Early Warning Disease Surveillance and Response Bulletin, Somalia 2018 Epidemiological Week 29 (Week ending 22nd July, 2018)
Highlights Cumulative figures as of week 29 235 (62.9%) health facilities across Somalia 1,635,194 consultations from submitted weekly reports of epidemic-prone week 1 to week 29. diseases in the electronic early warning alert 5,968 cumulative cases of and response network (EWARN) system in AWD/Cholera and 41 deaths week 29. Total number of consultations increased from (CFR 0.7%) since December 54,605 in week 28 to 58,449 in week 29. 2017. A total of 403 alerts were received. 33 of these 9,283 cumulative alerts were alerts were confirmed as true alerts in week received, 532 of these, were 29. confirmed as true alerts from The highest numbers of diseases reported in week 1 to week 29, 2018. week 29 were other acute diarrhoeas (2,045 6,255 cumulative cases of cases), influenza like illness (1,151 cases) and severe acute respiratory illness (912 cases). suspected measles cases since the beginning of 2018. Of the A total of 88 new cases of suspected AWD/cholera with 1 death were reported in 6,255 measles cases, 4,154 week 29 compared to 146 AWD cases with (66%) were under 5 years while no death in week 28. 2,101 (34%) were above 5 years. A cumulative total of 5,968 AWD/cholera 7,920 cumulative cases of 1 cases , including 41 deaths have been Malaria were reported since the reported since December 2017. beginning of 2018, 3,431 (43%) The number of reported measles cases slightly increased from 52 in week 28 to 54 cases in were under 5 years, while 4,489 week 29. (57%) were above 5 years.
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Table 1. Summary of Reports for epidemic prone diseases Disease Wk26 Wk28 Wk29 Cumulative cases (Wk 1 – 29, Wk27 2018 2018 2018 2018 2018) Total consultations 55,343 51,625 54,605 58,449 1,635,194 Other Acute Diarrheas 2,599 2,486 2,306 2,045 68346 Influenza Like Illness 1,195 1,342 1,245 1,151 48,224 Severe Acute Respiratory 29,158 1,212 1,173 1,559 912 Illness Suspected Measles 58 61 52 54 6,255 Confirmed Malaria 226 189 431 296 7,920 Acute Watery Diarrhoea 76 13 24 37 2,060 Bloody Diarrhea 107 62 144 83 2,525 Whooping Cough 58 45 74 53 1,411 Acute Jaundice 16 7 5 5 127 Suspected Meningitis 3 3 2 6 87 Diphtheria 2 0 3 9 57 Neonatal Tetanus 0 0 0 0 23 Acute Flaccid Paralysis 0 0 0 1 14 Viral Hemorrhagic Fever 0 1 0 0 5 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
Completeness of Reporting & Reporting Rate Of the 378 health facilities in the EWARN system, 235health facilities submitted their weekly reports on time in week 29 across the country.
Fig 1a. Completeness of reporting of the health facilities of Somalia as of Week 29, 2018 Completeness of reporting of the health facilities of Somalia as of Week 29, 2018 The national surveillance completeness rate was Caluula 62.9% in the week which is below the minimum Qandala
Bossaso Zeylac
Lughaye
Laasqoray
Berbera Iskushuban Baki Ceerigaabo Borama Ceel Afweyn
Sheikh requirement (80%). Apart from Somaliland Gebiley
Hargeysa Qardho
Owdweyne Caynabo Bandarbeyla Burco Xudun Taleex which exceeded the minimum target, none of
Garoowe Buuhoodle Laas Caanood
Eyl Burtinle the other state have reached the 80% minimum
Jariiban
Galdogob Gaalkacyo requirement (fig. 1a).
Cadaado
Hobyo
Cabudwaaq Dhuusamarreeb All the 77 active health facilities in Somaliland Xarardheere Ceel Buur Ceel Barde Belet Weyne
Rab Dhuure Xudur
Ceel Dheer Doolow Bulo Burto
Tayeeglow Luuq Waajid have submitted reports in week 29. In Puntland,
Adan Yabaal
Belet Xaawo Jalalaqsi
Baydhaba Garbahaarey
Cadale Jowhar
Qansax Dheere Wanla Weyn Ceel Waaq only 41(52%) health facilities of the 79 active Buur Hakaba Balcad
Afgooye
Baardheere Diinsoor Banadir
Qoryooley
Marka
Kurtunwaarey Saakow health facilities have submitted reports in week Sablaale
Heliwa
Bu'aale Baraawe Dayniile Yaaqshid
Karaan
Wardhigley
Hawl Wadaag Shibis Bondhere Hodan Afmadow Jilib Cabdulasiis Shangaani Hamar Weyne Legend Hamar Jabjab
Waaberi Wadajir (Medina) 29. None of the health facilities in Bari and Jamaame Dharkenley Completeness of reporting (%) 0 - 25 Kismaayo 26 - 50 Badhaadhe Sanag (Puntland state) have submitted reports 51 - 75 76 - 100 in week 29, whilst in South central, 117 (53%) Miles 0 60 120 240 360 480 µ health facilities of 222 active health facilities submitted reports in week 29. No reports were received from Galgadud region of Galmudug State. Page 2 of 23
Challenges to completeness of the reporting includes 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 have already completed the cascade training.
