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Toll free number for cholera alert is Office of the WHO Representative in 08089001 or 08089002 or 08089000 Mobile number for cholera alerts is 0912 104 257

Water and Sanitation alert numbers Date of issue:16th January, 2008 04 703 941-2 (during working hours) 2 917 710 (after hours) DAILY CHOLERA UPDATE AND ALERTS 16th January, 2009

A. Highlights of the day: • 997 cases and 65 deaths added today (in comparison 689 cases and 24 deaths yesterday) • 56.9 % of the areas affected have reported today (33 out of 58 affected districts) • 87.1 % of districts reported to be affected (54 districts/62) • All 10 of the country's provinces are affected • Newly affected areas Mayoka ( District)

Districts reported an high Districts with a daily CFR > 5% : Districts with high number of Districts which have not reported for more than 3 number of cases today (cases deaths outside health days: added today> 30) 1. Rushinga facility/ CTC > 3 1. Mudzi 1. BRIDH 2. 2. Murehwa 2. Budiriro 3. UMP 1. Makonde 3. Hwedza 3. 4. Makonde 2. Hurungwe 4. Mutasa 4. UMP 5. Zvimba 3. Bikita 5. City 5. Makonde 6. Norton 6. 6. Zvimba 7. 7. 7. Hurungwe 8. Bikita 8. Chimanimani 8. Norton 9. Zaka 9. Nyanga 9. Binga 10. Kwekwe 10. Beitbridge 11. Chirumanzu 11. Bikita 12. Mwenezi 13. Zaka 14. Gokwe North

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 1 B. Conclusion of the day:

High priority districts to 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) • BRIDH • Rushinga • Mudzi • Budiriro • Mutoko • Murehwa • Bindura • UMP • Hwedza • UMP • Makonde • Mutasa • Makonde • Zvimba • Mutare City • Zvimba • Norton • Buhera • Hurungwe • Beitbridge • Chipinge • Norton • Bikita • Chimanimani • Binga • Zaka • Nyanga • Beitbridge • Kwekwe • Bikita • Chirumanzu • Mwenezi • Makonde • Zaka • Hurungwe • Gokwe North • Bikita

C. 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 Harare 13/01/09 (High number • Follow up with City Health Directorate Data Managers Done of cases) • Follow up on the issue of disaggregating data • City Health Director has contacted MSF to provide data. MASH WEST 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 • Partners in the area have been contacted. Assessment being Cluster done – 16/01/09 Zvimba 13/01/09 (Water • District has problems with water supply at Dzivarasekwa NPO-EHA to follow up On-going problem) Extension clinic CTC and Banket District Hospital CTC. No with GAA partners in the district – 14/01/2009 • GAA doing some assessment in the area – 16/01/09 Hurungwe 12/01/09; 14/01/09; • Follow up with PMD NPO-EHA On-going 15/01/09 (High number of cases & CFR) Norton 13/01/09 (Not reporting • Follow up with PMD NPO-EHA Done for > 3days) • Reported today - 16/01/09 Kadoma 13/01/09 (High CFR) • Follow up with PMD NPO-EHA On-going 14/01/09 (High CFR and High number of cases) MASH EAST UMP 13/01/09; 4/01/09 (non • Follow up with PMD MOH Done

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 reporting) • Reported today - 16/01/09 Mudzi 14/01/09 (non reporting) • Follow up with PMD MOH On-going Murehwa 14/01/09 (non reporting) • Follow up with PMD MOH On-going Hwedza 10/01/09 (non reporting) • Follow up with PMD MOH On-going 14/01/09 (non reporting) • Telephone exchange not working • Health information officer gone out to collect data Mutoko 13/01/09 (non reporting) • Follow up with PMD for non reporting MOH On-going Goromonzi 12/01/09 (High CFR) • Follow up with PMD NPO-EHA On-going MASH Shamva 13/01/09 (High CFR) • Follow up with PMD NPO-EHA Done CENTRAL • World vision has provided fuel to some districts Mbire 13/01/09 (High CFR) • Follow up with PMD NPO-EHA Done • World vision has provided fuel to some districts Rushinga 14/01/09 (non reporting) • Follow up with PMD for non reporting Data Managers Done • Report received - 16/01/09 Centenary 15/01/09 (High CFR & • Follow up with PMD On-going community deaths>3) MANICALAND Chipinge 08/01/09; 11/01/09; • Follow up with PMD NPO-EHA to follow up On-going 12/01/09 (High number • PHE team not available to respond to the issue with MDM of cases) 06/01/09; 08/01/09; • Follow up with PMD MOH On-going 12/01/09 (High CFR & • PHE team not available to respond to the issue number of cases) Mutasa 10/01/09 (non reporting) • Follow up with PMD MOH On-going • PHE team not available to respond to the issue Chimanimani 12/01/09 (High number • Follow up with PMD MOH On-going of cases) • PHE team not available to respond to the issue Buhera 12/01/09 (High number • Follow up with PMD MOH On-going of cases) • PHE team not available to respond to the issue Mutare 12/01/09; 15/01/09 • PHE team not available to respond to the issue MOH On-going (High number of cases) • Governors visit to the District will be there tomorrow (15/01/09) • Follow up with PMD – 16/01/09 Zaka 11/01/09 (non reporting) • Follow up with PMD NPO-EHA Done • Data reported today – 16/01/09 Bikita 12/01/09 (High CFR & • Follow up with PMD MOH to follow up Done number of cases) • 26 cases and 17 deaths were reported 13/01/09 (High CFR ) • CTC was set up in the area 14/01/09 (High number • Cases were batched together for a period of more than 3 days of cases) Chiredzi 15/01/09 (High number • Follow up with PMD On-going of cases and CFR) Mwenezi 15/01/09 (High number • Follow up with PMD of cases and CFR) Chivi 14/01/09 (New area) • Newly affected area called Chigwikwi NPO-EHA On-going

