EMERGENCY AND HUMANITARIAN ACTION (EHA) WEEKLY UPDATE – WHO COUNTRY OFFICE ETHIOPIA: (Week 28, 6 – 12 July 2009) HIGH LIGHTS : • The nutritional situation in the surveyed woredas (Ayisha, Bare, Bokh, Degehabur, Filtu, Hamero and Kelafo) of Somali Region is generally considered as either serious or critical, with Global Acute Malnutrition (GAM) ranging from 14.5 to 21.9 per cent and Severe Acute Malnutrition (SAM) from 0.8 to 2.3 per cent. • According to official reports from the Federal Ministry of Health (FMOH), no new cases of Influenza A H1N1have been reported last week. The total confirmed cases in the country are still four. • According to official reports from the Federal Ministry of Health (FMOH), 567 new cases of AWD and five deaths (CFR of 0.9%) have been reported from Afar, Somali, Oromiya, Harari and SNNP Regions last week. I. GENERAL SITUATION : a) Political, social, security overview for the week • The overall security situation in the country remained stable during this week. No major security incidents involving humanitarian staff members have been reported. b) Main events of interest/ concern for health (displacements, conflicts, disease outbreaks, etc.) Food security and malnutrition • On 4 July, the Somali Regional Health Bureau (RHB) presented the findings of the nutrition assessments conducted between mid-April and mid-May in seven selected woredas across each of the region’s zones. The report cites a number of factors aggravating the situation, including acute water shortages, low access to safe water, sub-optimal immunization coverage, high childhood morbidity and dependence on relief food, as well as depletion of household coping mechanisms after years of successive droughts. • On overall relief food supply, WFP reports that the MV Eldore has made port in Djibouti and its cargo of 23,000 MT of wheat is now being off-loaded. Two other ships carrying food supplies for the NGO Joint Emergency Operation (JEOP) are at anchor, waiting for a berth. Together, WFP and the JEOP should have enough food for a fourth round of food distributions for the 4.9 million relief food beneficiaries in Ethiopia, although the distributions are unlikely to be completed until August due to continued transportation congestion. • WFP reports that, despite the continued break in its relief pipeline, there will be no reduction in July food rations for refugees following positive indications from the Ethiopian Food Security Reserve Administration (EFSRA) that another loan could be extended to cover August rations. The recent arrival of 112 MT of oil and expected delivery of locally purchased pulses in late July is expected to help reduce August shortfalls. However, WFP reports that salt and sugar will not be available for distribution, except in the Eritrean refugee camps where they are already in camp stocks. Delays in food deliveries will remain unavoidable in the next months, as trucking capacity shortages continue. Acute watery Diarrhoea (AWD) • According to official reports from the Federal Ministry of Health (FMOH), 567 new cases of AWD and five deaths (CFR of 0.9%) have been reported from Afar, Somali, Oromiya, Harari and SNNP Regions last week. A total of 23 districts have reported active cases from Afar, Somali, Oromiya, Haari and SNNP Regions in epidemic week 27. • A cumulative total of 1,876 AWD cases and 34 deaths (CFR 1.9%) have been reported from Afar, Somali, Oromiya, Harari and SNNP Regions from 8th June to 5th July 2009. A total of 23 districts have reported active cases from Afar, Somali, Oromiya, Harari and SNNPR Regions. One hundred and fifty seven cases and two deaths from five Woredas of Afar Region, 120 cases and 16 deaths from four Woredas of Somali Region, 1,347 cases and 15 deaths from 16 Woredas of Oromiya Region , 19 cases and no death from Harari Region 147 cases and one death from Konso special Woreda of SNNPR. See table 1 below. Table 1. Distribution AWD cases and death by epidemic week by region Ethiopia Week 24 Week 25 Week 26 Week 27 Week 24 - 27 Regions # Dist C D CFR # Dist C D CFR # Dist C D CFR # Dist C D CFR TOT_C TOT_D CFR Afar 3 130 2 1.5 3 5 0 0.0 3 5 0 0.0 5 17 0 0.0 157 2 1.3 Somali 3 34 6 17.6 3 61 6 9.8 4 15 4 26.7 4 10 0 0.0 120 16 13.3 Oromiya 16 130 2 1.5 16 204 3 1.5 14 519 5 1.0 12 490 5 1.0 1,343 15 1.1 SNNPR 1 27 1 3.7 1 27 0 0.0 1 55 0 0.0 1 38 0 0.0 147 1 0.7 Harari 1 3 0 0.0 1 2 0 0.0 1 2 0 0.0 1 12 0 0.0 19 0 0.0 National Total 24 324 11 3.4 24 299 9 3.0 23 596 9 1.5 23 567 5 0.9 1,786 34 1.9 Source: Federal Ministry of Health July 2009. 