Fig 1b: Completeness of reporting from EWARN sites, week 29, 2018 120.0
100.0
80.0
60.0
40.0
20.0
-
Bay
Bari
Sool Sool
Gedo
Nugal
Sanag Sanag
Awdal
Hiraan
Bakool
Mudug Mudug
Banadir
Somalia
Jubaland
Puntland
Galgadud
Togdheer
Galmudug
Southwest
Somaliland
Hirshabelle
Lower Juba Lower
Middle Juba Middle
Waqoy Galbed Waqoy
Lower Shabelle Lower Middle Shabelle Middle Banadir Somaliland Puntland Galmudug Hirshabelle Jubaland Southwest Somalia
Received (%) Target (%)
Fig 1c: Completness of reporting
Somaliland Puntland SCZ
100 90 80 70 60 50 40 30 20 10 0 Percentage of Percentage submitted HFs the report 26 27 28 29 Epi-week
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 29, the highest numbers of diseases were other acute diarrhoeas (2,045 cases), influenza like illness (1,151 cases), severe acute respiratory illness (912 cases), Suspected measles (54 cases) and Confirmed Malaria (296 cases).
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Fig 2: Commonest Causes of Morbidity during Week 1 to 29
3,000 2,500 2,000 1,500 1,000 500 0 Wk26 Wk27 Wk28 Wk29
other acute Diaria influence like illness Severe Acute Respiratory Illness Suspected Measles Confirmed Malaria
AWD/Cholera situation in Somalia
Following the heavy rains that led to the floods in the Jubaland and Shabelle basins, there has been an gradual increase in the number of new AWD/Cholera cases (fig b). 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 continue 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 Fig 3a: Districts reporting AWD/Cholera cases in week 29 Fig 2. Districts Reporting Cases in Week 29, 2018 which contributing to delayed health seeking by the affected populations with. Over the past 2 weeks, there has been decrease in the number of AWD/Cholera
Somaliland cases reported in Middle Shabelle, Banadir and Lower Jubba; the regions Puntland that are affected by floods. In week ending 22th July, active transmission of AWD/cholera was reported in Kismayo
Legend district in Lower Jubba, Jowhar in Middle Districts Shabelle as well as in 8 districts of Galmudug State AWD/Cholera Cases_WK29 No Case Banadir region (Darkenly, Daynile, 1 - 10 Cases 11 - 25 Cases Hodan, Madina, Waberi, Hamarjabjab, Hir-Shabelle State 26 - 47 Wardhigley, Yaqshid districts) (fig. 3a). In Districts Affected by Floods South West State Floods Kismayo, affected communities Banadir Major_Rivers Heliwa Dayniile Coastline especially in Farjano IDP are reportedly Yaaqshid Jubaland State Karaan HodanWardhigley Shibis .!Hawl WadaagCabdulasiis using contaminated stagnant water from
Wadajir (Medina)Waaberi Dharkenley the floods. As shown in table 2, there µ was a decrease in the number of cases reported from 146 in week 28 to 88 in
0 45 90 180 270 360 week 29. The Oral Cholera Vaccination 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 that was implemented in 11 high risk 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. 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.
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Fig 3b. AWD/Cholera cases in Somalia July 2017-July 2018
1400 4.0
1200 3.5 3.0 1000 2.5 800 2.0
Cases 600 1.5 400
1.0 Case Fatality Case Fatality Rate(%) 200 0.5 0 0.0 29 31 33 35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 2017 2018 Epi-week
Cases Deaths CFR (%)
Table 2. Summary of AWD/Cholera cases in different regions
States Week 28 Week 29 Cumulative as of 22th July 2018 Regions Ending 15th July 18 Ending 22th July 18
Cases Deaths CFR (%) Cases Deaths CFR (%) Cases Deaths CFR (%)
Banadir 49 0 0.0 33 1 3.0 2328 19 0.8
Jubba land L/ Jubba 74 0 0.0 47 0 0.0 2223 15 0.7
South west L/ Shabelle 5 0 0.0 0 0 0.0 294 4 1.4
Hir-shabele M/Shabelle 18 0 0.0 8 0 0.0 558 2 0.4
Hiraan 0 0 0.0 0 0 0.0 565 1 0.2
Total 146 0 0.0 88 1 0.0 5968 41 0.7
NB. Deaths are included among cases. Banadir Region is not a state Cholera Situation in Lower Jubba, Lower & Middle Shabelle and Banadir. Banadir regions 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, 11 have so far reported cases which have been managed in Banadir CTC located in the capital Mogadishu. There has been decrease in the number of AWD/Cholera cases from 49 including no death to 33 cases and 1 death in the past 2 weeks. More than 39% of the AWD cases reported in Banadir are children below 2 years of age. 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 number of AWD/Cholera cases in Lower Jubba have increased from 74 and no
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deaths to 47 no death. More than 47% of the cholera cases reported from Lower Jubba are children below 2 years. This region is one of the cholera hot spots for the past decade with limited access to safe water and sanitation. AWD/Cholera outbreak in Jowhar town of Middle Shabelle started in week 7 of 2018 following heavy rains that caused by flash floods caused by heavy rains. In week 29 a new outbreak was reported in the same villages that were affected before. During week 29, a total of 8 cases were reported of which 88% of them are children below 2 years. No deaths were reported. Most of the AWD/Cholera cases are coming from Hantiwadag, Bulosheick and Kumis.
