Somalia Health updates 2012/2013

[Ronan Kelly]

DISEASE HIGHLIGHTS FOR JANUARY 2012 *:
BULLETIN HIGHLIGHTS Weekly Highlights 28 January - 3 February 2012
� Started on 5th February 2012, more than 5000 vaccinators will be trained to carry out the first round of Child Health Days activities in Somaliland, which are planned to take place from 19-23 February 2012.
During this first round in Somaliland a total of 413,205 children under 5 years of age and 475,186 women of childbearing ages will be targeted with the usual Child Health Days package.

* Please note that data for Puntland only covers the three weeks of January 2012.
For further information please contact: Pieter Desloovere - Communications Officer - deslooverep@nbo.emro.who.int - T: +254 733 410 984
© WARDI

ACUTE WATERY DIARRHOEA
• South Central Somalia reported 1118 AWD cases including 880 (79%)
children under the age of five and 22 related deaths.
• Banadir region reported the highest number of cases, with 57% of all
reported cases and 59% of the reported deaths.
• Banadir hospital in Mogadishu reported 407 cases including 297 (73%)
children under the age of five and 16 related deaths.
• Somaliland reported 132 AWD cases including 108 (82%) children under
the age of five. Maroodijeh and Sanaag regions accounted for 39% and
56% of all cases respectively.
• Puntland* reported 279 AWD cases including 210 (75%) children under
the age of five. Bari region accounted for 107 (38%) of which 81% were
reported from Bossaso district.
SUSPECTED MEASLES
• South Central Somalia reported 483 cases including 385 (80%) children
under the age of five and 18 deaths. Banadir and Lower Shabelle regions
accounted for 82 (17%) and 199 (41%) of all reported cases respectively.
• Somaliland reported 11 cases including 5 children under the age of five
• Puntland* reported 279 cases including 210 (75%) children under the
age of five
SUSPECTED MALARIA
• South Central Somalia reported a total of 1879 cases including 975
(79%) children under the age of five and 2 related deaths.
• Somaliland reported 3 cases including one case under the age of five.
• Puntland* reported 0 cases.
CONFLICT RELATED INJURIES
• Four hospitals in Mogadishu treated 425 casualties from weapon-related
injuries. 28 cases (7%) are under the age of five. Four deaths were reported.

...

http://reliefweb.int/sites/reliefweb...eport_3486.pdf

[Ronan Kelly]

From: From: From: Horn of Africa Crisis
Situation Report No. 33
24 February 2012
http://www.flutrackers.com/forum/sho...197#post444197
...

Health: For 8 to 12 February, the cluster reported that 70 health facilities recorded 383 cases of acute
watery diarrhoea in southern and central Somalia, including 302 (79 per cent) in children under age 5. Also in
southern and central Somalia, 78 per cent of the 180 suspected measles cases reported were in children
under age 5, while malaria cases reached 565, of whom 225 (40 per cent) were children under age 5.

...

[Ronan Kelly]

BULLETIN HIGHLIGHTS Weekly Highlights 4 - 10 February 2012

...

Epidemiological surveillance (30 Jan - 5 Feb 2012, epi week 5)

Acute Watery Diarrhoea (source: CSR sentinel sites)
South Central Somalia
• In the reporting week 2
, 62 health facilities in South Central Somalia reported 293 cases of AWD, including 227 (78%) children under the age of five giving a CFR of 1.14. Banadir region which is home to a number of internally displaced
persons (IDPs) and informal settlements reported 191 (65%) of all the cases. Of these, 151 (79%) cases were children under the age of five years. Only 14 facilities reported this week from the region.
• WHO has urged all wash partners to step up activities in the
affected districts. Currently, Health and WASH cluster are disseminating ‘Stamp out cholera! campaign’ radio messages to the most affected areas in Somalia. This activity will take place during the next 4 months.

Banadir Hospital
• For this reporting week, Banadir Hospital reported 84 cases of AWD, including 70 (83%) children under the age of five (see graph). Of these cases, 42 (50%) are women and girls. This week, a slight decrease was observed compared to week 4 (95 cases were reported).

Lower Shabelle region
• 29 AWD cases were reported from 26 health facilities, including 23 (80%) children under the age of five.

Somaliland
• 54 health facilities from the six regions reported 11 cases of AWD, including 10 (91%) children under the age of five.

Measles (source: CSR sentinel sites)
South Central Somalia
• In week 5, 161 suspected measles cases were reported including 132 (82%) children under the age of five and one death under the age of five.

Banadir region
• 29 cases of suspected measles including 26 (90%) children under the age of five were reported.

Hiraan region
• 28 cases of suspected measles including 23 (82%) children under the age of five were reported.

Lower Shabelle region
• 26 health facilities in the region reported 50 suspected measles cases, including 41 (82%) children under the age of five.

Somaliland
• In the reporting week, 7 cases of suspected measles including 5 (72%) under the age of five years was reported from 54 health facilities in six regions.

Puntland
• In week 5, 12 case of suspected measles were reported from 46 health facilities in six regions, including 6 (88%) children
under the age of five. This signifies a 50% reduction in reported cases compared to week 4 (6 cases). Routine vaccination
activities are ongoing at health facilities.


Malaria (source: CSR sentinel sites)

Banadir region
• 159 confirmed malaria cases were reported from 14 health facilities, of which 73 (46%) were confirmed by rapid diagnostic test or microscopy. Most of the cases in this region were reported from Madina district which accounted for 127 (80%) of the total cases in the region.

Lower Shabelle region
• 119 confirmed malaria cases were reported from 26 health facilities, of which 67 (34%) were children under the age of five.

Somaliland
• In the reporting week, no cases of confirmed malaria were reported.
Puntland
• In week 5, no cases of confirmed malaria were reported

...
http://reliefweb.int/sites/reliefweb...bruary2012.pdf

[Ronan Kelly]

Humanitarian Bulletin
Somalia
Issue 02 | 07 March 2012

...

52 deaths from acute watery diarrhoea in southern and central regions
Health partners reported a total of 676 suspected cases of AWD in the first two weeks of February in southern and central Somalia, with 52 deaths. Of these, 382 cases, 57 per cent were reported in Banadir.

Malaria cases in the southern and central regions reached 1,030 confirmed cases including 393 children under five, while 341 cases of measles were reported, including 272 children under five. Lower Shabelle accounted for 33 per cent of all measles cases.

...
http://reliefweb.int/sites/reliefweb...rch%202012.pdf

[Ronan Kelly]

Humanitarian Bulletin
Somalia
Issue 03 | 21 March 2012

...

Expected rise in disease with Gu rains
Measles and suspected cholera expected to rise
Preparations by Health and WASH Clusters’ to minimize the health risks with the fast approaching Gu rains, are on-going. The Gu rains normally last from April to June.
Suspected cholera:
Concerns are expressed about the increasing potential for communicable disease outbreaks with people living in overcrowded IDP camps. Work to
build the capacity of new WASH Cluster local partners continues
as fears that they may focus on response rather than prevention
could result in an increased number of outbreaks.
Over the reporting period the WASH Cluster established a
Hygiene Promotion/Sanitation Technical Working Group, which
will oversee activities of the cluster in Mogadishu. So far, WASH
is supporting 327,154 people, 13 per cent of the 2.6 million
people targeted with sustainable water access across Somalia.
Concurrently, the cluster is reaching 803,188 beneficiaries with
temporary provision of safe water, of whom 789,588 are from
the south. Another, 197,889 beneficiaries are newly accessing
sanitation facilities (latrines), and 154,430 people benefited from
hygiene promotion and non-food item (NFI) hygiene packages.

Malaria:
The Health Cluster expects that malaria will increase once the
rains begin. The areas that will be most affected include along
the riverine areas of the Shabelles, the Jubas, Gedo, Hiraan and
Banadir regions. Rapid diagnostic tests and Artemisia combined therapy (malaria drug treatment) are on the ground, according to WHO, as well as interagency health kits with a malaria module to be deployed in the event of an outbreak.

Immunization:
In addition, the Health Cluster reported the start of the first round of Child Health Days in Puntland on 11 March with more than 160,000 children aged 0-59 months targeted with vaccinations against polio, measles, diphtheria, pertussis and tetanus. The children also received vitamin A supplements and de-worming tablets.
Access constraints in southern and central Somalia limited vaccination programmes to carry out their immunization activities for the past two years, leading to an increase of vaccine-preventable disease, such as measles. The Bay region reported a significant increase with 19 cases reported in week 10. In Somaliland 38 cases were reported in week 10 compared to five cases in the previous week.
...
http://reliefweb.int/sites/reliefweb...eport_3671.pdf

[Ronan Kelly]

Somalia
Emergency Weekly Health Update - Weekly Highlights 24 - 30 March 2012

Communicable Disease Surveillance and Response (CSR)
Reporting completeness:
A total of 222 CSR sentinel sites report on weekly basis from the three zones of
Somalia. During week 12, 98 % of all sentinel sites of Puntland reported (44 of
45), and so did report 98% (53 of 54) of all sentinel sites in Somaliland. A total
of 67% (82 of 123) of all sentinel sites of South and Central Somalia reported
on time (see graph 1), giving the highest number for this year and showing a
steady slow increase. Overall, only 81% of the 222 sentinel sites reported on
time for week 12.
...
Outbreak alerts
In South and Central Somalia, confirmed malaria was
the leading cause of morbidity among the priority
diseases (see table 1). There was a 36% increase in the
number of confirmed malaria cases compared with week
11, particularly from the Lower Juba, Gedo, Lower
Shabelle and Banadir regions. Suspected cholera cases
also reported a slight decrease of 4% compared with
week 11, particularly in Middle Shabelle, Middle Juba and
Gedo regions.
• In Somaliland, the proportional morbidity of suspected
measles continue to be reported with notably a 47%
increase in the number of reported cases compared to
week 10 (see table 2). The Ministry of Health has
released the Child Health Days immunization coverage
rates, with 91% for polio, 88% for measles, 81% for DPT,
49% for tetanus toxoid, 82% for deworming, 86% for
vitamin A, 88% for ORS, 90% for aqua tabs and 80%
were screened using MUAC.

