1704713 Consultations from Week 1 to Week 30. • 6018 Cumulative

Early Warning Disease Surveillance and Response Bulletin, Somalia 2018 Epidemiological Week 30 (Week ending 29th July, 2018)

Highlights Cumulative figures as of week 30  286 (73%) health facilities across Somalia  1,704,713 consultations from submitted weekly reports of epidemic-prone week 1 to week 30. diseases in the electronic early warning alert  6,018 cumulative cases of and response network (EWARN) system in AWD/Cholera and 41 deaths week 30.  Total number of consultations increased from (CFR 0.7%) since December 58,449 in week 29 to 69,519 in week 30. 2017.  A total of 432 alerts were received. 21 of these  9,715 cumulative alerts were alerts were confirmed as true alerts in week received, 553 of these, were 30. confirmed as true alerts from  The highest numbers of diseases reported in week 1 to week 30, 2018. week 30 were other acute diarrhoeas (2,083  6,326 cumulative cases of cases), influenza like illness (1,656 cases) and severe acute respiratory illness (689 cases). suspected measles cases since the beginning of 2018. Of the  A total of 50 new cases of suspected AWD/cholera with no deaths were reported 6,326 measles cases, 4,203 in week 30 compared to 88 AWD cases with 1 (66%) were under 5 years while death in week 29. 2,123 (34%) were above 5 years.  A cumulative total of 6,018 AWD/cholera  8,260 cumulative cases of 1 cases , including 41 deaths have been Malaria were reported since the reported since December 2017. beginning of 2018, 3,574 (43%)  The number of reported measles cases increased from 54 in week 29 to 71 cases in were under 5 years, while 4,686 week 30. (57%) were above 5 years.

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 Page 1 of 23

Table 1. Summary of Alerts for epidemic prone diseases

Disease Wk27 2018 Wk28 2018 Wk29 2018 Wk30 2018 Cumulative cases (Wk 1 – 30, 2018) Total consultations 51625 54605 58449 69519 1,704,713 Other Acute Diarrheas 2486 2306 2045 2083 70429 Influenza Like Illness 1342 1245 1151 1656 49,880 Severe Acute Respiratory Illness 1173 1559 912 689 29,847 Confirmed Malaria 189 431 296 340 8260 Suspected Measles 61 52 54 71 6326 Bloody Diarrhea 62 144 83 94 2619 Acute Watery Diarrhoea 13 24 37 2 2062 Whooping Cough 45 74 53 64 1475 Acute Jaundice 7 5 5 3 130 Suspected Meningitis 3 2 6 1 88 Diphtheria 0 3 9 6 63 Neonatal Tetanus 0 0 0 0 23 Viral Hemorrhagic Fever 1 0 0 15 20 Acute Flaccid Paralysis 0 0 1 1 15

Completeness of Reporting & Reporting Rate Of the 392 health facilities in the EWARN system, 286 health facilities submitted their weekly reports on time in week 30 across the country. The national surveillance completeness rate Fig. 1a: Completeness of Reporting of EWARN Facilities was 73% in the week which is below the

Caluula

Qandala

Bossaso Zeylac minimum requirement (80%). Apart from

Lughaye

Laasqoray

Berbera ± Iskushuban Baki Ceerigaabo

Borama Ceel Afweyn

Sheikh Gebiley Somaliland which exceeded the minimum

Hargeysa Qardho

Caynabo Owdweyne Bandarbeyla Burco Xudun Taleex target, none of the other states including

Garoowe Buuhoodle Laas Caanood

Eyl Burtinle Banadir region have reached the 80%

Jariiban

Galdogob Gaalkacyo minimum requirement (fig. 1a & 1b).

Cadaado

Hobyo

Cabudwaaq Dhuusamarreeb All the 77 active health facilities in Somaliland

Xarardheere Ceel Buur Belet Weyne Ceel Barde Legend

Rab Dhuure Xudur Somalia_Coastline_Extended Ceel Dheer Doolow Bulo Burto

Waajid Tayeeglow Somalia_Neighbouring_Countries_Polygon Luuq have submitted reports in week 30. In

Adan Yabaal Somalia_Sea_Cover Belet Xaawo Jalalaqsi

Baydhaba Garbahaarey Completeness of reporting (%)

Cadale Jowhar 0/No Data Qansax Dheere Wanla Weyn Ceel Waaq Puntland, 72(79%) health facilities of the 91 1 - 58.3

Buur Hakaba Balcad 58.4 - 81.8 Afgooye

Baardheere Banadir Diinsoor 81 - 100 Qoryooley

Marka Kurtunwaarey Saakow active health facilities submitted reports in

Sablaale

Bu'aale Baraawe

Heliwa

Dayniile

Afmadow Jilib Yaaqshid Karaan Wardhigley week 30, whilst in South central, 137 (61%) Hawl Wadaag Shibis Hodan BondhereCabdulasiis

Jamaame Hamar Weyne Hamar Jabjab Waaberi Wadajir (Medina) Dharkenley Kismaayo health facilities of 224 active health facilities

Badhaadhe

0 45 90 180 270 360 submitted reports in week 30. Challenges to Miles completeness of the reporting include; 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 has already completed the cascade training.

