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1635194 Consultations from Week 1 to Week 29. • 5968 Cumulative

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1635194 Consultations from Week 1 to Week 29. • 5968 Cumulative 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. Page 1 of 23 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). Page 3 of 23 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. Page 4 of 23 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.
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