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1943980 Consultations from Week 1 to Week 34. • 6245 Cumulative Cases of AWD/Cholera and 42 Deaths

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1943980 Consultations from Week 1 to Week 34. • 6245 Cumulative Cases of AWD/Cholera and 42 Deaths 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 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 report 0 31 32 33 34 Epi-week Percentage Percentage of the submitted HFs 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 Page 3 of 24 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). Page 4 of 24 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 Numberof AWD/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.
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