Re: Somalia Health updates 2012
Somalia Emergency Weekly Health Update
Reporting dates 26 May - 1 June 2012
(reflecting Epidemiological week 21)
BULLETIN HIGHLIGHTS
As a response to the current cholera outbreak in Mogadishu, a fourth cholera treatment center (CTC)
has been opened. The CTC, fully functional, is located in Xamarjajab district and acts as a referral
center for suspected cholera cases to decongest the caseload in Banadir hospital.
SITUATION OVERVIEW:
During week 21, the leading causes of morbidity across the
zones were suspected cholera and confirmed malaria.
Suspected cholera accounted for most consultations in Central
Somalia (3.22%), Somaliland (1.38%), and Puntland (5.44%) while confirmed malaria was the leading
cause of morbidity in Southern Somalia (3.96%). A steady increase in the number of consultations continues
to be observed in almost all areas of Somalia experiencing rains.
CENTRAL SOMALIA and SOUTHERN SOMALIA
More than 250 cases of suspected shigellosis are being reported in South and Central Somalia and 1% or
greater proportional morbidity in Somaliland and Puntland. Shigellosis can be associated with high attack rates
and case-fatality rates, especially among children aged less than 5 years. The Center for Disease Control
(CDC) recommends to minimize person-to-person transmission (fecal-oral) and keep food and water safe and
covered.
In Central Somalia, cases of neonatal tetanus are continuing to be reported intermittently (none last week;
however, 2 cases in South Somalia last week). Enforce strict adherence to aseptic deliveries, including cutting
of the umbilical cord, and administration of tetanus toxoid-containing vaccine during pregnancy.
In the Southern Somalia, confirmed malaria is the leading cause of morbidity accounting for 3.96%. For
Central and Southern Somalia, suspected whooping cough continues to be reported. Ensure vaccination and
adherence to the case definition is occurring.
...
SOMALILAND
Suspected cholera became this week the leading cause of morbidity in Somaliland (see table 3). A total of 58
out of 88 (67%) reported suspected cholera cases came from Erigavo district, Sanaag region. The exact
reasons for this sudden increase in Erigavo district are being investigated. Regarding suspected measles, the
proportional morbidity slightly decreased compared with last week (1.34% for week 20, compared with 1.00%
for week 21), however the total number of consultations was higher this week. Burao district (Togdheer
region), which also has the lowest vaccination coverage for the recently conducted Child Health Days,
accounts for most of the cases.
...
PUNTLAND
Suspected cholera remains the leading cause of morbidity in Puntland accounting for 5.44% during week 21
(see table 4).
A similar trend is being observed for suspected shigellosis, with almost remaining stable in terms of
proportional morbidity (1.44% last week compared to 1.27% this week).
...
MAIN CAUSES OF MORBIDITY:
SUSPECTED CHOLERA (SOURCE: CSR SENTINEL SITES)
Results of 23 out of 60 stool samples collected from suspected cholera cases in Banadir region (South
Central Somalia) during week 19 are still pending. The results of the 37 other samples were reported during
week 20.
Following the routine water quality monitoring exercise in Mogadishu, reported during week 18, UNICEF and
WASH cluster have dispatched additional chlorine to Mogadishu. In this regard, WASH partners will be able to
step up chlorination activities.
As response to the current cholera outbreak in Mogadishu, WHO and UNICEF have prepositioned adequate
stocks of diarrhoeal disease kits (DDKs). Partners who are in need of additional DDKs should contact
WHO/UNICEF staff in Mogadishu.
(2 deaths were recorded this week at Banadir hospital - Ro)
...
CONFIRMED MALARIA (SOURCE: CSR SENTINEL SITES)
WHO encourages all field partners to screen all fever cases with the rapid diagnostic tests (RDTs) as well as
microscopy whenever it is available. RDTs have been provided by UNICEF to all health facilities and are
available in large quantities.
WHO is still investigating the increased number of confirmed malaria cases reported over the past weeks, in
particular from six regions (Banadir, Lower Shabelle, Bay, Bakool and Lower Jubba). Cross-checking is being
carried out and a detailed report is still pending.
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SUSPECTED MEASLES (SOURCE: CSR SENTINEL SITES)
The increase in proportional morbidity for measles in Somaliland continues. The current measles outbreak
was detected back in February of this year, and case investigation has been conducted with the support of
WHO. The Ministry of Health of Somaliland plans to vaccinate about 180 000 children between the age of 6
months ? 15 years as part of the mop up measles campaign in Togdheer region. The planned National
Immunization Days for Somaliland (28-30 May) have been cancelled till further notice.
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Re: Somalia Health updates 2012
Somalia Emergency Weekly Health Update
Reporting dates 19 ? 25 May 2012
(reflecting Epidemiological week 20)
BULLETIN HIGHLIGHTS
Of 37 stool samples collected from patients in Mogadishu during the reporting week, 19% tested
positive for cholera on lab culture. Current armed conflict affecting the Afgooye corridor and parts of
Mogadishu resulting in renewed population displacement could accelerate the spread of cholera in
Mogadishu.
...