...
Suspected cholera (source: CSR sentinel sites)
The number of suspected cholera cases across Somalia is expected to further increase . Although the proportional
morbidity for South Central Somalia seems to remain stable during the past two weeks, looking at the regional breakdown,
a 73% increase has been reported, particularly in Lower Shabelle region.
During 2012, the biggest disease burden for suspected
cholera in South Central Somalia has been concentrated in
4 regions, namely Banadir, Lower Shabelle, Lower Juba
and Middle Juba regions. Lower Shabelle, Lower Juba and
Middle Juba are all located in riverine areas, while Banadir
region has a huge number of IDPs and returnees living
with lack of proper water and sanitation facilities.
As far as the immediate alert reporting of CSR, health
partners face challenges in terms of picking up timely
rumours for suspected cholera and other diseases with
outbreak potential, due to sporadic communication
network failures. This may mean an underreporting of the
reality on the ground.
...
Confirmed Malaria (source: CSR sentinel sites)
In South and Central Somalia, although two more
sentinel sites reported in week 12, a 36% increase of
confirmed malaria cases was reported during week 12.
A WHO investigation team, including an entomologist
and laboratory technicians, is looking into the sudden
increase of reported suspected malaria cases in Lower
and Middle Juba. The results are still pending. However,
Artemisinin-based combination therapy (ACT) and rapid
diagnostic tests (RDTs) are in place at all health
facilities.
...
Suspected Measles (source: CSR sentinel sites)
Suspected measles cases continue to be reported across Somalia. Proportionally, South Central Somalia continues
to report the highest number of suspected measles cases. This is due to the low vaccination coverage for all antigens as
some regions have never been vaccinated over the past two years.
...
http://reliefweb.int/sites/reliefweb...Report_691.pdf

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting dates 1-14 April 2012
(reflecting Epidemiological week 13 and 14)

Of the 222 sentinel sites reporting weekly from the three zones of Somalia, for week 13, 98% (53) in Puntland, 98% (44) in Somaliland, but only 36% (44) sentinel sites reported on time from South and Central Somalia or 64% (141) of all sentinel sites. Only 1 of 30 sentinel sites reported from Lower Shabelle region; reason being investigated.

SITUATION OVERVIEW:
SOUTH CENTRAL SOMALIA

During week 13, a case of acute flaccid paralysis was reported in South Central Somalia from Bondheere district, Mogadishu. This case is being investigated and it was found to be too late for collection of samples for
further investigation at the laboratory. In addition, two cases of suspected diphtheria and whooping cough (pertussis) have been reported. It was not possible to trace the two diphtheria cases due to lack of information.
It is suspected that both cases might have been IDPs. This all points out the need of greater routine Expanded Programme on Immunization for the zone. Finally, two cases of neonatal tetanus have been reported. This
shows that antenatal care needs to be strengthened to ensure two doses of tetanus toxoid (TT or Td) are given during pregnancy.
During week 14, none of the sentinel sites for South Central Somalia reported due to technical problems faced at the zonal collection level.

SOMALILAND

Given the disproportional number of suspected cholera cases during week 13 (although the numbers are small); there is still concern of non-adherence to the case definition for sentinel sites in Somaliland.
For week 14, the proportional morbidity for suspected measles keeps on increasing. Burao district (Togdheer region), which also has the lowest vaccination coverage for the recently conducted Child Health Days,
accounts for most of the cases.

PUNTLAND


Cholera
The proportional morbidity for suspected cholera in South Central Somalia is increasing during week 13. The most affected region for that reporting week was Middle Shabelle. However, WHO and partners observed a general increase in number of cases in Balcad district, Middle Shabelle region. An outbreak investigation team collected four samples that were sent to Nairobi for further investigation in the laboratory. Results are still pending. Health partners have launched response activities in some of the affected areas. Middle Shabelle
region is underserved with very few active health facilities.
During week 14, in South Central Somalia, a total of 30 stool samples were collected from suspected cholera cases coming from Banadir region. Results are still pending. For Puntland, the proportional morbidity reduced due to the fact that less sentinel sites reported compared to the previous week.
...
Malaria
In South Central Somalia, a WHO investigation team, including an entomologist and laboratory technicians, is looking into the sudden increase of suspected malaria cases in Lower and Middle Juba. The results are still pending.

...
Measles
Suspected measles cases continue to be reported from all the three zones of Somalia. During week 13 for South Central Somalia, and week 13 and 14 for Puntland, the number of cases has decreased compared to previous weeks. Child Health Days have kicked off, on 10 April in Gedo region as well as Banadir region. Two rounds will be organized in Banadir region, with round one from 14-18 April 2012 and round two from 21-25 April 2012.

The number of reported cases has increased in Somaliland. Immunization outreach activities have been started and the number is expected to decrease. The numbers of reported cases, in all zones, need to be assessed against the background of limited or no training, for health workers, on case-definitions of measles.
...
http://reliefweb.int/sites/reliefweb..._april_new.pdf

[Ronan Kelly]

Humanitarian Bulletin
Somalia
Issue 06 | 25 April to 04 May 2012
...
Cholera prevention measures put in place by
WASH cluster partners
Gu rains raise fears of disease outbreaks
In Balad district of Middle Shabelle Since, 2 confirmed cases of cholera, 76 cases of
acute watery diarrhoea (AWD) and one death were reported. On 26 April, four children all
under age 5 were transferred to Jowhar regional hospital for higher-level treatment for
severe AWD. In Banadir, cholera cases were reported in Hodan, Qaraan and Shibis and
brought to Banadir Hospital for treatment. Cases of acute watery diarrhoea (AWD) were
also reported in Belet Xaawo, in Gedo.
...

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting dates 15 April – 4 May 2012
(reflecting Epidemiological week 15-17)

...
Of the 222 sentinel sites reporting weekly from the three zones of Somalia, for week 17, 98% (53) in Puntland, 98% (44) in Somaliland, but only 79% (97) sentinel sites reported on time from South and Central Somalia or 87% (194)
of all sentinel sites. For South and Central Somalia had during week 17 the highest number of reporting sentinel sites since the beginning of the year.

SOUTH CENTRAL SOMALIA

During week 16, a total of five cases of acute flaccid paralysis were reported from South and Central Somalia. The cases were reported from sentinel sites located in Baidoa and Galgaduud region. The results of follow up investigation of those cases are still pending.
Over the past three weeks, the leading cause of morbidity for South and Central Somalia is suspected cholera. During week 17, the proportional morbidity reached 3%, a steady increase compared to the two previous
weeks. Between week 16 and 17, an increase of 12% in the number of reported suspected cholera cases was observed (see table 1). This increase is expected as part of the morbidity changes following the onset of the
Gu rains and the subsequent transmission of cholera in Somalia. Although not alarming, hospitals and cholera treatment centers are reporting a steady increase in admissions. The only confirmed cholera cases in 2012
have been in Mogadishu (Banadir region) and Balcad (Middle Shabelle region). Currently the cases in Balcad are under control. Response activities for Banadir are ongoing.

SOMALILAND

Suspected measles was the leading cause in Somaliland (see table 2). For week 17, the proportional morbidity for suspected measles keeps on increasing compared with the previous weeks. Burao district (Togdheer region), which also has the lowest vaccination coverage for the recently conducted Child Health Days, accounts for most of the cases.

PUNTLAND

During week 17, the leading cause of morbidity for Puntland is suspected cholera accounting for most of the consultations (proportional morbidity of 6.5%). A steady increase in the number of consultations for suspected
cholera is being observed with almost all areas in Somalia experiencing rains.

MAIN CAUSES OF MORBIDITY:
SUSPECTED CHOLERA (SOURCE: CSR SENTINEL SITES)

Many areas in Somalia have received rains in the past weeks. The number of suspected cholera cases is on the increase, particularly in South and Central Somalia and Puntland. This is expected to increase further.
During week 15, 9 out of 34 samples (or 23%) collected from Banadir and Middle Shabelle regions have tested positive for Vibrio cholera serotype ‘inaba’. Partners working in Hodan, Shibis, Karaan and Tawfiq settlement
of Banadir region and those working in Balcad district (Balcad town and Mukidheer village) are urged to step up both WASH interventions especially hand washing and point-of-use chlorination of water for domestic use.
Adequate case management supplies are available for partners who are urged to report all suspected cases.
Rapid diagnostic tests are also available for partners facing challenges in collection and transportation of stool samples.
During week 16, an additional 6 samples from Middle Shabelle region were collected by health partners and tested all positive for Vibrio cholera serotype ‘inaba’.
From 22 to 29 April, the newly opened cholera treatment centre (CTC) in Hodan district, Mogadishu, reported 33 admissions including 84% (28) children under the age of five. Of all patients using the health services of this
CTC, 33% were women and girls. No deaths were reported.
The CTC of Merka hospital, in Lower Shabelle region, reported 44 admissions during week 17 including 28 (64%) children under the age of five. Of all patients using the health services of this CTC, 45% were women and girls
and no deaths were reported. Compared with week 16, where only 18 cases were admitted, an increase of over 100% was reported in the number of admissions (see graph on the right). As of today, no confirmed cholera case
has been reported from Merka.
During week 17, Banadir hospital also reported a 15% increase in admissions for suspected cholera. A total of 236 patients including 172 (73%) children under the age of five, with four associated deaths of which 3 were under 5
years of age were treated at the hospital. Of all cases, 52% were women and girls. Of all case under 5 years, 70% were children under 2 years of age.

CONFIRMED MALARIA (SOURCE: CSR SENTINEL SITES)
In South Central Somalia, a WHO investigation team, including an entomologist and laboratory technicians, looked into the sudden increase of suspected malaria cases in Lower and Middle Juba. This focal investigation survey was
conducted in Jilib and Jamaame districts, Lower and Middle Juba. Both districts experienced unprecedented rains in October and November 2011, leading to an increase in suspected malaria cases. In January 2012, rapid diagnostic tests were not available for these health facilities, therefore the suspected malaria cases had to be diagnosed clinically (as reflected in the January
weekly health updates). In March 2012, epidemiological and entomological investigations were carried out at eight sites in both districts. The results showed that small foci of stable malaria were present. These foci were discovered mainly in ponds and streams. Two types of malaria-vector mosquitoes “anophlesarabiensis and anophlesfunestus” were found in the Jilib and Jammame districts.
Main Results
Out of 205 blood samples, 127 were positive using laboratory examinations. Both adult mosquitoes and larvae tested showed a minimum impact on malaria transmission.
Conclusion
Increased malaria cases reported during that particular investigation period were due to weaknesses in malaria control, such as insecurity and stock-out of rapid diagnostic tests. In addition, a combination of heavy rainfall
following a long and persistent drought and low usage of personal protection measures increased the number of malaria cases. Personal protection measures can include long-lasting insecticide treated mosquito nets, nofly
sheeting for IDP camps, and residual spraying. The study concluded that this particular increase was due to seasonal variations but cannot be considered as a malaria outbreak (no deaths were reported).
WHO takes this opportunity to encourage all partners to use rapid diagnostic tests, which are available in large quantities in all health facilities. This will facilitate screening of all fever cases and lead to prompt treatment of
all positive malaria cases as per the national treatment guidelines.

