs and secondly insecurity caused by tribal clashes between the community of Mariallou and the neighbors in the north (Akop) and the West (Rualbet). However the following activities were carried out during this reporting period:

1) Provision of curative services to children, mothers and other adults in both OPD and IPD including treatment of malnutrition and delivery of babies.

2) Assorted laboratory tests and Ultrasound imaging performed.3) Antenatal care.4) Expanded Program of Immunization (EPI).5) Emergence surgery including Caesarian Section.6) Growth monitoring of U5.7) Health education and health promotion.8) Provision of safe piped water to the community.9) Safe disposal of waste generated in the hospital.10) Health Management Information System (HMIS) using DHIS and agency reporting tools.11) Development works of the hospital i.e infrastructural improvement through

construction of new wards and operating theatre.12) Implementation of HPF project by CCM with emphasis on CEmONC.

3.0 Utilization of Hospital Services in 2015OPD & IPD were busy on a daily basis, day and night. Services were offered by both expatriates and national staffs.

3.1.0 Outpatient Department (OPD) Utilization in 2015

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The Outpatient department was operational throughout the year from Monday to Saturday.The OPD comprised:

I. Child Health Clinic for clients up to 5 years oldII. “Adult” Clinic for patients above 5 years old

III. Antenatal Clinic (ANC)IV. Laboratory and V. Expanded Program of Immunization Clinic (EPI) responsible for administering vaccines to

child up to 5 years old with emphasis on U1. The following antigens were used as vaccines; BCG, OPV/IPV, DPT-Hepatitis B + Haemophilus influenza type b and Measles. Other services in EPI clinic included growth monitoring and promotion of Infant and Young Child Feeding practices.

Figure below shows quarterly OPD attendance among U5 in 2015-head count

Q1 Q2 Q3 Q40

200

400

600

800

1000

1200

1400

1600

1800

2000

1398

1132

1482

1870

U5 quarterly OPD attendance in 2015

Figure below shows quarterly OPD attendance among patients 5 years and above-head count

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Q1 Q2 Q3 Q40

500

1000

1500

2000

2500

3000

3500

4000

4500

14421711

3688 3814

Above 5 years quarterly OPD attendance in 2015

The following statistics were obtained in 2015 in OPD at Mariallou hospital:- 16,537 patients attended OPD as compared with 15,348 attendances in 2014.

5,882 OPD patients were children up to 5 years old and 10,655 OPD patients were 5 years and above. Therefore OPD consultations increased by 7.7% in comparison with 2014 OPD data.

- 2,443 pregnant women attended antenatal clinic as compared with 3,294 ANC attendances in 2014.

- 2,010 children under 1 year (U1) were vaccinated with BCG, Polio, DPT-HepB + Hib and Measles vaccines as recommended by South Sudan EPI. 379 U1 were vaccinated with the same vaccines in 2014.

- 12,751 assorted laboratory tests were performed as compared with 11,746 tests done in 2014. Laboratory tests were performed on blood samples to detect Malaria, Syphilis, Brucellosis, Typhoid, Hepatitis B, Hepatitis C, HIV, Blood grouping and Cross matching, Haemoglobin level and blood glucose. Other tests performed were Stool analysis, Urine analysis and microscopy of genital discharges including high vaginal swabs.

- 4,082 Women of Child Bearing Age (WCBA) were sensitized about Infant and Young Child Feeding practices in comparison with 6,095 WCBA sensitized about IYCF in 2014.

- Growth monitoring of 1,579 children under five years old was done. This was done by the Nutrition Assistant and the EPI vaccinator in the child health clinic daily in both IPD & OPD respectively. These children were weighed and Mid

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Upper Arm Circumference measurements taken during triage. And then appropriate advice was given to the caretaker.

- 2,005 children aged 6 months to 5 years were dewormed as compared with 1,756 dewormed in 2014.

- 1,579 children 6-59 months received Vitamin A supplementation in comparison with 2,805 in 2014.

- 132 clients visited VCT Clinic, of which, 15 clients tested positive for HIV and all referred to Wau ART Clinic for Comprehensive HIV /AIDS Care. The ART Clinic was about 220 KM to the North West of Mariallou hospital.

- 414 pregnant women were tested for HIV. Only 1 tested positive and was initiated on ART for PMTCT.

- 339 pregnant women received IPT2.

