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Toll free number for alert is 08089001 or 08089002 or 08089000

Mobile number for alerts is 0912 104 257 Date of issue:13th January, 2009 DAILY CHOLERA UPDATE AND ALERTS 13th January, 2009

* Please note that daily information collection is a challenge due to communication and staff constraints. On-going data cleaning may result in an increase or decrease in the numbers. Any change will then be explained. ** Daily information on new deaths should not imply that these deaths occurred in cases reported that day. Therefore daily CFRs >100% may occasionally result

1- Highlights of the day: • 642 cases and 73 deaths added today (in comparison 1472 cases and 117 deaths yesterday) • 36.84% of the districts affected have reported today (21 out of 57 affected districts) • 87.1 % of districts reported to be affected (54 districts/62) • Newly affected areas: Denda (Gokwe North) Sesame (Gokwe North)

Districts reported high Districts with a daily CFR > 5% : Districts with high number Districts with cases re- Districts which have not reported for more number of cases today of deaths outside health occurring after more than 3 days: (cases added today> 30) facility/ CTC > 3 than 14 days 1. Shamva 6. Chikomba Nil 1. Mazowe 5. Hwedza 1. 2. Mbire 7. Binga 2. Rushinga 6. UMP 2. Kadoma 3. Rural 8. Bikita 1. Shamva 3. Mrehwa 7. Norton 2. Chikomba 3. Binga 4. Kadoma 9. 4. 8. Lupane 4. Gokwe North 3. Kadoma 5. 10. Gokwe South 4. Bikita

2- Conclusion of the day:

High priority districts to be investigated today Priority districts to call back on the phone (as delay of more than 3 days to report) and in red High priority districts which needs field visit (no report for more than 7 days) • Harare • Kariba Rural • Mazowe • UMP • Kadoma • Kadoma • Rushinga • Norton • Binga • Chegutu • Mrehwa • Lupane • Gokwe North • Bikita • Mutoko • Shamva • Zvishavane • Hwedza • Mbire • Gokwe South

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 1

3- Follow up actions Province District Flagged as a priority Action taken and next step (when and who will be doing what) Responsible for Follow up on Following up Status MASH WEST Chegutu 07/01/09 (High cases) • Follow up with PMD NPO-EHA to follow up Done 11/01/09 (High number • List of supplies gone to Mash West. To find partners to help in with Celebration health, of cases) distributing the supplies to the CTCs IOM and UNICEF, • SAVE have cars and fuel to assist in the distribution of supplies • HIV/AIDs programme can also be asked to assist in distributing supplies • UNICEF to assist with the distribution of supplies Kadoma 03/01/09 (High CFR) • Communication problem NPO-EHA follow up On-going 06/01/09 (High cases) • Follow up with PMD with GAA, Celebration 07/01/09 (High CFR & • List of supplies gone to Mash West. To find partners to help in Health and UNICEF High num of deaths distributing the supplies to the CTCs Social Mobilization outside HF) • SAVE have cars and fuel to assist in the distribution of supplies 08/01/09 (High CFR) • HIV/AIDs programme can also be asked to assist in distributing 10/01/09 (High CFR) supplies 10/01/09 (High number • UNICEF to assist with the distribution of supplies of cases) Makonde 12/01/09 (Borehole not • To contact partners to help with the repair of the borehole and NPO-EHA to follow up On-going functioning) water tank which is not functioning at Kamhonde CTC with WASH and Health Cluster Zvimba 13/01/09 • Rumours reported from Mutorashanga (1 case), Rafingora (7 NPO-EHA On-going cases), Darwendale (4 cases and 2 community deaths) and Mt NPO-EHA to Hampden (19 cases). followup with IOM • To make a follow up with IOM making a follow up Hurungwe 12/01/09 (High CFR) • Follow up with PMD NPO-EHA On-going MASH EAST UMP 08/01/09 (High number • Follow up with PMD NPO-EHA to followup On-going of cases) • Supplies have been delivered to the province. Find partners to with ZNFP, OXFAM, 10/01/09 (High number help in the distribution of cases. IOM, CRS of cases) • World vision has adopted a vehicle to be used for cholera issues only Hwedza 10/01/09 (More than 3 • Follow up with PMD NPO-EHA On-going days without cases) • Telephone exchange not working • Health information officer gone out to collect data Goromonzi 12/01/09 (High CFR) • Follow up with PMD MANICALAND 08/01/09 (High number • Follow up with PMD NPO-EHA to follow up On-going of cases) • PHE team not available to respond to the issue with MDM 11/01/09 (High number of cases) 11/01/09 (High number of cases) 12/01/09 (High number of cases) District 06/01/09 (High CFR) • Follow up with PMD Social Mobilization to On-going