SITUATION OVERVIEW:
The received data for South and Central Somalia has been split up this week and will be so in future. The
leading causes of morbidity varied across the zones with suspected cholera and confirmed malaria
accounting for most consultations in Southern Somalia (3.00% and 2.99% respectively), confirmed malaria
in Central Somalia with 4.29%, and suspected cholera in Puntland (5.58%). Suspected measles remains
the leading cause of morbidity in Somaliland (1.34%).
...
SOUTHERN SOMALIA
In Southern Somalia, confirmed malaria is the leading cause of morbidity accounting for 4.29% consultations.
CENTRAL SOMALIA
Epidemic numbers of cases of suspected whooping cough, continue in South and Central Somalia stressing
the need to ensure vaccination, 111 for week 20.
SOMALILAND
Suspected measles was the leading cause in Somaliland (see table 2). For week 20, the proportional morbidity
for suspected measles slightly decreased compared with last week, however the total number of consultations
went down too. Burao district (Togdheer region), which also has the lowest vaccination coverage for the
recently conducted Child Health Days, accounts for most of the cases. Suspected cholera is on the rise in
Somaliland. Sporadic cases of suspected whooping cough are detected in Somaliland.
PUNTLAND
During week 20, the leading cause of morbidity for Puntland is suspected cholera accounting for most of the
consultations (proportional morbidity of 5.58%), however, given the proportion of cases below the age of five,
the surveillance case definition is probably not being followed. Although last week the total number of
consultations was less, this is a sudden increase by almost 20% of proportional morbidity. A similar trend is
being observed for suspected shigellosis, here an increase of more than 50% compared with last week.
MAIN CAUSES OF MORBIDITY:
SUSPECTED CHOLERA (SOURCE: CSR SENTINEL SITES)
During week 20, a total of 37 stool samples were collected from Banadir hospital, and 19% (7) tested positive for Vibrio cholera serotype ?Inaba? sensitive to tetracycline and chloramphenicol and resistant to ampicillin and cotrimoxazole. These seven positive cases include five residents of Hodan district, one from Dharkeynley and one from Yaqshiid district. Partners in these districts are requested to step up all preventive activities for cholera and other diarrheal diseases. Banadir, Lower Shabelle and Bay regions recorded an increase in the number of suspected cholera cases compared to week 19. However, in Central Somalia, which also accounts for the greatest burden of communicable diseases in the whole country, the total number of cases decreased from over 650 in week 19 to 550 in week 20. However, the proportion of cases among children under the age of five continues to raise concerns of not meeting the surveillance case definition.
The number of admissions for suspected cholera to Banadir hospital continues to increase. Twice as many cases were seen in 2012 compared to 2011 for the same reporting period (week 20 2012: 333 cases, 2011: 140 cases). The CFR is also higher raising concern of the disease severity or the case management (CFR 2012: 5.7%, CFR 2011: 0.6%). Of the 333 admissions reported in week 20, 66% (220) were children under 5 years and 39% (130) of all were women and girls. Hodan CTC supported by ARC reported 58 admissions including 57% (33) children under 5 years. Of all admissions 50% were women and girls. In the past four weeks, Hodan CTC, a referral centre, has treated 210 cases with no associated deaths. Merka hospital CTC reported 32 admissions including 66% (21) children under 5 years with no associated death. Women and girls accounted for 56% of admissions.
CONFIRMED MALARIA (SOURCE: CSR SENTINEL SITES)
Six regions (Banadir, Lower Shabelle, Bay, Bakool and Lower Jubba) recorded an increase in the number of
confirmed malaria cases compared to week 19. WHO is investigating the increased number of confirmed
malaria cases reported over the past weeks. Cross-checking will be carried out and a detailed report will be
forthcoming, which will include week 1-21.
SUSPECTED MEASLES (SOURCE: CSR SENTINEL SITES)
The increase in proportional morbidity for measles in Somaliland continues. The current measles outbreak
was detected back in February of this year, and case investigation has been conducted with the support of
WHO. National Immunization Days are being organized in Somaliland (28-30 May) and Puntland (21-23 May),
targeting 412 800 and 178 000 children under the age of five respectively.
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Re: Somalia Health updates 2012
Humanitarian Bulletin
Eastern Africa
Issue 6 | 11 – 25 May 2012
...
Cholera and measles on the rise
The incidence of infectious diseases is increasing in numerous informal settlements due
to the ongoing rains and limited access to safe water. From 9 April to 6 May, a steady
increase in suspected cholera cases was reported in southern and central regions.
Banadir region accounted for 49 per cent of the 777 cases reported between 30 April and
6 May, representing an 11 per cent increase from the previous week. Although these
figures do not suggest a major epidemic, there are serious concerns of an increased risk
of a cholera outbreak in Banadir region and the Balcad and Afgooye corridors, where
there is a high density of IDPs significantly increasing the risk of the disease spreading. In
Balcad district, Middle Shabelle region, 77 cholera cases were confirmed since the end of
March at a cholera treatment centre. In an effort to speed treatment of the disease, WHO
provided two diarrhoeal disease kits to Banadir Hospital in Mogadishu to treat 200 adults
with severe cases and 800 people with moderate cases of suspected or confirmed
cholera. Health partners prepositioned 23 diarrhoeal disease kits in cholera treatment
units within mother and child health clinics in southern and central regions. There are
plans to open a further 12 units. Preventative activities include the airing of informational
radio messages, community sensitization, chlorination of water sources and distribution of
aqua tabs for water purification.