Clerking by a doctor in OPD Adult Clinic

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Crippled Mum brought her sick new born to Paediatric Clinic

Gravid women attending ANC

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Vaccinator & Midwife preparing for Vaccination of children in EPI Clinic

3.1.1 OPD Morbidity Burden in 2015Malaria was the commonest cause of OPD consultation for all age groups.The top 10 causes of morbidity among U5 in OPD in 2015 are shown in the column bar below.

10

0200400600800

10001200140016001800

1710 1667

920

538 503

200 191 185 185 169 119

Chart Title

Top 10 causes of morbity among U5 in OPD in 2015

Figure below shows the top 10 causes of morbidity among OPD patients above 5 years in 2015

Malaria

UTI/ST

I

Intestinal p

arasit

e

Upper res

piratory

tract i

nfection

Skin dise

ase

Typhoid

Trauma/ti

ssue in

fection

Brucel

losis

Diarrh

oea

Pneumonia

Ear in

fection

Eye in

fection

0100020003000400050006000 5264

2389

1276794 726

363 308 253 235 179 124 99

Top 10 causes of morbidity in OPD patients aged 5 years and above in 2015

Top 10 causes of morbidity in OPD patients aged 5 years and above in 2015

3.2.0 Inpatient Department (IPD) Utilization in 2015The IPD was open every day in 2015 and the bed occupancy rate was 33.7%. The IPD had 93 beds divided into:

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Children ward of 30 beds Adult ward for both medical and surgical patients of 47 beds Maternity ward of 16 beds Operating Theatre (both Minor and major) and Sterilization unit

There were 3,057 new admissions in the hospital in 2015 in comparison with 3,958 admissions in 2015.

Figure below shows # of quarterly admissions in each ward in the hospital in 2015

Q1 Q2 Q3 Q40

200

400

600

800

1000

1200

1400

Adult wardMaternity wardChildren wardQ Total

The different sections performed as follows: 1,382 admissions were done in Children ward. 1,203 patients were admitted in Adult ward for both medical & surgical cases. 472 women were admitted in Maternity ward. 182 deliveries were conducted (170 SVD & 12 C-Sections). Performed 96 evacuations of retained products of conception due to incomplete

abortions by either curettage or manual vacuum aspiration. 269 operations were performed, of which, 41 were major surgeries and 228 were minor

surgeries. 9 blood transfusions were carried out. The sterilization unit was operational and provided sterile materials on time. The 39L

ALL AMERICAN autoclave which was supplied by AAA was the only available autoclave.

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Patients in new maternity ward

Operating (Explorative Laparotomy) in old Theatre

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3.2.1 IPD Morbidity burden in 2015Malaria was the overall cause of admission in the hospital in 2015

Column graph below shows the top 5 causes of admissions in maternity ward in 2015

Labor

Malaria

in preg

nance

Incomplete a

bortion

Major O

bsttetr

ic Dire

ct Complica

tion

UTI in preg

nance

020406080

100120140160180200 182

132

9675

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Major causes of admission in Maternity ward in 2015

Causes of admission in Maternity ward in 2015

Pie chart below shows the top 7 causes of admissions in children ward in 2015.

759

403

380

162

12482 71

Top 5 Causes of admission in Children ward in 2015

Malaria

Acute watery diarrhoea

Pneumonia

Neonatal sepsis

Severe Acute Malnutrition

Trauma/burns

Other lower respiratory tract infection

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Bar graph below shows the top 9 causes of admissions in adult ward in 2015

Malaria

Trauma/burns/abscess

Acute watery diarrhoea

Typhoid

Genital Urinary Infection

Pneumonia

Brucellosis

Gunshot injury

Other lower respiratory tract infection

0 200 400 600 800 1000 1200

967

228

157

83

76

70

54

42

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Top 5 causes of admissions in Adult ward for both medical & surgical cases in 2015

Top 9 causes of admissions in adult ward in 2015

3.2.2 IPD patient exits in 2015The admissions exited as follows:

2834 patients cured (92.7% cure rate) 32 patients died (1% mortality rate). 17 deceased were U5 and 15 above 5 years old. 104 patients escaped (3.4% default rate) 60 patients were referred for specialized treatment (1.9%). U5 were 18 and other 42

were patients above 5 years old. 27 were still admitted at the end of 2015 (1%).

