Northeast Nigeria Response: Health Sector Bulletin #33, 15 October 2017

Situation Report
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- As of 15 October, the cumulative number of suspected and confirmed cholera cases is 4,936 and 61 deaths, with a Case Fatality Rate 1.2%. Out of the 144 samples taken, 119 (83%) were RDT positive and 107 (74%) were culture positive.
- The first preliminary analysis of impact of the age-target emergency Seasonal Malaria Chemo prevention (SMC) in Borno state so far carried out between week 28 and 38 of 2017 confirmed malaria in U5s decrease by 6.7% in the intervention LGAs, while a seasonal increase of 92.2% in the non-intervention LGAs.
- The third round of the SMC campaign for children aged 03-59 months in Borno state has started in Jere, Maiduguri Metropolitan Council, Konduga, Monguno and Mafa LGAs from 14 to 17 October 2017.
- During her visit to Borno, Dr Matshidiso Moeti, WHO Regional Director for Africa, renewed its commitment to assist Nigeria combat polio and other child killer diseases such as malaria.
- HeRAMS assessment concludes that 30% lack access to even rudimentary levels of water, 60% have no access to safe water and only 10% have access to safe water.
- Mental health at the workplace was the theme of World Mental Health Day 2017 observed on 10 October with the overall objective of raising mental health awareness.

Situation Update

The preliminary results of a joint WFP/FEWS NET (Famine Early Warning Systems Network a leading provider of early warning and analysis on food insecurity) market survey showed that market functioning in conflict-affected areas of Adamawa, Borno and Yobe States are gradually improving. However, staple food prices remain higher relative to the same time last year and well-above average price levels. Household demand remains elevated by 70, 63 and 64 percent, across Borno, Yobe and Adamawa States, respectively, relative to the same period of last year.

Most areas in Borno State, as well as parts of Yobe and Adamawa States that are most affected by the conflict, will remain in Emergency (IPC Phase 4) acute food insecurity. Humanitarian access has improved to many areas in Borno State over the last year, where many affected populations now reside. However, displaced households continue to be highly dependent on emergency assistance and remain in areas previously made inaccessible by the conflict. An elevated risk of Famine (IPC Phase 5) will continue in inaccessible areas. Other areas of the northeast will remain in Crisis (IPC Phase 3) as large populations continue to face significant difficulty meeting basic food needs during the lean season period. (

Besides the food insecurity and associated severe acute malnutrition, “In north-east Nigeria, some 8.5 million people now need humanitarian aid. We believe up to 700,000 people in parts of Borno and Yobe states are completely inaccessible and may need urgent support. Two thirds of health facilities in these states have been damaged. Those that are functioning are short of staff, and lack safe water, basic drugs and equipment. This poses very serious challenges in dealing with outbreaks of cholera, malaria and measles.” (UN Secretary-General António Guterres’ 12th October remarks to the Security Council briefing remarks about NE Nigeria)

In support to NE Nigeria response, the WHO Regional Director for Africa, Dr. Matshidiso Moeti, visited Maiduguri on Saturday 14 October 2017 and flagged off the integrated polio and third malaria (Seasonal Malaria Chemo prevention) campaign. Dr Moeti said that WHO in support to the Ministry of Health authorities and in collaboration with the health sector humanitarian partners had worked to combat the outbreak of diseases such as polio, cholera and malaria during the ongoing crises.

As of 15 October, the cumulative number of suspected and confirmed cholera cases is 4,936 and 61 deaths, with a Case Fatality Rate 1.2%. Out of the 144 samples taken, 119 (83%) were RDT positive and 107 (74%) were culture positive. To complement the ongoing efforts in the control of Cholera Outbreak 914,565 doses of Oral Cholera Vaccine (OCV) was secured from to International Coordinating Group (ICG) through the National Primary Health Care Development Agency with financial support by the Global Alliance for Vaccines and Immunization (GAVI).

The OCV campaign (18-22 September) covered all people greater than one year of age in the affected communities and IDP camps in Maiduguri, Jere, Konduga, Monguno, Dikwa, and Mafa Local Government Areas (LGs). A combination of fixed and mobile campaign strategies was employed. The OCV campaign in Mafa LGA was conducted from 29 September to 4 October 2017.

896,919 people were vaccinated compared to the 855,492 target, giving the coverage rate of 105%. The coverage ranged from 100% in Maiduguri to 121% in Monguno. The independent monitors also documented equivalent coverage rates with the administrative data. In Monguno, the administrative data documented coverage rate of 121% while the independent monitors recorded 98%. The main reason for this discrepancy and greater than 100% coverage rate is vaccination of additional people beyond the target figure. The average wastage rate was 0.4% with lowest (0) in Mafa and the highest 0.9%) in Jere. No Adverse Events Following Immunization (AEFI) were reported.

A new phase for the oral cholera vaccination campaign supported by the health partners is planned for end October, to target over 300,000 people above one year of age in Damasak, Banki, Bama, Gamboru, Ngala and Pulka camps and/or communities. The request for the importation of additional vaccines is to be submitted to the International Coordination Group on vaccine provision pending the clearance and approval of the state and health authorities.