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Fig 1b: Completeness of reporting from EWARN sites, week 30, 2018 100 90 80 70 60 50 40 30 20 10

Bay

Bari

Sool Sool

Gedo

Hiran

Bakol

Sanag Sanag

Awdal

Nugal

Mudug Mudug

Banadir

Togdher

Jubaland

Puntland

Galgadud

Galmudug

Southwest

Somaliland

Hirshabelle

Lower Jubba

MiddleJubba

WaqoyGalbed

Lower Shabelle MiddleShabelle Banadir Somaliland Puntland Galmudug SouthWest Jubaland Hirshabelle

Received (%) Target(%)

Fig 1c: Completness of reporting

Somaliland Puntland SCZ

100

27 28 29 30 Percentage Percentage of submitted theHFs report 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 30, the highest numbers of diseases were other acute diarrhoeas (2,083 cases), influenza like illness (1,656 cases), severe acute respiratory illness (689 cases), Confirmed Malaria (340 cases), bloody diarrhoea (94) and Suspected measles (71 cases).

Page 3 of 23

Fig 2: Commonest Causes of Morbidity during Week 1 to 30

2,500 2,000 1,500 1,000 500 0 Wk27 Wk28 Wk29 Wk30

other acute Diaria influence like illness Severe Acute Respiratory Illness Suspected Measles Confirmed Malaria

AWD/Cholera situation in Somalia

Generally, the AWD/cholera cases have been on the decline for the past four weeks (fig 3b) and cases are Fig 2. 3a Districts: Districts Reporting reporting Cases in Week 29, 2018 localized in Lower Juba and Banadir regions. The cholera spread is expected to increase due to the floods that have led to contamination

Somaliland of water sources in the flood affected regions. Floods have also led to

Puntland blockage of access of health services which contribute to delayed health seeking by the affected populations with. Over the past 2 Legend Districts Galmudug State AWD/Cholera Cases_WK29 weeks, there has been decrease in the number of AWD/Cholera cases No Case 1 - 10 Cases 11 - 25 Cases Hir-Shabelle State reported in Middle Shabelle, Banadir and Lower Jubba; the regions 26 - 47 Districts Affected by Floods South West State Floods th Major_Rivers that are affected by floods. In week ending 29 July, active Banadir Heliwa Dayniile Coastline Yaaqshid Jubaland State Karaan HodanWardhigley .! Shibis Hawl WadaagCabdulasiis transmission of AWD/cholera was reported in Kismayo district in Wadajir (Medina)Waaberi Dharkenley µ Lower Jubba, as well in 9 districts of Banadir region (Darkenly,

0 45 90 180 270 360 Miles Daynile, Hodan, Madina, Abdiazis, Hamarjabjab, Wardhigley, Heliwa,

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. Karaan districts) (fig 3a). In Kismayo, affected communities especially in Farjano IDP are reportedly using contaminated water due to floods. As shown in table 2, there was a decrease in the number of cases reported from 88 in week 29 to 50 in week 30. The Oral Cholera Vaccination that was implemented in 11 high risk 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(fig3b).

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Fig 3b. AWD/Cholera cases in Somalia July 2017-July 2018 450 4.0 400 Cases Total Deaths CFR (%) 3.5 350 3.0 300 2.5 250 2.0 200 150 1.5 100 1.0 50 0.5

0 0.0

week 2 week 4 week 6 week 8 week

week 16 week week 10 week 12 week 14 week 18 week 20 week 22 week 24 week 26 week 28 week 30 week

Week 32 Week 50 Week Week 30 Week 34 Week 36 Week 38 Week 40 Week 42 Week 44 Week 46 Week 48 Week 52 Week NumberofAWD/Cholera cases Aug.17 Sep.17 Oct.17 Nov.17 Dec.17 Jan-18 Feb-18 Mar.18 April.18 May.18 June.18 Jul.18

Epi-week

Table 2. Summary of AWD/Cholera cases in different regions

Week 29 Week 30 Cumulative as of th States Regions Ending 22th July 18 Ending 29th July 18 29 July 2018

Cases Deaths CFR (%) Cases Deaths CFR (%) Cases Deaths CFR (%)

Banadir 33 1 3 23 0 0 2,351 19 0.8

Jubba land L. Jubba 47 0 0 27 0 0 2,250 15 0.7

South west L. Shabelle 0 0 0 0 0 0 294 4 1.4

M. Shabelle 8 0 0 0 0 0 558 2 0.4 Hir-shabele Hiraan 0 0 0 0 0 0 565 1 0.2

Total 88 1 3 50 0 0 6,018 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 region which includes 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, 9 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 33 including 1 death to 23 cases no death in the past 2 weeks. More than 57% of the AWD cases reported in Banadir are children below 2 above 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 has decreased from 47 and no deaths to 27 no death. More than 37% of the cholera cases reported from Lower Jubba are children below 2 above years.