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 week 26, 2018 in Jowhar of Middle Shabelle (Table 3).
sTable 3. AWD/Cholera cases in different districts Week 29 Cumulative Week 49/17-week Region District Cases Deaths 29/18 <2 yrs 2 -5 yrs ≥ 5 yrs <2 yrs 2-5yrs ≥ 5 yrs Cases Deaths CFR (%) Darkenley 3 1 3 0 0 0 383 1 0.3 Daynile 4 0 3 0 0 0 419 7 1.7 HamarJabja 0 0 2 0 0 0 147 2 1.4 Hawlwadag 0 0 0 0 0 0 107 1 0.9 Hodan 5 3 2 1 0 0 498 2 0.4 Karaan 0 0 0 0 0 0 40 1 2.5 Madina 0 0 1 0 0 0 380 2 0.5 Banadir Waberi 1 0 1 0 0 0 111 2 1.8 Shibis 0 0 0 0 0 0 11 0 0 Shingani 0 0 0 0 0 0 8 0 0 Abdilaziz 0 0 0 0 0 0 3 0 0 HamarWeine 0 0 0 0 0 0 46 0 0 Heliwaa 0 0 0 0 0 0 22 0 0 Wardigley 0 0 2 0 0 0 97 1 1 Yaqshid 0 1 0 0 0 0 55 0 0 Middle Jowhar 7 0 1 0 0 0 558 2 0.4 Shabelle× Beletweyne 0 0 0 0 0 0 522 1 0.2 Hiran× BuloBarde 0 0 0 0 0 0 43 0 0 Afgoye 0 0 0 0 0 0 153 0 0 Lower Kurtunwarey 0 0 0 0 0 0 31 4 12.9 Shabelle× Merka 0 0 0 0 0 0 96 0 0 Brava 0 0 0 0 0 0 14 0 0 Lower Kismayo 22 11 14 0 0 0 2,223 15 0.7 Jubba× Total 43 16 29 1 0 0 5,968 41 0.7 × regions currently affected by floods. Cases include deaths.
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Response activities implemented during week 29, 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 Response teams are providing emergency response to affected areas
Surveillance and Laboratory Investigations
A Total of 33 new cases were treated at Banadir HOSP-CTC, from 16-22July 2018, Deaths were: 1 Total of 47 acute watery diarrhoea cases have been managed in the Kismayo hospital CTC and Farjano CTUs . There was no death reported Total of 8 acute watery diarrhoea cases have been managed in the Jowhar hospital CTC and there was no death cases reported.
Water Sanitation, Hygiene and risk communication
Chlorination of water sources in affected areas Hnati-wadaag, and Bulo-sheikh. AWD/Cholera prevention and control measure at community level are implementing by both health and was partners in Jowhar district. Chlorination of water sources in affected areas, Farjano, Allenley and Fanole have been made 1500 hygiene kits has been distributed in Bula-gaduud village, which is new liberated areas AWD/Cholera prevention and control forum among the community leaders have been made in Mariina IDP camp in Kismayo district Hygiene promotion of AWD prevention and control mechanism is on-going in Farjano, allanley, gulwade and shaqalaha.
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Measles Situation
The number of suspected measles cases slightly increased from 52 cases in week 28, to 54 cases in Fig. 4a: Districts reporting suspected measles cases, week 1 - 29 week 29. Cumulatively, 6,255 cases of suspected measles have been reported across Somalia since the beginning of 2018. Of the 6,255 measles cases, 4,154 (66%) were under 5 years while 2,101 (34%) were above 5 years. The most affected districts include; Abudwak (709 cases), Huruwa (470 cases), Lascanod (350 cases), Baidoa (354cases), Adado (293 cases), Galkacyo (274 cases), Wadajir (246 cases), Burao (209 cases) and Marka (191 cases). As shown in fig 4b below, the trends of measles cases have continued to decrease in all the regions following the successful implementation of measles vaccination campaign.
