Early Warning Disease Surveillance and Response Bulletin, Somalia 2018 Epidemiological Week 37 (Week ending 16th Sept, 2018)
Highlights Cumulative figures as of week 37 • 334 (78%) health facilities across Somalia • 2,174,021 consultations from submitted weekly reports of epidemic-prone week 1 to week 37. diseases in the electronic early warning alert • 6,364 cumulative cases of and response network (EWARN) system in AWD/Cholera and 42 deaths week 37. • Total number of consultations decreased from (CFR 0.7%) since December 78,270 in week 36 to 76,247 in week 37. 2017. • A total of 6,893 alerts were received. 30 of • 37,750 cumulative alerts were these alerts were confirmed as true alerts in received, 1,237 of these, were week 37. confirmed as true alerts from • The highest numbers of diseases reported in week 1 to week 37, 2018. week 37 were other acute diarrhoeas (3,524 • 6,869 cumulative cases of cases), influenza like illness (3,153 cases) and severe acute respiratory illness (1,329 cases). suspected measles cases since the beginning of 2018. Of the • A total of 34 new cases of suspected AWD/cholera with no death were reported in 6,869 measles cases, 4,626 week 37 compared to 36 AWD cases with no (67%) were under 5 years while deaths in week 36. 2,243 (33%) were above 5 years. • A cumulative total of 6,364 AWD/cholera • 9,981 cumulative cases of 1 cases , including 42 deaths have been Malaria were reported since the reported since December 2017. beginning of 2018, 4,323 (43%) • The number of reported measles increased from 68 in week 36 to 92 cases in week 37. were under 5 years, while 5,658 (57%) were above 5 years.
1 The Cases of AWD/Cholera in the eEWARN system are collected from sentinel sites. While the cases of AWD/cholera in Sitrep are collected from temporary CTC sites which doesn't include the Sentinel sites Page 1 of 24
Table 1. Summary of Alerts for epidemic prone diseases Disease Cumulative Wk34 Wk35 Wk36 Wk37 cases (Wk 1 – 2018 2018 2018 2018 37, 2018) Total consultations 61506 75524 78270 76247 2,174,021 Other Acute Diarrheas 2794 3310 3377 3524 90770 Influenza Like Illness 2925 2769 2974 3153 68,139 Severe Acute Respiratory Illness 1218 1618 1532 1329 38,876 Suspected Measles 98 96 68 92 6869 Confirmed Malaria 291 454 321 459 10440 Acute Watery Diarrhea 268 181 129 112 3030 Bloody Diarrhea 141 153 125 144 3492 Whooping Cough 75 71 56 59 1856 Acute Jaundice 17 12 14 22 248 Suspected Meningitis 194 320 7 259 1119 Diphtheria 27 1 1 3 152 Neonatal Tetanus 7 5 2 2 66 Acute Flaccid Paralysis 0 1 0 1 16 Viral Hemorrhagic Fever 0 0 0 0 3
Completeness of Reporting & Reporting Rate Of the 428 health facilities in the EWARN system, Fig. 1a: Completeness of Reporting of EWARN Facilities 334 health facilities submitted their weekly reports Caluula
Qandala
Bossaso Zeylac
Lughaye
Laasqoray on time in week 37 across the country. The national
Berbera Iskushuban Baki Ceerigaabo
Borama ± Ceel Afweyn
Sheikh
Gebiley
Hargeysa Qardho
Caynabo Owdweyne surveillance completeness rate was 78% in the Bandarbeyla Burco Xudun Taleex
Garoowe Buuhoodle Laas Caanood
Eyl week which is below to the minimum requirement
Burtinle
Jariiban
Galdogob Gaalkacyo (80%). Banadir region, Galmudug & Somaliland only
Cadaado
Hobyo
Cabudwaaq
Dhuusamarreeb exceeded the minimum target while the rest states
Xarardheere Ceel Buur Belet Weyne Ceel Barde Legend
Rab Dhuure Xudur Somalia_Coastline_Extended have not reached the 80% minimum requirement Ceel Dheer Doolow Bulo Burto
Waajid Tayeeglow Somalia_Neighbouring_Countries_Polygon Luuq
Adan Yabaal Somalia_Sea_Cover Belet Xaawo Jalalaqsi
Baydhaba Garbahaarey Completeness of reporting (%)
Cadale Jowhar 0/No Data Qansax Dheere Wanla Weyn (fig. 1a & 1b). In Somaliland 84(100%) health Ceel Waaq 1 - 58.3
Buur Hakaba Balcad 58.4 - 81.8 Afgooye
Baardheere Banadir Diinsoor 81 - 100 Qoryooley
Marka Kurtunwaarey Saakow facilities of the 84 active health facilities have Sablaale
Bu'aale Baraawe
Heliwa
Dayniile
Afmadow Jilib Yaaqshid Karaan Wardhigley Hawl Wadaag Shibis Hodan BondhereCabdulasiis submitted reports in week 37. In Puntland, 87(78%) Jamaame Hamar Weyne Hamar Jabjab Waaberi Wadajir (Medina) Dharkenley
Kismaayo
Badhaadhe health facilities of the 111 active health facilities
0 45 90 180 270 360 Miles submitted reports in week 37, whilst in South central, 163(70%) health facilities of 233 active health facilities submitted reports in week 37. Challenges to completeness of the reporting include; lack of training at the health facility level (see fig 1b and 1c). Cascade EWARN training is currently being conducted in health facilities in Puntland and South Central. Somaliland has already completed the cascade training.