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 2 Province District Flagged as a priority Action taken and next step (when and who will be doing what) Responsible for Follow up on Following up Status 08/01/09 (High number • High CFR was as a result of cases and deaths identified from the follow up with PMD and of cases) community through active community based surveillance groups. DMO 12/01/09 (High CFR & • Health promotion to follow up number of cases) • Community based surveillance teams discovering retrospective deaths from the community. • Governor meeting with the members of the apostolic sect today – 12/01/09 • PHE team not available to respond to the issue Mutasa 10/01/09 (Not reporting • Follow up with PMD NPO-EHA On-going for more than 3 days) • PHE team not available to respond to the issue Chimanimani 12/01/09 (High number • Follow up with PMD NPO-EHA On-going of cases) • PHE team not available to respond to the issue 12/01/09 (High number • Follow up with PMD NPO-EHA of cases) • PHE team not available to respond to the issue Mutare 12/01/09 (High number • PHE team not available to respond to the issue of cases) Chiredzi 07/01/09 (High number • Follow up with PMD office NPO-EHA to follow up Done of cases) • Figures have been revised with PEHO and WASH 10/01/09 (High number • Food supplied to the Province cluster of cases) 12/01/09 (High number of cases) Chivi 10/01/09 (High CFR) • Follow up with PMD NPO-EHA Done 12/01/09 (High CFR) • Situation has stabilised although still under close monitoring Gutu 10/01/09 (More than 3 • Follow up with PMD NPO-EHA to follow up Done days without reporting) • Zero cases reported for the past two weeks with PEHO Masvingo 08/01/09 (More than 3 • Follow up with PMD Done days without reporting) • Report received today. Cases reported are for more than 3 days 12/01/09 (High number • Two CTCs in Nyajena and Masvingo remand still operating of cases) Bikita 12/01/09 (High CFR & • Follow up with PMD On-going number of cases) Zaka 11/01/09 (Not reporting • Follow up with PMD On-going for more than 3 days) Gokwe North 11/01/09 (Not reporting • Follow up with PMD NPO-EHA follow up On-going for more than 3 days) • Denda reported 94 cases. Provincial team has gone to with CONCERN 13/01/09 (New cases) investigate. • Binga reported 200 cases and 26 deaths from Pashu, Shaba, Chunga and Siyabuwa areas • SAVE the children to provide supplies • UNICEF has been sending supplies • 600 litres available to send supplies • Dende clinic in Chireya ward 3 reported 129 cases and 6 deaths.