SUSPECTED MEASLES (SOURCE: CSR SENTINEL SITES)
Suspected measles cases continue to be reported from all the three zones of Somalia. The number of reported cases keeps on increasing in Somaliland. Burao district (Togdheer region) alone accounted for 79 of the 95
reported cases (or 83%) during week 17. Limited outbreak response was carried in Aynebo district and Burao town, in which 11 488 and 14 240 children respectively were vaccinated. Outreach immunization activities are
strengthened and ongoing in Burao town. In addition to immunization activities, surveillance is strengthened and local health authorities are monitoring measles data on a daily basis. Because of the continuation of the
outbreak despite the response, local health authorities in Somaliland have organized and deployed an outbreak investigation team with the support of WHO Somalia. The investigation team met with all political leaders, important religious leaders, and partners. The team conducted a rapid measles immunization coverage assessment and a house-to-house detection of measles cases. In addition, BBC Somali service made media coverage of the outbreak that was aired on BBC and other local media outlets. A television
debate was also organized on the importance of vaccination among medical doctors, sheiks and other prominent figures in the region that had not been actively supporting immunization activities. These media events and inclusion of prominent figures is expected to enhance acceptance of vaccination and improve measles immunization coverage rate that currently stands at about 50 percent.
...

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting dates 5 – 11 May 2012
(reflecting Epidemiological week 18)

BULLETIN HIGHLIGHTS
• The Ministry of Health, WHO and UNICEF have successfully concluded the two phases of Child Health Days in Banadir Region. The two phases of the vaccination campaign reached more than 295 000 children under the age of five and more than 317 000 women between the ages of 15 and 49. Child Health Days were also organized on 10 April 2012 in Gedo region, where a total of more than 47 000 children under the age of five and more than 35 000 women between the ages of 15 and 49 were reached.
• During a routine water quality monitoring exercise in 14 districts of Mogadishu, a WHO team conducted daily water testing for 50 water sources over three consecutive days. Of these, 50% (25) had no chlorine residual
over the three days of testing. WHO recommends improvement in water source chlorination and adding pointof- use, where appropriate. In addition, accelerated hygiene promotion is needed in view of confirmed cholera
cases in Mogadishu and the ongoing transmission season that stretches to July.
...
SITUATION OVERVIEW:
The leading causes of morbidity varied across the zones with suspected cholera accounting for most consultations in South Central Somalia (3.4%). Suspected measles remains the leading cause of morbidity in Somaliland (see tables). A steady increase in the number of consultations continues to be observed with almost all areas on Somalia experiencing rains.

SOUTH CENTRAL SOMALIA


In the last three weeks, the number of suspected pertussis (whooping cough) cases have double in South Central Somalia while the number of reporting sites have remained steady (77 cases for 75% of facilities vs. 153 cases for 76% of facilities, respectively). This is born out in the increasing proportional from 0.4% to 0.7% from week 15 to week 18, respectively. Reinforcement of EPI with DTP needs to be pushed for all clinic visits of children, including providing catch-up doses.

SOMALILAND



Suspected measles was the leading cause in Somaliland (see table 2). For week 18, the proportional morbidity for suspected measles remains high since a couple of weeks. Burao district (Togdheer region), which also has
the lowest vaccination coverage for the recently conducted Child Health Days, accounts for most of the cases.

PUNTLAND



During week 18, the leading cause of morbidity for Puntland is suspected cholera accounting for most of the consultations (proportional morbidity of 6.5%). A steady increase in the number of consultations for suspected
cholera is being observed with almost all areas in Somalia experiencing rains.

MAIN CAUSES OF MORBIDITY:
SUSPECTED CHOLERA (SOURCE: CSR SENTINEL SITES)

A steady increase in the number of reported suspected cholera is observed in South and Central Somalia for both age groups (under the age of five, and five and older). Banadir region alone accounted for 49% of the 777
cases reported in week 18. Confirmed cholera cases have been identified in Banadir region. Although these do not suggest a major outbreak at the moment, the risk of an outbreak in Banadir region, the Afgooye corridor
and the neighboring Balcad corridor in Middle Shabelle region cannot be understated. Numerous informal settlements and population displacement following the increasing personal insecurity within Mogadishu due to undeterminable daily explosions over the past weeks (see casualty data) pose a major challenge in prevention and control of diarrheal diseases outbreaks including cholera; which are accelerated by the ongoing rains and limited access to safe and clean drinking water.
...

CONFIRMED MALARIA (SOURCE: CSR SENTINEL SITES)
In regards to malaria, the trends have remained stable.

SUSPECTED MEASLES (SOURCE: CSR SENTINEL SITES)
The increase in proportional morbidity for measles in Somaliland continues. Since the beginning of 2012, Burao district (Togdheer region) alone accounted for 424 of the 628 reported measles cases (or 67.5%). The current measles outbreak was detected back in February of this year, and case investigation has been conducted with the support of WHO.

Distribution of the measles cases
Based on the data obtained from the records of 8 MCH and one hospital (all located in Burao town), with additional house to house search, it was found out that the majority of the measles cases in Burao town have
to be situated in the age group of 1-4 years and 5-9 years (see table 5). Looking at the vaccination status of those 520 measles cases in Burao town, the majority of them were not vaccinated (see table 6).

...

[Ronan Kelly]

Humanitarian Bulletin
Somalia
Issue 07 | 4-16 May 2012

Cholera and measles on the rise
The incidence of infectious diseases is increasing in numerous informal settlements due
to the on-going rains and limited access to safe water. From 9 April to 6 May, a steady
increase in suspected cholera cases was reported in southern and central regions.
Banadir region accounted for 49 per cent of the 777 cases reported between 30 April and
6 May, representing an 11 per cent increase from the previous week.
Although these figures do not suggest a major epidemic, there are serious concerns of an
increased risk of a cholera outbreak in Banadir region and the Balcad and Afgooye
corridors, where there is a high density of IDPs significantly increasing the risk of the disease spreading. In Balcad district, Middle Shabelle region, 77 cholera cases were
confirmed since the end of March at a cholera treatment center (CTC).
In an effort to speed treatement of the disease, WHO provided two diarrhoeal disease kits
to Banadir Hospital in Mogadishu. The kits can be used to treat 200 adults with severe
cases and 800 people with moderate cases of suspected or confirmed cholera. Health
partners prepositioned 23 diarrhoeal disease kits in cholera treatment units within mother
and child health clinics (MHC) in southern and central regions. There are plans to open a
further 12 units. Preventative activities include the airing of informational radio messages,
community sensitisation, chlorination of water sources and distribution of aqua tabs for
water purification.
In Somaliland, suspected measles cases have remained high since February. Burao,
Togdheer region, alone accounted for 424 of the 628 reported cases in Somaliland.
Burao had the lowest vaccination coverage for the recently completed Child Health Days
(CHDs) campaign. Obstacles to better coverage include recluctance on some
communities to participate in the vaccination campaign.
Incidence of malnutrition fall in the capital
...
http://reliefweb.int/sites/reliefweb...y%202012_0.pdf

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting dates 12 – 18 May 2012
(reflecting Epidemiological week 19)

BULLETIN HIGHLIGHTS

As a response to the current measles outbreak in Somaliland, particularly Burao district, the Ministry of Health has decided to organize a region-wide outbreak response campaign. Exact dates and target population figures are not known yet.
...
SITUATION OVERVIEW:
The leading causes of morbidity varied across the zones with suspected cholera and confirmed malaria accounting for most consultations in South Central Somalia (2.69% and 2.61% respectively) and suspected cholera in Puntland (4.5%). Suspected measles remains the leading cause of morbidity in Somaliland (1.88%). A steady increase in the number of consultations continues to be observed with almost all areas on Somalia experiencing rains. South Central Somalia reported over 7% increase, while Somaliland and Puntland remained stable compared to week 18.

SOUTH CENTRAL SOMALIA

In South Central Somalia, a steady increase in the number of reported cases of suspected shigellosis has been reported. Contact with the field suggests a lack of adherence to the stipulated case definition “visible blood in stool”. To tackle this issue, a series of planned trainings is expected to correct this among health workers. Similar challenges are fuelling the sustained spread of whooping cough and the increasing number of neonatal tetanus that will greatly affect neonatal mortality. While the number of suspected cholera cases slightly decreased compared to week 18, the risk of an increase in the number of cases remains. Results of over 60 stool samples collected from suspected cholera cases in Banadir region are still pending. Cholera was confirmed earlier and partners have been advised to step up WASH activities.

SOMALILAND

Suspected measles was the leading cause in Somaliland (see table 2). For week 19, the proportional morbidity for suspected measles increased compared with last week, although the total number of consultations remained the same. Burao district (Togdheer region), which also has the lowest vaccination coverage for the recently conducted Child Health Days, accounts for most of the cases.

PUNTLAND

During week 19, the leading cause of morbidity for Puntland is suspected cholera accounting for most of the consultations (proportional morbidity of 4.5%). However, since a few weeks the proportional morbidity for shigellosis is on the rise. A steady increase in the number of consultations for suspected cholera is being observed with almost all areas in Somalia experiencing rains.

MAIN CAUSES OF MORBIDITY:
SUSPECTED CHOLERA (SOURCE: CSR SENTINEL SITES)
Results of over 60 stool samples collected from suspected cholera cases in Banadir region (South Central Somalia) are still pending. Cholera was confirmed earlier and partners have been advised to step up WASH activities.
The number of suspected cholera cases reported from Puntland is decreasing. Most cases were reported from Bossaso district in Bari region. Information on current response activities is still pending.