2 Influenza A H1N1update National trend Shows Acute Watery Diarrhea (AWD) Cases and Deaths as of 05 July 2009 600 550 90 500 450 75 400 350 60 300 250 45 200 Number of Cases 30 150 Number of Deaths 100 15 50 0 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 Analysis: WHO - Ethiopia EHA and DPC Units Epidemic Weeks Data Source: FMOH-Ethiopia Date of Production: Cases Deaths Source: Federal Ministry of Health July 2009. • According to official reports from the Federal Ministry of Health (FMOH), no new cases of Influenza A H1N1have been reported last week. The total confirmed cases in the country are still four. The national technical working group is updating the National Influenza Pandemic Preparedness and response plan in view of the current pandemic phase. WHO supported the orientation of health workers on case management protocols. Daily coordination meetings continue at the FMoH chaired by the Minister with support from WHO. WHO and partners support for government in: • Reinforcing communication of appropriate messages and health promotion actions, mobilizing communities for preparedness and response. • Facilitated training for 105 health workers (health officers, nurses, laboratory technicians, physicians and environmental health officers) in Addis Ababa city administration for preparedness and response. • Reinforcing influenza surveillance by designating 30 major public health facilities (hospitals) in the country as surveillance centre – central and regional levels. FMOH distributed antiviral (Tamiflu) drugs to identified reference hospitals in the regions and to the 11Regional Health Bureaus. II. ANALYSIS & HEALTH CONSEQUENCES: Health problems & Needs of affected populations. Food insecurity and malnutrition • In Somali Region Nutrition Assessment, the GAM and SAM rates respectively for the specific woredas surveyed are as follows: 14.5 and 0.8 in Filtu woreda, Liben zone; 15.2 and 1.8 in Ayisha woreda, Shinile zone; 16.3 and 1.1 in Bare woreda, Afder zone; 18.2 and 2.3 in Kelafo woreda, Gode zone; 18.4 and 2.2 in Hamero woreda in Fik zone; 21.4 and 3.3 in Bokh woreda, Warder zone; and 21.9 and 2.2 in Degehabur woreda, Degehabur zone. The findings also indicate that the crude mortality rate is high in Degehabur and very low in Hamero, while the under-five mortality rate is very high in Bokh 3 and very low in Hamero. On the basis of these results, the situation is critical in Bokh and Degehabur woredas and serious in Kelafo, Hamero, Bare and Ayisha woredas. Meanwhile, the nutrition situation in Filtu was deemed ‘poor’, on the border of ‘serious’. While the report emphasizes that the findings are not representative, they may be indicative of the situation in similar livelihoods zones, assuming homogeneity of lifestyle and particular conditions. The report further suggests that the poor performance of the gu rains in 2009 will lead to further deterioration in food security and nutritional and health conditions, particularly among the most vulnerable members of society in the most affected areas of the region. Rabies Acute Watery Diarrhoea (AWD) • The technical committee of the Emergency Health and Nutrition Task Force continues to meet with secretariat support from WHO. Reports from Oromia, SNNPR, Afar and Harari indicated that AWD infection is spreading to new districts. • The absence of clean safe water supply, proper sanitation facilities, medical care and very poor and overcrowded living conditions in the state farms and holy water sites serves as an appropriate foci of infection for AWD transmission within the regions and other areas of the country. WHO and partners are addressing this issue at federal and regional level. Case treatment Center Marti Woreda, Gulgota Kebele 11/07/09 III. ACTIONS (in relation or response to the issues mentioned above): a) WHO activities (field trips, assessments, gap filling, coordination, information sharing, training, etc.) & needs (Human resources, material, and infrastructure) and other partners support. Food insecurity and malnutrition • This week WHO has continued its technical support to regions in responding to food and nutrition crisis in Ethiopia. To strengthen the nutrition response, the Government, with WHO and UNICEF support, have organized a Training of Trainers on OTP rollout for 64 MOH and NGO workers from Oromiya, Amhara and SNNPR on 2 nd and 3 rd . July 2009. Acute watery Diarrhoea (AWD) • WHO continues to provide technical support to the affected regions of Somali, Oromia, SNNPR, Afar and Harari through provisions of emergency drug kits to government and NGO partners, supporting assessment, assist in monitoring and supervision and strengthening surveillance activities. In addition support for emergency health response coordination activities are being supported through information sharing, working Cross woreda meeting Marti and Bo sat woreda , 11/07/09 together and sharing plans and resources.