Early Warning Disease Surveillance and Response Bulletin, Somalia 2018 Epidemiological Week 34 (Week ending 26th August, 2018)
Highlights Cumulative figures as of week 34 • 333 (80%) health facilities across Somalia • 1,943,980 consultations from submitted weekly reports of epidemic-prone week 1 to week 34. diseases in the electronic early warning alert • 6,245 cumulative cases of and response network (EWARN) system in AWD/Cholera and 42 deaths week 34. • Total number of consultations decreased from (CFR 0.7%) since December 67,588 in week 33 to 61,506in week 34. 2017. • A total of 6,130 alerts were received. 292 of • 16,812 cumulative alerts were these alerts were confirmed as true alerts in received, 980 of these, were week 34. confirmed as true alerts from • The highest numbers of diseases reported in week 1 to week 34, 2018. week 34 were other acute diarrhoeas (2,794 • 6,613 cumulative cases of cases), influenza like illness (2,925 cases) and severe acute respiratory illness (1,218 cases). suspected measles cases since the beginning of 2018. Of the • A total of 76 new cases of suspected AWD/cholera with 1 death were reported in 6,613 measles cases, 4,429 week 34 compared to 39 AWD cases with no (67%) were under 5 years while deaths in week 33. 2,184 (33%) were above 5 years. • A cumulative total of 6,245 AWD/cholera • 9,206 cumulative cases of 1 cases , including 42 deaths have been Malaria were reported since the reported since December 2017. beginning of 2018, 3,973 (43%) • The number of reported measles increased from 85 in week 33 to 98 cases in week 34. were under 5 years, while 5,233 (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 Wk31 Wk32 Wk34 Cumulative cases (Wk 1 Wk33 2018 2018 2018 2018 – 34, 2018) Total consultations 50136 60037 67588 61506 1,943,980 Other Acute Diarrheas 1939 2467 2930 2794 80559 Influenza Like Illness 1753 1990 2695 2925 59,243 Severe Acute Respiratory Illness 837 1298 1197 1218 34,397 Suspected Measles 33 71 85 98 6613 Confirmed Malaria 126 304 225 291 9206 Acute Watery Diarrhea2 41 87 150 2683 2608 Bloody Diarrhea 86 109 115 141 3070 Whooping Cough 17 50 53 75 1670 Acute Jaundice 6 15 15 17 200 Suspected Meningitis 3 4 244 194 533 Diphtheria 5 46 6 27 147 Neonatal Tetanus 1 0 26 7 57 Acute Flaccid Paralysis 0 1 0 0 14 Viral Hemorrhagic Fever 0 0 0 0 3
Completeness of Reporting & Reporting Rate Of the 415 health facilities in the EWARN system, 333 Fig. 1a: Completeness of Reporting of EWARN Facilities health facilities submitted their weekly reports on Caluula
Qandala
Bossaso Zeylac
Lughaye Laasqoray time in week 34 across the country. The national Berbera Iskushuban Baki Ceerigaabo
Borama ± Ceel Afweyn
Sheikh
Gebiley
Hargeysa Qardho
Caynabo Owdweyne Bandarbeyla Taleex surveillance completeness rate was 80% in the week Burco Xudun
Garoowe Buuhoodle Laas Caanood
Eyl which is equal to the minimum requirement (80%). Burtinle
Jariiban
Galdogob Gaalkacyo Most of the States exceeded the minimum target
Cadaado
Hobyo
Cabudwaaq
Dhuusamarreeb except Jubaland, Hirshabelle and Southwest which
Xarardheere Ceel Buur Belet Weyne Ceel Barde Legend
Rab Dhuure Xudur Somalia_Coastline_Extended Ceel Dheer Doolow have not reached the 80% minimum requirement (fig. 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 Ceel Waaq 1a & 1b). In Somaliland 77(100%) health facilities of 1 - 58.3
Buur Hakaba Balcad 58.4 - 81.8 Afgooye
Baardheere Banadir Diinsoor 81 - 100 Qoryooley
Marka Kurtunwaarey Saakow
Sablaale the 77 active health facilities have submitted reports
Bu'aale Baraawe
Heliwa
Dayniile
Afmadow Jilib Yaaqshid Karaan Wardhigley Hawl Wadaag Shibis Hodan BondhereCabdulasiis Jamaame Hamar Weyne in week 34. In Puntland, 93(86%) health facilities of Hamar Jabjab Waaberi Wadajir (Medina) Dharkenley
Kismaayo
Badhaadhe the 108 active health facilities submitted reports in
0 45 90 180 270 360 Miles week 34, whilst in South central, 163(71%) health facilities of 230 active health facilities submitted reports in week 34. 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.