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 • Patients travelling long distance to get to the nearest CTC • Team send out for investigations – 16/01/09 MIDLANDS Gokwe South 05/01/09; 07/01/09 • New cases and deaths reported in Gokwe in Mutenga area. NPO-EHA to follow up On-going (High CFR) • Health cluster coordinator making a follow up with MSF Spain, IFRC 08/01/09 (High number • Cases reported from 4 households in Mateta area – 08/01/2009 and Zimbwe Red Cross, of cases) • No medical facilities in the ward. Nearest facility is 30km away CONCERN 13/01/09 (New cases) • Follow up email send out. Waiting for response 14/01/09 (High number • Sesame reported 2 new cases. of cases)

Kwekwe 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 16/01/09 (New area) • Communication problem 04/01/09 • Rumour of cholera cases from area • PMD has been contacted. DEHO has gone to investigate • No fuel available to go and do investigations – 12/01/09 • Fuel to be available as from Friday this week • A new area called Mayoka reported some cases Mberengwa 12/01/09 (new area) • A new area in Mberengwa named Ngungumane reported 5 MOH On-going cases and zero deaths. Cases in Mberengwa are scattered NPO-EHA to follow throughout the district. Red cross pulled out of the district. up with World is requesting for fuel Vision • MOH to make a follow up on the issue of fuel MAT NORTH Lupane 11/01/09 (non reporting) • Follow up with PMD NPO-EHA Done 14/01/09; 15/01/09 (non reporting) Binga 13/01/09 (High number • Binga reported 200 cases and 26 deaths from Pashu, Shaba, NPO-EHA to follow up On-going of cases) Chunga and Siyabuwa areas with WASH and Save • SAVE the children to provide supplies the Children • UNICEF has been sending supplies • 600 litres available to send supplies • 4 teams have been send out to make investigations in the affected areas. Meeting to be held on Satarday by the team • The reported 200 cases were over a period of time • To find out if there is a CTC in Binga • Cases have been revised. Waiting for feedback from PMD – 16/01/09 MAT SOUTH Beitbridge 14/01/09 (New area) • A new area called Dite reported 2 cases NPO-EHA Done 14/01/09 (High number • Cases coming from an area were there was previously a CTC of cases) • Partners assisting with water. Bulawayo 15/01/09 (High CFR) • Follow up with City Directorate NPO-EHA Done • Case Management team has already visited the area – 16/01/09

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 4

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 5

Today's update Cumulative Province District/area Cases Deaths CFR of Communi Cumulative Cumulative Cumulative Community Proportion Date last Number of affected added added cases ty Deaths Cases Deaths CFR (%) Deaths Community updated days since today today added added (included Deaths (%) previous today (%) today in the total) report (included in the total) Harare 5 0 0.0 0 985 153 15.5 115 75.2 1/16/2009 0 BRIDH 76 1 1.3 0 4001 160 1/16/2009 Budiriro 53 0 0.0 0 7067 79 1.1 16 20.3 1/16/2009 0 Bulawayo Bulawayo urban - - - - 391 14 3.6 9 64.3 1/15/2009 1 Mashonaland Shamva 25 0 0.0 0 107 15 14.0 15 100.0 1/16/2009 0 Central Centenary - - - - 161 19 11.8 15 78.9 1/15/2009 1

Mazowe 15 0 0.0 0 175 4 2.3 3 75.0 1/16/2009 0

Guruve - - - - 126 10 7.9 7 70.0 1/15/2009 1 Mbire - - - - 28 7 25.0 0 0.0 1/13/2009 3 Mt Darwin 9 0 0.0 0 102 5 4.9 2 40.0 1/16/2009 0 Bindura 34 0 0.0 2 566 17 3.0 15 88.2 1/16/2009 0 Rushinga 2 1 50.0 1 98 5 5.1 5 100.0 1/16/2009 0 Mashonaland Mudzi - - - - 2051 125 6.1 62 49.6 1/10/2009 6 East Murehwa - - - - 113 19 16.8 13 68.4 1/9/2009 7 Makumbe 1 0 0.0 0 250 22 8.8 17 77.3 1/16/2009 0

