Somalia Health updates 2012/2013

[Ronan Kelly]

Re: Somalia Health updates 2012

Re: Somalia Health updates 2012

Somalia Emergency Weekly Health Update
Reporting dates 28 July ? 3 August 2012
(reflecting Epidemiological week 30)

...
SITUATION OVERVIEW:
The number of suspected cholera cases is expected to remain relatively stable with the rains having reduced across
Somalia. Health facility visits are observed to have remained stable in most regions.This particular trend is expected
to be sustained over the next coming weeks.


Continued decline in reported suspected cholera cases have been observed in South Zone where the number of
reported cases and the proportional morbidity have declined possibly due to an end of the rainy season along with
prevention activities. While the number of reported suspected shigellosis cases is higher, the trend is similar to
that of suspected cholera cases. However the trend in suspected whooping cough cases raises concerns while
suspected measles cases remain stable. Immunization coverage in the South Zone is low due to reduced access
and insecurity. Sixty percent of all confirmed malaria cases were reported from three districts namely Afgooye,
Baidoa and Kismayo. The reasons for the increase in reported confirmed malaria cases and proportional morbidity
are being investigated. In comparison to the month of June, in July the number of reported cases for suspected
cholera decreased by 84%, suspected measles by 6% and confirmed malaria by 45% (see chart below).
...

There was a 6.8% increase observed in reported suspected cholera cases in Central Zone, but a decrease seen
among children under the age of five. Adherence to surveillance case definition still remains a challenge. About
98.8% of the cases were reported from Banadir region which is densely populated with the internally displaced
persons (IDPs) moving into Mogadishu. Suspected shigellosis cases were reported from 11 of the 36 districts in
the Central Zone. High numbers of suspected measles cases continue to be reported. Huruwaa district in Banadir
region reported 67.8% of suspected shigellosis cases and suspected measles cases in week 30. Confirmed
malaria cases among children under the age of five increased in week 30 after steady decline since week 26.
Wadajir District accounted for 60% of the confirmed malaria cases reported in the zone. Central Zone continues to
report neonatal cases mainly from Wadajir district where the three cases were reported. This district has reported
at least one case since week 16, which may point to the low immunization coverage, poor cord care practices or
poor application of the case definition. In comparison to the month of June, in July the number of reported cases for
suspected cholera decreased by 38% and confirmed malaria by 15%. Suspected measles cases increased by 38%
...

...
Somaliland reported cases of suspected shigellosis and suspected measles. Sixty-four percent of the suspected
shigellosis cases were reported from Borama Hospital in Borama District (seven cases after at least 6 weeks without
a reported case). Follow up of these cases is been undertaken. No suspected cholera cases have been reported for
two consecutive weeks, attributable to the success of the prevention campaign including hygiene promotion and
water chlorination that was undertaken by the Ministry of Health and health cluster partners.


Reported cases of suspected cholera and suspected shigellosis have reduced. In week 30, only five suspected
cholera cases were reported from districts of Galdogob and Galkacyo. This reduction in cases is possibly attributed
to ongoing capacity building of health workers in communicable disease surveillance and response.
...

 

[Ronan Kelly]

Re: Somalia Health updates 2012

Re: Somalia Health updates 2012

Somalia Emergency Weekly Health Update
Reporting dates 4-10 August 2012
(reflecting Epidemiological week 31)

BULLETIN HIGHLIGHTS Reporting
? In week 31, Bakool region in Central Somalia, reported a significant increase in reported suspected
measles cases as compared to previous week. Eighteen of the 23 cases were reported from a single
facility. Investigations are ongoing to establish if it is an outbreak.

SITUATION OVERVIEW:
Suspected cholera cases are seen to be declining except in the region of Banadir where there is concentration of
internally displaced persons (IDP) resulting to overcrowding, as well as poor water and sanitation conditions. People
are moving to the Mogadishu area due to security and economic issues. However, no new outbreaks have been
reported. Trends in suspected whooping cough cases have stabilized at high levels in both the Southern and
Central Zones with caseloads higher in the Southern regions. This is possibly due to lack of access to routine
immunization services especially due to insecurity particularly in the South.


Reported suspected cholera, suspected measles and suspected shigellosis cases increased in week 31, following a
decrease in the previous week. Eleven suspected cholera cases were reported from Lower Jubba region, with 7 of
these cases being reported from Kismayo district where cases had generally declined in recent weeks. In Gedo
region, two suspected cholera cases were also reported for the first time in nine weeks. In Bakool region,
suspected measles cases almost doubled between weeks 30 and 31, from 12 to 23 cases respectively. Eighteen
of the 23 cases were reported from a single facility and investigations are ongoing to establish if it is an outbreak. In
the other regions the trend remained relatively stable. Suspected whooping cough continues at an unacceptably
high case count and proportional morbidity for three weeks in a row. Majority of the cases (96.6%) were reported
from Bakool and Bay regions. No deaths have been reported this year from the zone.