CONFIRMED MALARIA (SOURCE: CSR SENTINEL SITES)
In regards to malaria, the trends have remained stable.

SUSPECTED MEASLES (SOURCE: CSR SENTINEL SITES)
The increase in proportional morbidity for measles in Somaliland continues. The current measles outbreak was detected back in February of this year, and case investigation has been conducted with the support of WHO.
...

[Ronan Kelly]

Humanitarian Bulletin
Eastern Africa
Issue 6 | 11 – 25 May 2012
...

Cholera and measles on the rise
The incidence of infectious diseases is increasing in numerous informal settlements due
to the ongoing rains and limited access to safe water. From 9 April to 6 May, a steady
increase in suspected cholera cases was reported in southern and central regions.
Banadir region accounted for 49 per cent of the 777 cases reported between 30 April and
6 May, representing an 11 per cent increase from the previous week. Although these
figures do not suggest a major epidemic, there are serious concerns of an increased risk
of a cholera outbreak in Banadir region and the Balcad and Afgooye corridors, where
there is a high density of IDPs significantly increasing the risk of the disease spreading. In
Balcad district, Middle Shabelle region, 77 cholera cases were confirmed since the end of
March at a cholera treatment centre. In an effort to speed treatment of the disease, WHO
provided two diarrhoeal disease kits to Banadir Hospital in Mogadishu to treat 200 adults
with severe cases and 800 people with moderate cases of suspected or confirmed
cholera. Health partners prepositioned 23 diarrhoeal disease kits in cholera treatment
units within mother and child health clinics in southern and central regions. There are
plans to open a further 12 units. Preventative activities include the airing of informational
radio messages, community sensitization, chlorination of water sources and distribution of
aqua tabs for water purification.
...

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting dates 19 – 25 May 2012
(reflecting Epidemiological week 20)

BULLETIN HIGHLIGHTS

Of 37 stool samples collected from patients in Mogadishu during the reporting week, 19% tested
positive for cholera on lab culture. Current armed conflict affecting the Afgooye corridor and parts of
Mogadishu resulting in renewed population displacement could accelerate the spread of cholera in
Mogadishu.
...
SITUATION OVERVIEW:
The received data for South and Central Somalia has been split up this week and will be so in future. The
leading causes of morbidity varied across the zones with suspected cholera and confirmed malaria
accounting for most consultations in Southern Somalia (3.00% and 2.99% respectively), confirmed malaria
in Central Somalia with 4.29%, and suspected cholera in Puntland (5.58%). Suspected measles remains
the leading cause of morbidity in Somaliland (1.34%).
...
SOUTHERN SOMALIA
In Southern Somalia, confirmed malaria is the leading cause of morbidity accounting for 4.29% consultations.

CENTRAL SOMALIA
Epidemic numbers of cases of suspected whooping cough, continue in South and Central Somalia stressing
the need to ensure vaccination, 111 for week 20.

SOMALILAND
Suspected measles was the leading cause in Somaliland (see table 2). For week 20, the proportional morbidity
for suspected measles slightly decreased compared with last week, however the total number of consultations
went down too. Burao district (Togdheer region), which also has the lowest vaccination coverage for the
recently conducted Child Health Days, accounts for most of the cases. Suspected cholera is on the rise in
Somaliland. Sporadic cases of suspected whooping cough are detected in Somaliland.

PUNTLAND
During week 20, the leading cause of morbidity for Puntland is suspected cholera accounting for most of the
consultations (proportional morbidity of 5.58%), however, given the proportion of cases below the age of five,
the surveillance case definition is probably not being followed. Although last week the total number of
consultations was less, this is a sudden increase by almost 20% of proportional morbidity. A similar trend is
being observed for suspected shigellosis, here an increase of more than 50% compared with last week.

MAIN CAUSES OF MORBIDITY:

SUSPECTED CHOLERA (SOURCE: CSR SENTINEL SITES)
During week 20, a total of 37 stool samples were collected from Banadir hospital, and 19% (7) tested positive for Vibrio cholera serotype ‘Inaba’ sensitive to tetracycline and chloramphenicol and resistant to ampicillin and cotrimoxazole. These seven positive cases include five residents of Hodan district, one from Dharkeynley and one from Yaqshiid district. Partners in these districts are requested to step up all preventive activities for cholera and other diarrheal diseases. Banadir, Lower Shabelle and Bay regions recorded an increase in the number of suspected cholera cases compared to week 19. However, in Central Somalia, which also accounts for the greatest burden of communicable diseases in the whole country, the total number of cases decreased from over 650 in week 19 to 550 in week 20. However, the proportion of cases among children under the age of five continues to raise concerns of not meeting the surveillance case definition.
The number of admissions for suspected cholera to Banadir hospital continues to increase. Twice as many cases were seen in 2012 compared to 2011 for the same reporting period (week 20 2012: 333 cases, 2011: 140 cases). The CFR is also higher raising concern of the disease severity or the case management (CFR 2012: 5.7%, CFR 2011: 0.6%). Of the 333 admissions reported in week 20, 66% (220) were children under 5 years and 39% (130) of all were women and girls. Hodan CTC supported by ARC reported 58 admissions including 57% (33) children under 5 years. Of all admissions 50% were women and girls. In the past four weeks, Hodan CTC, a referral centre, has treated 210 cases with no associated deaths. Merka hospital CTC reported 32 admissions including 66% (21) children under 5 years with no associated death. Women and girls accounted for 56% of admissions.

CONFIRMED MALARIA (SOURCE: CSR SENTINEL SITES)
Six regions (Banadir, Lower Shabelle, Bay, Bakool and Lower Jubba) recorded an increase in the number of
confirmed malaria cases compared to week 19. WHO is investigating the increased number of confirmed
malaria cases reported over the past weeks. Cross-checking will be carried out and a detailed report will be
forthcoming, which will include week 1-21.

SUSPECTED MEASLES (SOURCE: CSR SENTINEL SITES)
The increase in proportional morbidity for measles in Somaliland continues. The current measles outbreak
was detected back in February of this year, and case investigation has been conducted with the support of
WHO. National Immunization Days are being organized in Somaliland (28-30 May) and Puntland (21-23 May),
targeting 412 800 and 178 000 children under the age of five respectively.
...

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting dates 26 May - 1 June 2012
(reflecting Epidemiological week 21)

BULLETIN HIGHLIGHTS
As a response to the current cholera outbreak in Mogadishu, a fourth cholera treatment center (CTC)
has been opened. The CTC, fully functional, is located in Xamarjajab district and acts as a referral
center for suspected cholera cases to decongest the caseload in Banadir hospital.

SITUATION OVERVIEW:
During week 21, the leading causes of morbidity across the
zones were suspected cholera and confirmed malaria.
Suspected cholera accounted for most consultations in Central
Somalia (3.22%), Somaliland (1.38%), and Puntland (5.44%) while confirmed malaria was the leading
cause of morbidity in Southern Somalia (3.96%). A steady increase in the number of consultations continues
to be observed in almost all areas of Somalia experiencing rains.

CENTRAL SOMALIA and SOUTHERN SOMALIA
More than 250 cases of suspected shigellosis are being reported in South and Central Somalia and 1% or
greater proportional morbidity in Somaliland and Puntland. Shigellosis can be associated with high attack rates
and case-fatality rates, especially among children aged less than 5 years. The Center for Disease Control
(CDC) recommends to minimize person-to-person transmission (fecal-oral) and keep food and water safe and
covered.
In Central Somalia, cases of neonatal tetanus are continuing to be reported intermittently (none last week;
however, 2 cases in South Somalia last week). Enforce strict adherence to aseptic deliveries, including cutting
of the umbilical cord, and administration of tetanus toxoid-containing vaccine during pregnancy.
In the Southern Somalia, confirmed malaria is the leading cause of morbidity accounting for 3.96%. For
Central and Southern Somalia, suspected whooping cough continues to be reported. Ensure vaccination and
adherence to the case definition is occurring.
...
SOMALILAND
Suspected cholera became this week the leading cause of morbidity in Somaliland (see table 3). A total of 58
out of 88 (67%) reported suspected cholera cases came from Erigavo district, Sanaag region. The exact
reasons for this sudden increase in Erigavo district are being investigated. Regarding suspected measles, the
proportional morbidity slightly decreased compared with last week (1.34% for week 20, compared with 1.00%
for week 21), however the total number of consultations was higher this week. Burao district (Togdheer
region), which also has the lowest vaccination coverage for the recently conducted Child Health Days,
accounts for most of the cases.
...
PUNTLAND
Suspected cholera remains the leading cause of morbidity in Puntland accounting for 5.44% during week 21
(see table 4).
A similar trend is being observed for suspected shigellosis, with almost remaining stable in terms of
proportional morbidity (1.44% last week compared to 1.27% this week).
...
MAIN CAUSES OF MORBIDITY:
SUSPECTED CHOLERA (SOURCE: CSR SENTINEL SITES)
Results of 23 out of 60 stool samples collected from suspected cholera cases in Banadir region (South
Central Somalia) during week 19 are still pending. The results of the 37 other samples were reported during
week 20.
Following the routine water quality monitoring exercise in Mogadishu, reported during week 18, UNICEF and
WASH cluster have dispatched additional chlorine to Mogadishu. In this regard, WASH partners will be able to
step up chlorination activities.
As response to the current cholera outbreak in Mogadishu, WHO and UNICEF have prepositioned adequate
stocks of diarrhoeal disease kits (DDKs). Partners who are in need of additional DDKs should contact
WHO/UNICEF staff in Mogadishu.
(2 deaths were recorded this week at Banadir hospital - Ro)
...
CONFIRMED MALARIA (SOURCE: CSR SENTINEL SITES)
WHO encourages all field partners to screen all fever cases with the rapid diagnostic tests (RDTs) as well as
microscopy whenever it is available. RDTs have been provided by UNICEF to all health facilities and are
available in large quantities.
WHO is still investigating the increased number of confirmed malaria cases reported over the past weeks, in
particular from six regions (Banadir, Lower Shabelle, Bay, Bakool and Lower Jubba). Cross-checking is being
carried out and a detailed report is still pending.
...
SUSPECTED MEASLES (SOURCE: CSR SENTINEL SITES)
The increase in proportional morbidity for measles in Somaliland continues. The current measles outbreak
was detected back in February of this year, and case investigation has been conducted with the support of
WHO. The Ministry of Health of Somaliland plans to vaccinate about 180 000 children between the age of 6
months – 15 years as part of the mop up measles campaign in Togdheer region. The planned National
Immunization Days for Somaliland (28-30 May) have been cancelled till further notice.
...