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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 Jowhar of Middle Shabelle (Table 3).

Table 3. AWD/Cholera cases in different districts Week 30 Cumulative Week 49/17-week 30/18 Region District Cases Deaths <2 2 -5 ≥ 5 ≥ 5 CFR <2 yrs 2-5yrs Cases Deaths yrs yrs yrs yrs (%)

Darkenley 1 1 1 0 0 0 386 1 0.3

Daynile 1 0 2 0 0 0 422 7 1.7 HamarJabja 0 0 1 0 0 0 148 2 1.4

Hawlwadag 0 0 0 0 0 0 107 1 0.9

Hodan 4 1 2 0 0 0 506 2 0.4 Karaan 1 0 1 0 0 0 42 1 2.4 Madina 0 0 3 0 0 0 383 2 0.5 Banadir Waberi 0 0 0 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 1 0 0 0 4 0 0

HamarWeine 0 0 0 0 0 0 46 0 0

Heliwaa 1 0 0 0 0 0 23 0 0

Wardigley 0 0 2 0 0 0 99 1 1

Yaqshid 0 0 0 0 0 0 55 0 0

Middle Jowhar 0 0 0 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 9 10 8 0 0 0 2,250 15 0.7 Jubba× Total 17 12 21 0 0 0 6,018 41 0.7

Page 6 of 23

Response activities implemented during week 30, 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 Marka (Ayuub Health Centre, CTCs, Kismayo hospital Jowhar hospital CTC and Farjano CTU Surveillance and Laboratory Investigations

 A Total of 23 new cases were treated at Banadir HOSP-CTC, from 23-29July 2018, there were no deaths. These new 23 cases from 9 different Districts in Mogadishu, Banadir Region  The total new alerts was 23 cases, no rumour was verified.  Total of 27cases have been recorded in week 30, from Kismayo hospital CTC and Farjano CTU. There is significant slowdown due to offensive WASH response Water Sanitation, Hygiene and risk communication

 Chlorination of water sources in affected areas Hnati-wadaag, and Bulo-sheikh have been made  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 Fanolehave 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

Page 7 of 23

Measles Situation

The number of suspected measles cases slightly increased from 54 cases in week 29, to 71 cases in

Districts Reporting Measles Cases in Week 30 week 30. Cumulatively, 6,326 cases of suspected

Caluula measles have been reported across Somalia since

Qandala

Zeylac Bossaso

Lughaye Laasqoray Berbera Iskushuban Baki Ceerigaabo Borama Ceel Afweyn Sheikh Gebiley the beginning of 2018. Of the 6,326 measles cases,

Hargeysa Somaliland Qardho Caynabo Owdweyne Bandarbeyla Burco Xudun Taleex

Puntland Buuhoodle Laas Caanood Garoowe 4,203 (66%) were under 5 years while 2,123 (34%)

Eyl

Burtinle

Jariiban Galdogob were above 5 years. The most affected districts Gaalkacyo

Cadaado Cabudwaaq Hobyo include; Abudwak (709 cases), Huruwa (470 cases), Dhuusamarreeb

Galmudug State

Ceel Buur Xarardheere Ceel Barde Belet Weyne Legend

Rab Dhuure Xudur Districts Reporting Measles Cases in Week 30 Lascanod (350 cases), Baidoa (361 cases), Adado Ceel Dheer Doolow Bulo Burto Waajid Tayeeglow 0/No Data Luuq Hir-Shabelle State Adan Yabaal Belet Xaawo Jalalaqsi 1 - 3 Cases Baydhaba Garbahaarey Cadale 4 - 7 Cases South West State Jowhar Qansax Dheere Wanla Weyn (293 cases), Galkacyo (274 cases), Wadajir (246 Ceel Waaq 7- 14 Cases Buur Hakaba Balcad

Afgooye Districts affected by Floods Baardheere Diinsoor Banadir

Qoryooley Banadir Marka Major_Rivers Kurtunwaarey Saakow Jubaland State Sablaale Coastline cases), Burao (209 cases) and Marka (193 cases). Bu'aale

Baraawe

Jilib Afmadow Heliwa Dayniile Yaaqshid Jamaame Karaan Wardhigley Banadir As shown in fig 4b below, the trends of measles Afgooye Hodan Shibis Kismaayo Hawl Wadaag

µ Badhaadhe Wadajir (Medina)Waaberi Dharkenley cases have continued to decrease in all the regions 0 45 90 180 270 360 Miles

Fig 4b: Measles Situation in Somalia from Week 1 to Week 30, 2018

South & Central Zone Somaliland Puntland

500 450 Measles Measles vaccination 400 vaccination implemented in SL & 350 in PL 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 30 Epi-Week

Page 8 of 23

Fig 4c. Districts reporting highest cases of Measles across Somalia from Wk1 - Wk30, 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 - 30, 2018 Wk27 Wk28 Wk29 Wk30 Cumulative cases (Wk 1 – Region 2018 2018 2018 2018 30) Awdal 0 1 0 0 13 Bakool 2 1 4 5 133 Banadir 7 0 2 5 901 Bari 0 0 - 0 92 Bay - 19 15 26 1019 Galgaduud 0 3 - 0 1092 Gedo 0 1 0 0 66 Hiraan 14 3 6 3 188 Lower Juba 18 7 9 5 323 Lower Shabelle 2 0 6 9 337 Middle Juba 9 7 5 10 178 Middle Shabelle 0 3 3 0 159 Mudug 7 5 0 7 632 Nugaal 0 0 - - 183 Sanaag 0 0 0 0 159 Sool 0 0 0 0 368 Togdher 2 2 1 0 232 Waqoyi Galbed 0 0 3 1 251 Grand Total 61 52 54 71 6326 Dash means there is no weekly Data/report submitted on the system during the specified reporting period.