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Fig 1b: Completeness of reporting from EWARN sites, week 37, 2018 100 90 80 70 60 50 40 30 20 10
0
Bay
Ayn
Bari
Sool Sool
Gedo
Hiran
Bakol
Sanag Sanag
Awdal
Nugal
Mudug Mudug
Banadir
Togdher
Jubaland
Puntland
Galgadud
Galmudug
Southwest
Somaliland
Hirshabelle
Lower Jubba
Middle Jubba Middle
WaqoyGalbed
Lower Shabelle MiddleShabelle Banadir Somaliland Puntland Galmudug SouthWest Jubaland Hirshabelle
Received (%) Target(%)
Fig 1c: Completness of reporting
Somaliland Puntland SCZ
100 80 60 40 20
0 report 34 35 36 37 Epi-week
Percentage Percentage of submitted theHFs Proportionate Morbidity As shown in figure 2; severe acute respiratory illness (SARI), influenza like illness (ILI), acute watery diarrhoea (AWD), bloody diarrhoea (BD) & other acute diarrhoeas (OAD) are the commonest causes of morbidity across Somalia in 2018. In week 37, the highest numbers of diseases were other acute diarrhoeas (3,524 cases), influenza like illness (3,153 cases), severe acute respiratory illness (1,329 cases), acute watery diarrhoea (112 cases) and bloody diarrhoea (144 cases)
Proportation of cases of SARI, ILI, AWD, BD & OAD by EPI Week34 to week 37, 2018 50
40 SARI 30 ILI AWD 20
Percentage BD 10 OAD
0 Wk34 Wk35 Wk36 Wk37
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AWD/Cholera situation in Somalia
Generally,Fig the 3a. DistrictsAWD/cholera Reporting cases Cases have in Weekbeen 37on the decline since weeks 29 (fig 3b) and cases are localized in Lower Juba and Banadir regions. However, cases are expected to increase due to the floods that led to contamination of water sources in the flood affected regions. Floods have also led to blockage of access of health services which have contributed to delayed health seeking by the affected populations with. The cholera outbreak that started in December 2017 in Beletweyne along river Shabelle has spread to Jowhar, Kismayo, Afgoye Merka and Banadir. The cholera spread is expected to increase due to the floods that have led to contamination of water sources in the flood affected regions. Floods have also led to blockage of access of health services which will contribute to delayed health seeking by the affected populations with. Over the past 2 weeks, there has been decrease in the number of AWD/Cholera cases reported in Banadir and Lower Jubba; the regions that were affected by floods. In week ending 16th Sept- 2018, active transmission of AWD/cholera was reported in Kismayo district in Lower Jubba, as well in 9 districts of Banadir region (Darkenly, Daynile, Hodan, Madina, Waberi Hamarjabjab, Karaan, Abdilaziz, Yaqshid districts) (fig 3a). In Kismayo, affected communities especially in Farjano IDP are reportedly using contaminated water due to floods. As shown in table 2, there was decrease in the number of cases reported from 36 in week 36 to 34 in week 37. The Oral Cholera Vaccination that was implemented in 11 high risk districts in 2017 of the central region has greatly contributed to the reduction in the number of new AWD/cholera cases compared to the same time in 2017 (fig 3b).
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Fig 3b. AWD/Cholera cases in Somalia Sept 2017-Sept 2018 450 4.0 400 Cases Total Deaths 3.5 350 3.0 300 2.5 250 2.0 200 150 1.5 100 1.0 50 0.5
0 0.0
NumberofAWD/Cholera cases
week 3 week 5 week 7 week 9 week
weeks 1 week
week 31 week 35 week week 11 week 13 week 15 week 17 week 19 week 21 week 23 week 25 week 27 week 29 week 33 week 37 week
Week 37 Week 39 Week 41 Week 43 Week 45 Week 47 Week 49 Week 51 Week Oct.17 Nov.17 Dec.17 Jan-18 Feb-18 Mar.18 April.18 May.18 June.18 Jul.18 Aug.18Sep.18
Table 1. Summary of AWD/Cholera cases in different regions
Week 36 Week 37 Cumulative as of 16th Sep- States Regions Ending 9th Sep -18 Ending 16th Sep -18 2018
Cases Deaths CFR (%) Cases Deaths CFR (%) Cases Deaths CFR (%)
Banadir Banadir 31 0 0 30 0 0 2,620 20 0.8
Jubba land L/ Jubba 5 0 0 4 0 0 2,327 15 0.6
South west L/ Shabelle 0 0 0 0 0 0 294 4 1.4
Hir- M/Shabelle 0 0 0 0 0 0 558 2 0.4 shabele Hiraan 0 0 0 0 0 0 565 1 0.2
Total 36 0 0 34 0 0 6,364 42 0.7
NB. Deaths are included among cases. Banadir Region is not a state
Cholera Situation in Lower Jubba, and Banadir.
• Banadir region which included Mogadishu city has one of the highest concentrations of refugees where access to safe water and proper sanitation is limited. The AWD/Cholera outbreak in Banadir region started in January 2018 following reports of similar outbreak in Beletweyne district of Hiraan region. Of the 17 districts that make up Banadir region, 9have so far reported cases which have been managed in Banadir CTC located in the capital Mogadishu. There has been decrease in the number of AWD/Cholera cases from 31 cases and no death to 30 cases with no death in the past 2 weeks. Of the 30 new cases reported during the week 37 (30%) of them where children below 5 years.
• The current AWD/Cholera outbreak in Kismayo district started in week 5 of 2018 in the IDP communities of Farjano where access to safe water and sanitation is limited. Over the past week, the numbers of AWD/Cholera cases in Lower Jubba have decreased from 5 and no deaths to 4 no death. Of the 4 cases reported in Farjano,3 where children below 5 years.
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AWD/Cholera cases and floods
Following heavy rains in Ethiopia and Somalia, flash floods have been reported in the basins of Juba and Shabelle in 4 states. An estimated 718,000 people have been affected of which 220,000 have been displaced. Floods contribute to contamination of water sources as well as disruption of health services which are precursors of cholera outbreaks. Current information from OCHA shows that the floods are receding in all states, however new cholera cases have been reported in Jowhar of Middle Shabelle (Table 3).