2 AWD cases don’t include confirmed cholera cases from flood affected regions 3 32 These cases were just normal watery diarrhoea reported from Bay region, according to the Cholera case definitions, as confirmed by Bay region CSR officer after contacting Horseed and SOS MCHs which are reported HFs. Page 2 of 24
Fig 1b: Completeness of reporting from EWARN sites, week 34, 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
MiddleJubba
WaqoyGalbed
LowerShabelle MiddleShabelle Banadir Somaliland Puntland Galmudug SouthWest Jubaland Hirshabelle
Received (%) Target(%)
Fig 1c: Completness of reporting
Somaliland Puntland SCZ
100 80 60 40 20
report 0 31 32 33 34 Epi-week
Percentage Percentage of submitted theHFs Proportionate Morbidity As shown in figure 2; other acute diarrhoeas (OAD), influenza like illness (ILI), severe acute respiratory illness (SARI), suspected measles and malaria are the commonest causes of morbidity across Somalia in 2018. In week 34, the highest numbers of diseases were other acute diarrhoeas (2,794 cases), influenza like illness (2,925 cases), severe acute respiratory illness (1,218 cases), Confirmed Malaria (291 cases), bloody diarrhoea (141) and Suspected measles (98 cases). Fig 2: Commonest Causes of Morbidity during Week 1 to 34
3,000
2,000
1,000
0 Wk31 Wk32 Wk33 Wk34
other acute Diaria influence like illness Severe Acute Respiratory Illness Suspected Measles Confirmed Malaria Bloody Diarrhea
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AWD/Cholera situation in Somalia
Generally,Fig 3a: Districts the reporting AWD/cholera AWD/Cholera cases cases inhave week been 34 on the decline for the past four weeks (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 increase in the number of AWD/Cholera cases reported in Banadir and Lower Jubba; the regions that were affected by floods. In week ending 26th August 2018, active transmission of AWD/cholera was reported in Kismayo district in Lower Jubba, as well in 8 districts of Banadir region (Darkenly, Daynile, Hodan, Madina, Waberi Hamarjabjab, Wardhigley, Hamerweyn districts) (fig 3a). In Kismayo, affected communities especially in Farjano IDP are reportedly using contaminated water due to floods. As shown in table 1, there was an increase in the number of cases reported from 39 in week 33 to 76 in week 34. 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 Aug 2017-Aug 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 4 week 6 week 8 week
weeks 2 week
week 10 week 12 week 14 week 16 week 18 week 20 week 22 week 24 week 26 week 28 week 30 week 32 week 34 week
Week 42 Week Week 34 Week 36 Week 38 Week 40 Week 44 Week 46 Week 48 Week 50 Week 52 Week Sep.17 Oct.17 Nov.17 Dec.17 Jan-18 Feb-18 Mar.18 April.18 May.18 June.18 Jul.18 Aug.18
Table 1. Summary of AWD/Cholera cases in different regions
States Week 33 Week 34 Cumulative as of 26th August 2018 Regions Ending 19th August 18 Ending 26th August 18
Cases Deaths CFR (%) Cases Deaths CFR (%) Cases Deaths CFR (%)
Banadir 31 0 0.0 66 1 1.5 2,519 20 0.8
Jubba land L/ Jubba 8 0 0.0 10 0 0.0 2,309 15 0.6
South west L/ Shabelle 0 0 0.0 0 0 0.0 294 4 1.4
Hir- M/Shabelle 0 0 0.0 0 0 0.0 558 2 0.4 shabele Hiraan 0 0 0.0 0 0 0.0 565 1 0.2
Total 39 0 0.0 76 1 1.3 6,245 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 concentration 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 increase in the number of AWD/Cholera cases from 31 cases to 66 cases 1 death in the past 2 weeks. Of the 66 new cases reported during the week ,17 (25%) 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 increased from 8 and no deaths to 10 no death. Of the 10 cases reported in Farjano, 7 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 34 Cumulative Week 49/17-week 34/18 Region District Cases CFR <2 yrs 2 -5 yrs ≥ 5 yrs <2 yrs 2-5yrs ≥ 5 yrs Cases Deaths (%) Darkenley 3 1 4 0 0 1 0.2 Daynile 1 3 10 0 1 8 1.8
HamarJabja 1 0 4 0 0 2 1.3
Hawlwadag 0 0 0 0 0 1 0.9
Hodan 0 1 15 0 0 2 0.4 Karaan 0 0 0 0 0 1 2.3 Madina 2 3 10 0 0 2 0.5 Banadir Waberi 0 0 2 0 0 2 1.8 Shibis 0 0 0 0 0 0 0 Shingani 0 0 0 0 0 0 0 Abdilaziz 0 0 0 0 0 0 0
HamarWeine 0 0 1 0 0 0 0
Heliwaa 0 0 0 0 0 0 0 Wardigley 1 0 4 0 0 1 0.9 Yaqshid 0 0 0 0 0 0 0
Middle Jowhar 0 0 0 0 0 2 0.4 Shabelle×
Beletweyne 0 0 0 0 0 1 0.2 Hiran× BuloBarde 0 0 0 0 0 0 0
Afgoye 0 0 0 0 0 0 0 Lower Kurtunwarey 0 0 0 0 0 4 12.9 Shabelle× Merka 0 0 0 0 0 0 0 Brava 0 0 0 0 0 0 0 Lower Kismayo 4 3 3 0 0 15 0.6 Jubba× Total 12 11 53 0 1 42 0.7
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Response activities implemented during week 34, 2018
Coordination and Leadership.
