CORE Group Polio & Global Health Security, Horn of Africa Weekly

Home , Afmadow District, Badhadhe District, Lamu, Mandera County, Marsabit, Marsabit County

CORE Group Polio & Global Health Security, Horn of Africa Weekly Bulletin: FY21 Q2 Week 7 (9-14 Feb, 2021) POLIO UPDATES: (KENYA) POLIO UPDATES: (SOMALIA) GLOBALGLOBAL HEALTH HEALTH SECURITY—PRIORITY SECURITY—PRIORITY ZOONOTIC ZOONOTIC ( ( • Mombasa County has reported 5 environmental sample sites, • The project supported 1 Routine Immunization outreaches DISEASES:DISEASES: KENYA) KENYA) with a positive for cVDPV2 isolated at the Golf Club site. The noti- session reaching children under the age of 1 year with vari- RVF Outbreak:UPDATES ON 1) ManderaRVF: County: fication was given in January 14 2021. Investigation still ongoing. ous routine vaccination antigens ( 0 zero doses, 2 OPV • 1 human case reported in Mandera county and investi- • There were reports of 2 camels death with bleeding at Bula Birth doses, 10 OPV 3, and 10 IPV doses) in the far-flung gated with positive lab tests. Sample collection for ani- • 13 counties have been considered for the supplementary immun- Power Yabicho (A), the center for RVF in Kalamalab. project regions of (Lower Juba, Gedo and Bakool) during mals were taken for investigation, with 4 camel deaths ization activities (SIA) with a target population of 3,437,378 under the week. • The veterinaryreported in county the same department herd as the is confirmed planning tohuman visit the 5 years with the first round of mOPV2 scheduled for 20-24 March area case. to confirm the situation before embarking on more 2021 and the second round tentatively set for 24-27 April 2021. • The project’s supported Community Volunteers (CVs) con- stringent measures. • In Garissa county, sample collection of around 40 cam- Possible synchronization of the polio campaigns with Somalia and ducted social mobilization and sensitized the communities • The countyels were government collected for also investigation supplied vaccines, out of which targeting 4 Ethiopia, on AFP (Polio), and COVID-19. The CVs visited 2,359 house- the entirewere confirmed county withcases. 300,000 doses vaccines for shoat holds and 2,810 under 5 years while observing COVID-19 (goats and sheep), camel and cattle especially in the out- • During the week, the project supported 12 Routine Immunization • No cases reported in the Turkana, Marsabit, Wajir and prevention protocols e.g. physical distancing, washing of break epicenter, Mandera North. outreaches session reaching children under the age of 1 year with Lamu counties, with ongoing sensitization of border hands, and wearing of masks. • Ring communities vaccination onand the vector risk factors control and in reporting Mandera of north sus- and various routine vaccination antigens ( 79 zero doses, 39 OPV Birth targetedpected in otherRVF cases. sub-counties Coordination ongoing meeting through at the the sub veteri- doses, 64 OPV 3, and 63 IPV doses) in the far-flung project coun- • During the week, border health facilities in Somalia report- nary departmentcounty and county with the level support ongoing of RACIDDA with preparedness and DRC ties of (Garissa, Lamu, Mandera, Marsabit, Nairobi, Turkana, ed that 94 children under the age of five failed to complete plans taking place. 2) Wajir county: Wajir). their routine immunizations respectively. The CVs traced 47 (50%) and referred them to the health facilities to com- • The project’s supported Community Volunteers (CVs) conducted • The vet department and partners mapped out RVF hotspot plete/continue their immunization schedule. areas (Kotkot in Wajir south Subcounty, LMD, Wara and Arbaja- social mobilization and sensitized the communities on AFP (Polio), han -Wajir west sub county, Lakole &Basir villages - Eldas Sub Priority Zoonotic diseases as well as COVID-19. The CVs visited county) and collected samples from both human and animals. On job training on 2,593 households and 2,897 under 5 years while observing COVID how to fill immun- • A total of 10 households/herd were reached with 10 -19 prevention protocols e.g. physical distancing, washing of ization monitoring questionnaires administered. No suspected human cases hands, and wearing of masks. chart to a health were reported. facility staff in Dho- • Border health facilities in Kenya reported that 776 children under bley general hospi- • Most of the herders visited were caprine and ovine and 50% tal, Lower juba of the herd owners interviewed did not report any RVF syn- the age of five failed to complete their routine immunizations re- Sample collection, community sensitization as well as ques- region, Somalia. dromes. spectively. The CVs traced 418 (54%) children and referred them Photo credit, Yusuf tionnaires for the line listed patients done in Mandera county. to the health facilities to complete/continue their immunization Alight) • AllPhoto the credit, Livestock Mohamed—ADRA. samples tested Negative for IgG and schedule. positive for IgG Strengthening of immunization systems: Outreach services to hard to reach border, nomadic pastoralist. (28/12/2020 – 14/02/2021)