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4.0 Nutrition Program in 2015

AAA implemented the activities of the nutrition program using funds donated by her benefactor called CAESAR.The donation mitigated in the problem of malnutrition amongst U5 and WCBA in Mariallou hospital. The nutrition program was static and based at Mariallou hospital. There was both Inpatient Therapeutic Feeding Program (ITP) which operated 24 hours a day, 7 days a week and Outpatient Therapeutic feeding Program (OTP) which was open Monday to Saturday during day time only. Also Blanket Feeding Program (BFP) for vulnerable U5 admitted in the hospital was provided.

4.1 Clientele admission criterion in 2015

Clients enrolled into the nutrition program through three nutrition interventions:

1. Therapeutic Feeding Program (TFP) for both Inpatient Therapeutic feeding Program (ITP) and Outpatient Therapeutic feeding Program (OTP).

2. Supplementary Feeding Program (SFP).3. Blanket Feeding Program (BFP).

The criterion of admission of clients was as follows:

For TFP

- <70 % weight for height index for ages 6 months up to age 5 years.- Body Mass Index (BMI) <16 for adults especially teenagers and PLW.- Visible wasting or bilateral pitting edema for children < 6 months old.- Bilateral pitting edema irrespective of % of weight for height, BMI and muscle wasting.- Any degree of malnutrition coupled with severe/complicated medical conditions.

For SFP

- 70-80% weight for height index.- Medical conditions that warranted nutrition intervention to enhance recuperation.- Neonate prone to malnutrition due to demise of mother/handicapped mother.

For BFP

- Vulnerable U5, especially those admitted in the hospital and had NO means of feeding

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4.2.0 Nutrition activities in 2015Below is the summary of activities carried out: - Therapeutic feeding for inpatient (ITP) on daily basis. - OTP & SFP for 6 days every week for new entrants and biweekly for follow up.- Distribution of food (BFP) to vulnerable U5 admitted in the hospital on daily basis.- Health education on admission, during admission and on exit with more emphasis put on

IYCF practices in both OPD and IPD- Treatment of all malnourished clients with medical complications.- Routine Vitamin A supplementation of children 6-59 months old.- De-worming of children 1 to 5 years old.- Routine growth monitoring of U5.- Quantification and ordering of supplies.- Monitoring and evaluation.- Referral for specialised treatment

Taking weight of a child < 6months old with low birth weight

Measuring MUAC of malnourished child

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4.2.1 Nutrition supplies received in 2015The year started with Ready to Use Therapeutic Food (RUTF) and tools supplied by UNICEF in 2014. Then in May and August 2015 AAA delivered a consignment of Essential Medicines and Health Supplies (EMHS) and food commodities to Mariallou under the project of CESAR as show below.

Delivery note /No of cartons

Description of items Unit of measure

Quantity received

Expiry date BALANCE (physical count)

15th

July 2015

28th

Nov. 2015

04th Jan. 2016

EMHS03202-28 cartons

Chloramphenicol capsule 250mg capsule 6,000 09/2017 5,000 5,000 4,000Cotrimoxazole tablet 480mg tablet 21,000 06/2017 21,000 21,000 21,000Ampicillin 250mg + Cloxacillin 250mg capsule capsule 2,500 09/2017 2,000 1,500 1,000Metronidazole tablet 200mg tablet 25,000 09/2016 25,000 25,000 25,000Paracetamol tablet 500mg tablet 19,000 03/2017 19,000 19,000 18,000Azithromycin tablet 500mg tablet 600 06/2017 600 600 600Artemether injection 80mg/ml ampoule 249 08/2017 249 6 00Amoxicillin capsule 250mg capsule 40,000 07/2017 40,000 40,000 40,000Dextrose 5% 500ml bottle 56 03/2017 56 56 50Dextrose 5% 500ml bottle 28 05/2017 28 28 20Normal saline 500ml bottle 270 09/2017 270 270 180Normal saline 500ml bottle 270 07/2017 270 180 180Normal saline 500ml bottle 90 06/2017 90 00 00Blood bag 450ml bag 100 28/4/2016 00 00 00Blood bag 450ml bag 100 19/3/2016 00 00 00Quinine syrup 5ml/50mg, 60ml bottle 240 07/2017 200 150 68Vacutainer with anticoagulant piece 300 09/2015 300 00 00HCV test strip strip 50 01/2017 40 In lab 00HBsAg test strip strip 50 08/2017 40 In lab 00Urine dip stick test 10 parameters strip 1,000 30/5/2016 800 In lab 600