Page 9 of 23

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. Malaria Situation in Somalia The number of Malaria cases decreased from 296 cases in week 29 to 340 cases in week 30. Districts Reporting Malaria Cases in Week 30 Cumulatively, 8,260 cases of Malaria cases have been

Caluula

Qandala Zeylac Bossaso reported across Somalia since the beginning of 2018. Of Lughaye Laasqoray Berbera Baki Ceerigaabo Iskushuban Borama Ceel Afweyn Sheikh Gebiley

Hargeysa Somaliland Qardho Caynabo Owdweyne Bandarbeyla the 8,260 malaria cases, 3,574 (43%) are under 5 years Burco Xudun Taleex

Puntland

Buuhoodle Laas Caanood Garoowe

Eyl Burtinle while 4,686 (57%) are above 5 years. The most affected

Jariiban Galdogob Gaalkacyo

Cadaado districts include; Baidoa district of Bay (1,589 cases), Cabudwaaq Hobyo

Dhuusamarreeb

Galmudug State Legend

Ceel Buur Xarardheere Ceel Barde Belet Weyne District reporting malaria cases in week 30 Wadajir district in Banadir (743 cases), Marka district of

Rab Dhuure 0/ No Data Xudur Ceel Dheer Doolow Bulo Burto Waajid Tayeeglow 1 - 35 Cases Luuq Hir-Shabelle State Adan Yabaal Belet Xaawo Jalalaqsi 36 - 75 Cases Baydhaba Garbahaarey Cadale 75.- 98 Cases South West State Jowhar Lower Shabelle (602 cases), wajid district of Bakol (447 Qansax Dheere Wanla Weyn Ceel Waaq Districts affected by Floods Buur Hakaba Balcad

Afgooye Major_Rivers Baardheere Diinsoor Banadir Qoryooley Banadir Coastline Marka Kurtunwaarey Saakow cases), Berdale district of Bay (540 cases) Adado district of Jubaland State Sablaale Bu'aale Heliwa Baraawe Dayniile Yaaqshid Afmadow Jilib Karaan Wardhigley Banadir Afgooye Hodan Shibis Jamaame Hawl Wadaag Galgadud (410 cases), Bal’ad district of Middle Shabelle Wadajir (Medina)Waaberi Kismaayo Dharkenley

µ Badhaadhe (352 cases) and Hudur district of Bakol (282 Cases). 0 45 90 180 270 360 Miles

Fig 5b: Malaria Situation in Somalia from Week 1 to Week 30, 2018 500 450 400 350 300 250 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 30 Epi-week

SC Zone Somaliland Puntland

Page 10 of 23

Fig 5c: Districts Reporting Highest Cases of Malaria Across Somalia from Wk1-30, 2018 1500 1000 500 0 Wadajir Adado Bal'ad Baidoa Berdale Huddur Marka Waajid Banadir Galmudug Hirshabelle SouthWest

Cases >5 Cases<5

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 29 were 2,045 compared to 2,083 cases in week 30. Cumulatively, 70,429 cases of OAD cases have been reported across Somalia since the beginning of 2018. Of the 70,429 OAD cases, 52,966 (75%) are under 5 years while 17,463 (25%) are above 5 years. The most affected districts include; Marka District of Lower Shabelle (4,957 cases), Beletweyn district of hiran (4,511 cases), Huruwa district of Banadir (3,354 cases), Wadajir district of Banadir (2,329 cases), Dharkinley of Banadir (2,116 cases) and Jowhar of Middle Shabelle (2075 Cases).

Fig 6a: Trends of Other Acute Diarrhoea cases in Somalia from Week 1-30, 2018 3000

2000

Cases 1000

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 30 Epi-week

SC Somaliland Puntland

Fig 6b: Districts Reporting highest cases of OAD Across Somalia from Wk1-30, 2018 4000

3000

2000

1000

0 Dharkinley Huruwaa Wadajir Belet Weyne Bulo Burto Jowhar Baidoa Kurtunwarey Marka Banadir Hirshabelle Southwest

Cases >5 Cases<5

Page 11 of 23

Bloody Diarrhea Situation in Somalia The number of BD cases has increased from last week, the cases in Week 29 were 83 compared to 94 cases in week 30. Cumulatively, 2,619 cases of BD cases have been reported across Somalia since the beginning of 2018. Of the 2,619 BD cases, 1,403 (53%) are under 5 years while 1,216 (47%) are above 5 years. The most affected districts include Baidoa of Bay (439 cases), Burhakaba of Bay (274 cases), Hargeisa of Waqoy Galbeed (161 cases), and Buhodle of Togdheer (174 cases).