After receiving retrospective updates for weeks 29 and 30 to complete the number of reports, there appear to be an
increase in the reported suspected cholera cases although the proportional morbidity has remained between 1%
and 1.2% in the last four weeks. No cases have been reported in Galgadud region since week 27 while in Middle
Shabelle region, cases were last reported in week 17. The reported cases are concentrated in the Banadir region
which accounted for 96.6% of reported cases in week 31. Within Banadir region, cases were reported in 4 districts
namely Abdiaziz, Hodan, Waberi and Wadajir. Wadajir district accounted for 91.9% of the reported cases in the
region, while two cases were reported in Abdiaziz district that had not reported any suspected cholera since the
beginning of the year. The CSR zonal and regional teams are investigating the cases reported in the district.
Huriwaa district continues to report most the suspected measles cases accounting for 54.8% of reported cases
from Central Zone, attributable to the low immunization coverage in the district. People from other regions where
vaccination has been banned continue to move to Mogadishu. This is also seen with the continued cases of
suspected whooping cough in all regions with the highest caseload reported from Lower Shabelle region. Neonatal
tetanus cases continue to be reported in Banadir region. This trend of both diseases is an indication of the low
immunity levels among the populations due to limited routine immunization services available to pregnant women
and children. WHO Somalia and partners are supporting immunization outreach activities all the districts of
Mogadishu.
Confirmed malaria cases and the proportional morbidity have stabilized although still at high levels. There is
adequate availability of rapid diagnostic test (RDT) kits and Artemisinin-based Combination Therapy (ACTs) after
shortages in some facilities was addressed. Recommended is the need for continued monitoring and strengthening
of the supply management systems to avoid any future stock-outs. In Banadir region, confirmed malaria cases have
consistently increased since week 29. During week 31, 11 out of the 61 health facilities reported at least one case
of confirmed malaria. 88.3% of cases were reported from five of those facilities. Since week 24, all reported
suspected shigellosis cases have been reported from one facility with no clear trend.



No suspected cholera cases have been reported since week 29. The trends in suspected measles and shigellosis
cases including the proportional morbidity have remained stable. Togdheer Region reported 4 suspected measles
cases from two facilities which had not reported a single case since weeks 18 and 26. This region had no reports of
any suspected measles cases for two consecutive weeks. Suspected shigellosis cases continue to be reported in
all regions except Togdheer and Sanaag regions. However, the trend is stable. No confirmed malaria cases have
been reported since week 26. One neonatal tetanus case has been reported in Maroodijeh region, the first such
case to be reported in Somaliland since the beginning of the 2012.



Two suspected cholera cases were reported from Mudug and Sanaag regions, which has shown a declining trend
since week 26. The regions of Bari, Mudug and Sool reported a total of seven suspected measles cases. Since
week 24 when one case was reported in Bari region, no suspected measles case had been reported since. In
Mudug region, suspected measles cases have declined, while a case was reported in Sool region after four weeks
of no cases reported.
...

 

[Ronan Kelly]

Re: Somalia Health updates 2012

Re: Somalia Health updates 2012

Somalia Emergency Weekly Health Update
Reporting dates 18-24 August 2012
(reflecting Epidemiological week 33)

BULLETIN HIGHLIGHTS
? Banadir and Lower Shabelle regions reported a total of 25 suspected shigellosis cases, with 84% (21
out of the 25 reported cases) located in Banadir region alone. Since week 23, all suspected shigellosis
cases reported in Banadir region are located in one health facility; however this is being investigated as
concerns were expressed about the adherence to the recommended case definition.

...
SITUATION OVERVIEW:
Suspected measles, confirmed malaria, suspected shigellosis and suspected cholera cases continue to be reported
across Somalia. Adherence to the recommended case definitions for health events under surveillance remains a
challenge, especially for suspected cholera and suspected shigellosis. In collaboration with the Ministries of Health
and health partners, targeted trainings for health workers in sentinel sites are ongoing as part of the capacity building
activities for the communicable diseases surveillance program. These aim to improve the adherence of the health
workers to the recommended case definitions, which is expected to improve disease specific data from health
facilities and case management. Current trends indicate a steady reduction in the number of health facility visits,
which has been observed in past years during August and stability is expected through October, when the next
seasonal changes will begin.

SOUTHERN SOMALIA


The trend in suspected cholera, measles, shigellosis and whooping cough in Southern Somalia continues to
decline. While the proportional morbidity of suspected whooping cough cases declined from 1% to 0.7% between
weeks 30 and 33, for the other conditions it remained stable. Total consultations have consistently declined in the
past 3 weeks.

Suspected cholera cases continue to be reported in Afmadow, Jamaame and Kismayo districts of Lower Jubba
region. Confirmed malaria cases have been reported from all regions in Southern Somalia although most of the
cases are located in Lower Jubba and Bay regions. Lower Jubba region accounts for the highest number of reported
cases for all health events. The region is currently the epicenter of armed conflict between government and their
allies against the opposing forces. In addition, the region became also a transit area for refugees moving from the
upper regions fleeing towards the border area with Kenya.