Country County/ Region # Outreach Zero Dose Birth Dose OPV 3 IPV Outreach Outreach Static Outreach Static Outreach Static KENYA Garissa 13 69 118 149 185 214 180 306 Lamu 3 1 0 15 0 20 2 26 Mandera 30 81 119 152 177 220 163 286 Marsabit 9 104 81 161 89 248 64 333 Nairobi 2 0 3 1 8 0 0 0 Turkana 10 16 6 103 25 131 59 138 Wajir 10 20 25 83 46 107 46 113 Total 77 291 352 664 530 940 514 1202 SOMALIA Bakool 0 0 0 0 0 0 0 0 Gedo 2 0 0 345 22 791 20 1220 Lower Juba 2 0 2 76 10 54 10 69 Total 4 0 2 421 32 845 30 1289 Grand Total 81 291 354 1085 562 1785 544 2491

Source: CGPP program data

The CGPP project support 97 border health facilities in Kenya and 27 border health facilities in Somalia. The border health facilities are required to analyze their catchment populations needs and immunization coverage hence plan for two integrated outreach sessions in the facility micro-plans. This outreach clinics should target the nomadic and hard to reach population and other vulnerable populations e.g. minorities/IDPs. The community mobilizers and community volunteers conduct social mobilization in the outreach sites for maximum utilization of the services including sensitization on vaccine preventable diseases. Active case search for AFP is also integrated during social mobilization/community sen- sitizations. A reward of KES 1000 ($10) is given to any community mobilizer/community informants who reports a suspected AFP case that meets the lay case definition. The project supports a maximum of 12 cases per County/region.

During migration of the pastoralist, parents are advised to complete their immunization schedule for their children in health facilities along their migratory routes. Facility-incharges with the help of community mobilizers, also coordinate on children who have KENYA: Total # of children Defaulted = 2,408 Total # of children traced= 1,234 (51%) defaulted so that they can be traced to complete the uptake of the remaining antigens. SOMALIA: Total # of children Defaulted = 309 Total # of children traced= 158 (51%) Community Based Disease Surveillance on Human Alerts/Active Case Search

AFP Active case search by Country (01/01/2021- 14/02/2021) Country County # HH Visited # Suspected AFP

Garissa 716 3

Lamu 610 0

KENYA Mandera 1257 0

Marsabit 2559 1

Nairobi 5264 0

Turkana 3260 2

Wajir 992

Total 14,658 6

Bakool 561 0

Gedo 11278 0 SOMALIA Lower Juba 3962 0

Total 15,801 6

• In strengthening community disease surveillance, the community mobilizers conduct active surveillance visits to villages, nomadic settlements, traditional healers on the need to report suspected disease conditions e.g. AFP, Measles, Cholera/AWDs. Any suspected disease conditions immediately are reported to health facilities incharges and disease surveillance coordinators for follow up and veri- fications.

• The community mobilizers keep record of the all the suspected disease conditions reported to health facilities. Community Based Disease Surveillance on Priority Zoonotic Diseases.

Rumour and Zero Reports as from 01/10/2020 - 14/02/2021 Country County/Region Rumour Zero reporting Garissa 3 132 Lamu 15 71 Mandera 4 182 Marsabit 12 435 Kenya Nairobi 21 94 Turkana 20 2517 Wajir 20 1844 Total 95 5275 Bakool 0 0 Gedo 0 0 Somalia Lower Juba 0 0 Grand Total 95 5275 GLOBAL HEALTH SECURITY—PRIORITY ZOONOTIC DISEASES: (KENYA) • A total of 14 new animal alerts received this week with 1 suspected anthrax, 4 suspected brucellosis, 1 suspected rabies, 2 suspected RVF and 6 suspected trypanosomiasis.

• 17 new human diseases alerts reported this week: 11, acute watery diarrhea, 2 fever, cough and breathing problems, 1 cluster of unusual illnesses or death of people, 1 Death of a child btw 3-28 days of age with unknown cause and 2 hot- ness of the body and rash.

• Cumulatively, over the reporting period (01/10 to 14/02/2021) there have been an increase in progressive loss of weight, Cluster of abortions or deaths of young animals and aggressive animal bites having recorded 153, 58 and 51 alerts respectively with Marsabit County having the highest alert with 90 alerts for progressive loss of weight and 35 cluster of abortions. Rumors reported during the week: COVID-19 • 294 zero reports as well 5 rumor reports received from the community volun-

• “This unusual illness where everybody is sick is corona but Moyale is very hot and we Africans are strong teers this week. that is why we are not that serious like European.” Moyale, Marsabit county. Social Mobilization Activities