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting dates 2 - 8 June 2012
(reflecting Epidemiological week 22)
...



...

...

[Ronan Kelly]

Somalia Emergency Weekly Health Update

Reporting dates 9 - 15 June 2012
(reflecting Epidemiological week 23)

[Ronan Kelly]

Somalia Emergency Weekly Health Update

Reporting dates 16 - 29 June 2012
(reflecting Epidemiological week 24 and 25)

...




Somaliland did not report for weeks 24 and 25.

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting dates 14 - 20 July 2012
(reflecting Epidemiological week 28)

SITUATION OVERVIEW:
During week 28, the leading causes of morbidity across the zones were suspected measles for Central Somalia (1.5%), confirmed malaria for Southern Somalia (2.7%), suspected shigellosis for Somaliland (0.3%) and suspected cholera for Puntland (0.4%). General caseload has remained relatively stable across all the 4 with Central reporting a total of 8488 consultations from 25 sentinel sites; Southern 5981 from 36 sites; North West zone (Puntland) 5124 from 45 sites; and North East zone (Somaliland) 3953 from 54 sites. These compare to last week except for Central which only 41% of sentinel sites reported on time.



Most of the confirmed malaria cases in Southern Somalia were reported from Lower Jubba and Bay regions, which accounted for 49% and 32% of all reported cases respectively in Southern Somalia. Afmadow and Kismayo districts accounted for 33% and 29% of cases reported from Lower Jubba. Mapping of the availability of rapid diagnostic tests and supplies for malaria treatment is ongoing.
Confirmed cholera cases were reported by partners in Lower Jubba; 6 of 10 cases tested positive for cholera using rapid diagnostic test. The situation was responded to immediately and controlled through case management. It has not been possible to implement water chlorination in the area pending clearance by local health authorities. Active case detection and referral is ongoing. The increased number of cases was localized and although under control, the risk for an outbreak remains. Adequate supplies have been made available for partners to access. Kismayo General Hospital reported only 3 cases under the age of 5 years of suspected cholera compared to 15 in
week 27. WHO, UNICEF and partners remain on high alert for any unusual number of cases.



The observed reduction in the overall health facility caseload is because over 50% of the health facilities did not report on time. This may be attributed to the participation of some of the health workers and the CSR team in various
training activities during the week. However the proportional morbidity for suspected measles cases increased almost threefold despite the fewer reporting facilities. The increase was observed in Mogadishu/Banadir region
where there was a 40% increase in the number of reported cases compared to week 27 despite fewer reporting sites. Mogadishu is still receiving internally displaced people from areas that have not received any vaccination over
the past two years such as from Lower and Middle Shabelle, Lower and Middle Jubba and Bay regions. Although vaccination activities have been done in Mogadishu, the continued population influx and overcrowding in informal
settlements provides amble conditions for the continued existence of cases and the risk of outbreaks.

SOMALILAND


Suspected cholera cases were reported during week 28 from Lascanod district, Sool region. Details of these cases
are still pending but the situation is reportedly stable. The Ministry of Health, WHO and partners in Somaliland have
adequate capacity to launch response activities if needed.
The number of suspected shigellosis is reducing. The health workers’ adherence to the recommended case
definitions remains a challenge. Cases were reported from Baki (3), Borama (4) districts in Awdal region; and Sheikh
district (2) in Togdheer region. Trainings on case definitions will be conducted after Ramadan.



Bari and Nugaal regions accounted for 30% and 29% of all suspected cholera cases in Puntland. There has been a
steady reduction in the number of reported cases. Preventive activities are ongoing with partners undertaking
chlorination and health education activities. Adequate case management supplies are on ground.
...

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting dates 21 - 27 July 2012
(reflecting Epidemiological week 29)
...
SITUATION OVERVIEW:
During week 29, the leading causes of morbidity across the zones were confirmed malaria for Southern Somalia
(1.8%) and Central Somalia (1.9%), suspected shigellosis for Somaliland (1.0%) and suspected measles for
Puntland (0.6%). An unknown illness was reported from Qol village (Nugaal region) in northeastern Somalia with
patients presenting with diarrhea and vomiting. A Ministry of Health (MoH) team verified 47 people affected of which
8 were hospitalized at Dhahar Hospital where they were treated with intravenous fluids and antibiotics. All patients
recovered. The source and cause of illness was suggested to be contaminated milk. There are no more cases.



The leading cause of morbidity in Southern Somalia was also confirmed malaria; Lower Jubba region accounted for
51% of all reported cases and Kismayo accounted 44% of these. Partners have reported lack of rapid diagnostic
tests, an issue that is being sorted.
The number of reported suspected cholera cases continues to decline and there were no alerts for suspected
cholera during the week. Of the cases reported from Southern Somalia, 89% were reported from Lower Jubba.
Knowing that the area is facing violence and fighting with the opposing forces, health partners are on high alert for
cases in the zone.
Suspected measles and whooping cough are a concern given the denied access for interventions that provide
vaccination. The proportion of children aged less than five years with suspected pertussis is increasing making the
risk of whooping cough-related death greater. Of 20 districts in Southern Somalia, 14 reported at least 1 case of
suspected measles (median 2.5 cases).
Suspected shigellosis cases continue to be reported from health facilities but verification indicated non-adherence
to the recommended case definitions at most. Classification is largely based on history of blood in stool rather than
visible blood in stool.
Comprehensive trainings for health staff have just been completed in both Central and Southern Somalia and it is
expected that application of case definitions will improve for all conditions.


The leading cause of morbidity for Central Somalia continues to be confirmed malaria. Over the past weeks
awareness of use and subsequent access to rapid diagnostic tests has been the focus of the health cluster and
partners. This is expected to regulate the number of reported cases as increase in adherence to the recommended
case definition is expected. Banadir region accounted for 76% of the reported cases of which Wadajir district alone
accounted for 59% while Madina district accounted for 18% of the total cases. These districts are densely populated,
mainly inhabited by internally displaced persons (IDPs) living in makeshift shelters that may not have been part of
those targeted for indoor residual spraying (IRS). These shelters are not suitable for IRS as they are too small to
ensure adequate distribution of the residue.
Despite a 4% reduction in the overall caseload, suspected cholera was the second leading cause of morbidity and
proportional morbidity compared to the previous week. Banadir region alone accounted for 98% (157) of the reported
cases followed by Wadajir and Huruwaa districts. The two districts are home to thousands of IDPs with limited
access to safe drinking water and poor sanitation. The cholera awareness activities are ongoing but all interventions
to ensure acceptable access to adequate water quantity and quality are still weak.
Measles remains a problem across Central Somalia, which is characterized by non-functioning routine vaccination
programs, population displacement and general low vaccination coverage. Banadir region accounted for 84% (109)
of all reported cases in Central Somalia, with Huruwaa district alone reporting 62% (80) of all reported cases for
Banadir region. Children are especially affected with 90% of the cases this week being less than 5 years old; the
population who need to be targeted for vaccination.



There were 36 reported suspected shigellosis cases reported in Somaliland, which is triple the proportional morbidity
and cases reported in week 28 after declines since week 26. The cases were reported from 9 of the 21 reporting
districts and 5 of these 9 districts did not report any cases in week 28. Five districts reported 23 cases in week 27;
hence the trend is showing a geographical spread of suspected shigellosis cases. Investigations are ongoing and the
MoH, WHO and partners in Somaliland have adequate response capacity if need arises. After weeks of no reported
cases of suspected pertussis, one case was reported for week 29.



One suspected shigellosis case was reported in week 29, indicating a sustained decline in reported cases for three
consecutive weeks. Prevention activities, mainly water chlorination and health education are ongoing. There was a
surge in reported suspected measles cases, with 16 cases (55.2%) reported in Galkacyo district and 9 cases
(31.0%) reported in Eyl district. There have been no suspected measles cases reported in Galkacyo in the previous
two weeks. Feedback on investigation is still awaited. The majority of cases are in children aged less than 5 years as
seen in weeks 26 and 27.

...

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting dates 28 July – 3 August 2012
(reflecting Epidemiological week 30)

...
SITUATION OVERVIEW:
The number of suspected cholera cases is expected to remain relatively stable with the rains having reduced across
Somalia. Health facility visits are observed to have remained stable in most regions.This particular trend is expected
to be sustained over the next coming weeks.


Continued decline in reported suspected cholera cases have been observed in South Zone where the number of
reported cases and the proportional morbidity have declined possibly due to an end of the rainy season along with
prevention activities. While the number of reported suspected shigellosis cases is higher, the trend is similar to
that of suspected cholera cases. However the trend in suspected whooping cough cases raises concerns while
suspected measles cases remain stable. Immunization coverage in the South Zone is low due to reduced access
and insecurity. Sixty percent of all confirmed malaria cases were reported from three districts namely Afgooye,
Baidoa and Kismayo. The reasons for the increase in reported confirmed malaria cases and proportional morbidity
are being investigated. In comparison to the month of June, in July the number of reported cases for suspected
cholera decreased by 84%, suspected measles by 6% and confirmed malaria by 45% (see chart below).
...

There was a 6.8% increase observed in reported suspected cholera cases in Central Zone, but a decrease seen
among children under the age of five. Adherence to surveillance case definition still remains a challenge. About
98.8% of the cases were reported from Banadir region which is densely populated with the internally displaced
persons (IDPs) moving into Mogadishu. Suspected shigellosis cases were reported from 11 of the 36 districts in
the Central Zone. High numbers of suspected measles cases continue to be reported. Huruwaa district in Banadir
region reported 67.8% of suspected shigellosis cases and suspected measles cases in week 30. Confirmed
malaria cases among children under the age of five increased in week 30 after steady decline since week 26.
Wadajir District accounted for 60% of the confirmed malaria cases reported in the zone. Central Zone continues to
report neonatal cases mainly from Wadajir district where the three cases were reported. This district has reported
at least one case since week 16, which may point to the low immunization coverage, poor cord care practices or
poor application of the case definition. In comparison to the month of June, in July the number of reported cases for
suspected cholera decreased by 38% and confirmed malaria by 15%. Suspected measles cases increased by 38%
...