CENTRAL SOMALIA


A retrospective update of the data of week 32 has been carried out since the report from Banadir region was
missing. Looking at the updated data for Central Somalia, the trend in suspected cholera cases shows an
increase from weeks 29 to 32. A decline was observed during week 33, with a total of 162 suspected cholera cases
reported in three regions with Banadir region accounted for 95.7% of those cases. Compared to week 32, this means
a 36.7% decrease; however it is not clear yet if this will be the start of a steady decline.
Banadir and Lower Shabelle regions reported a total of 25 suspected shigellosis cases, with 84% (21 out of the 25
reported cases) located in Banadir region alone. Since week 23, all suspected shigellosis cases reported in Banadir
region are located in one health facility; however this is being investigated as concerns were expressed about the
adherence to the recommended case definition.
During week 33, nine out of the twenty health facilities that reported in week 33, reported at least 1 case of
confirmed malaria with 73.9% of cases reported in 3 facilities.
Suspected measles cases continue to be reported and are mainly concentrated in Banadir region (62% of all
reported cases in week 33) and Lower Shabelle region (35% of all reported cases in week 33). Plans are underway
to carry out Child Health Days activities in October 2012, providing essential vaccination and treatment to children
and women of childbearing age.
Cases of suspected tetanus continue to be reported. This is due to the fact that the IDP population, mainly
concentrated in Banadir region, comes from areas where limited or no immunization services are available,
especially in Lower Shabelle region. A follow up investigation is underway to gather more information regarding
these cases.

SOMALILAND



Of all reported suspected measles cases during week 33, half of them were located in Burao Hospital. Back in June
2012, a measles outbreak was reported in Burao. As response, measles vaccination activities were undertaken.

PUNTLAND


...

 

[Ronan Kelly]

Re: Somalia Health updates 2012

Re: Somalia Health updates 2012

Somalia Emergency Weekly Health Update
Reporting dates 6-12 October 2012
(reflecting Epidemiological week 40)

for whatever reason, the PDF is hard to copy - has format problems, but is available to view here; http://reliefweb.int/sites/reliefwe...ncy_weekly_health_update_6-12october_2012.pdf

Bulletin Highlights
Following the recent confirmation of three vaccine-derived poliovirus type 2 (cVDPV2) cases in the refugee camps in Dadaab, Kenya and one cVDPVs case in Kismayo, South Central Somalia, an immunization response is currently being planned.
...
SOUTHERN SOMALIA
Confirmed malaria was the leading cause of morbidity, having increased its caseload by 17% compared to week
39. Lower Jubba and Bay regions accounted for 48% and 30% of all reported cases.

Cases of suspected shigellosis continue to be reported. A suspected outbreak with 12 cases including 11 children under the age of five is being investigated in Qooqani village, which is located about 65km from Afmadow town.
Samples collection kits are available on the ground and WHO and health partners are conducting case based
surveillance to collect samples for laboratory confirmation.

Trends of reported suspected measles cases have remained stable. No vaccination activities have been conducted
in the region in the past two years.

CENTRAL SOMALIA
Cases of reported suspected cholera remained stable for week 40. However, as part of the pre-season random
check for cholera, samples were collected from two sentinel sites and referred to a laboratory for confirmation. This
exercise is being conducted due to the confirmed cholera cases in Lower Jubba region. In addition, observed
population movements out of and into Mogadishu, which remains densely populated with variable access to safe
drinking water, sanitation and water safety interventions, is one of the risk factors for a potential outbreak.

Suspected shigellosis and suspected measles cases continue to be reported as well. Follow up investigations are
being made to ascertain the status of the reported cases and if they all fulfill to the recommended case definitions so
that samples can be collected.

Confirmed malaria is the leading cause of morbidity with Banadir region accounting for 83% (186) of the cases.

SOMALILAND
Trends for events under surveillance remained stable compared to the previous two weeks.

PUNTLAND
The investigation team has finally carried out case investigation, and confirmed that the reported malaria case on
week 38 was false positive. Other more false positive cases from Darasalam and the other MCH were also
identified by the investigating team. Trends for events under surveillance remained stable compared to the previous
two weeks.
...

 

[Ronan Kelly]

Re: Somalia Health updates 2012

Re: Somalia Health updates 2012

Somalia Emergency Weekly Health Update
Reporting December 2012 - Epidemiological weeks 49 ? 52

...
Ten alerts of suspected cholera were reported, eight in Lower Jubba and two in Bay
Lower Jubba - Eight alerts were reported by partners in Hido, Jedecaley, Jaaro, Diidadey, Dhobley,
Kulbio, Durow and Gora. A total of 241 cases were reported, mainly children under the age of five, with
three-related deaths (Case Fatality Rate: 1.2). Of these cases, 200 were treated as out-patients while 39
required in-patient treatment. Results of the verification of cases and deaths are still pending.
Bay region - Two alerts were verified and 13 cases and four-related deaths (including one adult) were
registered. It was concluded that the affected victims developed diarrhea after consuming contaminated
camel milk. The situation is back to normal.

Malaria: outbreak declared in Bossaso
An outbreak of confirmed malaria in Bossaso district (Bari region) was declared by health authorities,
following an observed increase in cases attended to at private health facilities. The authorities requested
the coordination of response activities and evaluation of impact integrating all data from both private and
public health facilities. Outbreak investigation is currently ongoing. In the last week of December, 119
malaria cases were confirmed by Rapid-Diagnostic Testing (RDT).

...
SOUTHERN SOMALIA
In the month of December, from weeks 49 to 52, four
cases of suspected cholera were reported from the
36 sentinel sites in southern zone. This represents a
73.3% decrease compared to the month of
November, when 15 cases of suspected cholera were
reported, mainly in weeks 45 and 48. Over the past 4
months, adherence to the recommended case
definition for suspected cholera has improved
significantly among partners working in the Southern
zone. Trainings on revised reporting tools for 2013
are planned, with the objective to cover case
definitions and the monitoring and evaluation
component of the program, and to ensure at least
one visit to each sentinel site per month (where and
when access is possible).