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Re: Somalia Health updates 2012
Somalia Emergency Weekly Health Update
Reporting dates 12 ? 18 May 2012
(reflecting Epidemiological week 19)
BULLETIN HIGHLIGHTS
As a response to the current measles outbreak in Somaliland, particularly Burao district, the Ministry of Health has decided to organize a region-wide outbreak response campaign. Exact dates and target population figures are not known yet.
...
SITUATION OVERVIEW:
The leading causes of morbidity varied across the zones with suspected cholera and confirmed malaria accounting for most consultations in South Central Somalia (2.69% and 2.61% respectively) and suspected cholera in Puntland (4.5%). Suspected measles remains the leading cause of morbidity in Somaliland (1.88%). A steady increase in the number of consultations continues to be observed with almost all areas on Somalia experiencing rains. South Central Somalia reported over 7% increase, while Somaliland and Puntland remained stable compared to week 18.
SOUTH CENTRAL SOMALIA
In South Central Somalia, a steady increase in the number of reported cases of suspected shigellosis has been reported. Contact with the field suggests a lack of adherence to the stipulated case definition ?visible blood in stool?. To tackle this issue, a series of planned trainings is expected to correct this among health workers. Similar challenges are fuelling the sustained spread of whooping cough and the increasing number of neonatal tetanus that will greatly affect neonatal mortality. While the number of suspected cholera cases slightly decreased compared to week 18, the risk of an increase in the number of cases remains. Results of over 60 stool samples collected from suspected cholera cases in Banadir region are still pending. Cholera was confirmed earlier and partners have been advised to step up WASH activities.
SOMALILAND
Suspected measles was the leading cause in Somaliland (see table 2). For week 19, the proportional morbidity for suspected measles increased compared with last week, although the total number of consultations remained the same. Burao district (Togdheer region), which also has the lowest vaccination coverage for the recently conducted Child Health Days, accounts for most of the cases.
PUNTLAND
During week 19, the leading cause of morbidity for Puntland is suspected cholera accounting for most of the consultations (proportional morbidity of 4.5%). However, since a few weeks the proportional morbidity for shigellosis is on the rise. A steady increase in the number of consultations for suspected cholera is being observed with almost all areas in Somalia experiencing rains.
MAIN CAUSES OF MORBIDITY:
SUSPECTED CHOLERA (SOURCE: CSR SENTINEL SITES)
Results of over 60 stool samples collected from suspected cholera cases in Banadir region (South Central Somalia) are still pending. Cholera was confirmed earlier and partners have been advised to step up WASH activities.
The number of suspected cholera cases reported from Puntland is decreasing. Most cases were reported from Bossaso district in Bari region. Information on current response activities is still pending.
CONFIRMED MALARIA (SOURCE: CSR SENTINEL SITES)
In regards to malaria, the trends have remained stable.
SUSPECTED MEASLES (SOURCE: CSR SENTINEL SITES)
The increase in proportional morbidity for measles in Somaliland continues. The current measles outbreak was detected back in February of this year, and case investigation has been conducted with the support of WHO.
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Re: Somalia Health updates 2012
Humanitarian Bulletin
Somalia
Issue 07 | 4-16 May 2012
Cholera and measles on the rise
The incidence of infectious diseases is increasing in numerous informal settlements due
to the on-going rains and limited access to safe water. From 9 April to 6 May, a steady
increase in suspected cholera cases was reported in southern and central regions.
Banadir region accounted for 49 per cent of the 777 cases reported between 30 April and
6 May, representing an 11 per cent increase from the previous week.
Although these figures do not suggest a major epidemic, there are serious concerns of an
increased risk of a cholera outbreak in Banadir region and the Balcad and Afgooye
corridors, where there is a high density of IDPs significantly increasing the risk of the disease spreading. In Balcad district, Middle Shabelle region, 77 cholera cases were
confirmed since the end of March at a cholera treatment center (CTC).
In an effort to speed treatement of the disease, WHO provided two diarrhoeal disease kits
to Banadir Hospital in Mogadishu. The kits can be used to treat 200 adults with severe
cases and 800 people with moderate cases of suspected or confirmed cholera. Health
partners prepositioned 23 diarrhoeal disease kits in cholera treatment units within mother
and child health clinics (MHC) in southern and central regions. There are plans to open a
further 12 units. Preventative activities include the airing of informational radio messages,
community sensitisation, chlorination of water sources and distribution of aqua tabs for
water purification.
In Somaliland, suspected measles cases have remained high since February. Burao,
Togdheer region, alone accounted for 424 of the 628 reported cases in Somaliland.
Burao had the lowest vaccination coverage for the recently completed Child Health Days
(CHDs) campaign. Obstacles to better coverage include recluctance on some
communities to participate in the vaccination campaign.
Incidence of malnutrition fall in the capital
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Re: Somalia Health updates 2012
Somalia Emergency Weekly Health Update
Reporting dates 5 ? 11 May 2012
(reflecting Epidemiological week 18)
BULLETIN HIGHLIGHTS
? The Ministry of Health, WHO and UNICEF have successfully concluded the two phases of Child Health Days in Banadir Region. The two phases of the vaccination campaign reached more than 295 000 children under the age of five and more than 317 000 women between the ages of 15 and 49. Child Health Days were also organized on 10 April 2012 in Gedo region, where a total of more than 47 000 children under the age of five and more than 35 000 women between the ages of 15 and 49 were reached.