• Social mobilizations is to sensitize communities on the importance of personal iene,hyg regular handwashing, physical distancing and wearing of masks (especially in this period of COVID-19) in disease prevention at com- Summary: Social Mobilization Activities munity level. Also community mobilizers & Community Disease Reporters (CMs/CDRs) are looking for suspected AFP & Zoonotic cases using simplified lay case definitions to identify suspected AFP cases and other disease # of times HH visited # of children < 5 yrs. reached conditions ( e.g. measles, Acute Watery Diarrhea—AWDs). This is done through one to onemeeting at house- • Kenya = 18,090 Kenya = 19,838 hold level or group meeting organized at the community level. The community mobilizers are required to gen- - • Somalia = 12,302 Somalia = 14,552 erate reports to the project supervisors and also CHAs or border health facility in charges. • The CMs engage in community mobilization for RI services especially during outreach clinic sessions and in RI defaulter tracing. COVID-19 SITUATIONAL UPDATES. KENYA SOMALIA

C Counties supported by Confirmed cases. onfirmed 102,867 Regions supported by CGPP Confirmed cas- 5,632 Confirmed cases. cases CGPP

Nairobi Male cases 65,120 44,678 Male cases 4,168 Lower Juba 168 Mandera 107 Female cases 37,747 Female cases 1,464 Wajir 84 Gedo 41 Death 1,795 Death 179 (CFR=1.7%) Garissa 727

Turkana 993 Recoveries & 3,757 Bakool 8 Recoveries & 85,008 discharges discharges Marsabit 148 Lamu 314 A total 100,527 COVID-19 tests have A total 1,241,367 COVID-19 been conducted. tests have been conducted. Source: WHO Somalia Source: MoH Kenya

MEASLES OUTBREAK IN BADHADHE DISTRICT, LOWER JUBA SOMALIA

• There has been dramatic increase of cases of measles in Badhadhe district of Location Suspected Adult Children Death cases measles reported Lower Juba Somalia. The age group of the cases reported vary between the age cases of under 1 year to 70 years with a median of 3 years. Kulbiyo 125 37 87 1

• Of the total reported cases , about 60% are aged between one to five years. Hosingo 6 1 5 -

• Immunization coverage in these districts is less than 50% (data source: WHO Kudhaa 200 33 167 - weekly report) and needs to be heightened to alter the rise and increase of the Madowa 70 20 50 - Island disease. There is expectancy of increase of cases. Jula Island 240 60 180 -

• The table shows the different locations affected by the outbreak of measles Chuway 29 23 6 - island with one of the location already reporting 1 death case. COORDINATION MEETINGS DURING THE WEEK Date Venue Type of meeting Objective Outcome # Males # Females 2021-02-14 Mandera Community sensitization Sensitize community on unusu- Community sensitized, 10 15 al animal death with bleeding samples collected from sick and health cattle for further verification

2021-02-09 – Marsabit (Yaballo, Community dialogue Share information on rift valley Improved knowledge on 62 14 2021/02/12 Anona, Dambala fever and vaccine preventable vaccine preventable dis- Fachana) diseases eases and rift valley fever

2021-02-10 Lower Juba Review the immunization indi- Review the immunization indi- Reviewing the existing 9 1 cators in afmadow district and cators in Afmadow district and microplans and updating provide the necessary tech- provide the necessary tech- regularly. nical support nical support

JOINT SUPPORT SUPERVISION Date Type of Supervi- County Objective Key Findings # Dis- # Health facili- sion tricts ties visited Visited 08/02/2021- Joint supervision Marsabit To encourages • The vaccine monitor chart for 2021 was missing in all the 6 1 6 building of 014/02/2021 (Health & Vet) team approach- facilities. es that facilitate • Knowledge gap as the health facility incharges were last problem- solving. trained in 2018 • Data was well managed in this facility. • Three (3) out of the six facilities had their fridge tempera- tures which were irregular. 08/02/2021– Joint supervision Wajir Gaps in GIS mapping and verification of PZDs challenges and 2 2 014/02/2021 (Health & Vet) OJT was conducted. CHALLENGES PICTURE SPEAK

• Poor network connectivity in some areas

• Competing priorities affecting project planned activities due to Covid-19 pan- demic.

• Cases of community mobilizers have issues with their phone leading to late Animal RVF vaccination in reporting Sangailu Garisa County Photo credit, Olow - • Drought, insecurity and lack of essential drugs in some parts of Garissa AHA Hulugho sub county. county

PLANNED ACTIVITES

• Redistribution of essential drugs in some of the facilities in Garissa by the department of health.

• Integration of COVID-19 activities with the routine AFP, zoonotic and immunization Community • Repairing of phones to increase the levels of reporting. dialogue in yaballo • Supportive supervision and RDQA in Turkana West dispensary in Moyale, topics • Joint support supervision in Lamu East. covered trypanosomiasis and RVF. • Planning for Mop up SIA in Garissa County Photo credit, • Active case search (AFP, other Priority conditions & Zoonotic Priority disease) Jenipher-CRS

• Cross border meeting planned in Moyale