Zahedan University of Medical Sciences

 

       The report on conducting workshop on impelmetation of Polio Environmental Surveillance in Iranshahr Faculty of Medical Sciences

 

 

 

 

 

 

 

Report from: Communicable Diseases Control Center (CDC) ,Iran Ministry of Health, Vice Chancellor for Health of Zahedan University of Medical Sciences

Published on: 5 December 2018

 

 

Introduction

Drawing on the successful experience of implementation of polio environmental surveillance (ES) in Zahedan University of Medical Sciences, the experts of the World Health Organization(WHO) and Ministry of Health and Medical Education of Iran tasked Zahedan University of Medical Sciences with selecting sampling sites, training and implementation of  environmental surveillance in the area under the coverage of IranshahrFaculty of Medicine.

The polio environmental surveillance and detection of virus in wastewater and eradication of polio is an ultimate goal emphasized by WHO. The system was launched for the first time in the country in Zahedan in 2017 and Zahedan University of Medical Sciences has been designated as the scientific focal point  of the program and it has been assigned with the responsibility of providing training and expansion of the program in other cities and towns of the province and the country.

Considering the successful implementation of the polio environmental surveillance  inZahedan and based on the  programs devised by the Communicable Diseases Control Center, Iranian Ministry of Health, the Vice Chancellor for Health of Zahedan University of Medical Sciences and environmental health and diseases control experts of the University,  attendedChabaharcityand took the responsibility of  conducting the ES workshop.

 

 

 

 

Iranshahr Faculty  of Medical Sciences

Iranshahr Faculty of Medical Sciences (IFMS)  covers a surface area of 93000 km sq. in the South of Sistan and BaluchestanProvince. It consists of nine cities and towns(Iranshahr, Nikshahr, Sarbaz, Gasr-e- Ghand, Fannuj, Dalgan, Chbahar, Mehrestan, Konarak) with a population of 1234496.

Considering its common border with two polio endemic countries of Pakistan and Afghanistan, polio is a potential threat to the people of the province and and there is the risk of the re-introduction of the polio in Sistan and Baluchestan and other parts of the country. Overall, 72 percent of the population under the coverage of the IFMS reside in the rural areas and the common border with Pakistan and illegal border crossings double the challenge.

 

The map of towns and cities under the coverage of Iranshahr Faculty of Medical Sciences (the colored areas)

 

 

 

 

 

 

Table1- The districts and the population covered by Iranshhar Faculty of Medical Sciences

 

 

 

Table2- Performance  of polio surveillance program in Iranshahr Faculty of Medical Sciences

 

The three dosespolio vaccination coverage in three years of 2016, 2017, 2018 is higher than 95 percentand all the children under 5 years of age get the oral polio vaccine(OPV) during 2 rounds of polio campaigns each year.

 

Polio Environmental Surveillance workshop

Taking into consideration the above mentioned facts, a team comprising of six experts from the Vice Cahncellory for Heath from Zahedsna University of Medcial Sciences and the the Ministry of Health was dispatched to train operational personnel in  Chabahar and Konarakfrom 19. 10. 2018 to 21. 10. 2018. On the first day a meeting was held with the Technical Deputy of IranshahrFaculty of Medical Sciences and experts of the program and necessary instructions were given and sampling method was  taught in theory in a training session. On the second day, chabahar sites were visited in the morning and konarak sites were visited in the afternoon. Holding a meeting with the staff from Water and Wastewater Departments of Chabahar and konarak, an implementation plan was devised and was directed for implementation. The workshop aimed at:Firstly, to select high risk areas  ofChabahar and Konarak, which were recommended by WHO experts in their previous visits to the area, due to their proximity with polio endemic countries of Pakistan and Afghanistan, particularly Pakistan,.Secondly, to teach and prepare the trainees for sample collection, storage, and transport .

