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Cholera Factsheet Somalia

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Cholera Factsheet Somalia Cholera Factsheet for Action - ZAMBIA CHOLERA FACTSHEET SOMALIA Figure 1. Annual number of suspected cholera cases and case fatality CHOLERA OVERVIEW rate in Somalia, 1990 – 20171 Seventh pandemic cholera was first reported in Somalia in 1970. Since 1990, the largest outbreaks were reported in 1994- 1996, 1999, 2003, 2007, 2011-2012 and 2016-2017. Large- scale epidemics have increased over the past two decades (Fig. 1).1 During 2012 and 2016-2018, epidemiological surveillance reported 112,736 suspected cholera cases. South-Central Somalia accounted for 77% of all reported cholera cases (Table I). In South-Central, the regions of Banadir and Bay, were most affected with a combined 32.3% of all suspected cases during the near four-year period (Fig. 2, Table II).2 The country has been affected by recent cross-border cholera outbreaks involving Ethiopia, Kenya and likely Yemen.3 CHOLERA DISTRIBUTION Figure 2. Cumulative cholera incidence by region in Somalia, 2012, In South-Central Somalia, Banadir Region (coterminous with 2 the city of Mogadishu) reported cholera outbreaks every year of 2016-2018 the study period and accounted for the highest percentage of cholera cases among all regions (17.6%). Bay Region reported 14.7% of all suspected cases, of which 90.2% were reported during the recent outbreak in 2017 (Fig. 4, Table II).2 Lower Juba Region, which borders Garissa County and Wajir County in Kenya, reported 9.2% of all suspected cases. Lower Juba consistently reported cholera outbreaks all four years. Lower Shabelle Region, which borders Banadir Region, reported 7.1% of all suspected cases. Lower Shabelle also experienced cholera outbreaks every year, although 70% were notified in 2017. Gedo Region, which borders Somali Region in Ethiopia and Mandera County in Kenya, reported 6.6% of all suspected cases (Fig. 4, Table II).2 Cholera outbreaks often started following the Deyr rains (October to December) and peaked during the Gu rains (late- March to June), characterized by monsoon-like rain and flash flooding. Flash floods hit the Juba River and Shebelle River valleys, affecting the regions of Middle Juba, Lower Juba and Lower Shabelle. During the 2016 El-Niño, the number of cholera cases increased throughout South-Central Somalia.2,4 Drought also aggravated cholera outbreaks, as observed in 2016-2017.3 From 2012 to early-2018, the lulls in cholera outbreaks occurred from August to November (Fig. 3).2 Risk factors3,5 Figure 3. Weekly suspected cholera case numbers and estimated Conflict, insecurity and inaccessibility due to Al-Shabaab precipitation levels in Somalia, 2012 – 20182,4 control Living in internally displaced person (IDP) settlements/camps – overcrowding, poor sanitation, and limited water access (access to water in IDPs camps can be as low as 34%) Natural disasters such as drought and flooding Living in floodplains of the Shebelle and Juba River Valleys Living along the border with Kenya and Ethiopia (e.g., Gedo Region and Hiran Region) Table I. Epidemiological parameters of cholera in Somalia by zone, 2012, 2016, 2017, and 20182 ZONE Cases [1] % of total cases South-Central 86,892 77.1 Puntland 13,786 12.2 Somaliland 12,058 10.7 Somalia total 112,736 100% Note: [1] 2018 data includes weeks 1-22. Death data was unavailable for 2012. CHOLERA FACTSHEET SOMALIA CHOLERA DISTRIBUTION 2 Figure 4. Regions affected by cholera in Somalia - 2012, 2016-2018 HIGHLY AFFECTED REGIONS Location of cholera foci (Fig. 4, Table II): South-Central: Banaadir, Bay, Lower Juba, Lower Shabelle, Gedo, Hiran and Middle Shabelle Puntland: Nugal and Ayn Somaliland: Togdheer STRATEGIC RECOMMENDATIONS Somalia has been periodically affected by cross-border cholera outbreaks involving Ethiopia, Kenya and likely Yemen,3 thus highlighting the importance of coordinating response efforts with neighboring countries. Preparedness and response plans should be developed and implemented including: (1) strengthening early detection and rapid response including community-based surveillance and cross-border alerts; (2) establishing multisectoral and cross border coordination mechanisms; (3) building outbreak management capacity; (4) targeting pre-positioning of supplies and (5) developing risk communication, social mobilization and community engagement plans with harmonized approaches and messaging. Sustainable Water, Sanitation, Hygiene (WASH) and social mobilization activities should be implemented in heavily affected regions in South-Central (Table II). During the study period, cholera was diffused throughout Somalia, especially in South-Central. Facility and community surveillance should be enhanced, including adherence to the cholera standard case definition (WHO). Identification of transmission foci over an extended timeframe and at a finer geographical scale (e.g., district level), is necessary to clearly understand the cholera dynamics in the country, identify cholera hotspots, optimize resources, and maximize the impact of WASH and social mobilization interventions. Table II. Epidemiological parameters of cholera in Somalia by region, 2012, 2016, 2017, and 20182 Attack rate Total suspected Cross-border ZONE REGION % of total cases (per 10,000 cholera cases area inhabitants) BANAADIR 19,858 17.6 142.0 No BAY 16,518 14.7 225.2 No LOWER JUBA 10,328 9.2 227.7 Yes LOWER SHABELLE 7,990 7.1 73.3 No GEDO 7,474 6.6 166.7 Yes SOUTH-CENTRAL HIRAN 4,672 4.1 102.2 Yes MIDDLE SHABELLE 4,551 4 93.1 No GALGUDUUD 4,067 3.6 89.6 Yes BAKOOL 3,995 3.5 115.6 Yes MIDDLE JUBA 3,948 3.5 127.3 No MUDUG 3,491 3.1 57.1 Yes NUGAL 3,881 3.4 122.1 Yes PUNTLAND AYN 3,751 3.3 54.2 Yes BARI 2,797 2.5 45.3 No SOMALILAND TOGDHEER 6,838 6.1 156.6 Yes Note: Year 2018 data includes weeks 1-22. All other regions in Puntland and Somaliland reported less than 2.5% of all cholera cases. Only Sahil Region (Somaliland) was unaffected by cholera outbreaks during the study period (reporting only eight cases). References Authors 1. Global Health Atlas. WHO (http://apps.who.int/globalatlas). Moore S. PhD, Dunoyer J. MSc, Khambira M. MSc, Valingot C. MSc, 2. Cholera surveillance data, 2012 & 2016-2018, Ministry of Health Somalia. Piarroux M. MD PhD, Piarroux R. MD PhD, Sudre B. MD PhD. 3. Moore et al., Epidemiological study of cholera hotspots and epidemiological basins in East and Southern Africa. In-depth report on cholera epidemiology in Kenya and Somalia (2018), UNICEF. Acknowledgements 4. Precipitation data, Famine Early Warning Systems Network (http://www.fews.net). Mohamed AM, Hussein A, Jim’ale QA, Mohamed ZI, Nuur FA (Somalia MoH) 5. UN Office for the Coordination of Humanitarian Affairs 08/2018 Ibrahim AR, Gatscher S (UNICEF Somalia) https://reliefweb.int/sites/reliefweb.int/files/resources/Somalia Revised HRP July 2018-FINAL.pdf Angaluki, A.A. Ameda M.I., Tabbal G. and Oger PY (UNICEF ESARO) .
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