During the same period, 69 cases of suspected
measles were reported, showing a slight decrease
compared to the 61 cases reported during the month
of November (weeks 45-48).
A 23 % increase in the reported confirmed malaria
cases was observed. About 682 cases were reported
in December compared to 526 cases reported during
November.

Cases of suspected shigellosis continue to be
reported and all verifications indicate non-adherence
to the recommended case definition for suspected
shigellosis, which is: ?visible blood in stool?. This is
expected to improve following the weekly feedback
as part of the weekly monitoring and evaluation
protocol and through the planned trainings of health
workers.
...
CENTRAL SOMALIA
In central zone, a 19.5% increase of suspected cholera
cases was observed during the month of December
(weeks 49 to 52) with a total of 657 cases reported
compared to 529 cases reported in the month of
November. In the reporting month, Banadir region alone
accounted for 94.2% (619) of all the reported cases with
majority reported from Banadir hospital. While there were
cases meeting the recommended case definition for
suspected cholera, most did not. All diarrhea cases are
still being reported as suspected cholera. Some
improvement in adherence to case definition among
health workers and partners working in central zone has
been observed, but in Banadir region this still remains a
challenge.

There were 317 cases of suspected measles reported
in December, which compares to 314 cases reported in
November. Mogadishu still receives IDPs from areas
that have had no access to vaccination interventions,
hosting thousands in makeshift and overcrowded
settlements, which provide for easy transmission. A
significant proportion of this population is reported to be
malnourished. Measles cases are expected to continue
to be reported. Plans for a number of vaccination
interventions are underway by to prevent cases and
deaths.

From week 49-52, central zone reported a total of
1758 confirmed malaria cases, which accounted for a
25% increase compared to November where 1317 confirmed malaria cases were reported. In
Mogadishu, Ministry of Health (MOH), WHO and partners for the National Malaria Control Programme
conducted an Insecticide-Residual Spraying (IRS) campaign at the internally displaced persons (IDPs)
settlements, covering 51,000 households. This is expected to protect an estimated 300,000 population
from malaria infection over the coming months.

Like southern zone, case of suspected shigellosis continues to be reported and verification reveals poor
adherence to the recommended case definition.
...
SOMALILAND
There were no reported cases of suspected cholera
reported in December from the 54 health sentinel
sites in Somaliland.

From week 49-52, Somaliland reported a total of 54
suspected measles cases, which accounted for a
70.3% increase compared to cases reported in
November (weeks 45-48) in which 16 cases were
registered. The cases were reported from
Maroodijeh, Sahil, Togdheer and Sanag regions.
Maroodijeh alone accounted for over 50% of all the
cases.

In December, 6 cases of confirmed malaria were
reported in Somaliland compared to 2 cases which
were reported in the previous month.
...
PUNTLAND
During week 52, two confirmed malaria cases (both
above the age of five) were reported in Bossaso district,
Bari region. One case was from Bossaso hospital and the
other case was reported from Bossaso mother and child
health center (MCH). MOH has since declared an outbreak
of malaria in the district. Sentinel sites are not reporting
these cases (outbreak). A total of 119 malaria cases were
confirmed by RDT in the last week of December (see
graph below) majority reported from private health facilities
(see below graph on trends in the month of December).
...

 

[Ronan Kelly]

Re: Somalia Health updates 2012/2013

Somalia Emergency Weekly Health Update
HIGHLIGHTS
Reporting January 2013 - Epidemiological weeks 1-3
 DENGUE FEVER 23 cases of Dengue fever reported from Mogadishu
 MALARIA 410 cases detected in Bossaso outbreak
 ACUTE FLACCID Three cases reported in Berbera and Wardighley districts
PARALYSIS

23 cases of Dengue fever reported from Mogadishu
Mogadishu ? Twenty three (61%) of 28 serum samples collected from patients at health facilities in
Mogadishu have tested positive for dengue fever. In recent weeks, dengue infections have also been
reported among AMISOM troops in Mogadishu. Blood samples that were collected in Mogadishu in the
previous years had a 30-38% dengue positivity rate, calling for interventions related to dengue control in
Mogadishu and other parts of Somalia. Follow-up of past patients that have since been traced, indicate
that they had improved. Results of an entomological survey conducted in Mogadishu at the end of 2011
showed that 19% of the adult mosquito and over 18% of the larvae populations collected were Aedes
aegypti, the carrier for dengue virus, as well as Chikungunya and yellow fever viruses.

Ongoing response to malaria outbreak in Bossaso
Response to the outbreak of malaria in Bossaso (Puntland) is ongoing. Since the beginning of the
outbreak in December 2012, 410 cases have been reported including 61 (15%) children under the age of
five. Mixed Plasmodium falciparum and P. vivax infections accounted for 67% of the cases, while the
remaining 33% had single infection with P. falciparum. No single infection case with P. vivax alone has
been detected. Health authorities and partners continue to respond and undertake preventive measures.