03205-58 cartons

Distilled water nonionised 5L bottle 3 10/2016 2 1 0Distilled water nonionised 5L bottle 2 12/2032 2 2 2Acetone solution 5L bottle 1 03/2019 1 In lab 0Gentian violet 1% 500ml bottle 5 07/2016 5 In lab 4Neutral red powder packet 5 02/2017 5 In lab 4Oil immersion 100ml bottle 9 07/2016 9 In lab 8HBsAg test strip strip 200 08/2017 200 In lab 0HCV test strip strip 200 01/2017 200 In lab 0Field stain A 500ml bottle 15 09/2018 14 In lab 9Field stain B 500ml bottle 15 09/2018 14 In lab 9Giemsa stain 500ml bottle 10 03/2019 9 In lab 10Turks solution 500ml bottle 5 02/2017 5 In lab 5Lugols iodine 1L bottle 5 09/2016 5 In lab 4Lab marker pen piece 10 NA 6 In labWall clock piece 1 NA 1 1 1Vacutainer with anticoagulant piece 500 10/2015 500 00 00Rotator electric piece 1 NA 1 1 1

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WBC tube piece 19 NA 19 19 19Haemometer (sahli kit) piece 2 NA 2 2 2Sahli 20UL pippet piece 3 NA 3 3 3HIV ½ test strip strip 25 07/2016 00 00 00HIV UNIGOLD test strip 20 11/5/2015 00 00 00Blood administration set piece 100 11/2016 100 In lab 100Applicator stick piece 3,000 NA 2500 In lab 2500Blood bag 450ml bag 205 28/4/2016 105 In lab 75Hartman’s solution 500ml bottle 224 04/2017 124 124 100Normal saline 500ml bottle 120 09/2017 120 120 90Dextrose with normal saline 500ml bottle 48 06/2017 40 16 5Dextrose 5% 500ml bottle 24 03/2017 24 00 00Gauze roll 750g roll 20 02/2019 20 2 1Syringes 5ml without needles piece 2,500 09/2019 2,500 2,400 2,000IV Cannula G24 piece 1,000 08/2019 1,000 900 700IV Cannula G22 piece 1,000 06/2018 1,000 900 700Dettol soap 100g piece 100 07/2017 70 00 00Soap laundry powder 25Kg bag 1 06/2016 1 00 00Soap liquid detergent 20L bottle 2 NA 1 1 0JIK 3.5% 5L bottle 8 11/2016 8 8 6Povidone iodine 10% 5L bottle 4 04/2017 4 4 3Hydrogen peroxide 5L bottle 4 08/2016 4 2 2Cetrimide tropical solution 5L bottle 4 03/2016 4 4 3Black disinfectant 5L bottle 4 08/2017 4 4 3Paracetamol suppository 125mg piece 500 02/2017 500 430 400Phenobarbital tablet 30mg tablet 400 06/2017 200 200 30Quinine paediatric drops 20% bottle 50 08/2016 40 39 15Quinine injection 600mg/2ml ampoule 500 07/2017 500 470 400Benzyl penicillin 5MEGA vial 1,000 05/2017 1,000 1,000 800Paracetamol syrup 5ml/120mg 60mg bottle 200 10/2017 200 37 21Metronidazole /Diloxanide syrup 100ml bottle 50 08/2017 50 41 36Paracetamol junior tablet 100mg tablet 6,000 02/2017 6,000 6,000 6,000Paracetamol junior tablet 100mg tablet 13,000 11/2016 13,000 13,000 13,000Paracetamol junior tablet 100mg tablet 1,000 02/2016 1,000 1,000 1,000Salbutamol tablet 4mg tablet 6,000 01/2017 5,000 5,000 4,000Aminophyline tablet 100mg tablet 1,000 11/2016 1,000 1,000 1,000Azithromycin suspension 5ml/200mg 15ml bottle 100 02/2017 100 100 90Ampicillin injection 500mg vial 500 04/2017 500 250 200Adrenalin injection 1ml/1mg ampoule 20 01/2017 15 00 00Atropine injection ampoule 25 01/2017 20 11 5Bupivacaine injection in dextrose ampoule 30 09/2015 25 10 10Aminophyline injection 10ml/250mg ampoule 20 07/2017 15 15 10Azithromycin tablet 500mg tablet 300 06/2017 300 300 300Amoxicillin/Clavulanic acid 5ml/156mg 100ml bottle 25 06/2016 15 14 10Artemether injection 40mg/1ml ampoule 250 08/2016 250 150 68Flucloxacillin suspension 5ml/125mg 100ml bottle 75 09/2017 70 68 43Ibuprofen suspension 5ml/100mg bottle 50 05/2017 40 4 00Furosemide tablet 40mg tablet 2,000 11/2016 2,000 1,800 1,500Furosemide injection 2ml/20mg ampoule 50 06/2016 45 40 32Hydrocortisone injection 100mg vial 100 05/2016 100 100 100