? During a routine water quality monitoring exercise in 14 districts of Mogadishu, a WHO team conducted daily water testing for 50 water sources over three consecutive days. Of these, 50% (25) had no chlorine residual
over the three days of testing. WHO recommends improvement in water source chlorination and adding pointof- use, where appropriate. In addition, accelerated hygiene promotion is needed in view of confirmed cholera
cases in Mogadishu and the ongoing transmission season that stretches to July.
...
SITUATION OVERVIEW:
The leading causes of morbidity varied across the zones with suspected cholera accounting for most consultations in South Central Somalia (3.4%). Suspected measles remains the leading cause of morbidity in Somaliland (see tables). A steady increase in the number of consultations continues to be observed with almost all areas on Somalia experiencing rains.
SOUTH CENTRAL SOMALIA
In the last three weeks, the number of suspected pertussis (whooping cough) cases have double in South Central Somalia while the number of reporting sites have remained steady (77 cases for 75% of facilities vs. 153 cases for 76% of facilities, respectively). This is born out in the increasing proportional from 0.4% to 0.7% from week 15 to week 18, respectively. Reinforcement of EPI with DTP needs to be pushed for all clinic visits of children, including providing catch-up doses.
SOMALILAND
Suspected measles was the leading cause in Somaliland (see table 2). For week 18, the proportional morbidity for suspected measles remains high since a couple of weeks. Burao district (Togdheer region), which also has
the lowest vaccination coverage for the recently conducted Child Health Days, accounts for most of the cases.
PUNTLAND
During week 18, the leading cause of morbidity for Puntland is suspected cholera accounting for most of the consultations (proportional morbidity of 6.5%). A steady increase in the number of consultations for suspected
cholera is being observed with almost all areas in Somalia experiencing rains.
MAIN CAUSES OF MORBIDITY:
SUSPECTED CHOLERA (SOURCE: CSR SENTINEL SITES)
A steady increase in the number of reported suspected cholera is observed in South and Central Somalia for both age groups (under the age of five, and five and older). Banadir region alone accounted for 49% of the 777
cases reported in week 18. Confirmed cholera cases have been identified in Banadir region. Although these do not suggest a major outbreak at the moment, the risk of an outbreak in Banadir region, the Afgooye corridor
and the neighboring Balcad corridor in Middle Shabelle region cannot be understated. Numerous informal settlements and population displacement following the increasing personal insecurity within Mogadishu due to undeterminable daily explosions over the past weeks (see casualty data) pose a major challenge in prevention and control of diarrheal diseases outbreaks including cholera; which are accelerated by the ongoing rains and limited access to safe and clean drinking water.
...
CONFIRMED MALARIA (SOURCE: CSR SENTINEL SITES)
In regards to malaria, the trends have remained stable.
SUSPECTED MEASLES (SOURCE: CSR SENTINEL SITES)
The increase in proportional morbidity for measles in Somaliland continues. Since the beginning of 2012, Burao district (Togdheer region) alone accounted for 424 of the 628 reported measles cases (or 67.5%). The current measles outbreak was detected back in February of this year, and case investigation has been conducted with the support of WHO.
Distribution of the measles cases
Based on the data obtained from the records of 8 MCH and one hospital (all located in Burao town), with additional house to house search, it was found out that the majority of the measles cases in Burao town have
to be situated in the age group of 1-4 years and 5-9 years (see table 5). Looking at the vaccination status of those 520 measles cases in Burao town, the majority of them were not vaccinated (see table 6).
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Re: Somalia Health updates 2012
Somalia Emergency Weekly Health Update
Reporting dates 15 April – 4 May 2012
(reflecting Epidemiological week 15-17)
...
Of the 222 sentinel sites reporting weekly from the three zones of Somalia, for week 17, 98% (53) in Puntland, 98% (44) in Somaliland, but only 79% (97) sentinel sites reported on time from South and Central Somalia or 87% (194)
of all sentinel sites. For South and Central Somalia had during week 17 the highest number of reporting sentinel sites since the beginning of the year.
SOUTH CENTRAL SOMALIA
During week 16, a total of five cases of acute flaccid paralysis were reported from South and Central Somalia. The cases were reported from sentinel sites located in Baidoa and Galgaduud region. The results of follow up investigation of those cases are still pending.
Over the past three weeks, the leading cause of morbidity for South and Central Somalia is suspected cholera. During week 17, the proportional morbidity reached 3%, a steady increase compared to the two previous
weeks. Between week 16 and 17, an increase of 12% in the number of reported suspected cholera cases was observed (see table 1). This increase is expected as part of the morbidity changes following the onset of the
Gu rains and the subsequent transmission of cholera in Somalia. Although not alarming, hospitals and cholera treatment centers are reporting a steady increase in admissions. The only confirmed cholera cases in 2012
have been in Mogadishu (Banadir region) and Balcad (Middle Shabelle region). Currently the cases in Balcad are under control. Response activities for Banadir are ongoing.