Ruwa - - - - 332 16 4.8 11 68.8 1/14/2009 2 Mutoko 20 9 45.0 - 174 29 16.7 23 79.3 1/16/2009 0 0 0 0.0 1 93 8 8.6 6 75.0 1/16/2009 0 Chikomba - - - - 80 17 21.3 16 94.1 1/14/2009 2 Hwedza - - - - 27 1 3.7 1 100.0 1/6/2009 10 UMP 42 9 21.4 3 187 25 13.4 11 44.0 1/16/2009 0

Seke 3 0 0.0 1 543 19 3.5 12 63.2 1/15/2009 1 Mashonaland Makonde 41 5 12.2 5 3356 121 3.6 71 58.7 1/16/2009 0 West Urban - - - - 282 14 5.0 2 14.3 1/13/2009 3 Kariba Rural - - - - 354 34 9.6 24 70.6 1/13/2009 3

Zvimba 41 5 12.2 - 261 25 9.6 23 92.0 1/16/2009 0

Kadoma 0 0 0.0 0 1743 125 7.2 73 58.4 1/16/2009 0 Hurungwe 71 0 0.0 6 1255 72 5.7 47 65.3 1/16/2009 0 Norton 38 3 7.9 1 824 36 4.4 12 33.3 1/16/2009 0 14 0 0.0 - 2281 141 6.2 30 21.3 1/16/2009 0 Manicaland Mutasa - - - - 9 5 55.6 5 100.0 1/12/2009 4

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 6 Today's update Cumulative Province District/area Cases Deaths CFR of Communi Cumulative Cumulative Cumulative Community Proportion Date last Number of affected added added cases ty Deaths Cases Deaths CFR (%) Deaths Community updated days since today today added added (included Deaths (%) previous today (%) today in the total) report (included in the total) Mutare City - - - - 18 1 5.6 0 0.0 1/12/2009 4 Buhera - - - - 1229 43 3.5 37 86.0 1/12/2009 4 Chipinge - - - - 1174 56 4.8 32 57.1 1/12/2009 4

Makoni - - - - 415 49 11.8 44 89.8 1/15/2009 1

Mutare - - - - 1716 156 9.1 154 98.7 1/15/2009 1 Chimanimani - - - - 741 45 6.1 15 33.3 1/12/2009 4 Nyanga - - - - 38 2 5.3 2 100.0 1/12/2009 4 Matebeleland Lupane 0 0 0 0 2 0 0.0 0 0.0 1/16/2009 0 North Binga 185 3 1.6 0 385 29 7.5 0 0.0 1/16/2009 0 Matabeleland 0 0 0 0 73 8 11.0 4 50.0 1/16/2009 0 South Plumtree 0 0 0 0 3 0 0.0 0 0.0 1/16/2009 0 Beitbridge 43 3 7.0 0 4383 137 3.1 45 32.8 1/16/2009 0 Masvingo Masvingo - - - - 558 45 8.1 17 37.8 1/14/2009 2 Gutu 0 0 0.0 0 26 3 11.5 1 33.3 1/16/2009 0 Chivi - - - - 721 86 11.9 69 80.2 1/14/2009 2

Bikita 65 7 10.8 5 1091 79 7.2 58 73.4 1/16/2009 0

Chiredzi 0 0 0.0 3 1193 53 4.4 34 64.2 1/16/2009 0 Mwenezi 31 0 0.0 0 416 30 7.2 20 66.7 1/16/2009 0 Zaka 101 17 16.8 - 280 38 13.6 38 100.0 1/16/2009 0 Midlands City 1 0 0.0 0 190 4 2.1 2 50.0 1/16/2009 0 10 0 0.0 0 241 14 5.8 8 57.1 1/15/2009 1

Mberengwa 0 0 0.0 0 124 20 16.1 18 90.0 1/16/2009 0

Gokwe North 67 0 0.0 0 293 24 8.2 20 83.3 1/16/2009 0 Gokwe South - - - - 264 9 3.4 8 88.9 1/14/2009 2 Kwekwe 3 1 33.3 1 45 7 15.6 4 57.1 1/16/2009 0 - - - - 26 8 30.8 7 87.5 1/14/2009 2 Chirumhanzu 1 1 100.0 1 5 2 40.0 2 100.0 1/16/2009 0 Total 997 65 6.5 30 43672 2290 5.2 1300 56.8

Key: - No Report Flagged for follow-up Report received after more than 1 day

Source: Ministry of Health and Child Welfare Rapid Disease Notification System 7