EMERGENCY AND HUMANITARIAN ACTION (EHA) WEEKLY UPDATE – WHO COUNTRY OFFICE ETHIOPIA: (Week 21, 18 – 24 May 2009) HIGH LIGHTS : • According to official reports from the Federal Ministry of Health (FMOH), 222 cases of AWD have been reported from Oromiya, SNNP and Afar Regions last week. • Increased cases of malnutrition continue to be reported during the week in many woredas of SNNPR, and East and West Hararghe zones in Oromiya. The nutritional problem in parts of West Arsi, Agarfa and Bale (Oromiya) and Dessie Zuria (Amhara) also remains to be of concern. • According to official reports from the Federal Ministry of Health (FMOH), no case of Influenza A H1N1 has been reported from Ethiopia and the situation is being monitored closely. 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 • Malnourished cases are hazardously increasing in SNNPR. According to the Regional Health Bureua, in Boloso Sore woreda, 1400 malnourished children were admitted to OTPs during the month of April; in East Badawacho 740 were admitted; and during April in Boricha 101 children were admitted into Stabilisation Centres. It is reported that out of 1,773 screened mothers in Burji, 14% were reported malnourished. Malaria and AWD out breaks occurred in low land areas of Hadiya, Welayta, and KT zones. Malaria has occurred at the level of epidemic and according to wereda health offices, the prevalence rate has reached around 62% in West Badawacho, 57% in Gomboro, 30% in East Badawacho, 30-60% in Konso. Gomboro and Konso have reported 7 and 8 deaths due to malaria outbreak. DDT spraying, mosquito nets distribution and supply of anti malarial drugs are some of the measures being undertaken to contain malaria. • The SNNPR has started receiving adequate rain in amount and coverage. Belg crops performance and availability of pasture and water for the livestock is expected to improve. Hailstorm accompanied with strong wind resulting in damage of perennial and annual crops was reported from Dale, Aleta wondo, Kochore and Yirga Chefe woredas. In all woredas of Hadiya zone and some kebeles of Boricha woreda of Sidama zone, supply of water for human consumption is poor. Maize is highly stunted and Irish potato and haricot bean are damaged due to moisture stresses. Prices of cereals and coffee remained same as last week. • I Amhara Region the malnutrition problem in Dessie and Zuria has been increasing in the past weeks. The Globa Acute Malnutrition (GAM) has increased from 12.5% to 14.4% and the Severe Acute Malnutrition (SAM) from 0.5% to 0.9%. Some wordas in Wag Himra, North Wello and South Wollo have received showers in the past couple of days. However, the precipitation in these areas has been inadequate both in amount and coverage. The poor performance of the belg rains in the past couple of weeks is a matter of grave concern for the wellbeing of the animals and crops as well. High prices have continued to exhibit, stability has continued in both supply and demand of crops and livestock as well. Acute watery Diarrhoea (AWD) • According to official reports from the Federal Ministry of Health (FMOH), 222 cases of AWD have been reported from Oromiya, SNNP and Afar Regions in last week. A total of 10 districts have reported active cases and deaths from in epidemic week 20 • Six Hundred Forty Nine cases of AWD and 20 deaths (CFR 3.0%) have been reported from Somali, Oromiya, SNNP and Afar Regions from 13 th April to 17th May, 2009. Two Hundred and Twenty Six cases and 11 deaths from Gewane and Buremudaitu Woredas of Afar Region, five cases and no death from Moyale Woredas of Somali Region, 104 cases and two deaths from Moyale, Dire, Meki, Shashemene, Shashemene Town, Arsi Negele Shala, Kofele and Nansebo Woredas of Oromiya Region and 314 cases and seven deaths from Konso special Woreda of SNNPR. Map of Ethiopia Showing affected districts by Acute Watery Diarrhea [ AWD ] Cases and Deaths as of 17 May 2009, Ethiopia Legend Tigray Districts Currently reporting active Cases Afar List of Districts Currently reporting, expected to report Amhara and newly affected districts: 1. Somali Region * Moyale District Benishangul Gumuz Gewane * Galadi Bure Mudaytu 2. Afar Oromiya Amibara Dire Dawa Awash Fentale Harari * Gewane Addis Ababa * Buremudayitu 3. Oromia Gambella * Moyale Arsi Negele * Dire Shashemene Kofele * Meki Town * Shashemene Woreda Humbo Nenesebo SNNPR * Shashemene Twon * Arsi Negele * Shala * Kofele Konso * Nansebo Somali 4. SNNPR Dire Moyale_Somali Dire * Konso Analysis and Mapping by: Emergency and Humanitarian Action and DPC Units World Health Organization - Ethiopia Country Office µ Data Source: Federal Ministry of Health - Ethiopia 0125,000 250,000 500,000 750,000 1,000,000 Date of Production: May 23, 2009 Meters Distribution of AWD cases by region and district Influenza A H1N1 • To date no confirm or suspected cases of Influenza A H1N1 have been reported by the Federal Ministry of Health. In line with the required preparation, the United Nations system has started revising its country plan coordinated by WHO Country Office. About 28 UN agencies are taking part in this process. Five ( finance, logistics, security, communication and technical) working groups have been formed to support this process and are providing weekly brief to the SMT chaired by the Designated Officer (DO) of the UNECA. • FMOH has identified 32 hospitals nationwide to support any required response to influenza A H1N1 and has identified national requirements and presented to partners for funding. II. ANALYSIS & HEALTH CONSEQUENCES: Health problems & Needs of affected populations. Food insecurity and malnutrition • Admissions of acutely malnourished children to Stabilization Centers (SCs) and Outreach Theurapidic Centers (OTPs) continue to increase in many parts of SNNPR, West Arsi, East and West Harerge zones (Oromiya). New SCs and OTPs are being established in Seraro, Shashemene, Shala and Arsi Negele (West Arsi) to cope with the rapidly deteriorating nutritional situation. Serious nutritional situation is also reported in Agarfa woreda of Bale Zone. The nutritional situation in SNNPR is further aggravated by the current outbreak of malaria in many low and mid altitude areas where control operations are now underway. In summary, the poor performance of the current rains will exacerbate the situation unless assistance interventions are timely and adequate. 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 partners, Oromia and Somali RHBs reported AWD infection spreading to new districts. The identified gaps are poor case management, inadequate CTCs materials and drugs, poor water supply, inadequate human resources, poor hygiene and sanitation. High movement of Internally Displaced People (IDPs) is a major challenge for the control of the disease. The needs of affected people are drugs, water treatment chemicals, awareness creation and trained health staff to support proper case management. Government and partners are responding and mobilising more resource to support response. 2 Malaria Reports from FMOH indicated an upsurge of malaria cases from SNNPR, Tigray and Amhara Regions. Information from the Welayita zone in SNNPR indicated about 78,000 clinical cases of malaria have been reported from 3 districts. An estimated150,000 daily labourers are expected in Umera woreda in Tigray Region for the next 3 months and without urgent action malaria outbreak is highly probable. Assessment conducted in affected districts of Amhara Region has identified the following gaps: • Shortage of antimalarial drugs- Coartem • Shortage of ITNs and under utilization • Delay in reporting the malaria situation to the Regional Health Bureau (almost the affected woreda are assisted by RHB and Partners to respond) • Inadequate follow-up of malaria monitoring chart and taking timely action. • Limited social mobilization to increase the utilization of ITNs and managing the identified mosquito breeding sites • Delay of patients coming to health facilities (usually coming to health facilities 5 days after the The regional Health Bureau has planned to conduct DDT spraying in the affected communities. Community mobilization and Health education is being conducted. Most of the ITNs supplied to the communities are no longer effective and needs replacement. An additional team was deployed to Oromia region to assess malaria outbreak in Finchewa sugar factory and to give technical assistance. 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. The nutritional survey in Somali Region has been completed in the seven sample woreda of Filtu, Aysha, Degehabur, Hamero, Bare, Kelafu and Bokh. Preliminary findings are expected to be shared with Emergency Nutrition Unit at the end of May. Acute watery Diarrhoea (AWD) • WHO continues to