Alert for Acute Flaccid Paralysis (AFP) cases reported in two districts
In the reporting weeks, two cases of AFP were reported from Berbera district and another in Wardhigley
district. Stool samples were collected by and referred for further investigation.
Meanwhile, vaccination campaigns continue in newly accessible areas of Southern and Central Somalia.
From 14 to 16 January 2013, Health Authorities, UNICEF and WHO conducted a second round of polio
vaccination in urban areas of Kismayo district in Lower Jubba region. Over 17 000 children under the age
of five were reached. However, 30% of the children in rural areas of Kismayo still remain inaccessible.
...
SUSPECTED CHOLERA
Central Somalia accounted for 98% of the
suspected cholera cases reported from weeks1-3,
i.e. 358 out of 366 cases reported. Majority of the
cases were from Banadir region.
Poor adherence to the recommended case
definition for suspected cholera has been
observed. On-the-job training during weekly and
monthly visits to the sentinel sites is planned to
improve case detection and data quality.
In week 1-3, seven rumors of outbreak of
suspected cholera were reported in Lower Jubba region. WHO and partners collected stool samples of
the cases from affected villages of Jedecaley and Kulbio for verification. All samples tested negative for
any enteric bacterial infection including shigella and salmonella. Following response activities by
partners the situation is under control and stable. The Lower Jubba region remains a high risk area for
cholera and other water-borne disease outbreaks and access is still a challenge.
In Galgaduud region, the cholera situation has remained stable and partners on the ground have
ongoing preventive and control activities. Adequate water and sanitation supplies have been provided
by UNICEF and case management supplies were provided by WHO. Adequate stocks are available in
the event of a potential outbreak.

SUSPECTED MEASLES
With low vaccination coverage and poor access to
vulnerable populations across Somalia, especially
in Southern and Central Somalia, suspected
measles remains a challenge. Central zone
reported 64% of the 366 suspected measles
cases: Somaliland 22%; Southern 13% and
Puntland 1%.
Suspected measles cases continue to be reported
across Somalia. Four alerts were reported from
Lower Jubba region and Somaliland. Response
activities are ongoing in collaboration with the
health authorities.

CONFIRMED MALARIA
Confirmed malaria was the leading cause of
morbidity for the 3 week reporting period, with over
2000 cases reported from sentinel sites across
Somalia. Central and Southern zones reported
63% and 33% of all cases respectively.
Following the malaria outbreak in Bossaso
declared by the health authorities on 29 December
2012, a joint team, composed by Health
Authorities, UNICEF and WHO, has initiated
response activities. A total of 410 confirmed
malaria cases, including 61 children under the age
of five, have been recorded in the past seven
weeks (see Confirmed Malaria Trend graph).
Provision of supplies include rapid diagnostic
testing kits and Artemisinin Combination Therapies
(ACTs) to health facilities, training of both public
and private health facility workers, distribution of
malaria treatment guidelines and long-lasting
insecticide treated nets. Outreach initiatives
including social mobilization will continue.

OTHER HEALTH EVENTS
All zones except Puntland continue to report cases of suspected shigellosis. Although this have been
decreasing gradually, adherence to the recommended case definition for shigellosis of visible blood
remains a challenge. On-the-job trainings are being conducted to improve this. Central Somalia reported
145 (65%) of the 223 cases, while Southern Somalia and Somaliland reported 69 (31%) and 9 (4%)
cases respectively.
An alert on 25 cases of suspected neonatal tetanus had been reported from one zone. Subsequent
verifications proved that the reported cases were a data entry error.
Alerts on suspected diphtheria have been reported from Galinsoor district in Galgaduud region. Sample
collection for further investigation is currently being initiated.
Whooping cough control continues to remain a challenge.
...

 

[Ronan Kelly]

Re: Somalia Health updates 2012/2013

Somalia Emergency Weekly Health Update

Reporting 21-27 January 2013 - Epidemiological week 4

Response plan following reports of cases of Dengue fever in Mogadishu
Following the detection of 28 cases of Dengue Fever in Mogadishu, the World Health Organization
(WHO) has taken immediate action to integrate vector control of Aedes aegypti in the malaria elimination
programme. Dengue fever is a flu-like illness, transmitted to humans primarily through Aedes aegypti
mosquito, which is a day biter. Dengue fever should be suspected when a sudden onset of fever (above
38?C) is accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle
and joint pains, measles-like rash. Complicated cases develop bleeding from eyes, nose, mouth, birth
canal, anus or any opening.
WHO urges health workers to report any case that meets the above description to WHO staff, when
diagnosis of malaria or any other sever disease has been excluded by Rapid Diagnostic Testing (RDT) or
microscopy testing.

Ongoing response to malaria outbreak in Bossaso
Health authorities and partners continue to respond and undertake preventive measures. A total of 1227
confirmed cases of malaria have been reported since 2 December 2012, including 171 (14%) children
under the age of five and four-related deaths. Mixed Plasmodium falciparum and Ovale infections account
for the majority of the cases reported.

Disease alerts
Alerts for suspected measles have been reported in parts of Bay and Bakool regions, where health
partners have reported more than 47 cases, including 31 (66%) children under the age of five.

Virology results are still pending for the Acute Flaccid Paralysis (AFP) cases reported in the first three
weeks from Berbera district in Somaliland and Wardhigley in Mogadishu.