...
Somaliland reported cases of suspected shigellosis and suspected measles. Sixty-four percent of the suspected
shigellosis cases were reported from Borama Hospital in Borama District (seven cases after at least 6 weeks without
a reported case). Follow up of these cases is been undertaken. No suspected cholera cases have been reported for
two consecutive weeks, attributable to the success of the prevention campaign including hygiene promotion and
water chlorination that was undertaken by the Ministry of Health and health cluster partners.


Reported cases of suspected cholera and suspected shigellosis have reduced. In week 30, only five suspected
cholera cases were reported from districts of Galdogob and Galkacyo. This reduction in cases is possibly attributed
to ongoing capacity building of health workers in communicable disease surveillance and response.
...

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting dates 4-10 August 2012
(reflecting Epidemiological week 31)

BULLETIN HIGHLIGHTS Reporting
• In week 31, Bakool region in Central Somalia, reported a significant increase in reported suspected
measles cases as compared to previous week. Eighteen of the 23 cases were reported from a single
facility. Investigations are ongoing to establish if it is an outbreak.

SITUATION OVERVIEW:
Suspected cholera cases are seen to be declining except in the region of Banadir where there is concentration of
internally displaced persons (IDP) resulting to overcrowding, as well as poor water and sanitation conditions. People
are moving to the Mogadishu area due to security and economic issues. However, no new outbreaks have been
reported. Trends in suspected whooping cough cases have stabilized at high levels in both the Southern and
Central Zones with caseloads higher in the Southern regions. This is possibly due to lack of access to routine
immunization services especially due to insecurity particularly in the South.


Reported suspected cholera, suspected measles and suspected shigellosis cases increased in week 31, following a
decrease in the previous week. Eleven suspected cholera cases were reported from Lower Jubba region, with 7 of
these cases being reported from Kismayo district where cases had generally declined in recent weeks. In Gedo
region, two suspected cholera cases were also reported for the first time in nine weeks. In Bakool region,
suspected measles cases almost doubled between weeks 30 and 31, from 12 to 23 cases respectively. Eighteen
of the 23 cases were reported from a single facility and investigations are ongoing to establish if it is an outbreak. In
the other regions the trend remained relatively stable. Suspected whooping cough continues at an unacceptably
high case count and proportional morbidity for three weeks in a row. Majority of the cases (96.6%) were reported
from Bakool and Bay regions. No deaths have been reported this year from the zone.



After receiving retrospective updates for weeks 29 and 30 to complete the number of reports, there appear to be an
increase in the reported suspected cholera cases although the proportional morbidity has remained between 1%
and 1.2% in the last four weeks. No cases have been reported in Galgadud region since week 27 while in Middle
Shabelle region, cases were last reported in week 17. The reported cases are concentrated in the Banadir region
which accounted for 96.6% of reported cases in week 31. Within Banadir region, cases were reported in 4 districts
namely Abdiaziz, Hodan, Waberi and Wadajir. Wadajir district accounted for 91.9% of the reported cases in the
region, while two cases were reported in Abdiaziz district that had not reported any suspected cholera since the
beginning of the year. The CSR zonal and regional teams are investigating the cases reported in the district.
Huriwaa district continues to report most the suspected measles cases accounting for 54.8% of reported cases
from Central Zone, attributable to the low immunization coverage in the district. People from other regions where
vaccination has been banned continue to move to Mogadishu. This is also seen with the continued cases of
suspected whooping cough in all regions with the highest caseload reported from Lower Shabelle region. Neonatal
tetanus cases continue to be reported in Banadir region. This trend of both diseases is an indication of the low
immunity levels among the populations due to limited routine immunization services available to pregnant women
and children. WHO Somalia and partners are supporting immunization outreach activities all the districts of
Mogadishu.
Confirmed malaria cases and the proportional morbidity have stabilized although still at high levels. There is
adequate availability of rapid diagnostic test (RDT) kits and Artemisinin-based Combination Therapy (ACTs) after
shortages in some facilities was addressed. Recommended is the need for continued monitoring and strengthening
of the supply management systems to avoid any future stock-outs. In Banadir region, confirmed malaria cases have
consistently increased since week 29. During week 31, 11 out of the 61 health facilities reported at least one case
of confirmed malaria. 88.3% of cases were reported from five of those facilities. Since week 24, all reported
suspected shigellosis cases have been reported from one facility with no clear trend.



No suspected cholera cases have been reported since week 29. The trends in suspected measles and shigellosis
cases including the proportional morbidity have remained stable. Togdheer Region reported 4 suspected measles
cases from two facilities which had not reported a single case since weeks 18 and 26. This region had no reports of
any suspected measles cases for two consecutive weeks. Suspected shigellosis cases continue to be reported in
all regions except Togdheer and Sanaag regions. However, the trend is stable. No confirmed malaria cases have
been reported since week 26. One neonatal tetanus case has been reported in Maroodijeh region, the first such
case to be reported in Somaliland since the beginning of the 2012.



Two suspected cholera cases were reported from Mudug and Sanaag regions, which has shown a declining trend
since week 26. The regions of Bari, Mudug and Sool reported a total of seven suspected measles cases. Since
week 24 when one case was reported in Bari region, no suspected measles case had been reported since. In
Mudug region, suspected measles cases have declined, while a case was reported in Sool region after four weeks
of no cases reported.
...

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting dates 18-24 August 2012
(reflecting Epidemiological week 33)

BULLETIN HIGHLIGHTS
• Banadir and Lower Shabelle regions reported a total of 25 suspected shigellosis cases, with 84% (21
out of the 25 reported cases) located in Banadir region alone. Since week 23, all suspected shigellosis
cases reported in Banadir region are located in one health facility; however this is being investigated as
concerns were expressed about the adherence to the recommended case definition.

...
SITUATION OVERVIEW:
Suspected measles, confirmed malaria, suspected shigellosis and suspected cholera cases continue to be reported
across Somalia. Adherence to the recommended case definitions for health events under surveillance remains a
challenge, especially for suspected cholera and suspected shigellosis. In collaboration with the Ministries of Health
and health partners, targeted trainings for health workers in sentinel sites are ongoing as part of the capacity building
activities for the communicable diseases surveillance program. These aim to improve the adherence of the health
workers to the recommended case definitions, which is expected to improve disease specific data from health
facilities and case management. Current trends indicate a steady reduction in the number of health facility visits,
which has been observed in past years during August and stability is expected through October, when the next
seasonal changes will begin.

SOUTHERN SOMALIA


The trend in suspected cholera, measles, shigellosis and whooping cough in Southern Somalia continues to
decline. While the proportional morbidity of suspected whooping cough cases declined from 1% to 0.7% between
weeks 30 and 33, for the other conditions it remained stable. Total consultations have consistently declined in the
past 3 weeks.

Suspected cholera cases continue to be reported in Afmadow, Jamaame and Kismayo districts of Lower Jubba
region. Confirmed malaria cases have been reported from all regions in Southern Somalia although most of the
cases are located in Lower Jubba and Bay regions. Lower Jubba region accounts for the highest number of reported
cases for all health events. The region is currently the epicenter of armed conflict between government and their
allies against the opposing forces. In addition, the region became also a transit area for refugees moving from the
upper regions fleeing towards the border area with Kenya.

CENTRAL SOMALIA


A retrospective update of the data of week 32 has been carried out since the report from Banadir region was
missing. Looking at the updated data for Central Somalia, the trend in suspected cholera cases shows an
increase from weeks 29 to 32. A decline was observed during week 33, with a total of 162 suspected cholera cases
reported in three regions with Banadir region accounted for 95.7% of those cases. Compared to week 32, this means
a 36.7% decrease; however it is not clear yet if this will be the start of a steady decline.
Banadir and Lower Shabelle regions reported a total of 25 suspected shigellosis cases, with 84% (21 out of the 25
reported cases) located in Banadir region alone. Since week 23, all suspected shigellosis cases reported in Banadir
region are located in one health facility; however this is being investigated as concerns were expressed about the
adherence to the recommended case definition.
During week 33, nine out of the twenty health facilities that reported in week 33, reported at least 1 case of
confirmed malaria with 73.9% of cases reported in 3 facilities.
Suspected measles cases continue to be reported and are mainly concentrated in Banadir region (62% of all
reported cases in week 33) and Lower Shabelle region (35% of all reported cases in week 33). Plans are underway
to carry out Child Health Days activities in October 2012, providing essential vaccination and treatment to children
and women of childbearing age.
Cases of suspected tetanus continue to be reported. This is due to the fact that the IDP population, mainly
concentrated in Banadir region, comes from areas where limited or no immunization services are available,
especially in Lower Shabelle region. A follow up investigation is underway to gather more information regarding
these cases.

SOMALILAND



Of all reported suspected measles cases during week 33, half of them were located in Burao Hospital. Back in June
2012, a measles outbreak was reported in Burao. As response, measles vaccination activities were undertaken.

PUNTLAND


...

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting dates 6-12 October 2012
(reflecting Epidemiological week 40)

for whatever reason, the PDF is hard to copy - has format problems, but is available to view here; http://reliefweb.int/sites/reliefweb...tober_2012.pdf

Bulletin Highlights
Following the recent confirmation of three vaccine-derived poliovirus type 2 (cVDPV2) cases in the refugee camps in Dadaab, Kenya and one cVDPVs case in Kismayo, South Central Somalia, an immunization response is currently being planned.
...
SOUTHERN SOMALIA
Confirmed malaria was the leading cause of morbidity, having increased its caseload by 17% compared to week
39. Lower Jubba and Bay regions accounted for 48% and 30% of all reported cases.

Cases of suspected shigellosis continue to be reported. A suspected outbreak with 12 cases including 11 children under the age of five is being investigated in Qooqani village, which is located about 65km from Afmadow town.
Samples collection kits are available on the ground and WHO and health partners are conducting case based
surveillance to collect samples for laboratory confirmation.

Trends of reported suspected measles cases have remained stable. No vaccination activities have been conducted
in the region in the past two years.

CENTRAL SOMALIA
Cases of reported suspected cholera remained stable for week 40. However, as part of the pre-season random
check for cholera, samples were collected from two sentinel sites and referred to a laboratory for confirmation. This
exercise is being conducted due to the confirmed cholera cases in Lower Jubba region. In addition, observed
population movements out of and into Mogadishu, which remains densely populated with variable access to safe
drinking water, sanitation and water safety interventions, is one of the risk factors for a potential outbreak.