Fig 7a: Trends of Bloody Diarrhea cases in Somalia from Week1-30, 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 30 Epi-week

SC Somaliland Puntland

Fig 7b: Districts Reporting the Highest Cases of Bloody Diarrhea Across Somalia

300

250 Cases >5 Cases<5 200

150 100 50

0 Afmadow Kismayo Luuq Buhodle Gabiley Hargeisa Baidoa Burhakaba Waajid Jubaland Somaliland SouthWest

Page 12 of 23

Whooping Cough Situation in Somalia

Fig 8a. Districts Reporting Whooping Cough Cases in Week 30 The number of WC cases has also been floatingly going

Caluula up and down for the last four weeks, the cases in Week Qandala Zeylac Bossaso

Lughaye Laasqoray Berbera Baki Ceerigaabo Iskushuban Borama Ceel Afweyn Sheikh Gebiley

Hargeysa Qardho 29 were 53 compared to 64 cases in week 30. Somaliland Caynabo Owdweyne Bandarbeyla Burco Xudun Taleex

Puntland

Buuhoodle Laas Caanood Garoowe

Eyl Burtinle Cumulatively, 1,475 cases of WC cases have been

Jariiban Galdogob Gaalkacyo

Cadaado Cabudwaaq Hobyo reported across Somalia since the beginning of 2018. Of

Dhuusamarreeb

Galmudug State Legend

Ceel Buur Xarardheere Ceel Barde Belet Weyne WC

Rab Dhuure 0/No Data Xudur the 1,475 WC cases, 1,136 (77%) are under 5 years while Ceel Dheer Doolow Bulo Burto Waajid Tayeeglow 1 - 10 Case Luuq Hir-Shabelle State Adan Yabaal Belet Xaawo Jalalaqsi 11 - 20 Cases Baydhaba Garbahaarey Cadale 21 - 30 Cases South West State Jowhar

Qansax Dheere Wanla Weyn Ceel Waaq Districts affected by Floods Buur Hakaba Balcad 339 (23%) are above 5 years. The most affected districts

Afgooye Major_Rivers Baardheere Diinsoor Banadir Qoryooley Banadir Coastline Marka Kurtunwaarey Saakow

Jubaland State Sablaale Bu'aale Heliwa Baraawe Dayniile Yaaqshid include Galkacyo (344 cases), Jilib (170 cases), Berbera Afmadow Jilib Karaan Wardhigley Banadir Afgooye Hodan Shibis Jamaame Hawl Wadaag

Wadajir (Medina)Waaberi Kismaayo Dharkenley

µ Badhaadhe (94 cases), Erigavo (72 cases), Buale (77 cases) and

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 Adaado (77 Cases). 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 Week1-30, 2018 100

Cases 40

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 30 Epi-week

SC Somaliland Puntland

Fig8c: Most affected Districts by Whooping Cough in Somalia from Wk1-30, 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

Page 13 of 23

Other Common Causes of Morbidity 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 29 were 912 compared to 689 cases in week 30. Cumulatively, 29,847 cases of SARI cases have been reported across Somalia since the beginning of 2018. Of the 29,847 SARI cases, 17,911(60%) are under 5 years while 11,936 (40%) are above 5 years. The most affected districts include Beletweyne (4,899 cases), Buloburte (2,404 cases), Abudwak (1,659 cases), Yaqshid (1,515 Cases), Wadajir (1,464 cases), and Huruwa (1,482 cases).

Fig 9a: Trends of SARI cases in Somalia from Week1-30, 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 30 Epi-week

SC Somaliland Puntland

Fig 9b: Districts Reporting the Highest Cases of SARI across Somalia from Wk1-30, 2018

Cases <5 Cases >5

3000

2500

2000

1500

1000

500

0 Huruwaa Wadajir Yaqshid Abudwak Adado Dhuusamarreeb Belet Weyne Bulo Burto Jalalaqsi Banadir Galmudug Hirshabelle

Page 14 of 23

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 29 were 1,151 compared to 1,656 cases in week 30. Cumulatively, 49,880 cases of ILI cases have been reported across Somalia since the beginning of 2018. Of the 49,880 ILI cases, 29,606 (59%) are under 5 years while 20,274 (41%) are above 5 years. The most affected districts include Borama (5,571 cases), Huruwa (3,364 cases), Beletweyne (3,648 cases), Lascanod (3,510 cases), Berbera (3,128 cases) Wadajir (1,598 cases) and Dharkenley (1,227 cases).