• Coordination meetings were conducted in the flood affected districts. 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, 118 health facilities submit on time, • 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 33 The number of suspected measles cases increased
Caluula from 85 cases in week 33, to 98 cases in week 34.
Qandala
Zeylac Bossaso
Lughaye Laasqoray Berbera Iskushuban Baki Ceerigaabo Borama Ceel Afweyn Cumulatively, 6,613 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 6,613 measles cases, 4,429 (67%) were Jariiban Galdogob Gaalkacyo
Cadaado Cabudwaaq Hobyo under 5 years while 2,184 (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 (542 cases), Lascanod (354 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 Baidoa (369 cases), Adado (295 cases), Galkacyo (278 Jubaland State Sablaale Coastline Bu'aale
Baraawe
Jilib Afmadow Heliwa Dayniile Yaaqshid cases), Wadajir (255 cases), Burao (214 cases) and Jamaame Karaan Wardhigley Banadir Afgooye Hodan Shibis Kismaayo Hawl Wadaag
Badhaadhe Wadajir (Medina)Waaberi µ Dharkenley Marka (195 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 34, 2018 500 450 400 Measles vaccination implemented350 in SL & SCZ on Week 10 300
250 Cases 200 150 100 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 Epi-Week
South & Central Zone Somaliland Puntland
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Fig 4c. Districts reporting highest cases of Measles across Somalia from Wk1 - Wk34, 2018 500 450 400 350 300 250 200 150 100 50 0 Huruwaa Wadajir Abudwak Adado Galkacyo Burao Lasacanod Baidoa Marka Banadir Galmudug Somaliland Southwest
Cases >5 Cases<5
Table 4: Summary of Suspected measles cases by region week 1 - 34, 2018
Region 31 32 33 34 Cumulative cases (Wk 1 – 34)
Awdal 0 1 0 0 14 Bakool 1 0 0 1 135 Banadir 6 43 20 28 998 Bari 1 1 2 1 97 Bay 0 1 8 6 1034 Galgaduud 0 3 7 0 1102 Gedo - 0 0 2 68 Hiraan 3 2 5 9 207 Lower Juba 0 0 9 5 337 Lower Shabelle - 1 4 4 346 Middle Juba 7 7 10 16 218 Middle Shabelle 5 1 9 5 179 Mudug 3 5 4 8 652 Nugaal 4 0 2 1 190 Sanaag 0 0 0 1 160 Sool 1 5 2 9 385 Togdher 2 0 3 2 239 Waqoyi Galbed 0 1 0 0 252 Grand Total 33 71 85 98 6613 Dash means there is no weekly Data/report submitted on the system during the specified reporting period.