Suspected shigellosis and suspected measles cases continue to be reported as well. Follow up investigations are
being made to ascertain the status of the reported cases and if they all fulfill to the recommended case definitions so
that samples can be collected.

Confirmed malaria is the leading cause of morbidity with Banadir region accounting for 83% (186) of the cases.

SOMALILAND
Trends for events under surveillance remained stable compared to the previous two weeks.

PUNTLAND
The investigation team has finally carried out case investigation, and confirmed that the reported malaria case on
week 38 was false positive. Other more false positive cases from Darasalam and the other MCH were also
identified by the investigating team. Trends for events under surveillance remained stable compared to the previous
two weeks.
...

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting December 2012 - Epidemiological weeks 49 – 52

...
Ten alerts of suspected cholera were reported, eight in Lower Jubba and two in Bay
Lower Jubba - Eight alerts were reported by partners in Hido, Jedecaley, Jaaro, Diidadey, Dhobley,
Kulbio, Durow and Gora. A total of 241 cases were reported, mainly children under the age of five, with
three-related deaths (Case Fatality Rate: 1.2). Of these cases, 200 were treated as out-patients while 39
required in-patient treatment. Results of the verification of cases and deaths are still pending.
Bay region - Two alerts were verified and 13 cases and four-related deaths (including one adult) were
registered. It was concluded that the affected victims developed diarrhea after consuming contaminated
camel milk. The situation is back to normal.

Malaria: outbreak declared in Bossaso
An outbreak of confirmed malaria in Bossaso district (Bari region) was declared by health authorities,
following an observed increase in cases attended to at private health facilities. The authorities requested
the coordination of response activities and evaluation of impact integrating all data from both private and
public health facilities. Outbreak investigation is currently ongoing. In the last week of December, 119
malaria cases were confirmed by Rapid-Diagnostic Testing (RDT).

...
SOUTHERN SOMALIA
In the month of December, from weeks 49 to 52, four
cases of suspected cholera were reported from the
36 sentinel sites in southern zone. This represents a
73.3% decrease compared to the month of
November, when 15 cases of suspected cholera were
reported, mainly in weeks 45 and 48. Over the past 4
months, adherence to the recommended case
definition for suspected cholera has improved
significantly among partners working in the Southern
zone. Trainings on revised reporting tools for 2013
are planned, with the objective to cover case
definitions and the monitoring and evaluation
component of the program, and to ensure at least
one visit to each sentinel site per month (where and
when access is possible).

During the same period, 69 cases of suspected
measles were reported, showing a slight decrease
compared to the 61 cases reported during the month
of November (weeks 45-48).
A 23 % increase in the reported confirmed malaria
cases was observed. About 682 cases were reported
in December compared to 526 cases reported during
November.

Cases of suspected shigellosis continue to be
reported and all verifications indicate non-adherence
to the recommended case definition for suspected
shigellosis, which is: “visible blood in stool”. This is
expected to improve following the weekly feedback
as part of the weekly monitoring and evaluation
protocol and through the planned trainings of health
workers.
...
CENTRAL SOMALIA
In central zone, a 19.5% increase of suspected cholera
cases was observed during the month of December
(weeks 49 to 52) with a total of 657 cases reported
compared to 529 cases reported in the month of
November. In the reporting month, Banadir region alone
accounted for 94.2% (619) of all the reported cases with
majority reported from Banadir hospital. While there were
cases meeting the recommended case definition for
suspected cholera, most did not. All diarrhea cases are
still being reported as suspected cholera. Some
improvement in adherence to case definition among
health workers and partners working in central zone has
been observed, but in Banadir region this still remains a
challenge.

There were 317 cases of suspected measles reported
in December, which compares to 314 cases reported in
November. Mogadishu still receives IDPs from areas
that have had no access to vaccination interventions,
hosting thousands in makeshift and overcrowded
settlements, which provide for easy transmission. A
significant proportion of this population is reported to be
malnourished. Measles cases are expected to continue
to be reported. Plans for a number of vaccination
interventions are underway by to prevent cases and
deaths.

From week 49-52, central zone reported a total of
1758 confirmed malaria cases, which accounted for a
25% increase compared to November where 1317 confirmed malaria cases were reported. In
Mogadishu, Ministry of Health (MOH), WHO and partners for the National Malaria Control Programme
conducted an Insecticide-Residual Spraying (IRS) campaign at the internally displaced persons (IDPs)
settlements, covering 51,000 households. This is expected to protect an estimated 300,000 population
from malaria infection over the coming months.

Like southern zone, case of suspected shigellosis continues to be reported and verification reveals poor
adherence to the recommended case definition.
...
SOMALILAND
There were no reported cases of suspected cholera
reported in December from the 54 health sentinel
sites in Somaliland.

From week 49-52, Somaliland reported a total of 54
suspected measles cases, which accounted for a
70.3% increase compared to cases reported in
November (weeks 45-48) in which 16 cases were
registered. The cases were reported from
Maroodijeh, Sahil, Togdheer and Sanag regions.
Maroodijeh alone accounted for over 50% of all the
cases.

In December, 6 cases of confirmed malaria were
reported in Somaliland compared to 2 cases which
were reported in the previous month.
...
PUNTLAND
During week 52, two confirmed malaria cases (both
above the age of five) were reported in Bossaso district,
Bari region. One case was from Bossaso hospital and the
other case was reported from Bossaso mother and child
health center (MCH). MOH has since declared an outbreak
of malaria in the district. Sentinel sites are not reporting
these cases (outbreak). A total of 119 malaria cases were
confirmed by RDT in the last week of December (see
graph below) majority reported from private health facilities
(see below graph on trends in the month of December).
...

[Ronan Kelly]

Somalia Emergency Weekly Health Update
HIGHLIGHTS
Reporting January 2013 - Epidemiological weeks 1-3
 DENGUE FEVER 23 cases of Dengue fever reported from Mogadishu
 MALARIA 410 cases detected in Bossaso outbreak
 ACUTE FLACCID Three cases reported in Berbera and Wardighley districts
PARALYSIS

23 cases of Dengue fever reported from Mogadishu
Mogadishu – Twenty three (61%) of 28 serum samples collected from patients at health facilities in
Mogadishu have tested positive for dengue fever. In recent weeks, dengue infections have also been
reported among AMISOM troops in Mogadishu. Blood samples that were collected in Mogadishu in the
previous years had a 30-38% dengue positivity rate, calling for interventions related to dengue control in
Mogadishu and other parts of Somalia. Follow-up of past patients that have since been traced, indicate
that they had improved. Results of an entomological survey conducted in Mogadishu at the end of 2011
showed that 19% of the adult mosquito and over 18% of the larvae populations collected were Aedes
aegypti, the carrier for dengue virus, as well as Chikungunya and yellow fever viruses.

Ongoing response to malaria outbreak in Bossaso
Response to the outbreak of malaria in Bossaso (Puntland) is ongoing. Since the beginning of the
outbreak in December 2012, 410 cases have been reported including 61 (15%) children under the age of
five. Mixed Plasmodium falciparum and P. vivax infections accounted for 67% of the cases, while the
remaining 33% had single infection with P. falciparum. No single infection case with P. vivax alone has
been detected. Health authorities and partners continue to respond and undertake preventive measures.

Alert for Acute Flaccid Paralysis (AFP) cases reported in two districts
In the reporting weeks, two cases of AFP were reported from Berbera district and another in Wardhigley
district. Stool samples were collected by and referred for further investigation.
Meanwhile, vaccination campaigns continue in newly accessible areas of Southern and Central Somalia.
From 14 to 16 January 2013, Health Authorities, UNICEF and WHO conducted a second round of polio
vaccination in urban areas of Kismayo district in Lower Jubba region. Over 17 000 children under the age
of five were reached. However, 30% of the children in rural areas of Kismayo still remain inaccessible.
...
SUSPECTED CHOLERA
Central Somalia accounted for 98% of the
suspected cholera cases reported from weeks1-3,
i.e. 358 out of 366 cases reported. Majority of the
cases were from Banadir region.
Poor adherence to the recommended case
definition for suspected cholera has been
observed. On-the-job training during weekly and
monthly visits to the sentinel sites is planned to
improve case detection and data quality.
In week 1-3, seven rumors of outbreak of
suspected cholera were reported in Lower Jubba region. WHO and partners collected stool samples of
the cases from affected villages of Jedecaley and Kulbio for verification. All samples tested negative for
any enteric bacterial infection including shigella and salmonella. Following response activities by
partners the situation is under control and stable. The Lower Jubba region remains a high risk area for
cholera and other water-borne disease outbreaks and access is still a challenge.
In Galgaduud region, the cholera situation has remained stable and partners on the ground have
ongoing preventive and control activities. Adequate water and sanitation supplies have been provided
by UNICEF and case management supplies were provided by WHO. Adequate stocks are available in
the event of a potential outbreak.

SUSPECTED MEASLES
With low vaccination coverage and poor access to
vulnerable populations across Somalia, especially
in Southern and Central Somalia, suspected
measles remains a challenge. Central zone
reported 64% of the 366 suspected measles
cases: Somaliland 22%; Southern 13% and
Puntland 1%.
Suspected measles cases continue to be reported
across Somalia. Four alerts were reported from
Lower Jubba region and Somaliland. Response
activities are ongoing in collaboration with the
health authorities.

CONFIRMED MALARIA
Confirmed malaria was the leading cause of
morbidity for the 3 week reporting period, with over
2000 cases reported from sentinel sites across
Somalia. Central and Southern zones reported
63% and 33% of all cases respectively.
Following the malaria outbreak in Bossaso
declared by the health authorities on 29 December
2012, a joint team, composed by Health
Authorities, UNICEF and WHO, has initiated
response activities. A total of 410 confirmed
malaria cases, including 61 children under the age
of five, have been recorded in the past seven
weeks (see Confirmed Malaria Trend graph).
Provision of supplies include rapid diagnostic
testing kits and Artemisinin Combination Therapies
(ACTs) to health facilities, training of both public
and private health facility workers, distribution of
malaria treatment guidelines and long-lasting
insecticide treated nets. Outreach initiatives
including social mobilization will continue.