An alert for suspected diphtheria from Galinsor (Galgadud region) was verified. Samples collected from
two cases are under further investigation.

EPIDEMIOLOGICAL SURVEILLANCE (EPI WEEK 4, 21 ? 27 January 2013)
During the reporting week, more than 29 000 health facility visits were reported, including over 44%
children under the age of five. Central Somalia accounted for over 58% of the reported visits, Southern
Somalia 23% and Somaliland and Puntland accounted for 18%. Confirmed malaria was the leading cause
of disease. The number of reported suspected cholera increased by over 50%, with a majority of the
cases reported from Banadir region of Central Somalia.

TIMELY REPORTING
In week 4, the 45 health sentinel sites in Puntland and the 36 sites in Southern Somalia currently
reporting to the Communicable disease Surveillance and Response (CSR) network reported timely. In
Central Somalia 98% (60 out of the 61) reported on time. No data was received from Somaliland due to
technical reasons.

SUSPECTED CHOLERA
Central Somalia accounted for nearly all of the
suspected cholera cases reported in week 4, i.e.
139 out of 140 cases reported. All the suspected
cases were reported from Banadir region.
Poor adherence to the recommended case
definition for suspected cholera1 has been
observed, since 67% of the reported cases are
children under the age of two. On-the-job training
during weekly and monthly visits to the sentinel
sites is planned to improve case detection and
data quality. Following an observed increase since
the previous week, WHO teams collected stool
samples from three facilities in the region. Results are still pending.

SUSPECTED MEASLES
With low vaccination coverage and poor access to vulnerable populations across Somalia, especially in Southern and Central Somalia, suspected measles remains a challenge. In week 4, Central Somalia reported 76% of the 115 suspected measles cases, while Southern Somalia reported 14% and Puntland 10%.
In collaboration with the Health Authorities, partners are undertaking response activities.

CONFIRMED MALARIA
Confirmed malaria was the leading cause of morbidity during week 4, with 679 cases reported from sentinel sites across Somalia. Central and Southern Somalia reported 55% and 34% of all cases respectively.
Puntland reported 75 (11%) of the cases, mainly from Bossaso district, where response activities to a malaria outbreak are ongoing. With active case finding, the number of reported malaria cases has increased by 69% in the affected areas.

OTHER HEALTH EVENTS
During week 4, Central and Southern Somalia reported cases of suspected shigellosis. Although this have been decreasing gradually, adherence to the recommended case definition for shigellosis of visible blood remains a challenge. On-the-job trainings are being conducted to improve adherence to case definition. Central Somalia reported 59 (69%) of the 85 cases, while Southern Somalia reported 26 (30%) cases.

Whooping cough control continues to remain a challenge. In the reporting week, 48 cases of suspected whooping cough were reported from Central and Southern Somalia. Parts of these areas have issues of insecurity and inaccessibility for vaccination interventions to be undertaken.

Suspected neonatal tetanus has been reported in Central Somalia. Verifications need to be undertaken to confirm tetanus but tracking these patients in the past has remained a major challenge. Prevention needs to be strengthened through vaccination activities among pregnant women and clean delivery methods
...

 

[Ronan Kelly]

Re: Somalia Health updates 2012/2013

Somalia Emergency Weekly Health Update
Reporting 28 January to 3 February 2013 - Epidemiological week 5

Seven cholera cases detected in Mogadishu
In week 5 seven cholera cases were confirmed in Mogadishu. Samples of suspected cases were
collected in Banadir hospital, and in Hodan?s and Ceel Gaab?s Cholera Treatment Centres (CTC). Six of
the eight stool samples from Hodan CTC and one of the 15 samples from Banadir Hospital tested positive
for Vibrio cholera, serotype ?Inaba?. The five samples collected from Ceel Gaab CTC were negative. High
positive rates, like in Hodan CTC, are expected among admissions, when the case definition is followed.
Since December 2012, the number of admissions to Hodan facility related to cholera has remained
stable, with an average of 69 cases per week and no related deaths.
Bio-surveillance for cholera has begun in preparation for the Gu rains (end of March to beginning of April),
which marks the beginning of the first annual cholera transmission season in Somalia.

Ongoing response to malaria outbreak in Bossaso
The number of confirmed malaria cases detected in Bossaso remains stable compared to previous
weeks. Health authorities and partners are planning to initiate response activities, such as Insecticide-
Residual Spraying (IRS) campaigns and community social mobilization. A total of 1137 cases of malaria
have been reported since 2 December 2012, including 14% children under the age of five and two-related
deaths (Case Fatality Rate: 0.18). Mixed Plasmodium falciparum and Ovale infections account for about
67% of the cases, while Falciparum accounts for 33%. Three locations reported over 98% of all cases,
i.e. Biyo Kulule (41.2%), New Bossaso (31.2%) and Baalade (26.1%).

Dengue Fever
Following the detection of cases of Dengue Fever in Mogadishu, WHO urges health workers to report any
case, presenting the symptoms described below, to WHO staff, when diagnosis of malaria or any other
severe disease has been excluded by Rapid Diagnostic Testing (RDT) or microscopy testing.
Dengue fever is a flu-like illness, transmitted to humans primarily through Aedes aegypti mosquito, which
is a day biter. Dengue fever should be suspected when a sudden onset of fever (above 38?C) is
accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle and joint
pains, measles-like rash. Complicated cases develop bleeding from eyes, nose, mouth, birth canal, anus
or any opening.