Measles Outbreak Response Activities Page 9 of 24
• 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 The number of Malaria cases increased from 225 cases in week 33 to 291 cases in week 34. Cumulatively, 9,206 cases of Malaria cases have been reported across Somalia since the beginning of
Districts Reporting Malaria Cases in Week 34 2018. Of the 9,206 malaria cases, 3,973 (43%) are under 5
Caluula years while 5,233 (57%) are above 5 years. The most Qandala Zeylac Bossaso
Lughaye Laasqoray Berbera Baki Ceerigaabo Iskushuban Borama Ceel Afweyn Sheikh Gebiley affected districts include; Baidoa district of Bay (1,661 Hargeysa Somaliland Qardho Caynabo Owdweyne Bandarbeyla Burco Xudun Taleex
Puntland Buuhoodle Laas Caanood Garoowe cases), Wadajir district in Banadir (807 cases), Berdale Eyl
Burtinle
Jariiban Galdogob Gaalkacyo district of Bay (774 cases), Marka district of Lower Shabelle
Cadaado Cabudwaaq Hobyo
Dhuusamarreeb Galmudug State Legend (694 cases), wajid district of Bakol (469 cases), Adado
Ceel Buur Xarardheere Ceel Barde Belet Weyne District reporting malaria cases in week 30
Rab Dhuure 0/ No Data Xudur Ceel Dheer Doolow Bulo Burto Waajid Tayeeglow 1 - 35 Cases Luuq Hir-Shabelle State Adan Yabaal 36 - 75 Cases Belet Xaawo Jalalaqsi district of Galgadud (461 cases), Bal’ad district of Middle Baydhaba Garbahaarey Cadale 75.- 98 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 Shabelle (381 cases) and Hudur district of Bakol (305 Coastline Marka Kurtunwaarey Saakow
Jubaland State Sablaale Bu'aale Heliwa Baraawe Dayniile Yaaqshid Afmadow Jilib Karaan Wardhigley Banadir Afgooye Shibis Cases). Hodan 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 34, 2018 500 450 400 350 300 250 Cases 200 150 100 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 Epi-week
SC Zone Somaliland Puntland
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Fig 5c: Districts Reporting Highest Cases of Malaria Across Somalia from Wk1-34, 2018 1500
1000
500
0 Wadajir Adado Bal'ad Baidoa Berdale Huddur Marka Waajid Banadir Galmudug Hirshabelle SouthWest
Cases >5 Cases<5
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 33 were 2,930 compared to 2,794 cases in week 34. Cumulatively, 80,559 cases of OAD cases have been reported across Somalia since the beginning of 2018. Of the 80,559 OAD cases, 60,402 (75%) are under 5 years while 20,157 (25%) are above 5 years. The most affected districts include; Marka District of Lower Shabelle (5,288 cases), Beletweyn district of hiran (5,083 cases), Huruwa district of Banadir (3,811 cases), Wadajir district of Banadir (2,444 cases), Jowhar of Middle Shabelle (2,424 Cases), and Dharkinley of Banadir (2,398 cases).
Fig 6a: Trends of Other Acute Diarrhoea cases in Somalia from Week 1-34, 2018 2500 2000 1500
Cases 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 Epi-week
SC Somaliland Puntland
Fig 6b: Districts Reporting highest cases of OAD Across Somalia from Wk1-34, 2018 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 33 were 115 compared to 141 cases in week 34. Cumulatively, 3,070 cases of BD cases have been reported across Somalia since the beginning of 2018. Of the 3,070 BD cases, 1,646 (53%) are under 5 years while 1,424 (47%) are above 5 years. The most affected districts include Baidoa of Bay (466 cases), Burhakaba of Bay (303 cases), Buhodle of Togdheer (220 cases) and Hargeisa of Waqoy Galbeed (171 cases).
Fig 7a: Trends of Bloody Diarrhea cases in Somalia from Week1-34, 2018 140 120 100 80
Cases 60 40 20 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 Epi-week
SC Somaliland Puntland
Fig 7b: Districts Reporting the Highest Cases of Bloody Diarrhea Across from week1-34, 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 and Fig 8a. Districts Reporting Whooping Cough Cases in Week 34 down for the last four weeks, the cases in Week 33 were 53 Caluula
Qandala Zeylac Bossaso
Lughaye Laasqoray Berbera Baki Ceerigaabo Iskushuban Borama Ceel Afweyn compared to 75 cases in week 34. Cumulatively, 1,670 cases of WC Sheikh Gebiley
Hargeysa Somaliland Qardho Caynabo Owdweyne Bandarbeyla Burco Xudun Taleex
Puntland Buuhoodle Laas Caanood Garoowe cases have been reported across Somalia since the beginning of
Eyl
Burtinle
Jariiban Galdogob Gaalkacyo 2018. Of the 1,670 WC cases, 1,300 (78%) are under 5 years while
Cadaado Cabudwaaq Hobyo
Dhuusamarreeb Galmudug State Legend 370 (23%) are above 5 years. The most affected districts include 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 Belet Xaawo Jalalaqsi 11 - 20 Cases Baydhaba Garbahaarey Galkacyo (365 cases), Jilib (174 cases), Berbera (94 cases), Buale 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 Coastline Marka Kurtunwaarey Saakow (81cases), Adaado (77 Cases) and Erigavo (72 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 8b: Trends of Whooping Cough in Somalia from Week1-34, 2018 90 80 70 60 50
Cases 40 30 20 10 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 Epi-week
SC Somaliland Puntland
Fig8c: Most affected Districts by Whooping Cough in Somalia from Wk1-34, 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 33 were 1,197 compared to 1,218 cases in week 34. Cumulatively, 34,397 cases of SARI cases have been reported across Somalia since the beginning of 2018. Of the 34,397 SARI cases, 20,689(60%) are under 5 years while 13,708 (40%) are above 5 years. The most affected districts include Beletweyne (5,390 cases), Buloburte (2,454 cases), Yaqshid (1,798 Cases), Abudwak (1,703 cases), Huruwa (1,616 cases), and Wadajir (1,517 cases).
