Somalia Emergency Weekly Health Update The Somalia emergency weekly health update aims to provide an overview of the health activities conducted by WHO and health partners in Somalia. It compiles health information including nine health events (epidemiological surveillance) reported in Somalia, information on ongoing conflicts in some regions of Somalia and health responses from partners. For further information please contact: Pieter Desloovere – WHO Communications Officer - [email protected] - T: +254 733 410 984 BULLETIN HIGHLIGHTS Reporting dates 15 - 21 September 2012 (reflecting Epidemiological week 37) Since 5 September, over 180 suspected cholera cases and 18 deaths have been reported from Hoosingow (most affected), Dhobley, Waraq and Afmadow. Ten stool samples were collected from Hoosingow in Badade district and four from Dhobley in Afmadow district, and are being tested in the lab. Preliminary results are expected on Saturday 22 September. ©HIJRA IN FOCUS STORY: Dangerous pregnancy complications in Badbaado IDP camp, Mogadishu For the past 10 months, Nadifo Mohamoud, a young mother, has been living in Badbaado IDP camp, Mogadishu. She has a small kiosk in front of her makeshift shelter and she vends clay-made ovens. Last Sunday, Nadifo’s mother ran to the Badbaado health clinic, supported by health partner HIJRA. Nadifo fainted while she was trying to cook food on an open fire near her makeshift shelter. Nadifo is 9 months pregnant and is expecting her baby any time. This is not her first pregnancy; she has already given birth to three children. Unfortunately, two of her children passed away before they reached Medical staff of HIJRA put Nadifo on a stretcher to the age of five. The medical staff of HIJRA quickly dispatched an bring her to the ambulance ambulance to the IDP camp, which wasn’t an easy task at all. The ©HIJRA medics were forced to leave the ambulance and take a stretcher on foot to find the unconscious mother in the camp. A few minutes later, Nadifo was brought to the clinic where she got the necessary treatment. “She is suffering from hypoglycemia or low blood sugar” says Abba Yusuf Awies, HIJRA qualified midwife. “Without proper medical care, it may affect both the mother and the baby” she added. Since Nadifo is pregnant and did not eat well due to certain circumstances, her blood sugar had dangerously dropped down. Her condition was stabilized and few hours later she came out of her coma. Nadifo will remain in the clinic a few more days till she is fully recovered. “The last thing I can remember is when I was trying to put a kettle on the fire”, Nadifo recalls. “My mother told me later that an ambulance brought me here. I am very grateful for the help I got” she says. Nadifo is carried to the ambulance and later brought to the Badbaado health clinic in Mogadishu EPIDEMIOLOGICAL SURVEILLANCE (EPI WEEK 37, 10 – 16 September 2012) © AVRO TIMELY REPORTING: Proportion of timely reporting sentinel sites by zone % Of the 196 facilities currently reporting to the 100 Communicable diseases Surveillance and Response (CSR) sentinel surveillance network, 192 reported 80 timely during week 37. All reporting facilities in 60 Puntland were timely. In Southern Somalia 97% (35 of 36), Central Somalia 96.7% (59 of 61) facilities 40 reported timely while in Somaliland, 98% (53 of 54) 20 facilities did report timely. Proportonfacilitiess of R. 0 SITUATION OVERVIEW: 14 16 18 20 22 24 26 28 30 32 34 36 Ongoing suspected outbreak of suspected cholera in Weeks Lower Jubba region is stabilizing but the case fatality Central Southern Puntland Somaliland rates remain high. Ten stool samples were collected from Hoosingow in Badade district and four from Dhobley in Afmadow district, now being processed in the lab. Preliminary results are expected on Saturday 22 September. On 17 September, three stool samples collected from cases presenting with suspected cholera in Dhobley MCH were tested using Cholera 0139 Smart ™ II – New Horizons Diagnostics Inc (Sensitive Membrane Antigen Rapid Test). All were negative for cholera. Tests are still available on ground and will continue to be used. More samples are expected. Since 5 September, over 180 cases and 18 deaths have been reported from Hoosingow (most affected), Dhobley, Waraq and Afmadow. Cross-border cases have been reported in Dadaab, Kenya. Mudug and Nugaal regions reported two cases of suspected cholera as during week 37. Number of regions reporting cases of suspected measles