SOMALILAND
Suspected measles was the leading cause in Somaliland (see table 2). For week 17, the proportional morbidity for suspected measles keeps on increasing compared with the previous weeks. Burao district (Togdheer region), which also has the lowest vaccination coverage for the recently conducted Child Health Days, accounts for most of the cases.
PUNTLAND
During week 17, the leading cause of morbidity for Puntland is suspected cholera accounting for most of the consultations (proportional morbidity of 6.5%). A steady increase in the number of consultations for suspected
cholera is being observed with almost all areas in Somalia experiencing rains.
MAIN CAUSES OF MORBIDITY:
SUSPECTED CHOLERA (SOURCE: CSR SENTINEL SITES)
Many areas in Somalia have received rains in the past weeks. The number of suspected cholera cases is on the increase, particularly in South and Central Somalia and Puntland. This is expected to increase further.
During week 15, 9 out of 34 samples (or 23%) collected from Banadir and Middle Shabelle regions have tested positive for Vibrio cholera serotype ‘inaba’. Partners working in Hodan, Shibis, Karaan and Tawfiq settlement
of Banadir region and those working in Balcad district (Balcad town and Mukidheer village) are urged to step up both WASH interventions especially hand washing and point-of-use chlorination of water for domestic use.
Adequate case management supplies are available for partners who are urged to report all suspected cases.
Rapid diagnostic tests are also available for partners facing challenges in collection and transportation of stool samples.
During week 16, an additional 6 samples from Middle Shabelle region were collected by health partners and tested all positive for Vibrio cholera serotype ‘inaba’.
From 22 to 29 April, the newly opened cholera treatment centre (CTC) in Hodan district, Mogadishu, reported 33 admissions including 84% (28) children under the age of five. Of all patients using the health services of this
CTC, 33% were women and girls. No deaths were reported.
The CTC of Merka hospital, in Lower Shabelle region, reported 44 admissions during week 17 including 28 (64%) children under the age of five. Of all patients using the health services of this CTC, 45% were women and girls
and no deaths were reported. Compared with week 16, where only 18 cases were admitted, an increase of over 100% was reported in the number of admissions (see graph on the right). As of today, no confirmed cholera case
has been reported from Merka.
During week 17, Banadir hospital also reported a 15% increase in admissions for suspected cholera. A total of 236 patients including 172 (73%) children under the age of five, with four associated deaths of which 3 were under 5
years of age were treated at the hospital. Of all cases, 52% were women and girls. Of all case under 5 years, 70% were children under 2 years of age.
CONFIRMED MALARIA (SOURCE: CSR SENTINEL SITES)
In South Central Somalia, a WHO investigation team, including an entomologist and laboratory technicians, looked into the sudden increase of suspected malaria cases in Lower and Middle Juba. This focal investigation survey was
conducted in Jilib and Jamaame districts, Lower and Middle Juba. Both districts experienced unprecedented rains in October and November 2011, leading to an increase in suspected malaria cases. In January 2012, rapid diagnostic tests were not available for these health facilities, therefore the suspected malaria cases had to be diagnosed clinically (as reflected in the January
weekly health updates). In March 2012, epidemiological and entomological investigations were carried out at eight sites in both districts. The results showed that small foci of stable malaria were present. These foci were discovered mainly in ponds and streams. Two types of malaria-vector mosquitoes “anophlesarabiensis and anophlesfunestus” were found in the Jilib and Jammame districts.
Main Results
Out of 205 blood samples, 127 were positive using laboratory examinations. Both adult mosquitoes and larvae tested showed a minimum impact on malaria transmission.
Conclusion
Increased malaria cases reported during that particular investigation period were due to weaknesses in malaria control, such as insecurity and stock-out of rapid diagnostic tests. In addition, a combination of heavy rainfall
following a long and persistent drought and low usage of personal protection measures increased the number of malaria cases. Personal protection measures can include long-lasting insecticide treated mosquito nets, nofly
sheeting for IDP camps, and residual spraying. The study concluded that this particular increase was due to seasonal variations but cannot be considered as a malaria outbreak (no deaths were reported).
WHO takes this opportunity to encourage all partners to use rapid diagnostic tests, which are available in large quantities in all health facilities. This will facilitate screening of all fever cases and lead to prompt treatment of
all positive malaria cases as per the national treatment guidelines.
SUSPECTED MEASLES (SOURCE: CSR SENTINEL SITES)
Suspected measles cases continue to be reported from all the three zones of Somalia. The number of reported cases keeps on increasing in Somaliland. Burao district (Togdheer region) alone accounted for 79 of the 95
reported cases (or 83%) during week 17. Limited outbreak response was carried in Aynebo district and Burao town, in which 11 488 and 14 240 children respectively were vaccinated. Outreach immunization activities are
strengthened and ongoing in Burao town. In addition to immunization activities, surveillance is strengthened and local health authorities are monitoring measles data on a daily basis. Because of the continuation of the
outbreak despite the response, local health authorities in Somaliland have organized and deployed an outbreak investigation team with the support of WHO Somalia. The investigation team met with all political leaders, important religious leaders, and partners. The team conducted a rapid measles immunization coverage assessment and a house-to-house detection of measles cases. In addition, BBC Somali service made media coverage of the outbreak that was aired on BBC and other local media outlets. A television
debate was also organized on the importance of vaccination among medical doctors, sheiks and other prominent figures in the region that had not been actively supporting immunization activities. These media events and inclusion of prominent figures is expected to enhance acceptance of vaccination and improve measles immunization coverage rate that currently stands at about 50 percent.