OTHER HEALTH EVENTS
All zones except Puntland continue to report cases of suspected shigellosis. Although this have been
decreasing gradually, adherence to the recommended case definition for shigellosis of visible blood
remains a challenge. On-the-job trainings are being conducted to improve this. Central Somalia reported
145 (65%) of the 223 cases, while Southern Somalia and Somaliland reported 69 (31%) and 9 (4%)
cases respectively.
An alert on 25 cases of suspected neonatal tetanus had been reported from one zone. Subsequent
verifications proved that the reported cases were a data entry error.
Alerts on suspected diphtheria have been reported from Galinsoor district in Galgaduud region. Sample
collection for further investigation is currently being initiated.
Whooping cough control continues to remain a challenge.
...

[Ronan Kelly]

Somalia Emergency Weekly Health Update

Reporting 21-27 January 2013 - Epidemiological week 4

Response plan following reports of cases of Dengue fever in Mogadishu
Following the detection of 28 cases of Dengue Fever in Mogadishu, the World Health Organization
(WHO) has taken immediate action to integrate vector control of Aedes aegypti in the malaria elimination
programme. Dengue fever is a flu-like illness, transmitted to humans primarily through Aedes aegypti
mosquito, which is a day biter. Dengue fever should be suspected when a sudden onset of fever (above
38°C) is accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle
and joint pains, measles-like rash. Complicated cases develop bleeding from eyes, nose, mouth, birth
canal, anus or any opening.
WHO urges health workers to report any case that meets the above description to WHO staff, when
diagnosis of malaria or any other sever disease has been excluded by Rapid Diagnostic Testing (RDT) or
microscopy testing.

Ongoing response to malaria outbreak in Bossaso
Health authorities and partners continue to respond and undertake preventive measures. A total of 1227
confirmed cases of malaria have been reported since 2 December 2012, including 171 (14%) children
under the age of five and four-related deaths. Mixed Plasmodium falciparum and Ovale infections account
for the majority of the cases reported.

Disease alerts
Alerts for suspected measles have been reported in parts of Bay and Bakool regions, where health
partners have reported more than 47 cases, including 31 (66%) children under the age of five.

Virology results are still pending for the Acute Flaccid Paralysis (AFP) cases reported in the first three
weeks from Berbera district in Somaliland and Wardhigley in Mogadishu.

An alert for suspected diphtheria from Galinsor (Galgadud region) was verified. Samples collected from
two cases are under further investigation.

EPIDEMIOLOGICAL SURVEILLANCE (EPI WEEK 4, 21 – 27 January 2013)
During the reporting week, more than 29 000 health facility visits were reported, including over 44%
children under the age of five. Central Somalia accounted for over 58% of the reported visits, Southern
Somalia 23% and Somaliland and Puntland accounted for 18%. Confirmed malaria was the leading cause
of disease. The number of reported suspected cholera increased by over 50%, with a majority of the
cases reported from Banadir region of Central Somalia.

TIMELY REPORTING
In week 4, the 45 health sentinel sites in Puntland and the 36 sites in Southern Somalia currently
reporting to the Communicable disease Surveillance and Response (CSR) network reported timely. In
Central Somalia 98% (60 out of the 61) reported on time. No data was received from Somaliland due to
technical reasons.

SUSPECTED CHOLERA
Central Somalia accounted for nearly all of the
suspected cholera cases reported in week 4, i.e.
139 out of 140 cases reported. All the suspected
cases were reported from Banadir region.
Poor adherence to the recommended case
definition for suspected cholera1 has been
observed, since 67% of the reported cases are
children under the age of two. On-the-job training
during weekly and monthly visits to the sentinel
sites is planned to improve case detection and
data quality. Following an observed increase since
the previous week, WHO teams collected stool
samples from three facilities in the region. Results are still pending.

SUSPECTED MEASLES
With low vaccination coverage and poor access to vulnerable populations across Somalia, especially in Southern and Central Somalia, suspected measles remains a challenge. In week 4, Central Somalia reported 76% of the 115 suspected measles cases, while Southern Somalia reported 14% and Puntland 10%.
In collaboration with the Health Authorities, partners are undertaking response activities.

CONFIRMED MALARIA
Confirmed malaria was the leading cause of morbidity during week 4, with 679 cases reported from sentinel sites across Somalia. Central and Southern Somalia reported 55% and 34% of all cases respectively.
Puntland reported 75 (11%) of the cases, mainly from Bossaso district, where response activities to a malaria outbreak are ongoing. With active case finding, the number of reported malaria cases has increased by 69% in the affected areas.

OTHER HEALTH EVENTS
During week 4, Central and Southern Somalia reported cases of suspected shigellosis. Although this have been decreasing gradually, adherence to the recommended case definition for shigellosis of visible blood remains a challenge. On-the-job trainings are being conducted to improve adherence to case definition. Central Somalia reported 59 (69%) of the 85 cases, while Southern Somalia reported 26 (30%) cases.

Whooping cough control continues to remain a challenge. In the reporting week, 48 cases of suspected whooping cough were reported from Central and Southern Somalia. Parts of these areas have issues of insecurity and inaccessibility for vaccination interventions to be undertaken.

Suspected neonatal tetanus has been reported in Central Somalia. Verifications need to be undertaken to confirm tetanus but tracking these patients in the past has remained a major challenge. Prevention needs to be strengthened through vaccination activities among pregnant women and clean delivery methods
...

[Ronan Kelly]

Somalia Emergency Weekly Health Update
Reporting 28 January to 3 February 2013 - Epidemiological week 5

Seven cholera cases detected in Mogadishu
In week 5 seven cholera cases were confirmed in Mogadishu. Samples of suspected cases were
collected in Banadir hospital, and in Hodan’s and Ceel Gaab’s Cholera Treatment Centres (CTC). Six of
the eight stool samples from Hodan CTC and one of the 15 samples from Banadir Hospital tested positive
for Vibrio cholera, serotype ‘Inaba’. The five samples collected from Ceel Gaab CTC were negative. High
positive rates, like in Hodan CTC, are expected among admissions, when the case definition is followed.
Since December 2012, the number of admissions to Hodan facility related to cholera has remained
stable, with an average of 69 cases per week and no related deaths.
Bio-surveillance for cholera has begun in preparation for the Gu rains (end of March to beginning of April),
which marks the beginning of the first annual cholera transmission season in Somalia.

Ongoing response to malaria outbreak in Bossaso
The number of confirmed malaria cases detected in Bossaso remains stable compared to previous
weeks. Health authorities and partners are planning to initiate response activities, such as Insecticide-
Residual Spraying (IRS) campaigns and community social mobilization. A total of 1137 cases of malaria
have been reported since 2 December 2012, including 14% children under the age of five and two-related
deaths (Case Fatality Rate: 0.18). Mixed Plasmodium falciparum and Ovale infections account for about
67% of the cases, while Falciparum accounts for 33%. Three locations reported over 98% of all cases,
i.e. Biyo Kulule (41.2%), New Bossaso (31.2%) and Baalade (26.1%).

Dengue Fever
Following the detection of cases of Dengue Fever in Mogadishu, WHO urges health workers to report any
case, presenting the symptoms described below, to WHO staff, when diagnosis of malaria or any other
severe disease has been excluded by Rapid Diagnostic Testing (RDT) or microscopy testing.
Dengue fever is a flu-like illness, transmitted to humans primarily through Aedes aegypti mosquito, which
is a day biter. Dengue fever should be suspected when a sudden onset of fever (above 38°C) is
accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle and joint
pains, measles-like rash. Complicated cases develop bleeding from eyes, nose, mouth, birth canal, anus
or any opening.

Disease alerts
Alerts of 47 suspected measles cases were reported from parts of Bay and Bakool regions. Results of
investigation are still pending.
An alert for suspected diphtheria from Galinsor (Galgadud region) was verified, and samples collected
from two cases are under further investigation. No more cases were reported.
...
SUSPECTED CHOLERA
Cholera is endemic in Somalia, with sporadic
cases and occasional outbreaks occurring in a
number of areas all year round. 74% of the
reported cases were children under the age of
two which does not meet the case definition of
suspected cholera1. Collaborative activities (like
tracing patients) and on-the-job training are being
carried out to address this issue. Adequate water
and sanitation supplies have been, prepositioned
in strategic warehouses by UNICEF and WHO, to
be distributed in the event of an outbreak.
Central Somalia accounted for all the 102 suspected cholera cases reported in week 5, which represents a
27% decrease compared to week 4 (140 cases). All the suspected cases were reported from Banadir region.

SUSPECTED MEASLES
Suspected measles cases continue to be reported
from Somalia, with poor access to vulnerable
populations still a challenge in many areas.
The number of cases reported remained stable in
week 5. Central Somalia reported over 57% of the
119 suspected measles cases, while Southern
Somalia accounted for 27% of those. Somaliland
and Puntland reported 13% and 3%of the total
cases respectively. In collaboration with the health
authorities, partners are undertaking response
activities.

CONFIRMED MALARIA
Confirmed malaria was the leading cause of
morbidity during week 5, with 794 cases reported
from sentinel sites across Somalia. This
represents a 17% increase as compared to week
4, when Central and Southern Somalia reported
76% of the cases.
Puntland reported 190 (24%) cases, mainly from
Bossaso district.

OTHER HEALTH EVENTS
In week 5, 109 cases of suspected shigellosis were reported, including 81 children under the age of
five. Banadir Hospital alone reported 70% of these cases. No case with “visible blood in stool” was
identified. Adherence to the recommended case definition for shigellosis2 remains a challenge in
Southern and Central Somalia. It has been observed that health workers classify cases as suspected
shigellosis based on patient reports during history taking, and not the actual physical examination. WHO,
in collaboration with partners and staffs from health facilities, is on high alert and will trace reported cases
and collect stool samples.

Whooping cough control continues to remain a challenge. In the reporting week, 52 cases of suspected
whooping cough were reported, all from Central and Southern Somalia. Parts of these areas have issues
of insecurity and inaccessibility for vaccination interventions to be undertaken.

Three cases of suspected neonatal tetanus have been reported in Central Somalia. Mechanisms are
being put in place for purposes of verification to confirm tetanus cases. Tracking these patients in the past
has remained a major challenge. Prevention needs to be strengthened through vaccination activities
among pregnant women and clean delivery methods.
...