Disease alerts
Alerts of 47 suspected measles cases were reported from parts of Bay and Bakool regions. Results of
investigation are still pending.
An alert for suspected diphtheria from Galinsor (Galgadud region) was verified, and samples collected
from two cases are under further investigation. No more cases were reported.
...
SUSPECTED CHOLERA
Cholera is endemic in Somalia, with sporadic
cases and occasional outbreaks occurring in a
number of areas all year round. 74% of the
reported cases were children under the age of
two which does not meet the case definition of
suspected cholera1. Collaborative activities (like
tracing patients) and on-the-job training are being
carried out to address this issue. Adequate water
and sanitation supplies have been, prepositioned
in strategic warehouses by UNICEF and WHO, to
be distributed in the event of an outbreak.
Central Somalia accounted for all the 102 suspected cholera cases reported in week 5, which represents a
27% decrease compared to week 4 (140 cases). All the suspected cases were reported from Banadir region.

SUSPECTED MEASLES
Suspected measles cases continue to be reported
from Somalia, with poor access to vulnerable
populations still a challenge in many areas.
The number of cases reported remained stable in
week 5. Central Somalia reported over 57% of the
119 suspected measles cases, while Southern
Somalia accounted for 27% of those. Somaliland
and Puntland reported 13% and 3%of the total
cases respectively. In collaboration with the health
authorities, partners are undertaking response
activities.

CONFIRMED MALARIA
Confirmed malaria was the leading cause of
morbidity during week 5, with 794 cases reported
from sentinel sites across Somalia. This
represents a 17% increase as compared to week
4, when Central and Southern Somalia reported
76% of the cases.
Puntland reported 190 (24%) cases, mainly from
Bossaso district.

OTHER HEALTH EVENTS
In week 5, 109 cases of suspected shigellosis were reported, including 81 children under the age of
five. Banadir Hospital alone reported 70% of these cases. No case with ?visible blood in stool? was
identified. Adherence to the recommended case definition for shigellosis2 remains a challenge in
Southern and Central Somalia. It has been observed that health workers classify cases as suspected
shigellosis based on patient reports during history taking, and not the actual physical examination. WHO,
in collaboration with partners and staffs from health facilities, is on high alert and will trace reported cases
and collect stool samples.

Whooping cough control continues to remain a challenge. In the reporting week, 52 cases of suspected
whooping cough were reported, all from Central and Southern Somalia. Parts of these areas have issues
of insecurity and inaccessibility for vaccination interventions to be undertaken.

Three cases of suspected neonatal tetanus have been reported in Central Somalia. Mechanisms are
being put in place for purposes of verification to confirm tetanus cases. Tracking these patients in the past
has remained a major challenge. Prevention needs to be strengthened through vaccination activities
among pregnant women and clean delivery methods.
...

 

[Ronan Kelly]

Re: Somalia Health updates 2012/2013

WHO Somalia Emergency Health Update

Reporting 13 May-2 June 2013 - Epidemiological weeks 20 to 22
http://reliefweb.int/sites/reliefwe...malia_Emergency_Health_Update_2_June_2013.pdf

...
MILLIONS OF CHILDREN PROTECTED FROM POLIO OUTBREAK
Outbreak response vaccination campaigns started on 14 May 2013,
within four days after the first case of polio was confirmed on 9 May
in Mogadishu. As of 30 May 2013 four cases have been confirmed
(three from Banadir and one from Bay region).
In the month of May, two outbreak response campaigns were
conducted. More than 400,000 children were vaccinated in the 16
districts of Banadir region and the neighbouring district of Afgooye
during the first round between 14 and 18 May. A second round of
mass vaccinations took place between 26 May and 2 June, targeting
1.6 million children in southern and central Somalia and Puntland. The response took place smoothly with
encouraging local leadership from authorities in all areas, high-quality coverage and strong community
participation.
A third round will target 3.9 million people countrywide starting from 12 June. As adults are also deemed
to be at risk of the current outbreak, in Banadir all age groups will be targeted for polio vaccination, while
children under the age of 10 will be targeted in the remaining regions of South Central Zone, and children
under the age of five in Somaliland and Puntland.

DISEASE ALERTS
During the reporting period, a total of 85 disease
alerts, were reported through MAY the surveillance
network. Central Somalia and Somaliland accounted
for 30 alerts respectively, accounting for 71% of all
reported alerts. Suspected measles cases accounted
for 74% of the alerts, with Acute Flaccid Paralysis
accounting for 10 alerts; Central zone reported eight
alerts while Somaliland reported two alerts. There were three alerts for suspected cholera, all reported from Central
Somalia. Monitoring of alerts through the weekly database and reporting of outbreak rumors outside the sentinel
surveillance network continues to be undertaken.

SUSPECTED CHOLERA
During the reporting period, 451 suspected cholera cases were
reported from Banadir Hospital in Banadir region of Central
Somalia. Adherence to the recommended case definition for
suspected cholera remains a challenge. However, the current
trend shows a steady reduction in the number of reported cases
due to seasonal change, as observed in previous years at the end
of the rainy season.