Table 3. AWD/Cholera cases in different districts Week 37 Cumulative Week 49/17- week 37/18 Region District Cases Deaths ≥ 5 CFR <2 yrs 2 -5 yrs ≥ 5 yrs <2 yrs 2-5yrs Cases Deaths yrs (%) Darkenley 2 0 4 0 0 425 1 0.2 Daynile 1 0 2 0 0 468 8 1.7
HamarJabja 0 0 2 0 0 163 2 1.2
Hawlwadag 0 0 1 0 0 114 1 0.9
Hodan 2 1 2 0 0 566 2 0.4 Karaan 2 0 0 0 0 46 1 2.2 Madina 1 0 7 0 0 440 2 0.5 Banadir Waberi 0 0 1 0 0 118 2 1.7 Shibis 0 0 0 0 0 13 0 0 Shingani 0 0 0 0 0 8 0 0 Abdilaziz 0 0 1 0 0 6 0 0
HamarWeine 0 0 0 0 0 50 0 0
Heliwaa 0 0 0 0 0 25 0 0 Wardigley 0 0 0 0 0 118 1 0.8 Yaqshid 0 0 1 0 0 60 0 0
Middle Jowhar 0 0 0 0 0 558 2 0.4 Shabelle×
Beletweyne 0 0 0 0 0 522 1 0.2 Hiran× BuloBarde 0 0 0 0 0 43 0 0
Afgoye 0 0 0 0 0 153 0 0 Lower Kurtunwarey 0 0 0 0 0 31 4 12.9 Shabelle× Merka 0 0 0 0 0 96 0 0 Brava 0 0 0 0 0 14 0 0 Lower Kismayo 2 1 1 0 0 2,327 15 0.6 Jubba× Total 10 2 22 0 0 6,364 42 0.7 × regions currently affected by floods. Cases include deaths.
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Response activities implemented during week 37, 2018
Coordination and Leadership.
• Coordination meetings were conducted in the flood affected states. The coordination meetings are coordinated by Federal Ministry and State level MoH in coordination with health cluster partners • Weekly coordination meeting for WASH cluster, MoH were conducted in Banadir region as well as Middle Shebelle in Jowhar Case management
• On job training was conducted for the health workers working in cholera treatment centres in Kismayo, Farjano and Banadir, Merka (Ayuub Health Centre, and Afgoye Hospital CTCs • Management of cholera cases is being conducted in Banadir hospital CTC,Afgoye Hospital Merka (Ayuub Health Centre, CTCs, Kismayo hospital Jowhar hospital CTC and Farjano CTU
Surveillance and Laboratory Investigations
• Routine data collection using EWARN system, 46 health facilities at timeliness, 47/47 • AWD/Cholera data base updates, • Stool sample taken 6 cases 1 of them are vibrio cholera positive • AWD/Cholera data base updates Detection, notification and investigation of AWD/Cholera
Water Sanitation, Hygiene and risk communication
• Chlorination of water sources in affected areas Hnati-wadaag, Bulo-sheikh, Farjano, Allenley and Fanole have been done • A total of 1,500 hygiene kits have been distributed in selected villages affected by AWD in Kismayo • Hygiene promotion of AWD prevention and control mechanism is on-going in Farjano, Allanley, Gulwade and Shaqalaha, Kismayo district
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Measles Situation
Districts Reporting Measles Cases in Week 37 The number of suspected measles cases increased
Caluula from 68 cases in week 36, to 92 cases in week 37.
Qandala
Zeylac Bossaso
Lughaye Laasqoray Berbera Iskushuban Baki Ceerigaabo Borama Ceel Afweyn Cumulatively, 6,869 cases of suspected measles have Sheikh Gebiley
Hargeysa Somaliland Qardho Caynabo Owdweyne Bandarbeyla Burco Xudun Taleex been reported across Somalia since the beginning of Puntland
Buuhoodle Laas Caanood Garoowe
Eyl Burtinle 2018. Of the 6,869 measles cases, 4,626 (67%) were Jariiban Galdogob Gaalkacyo
Cadaado Cabudwaaq Hobyo under 5 years while 2,243 (33%) were above 5 years.
Dhuusamarreeb
Galmudug State
Ceel Buur Xarardheere Ceel Barde Belet Weyne Legend The most affected districts include; Abudwak (709 Rab Dhuure Xudur Districts Reporting Measles Cases in Week 30 Ceel Dheer Doolow Bulo Burto Waajid Tayeeglow 0/No Data Luuq Hir-Shabelle State Adan Yabaal Belet Xaawo Jalalaqsi 1 - 3 Cases Baydhaba Garbahaarey Cadale 4 - 7 Cases cases), Huruwa (584 cases), Baidoa (378 cases), South West State Jowhar
Qansax Dheere Wanla Weyn Ceel Waaq 7- 14 Cases Buur Hakaba Balcad
Afgooye Districts affected by Floods Baardheere Diinsoor Banadir
Qoryooley Banadir Marka Major_Rivers Kurtunwaarey Saakow Lascanod (354 cases), Adado (314 cases), Galkacyo Jubaland State Sablaale Coastline Bu'aale
Baraawe
Jilib Afmadow Heliwa Dayniile Yaaqshid (279 cases), Wadajir (264 cases), Burao (215 cases) Jamaame Karaan Wardhigley Banadir Afgooye Hodan Shibis Kismaayo Hawl Wadaag
Badhaadhe Wadajir (Medina)Waaberi µ Dharkenley and Marka (196 cases). As shown in fig 4b below, the
0 45 90 180 270 360 Miles The designation employed and presentation of material on the map do not imply the expression on any opinion whatsoever on the part of the Secretariat or the trends of measles cases have continued to decrease in United Nations concerning the legal status of any country, territory, city or any any area of authority, or concerning determination of its fronteers or boundaries. all the regions following the successful implementation of measles vaccination campaign.