 

 

 

The members of training team for implementation program of Polio Environmental Surveillance in IranshahrFacultyof  Medical Sciences (Chabahr&Konarak districts)

Dr.  Susan Mahmoudi (National Polio Porgram Focal Point, CDC, MoH)

Dr. Seyed Mehdi Tabatabaei-  Vice Chancellor for Health of ZAUMS,

Eng. AbdurrazaghPakzad- Director of Environmental Health Dep., ZAUMS,

Eng. Faiz Mohammad Elhami- The expert in Charge of Immunization at ZAUMS

Eng. HasanKarimian- The expert in charge of Environmental Health at ZAUMS

Eng. Morad Mohammad Elhami- Nia – The expert in  Environmental Health in Zahedan Health Center

Eng. MaisamBetaleblouei – The expert in Diseases Control & Prevention in Zahedan Health Center

 

 

The particpants in the training workshop in  Polio Environmental Surveillance in IranshahrFaulty of Medical Sciences

 

 

12 experts and assistance experts in diseases and environmental health in 6 teams received training

 

Team 1. Mr. JalilBaluchi- Niyaz:  assistant expert in Diseases, PeymanBolaideh, Environmental Health Expert

Team 2. Mr. EmranBaluchzadeh: assistant expert in diseases, Mr. Ahmad Naser- Pour: Expert in Environmental Health

Team 3. Mr. Mohsen Aramesh: Expert in Diseases, Ms. Zahra AtashBahar: Expert in Environmental Health

Team 4. Mr. Abdul Wahid Hooti: Expert in Diseases,  Mr. Mohammad Behroozi: Expert in Environmental Health

Team 5. Mr. Mehdi Sohrabi: Assistant Expert in Diseases, Mr. MahidNooraei: Expert in Environmental Health

Team 6. Mr. NaserVidadzahi: Expert in Diseases, Ms. SarehBojdi: Expert in Enviromental Health

 

 

The report on the first day: 19.10.2018

Holding a joint meeting on how to implement the program. The meeting was attended by the colleagues from Communicable Diseases Management Center and Diseases and Environmental Health Unit of Zahedan University of Medical Sciences with their counterparts from Iranshahrfaculty of Medical Sciences.

Conducting workshop for the trainees and colleagues from IranshahrFacultyof Medical Sciences, Water and Wastewater Organization and other colleagues involved in implementation of the program in Chabahar and Konarak as well as implementation of the program with colleagues with regard to sample collection, the details of the sampling sites, the responsibility of sample collectors, instructions for sample collection and instruments and tools for sample collection and their maintenance, timetable, and the number of samples in each site were discussed.

 

The report on the second day: 21. 10. 2018

Holding a meeting with the colleagues from Chabahar and Konarak Health Centers and Water and Wastewater Organization and review of wastewater collection maps of Chabahar and Konarak.

·         Field and wastewater collection network visit

·         Selected wastewater pumping stations  visit

·         Training and practical work in Chabahar and Konarak districts

·         Practical work training in SOPs and instructing the trainees how to collect sample

·         Practical workshop in wastewater pumping station in Chabahar and Konarak. Health personnel, trainees and Colleagues from Wastewater organization were actively involved in the project.

Practical work ended with briefing the trainees about concepts, knowledge, location criteria and sample collection method, standard practical methods for sampling, labeling, packaging, filling out the forms, and sample transfer to the National PolioReferenceLaboratory.

Two samples were collected from two sites in Chabahar andKonarak, as a test,  andwere dispatched to the laboratory.

The health personnel, trainees, and colleagues were provided with training about standard forms during the training session.

 

 

The district of Chabahar

The Iranian Souteastern port of Chabahar  is located in the far South of the province of Sistan and Baluchestan.  Covering a surface area of some 17000 kmsq, it is situated on the eastern side of Chabahar Gulf at 25 degree 20 minutes longitude and 60 degree 27 minutes altitude. Chabahar has maritime boundaries with Oman Sea.

Chabahar county borders the city of Jask to the west in HormozganProvince,Nikshahr and Sarbaz to the north and shares a longer border with Pakistan in the West.

The districts of Chabahar consist of 3 divisions- Central, Polan and Dashteyari, and 9 rural divisions with 457 villages.

Urban areas of Chabahar consist of two- the city of Chabahar and the township of Negor.

