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Horn of Africa Emergency-Affected Countries 2007 WHO/CDS/NTD/DCE/2007.1 COMMUNICABLE DISEASE EPIDEMIOLOGICAL PROFILE Horn of Africa Emergency-affected countries 2007 WHO Communicable Diseases Working Group on Emergencies WHO Regional Offi ce for Africa WHO Regional Offi ce for the Eastern Mediterranean WHO country offi ces – Djibouti, Eritrea, Ethiopia and Somalia COMMUNICABLE DISEASE EPIDEMIOLOGICAL PROFILE Horn of Africa Emergency-affected countries, 2007 WHO Communicable Diseases Working Group on Emergencies WHO Regional Office for Africa WHO Regional Office for the Eastern Mediterranean WHO country offices – Djibouti, Eritrea, Ethiopia and Somalia Communicable disease epidemiological profile for HORN OF AFRICA 2007 © World Health Organization 2007 All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. The named editors alone are responsible for the views expressed in this publication. Further information is available at: CDS Information Resource Centre, World Health Organization, 1211 Geneva 27, Switzerland; Fax: + (41) 22 791 4285, e-mail: [email protected] or [email protected] 2 World Health Organization Communicable disease epidemiological profile for HORN OF AFRICA 2007 CONTENTS ACKNOWLEDGEMENTS ........................................................................................................... 4 Part I INTRODUCTION......................................................................................................................... 5 MALNUTRITION AND COMMUNICABLE DISEASES............................................................... 6 Part II Country-specific summaries – communicable disease risk assessments: DJIBOUTI.................................................................................................................................. 11 ERITREA................................................................................................................................... 19 ETHIOPIA.................................................................................................................................. 25 SOMALIA .................................................................................................................................. 36 Part III High-burden communicable diseases 1. ACUTE LOWER RESPIRATORY INFECTIONS (ALRI) ............................................. 49 2. AFRICAN TRYPANOSOMIASIS (SLEEPING SICKNESS)......................................... 52 3. BACILLARY DYSENTERY (SHIGELLOSIS)............................................................... 57 4. CHOLERA.................................................................................................................... 61 5. DIARRHOEAL DISEASES (OTHERS) ........................................................................ 66 6. DIPHTHERIA ............................................................................................................... 69 7. DRACUNCULIASIS ..................................................................................................... 73 8. HIV/AIDS...................................................................................................................... 79 9. INFLUENZA ................................................................................................................. 97 10. LEPROSY .................................................................................................................. 113 11. LYMPHATIC FILARIASIS .......................................................................................... 117 12. MALARIA ................................................................................................................... 123 13. MEASLES .................................................................................................................. 131 14. MENINGOCOCCAL DISEASE .................................................................................. 134 15. ONCHOCERCIASIS (RIVER BLINDNESS) .............................................................. 139 16. PERTUSSIS (WHOOPING COUGH) ........................................................................ 144 17. POLIOMYELITIS........................................................................................................ 148 18. RABIES ......................................................................................................................155 19. RIFT VALLEY FEVER................................................................................................ 159 20. SCHISTOSOMIASIS (BILHARZIASIS)...................................................................... 167 21. SOIL-TRANSMITTED HELMINTHIASES.................................................................. 172 22. TUBERCULOSIS ....................................................................................................... 176 23. TYPHOID FEVER...................................................................................................... 188 24. YELLOW FEVER....................................................................................................... 191 Part IV APPENDIX 1: FLOWCHARTS FOR THE DIAGNOSIS OF COMMUNICABLE DISEASES.. 194 APPENDIX 2: STEPS IN OUTBREAK MANAGEMENT......................................................... 201 APPENDIX 3: SAFE WATER AND SANITATION .................................................................. 202 APPENDIX 4: INJECTION SAFETY....................................................................................... 203 APPENDIX 5: KEY CONTACTS FOR THE HORN OF AFRICA............................................ 204 APPENDIX 6: LIST OF WHO GUIDELINES ON COMMUNICABLE DISEASES .................. 208 APPENDIX 7: MAP OF AREAS AFFECTED BY SEVERE FOOD CRISES, HORN OF AFRICA AND NEIGHBOURING COUNTRIES ............................................................................. 213 APPENDIX 8: DEMOGRAPHIC CHARACTERISTICS OF HORN OF AFRICA COUNTRIES ..214 World Health Organization 3 Communicable disease epidemiological profile for HORN OF AFRICA 2007 ACKNOWLEDGEMENTS Edited by Dr Pamela Sabina Mbabazi, Dr Michelle Gayer and Dr Máire Connolly of the World Health Organization (WHO) Programme on Disease Control in Humanitarian Emergencies (DCE). This communicable disease profile is the result of collaboration between the Communicable Diseases Working Group on Emergencies at WHO headquarters, the Division of Communicable Disease Prevention and Control (DCD) at the WHO Regional Office for Africa (AFRO) and the WHO Regional Office for the Eastern Mediterranean (EMRO), and the Office of the WHO Representatives for Djibouti, Eritrea, Ethiopia and Somalia. The working group provides technical and operational support on communicable disease issues to WHO regional and country offices, ministries of health, other United Nations agencies, and nongovernmental and international organizations. It includes the departments of Control of Neglected Tropical Diseases (NTD), Epidemic and Pandemic Alert and Response (EPR), Special Programme for Research and Training in Tropical Diseases (TDR) in the Communicable Diseases (CDS) cluster; Global Malaria Programme (GMP), Stop TB (STB) and HIV/AIDS (HIV) in the HIV/AIDS, Tuberculosis and Malaria (HTM) cluster; departments of Child and Adolescent Health and Development (CAH), Immunization, Vaccines and Biologicals (IVB) in the Family and Community Health (FCH) cluster; Food Safety, Zoonoses and Foodborne Diseases (FOS), Protection of the Human Environment (PHE) in the Sustainable Development and Healthy Environments (SDE) cluster; Chronic Diseases and Health Promotion (CHP), Injuries and Violence Prevention (VIP), and Nutrition for Health and Development (NHD) in the Noncommunicable Diseases and Mental Health (NMH) cluster; Security and Staff Services (SES) in the General Management (GMG) cluster; and Representatives of the Director-General (DGR) for Health Action in Crises (HAC) and the Polio Eradication Initiative (POL). The following people were involved in the development and review of this document and their contribution is gratefully acknowledged: Henrietta Allen (CDS/NTD), WHO Country Representatives for Djibouti, Eritrea, Ethiopia and Somalia, Eric Bertherat (CDS/EPR), Gautam Biswas (CDS/NTD), Sylvie Briand (CDS/EPR), Claire-Lise Chaignat (CDS/NTD), Claire Chauvin (DGO/POL), Alice Croisier (CDS/GIP), Denis Daumerie (CDS/NTD), Micheline Diepart (HTM/HIV), Pierre Formenty (CDS/EPR), Albis Gabrielli (CDS/NTD),
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