and confirmed malaria have increased significantly compared to week 36. Districts reporting cholera cases Districts reporting measles cases Districts reporting malaria cases SOUTHERN SOMALIA Table 1. Week 34 (20-26 August Week 35 (27 Aug-2 Sept Southern Somalia 2012) - Number of reporting 2012) - Number of reporting Week 36 (3 - 9 Sept 2012) - Week 37 (10 -16 Sept 2012) - (36 sentinel sites) sites 35 sites 36 Number of reporting sites 35 Number of reporting sites 35 Total cases *Proportional Total cases *Proportional Total cases *Proportional Total cases *Proportional Health Event (% < 5 yrs) morbidity (% < 5 yrs) morbidity (% < 5 yrs) morbidity (% < 5 yrs) morbidity Susp. Cholera 0 0 6 (83.3) 0.1 1 (100) 0.01 2 (100) 0.03 Susp. Shigellosis 29 (65.5) 0.5 27 (81.5) 0.4 35 (80) 0.5 35 (71.4) 0.5 Susp. Measles 26 (100) 0.4 40 (90) 0.6 27 (81.5) 0.4 33 (84.8) 0.5 Acute Flaccid Paralysis 0 0 0 0 0 0 0 0 Susp. Hemorrh. Fever 0 0 0 0 0 0 0 0 Susp. Diphtheria 0 0 0 0 0 0 0 0 Susp. Whooping Cough 34 (70.6) 0.6 27 (88.9) 1.5 16 (93.7) 0.2 21 (81) 0.3 Confirmed Malaria 108 (54.6) 1.7 133 (57.9) 1.9 115 (65.2) 1.6 132 (57.6) 1.9 Neonatal Tetanus 0 0 0 0 0 0 0 0 All other consultations 5979 (48.5) 6739 (47.0) 6822 (48.5) 6740 (47.5) Total consultations 6176 (48.8) 7053 (47.3) 7016 (49.2) 6963 (48.1) *Proportional morbidity is the number of cases for individual health event as a proportion of all consultations for the reporting week. Trends of cases by age group and proportional morbidity Trends of cases by age group and proportional morbidity of for suspected cholera in Southern Zone week 1-37, 2012 % suspected measles in Southern zone from week 1-37, 2012 % 600 20 160 8 18 140 500 ≥5 yrs < 5 yrs p. morb 16 120 ≥5 yrs < 5 yrs p.morb 6 400 14 12 100 Cases 300 10 80 4 8 Cases 200 6 60 100 4 40 2 2 Proportionalmorbidity proportionalmorbidity 20 0 0 0 0 Weeks 1 3 5 7 9 1113151719212325272931333537 Weeks 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 Trends of cases by age group and proportional morbidity for confirmed Malaria in Southern Zone week 1-37, 2012 % 800 12 700 ≥5 yrs < 5 yrs P. morb 10 600 500 8 Cases 400 6 300 4 200 2 ProportionalMorbidity 100 0 0 Weeks 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 While trends of suspected cholera cases reported in the sentinel sites have shown a decline since week 25, suspected cases have been reported in Afmadow and Badade districts. Between 5-16 September, a total of 93 cases and 11 deaths were reported in Hosingow village in Badade district. Suspected cases have also been reported in Dobley town in Afmadow district as well as Afmadow town. Sonce 18 September an estimated 35 cases were reported by partners in Afmadow town. More information is being gathered and samples will be collected as well. Sentinel sites in 7 out of 18 districts reported suspected measles cases with stable trends. Trends in suspected shigellosis cases have also stabilized. Immunization activities have not been conducted in Southern Somalia for the past three years. The suspected whooping cough cases have also stabilized at high levels. The proportional morbidity of confirmed malaria cases remains high at almost 2%. CENTRAL SOMALIA Table 2. Week 34 (20-26 August 2012) Week 35 (27 Aug-2 Sept Week 36 (3 - 9 Sept 2012) - Week 37 (10 -16 Sept 2012) Central Somalia - number of reporting sites 2012) - Number of reporting Number of reporting sites - Number of reporting sites 61 sentinel sites 61 sites 58 57 59 Total cases *Proportional Total cases *Proportional Total cases *Proportional Total cases *Proportional Health Event (% < 5 yrs) morbidity (% < 5 yrs) morbidity (% < 5 yrs) morbidity (% < 5 yrs) morbidity Susp. Cholera 186 (52.7) 1.2 156 (72) 1 138 (71.7.) 0.9 114 (71.9) 0.7 Susp. Shigellosis 53 (79.2) 0.3 31 (80.6) 0.2 27 (92.6) 0.2 25 (72) 0.2 Susp. Measles 111 (74.8) 0.7 164 (73.8) 1 134 (86.6) 0.8 97 (91.7) 0.6 Acute Flaccid Paralysis 0 0 0 0 0 0 0 0 Susp. Hemorrh. Fever 0 0 0 0 0 0 0 0 Susp. Diphtheria 0 0 0 0 0 0 0 0 Susp. Whooping Cough 23 (86.9) 0.1 11 (100) 0.1 32 (87.5) 0.2 51 (82.3) 0.3 Confirmed Malaria 309 (30.7) 2 287 (34.5) 1.8 186 (22) 1.1 294 (34.7) 1.8 Neonatal Tetanus 2 (100) 0.01 2 (100) 0.01 5 (100) 0.03 8 (100) 0.05 15049 15657 All other consultations 14565 (43) (44.2) (41.5) 15740 (43) 15700 16179 16329 Total consultations 15249 (43.4) (44.7) (42.1) (43.6) *Proportional Morbidity is the number of cases for individual health event as a proportion of all consultations for the reporting week.