Fig10a: Trends of ILI cases in Somalia from Week 1-30, 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 30 Epi-week

SC Somaliland Puntland

Fig10b: Districts REporting Highest Cases of ILI across Somalia from Wk 1-30, 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 30, 2018

# of HFs submitted report in Completeness of reporting State Region District # of active HFs to submit report week30 (%) Abdiaziz 1 0 0 Boondhere 1 1 100 Dayniile 4 1 25 Dharkinley 4 4 100 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 3 75 Shangani 1 1 100 Shibis 1 1 100 Waberi 1 1 100 Wadajir 9 1 11 Wardhigley 4 0 0 Yaqshid 5 5 100 Subtotal of Banadir 47 26 55 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 Alula 1 1 100 Banderbayla 3 3 100 Bossaso 8 7 88 Bargal 1 1 100 Carmo 1 2 200 Bari Hafun 2 1 50 Iskushuban 1 1 100 Qardho 4 3 75 Rakko 3 1 33 Ufeyn 1 1 100 Waciya 2 1 50 Galdogob 9 6 67 Mudug Galkacyo 16 12 75 Puntland Jariiban 4 3 75 Burtinle 6 6 100 Dangorayo 1 1 100 Nugal Eyl 5 4 80 Garoowe 6 2 33 Badhan 6 6 100 Dhahar 3 3 100 Sanag Lasqoray 1 1 100 Xingalol 1 1 100 Bocame 2 2 100 Hudun 2 1 50 Sool Lasacanod 1 0 0 Taleex 2 2 100 Subtotal of Puntland 91 72 79 Galmudug Galgadud Abudwak 4 2 50

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Adado 4 4 100 Balanbale 1 1 100 Dhuusamarreeb 3 2 67 Guriel 1 1 100 El Bur 1 0 0 El Dere 2 2 100 Gelinsor 1 1 100 Galkacyo 6 6 100 Mudug Hobyo 13 12 92 Harardhere 4 0 0 Subtotal of Galmudug 40 31 78 Belet Weyne 10 9 90 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 6 50 Middle Jowhar 6 6 100 Shabelle Mahaday 3 1 33 Warsheikh 5 3 60 Subtotal of Hirshabelle 48 32 67 B/hawo 2 1 50 Baardhere 1 0 0 Doolow 2 1 50 Gedo Elwak 1 0 0 Garbahaarey 2 1 50 Gedweyne 1 0 0 Jubaland Luuq 3 1 33 Afmadow 2 0 0 Lower Hagar 2 0 0 Juba Jamaame 2 1 50 Kismayo 11 6 55 Middle Bu,aale 2 1 50 Juba Jilib 3 1 33

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Salagle 1 1 100 Subtotal of Jubaland 35 14 40 Afgoi 5 3 60 Kurtunwarey 3 2 67 Lower Marka 12 7 58 Shabelle Qoryooley 2 1 50 Wanla Weyn 2 1 50 Elberde 3 3 100 SouthWest Huddur 2 2 100 Bakool Tayeeglow 1 1 100 Waajid 3 3 100 Baidoa 13 6 46 Berdale 3 1 33 Bay Burhakaba 3 2 67 Qansahdere 2 2 100 Subtotal of Southwest 54 34 63 Grand Total 392 286 73

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Table 6. Cumulative Summary of Epidemic-prone Diseases in different Districts of Somalia as of Week 1-30, 2018

Regions District SARI ILI AWD BD OAD DIPH WC MEAS NNT AFP AJS VHF MAL MENG OC Total_cons Total 0 9045 11 153 4352 0 0 13 0 0 0 0 58 2 36673 50336 Baki 0 1186 0 67 313 0 0 0 0 0 0 0 0 0 3309 4875 Awdal Borama 0 5571 11 83 3023 0 0 8 0 0 0 0 41 0 24084 32849 Lughaya 0 201 0 2 250 0 0 0 0 0 0 0 0 0 1885 2338 Zeila 0 2087 0 1 766 0 0 5 0 0 0 0 17 2 7395 10274 Total 243 148 0 100 597 0 20 133 0 0 0 1 820 2 66997 69061 Elberde 0 48 0 2 153 0 1 0 0 0 0 0 0 0 11096 11300 Bakool Huddur 63 5 0 13 111 0 0 1 0 0 0 0 282 0 9652 10127 Tayeeglow 44 47 0 3 55 0 0 6 0 0 0 1 91 2 1753 2002 Waajid 136 48 0 82 278 0 19 126 0 0 0 0 447 0 44496 45632 Total 5799 8520 926 65 13741 0 9 901 0 1 0 0 783 12 375307 408755 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 25 0 0 0 0 0 0 7030 7323 Dayniile 30 180 0 0 289 0 0 7 0 0 0 0 1 0 13818 14353 Dharkinley 635 1227 2 1 2116 0 0 56 0 0 0 0 1 0 23254 27551 Hamar Jab Jab 240 668 0 4 612 0 1 11 0 0 0 0 1 0 15589 17126 Hamar Weyne 127 475 0 0 1128 0 0 11 0 0 0 0 0 0 12582 14323 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 39654 40077 Banadir Huruwaa 1482 3364 15 6 3354 0 0 470 0 1 0 0 3 12 39531 49769 Kaaraan 10 69 0 0 47 0 0 1 0 0 0 0 0 0 17534 17661 Kahda 126 589 0 0 413 0 0 1 0 0 0 0 10 0 4789 5948 Shangani 149 145 0 0 137 0 0 0 0 0 0 0 0 0 589 1078 Shibis 0 0 0 0 578 0 0 11 0 0 0 0 2 0 8907 9525 Waberi 0 0 0 0 33 0 0 0 0 0 0 0 0 0 19780 19813 Wadajir 1464 1598 886 5 2329 0 2 246 0 0 0 0 743 0 84672 91945 Wardhigley 18 1 0 30 1450 0 6 34 0 0 0 0 15 0 44584 46138 Yaqshid 1515 89 0 19 806 0 0 22 0 0 0 0 0 0 24656 27444 Total 107 1020 5 10 698 0 0 92 0 0 0 0 340 0 51460 63312 Bari Alula ------66 77 Bandarbayla 61 153 1 0 31 0 0 1 0 0 0 0 0 0 1382 1656