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Re: Somalia Health updates 2012
Humanitarian Bulletin
Somalia
Issue 06 | 25 April to 04 May 2012
...
Cholera prevention measures put in place by
WASH cluster partners
Gu rains raise fears of disease outbreaks
In Balad district of Middle Shabelle Since, 2 confirmed cases of cholera, 76 cases of
acute watery diarrhoea (AWD) and one death were reported. On 26 April, four children all
under age 5 were transferred to Jowhar regional hospital for higher-level treatment for
severe AWD. In Banadir, cholera cases were reported in Hodan, Qaraan and Shibis and
brought to Banadir Hospital for treatment. Cases of acute watery diarrhoea (AWD) were
also reported in Belet Xaawo, in Gedo.
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Re: Somalia Health updates 2012
Somalia Emergency Weekly Health Update
Reporting dates 1-14 April 2012
(reflecting Epidemiological week 13 and 14)
Of the 222 sentinel sites reporting weekly from the three zones of Somalia, for week 13, 98% (53) in Puntland, 98% (44) in Somaliland, but only 36% (44) sentinel sites reported on time from South and Central Somalia or 64% (141) of all sentinel sites. Only 1 of 30 sentinel sites reported from Lower Shabelle region; reason being investigated.
SITUATION OVERVIEW:
SOUTH CENTRAL SOMALIA
During week 13, a case of acute flaccid paralysis was reported in South Central Somalia from Bondheere district, Mogadishu. This case is being investigated and it was found to be too late for collection of samples for
further investigation at the laboratory. In addition, two cases of suspected diphtheria and whooping cough (pertussis) have been reported. It was not possible to trace the two diphtheria cases due to lack of information.
It is suspected that both cases might have been IDPs. This all points out the need of greater routine Expanded Programme on Immunization for the zone. Finally, two cases of neonatal tetanus have been reported. This
shows that antenatal care needs to be strengthened to ensure two doses of tetanus toxoid (TT or Td) are given during pregnancy.
During week 14, none of the sentinel sites for South Central Somalia reported due to technical problems faced at the zonal collection level.
SOMALILAND
Given the disproportional number of suspected cholera cases during week 13 (although the numbers are small); there is still concern of non-adherence to the case definition for sentinel sites in Somaliland.
For week 14, the proportional morbidity for suspected measles keeps on increasing. Burao district (Togdheer region), which also has the lowest vaccination coverage for the recently conducted Child Health Days,
accounts for most of the cases.
PUNTLAND
Cholera
The proportional morbidity for suspected cholera in South Central Somalia is increasing during week 13. The most affected region for that reporting week was Middle Shabelle. However, WHO and partners observed a general increase in number of cases in Balcad district, Middle Shabelle region. An outbreak investigation team collected four samples that were sent to Nairobi for further investigation in the laboratory. Results are still pending. Health partners have launched response activities in some of the affected areas. Middle Shabelle
region is underserved with very few active health facilities.
During week 14, in South Central Somalia, a total of 30 stool samples were collected from suspected cholera cases coming from Banadir region. Results are still pending. For Puntland, the proportional morbidity reduced due to the fact that less sentinel sites reported compared to the previous week.
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Malaria
In South Central Somalia, a WHO investigation team, including an entomologist and laboratory technicians, is looking into the sudden increase of suspected malaria cases in Lower and Middle Juba. The results are still pending.
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Measles
Suspected measles cases continue to be reported from all the three zones of Somalia. During week 13 for South Central Somalia, and week 13 and 14 for Puntland, the number of cases has decreased compared to previous weeks. Child Health Days have kicked off, on 10 April in Gedo region as well as Banadir region. Two rounds will be organized in Banadir region, with round one from 14-18 April 2012 and round two from 21-25 April 2012.
The number of reported cases has increased in Somaliland. Immunization outreach activities have been started and the number is expected to decrease. The numbers of reported cases, in all zones, need to be assessed against the background of limited or no training, for health workers, on case-definitions of measles.
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Re: Somalia Health updates 2012
Somalia
Emergency Weekly Health Update - Weekly Highlights 24 - 30 March 2012
Communicable Disease Surveillance and Response (CSR)
Reporting completeness:
A total of 222 CSR sentinel sites report on weekly basis from the three zones of
Somalia. During week 12, 98 % of all sentinel sites of Puntland reported (44 of
45), and so did report 98% (53 of 54) of all sentinel sites in Somaliland. A total
of 67% (82 of 123) of all sentinel sites of South and Central Somalia reported
on time (see graph 1), giving the highest number for this year and showing a
steady slow increase. Overall, only 81% of the 222 sentinel sites reported on
time for week 12.
...
Outbreak alerts
In South and Central Somalia, confirmed malaria was
the leading cause of morbidity among the priority
diseases (see table 1). There was a 36% increase in the
number of confirmed malaria cases compared with week
11, particularly from the Lower Juba, Gedo, Lower
Shabelle and Banadir regions. Suspected cholera cases
also reported a slight decrease of 4% compared with
week 11, particularly in Middle Shabelle, Middle Juba and
Gedo regions.