Fig 4b: Measles Situation in Somalia from Week 1 to Week 29, 2018
South & Central Zone Somaliland Puntland
500 Measles 450 vaccination Measles vaccination 400 in PL implemented in SL & 350 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 Epi-Week
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Fig 4c. Districts reporting highest cases of Measles across Somalia from Wk1 - Wk29, 2018 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 - 29, 2018 Wk26 Wk27 Wk28 Wk29 Cumulative cases (Wk 1 – Region 2018 2018 2018 2018 29) Awdal 0 0 1 0 13 Bakool 2 2 1 4 128 Banadir 0 7 0 2 896 Bari 0 0 0 - 92 Bay - - 19 15 993 Galgaduud 3 0 3 - 1092 Gedo 1 0 1 0 66 Hiraan 9 14 3 6 185 Lower Juba 18 18 7 9 318 Lower Shabelle 3 2 0 6 328 Middle Juba 10 9 7 5 168 Middle Shabelle 1 0 3 3 159 Mudug 3 7 5 0 625 Nugaal - 0 0 - 183 Sanaag 0 0 0 0 159 Sool 1 0 0 0 368 Togdher 5 2 2 1 232 Waqoyi Galbed 2 0 0 3 250 Grand Total 58 61 52 54 6255 Dash means there is no weekly Data/report submitted on the system during the specified reporting period.
Measles Outbreak Response Activities 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.
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Malaria Situation in Somalia The number of Malaria cases decreased from 431 cases in week 28 to 296 cases in week 29. Fig 5a: Malaria Situation in Somalia from Week 1 to Cumulatively, 7,624 cases of Malaria cases have been Week 29, 2018 reported across Somalia since the beginning of 2018.
Of the 7,920 malaria cases, 3,431 (43%) are under 5 years while 4,489 (57%) are above 5 years. The most affected districts include; Baidoa district of Bay (1,491 cases), Wadajir district in Banadir (712 cases), Marka district of Lower Shabelle (586 cases), wajid district of Bakol (434 cases), Berdale district of Bay (458 cases) Adado district of Galgadud (410 cases), Bal’ad district of Middle Shabelle (344 cases) and Hudur district of Bakol (279 Cases).
Fig 5b: Malaria Situation in Somalia from Week 1 to Week 29, 2018 500 400 300
Cases 200 100 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 Epi-week
SC Zone Somaliland Puntland
Fig 5c: Malaria Cases Per District Across Somalia from Wk1-29, 2018 1200 1000 800 600 400 200 0 Wadajir Adado Bal'ad Baidoa Berdale Huddur Marka Waajid Banadir Galmudug Hirshabelle SouthWest
Cases >5 Cases<5
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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 28 were 2,306 compared to 2,045 cases in week 29. Cumulatively, 68,346 cases of OAD cases have been reported across Somalia since the beginning of 2018. Of the 68,346 OAD cases, 51,468 (75%) are under 5 years while 16,878 (25%) are above 5 years. The most affected districts include; Marka District of Lower Shabelle (4,787 cases), Beletweyn district of hiran (4,391 cases), Huruwa district of Banadir (3,354 cases), Wadajir district of Banadir (2,315 cases), Dharkinley of Banadir (2,034 cases) and Jowhar of Middle Shabelle (2057 Cases).
Fig 6a: Trends of Other Acute Diarrhoea cases in Somalia from Week1-29, 2018 2500
2000
1500
Cases 1000
500
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 Epi-week
SC Somaliland Puntland
Fig 6b: OAD Cases Per District Across Somalia from Wk1-29, 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 also been floatingly decreasing for the last four weeks, the cases in Week 28 were 144 compared to 83 cases in week 29. Cumulatively, 2,525 cases of BD cases have been reported across Somalia since the beginning of 2018. Of the 2,525 BD cases, 1,351 (53%) are under 5 years while 1,174 (47%) are above 5 years. The most affected districts include Baidoa of Bay (424 cases), Burhakaba of Bay (269 cases), Hargeisa of Waqoy Galbeed (159 cases), and Buhodle of Togdheer (164 cases).