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 3 Province District Flagged as a priority Action taken and next step (when and who will be doing what) Responsible for Follow up on Following up Status There are currently no medical NGOs. • MOH are aware and are doing their best. Gokwe South 05/01/09 • New cases and deaths reported in Gokwe in Mutenga area. NPO-EHA to follow up On-going 07/01/09 (High CFR) • Follow up with PMD with MSF Spain, IFRC 08/01/09 (High number • Health cluster coordinator making a follow up and Zimbwe Red Cross, of cases) • Follow up with PMD CONCERN 13/01/09 (New cases) • Cases reported from 4 households in Mateta area – 08/01/2009 • No medical facilities in the ward. Nearest facility is 30km away • Follow up email send out. Waiting for response • Sesame reported 2 new cases. 09/01/09 (High CFR) • Follow up with PMD NPO-EHA follow up Done • Situation has stabilize although under close monitoring with CONCERN 03/01/09 • 4 cases reported in new area (). PNO relayed NPO-EHA follow up On going 08/01/09 (Rumour) information. PMD office following up with CONCERN • Communication problem 04/01/09 • Rumour of cholera cases from Munyati area • PMD has been contacted. DEHO has gone to investigate • No fuel available to go and do investigations – 12/01/09 Mberengwa 12/01/09 • A new area in Mberengwa named Ngungumane reported 5 NPO-EHA follow up On-going cases and zero deaths. Cases in Mberengwa are scattered with CONCERN NPO-EHA to follow throughout the district. Red cross pulled out of the district. up with World Mberengwa district is requesting for fuel Vision MAT SOUTH 08/01/09 (High CFR) • Follow up with PMD NPO-EHA Done 10/01/09 (High CFR) • Shambwe RHC which has not been reporting cases since 11/01/09 (High number 01/01/09 reported 45 cases and 4 community deaths today. of cases) Three of the reported deaths were from the same family. They 12/01/09 were given ORS and discharged. They later died at home. 11/01/09 (High CFR) • A new area named Chomunangana reported 8 cases and zero deaths – 12/01/09 • Need fuel • Sporadic cases being reported • Issue of case management has been attended to. Situation has stabilised. 09/01/09 • Rumour confirmed in West Nicholson. 4 cases and 1 death NPO-EHA On-going MAT NORTH Lupane 11/01/09 (Not reporting • Follow up with PMD NPO-EHA On-going for more than 3 days)

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 4 4- Epidemiological data Today's update Cumulative Province District/area Cases Deaths CFR of Communit Cumulative Cumulative Cumulative Community Proportion Date last Number affected added added cases y Deaths Cases Deaths CFR (%) Deaths Community updated of days today today added added (included Deaths (%) since today (%) today in the total) previous report Harare 6 0 0.0 0 977 153 15.7 115 75.2 13/01/2009 0 Harare 126 0 0.0 0 10939 238 2.2 16 6.7 13/01/2009 0 Bulawayo urban - - - - 387 12 3.1 8 66.7 12/01/2009 1 Mashonaland Shamva 17 7 41.2 7 66 15 22.7 15 100.0 13/01/2009 0 Central Centenary - - - - 140 15 10.7 11 73.3 12/01/2009 1 Mazowe - - - - 155 4 2.6 3 75.0 09/01/2009 4 Guruve - - - - 62 9 14.5 7 77.8 10/01/2009 3 Mbire 21 7 33.3 0 28 7 25.0 0 0.0 13/01/2009 0

Mt Darwin - - - - 93 5 5.4 2 40.0 12/01/2009 1 - - - - 384 15 3.9 13 86.7 10/01/2009 3 Rushinga - - - - 96 4 4.2 4 100.0 09/01/2009 4 Mashonaland Mudzi - - - - 2051 125 6.1 62 49.6 10/01/2009 3 East Murehwa - - - - 113 19 16.8 13 68.4 09/01/2009 4

Makumbe - - - - 249 22 8.8 17 77.3 12/01/2009 1

(Goromonzi)