Fig 4b: Measles Situation in Somalia from Week 1 to Week 37, 2018 700
600 Measles vaccination 500 in PL Measles vaccination implemented in SL & 400 SCZ on Week 10
Cases 300
200
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Epi-Week
South & Central Zone Somaliland Puntland National
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Fig 4c. Districts reporting highest cases of Measles across Somalia from Wk1 - Wk37, 2018 600 500 400 300 200 100 0 Huruwaa Wadajir Abudwak Adado Galkacyo Burao Lasacanod Baidoa Marka Banadir Galmudug Somaliland Southwest
Cases >5 Cases<5
Table 2: Summary of Suspected measles cases by region week 1 - 37, 2018 Cumulative cases (Wk 1 – Region 34 35 36 37 37) Awdal 0 0 0 1 15 Bakool 1 1 1 0 137 Banadir 28 30 21 23 1072 Bari 1 0 1 0 98 Bay 6 6 2 1 1043 Galgaduud 0 7 3 32 1144 Gedo 2 2 1 2 73 Hiraan 9 5 3 2 217 Lower Juba 5 5 0 9 351 Lower Shabelle 4 7 0 5 358 Middle Juba 16 8 10 7 243 Middle Shabelle 5 6 3 4 192 Mudug 8 8 8 1 669 Nugaal 1 7 5 2 204 Sanaag 1 0 5 2 167 Sool 9 0 1 1 387 Togdher 2 3 3 0 245 Waqoyi Galbed 0 1 1 0 254 Grand Total 98 96 68 92 6869
Measles Outbreak Response Activities • The Federal Ministry of Health in collaboration with WHO, UNICEF and other partners conducted a measles vaccination campaign across the country between January and March 2018. • Over 4.4 million children aged 6 months to 10 years were vaccinated. • There has been a significant reduction in the number of measles cases reported from all the states following the vaccination campaign.
Malaria Situation in Somalia
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The number of Malaria cases increased from 321 cases in week 36 to 459 cases in week 37. Cumulatively, 10,440 cases of Malaria cases have been reported across Somalia since the beginning Districts Reporting Malaria Cases in Week 36 of 2018. Of the 10,440 malaria cases, 4,520 (43%) are under
Caluula
Qandala Zeylac Bossaso 5 years while 5,920 (57%) are above 5 years. The most Lughaye Laasqoray Berbera Baki Ceerigaabo Iskushuban Borama Ceel Afweyn Sheikh Gebiley
Hargeysa Somaliland Qardho Caynabo Owdweyne Bandarbeyla affected districts include; Baidoa district of Bay (1,732 cases), Burco Xudun Taleex
Puntland
Buuhoodle Laas Caanood Garoowe
Eyl Burtinle Berdale district of Bay (946 cases), Wadajir district in Banadir
Jariiban Galdogob Gaalkacyo
Cadaado (864 cases), Marka district of Lower Shabelle (740 cases), Cabudwaaq Hobyo
Dhuusamarreeb
Galmudug State Legend
Ceel Buur Xarardheere Ceel Barde Belet Weyne District reporting malaria cases in week 30 Adado district of Galgadud (494 cases), wajid district of Bakol
Rab Dhuure 0/ No Data Xudur Ceel Dheer Doolow Bulo Burto Waajid Tayeeglow 1 - 35 Cases Luuq Hir-Shabelle State Adan Yabaal Belet Xaawo Jalalaqsi 36 - 75 Cases Baydhaba Garbahaarey Cadale 75.- 98 Cases Jowhar (477 cases), Bal’ad district of Middle Shabelle (382 cases) and South West State
Qansax Dheere Wanla Weyn Ceel Waaq Districts affected by Floods Buur Hakaba Balcad
Afgooye Major_Rivers Baardheere Diinsoor Banadir Qoryooley Banadir Coastline Marka Kurtunwaarey Saakow Hudur district of Bakol (318 Cases). Jubaland State Sablaale Bu'aale Heliwa Baraawe Dayniile Yaaqshid Afmadow Jilib Karaan Wardhigley Banadir Afgooye Hodan Shibis Jamaame Hawl Wadaag
Wadajir (Medina)Waaberi Kismaayo Dharkenley µ Badhaadhe
0 45 90 180 270 360 Miles
The designation employed and presentation of material on the map do not imply the expression on any opinion whatsoever on the part of the Secretariat or the United Nations concerning the legal status of any country, territory, city or any any area of authority, or concerning determination of its fronteers or boundaries. Fig 5b: Malaria Situation in Somalia from Week 1 to Week 37, 2018 500
400
300
Cases 200
100
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Epi-week
SC Zone Somaliland Puntland National
Fig 5c: Districts Reporting Highest Cases of Malaria Across Somalia from Wk1-37, 2018 1400 1200 1000 800 600 400 200 0 Wadajir Adado Bal'ad Baidoa Berdale Huddur Marka Waajid Banadir Galmudug Hirshabelle SouthWest
Cases >5 Cases<5
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Other Acute Diarrhea Situation in Somalia The number of OAD cases has been floatingly going up and down for the last four weeks, the cases in Week 36 were 3,377 compared to 3,524 cases in week 37. Cumulatively, 90,770 cases of OAD cases have been reported across Somalia since the beginning of 2018. Of the 90,770 OAD cases, 67,908 (75%) are under 5 years while 22,862 (25%) are above 5 years. The most affected districts include; Marka District of Lower Shabelle (5,754 cases), Beletweyn district of hiran (5,498 cases), Huruwa district of Banadir (4,364 cases), Dharkinley of Banadir (2,777 cases), Wadajir district of Banadir (2,626 cases) and Jowhar of Middle Shabelle (2,642 Cases).
Fig 6a: Trends of Other Acute Diarrhoea cases in Somalia from Week 1-37, 2018 4000 3500 3000 2500 2000 Cases 1500 1000 500 0 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Epi-week
SC Somaliland Puntland National
Fig 6b: Districts Reporting highest cases of OAD Across Somalia from Wk1-37, 2018 4500 4000 3500 3000 2500 2000 1500 1000 500 0 Dharkinley Huruwaa Wadajir Belet Weyne Bulo Burto Jowhar Baidoa Kurtunwarey Marka Banadir Hirshabelle Southwest
Cases >5 Cases<5
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Bloody Diarrhea Situation in Somalia The number of BD cases has increased from last week, the cases in Week 36 were 125 compared to 144 cases in week 36. Cumulatively, 3,492 cases of BD cases have been reported across Somalia since the beginning of 2018. Of the 3,492 BD cases, 1,847 (53%) are under 5 years while 1,645 (47%) are above 5 years. The most affected districts include Baidoa of Bay (504 cases), Burhakaba of Bay (343 cases), Buhodle of Togdheer (257 cases) and Hargeisa of Waqoy Galbeed (176 cases).