? In Somaliland, the proportional morbidity of suspected
measles continue to be reported with notably a 47%
increase in the number of reported cases compared to
week 10 (see table 2). The Ministry of Health has
released the Child Health Days immunization coverage
rates, with 91% for polio, 88% for measles, 81% for DPT,
49% for tetanus toxoid, 82% for deworming, 86% for
vitamin A, 88% for ORS, 90% for aqua tabs and 80%
were screened using MUAC.
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Suspected cholera (source: CSR sentinel sites)
The number of suspected cholera cases across Somalia is expected to further increase . Although the proportional
morbidity for South Central Somalia seems to remain stable during the past two weeks, looking at the regional breakdown,
a 73% increase has been reported, particularly in Lower Shabelle region.
During 2012, the biggest disease burden for suspected
cholera in South Central Somalia has been concentrated in
4 regions, namely Banadir, Lower Shabelle, Lower Juba
and Middle Juba regions. Lower Shabelle, Lower Juba and
Middle Juba are all located in riverine areas, while Banadir
region has a huge number of IDPs and returnees living
with lack of proper water and sanitation facilities.
As far as the immediate alert reporting of CSR, health
partners face challenges in terms of picking up timely
rumours for suspected cholera and other diseases with
outbreak potential, due to sporadic communication
network failures. This may mean an underreporting of the
reality on the ground.
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Confirmed Malaria (source: CSR sentinel sites)
In South and Central Somalia, although two more
sentinel sites reported in week 12, a 36% increase of
confirmed malaria cases was reported during week 12.
A WHO investigation team, including an entomologist
and laboratory technicians, is looking into the sudden
increase of reported suspected malaria cases in Lower
and Middle Juba. The results are still pending. However,
Artemisinin-based combination therapy (ACT) and rapid
diagnostic tests (RDTs) are in place at all health
facilities.
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Suspected Measles (source: CSR sentinel sites)
Suspected measles cases continue to be reported across Somalia. Proportionally, South Central Somalia continues
to report the highest number of suspected measles cases. This is due to the low vaccination coverage for all antigens as
some regions have never been vaccinated over the past two years.
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Re: Somalia Health updates 2012
Humanitarian Bulletin
Somalia
Issue 03 | 21 March 2012
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Expected rise in disease with Gu rains
Measles and suspected cholera expected to rise
Preparations by Health and WASH Clusters? to minimize the health risks with the fast approaching Gu rains, are on-going. The Gu rains normally last from April to June.
Suspected cholera:
Concerns are expressed about the increasing potential for communicable disease outbreaks with people living in overcrowded IDP camps. Work to
build the capacity of new WASH Cluster local partners continues
as fears that they may focus on response rather than prevention
could result in an increased number of outbreaks.
Over the reporting period the WASH Cluster established a
Hygiene Promotion/Sanitation Technical Working Group, which
will oversee activities of the cluster in Mogadishu. So far, WASH
is supporting 327,154 people, 13 per cent of the 2.6 million
people targeted with sustainable water access across Somalia.
Concurrently, the cluster is reaching 803,188 beneficiaries with
temporary provision of safe water, of whom 789,588 are from
the south. Another, 197,889 beneficiaries are newly accessing
sanitation facilities (latrines), and 154,430 people benefited from
hygiene promotion and non-food item (NFI) hygiene packages.
Malaria:
The Health Cluster expects that malaria will increase once the
rains begin. The areas that will be most affected include along
the riverine areas of the Shabelles, the Jubas, Gedo, Hiraan and
Banadir regions. Rapid diagnostic tests and Artemisia combined therapy (malaria drug treatment) are on the ground, according to WHO, as well as interagency health kits with a malaria module to be deployed in the event of an outbreak.
Immunization:
In addition, the Health Cluster reported the start of the first round of Child Health Days in Puntland on 11 March with more than 160,000 children aged 0-59 months targeted with vaccinations against polio, measles, diphtheria, pertussis and tetanus. The children also received vitamin A supplements and de-worming tablets.
Access constraints in southern and central Somalia limited vaccination programmes to carry out their immunization activities for the past two years, leading to an increase of vaccine-preventable disease, such as measles. The Bay region reported a significant increase with 19 cases reported in week 10. In Somaliland 38 cases were reported in week 10 compared to five cases in the previous week.
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Re: Somalia Health updates 2012
Humanitarian Bulletin
Somalia
Issue 02 | 07 March 2012
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52 deaths from acute watery diarrhoea in southern and central regions
Health partners reported a total of 676 suspected cases of AWD in the first two weeks of February in southern and central Somalia, with 52 deaths. Of these, 382 cases, 57 per cent were reported in Banadir.
Malaria cases in the southern and central regions reached 1,030 confirmed cases including 393 children under five, while 341 cases of measles were reported, including 272 children under five. Lower Shabelle accounted for 33 per cent of all measles cases.
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Re: Somalia Health updates 2012
BULLETIN HIGHLIGHTS Weekly Highlights 4 - 10 February 2012
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Epidemiological surveillance (30 Jan - 5 Feb 2012, epi week 5)
Acute Watery Diarrhoea (source: CSR sentinel sites)
South Central Somalia
? In the reporting week 2
, 62 health facilities in South Central Somalia reported 293 cases of AWD, including 227 (78%) children under the age of five giving a CFR of 1.14. Banadir region which is home to a number of internally displaced
persons (IDPs) and informal settlements reported 191 (65%) of all the cases. Of these, 151 (79%) cases were children under the age of five years. Only 14 facilities reported this week from the region.