Fig 9a: Trends of SARI cases in Somalia from Week1-34, 2018 1600 1400 1200 1000
800 Cases 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 Epi-week
SC Somaliland Puntland
Fig 9b: Districts Reporting the Highest Cases of SARI across Somalia from Wk1-34, 2018
Cases <5 Cases >5
3500 3000 2500 2000 1500 1000 500 0 Huruwaa Wadajir Yaqshid Abudwak Adado Dhuusamarreeb Belet Weyne Bulo Burto Jalalaqsi Banadir Galmudug Hirshabelle
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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 33 were 2,695 compared to 2,925 cases in week 34. Cumulatively, 59,243 cases of ILI cases have been reported across Somalia since the beginning of 2018. Of the 59,243 ILI cases, 34,787 (59%) are under 5 years while 24,456 (41%) are above 5 years. The most affected districts include Borama (6,135 cases), Beletweyne (4,304 cases), Lascanod (3,936 cases), Huruwa (3,729 cases), Berbera (3,484 cases) Wadajir (1,661 cases) and Dharkenley (1,337 cases).
Fig10a: Trends of ILI cases in Somalia from Week 1-34, 2018 1400 1200 1000 800
Cases 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 Epi-week
SC Somaliland Puntland
Fig10b: Districts Reporting Highest Cases of ILI across Somalia from Wk 1-34, 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 34, 2018
# of HFs submitted report in Completeness of reporting State Region District # of active HFs to submit report week34 (%) Abdiaziz 1 1 100 Boondhere 1 1 100 Dayniile 6 6 100 Dharkinley 4 4 100 Hamar Jab Jab 2 1 50 Hamar Weyne 1 1 100 Hodan 2 1 50 Howl-wadaag 3 2 67 Banadir Banadir Huruwaa 3 3 100 Kaaraan 1 0 0 Kahda 5 5 100 Shangani 1 1 100 Shibis 1 1 100 Waberi 1 1 100 Wadajir 9 8 89 Wardhigley 4 3 75 Yaqshid 5 5 100 Subtotal of Banadir 50 44 88 Baki 1 1 100 Borama 9 9 100 Awdal Lughaya 1 1 100 Zeila 2 2 100 Badhan 2 2 100 Sanag Eil-afweine 3 3 100 Erigavo 3 3 100 Somaliland Hudun 1 1 100 Sool Lasacanod 7 7 100 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 1 1 100 Ballayabane 2 2 100 Waqoy Berbera 6 6 100 Galbed Gabiley 4 4 100 Hargeisa 14 14 100 Sheikh 3 3 100 Subtotal of Somaliland 77 77 100 Alula 2 0 0 Banderbayla 3 3 100 Bossaso 8 6 75 Bargal 1 1 100 Carmo 2 2 100 Hafun 2 2 100 Bari Iskushuban 1 0 0 Qandala 1 1 100 Qardho 5 5 100 Rakko 3 3 100 Ufeyn 1 0 0 Waciya 2 2 100 Galdogob 9 5 56 Mudug Galkacyo 16 14 88 Puntland Jariiban 4 4 100 Burtinle 6 6 100 Dangorayo 1 1 100 Nugal Eyl 7 6 86 Garoowe 11 11 100 Badhan 6 5 83 Dhahar 3 3 100 Sanag Lasqoray 1 1 100 Xingalol 1 1 100 Bocame 2 2 100 Hudun 2 2 100 Sool Lasacanod 1 0 0 Taleex 3 3 100 Xalin 1 1 100
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Ayn Buhodle 2 2 100 (Togdher) Widhwidh 1 1 100 Subtotal of Puntland 108 93 86 Abudwak 4 3 75 Adado 4 4 100 Balanbale 