Fig 7a: Trends of Bloody Diarrhea cases in Somalia from Week1-37, 2018 200
150
100 Cases
50
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Epi-week
SC Somaliland Puntland National
Fig 7b: Districts Reporting the Highest Cases of Bloody Diarrhea Across from week1-37, 2018
350
300 Cases >5 Cases<5
250
200
150
100
50
0 Afmadow Kismayo Luuq Buhodle Gabiley Hargeisa Baidoa Burhakaba Waajid Jubaland Somaliland SouthWest
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Whooping Cough Situation in Somalia The number of WC cases has also been floatingly going up Fig 8a. Districts Reporting Whooping Cough Cases in Week 37 and down for the last four weeks, the cases in Week 36
Caluula
Qandala Zeylac Bossaso
Lughaye Laasqoray were 56 compared to 59 cases in week 37. Cumulatively, Berbera Baki Ceerigaabo Iskushuban Borama Ceel Afweyn Sheikh Gebiley
Hargeysa Somaliland Qardho Caynabo Owdweyne Bandarbeyla Burco Xudun Taleex 1,856 cases of WC cases have been reported across Somalia Puntland
Buuhoodle Laas Caanood Garoowe
Eyl
Burtinle
Jariiban Galdogob since the beginning of 2018. Of the 1,856 WC cases, 1,444 Gaalkacyo
Cadaado Cabudwaaq Hobyo
Dhuusamarreeb (78%) are under 5 years while 412 (22%) are above 5 years. Galmudug State Legend
Ceel Buur Xarardheere Ceel Barde Belet Weyne WC
Rab Dhuure 0/No Data Xudur Ceel Dheer Doolow Bulo Burto Waajid Tayeeglow 1 - 10 Case Luuq Hir-Shabelle State Adan Yabaal The most affected districts include Galkacyo (365 cases), Jilib Belet Xaawo Jalalaqsi 11 - 20 Cases Baydhaba Garbahaarey Cadale 21 - 30 Cases South West State Jowhar
Qansax Dheere Wanla Weyn Ceel Waaq Districts affected by Floods Buur Hakaba Balcad
Afgooye Major_Rivers Baardheere Diinsoor Banadir Qoryooley Banadir (174 cases), Berbera (94 cases), Buale (81cases), Adaado (77 Coastline Marka Kurtunwaarey Saakow
Jubaland State Sablaale Bu'aale Heliwa Baraawe Dayniile Yaaqshid Afmadow Jilib Karaan Wardhigley Banadir Afgooye Hodan Shibis Jamaame Cases) and Erigavo (72 cases), Hawl Wadaag
Wadajir (Medina)Waaberi Kismaayo Dharkenley µ Badhaadhe
0 45 90 180 270 360 Miles The designation employed and presentation of material on the map do not imply the expression on any opinion whatsoever on the part of the Secretariat or the United Nations concerning the legal status of any country, territory, city or any any area of authority, or concerning determination of its fronteers or boundaries.
Fig 8b: Trends of Whooping Cough in Somalia from Week1-37, 2018 120
100
80
60 Cases 40
20
0 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Epi-week
SC Somaliland Puntland National
Fig8c: Most affected Districts by Whooping Cough in Somalia from Wk1-37, 2018 350
300
250
200
150
100
50
0 Adado Galkacyo Gelinsor Bu,aale Jilib Salagle Berbera Burao Erigavo Galmudug Jubaland Somaliland
Cases <5 Cases >5
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Other Common Causes of Morbidity across Somalia Severe Acute respiratory Illness (SARI) The number of SARI cases has also been floatingly going up and down for the last four weeks, the cases in Week 36 were 1,532 compared to 1,329 cases in week 37. Cumulatively, 37,547 cases of SARI cases have been reported across Somalia since the beginning of 2018. Of the 38,876 SARI cases, 23,489(60%) are under 5 years while 15,387 (40%) are above 5 years. The most affected districts include Beletweyne (5,803 cases), Buloburte (2,468 cases), Yaqshid (2,118 Cases), Abudwak (1,738 cases), Huruwa (1,732 cases), and Wadajir (1,600 cases).
Fig 9a: Trends of SARI cases in Somalia from Week1-37, 2018 1800 1600 1400 1200 1000
Cases 800 600 400 200 0 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Epi-week
SC Somaliland Puntland National
Fig 9b: Districts Reporting the Highest Cases of SARI across Somalia from Wk1-37, 2018 3500
3000
2500
2000
1500
1000
500
0 Huruwaa Wadajir Yaqshid Abudwak Adado Dhuusamarreeb Belet Weyne Bulo Burto Jalalaqsi Banadir Galmudug Hirshabelle
Cases <5 Cases >5
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Influenza like Illness (ILI): The number of ILI cases has also been floatingly going up and down for the last four weeks, the cases in Week 35 were 2,974 compared to 3,153 cases in week 36. Cumulatively, 68,139 cases of ILI cases have been reported across Somalia since the beginning of 2018. Of the 68,139 ILI cases, 39,961 (59%) are under 5 years while 28,178 (41%) are above 5 years. The most affected districts include Borama (6,609 cases), Beletweyne (4,815 cases), Lascanod (4,279 cases), Huruwa (4,093 cases), Berbera (3,699 cases) Wadajir (1,790 cases) and Dharkenley (1,504 cases).