SUSPECTED MEASLES
A total of 199 suspected measles cases were reported in the four
zones. Central Somalia accounted for 38% (76) of the cases,
Somaliland for 27% (54), Southern zone for 11% (21) and
Puntland for 24% (48) of the cases. Immunization activities are
ongoing in accessible areas, to increase vaccination coverage.

CONFIRMED MALARIA
Confirmed malaria remained the leading cause of morbidity
during this reporting period. A total of 2400 cases were reported
from the four zones. 37% (889) of the reported cases were
children under the age of five. Central zone accounted for 52%
(1252) cases, Southern 42% (1018), Somaliland 0.6% (16) and
Puntland 5 % (114).

OTHER HEALTH EVENTS
Cases of suspected shigellosis are still being reported in some areas. Although tracing patients remains a challenge, all
the cases that were found did not show signs or symptoms that conform to the recommended case definitions.
Training and monitoring of health workers and has shown improvement of the adherence to case definition.
16 cases suspected whooping cough were reported. Similarly, a case of suspected diphtheria was reported. Low
vaccination coverage, and a large number of unvaccinated children, due to lack of access to large geographical areas
in southern and central zones, will continue to pose a challenge in the event of an outbreak. Vaccination activities are
ongoing and routine immunization programmes have been re-initiated in accessible locations.
...

 

[Ronan Kelly]

Re: Somalia Health updates 2012/2013

Humanitarian Bulletin
Somalia
September 2013 | Issued on 15 October 2013
http://reliefweb.int/sites/reliefwe...alia Humanitarian Bulletin September 2013.pdf
...
Health indicators among the worst in the world
Joint five-year commitment aims to strengthen health sector

Somalia is battling an outbreak of polio with over 170 cases confirmed since the outbreak
started in May this year. Health authorities, with the support of the UN?s Children?s Fund
(UNICEF) and the World Health Organization (WHO) have continued mass vaccination
campaigns, the seventh in September reached 3.4 million children up to the age of 10.
Since 19 July, no new cases have been reported in Mogadishu, where the outbreak
started, which indicates that the emergency response activities have been effective. But
up to 600,000 children in the most difficult-to-reach areas remain at risk. The health
challenges do not stop there.

After decades of civil war, Somalia has some of the worst humanitarian indicators in the
world. In an effort to address this, in early October, the Somali health authorities, UN
agencies and donors renewed their commitment to improve maternal and child health and
reduce mortality. The five-year plan to strengthen the Somali health system focuses on
improving the health of mothers and children and access to quality health care. It aims to
reach 3.4 million people for service delivery across the country.

70,000 children every year die before their fifth birthday
206,000 children are acutely malnourished
30.5% of women of reproductive age die of pregnancy related causes
25,000 people, on average, are served by one physician
9,000 people, on average, served by one nurse/midwife

Sources: WHO ? World Health Statistics 2013 and trends in maternal mortality 1990-2010 (WHO, UNICEF, UNFPA and World Bank estimates)

The scope of health and nutrition needs is sobering

Almost one in five children die before their fifth birthday. According to WHO, the main
causes of death are preventable diseases such as pneumonia, diarrhoea, measles and
malaria. Poor hygiene and sanitation and high malnutrition rates among children are
directly correlated with high child mortality and morbidity in Somalia. Sanitation coverage
in Somalia remains very low and only 29 per cent of the population has access to safe
drinking water. Water, sanitation and hygiene (WASH) partners are improving awareness
of sanitation, including the importance of washing hands with soap, which is one of the
simplest, most affordable and effective ways of preventing disease and saving lives. The
Global Handwashing Day is marked on 15 October and WASH partners are spreading
the message aiming to reach out to millions of Somalis, especially children.

Conflict further complicates the picture, making access to healthcare more difficult and
too often resulting in civilian casualties. Over 3,500 civilians with weapon-related injuries
have so far been treated at four hospitals supported by WHO in Mogadishu this year,
while another 1,500 were treated at the main hospital in Kismayo.

Women in Somalia also suffer from alarming levels of morbidity and mortality related to pregnancy and childbirth. It is estimated that every two hours a Somali woman dies due to complications during pregnancy; this is higher than the number of deaths due to conflict in Somalia. Early detection of pregnancy-related complications can allow for timely referral of the woman to proper facilities with skilled health personnel. In the past two years, health partners working to address the gap have strengthened emergency obstetric care, including through deployment of medical doctors, on-the-job and specialized training for health service providers, provision of medical equipment and supplies and technical assistance to partners and hospitals. To improve access for people in rural areas to essential services, 200 female health workers have been recruited and trained on reproductive, maternal, neonatal and child healthcare. They will be based in communities across Somalia.

Efforts ongoing to mitigate the health gap after MSF departure

Humanitarian partners together with M?decins Sans Frontier?s (MSF) have continued to work to fill as much of the gap as possible left by the aid group?s withdrawal from Somalia to meet the needs of the most vulnerable people. The Health Cluster estimates that US$14 million will be needed to continue running for one year 14 of the 20 facilities that MSF had supported, across Somalia. The facilities provide basic healthcare, including maternal and child health services, malnutrition treatment, treatment of common illnesses, surgery, epidemic response, and immunization campaigns. The Somalia Common Humanitarian Fund emergency reserve will provide $3 million, to give time for development partners to mobilize further support.
...