1 1 100 Dhuusamarreeb 3 2 67 Galgadud Guriel 1 1 100 Galmudug El Bur 1 0 0 El Dere 2 2 100 Gelinsor 1 1 100 Galkacyo 6 6 100 Mudug Hobyo 13 12 92 Harardhere 4 0 0 Subtotal of Galmudug 40 32 80 Belet Weyne 10 7 70 Bulo Burto 4 2 50 Hiraan Jalalaqsi 1 1 100 Matabaan 4 2 50 Maxaas 1 2 200 Hirshabelle Adale 2 2 100 Bal'ad 12 8 67 Middle Jowhar 6 6 100 Shabelle Mahaday 3 2 67 Warsheikh 5 3 60 Subtotal of Hirshabelle 48 35 73 B/hawo 2 1 50 Baardhere 1 0 0 Doolow 2 1 50 Gedo Elwak 1 1 100 Jubaland Garbahaarey 2 1 50 Gedweyne 1 0 0 Luuq 3 0 0 Lower Afmadow 2 1 50 Juba Dhobley 1 1 100
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Hagar 2 0 0 Jamaame 2 1 50 Kismayo 11 7 64 Bu,aale 2 1 50 Middle Jilib 3 2 67 Juba Salagle 1 1 100 Subtotal of Jubaland 36 18 50 Afgoi 5 3 60 Awdhegle 1 1 100 Barawe 1 1 100 Lower Kurtunwarey 3 3 100 Shabelle Marka 12 7 58 Qoryooley 2 1 50 Wanla Weyn 2 0 0 SouthWest Elberde 3 3 100 Huddur 2 2 100 Bakool Tayeeglow 1 1 100 Waajid 3 2 67 Baidoa 13 7 54 Berdale 3 1 33 Bay Burhakaba 3 2 67 Qansahdere 2 0 0 Subtotal of Southwest 56 34 61 Grand Total 415 333 80
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Table 6. Summary of Epidemic-prone Diseases in different Districts of Somalia as of Week 34, 2018
State/Region/District SARI ILI AWD BD OAD DIPH WC MEAS NNT AFP AJS VHF MAL MENG OC Total_cons Banadir 297 411 78 6 379 0 6 28 1 0 0 0 42 0 9998 11246 Banadir 297 411 78 6 379 0 6 28 1 0 0 0 42 0 9998 11246 Abdiaziz 0 0 0 0 0 0 0 0 0 0 0 0 0 0 481 481 Boondhere 0 0 0 0 2 0 0 1 0 0 0 0 0 0 246 249 Dayniile 17 27 0 0 26 0 0 0 0 0 0 0 1 0 938 1009 Dharkinley 38 27 2 1 69 0 1 1 0 0 0 0 0 0 734 873 Hamar Jab Jab 8 25 0 0 16 0 1 0 0 0 0 0 0 0 82 132 Hamar Weyne 12 0 0 0 12 0 0 0 0 0 0 0 0 0 288 312 Hodan 0 0 0 0 5 0 0 0 0 0 0 0 0 0 421 426 Howl-wadaag 0 85 6 0 6 0 0 0 0 0 0 0 0 0 791 888 Huruwaa 45 89 0 0 104 0 1 23 0 0 0 0 2 0 1026 1290 Kahda 40 48 0 5 54 0 0 0 0 0 0 0 4 0 1032 1183 Shangani 17 29 0 0 13 0 0 0 0 0 0 0 0 0 28 87 Shibis 0 0 0 0 3 0 0 0 0 0 0 0 0 0 471 474 Waberi 0 0 0 0 0 0 0 0 0 0 0 0 0 0 335 335 Wadajir 44 50 66 0 34 0 3 3 1 0 0 0 35 0 1542 1778 Wardhigley 0 0 0 0 16 0 0 0 0 0 0 0 0 0 808 824 Yaqshid 76 31 4 0 19 0 0 0 0 0 0 0 0 0 775 905 Galmudug 123 24 1 1 327 0 24 3 0 0 0 0 15 2 6863 7383 Galgadud 116 24 1 1 27 0 4 0 0 0 0 0 15 0 2743 2931 Abudwak 13 0 0 0 2 0 0 0 0 0 0 0 0 0 498 513 Adado 40 19 1 0 6 0 4 0 0 0 0 0 11 0 558 639 Balanbale 0 0 0 0 5 0 0 0 0 0 0 0 0 0 137 142 Dhuusamarreeb 43 5 0 1 6 0 0 0 0 0 0 0 0 0 958 1013 El Dere 20 0 0 0 8 0 0 0 0 0 0 0 4 0 470 502 Gelinsor 0 0 0 0 0 0 0 0 0 0 0 0 0 0 122 122 Mudug (South Mudug) 7 0 0 0 300 0 20 3 0 0 0 0 0 2 4120 4452 Galkacyo 7 0 0 0 117 0 20 3 0 0 0 0 0 2 2805 2954 Hobyo 0 0 0 0 183 0 0 0 0 0 0 0 0 0 1315 1498