Ruwa - - - - 304 16 5.3 11 68.8 12/01/2009 1

Mutoko - - - - 166 36 21.7 31 86.1 09/01/2009 4 - - - - 71 7 9.9 5 71.4 10/01/2009 3 Chikomba 10 9 90.0 9 77 17 22.1 16 94.1 13/01/2009 0 Hwedza - - - - 27 1 3.7 1 100.0 06/01/2009 7 UMP - - - - 145 16 11.0 8 50.0 09/01/2009 4 Seke - - - - 516 25 4.8 20 80.0 12/01/2009 1 Mashonaland Makonde - - - - 3046 102 3.3 54 52.9 12/01/2009 1 West Kariba Urban 16 0 0.0 0 282 14 5.0 2 14.3 13/01/2009 0 Kariba Rural 11 1 9.1 1 354 34 9.6 24 70.6 13/01/2009 0 Zvimba 15 1 0.0 1 220 20 9.1 18 90.0 13/01/2009 0 Kadoma 39 11 28.2 11 1601 103 6.4 51 49.5 13/01/2009 0 Hurungwe 27 0 0.0 0 1005 60 6.0 39 65.0 13/01/2009 0

Norton - - - - 786 33 4.2 11 33.3 09/01/2009 4 Chegutu 12 1 8.3 1 2243 141 6.3 30 21.3 13/01/2009 0 Manicaland Mutasa - - - - 9 5 55.6 5 100.0 12/01/2009 1 Mutare City - - - - 18 1 5.6 0 0.0 12/01/2009 1

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 5 Today's update Cumulative Province District/area Cases Deaths CFR of Communit Cumulative Cumulative Cumulative Community Proportion Date last Number affected added added cases y Deaths Cases Deaths CFR (%) Deaths Community updated of days today today added added (included Deaths (%) since today (%) today in the total) previous report Buhera - - - - 1229 43 3.5 37 86.0 12/01/2009 1

Chipinge - - - - 1174 56 4.8 32 57.1 12/01/2009 1

Makoni - - - - 406 49 12.1 44 89.8 12/01/2009 1 Mutare - - - - 1585 156 9.8 154 98.7 12/01/2009 1 Chimanimani - - - - 741 45 6.1 15 33.3 12/01/2009 1 Nyanga - - - - 38 2 5.3 2 100.0 12/01/2009 1 Matebeleland Lupane - - - - 2 0 0.0 0 - 07/01/2009 6 North Binga 200 26 13.0 0 200 26 13.0 0 0.0 13/01/2009 0 Matabeleland Gwanda - - - - 73 8 11.0 4 50.0 10/01/2009 3 South Plumtree - - - - 3 0 0.0 0 0 10/01/2009 3 Beitbridge 7 0 0.0 0 4282 134 3.1 45 33.6 13/01/2009 0

Masvingo Masvingo - - - - 523 45 8.6 17 37.8 12/01/2009 1 Gutu - - - - 26 3 11.5 1 33.3 12/01/2009 1 Chivi - - - - 625 63 10.1 52 82.5 12/01/2009 1

Bikita 26 8 30.8 4 525 51 9.7 34 66.7 13/01/2009 0

Chiredzi - - - - 1145 50 4.4 31 62.0 12/01/2009 1

Mwenezi - - - - 243 35 14.4 28 80.0 12/01/2009 1 Zaka - - - - 179 21 11.7 21 100.0 12/01/2009 1 Midlands City 0 0 0.0 0 189 4 2.1 2 50.0 13/01/2009 0 (Mkoba) Zvishavane 10 1 10.0 0 148 13 8.8 8 61.5 13/01/2009 0 Mberengwa - - - - 114 20 17.5 18 90.0 12/01/2009 1 Gokwe North 94 0 0.0 0 146 8 5.5 8 100.0 13/01/2009 0 Gokwe South 3 1 33.3 1 174 7 4.0 6 85.7 13/01/2009 0 Kwekwe 0 0 0.0 0 38 5 13.2 3 60.0 13/01/2009 0

Shurugwi 0 0 0.0 0 26 8 30.8 7 87.5 13/01/2009 0 Chirumhanzu 2 0 0.0 0 4 1 25.0 1 100.0 13/01/2009 0 Total 642 73 11.4 35 40448 2127 5.3 1182 55.6

“-“ : No report, - Flagged for follow up -Report received after more than 1 day

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 6