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Bargal 61 78 Bossaso 46 847 3 0 345 0 0 28 0 0 0 0 331 0 27163 38096 Carmo 0 6 0 0 4 0 0 0 0 0 0 0 2 0 921 996 Hafun 0 0 0 0 51 0 0 0 0 0 0 0 0 0 2462 2513 Iskushuban 0 7 0 1 5 0 0 0 0 0 0 0 0 0 691 748 Qardho 0 0 0 9 169 0 0 45 0 0 0 0 6 0 11161 11434 Rakko 0 0 1 0 73 0 0 18 0 0 0 0 1 0 3243 3339 Ufeyn 0 7 0 0 2 0 0 0 0 0 0 0 0 0 496 543 waciya 0 0 0 0 18 0 0 0 0 0 0 0 0 0 3814 3832 Total 1450 3504 62 851 2238 31 93 658 1 0 1 0 2309 6 102296 113586 Baidoa 1302 2052 47 439 1460 25 49 361 0 0 1 0 1589 6 85742 93159 Bay Berdale 43 427 6 88 105 0 31 81 0 0 0 0 540 0 5470 6791 Burhakaba 71 388 8 274 378 0 11 210 1 0 0 0 68 0 6299 7708 Qansahdere 34 637 1 50 295 6 2 6 0 0 0 0 112 0 4785 5928 Total 5036 2082 200 5 1253 0 217 1453 1 0 3 0 1179 9 70178 81723 Abudwak 1659 588 0 0 329 0 33 709 1 0 0 0 233 4 15877 19433 Adado 1070 593 12 1 304 0 77 293 0 0 3 0 410 2 12484 15356 Balanbale 428 239 0 1 53 0 18 129 0 0 0 0 85 0 3256 4209 Galgadud Dhuusamarreeb 1009 355 10 2 222 0 28 160 0 0 0 0 204 0 21766 23756 El Bur 24 6 178 0 38 0 0 34 0 0 0 0 17 0 533 830 El Dere 610 206 0 1 242 0 24 64 0 0 0 0 131 3 12958 14239 Gelinsor 236 95 0 0 65 0 37 64 0 0 0 0 99 0 3304 3900 Total 413 1434 58 117 481 0 0 66 0 0 0 0 370 0 23814 26869 B/hawo 76 256 39 3 71 0 0 20 0 0 0 0 96 0 7773 8353 Baardheere 0 0 0 51 9 0 0 0 0 0 0 0 8 0 0 68 Doolow 181 566 0 8 98 0 0 36 0 0 0 0 110 0 4581 5580 Gedo Elwak 0 37 Garbahaarey 21 227 14 0 155 0 0 4 0 0 0 0 55 0 3061 3580 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 7871 8591 Total 8631 4974 313 7 7314 0 58 188 0 0 0 0 178 2 78031 100449 Belet Weyne 4899 3648 307 0 4511 0 7 143 0 0 0 0 176 1 44627 58623 Hiraan Bulo Burto 2404 677 6 7 1768 0 2 29 0 0 0 0 2 1 17109 22454 Jalalaqsi 1140 187 0 0 808 0 0 2 0 0 0 0 0 0 2636 4773 Matabaan 115 333 0 0 162 0 0 0 0 0 0 0 0 0 7338 7948