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State/Region/District SARI ILI AWD BD OAD DIPH WC MEAS NNT AFP AJS VHF MAL MENG OC Total_cons Hirshabele 151 246 9 3 375 0 6 14 1 0 0 0 7 0 7433 8245 Hiraan 146 246 4 1 229 0 6 9 1 0 0 0 3 0 2391 3036 Belet Weyne 116 146 0 1 135 0 0 9 1 0 0 0 2 0 1501 1911 Bulo Burto 11 59 0 0 42 0 0 0 0 0 0 0 0 0 444 556 Jalalaqsi 2 12 0 0 18 0 0 0 0 0 0 0 0 0 37 69 Matabaan 6 2 4 0 6 0 0 0 0 0 0 0 1 0 173 192 Maxaas 11 27 0 0 28 0 6 0 0 0 0 0 0 0 236 308 Middle Shabelle 5 0 5 2 146 0 0 5 0 0 0 0 4 0 5042 5209 Adale 0 0 0 0 5 0 0 0 0 0 0 0 0 0 402 407 Bal'ad 2 0 0 0 56 0 0 3 0 0 0 0 3 0 2079 2143 Jowhar 3 0 5 2 52 0 0 2 0 0 0 0 1 0 1321 1386 Mahaday 0 0 0 0 21 0 0 0 0 0 0 0 0 0 544 565 Warsheikh 0 0 0 0 12 0 0 0 0 0 0 0 0 0 696 708 Jubbaland 172 43 34 10 191 0 11 23 0 0 0 0 27 0 2533 3044 Gedo 2 43 19 0 50 0 0 2 0 0 0 0 13 0 254 383 Belet-hawa 0 0 0 0 7 0 0 0 0 0 0 0 0 0 43 50 Doolow 0 19 0 0 23 0 0 0 0 0 0 0 0 0 177 219 Elwak 0 0 18 0 0 0 0 2 0 0 0 0 0 0 0 20 Garbahaarey 2 24 1 0 20 0 0 0 0 0 0 0 13 0 34 94 Lower Juba 141 0 15 5 122 0 0 5 0 0 0 0 5 0 1844 2137 Afmadow 26 0 0 2 16 0 0 0 0 0 0 0 0 0 133 177 Dhobley 22 0 0 0 16 0 0 0 0 0 0 0 5 0 225 268 Jamaame 10 0 0 0 3 0 0 0 0 0 0 0 0 0 80 93 Kismayo 83 0 15 3 87 0 0 5 0 0 0 0 0 0 1406 1599 Middle Juba 29 0 0 5 19 0 11 16 0 0 0 0 9 0 435 524 Bu,aale 7 0 0 1 4 0 2 4 0 0 0 0 0 0 87 105 Jilib 15 0 0 2 10 0 7 7 0 0 0 0 9 0 258 308 Salagle 7 0 0 2 5 0 2 5 0 0 0 0 0 0 90 111
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Puntland 194 1300 104 44 740 25 16 16 4 0 5 0 19 191 12067 15460 Bari (Bari & Karkar) 29 526 34 23 158 18 6 1 0 0 0 0 4 0 4056 4855 Bandarbayla 0 0 0 0 6 0 0 0 0 0 0 0 0 0 211 217 Bargal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Bossaso 3 445 3 1 70 0 0 0 0 0 0 0 3 0 1423 1948 Carmo 0 68 0 0 35 0 0 0 0 0 0 0 1 0 190 294 Hafun 0 0 0 0 3 0 0 0 0 0 0 0 0 0 253 256 Qandala 19 13 16 14 10 18 6 0 0 0 0 0 0 0 203 299 Qardho 0 0 9 0 18 0 0 1 0 0 0 0 0 0 1091 1119 Rako 7 0 6 8 16 0 0 0 0 0 0 0 0 0 496 533 waciya 0 0 0 0 0 0 0 0 0 0 0 0 0 0 189 189 Mudug 142 170 11 2 223 0 5 5 3 0 4 0 0 188 2800 4117 Galdogob 7 4 9 2 17 0 4 5 0 0 1 0 0 0 485 797 Galkacyo 131 126 0 0 177 0 0 0 3 0 0 0 0 188 1864 2790 Jariiban 4 40 2 0 29 0 1 0 0 0 3 0 0 0 451 530 Nugaal 1 468 0 2 282 0 2 1 0 0 0 0 0 1 2582 3339 Burtinle 0 163 0 0 62 0 0 0 0 0 0 0 0 1 703 929 Dangorayo 0 5 0 0 13 0 0 0 0 0 0 0 0 0 152 170 Eyl 1 97 0 0 41 0 0 0 0 0 0 0 0 0 574 713 Garoowe 0 203 0 2 166 0 2 1 0 0 0 0 0 0 1153 1527 Sanaag 17 53 10 14 38 0 3 1 0 0 0 0 3 2 738 1040 Badhan 1 30 10 0 13 0 2 1 0 0 0 0 3 2 253 350 Dhahar 16 23 0 13 15 0 0 0 0 0 0 0 0 0 361 428 Lasqoray 0 0 0 0 0 0 1 0 0 0 0 0 0 0 15 16 Xingalol 0 0 0 1 10 0 0 0 0 0 0 0 0 0 109 246 Sool 3 47 49 3 26 2 0 6 0 0 0 0 12 0 1816 1964 Bocame 3 0 13 3 6 0 0 3 0 0 0 0 1 0 873 902 Hudun 0 30 27 0 13 0 0 2 0 0 0 0 11 0 336 419 Taleex 0 12 9 0 5 2 0 0 0 0 0 0 0 0 504 532 Xalin 0 5 0 0 2 0 0 1 0 0 0 0 0 0 103 111 Togdheer(Ayn) 2 36 0 0 13 5 0 2 1 0 1 0 0 0 75 145 Buhodle 1 11 0 0 3 5 0 2 0 0 0 0 0 0 75 107 Widhwidh 1 25 0 0 10 0 0 0 1 0 1 0 0 0 0 38