Fig 7a: Trends of Bloody Diarrhea cases in Somalia from Week1-29, 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 Epi-week
SC Somaliland Puntland
Fig 7b: Bloody Diarrhea Cases Per District Across Somalia from Wk1-29, 2018
300
250 Cases >5 Cases<5
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
Fig 8a: WhoopingFig 2. Districts reportingcough whoopingaffected cough districts Week1 week- 29, 2018 1-29 The number of WC cases has also been floatingly
Caluula going up and down for the last four weeks, the cases Qandala
Zeylac Bossaso
Lughaye Laasqoray Berbera Iskushuban Baki Ceerigaabo Borama Ceel Afweyn Sheikh Gebiley
Hargeysa in Week 28 were 74 compared to 53 cases in week 29. Qardho
Caynabo Owdweyne Bandarbeyla Burco Xudun Taleex
Buuhoodle Laas Caanood Garoowe
Eyl Cumulatively, 1,411 cases of WC cases have been Burtinle
Jariiban Galdogob Gaalkacyo reported across Somalia since the beginning of 2018. Cadaado Cabudwaaq Hobyo
Dhuusamarreeb
Legend Ceel Buur Xarardheere Ceel Barde Belet Weyne Of the 1,411 WC cases, 1,085 (77%) are under 5 years WC Rab Dhuure Xudur Ceel Dheer Doolow 0/No Cases Bulo Burto Tayeeglow Luuq Waajid
Adan Yabaal 1 - 57 Cases Belet Xaawo Jalalaqsi Baydhaba Garbahaarey 51 - 170 Cases Cadale while 326 (23%) are above 5 years. The most affected Jowhar Qansax Dheere Wanla Weyn 171 - 348 Cases Ceel Waaq Buur Hakaba Balcad Districts Affected by Floods Afgooye Baardheere Diinsoor Banadir
Qoryooley Marka Kurtunwaarey Saakow Major_Rivers Sablaale districts include Galkacyo (344 cases), Jilib (170 Bu'aale Coastline Heliwa Baraawe Dayniile Yaaqshid Afmadow Jilib Karaan Wardhigley Hodan Shibis Jamaame Hawl Wadaag cases), Berbera (94 cases), Erigavo (72 cases), Buale Kismaayo Wadajir (Medina)Waaberi Dharkenley µ Badhaadhe (77 cases) and Adaado (77 Cases). 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 Week1-29, 2018 100
80
60
Cases 40
20
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 Epi-week
SC Somaliland Puntland
Fig8c: Most affected districts of Whouping Cough in Somalia from Wk1-29, 2018 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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Most Other affected diseases 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 28 were 1,559 compared to 912 cases in week 29. Cumulatively, 29,158 cases of SARI cases have been reported across Somalia since the beginning of 2018. Of the 29,158 SARI cases, 17,490(60%) are under 5 years while 11,668 (40%) are above 5 years. The most affected districts include Beletweyne (4,824 cases), Buloburte (2,390 cases), Abudwak (1,634 cases), Yaqshid (1,477 Cases), Wadajir (1,464 cases), and Huruwa (1,482 cases).
Fig 9a: Trends of SARI cases in Somalia from Week1-29, 2018 1600 1400 1200 1000
800 Cases 600 400 200 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 Epi-week
SC Somaliland Puntland
Fig 9b: Most SARI affected districts across Somalia from Wk1-29, 2018
Cases <5 Cases >5
3000
2500
2000
1500
1000
500
0
Adado
Yaqshid
Wadajir
Jalalaqsi
Huruwaa
Abudwak
Bulo Burto Bulo
Belet Weyne Belet Dhuusamarreeb 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 28 were 1,245 compared to 1,151 cases in week 29. Cumulatively, 48,224 cases of ILI cases have been reported across Somalia since the beginning of 2018. Of the 48,224 ILI cases, 28,609 (59%) are under 5 years while 19,615 (41%) are above 5 years. The most affected districts include Borama (5,410 cases), Huruwa (3,364 cases), Beletweyne (3,475 cases), Lascanod (3,409 cases), Berbera (2,942 cases) Wadajir (1,598 cases) and Dharkenley (1,159 cases).