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Gentamycin injection 2ml/80mg ampoule 200 03/2017 180 180 180KY Jelly tube 20 03/2017 20 14 10Ascorbic acid tablet 250mg tablet 2,000 06/2017 2,000 1,000 1,000Artemether/Lumefantrine tablet 20/120mg tablet 2,400 06/2016 2,400 1,080 840Ampicillin/Cloxacillin neonate drops bottle 50 02/2017 50 20 9Metronidazole suspension 5ml/200mg bottle 200 06/2017 200 200 200Cotrimoxazole suspension 5ml/240mg bottle 500 10/2017 500 500 500Dextrose 50% solution 100ml pack 50 11/2016 45 17 14Chloramphenicol injection 1g vial 200 04/2017 200 139 90Ceftriaxone injection 1g vial 500 05/2017 500 400 152Cephalexine suspension bottle 100 08/2017 100 90 81Chloramphenicol susp. 5ml/125mg 100ml bottle 100 06/2017 100 85 53Cotrimoxazole tablets 120mg tablet 5,000 04/2017 5,000 5,000 5,000Clotrimazole mouth paint 15ml bottle 100 05/2017 100 100 94Diazepam injection 2ml/10mg ampoule 200 12/2016 180 10 5Dexamethasone injection 1ml/4mg ampoule 100 03/2017 80 40 28Diazepam tablet 5mg tablet 1000 05/2015 1000 00 00Cotrimoxazole tablet 120mg tablet 5,000 03/2016 5,000 5,000 5,000Amoxicillin suspension 5ml/125mg bottle 150 09/2017 150 150 150Amoxicillin suspension 5ml/125mg bottle 150 05/2017 150 150 100

03205-ctn # 3 delivered in August 2015

Brucella Abortus kits Kit 14 00 In lab 00Brucella Mellitensis kits Kit 14 00 In lab 00Widal test kits Kit 8 00 In lab 00RPR kits Kit 6 00 In lab 00Anti A monoclonal bottles @10ml Bottle 7 7 In lab 6Suxamethonium ampoules Ampoule 25 00 25 00Insulin Mixtard vials @100ml Vial 5 00 5 2insulin Actrapid vials@100ml vial 2 00 2 2Paracetamol injection 150mg/ml @ 10ml vial 50 00 6 00

03223-3 cartons & 1 bag of staff uniforms

Non electric centrifuge 4 tubes piece 1 NA 1 1 1Staff uniforms shirt/trouser (white) pair 22 NA 00 00 00Non electric centrifuge 2 tubes piece 1 NA 1 1 1Electric centrifuge 6 tubes piece 1 NA 1 1 1Non electric autoclave-ALL AMERICAN 39L piece 1 NA 1 1 1

03243-7 cartons

Quinine suspension 5ml/50mg 60ml bottle 240 12/2017 240 171 100Artesunate/Amodiaquine 100/270mg tablet tablet 6,000 08/2016 6,000 4,920 00

Nutrition food commodities03208-49PKGs

Milk powder 25Kg @ bag bag 10 12/2015 6 1 00Cooking oil 20L @ Jerrican Jerrican 10 12/2015 7 2 00Sugar 50Kg @ bag bag 10 NA 6 1 00UNIMIX 25Kg @ bag bag 9 NA 3 1 00High energy biscuits 20Kg @ carton carton 10 03/2016 4 1 00

4.2.2 Nutrition program Output in 2015

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633 clients of all age groups were enrolled in the feeding program in 2015. 607 U5 benefitted (190 TFP, 109 SFP & 308 BFP), 7 pregnant women benefitted and 19 clients above 5 years were served. The table below summarizes clientele admissions based on feeding intervention, age group and gender.