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Maxaas 73 129 0 0 65 0 49 14 0 0 0 0 0 0 6321 6651 Total 2053 15 52 211 2500 5 24 323 0 0 0 0 208 0 69982 75588 Afmadow 774 0 28 87 455 0 1 4 0 0 0 0 4 0 8727 10080 Lower Juba Hagar 136 5 0 16 202 2 5 48 0 0 0 0 0 0 3403 3817 Jamaame 102 0 6 8 140 0 0 51 0 0 0 0 118 0 7249 7674 Kismayo 1041 10 18 100 1703 3 18 220 0 0 0 0 86 0 50603 54017 Total 1038 882 283 37 8877 4 16 337 0 0 0 0 1001 2 140474 152951 Afgoi 279 137 25 2 360 0 0 50 0 0 0 0 248 0 27555 28656 Lower Kurtunwarey 48 3 41 0 1582 0 0 37 0 0 0 0 49 0 15604 17364 Shabelle Marka 281 3 173 6 4957 4 16 193 0 0 0 0 602 2 81482 87719 Qoryooley 80 0 44 0 1108 0 0 51 0 0 0 0 71 0 13770 15124 Wanla Weyn 350 739 0 29 870 0 0 6 0 0 0 0 31 0 2063 4088 Total 245 0 1 94 639 9 314 185 0 0 0 0 203 0 12007 13697 Middle Bu,aale 56 0 0 25 153 0 81 48 0 0 0 0 0 0 2367 2730 Juba Jilib 125 0 1 45 376 5 174 106 0 0 0 0 203 0 7528 8563 Salagle 64 0 0 24 110 4 59 31 0 0 0 0 0 0 2112 2404 Total 655 309 109 108 3564 0 1 152 0 0 0 0 524 0 113415 119114 Adale 0 0 0 0 55 0 0 0 0 0 0 0 3 0 8303 8361 Middle Bal'ad 597 280 22 34 941 0 1 115 0 0 0 0 352 0 45561 47906 Shabelle Jowhar 46 0 82 62 2075 0 0 37 0 0 0 0 114 0 31550 34240 Mahaday 4 17 0 12 168 0 0 0 0 0 0 0 22 0 9401 9624 Warsheikh 8 12 5 0 325 0 0 0 0 0 0 0 33 0 18600 18983 Total 829 43 14 49 5308 7 402 632 21 9 34 6 24 24 177501 185035 Galdogob 94 2 1 7 409 0 0 14 0 0 1 0 0 0 19925 20453 Galkacyo 481 5 13 36 3203 5 369 480 3 9 3 3 13 24 122332 126979 Mudug Harardere 35 36 0 1 205 0 12 29 0 0 0 0 4 0 4673 4995 Hobyo 207 0 0 0 1397 2 20 99 18 0 29 3 7 0 15304 17218 Jariiban 12 0 0 5 94 0 1 10 0 0 1 0 0 0 15267 15390 Total 77 866 6 0 519 1 6 183 0 0 0 0 0 0 15550 19868 Burtinle 1 175 0 0 127 0 0 29 0 0 0 0 0 0 3396 4373 Nugaal Dangorayo 1 33 0 0 40 1 0 0 0 0 0 0 0 0 1828 1932 Eyl 13 236 0 0 107 0 0 44 0 0 0 0 0 0 4371 5156 Garoowe 62 422 6 0 245 0 6 110 0 0 0 0 0 0 5955 8407 Total 1653 870 22 69 1484 6 76 159 0 0 0 0 35 1 35462 40216 Sanag Badhan 615 213 10 0 480 0 1 136 0 0 0 0 30 0 8792 10371

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Dhahar 471 1 2 67 265 0 3 3 0 0 0 0 3 0 4928 5786 Eil-afweine 459 293 9 2 478 1 0 12 0 0 0 0 0 0 11012 12310 Erigavo 108 363 1 0 261 5 72 8 0 0 0 0 2 1 10617 11521 Lasqoray ------15 17 Xingalol ------98 211 Total 38 4647 0 6 3753 0 36 368 0 0 0 0 51 0 42246 51366 Bocame 0 0 0 0 5 0 0 2 0 0 0 0 0 0 939 960 Sool Hudun 0 777 0 0 464 0 1 14 0 0 0 0 0 0 3947 5333 Lasacanod 38 3510 0 6 3089 0 35 350 0 0 0 0 51 0 34032 41111 Taleex 0 360 0 0 195 0 0 2 0 0 0 0 0 0 3328 3962 Total 271 2255 0 401 4107 0 42 225 0 1 8 0 3 13 37420 44758 Ainabo 1 85 0 61 204 0 0 3 0 0 0 0 0 0 2376 2730 Togdheer Buhodle 23 156 0 174 350 0 0 13 0 0 0 0 0 0 5365 6081 Burao 221 1735 0 127 3214 0 42 209 0 1 8 0 3 13 25182 30767 Odwayne 26 279 0 39 339 0 0 0 0 0 0 0 0 0 4497 5180 Total 1309 9266 0 336 9004 0 161 258 0 2 10 87 174 15 67407 88029 Ballayabane 180 249 0 45 277 0 24 9 0 0 7 22 0 1 2720 3534 Ballaygubadle 26 26 0 8 28 0 1 0 0 0 2 6 0 0 500 597 Waqoy Galbed Berbera 340 3128 0 2 2641 0 94 107 0 1 1 59 5 1 18455 24834 Gabiley 249 2784 0 120 2247 0 6 21 0 0 0 0 41 0 7773 13241 Hargeisa 311 2273 0 161 2987 0 33 103 0 1 0 0 122 13 32051 38055 Sheikh 203 806 0 0 824 0 3 18 0 0 0 0 6 0 5908 7768 Grand Total 29847 49880 2062 2619 70429 63 1475 6326 23 13 56 94 8260 88 1516220 1704713 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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