Fig10a: Trends of ILI cases in Somalia from Week1-29, 2018 1400
1200
1000
800
Cases 600
400
200
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 Epi-week
SC Somaliland Puntland
Fig10b: Most ILI affected districts across Somalia from Wk1-29, 2018 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 29, 2018
# of HFs submitted report in Completeness of reporting State Region District # of active HFs to submit report week29 (%) Abdiaziz 1 1 100 Boondhere 1 0 0 Dayniile 4 1 25 Dharkinley 4 3 75 Hamar Jab Jab 2 2 100 Hamar Weyne 1 1 100 Hodan 2 0 0 Howl-wadaag 3 2 67 Banadir Banadir Huruwaa 3 3 100 Kaaraan 1 0 0 Kahda 4 4 100 Shangani 1 1 100 Shibis 1 1 100 Waberi 1 0 0 Wadajir 9 2 22 Wardhigley 4 1 25 Yaqshid 4 4 100 Subtotal of Banadir 46 26 57 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 23
Ballaygubadle 1 1 100 Ballayabane 2 2 100 Berbera 6 6 100 Waqoy Gabiley 4 4 100 Galbed Hargeisa 14 14 100 Sheikh 3 3 100 Subtotal of Somaliland 77 77 100 Banderbayla 2 0 0 Bossaso 8 0 0 Carmo 1 0 0 Hafun 2 0 0 Bari Iskushuban 1 0 0 Qardho 4 0 0 Rakko 3 0 0 Ufeyn 1 0 0 Waciya 2 0 0 Galdogob 9 6 67 Mudug Galkacyo 16 12 75 Puntland Jariiban 4 3 75 Burtinle 4 4 100 Dangorayo 1 1 100 Nugal Eyl 5 5 100 Garoowe 6 6 100 Badhan 2 0 0 Sanag Dhahar 2 0 0 Bocame 1 0 0 Hudun 2 2 100 Sool Lasacanod 1 0 0 Taleex 2 2 100 Subtotal of Puntland 79 41 52 Abudwak 4 0 0 Adado 3 0 0 Galmudug Galgadud Balanbale 1 0 0 Dhuusamarreeb 3 0 0 Guriel 1 0 0
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El Bur 1 0 0 El Dere 2 0 0 Gelinsor 1 0 0 Galkacyo 6 6 100 Mudug Hobyo 13 3 23 Harardhere 4 0 0 Subtotal of Galmudug 39 9 23 Belet Weyne 10 8 80 Bulo Burto 4 2 50 Hiraan Jalalaqsi 1 1 100 Matabaan 4 1 25 Maxaas 1 1 100 Hirshabelle Adale 2 2 100 Bal'ad 12 5 42 Middle Jowhar 6 5 83 Shabelle Mahaday 3 1 33 Warsheikh 5 3 60 Subtotal of Hirshabelle 48 29 60 B/hawo 2 1 50 Baardhere 1 0 0 Doolow 2 2 100 Gedo Elwak 1 1 100 Garbahaarey 2 1 50 Gedweyne 1 0 0 Luuq 3 1 33 Jubaland Afmadow 2 1 50 Lower Hagar 2 1 50 Juba Jamaame 2 0 0 Kismayo 11 8 73 Bu,aale 2 1 50 Middle Jilib 3 2 67 Juba Salagle 1 1 100 Subtotal of Jubaland 35 20 57 Lower Afgoi 5 3 60 SouthWest Shabelle Kurtunwarey 3 2 67
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Marka 12 8 67 Qoryooley 2 1 50 Wanla Weyn 2 1 50 Elberde 3 3 100 Huddur 2 2 100 Bakool Tayeeglow 1 0 0 Waajid 3 3 100 Baidoa 13 9 69 Berdale 3 0 0 Bay Burhakaba 3 1 33 Qansahdere 2 0 0 Subtotal of Southwest 54 33 61 Grand Total 378 235 62
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Table 6. Cumulative Summary of Epidemic-prone Diseases in different Districts of Somalia as of Week 1-29, 2018