Fig10a: Trends of ILI cases in Somalia from Week 1-37, 2018 3500 3000 2500 2000
Cases 1500 1000 500 0 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 Epi-week
SC Somaliland Puntland National
Fig10b: Districts Reporting Highest Cases of ILI across Somalia from Wk 1-37, 2018 4000
3500
3000
2500
2000
1500
1000
500
0 Dharkinley Huruwaa Wadajir Belet Weyne Berbera Borama Lasacanod Banadir Hirshabelle Somaliland
Cases <5 Cases >5
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Table 5. Completeness of reporting of the health facilities of Somalia as of Week 37, 2018
# of HFs submitted report in Completeness of reporting State Region District # of active HFs to submit report week37 (%) Abdiaziz 1 1 100 Boondhere 1 1 100 Dayniile 6 5 83 Dharkinley 4 4 100 Hamar Jab Jab 2 2 100 Hamar Weyne 1 1 100 Hodan 2 1 50 Howl-wadaag 3 2 67 Banadir Banadir Huruwaa 3 3 100 Kaaraan 1 1 100 Kahda 5 4 80 Shangani 1 1 100 Shibis 1 1 100 Waberi 1 1 100 Wadajir 9 9 100 Wardhigley 4 3 75 Yaqshid 5 5 100 Subtotal of Banadir 50 45 90 Baki 1 1 100 Borama 9 9 100 Awdal Lughaya 1 1 100 Zeila 2 2 100 Badhan 4 4 100 Sanag Eil-afweine 3 3 100 Erigavo 6 6 100 Somaliland Hudun 1 1 100 Sool Lasacanod 9 9 100 Taleex 1 1 100 Ainabo 1 1 100 Buhodle 2 2 100 Togdheer Burao 12 12 100 Odwayne 2 2 100 Page 16 of 24
Ballaygubadle 3 3 100 Berbera 6 6 100 Waqoy Gabiley 4 4 100 Galbed Hargeisa 14 14 100 Sheikh 3 3 100 Subtotal of Somaliland 84 84 100 Alula 2 0 0 Banderbayla 3 3 100 Bossaso 8 7 88 Bargal 1 1 100 Carmo 2 0 0 Hafun 2 2 100 Bari Iskushuban 1 1 100 Qandala 1 1 100 Qardho 5 5 100 Rakko 3 3 100 Ufeyn 1 0 0 Waciya 2 2 100 Galdogob 9 3 33 Mudug Galkacyo 16 11 69 Puntland Jariiban 4 3 75 Burtinle 7 7 100 Dangorayo 1 1 100 Nugal Eyl 7 6 86 Garoowe 11 11 100 Badhan 6 6 100 Dhahar 4 2 50 Sanag Lasqoray 1 1 100 Xingalol 1 1 50 Bocame 2 2 100 Hudun 3 2 67 Sool Lasacanod 1 0 0 Taleex 3 3 100 Xalin 1 0 0 Buhodle 2 2 100
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Ayn Widhwidh 1 1 100 (Togdher) Subtotal of Puntland 111 87 78 Abudwak 4 1 25 Adado 4 4 100 Balanbale 1 1 100 Galgadud Dhuusamarreeb 4 3 75 El Bur 1 0 0 Galmudug El Dere 4 5 125 Gelinsor 1 1 100 Galkacyo 6 5 83 Mudug Hobyo 13 11 85 Harardhere 4 4 100 Subtotal of Galmudug 42 35 83 Belet Weyne 10 8 80 Bulo Burto 4 1 25 Hiraan Jalalaqsi 1 0 0 Matabaan 4 2 50 Maxaas 1 1 100 Hirshabelle Adale 2 2 100 Bal'ad 12 8 67 Middle Jowhar 6 5 83 Shabelle Mahaday 3 2 67 Warsheikh 5 3 60 Subtotal of Hirshabelle 48 32 67 B/hawo 2 1 50 Baardhere 1 0 0 Doolow 2 2 100 Gedo Elwak 1 0 0 Garbahaarey 2 1 50 Jubaland Gedweyne 1 0 0 Luuq 3 1 33 Afmadow 2 1 50 Lower Dhobley 1 0 0 Juba Hagar 2 1 50 Jamaame 2 1 50 Page 18 of 24
Kismayo 11 9 82 Bu,aale 2 1 50 Middle Jilib 3 2 67 Juba Salagle 1 1 100 Subtotal of Jubaland 36 21 58 Afgoi 5 1 20 Awdhegle 1 0 0 Barawe 2 1 50 Lower Kurtunwarey 3 2 67 Shabelle Marka 12 7 58 Qoryooley 2 1 50 Wanla Weyn 2 1 50 SouthWest Elberde 3 3 100 Huddur 2 2 100 Bakool Tayeeglow 1 1 100 Waajid 3 2 67 Baidoa 13 6 46 Berdale 3 1 33 Bay Burhakaba 3 2 67 Qansahdere 2 0 0 Subtotal of Southwest 57 30 53 Grand Total 428 334 78
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Table 6. Summary of Epidemic-prone Diseases in different Districts of Somalia as of Week 37, 2018
State/Region/District SARI ILI AWD BD OAD DIPH WC MEAS NNT AFP AJS VHF MAL MENG OC Total_cons