? WHO has urged all wash partners to step up activities in the
affected districts. Currently, Health and WASH cluster are disseminating ?Stamp out cholera! campaign? radio messages to the most affected areas in Somalia. This activity will take place during the next 4 months.
Banadir Hospital
? For this reporting week, Banadir Hospital reported 84 cases of AWD, including 70 (83%) children under the age of five (see graph). Of these cases, 42 (50%) are women and girls. This week, a slight decrease was observed compared to week 4 (95 cases were reported).
Lower Shabelle region
? 29 AWD cases were reported from 26 health facilities, including 23 (80%) children under the age of five.
Somaliland
? 54 health facilities from the six regions reported 11 cases of AWD, including 10 (91%) children under the age of five.
Measles (source: CSR sentinel sites)
South Central Somalia
? In week 5, 161 suspected measles cases were reported including 132 (82%) children under the age of five and one death under the age of five.
Banadir region
? 29 cases of suspected measles including 26 (90%) children under the age of five were reported.
Hiraan region
? 28 cases of suspected measles including 23 (82%) children under the age of five were reported.
Lower Shabelle region
? 26 health facilities in the region reported 50 suspected measles cases, including 41 (82%) children under the age of five.
Somaliland
? In the reporting week, 7 cases of suspected measles including 5 (72%) under the age of five years was reported from 54 health facilities in six regions.
Puntland
? In week 5, 12 case of suspected measles were reported from 46 health facilities in six regions, including 6 (88%) children
under the age of five. This signifies a 50% reduction in reported cases compared to week 4 (6 cases). Routine vaccination
activities are ongoing at health facilities.
Malaria (source: CSR sentinel sites)
Banadir region
? 159 confirmed malaria cases were reported from 14 health facilities, of which 73 (46%) were confirmed by rapid diagnostic test or microscopy. Most of the cases in this region were reported from Madina district which accounted for 127 (80%) of the total cases in the region.
Lower Shabelle region
? 119 confirmed malaria cases were reported from 26 health facilities, of which 67 (34%) were children under the age of five.
Somaliland
? In the reporting week, no cases of confirmed malaria were reported.
Puntland
? In week 5, no cases of confirmed malaria were reported
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Re: Somalia Disease highlights Jan 2012
From: From: From: Horn of Africa Crisis
Situation Report No. 33
24 February 2012
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Health: For 8 to 12 February, the cluster reported that 70 health facilities recorded 383 cases of acute
watery diarrhoea in southern and central Somalia, including 302 (79 per cent) in children under age 5. Also in
southern and central Somalia, 78 per cent of the 180 suspected measles cases reported were in children
under age 5, while malaria cases reached 565, of whom 225 (40 per cent) were children under age 5.
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Somalia Health updates 2012/2013
DISEASE HIGHLIGHTS FOR JANUARY 2012 *:
BULLETIN HIGHLIGHTS Weekly Highlights 28 January - 3 February 2012
? Started on 5th February 2012, more than 5000 vaccinators will be trained to carry out the first round of Child Health Days activities in Somaliland, which are planned to take place from 19-23 February 2012.
During this first round in Somaliland a total of 413,205 children under 5 years of age and 475,186 women of childbearing ages will be targeted with the usual Child Health Days package.
* Please note that data for Puntland only covers the three weeks of January 2012.
For further information please contact: Pieter Desloovere - Communications Officer - deslooverep@nbo.emro.who.int - T: +254 733 410 984
? WARDI
ACUTE WATERY DIARRHOEA
? South Central Somalia reported 1118 AWD cases including 880 (79%)
children under the age of five and 22 related deaths.
? Banadir region reported the highest number of cases, with 57% of all
reported cases and 59% of the reported deaths.
? Banadir hospital in Mogadishu reported 407 cases including 297 (73%)
children under the age of five and 16 related deaths.
? Somaliland reported 132 AWD cases including 108 (82%) children under
the age of five. Maroodijeh and Sanaag regions accounted for 39% and
56% of all cases respectively.
? Puntland* reported 279 AWD cases including 210 (75%) children under
the age of five. Bari region accounted for 107 (38%) of which 81% were
reported from Bossaso district.
SUSPECTED MEASLES
? South Central Somalia reported 483 cases including 385 (80%) children
under the age of five and 18 deaths. Banadir and Lower Shabelle regions
accounted for 82 (17%) and 199 (41%) of all reported cases respectively.
? Somaliland reported 11 cases including 5 children under the age of five
? Puntland* reported 279 cases including 210 (75%) children under the
age of five
SUSPECTED MALARIA
? South Central Somalia reported a total of 1879 cases including 975
(79%) children under the age of five and 2 related deaths.
? Somaliland reported 3 cases including one case under the age of five.
? Puntland* reported 0 cases.
CONFLICT RELATED INJURIES
? Four hospitals in Mogadishu treated 425 casualties from weapon-related
injuries. 28 cases (7%) are under the age of five. Four deaths were reported.
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