Regions District SARI ILI AWD BD OAD DIPH WC MEAS NNT AFP AJS VHF MAL MENG OC Total_cons Total 0 8791 11 142 4200 0 0 13 0 0 0 0 57 2 35406 48651 Baki 0 1150 0 67 298 0 0 0 0 0 0 0 0 0 3218 4733 Awdal Borama 0 5410 11 72 2920 0 0 8 0 0 0 0 40 0 23211 31700 Lughaya 0 195 0 2 239 0 0 0 0 0 0 0 0 0 1823 2259 Zeila 0 2036 0 1 743 0 0 5 0 0 0 0 17 2 7154 9959 Total 228 132 0 97 570 0 18 128 0 0 1 0 801 2 65302 67279 Elberde 0 40 0 2 147 0 1 0 0 0 0 0 0 0 10627 10817 Bakool Huddur 51 5 0 13 104 0 0 1 0 0 0 0 279 0 9379 9832 Tayeeglow 41 39 0 3 50 0 0 6 0 0 1 0 88 2 1667 1897 Waajid 136 48 0 79 269 0 17 121 0 0 0 0 434 0 43629 44733 Total 5708 8312 924 62 13527 0 9 896 0 1 0 0 751 12 365808 397797 Abdiaziz 0 93 0 0 115 0 0 0 0 0 0 0 0 0 8806 9029 Boondhere 0 0 18 0 250 0 0 24 0 0 0 0 0 0 6736 7028 Dayniile 30 180 0 0 289 0 0 7 0 0 0 0 1 0 13403 13921 Dharkinley 604 1159 0 0 2034 0 0 56 0 0 0 0 0 0 22055 26115 Hamar Jab Jab 222 624 0 2 585 0 1 8 0 0 0 0 1 0 15017 16460 Hamar Weyne 127 437 0 0 1095 0 0 10 0 0 0 0 0 0 11903 13572 Hodan 3 22 5 0 84 0 0 0 0 0 0 0 6 0 9532 9652 Howl-wadaag 0 0 0 0 0 0 0 6 0 0 0 0 1 0 38247 38532 Banadir Huruwaa 1482 3364 15 6 3354 0 0 470 0 1 0 0 3 12 37932 47589 Kaaraan 10 69 0 0 47 0 0 1 0 0 0 0 0 0 17534 17661 Kahda 122 531 0 0 364 0 0 1 0 0 0 0 10 0 4086 5123 Shangani 149 145 0 0 137 0 0 0 0 0 0 0 0 0 498 965 Shibis 0 0 0 0 578 0 0 11 0 0 0 0 2 0 8211 8820 Waberi 0 0 0 0 33 0 0 0 0 0 0 0 0 0 19172 19205 Wadajir 1464 1598 886 5 2315 0 2 246 0 0 0 0 712 0 84448 91676 Wardhigley 18 1 0 30 1450 0 6 34 0 0 0 0 15 0 44584 46138 Yaqshid 1477 89 0 19 797 0 0 22 0 0 0 0 0 0 23644 26311 Total 107 1020 5 10 698 0 0 92 0 0 0 0 340 0 47419 58421 Bari Banderbayla 61 153 1 0 31 0 0 1 0 0 0 0 0 0 1111 1358 Page 20 of 23
Bossaso 46 847 3 0 345 0 0 28 0 0 0 0 331 0 25312 35620 Carmo 0 6 0 0 4 0 0 0 0 0 0 0 2 0 634 668 Hafun 0 0 0 0 51 0 0 0 0 0 0 0 0 0 2386 2437 Iskushuban 0 7 0 1 5 0 0 0 0 0 0 0 0 0 614 627 Qardho 0 0 0 9 169 0 0 45 0 0 0 0 6 0 10092 10321 Rakko 0 0 1 0 73 0 0 18 0 0 0 0 1 0 3182 3275 Ufeyn 0 7 0 0 2 0 0 0 0 0 0 0 0 0 374 383 Waciya 0 0 0 0 18 0 0 0 0 0 0 0 0 0 3714 3732 Total 1397 3449 62 821 2183 25 68 632 1 0 1 0 2129 6 99082 109942 Baidoa 1266 2016 47 424 1431 25 35 354 0 0 1 0 1491 6 83381 90563 Bay Berdale 34 416 6 84 101 0 29 76 0 0 0 0 458 0 5368 6572 Burhakaba 71 388 8 269 360 0 4 196 1 0 0 0 68 0 6032 7397 Qansahdere 26 629 1 44 291 0 0 6 0 0 0 0 112 0 4301 5410 Total 4906 2023 200 5 1229 0 212 1453 1 0 3 0 1179 9 67000 78290 Abudwak 1634 574 0 0 327 0 33 709 1 0 0 0 233 4 15211 18726 Adado 1026 579 12 1 304 0 77 293 0 0 3 0 410 2 11928 14705 Balanbale 428 239 0 1 53 0 18 129 0 0 0 0 85 0 3159 4112 Galgadud Dhuusamarreeb 965 324 10 2 219 0 23 160 0 0 0 0 204 0 20514 22421 El Bur 24 6 178 0 38 0 0 34 0 0 0 0 17 0 533 830 El Dere 593 206 0 1 223 0 24 64 0 0 0 0 131 3 12470 13715 Gelinsor 236 95 0 0 65 0 37 64 0 0 0 0 99 0 3185 3781 Total 408 1415 58 110 476 0 0 66 0 0 0 0 370 0 23279 26219 B/hawo 76 256 39 3 71 0 0 20 0 0 0 0 96 0 7683 8244 Baardheere 0 0 0 51 9 0 0 0 0 0 0 0 8 0 0 68 Doolow 176 547 0 1 93 0 0 36 0 0 0 0 110 0 4427 5390 Gedo Elwak 0 37 Garbahaarey 21 227 14 0 155 0 0 4 0 0 0 0 55 0 3016 3492 Gedweyne 22 47 0 0 63 0 0 0 0 0 0 0 0 0 528 660 Luuq 113 338 5 55 85 0 0 6 0 0 0 0 101 0 7625 8328 Total 8527 4631 313 7 7110 0 58 185 0 0 0 0 173 2 75174 96669 Belet Weyne 4824 3475 307 0 4391 0 7 140 0 0 0 0 171 1 42879 56235 Bulo Burto 2390 572 6 7 1713 0 2 29 0 0 0 0 2 1 16502 21673 Hiraan Jalalaqsi 1134 139 0 0 784 0 0 2 0 0 0 0 0 0 2541 4600 Matabaan 111 328 0 0 157 0 0 0 0 0 0 0 0 0 7174 7770 Maxaas 68 117 0 0 65 0 49 14 0 0 0 0 0 0 6078 6391