Banadir 295 641 46 6 691 0 5 23 0 0 1 0 69 0 17485 19263 Banadir 295 641 46 6 691 0 5 23 0 0 1 0 69 0 17485 19263 Abdiaziz 0 0 0 0 3 0 0 0 0 0 0 0 0 0 499 502 Boondhere 0 0 0 0 3 0 0 4 0 0 0 0 0 0 222 229 Dayniile 4 27 1 1 38 0 0 1 0 0 0 0 0 0 1445 1517 Dharkinley 53 54 1 2 129 0 0 0 0 0 0 0 0 0 1266 1505 Hamar Jab Jab 11 72 0 0 46 0 0 0 0 0 0 0 0 0 708 837 Hamar Weyne 3 19 0 0 22 0 0 0 0 0 0 0 0 0 538 582 Hodan 0 0 0 0 14 0 0 0 0 0 0 0 0 0 1062 1076 Howl-wadaag 0 99 2 0 4 0 0 0 0 0 0 0 0 0 1014 1119 Huruwaa 46 145 0 0 169 0 4 8 0 0 0 0 2 0 1480 1854 Kaaraan 0 0 0 0 0 0 0 0 0 0 0 0 0 0 726 726 Kahda 4 130 0 0 57 0 0 0 0 0 0 0 9 0 1130 1330 Shangani 19 6 0 0 13 0 0 0 0 0 0 0 0 0 21 59 Shibis 0 0 0 0 14 0 0 1 0 0 0 0 0 0 814 829 Waberi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 459 459 Wadajir 39 60 39 0 80 0 0 6 0 0 1 0 53 0 3597 3876 Wardhigley 0 0 0 3 48 0 1 2 0 0 0 0 4 0 1514 1572 Yaqshid 116 29 3 0 51 0 0 1 0 0 0 0 1 0 990 1191 Galmudug 212 5 0 0 310 0 17 33 0 0 0 0 67 0 8687 9331 Galgadud 203 5 0 0 78 0 13 32 0 0 0 0 67 0 3354 3752 Abudwak 9 0 0 0 2 0 2 0 0 0 0 0 0 0 489 502 Adado 57 5 0 0 15 0 0 15 0 0 0 0 36 0 611 739 Balanbale 0 0 0 0 7 0 0 0 0 0 0 0 0 0 204 211 Dhuusamarreeb 76 0 0 0 6 0 9 6 0 0 0 0 31 0 1190 1318 El Dere 61 0 0 0 48 0 2 11 0 0 0 0 0 0 740 862 Gelinsor 0 0 0 0 0 0 0 0 0 0 0 0 0 0 120 120 Mudug 9 0 0 0 232 0 4 1 0 0 0 0 0 0 5333 5579 Galkacyo 0 0 0 0 57 0 4 1 0 0 0 0 0 0 3307 3369 Harardere 2 0 0 0 25 0 0 0 0 0 0 0 0 0 639 666 Hobyo 7 0 0 0 150 0 0 0 0 0 0 0 0 0 1387 1544 Hirshabele 145 166 3 3 347 0 1 6 0 0 0 0 9 0 9317 10037 Page 20 of 24
Hiraan 136 161 3 0 125 0 1 2 0 0 0 0 3 0 2423 2894 Belet Weyne 132 134 0 0 120 0 0 2 0 0 0 0 3 0 1766 2157 Bulo Burto 0 2 0 0 1 0 0 0 0 0 0 0 0 0 318 321 Matabaan 2 18 3 0 4 0 0 0 0 0 0 0 0 0 122 189 Maxaas 2 7 0 0 0 0 1 0 0 0 0 0 0 0 217 227 Middle Shabelle 9 5 0 3 222 0 0 4 0 0 0 0 6 0 6894 7143 Adale 0 0 0 0 11 0 0 0 0 0 0 0 0 0 637 648 Bal'ad 5 1 0 0 83 0 0 1 0 0 0 0 0 0 3119 3209 Jowhar 3 4 0 3 93 0 0 3 0 0 0 0 3 0 1525 1634 Mahaday 1 0 0 0 21 0 0 0 0 0 0 0 1 0 725 748 Warsheikh 0 0 0 0 14 0 0 0 0 0 0 0 2 0 888 904 Jubbaland 314 53 14 24 283 0 13 18 0 0 0 0 31 0 3703 4453 Gedo 51 53 0 9 87 0 0 2 0 0 0 0 10 0 634 846 Belet-hawa 0 0 0 0 17 0 0 0 0 0 0 0 3 0 65 85 Doolow 43 28 0 7 46 0 0 2 0 0 0 0 0 0 345 471 Garbahaarey 4 24 0 0 22 0 0 0 0 0 0 0 4 0 23 77 Luuq 4 1 0 2 2 0 0 0 0 0 0 0 3 0 201 213 Lower Juba 217 0 14 10 171 0 0 9 0 0 0 0 12 0 2610 3043 Afmadow 46 0 0 2 16 0 0 3 0 0 0 0 0 0 107 174 Hagar 6 0 0 1 8 0 0 2 0 0 0 0 0 0 84 101 Jamaame 8 0 0 1 12 0 0 0 0 0 0 0 8 0 181 210 Kismayo 157 0 14 6 135 0 0 4 0 0 0 0 4 0 2238 2558 Middle Juba 46 0 0 5 25 0 13 7 0 0 0 0 9 0 459 564 Bu,aale 10 0 0 2 8 0 2 1 0 0 0 0 0 0 104 127 Jilib 28 0 0 2 13 0 9 5 0 0 0 0 9 0 273 339 Salagle 8 0 0 1 4 0 2 1 0 0 0 0 0 0 82 98 Puntland 44 1207 6 27 839 3 7 5 1 0 1 0 87 257 12785 15969 Bari 1 658 0 14 217 0 2 0 0 0 0 0 7 0 4414 5313 Bandarbayla 0 0 0 0 11 0 0 0 0 0 0 0 0 0 267 278 Bargal 1 4 0 1 4 0 0 0 0 0 0 0 0 0 155 165 Bossaso 0 599 0 6 136 0 0 0 0 0 0 0 7 0 1525 2273 Hafun 0 0 0 0 11 0 0 0 0 0 0 0 0 0 208 219 Iskushuban 0 18 0 0 12 0 0 0 0 0 0 0 0 0 127 157 Qandala 0 37 0 7 5 0 2 0 0 0 0 0 0 0 210 261 Qardho 0 0 0 0 27 0 0 0 0 0 0 0 0 0 1262 1289