Based on the latest census, Chabahar has a population of 283000. Chabahar is hot and humid. The humidity is very high in summer and sometimes reaches up to 91% and in autumn ( the months of Aban and Azar) also some degree of humidity is present in Chabahar. With increase in distance from the coast, humidity decreases and difference between day and night temperatures increases. Wastewater treatment plant of Chabahar has 2580 subscribers and it provides coverage for 15000 people in urban areas of Golshahr, Zibashahr and Kowrsar neighborhoods.

 

Urban population	89543
Household  covered by sewage network	2160
Percentage of population covered by sewage network	10.37%

 

 

 

Chabahar sewage treatment plant performance

 

 

The map of the areas under the coverage of Chabahar wastewater network (red line)

 

 

 

 

 

Information of Chabahar Free Trade Zone

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The district of Konarak

Konarak is located in the far Southeast of the country in the South of Sistan and Baluchestan province in a distance of 750 kilometers from Zahedan- the center of the province. Konarakcounty consists of two districts: Zarabad and Central district. Konarak was formerly a district under administrative rule of chabahar, but it assumed the stats of a county indepenent of Chabahr in the second half of 2005.

The districts of Konarak cover an area of 8000 sqkm is in the proximity with the Sea of Oman, and it is the underlying reason for its hot and humid weather unlike other parts of the province. This area of the province has 98 km shared maritime boundaries with the sea of Oman. Konarakcounty borders Jask City in the West, Chabahar in the East, Nikshahr in the North and Oman Sea in the South.

The districts of Konarak consists of two districts- Central district and Zarabad district, and 142 villages. Urban areas of Konarakcounty are Konarak port and Zarabad.

Based on the recent census, Konarak has a population of 81748. Konarak is hot and humid. The humidity is very high in summer and sometimes reaches up to 91% and in autumn ( the months of November and December) also some degree of humidity is present in Konarak. With increase in distance from the coast, humidity decreases and difference between day and night temperatures increases.

 

 

Konarak sewage network treatment performance

 

 

 

Sewage Pumping Stationof Konarak District

The number of polulationundr coverage was 17500 and an increase to 30000 is predicted for 2026.  The capacity of the plant is 7149 m3 and its input BOD is 300 mg/liter and output BOD is 30 mg/liter. Average Flow of Tratment Plant 83 liter/second.

Implementation of wastewater plan of Konarak started in 2004 and commenced with putting into effect wastewater network. with23 km tributary and 4 km primary  pipelines. Moreover, in 2011-2012, 6 km transfer line was installed to connect station number 3 to the plant.

Ovrall, Konarak wastewater netwok consists of three pumping station in the North, South and West. The wastewater of the city  is transferred through Pumping station number 3 and a transfer polyethylene line- 400 ml diameter and 6 km long towards the plant. Total flow is168 liter andpumping head is 36 meter..

The number of subscriber: 258( 5% of the total population)

Primary collection lines and transfer line : 11 km

Bypass and transfer lines: 26 km

Operational primary lines: 8 km

Operational bypass lines:  9 km

Pumping capacity on the basis of the initial plan : 7000 m³ per day

Current pumping capacity per day: 300 m³

Chlorination and laboratory units are currently out of operation.

Access to healthy drinking water is 100 percent.

 

 

The three finally proposed sampling sites for Chabahar and Kanarak districts

1. Chabahar  sewagepumping station (25.16.15N 60.41.32E)

 

 

                                                                                                         

 

2. Chabahar Free Trade Zone sewage pumping station  map(25.19.15 N 60.37.32 E)

 

 

 

 

 

 

3. Konarak sewage pumping station  map (25.23.37 N 60.29.38 E)

 

 

 

 

 

Acknowledgement

We express our sincere thanks and gratitudes to Humayun Asghar, Coordinator of Polio Eradication Program, World Health Organization, Eastern Mediterannean Region, Dr. Susan Mahmoudi, National Focal Point for Polio Program, our colleagues in Zahedan University of Medical Sciences, and Iranshahr Faculty Medical Sciences and everybody who contributed to implementation of the program.

 

 

Chabahar workshop & field visit photos

 

 

 

 

 

 

 

      

 

 

 

Konarak workshop & field visit photos

 

 

Copyright © 2018 Zahedan University of Medical Sciences. All rights reserved.Date updated: 08/12/2018

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