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Total 2035 15 52 208 2468 5 24 318 0 0 0 0 203 0 68160 73504 Afmadow 774 0 28 87 455 0 1 4 0 0 0 0 4 0 8727 10080 Lower Hagar 136 5 0 16 202 2 5 48 0 0 0 0 0 0 3403 3817 Juba Jamaame 102 0 6 8 140 0 0 51 0 0 0 0 113 0 7088 7508 Kismayo 1023 10 18 97 1671 3 18 215 0 0 0 0 86 0 48942 52099 Total 965 809 283 35 8551 4 16 328 0 0 0 0 938 2 135387 147318 Afgoi 235 121 25 2 333 0 0 45 0 0 0 0 210 0 26072 27043 Lower Kurtunwarey 45 3 41 0 1538 0 0 35 0 0 0 0 45 0 15091 16798 Shabelle Marka 271 3 173 6 4787 4 16 191 0 0 0 0 586 2 78984 85023 Qoryooley 76 0 44 0 1051 0 0 51 0 0 0 0 68 0 13292 14582 Wanla Weyn 338 682 0 27 842 0 0 6 0 0 0 0 29 0 1948 3872 Total 228 0 1 92 618 9 304 175 0 0 0 0 198 0 11662 13287 Middle Bu,aale 50 0 0 23 145 0 77 42 0 0 0 0 0 0 2272 2609 Juba Jilib 119 0 1 45 367 5 170 103 0 0 0 0 198 0 7358 8366 Salagle 59 0 0 24 106 4 57 30 0 0 0 0 0 0 2032 2312 Total 613 309 109 108 3474 0 1 152 0 0 0 0 502 0 107149 112553 Adale 0 0 0 0 37 0 0 0 0 0 0 0 3 0 7653 7693 Middle Bal'ad 555 280 22 34 920 0 1 115 0 0 0 0 344 0 43654 45925 Shabelle Jowhar 46 0 82 62 2057 0 0 37 0 0 0 0 107 0 29434 31961 Mahaday 4 17 0 12 154 0 0 0 0 0 0 0 15 0 8853 9055 Warsheikh 8 12 5 0 306 0 0 0 0 0 0 0 33 0 17555 17919 Total 781 43 14 47 4995 7 381 625 21 9 38 2 24 23 166393 173464 Galdogob 92 2 1 5 398 0 0 14 0 0 1 0 0 0 18517 19030 Galkacyo 446 5 13 36 3067 5 348 473 3 9 5 1 13 23 115138 119585 Mudug Harardere 35 36 0 1 205 0 12 29 0 0 0 0 4 0 4673 4995 Hobyo 200 0 0 0 1234 2 20 99 18 0 31 1 7 0 13453 15126 Jariiban 8 0 0 5 91 0 1 10 0 0 1 0 0 0 14612 14728 Total 77 866 6 0 519 1 6 183 0 0 0 0 0 0 14234 18104 Burtinle 1 175 0 0 127 0 0 29 0 0 0 0 0 0 2718 3387 Nugaal Dangorayo 1 33 0 0 40 1 0 0 0 0 0 0 0 0 1668 1753 Eyl 13 236 0 0 107 0 0 44 0 0 0 0 0 0 4046 4752 Garoowe 62 422 6 0 245 0 6 110 0 0 0 0 0 0 5802 8212 Total 1604 830 22 69 1438 6 76 159 0 0 0 0 35 1 33288 37689 Sanag Badhan 599 210 10 0 464 0 1 136 0 0 0 0 30 0 8138 9622 Dhahar 471 1 2 67 265 0 3 3 0 0 0 0 3 0 4542 5357
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Eil-afweine 431 274 9 2 457 1 0 12 0 0 0 0 0 0 10438 11668 Erigavo 103 345 1 0 252 5 72 8 0 0 0 0 2 1 10170 11042 Total 38 4519 0 6 3658 0 36 368 0 0 0 0 48 0 39907 48699 Bocame 0 0 0 0 5 0 0 2 0 0 0 0 0 0 222 229 Sool Hudun 0 756 0 0 452 0 1 14 0 0 0 0 0 0 3852 5183 Lasacanod 38 3409 0 6 3012 0 35 350 0 0 0 0 48 0 32984 39882 Taleex 0 354 0 0 189 0 0 2 0 0 0 0 0 0 2849 3405 Total 268 2194 0 377 3938 0 41 225 0 1 7 0 3 13 35564 42643 Ainabo 1 85 0 59 196 0 0 3 0 0 0 0 0 0 2268 2612 Togdheer Buhodle 23 149 0 164 324 0 0 13 0 0 0 0 0 0 5052 5725 Burao 218 1692 0 117 3096 0 41 209 0 1 7 0 3 13 24023 29432 Odwayne 26 268 0 37 322 0 0 0 0 0 0 0 0 0 4221 4874 Total 1268 8866 0 329 8694 0 161 257 0 1 79 1 169 15 64825 84665 Ballayabane 180 249 0 45 277 0 24 9 0 0 29 0 0 1 2720 3534 Ballaygubadle 18 20 0 8 13 0 1 0 0 0 4 0 0 0 341 405 Waqoy Berbera 329 2942 0 2 2531 0 94 106 0 1 46 1 5 1 17587 23645 Galbed Gabiley 243 2683 0 115 2174 0 6 21 0 0 0 0 39 0 7492 12773 Hargeisa 304 2182 0 159 2901 0 33 103 0 0 0 0 120 13 31070 36885 Sheikh 194 790 0 0 798 0 3 18 0 0 0 0 5 0 5615 7423 Grand Total 29158 48224 2060 2525 68346 57 1411 6255 23 12 129 3 7920 87 1455039 1,635,194
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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