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Rako 0 0 0 0 11 0 0 0 0 0 0 0 0 0 478 489 waciya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 182 182 Mudug 19 9 0 0 171 0 1 0 0 0 0 0 8 257 2907 3764 Galdogob 1 0 0 0 16 0 0 0 0 0 0 0 0 0 747 764 Galkacyo 16 9 0 0 113 0 0 0 0 0 0 0 8 257 1780 2575 Jariiban 2 0 0 0 42 0 1 0 0 0 0 0 0 0 380 425 Nugaal 2 373 0 1 277 0 1 2 0 0 0 0 0 0 2873 3589 Burtinle 0 143 0 0 76 0 0 0 0 0 0 0 0 0 903 1122 Dangorayo 0 14 0 0 7 0 0 0 0 0 0 0 0 0 153 174 Eyl 0 103 0 0 41 0 1 0 0 0 0 0 0 0 739 884 Garoowe 2 113 0 1 153 0 0 2 0 0 0 0 0 0 1078 1409 Sanaag 19 33 4 10 61 0 2 2 0 0 0 0 71 0 777 1174 Badhan 8 21 4 2 32 0 2 2 0 0 0 0 71 0 308 524 Dhahar 11 12 0 8 16 0 0 0 0 0 0 0 0 0 338 385 Lasqoray 0 0 0 0 1 0 0 0 0 0 0 0 0 0 27 28 Xingalol 0 0 0 0 12 0 0 0 0 0 0 0 0 0 104 237 Sool 2 36 2 2 44 3 1 1 1 0 0 0 0 0 1738 1830 Bocame 1 0 2 2 6 1 0 1 0 0 0 0 0 0 914 927 Hudun 0 21 0 0 19 0 1 0 0 0 0 0 0 0 206 247 Taleex 1 15 0 0 19 2 0 0 1 0 0 0 0 0 618 656 Togdheer 1 98 0 0 69 0 0 0 0 0 1 0 1 0 76 299 Buhodle 0 68 0 0 56 0 0 0 0 0 0 0 0 0 73 248 Widhwidh 1 30 0 0 13 0 0 0 0 0 1 0 1 0 3 51 Somaliland 116 808 8 49 703 0 0 1 0 0 20 0 3 1 8047 9756 Awdal 0 298 8 11 143 0 0 1 0 0 0 0 2 0 1104 1567 Baki 0 36 0 5 12 0 0 0 0 0 0 0 0 0 93 146 Borama 0 202 0 6 109 0 0 0 0 0 0 0 2 0 759 1078 Lughaya 0 1 0 0 7 0 0 0 0 0 0 0 0 0 41 49 Zeila 0 59 8 0 15 0 0 1 0 0 0 0 0 0 211 294 Sanaag 76 61 0 6 76 0 0 0 0 0 15 0 0 1 1647 1882 Badhan 11 10 0 0 29 0 0 0 0 0 0 0 0 1 461 512 Eil-afweine 23 16 0 2 10 0 0 0 0 0 0 0 0 0 390 441 Erigavo 42 35 0 4 37 0 0 0 0 0 15 0 0 0 796 929 Sool 0 144 0 0 116 0 0 0 0 0 0 0 0 0 1322 1582 Hudun 0 24 0 0 12 0 0 0 0 0 0 0 0 0 138 174
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Lasanod 0 111 0 0 99 0 0 0 0 0 0 0 0 0 1059 1269 Taleex 0 9 0 0 5 0 0 0 0 0 0 0 0 0 125 139 Togdheer 5 60 0 21 147 0 0 0 0 0 0 0 0 0 1794 2027 Ainabo 0 0 0 3 8 0 0 0 0 0 0 0 0 0 94 105 Buhodle 0 6 0 12 30 0 0 0 0 0 0 0 0 0 322 370 Burao 5 43 0 3 96 0 0 0 0 0 0 0 0 0 1095 1242 Odwayne 0 11 0 3 13 0 0 0 0 0 0 0 0 0 283 310 Waqoy Galbed 35 245 0 11 221 0 0 0 0 0 5 0 1 0 2180 2698 Ballaygubadle 3 7 0 0 6 0 0 0 0 0 4 0 0 0 154 174 Berbera 13 64 0 4 83 0 0 0 0 0 1 0 0 0 505 670 Gabiley 2 70 0 3 46 0 0 0 0 0 0 0 1 0 198 320 Hargeisa 6 83 0 4 65 0 0 0 0 0 0 0 0 0 1021 1179 Sheikh 11 21 0 0 21 0 0 0 0 0 0 0 0 0 302 355 SouthWest 203 273 35 35 351 0 16 6 1 1 0 0 193 1 6315 7438 Bakool 16 10 0 3 24 0 4 0 0 0 0 0 18 0 1151 1226 Elberde 0 7 0 1 7 0 0 0 0 0 0 0 0 0 448 463 Huddur 9 0 0 0 11 0 0 0 0 0 0 0 9 0 270 299 Tayeeglow 4 0 0 0 0 0 3 0 0 0 0 0 3 0 70 80 Waajid 3 3 0 2 6 0 1 0 0 0 0 0 6 0 363 384 Bay 160 181 32 32 73 0 2 1 1 1 0 0 146 1 1395 2033 Baidoa 90 119 32 17 56 0 2 1 0 1 0 0 74 0 1006 1398 Berdale 56 60 0 0 0 0 0 0 1 0 0 0 70 1 33 229 Burhakaba 14 2 0 15 17 0 0 0 0 0 0 0 2 0 356 406 Lower Shabelle 27 82 3 0 254 0 10 5 0 0 0 0 29 0 3769 4179 Afgoi 0 8 0 0 5 0 0 0 0 0 0 0 1 0 45 59 Baraawe 3 2 2 0 0 0 0 4 0 0 0 0 0 0 183 194 Kurtunwarey 1 0 0 0 35 0 10 0 0 0 0 0 2 0 602 650 Marka 16 34 1 0 147 0 0 1 0 0 0 0 22 0 2520 2741 Qoryooley 2 0 0 0 30 0 0 0 0 0 0 0 2 0 294 328 Wanla Weyn 5 38 0 0 37 0 0 0 0 0 0 0 2 0 125 207 Grand Total 1,329 3,153 112 144 3,524 3 59 92 2 1 22 - 459 259 66,339 76,247
SARI-Severe Acute respiratotyIllness,ILI-Influenza Like Illness, AWD-Acute Watery Diarrhoea,BD-Bloody Diarrhoea, Diph-Diptheria,WC-Whooping cough, Meas-Fever With Rash/Measles,NNT-Neonatal Tetanus,AJS-Acute Jaundice Syndrome, VHF-Viral Heamorrhagic Fever,Mal-Confirmed Malaria, Men-Bacterial Meningitis
For inquires please contact the Surveillance team, Ahmed Moalim Mohamed, Emergency Coordinator FMoH, [email protected] and WHO country office in Somalia or Dr Mutaawe Lubogo, Epidemiologist, [email protected] Page 23 of 24
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