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Somaliland 70 647 0 37 521 0 0 3 0 0 4 0 11 1 5785 7079 Awdal 0 193 0 10 118 0 0 0 0 0 0 0 4 0 802 1127 Baki 0 29 0 2 9 0 0 0 0 0 0 0 0 0 56 96 Borama 0 129 0 8 88 0 0 0 0 0 0 0 4 0 573 802 Lughaya 0 1 0 0 5 0 0 0 0 0 0 0 0 0 36 42 Zeila 0 34 0 0 16 0 0 0 0 0 0 0 0 0 137 187 Sanaag 37 46 0 0 28 0 0 0 0 0 0 0 1 0 814 926 Badhan 15 8 0 0 4 0 0 0 0 0 0 0 0 0 204 231 Eil-afweine 20 14 0 0 14 0 0 0 0 0 0 0 0 0 352 400 Erigavo 2 24 0 0 10 0 0 0 0 0 0 0 1 0 258 295 Sool 0 131 0 0 95 0 0 3 0 0 0 0 0 0 1351 1580 Hudun 0 30 0 0 15 0 0 3 0 0 0 0 0 0 239 287 Lasacanod 0 95 0 0 75 0 0 0 0 0 0 0 0 0 971 1141 Taleex 0 6 0 0 5 0 0 0 0 0 0 0 0 0 141 152 Togdheer 1 45 0 20 87 0 0 0 0 0 1 0 0 1 1080 1235 Ainabo 0 0 0 4 8 0 0 0 0 0 0 0 0 0 93 105 Buhodle 0 5 0 12 17 0 0 0 0 0 0 0 0 0 189 223 Burao 1 31 0 3 51 0 0 0 0 0 1 0 0 1 647 735 Odwayne 0 9 0 1 11 0 0 0 0 0 0 0 0 0 151 172 Waqoy Galbed 32 232 0 7 193 0 0 0 0 0 3 0 6 0 1738 2211 (Marodijeh & Sahil) Ballaygubadle 2 11 0 0 3 0 0 0 0 0 1 0 0 0 51 68 Berbera 6 48 0 3 65 0 0 0 0 0 2 0 0 0 319 443 Gabiley 1 27 0 1 24 0 0 0 0 0 0 0 6 0 204 263 Hargeisa 7 130 0 3 67 0 0 0 0 0 0 0 0 0 923 1130 Sheikh 16 16 0 0 34 0 0 0 0 0 0 0 0 0 241 307 SouthWest 211 254 42 40 261 2 12 11 1 0 8 0 170 0 8032 9049 Bakool 15 46 0 5 31 0 1 1 0 0 1 0 14 0 1887 2001 Elberde 3 11 0 0 11 0 1 1 0 0 0 0 0 0 459 486 Huddur 10 6 0 0 5 0 0 0 0 0 0 0 6 0 187 214 Tayeeglow 2 0 0 0 8 0 0 0 0 0 1 0 8 0 83 102 Waajid 0 29 0 5 7 0 0 0 0 0 0 0 0 0 1158 1199
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State/Region/District SARI ILI AWD BD OAD DIPH WC MEAS NNT AFP AJS VHF MAL MENG OC Total_cons
Bay 123 169 32 35 102 0 10 6 1 0 1 0 106 0 2469 3059 Baidoa 56 66 32 7 71 0 2 4 0 0 1 0 24 0 2147 2410 Berdale 67 70 0 0 6 0 8 0 1 0 0 0 81 0 0 238 Burhakaba 0 33 0 28 25 0 0 2 0 0 0 0 1 0 322 411 Lower Shabelle 73 39 10 0 128 2 1 4 0 0 6 0 50 0 3676 3989 Afgoi 34 0 0 0 25 0 0 0 0 0 0 0 26 0 1209 1294 Awdhegle 3 5 4 0 0 0 0 2 0 0 0 0 5 0 0 19 Baraawe 8 15 0 0 11 0 0 2 0 0 0 0 0 0 276 312 Kurtunwarey 27 19 4 0 44 2 1 0 0 0 6 0 8 0 396 507 Marka 0 0 2 0 38 0 0 0 0 0 0 0 11 0 1617 1668 Qoryooley 1 0 0 0 10 0 0 0 0 0 0 0 0 0 178 189 Grand Total 1218 2925 268 141 2794 27 75 98 7 0 17 0 291 194 52711 61506
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]
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