Category

Intervention

Gender

Clients U5 TotJan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

SAM

ITP(SC)

M 3 5 5 8 4 1 1 5 10 12 14 4 72F 1 5 4 3 3 1 2 4 6 5 13 5 52

OTP M 5 4 3 3 1 2 0 0 0 9 7 3 37F 2 8 2 1 1 1 0 0 0 5 5 4 29

MAM

SFP M 5 2 5 6 2 1 1 4 16 9 5 6 62F 0 0 0 2 0 1 1 5 12 7 13 6 47

Blanket Feeding

M 0 0 0 0 0 52 15 31 9 24 13 15 159F 0 0 0 0 0 40 2 47 13 16 8 23 149

Totals 16 24 19 23 11 99 22 96 66 87 78 66 607

Clients 5 years & above excluding pregnant/lactating womenTot

SAM

ITP(SC)

M 0 0 0 0 0 0 0 0 0 0 1 1 2F 0 0 1 0 0 0 0 0 0 0 0 0 1

OTP M 1 1 7 0 0 0 0 1 0 1 0 0 11F 0 0 4 0 0 0 0 0 0 0 0 0 4

MAM

SFP M 0 0 0 0 0 0 0 0 0 0 0 0 0F 0 0 0 0 0 0 0 0 0 0 0 0 0

Blanket Feeding

M 0 0 0 0 0 0 0 0 0 0 0 0 0F 0 0 0 0 0 0 1 0 0 0 0 0 1

Totals 1 1 12 0 0 0 1 1 0 1 1 1 19

Pregnant & Lactating Women clientsTot

SAM

ITP(SC)

F 0 1 0 0 0 0 0 0 1 0 0 0 2

OTP F 0 1 1 0 0 1 0 0 0 2 0 0 5

MAM

SFP F 0 0 0 0 0 0 0 0 0 0 0 0 0

Blanket Feeding

F 0 0 0 0 0 0 0 0 0 0 0 0 0

Totals 0 2 1 0 0 1 0 0 1 2 0 0 7

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4.2.3 Nutrition Project Clientele Exit for U5U5 clients exited as follows:

604 recuperated (99.5% cure rate). 3 clients escaped (0.5% default rate) No client was still in the feeding program at the end of 2015.

Malnourished child on admission

Same child following nutrition intervention

5.0 Hospital Infrastructure ImprovementAAA and her benefactors committed themselves to improving the infrastructure of the hospital where as CCM/SMOH took a lead in service delivery using HPF funds.Various infrastructural projects were undertaken by the AAA benefactors as indicated below:

1. MISEREOR (Germany Catholic NGO) sponsored construction of a new modern operating theatre. The construction works are now in finishing stages and inauguration is expected to be in late February 2016. MISEREOR has also sponsored furnishing of the operating theatre and maternity ward and as well construction of 12 stances of sealed VIP latrines plus bathing shelter for the staff quarters. Excavation of pits for the VIP latrines was

22

done only waiting for construction of the super structure. This is expected to be completed by June 2016.

Front elevation of new OT under construction

Side elevation of new OT under construction

2. ERKO and DKA (both catholic NGO from Slovakia and Austria respectively) have sponsored various buildings at Mariallou hospital, of which, some are already in use and other under construction. They started with building of hospital office block &staff dining hall, waste water system, fresh water system, installation of solar systems, construction of hospital laundry and children ward and of recent maternity ward, which was inaugurated in July 2015. All the above infrastructures were handed over and now in use. The infrastructures now being done are extension of children ward and new surgical ward. One block is in finishing touches and the other is now at the floor slab level. Both blocks are expected to be completed in June 2016.

New maternity ward being christened during its inauguration in July 2015

23

Front elevation of new maternity ward now in use

6.0 Achievements in 2015The following achievements were realized in 2015.

1. Uninterrupted provision of health services in the hospital.2. Regularization of payment of all National staffs using HPF project budget implemented

by CCM.3. Improvement in the utilization of the hospital services as evidenced by increased patient

influx OPD and EPI.4. Provision of Nutrition project food and medicines under CESAR project.5. Inauguration of new maternity ward of 16 beds in comparison to the former

impoverished maternity ward of 9 beds.6. Continuation of improvement of the hospital infrastructure owing to commitment of

AAA and its donors.

6.0 Challenges/Constraints Faced In Provision of Services in Mariallou in Q4 2015No major challenge/constraint faced the hospital except

1. Stock out of RUTF for the nutrition program2. Panic caused by insecurity that arose from tribal clashes in October and December 2015.

Conclusion

We are grateful to AAA and CCM for enabling service delivery at Mariallou hospital and improving the infrastructure of the hospital through donors like ERKO, DKA, MISEREOR, HPF and other benefactors such CESAR, LAGOCCIA and ARCALI-AFRICA who supported the program in their capacity with the available budget. We look forward to receiving more from you.

Kivumbi Jimmy/2015

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