19 November 2020 -- In Kaamjiron village in Kismayo, Jubaland State, a young farmer and mother of 8, Khadijo Mohamed solemnly reflects about her children's health. Khadijo has already lost 2 children to measles, and now a third, their one-year-old son Abdi has the same symptoms her other 2 children did -- a cough, fever and rash.
"I rushed my child to the hospital because I know the signs and symptoms of this disease. I saw this happen in 2013 to 2 of my children and now, I want to protect my son," says Khadijo.
She explains there are limited health services in her village, which proves to be difficult for families living in Kismayo. Despite this, there are stakeholders monitoring and responding to the situation.
Outbreak of measles in Jubaland: moving fast and first
Between the epidemiological weeks of 15 and 23 in 2020, the state surveillance data gathered by the Early Warning and Alert Response Network (EWARN) detected a large number of suspected measles cases in Jubaland State. This increase in number triggered a field investigation by the World Health Organization (WHO) during the first week of July. The outbreak was laboratory-confirmed following the detection of the measles IgM by enzyme-linked immunosorbent assay (ELISA).
Offering children health services in hard-to-reach locations
Following the confirmation of the outbreak, a series of coordination meetings were held, microplans were developed and using the surveillance data, a plan for organizing a mass measles campaign was developed, targeting 59 642 children from 6 months to 5 years of age in Kismayo district.
To ensure Somali children in Kismayo, a hotspot for measles, have access to immunization services to stop the spread of measles, the Federal Ministry of Health and Human Services (MOH) and State Ministry of Health of Jubaland have worked together to coordinate the outbreak response activities. They have worked in collaboration with WHO and the United Nations Children's Fund (UNICEF) to offer outreach campaigns delivering measles vaccinations to children from 2000 outreach/vaccination posts.
From 7 to 11 October 2020, they partnered again to conduct a measles campaign in Kismayo, where more than 56 500 (95%) out of the targeted 59 642 children received measles vaccines and vitamin A capsules. During this campaign, 176 vaccination teams were deployed to provide measles vaccines and vitamin A capsules to children aged between 6 months and 5 years, and deworming tablets to children above 1 year of age. The teams also mobilized the community for vaccination, spreading key messages about the benefits of vaccination and disease prevention.
While at work during the campaign, health workers maintained physical distance, washed hands as often as they could, and wore face masks in efforts to protect themselves and others from spread of the coronavirus disease (COVID-19).
The campaign was supervised by 46 team supervisors, including staff from the Ministry of Health, WHO and UNICEF, to ensure every child possible received vaccines and that the campaign was conducted to the expected health standards.**\ ** A total of 441 cases of measles were reported from June to October 2020 during this measles outbreak. 39 cases tested positive for measles so far. Following the mass immunization campaign, cases have started to decline.
Following up with missed children
Health teams continue to search for measles cases and children who had missed the measles vaccine. Those who have missed the vaccines during the mass campaign are tracked regularly and are receiving an extra dose of measles vaccine irrespective of their previous vaccination status.
Routine immunization in Jubaland State: historically low with pockets of inaccessibility rendering immunization coverage far from expected
Historically, routine immunization coverage has remained low in Jubaland State. During 2019, the routine immunization coverage of Penta 1 was 71%; Penta 3 and IPV were 51%; and measles coverage was only 58% in this state.
2 districts (Hagar and Jamame) out of 5 in Lower Juba region are inaccessible, with no health/immunization services. In the accessible districts, there are some inaccessible villages and pockets where health care workers have only partial access to these areas.**\ **
Caregivers need to keep track of vaccines received
In Gulwade village in Kismayo, Maryan Abdi has a 3-year-old daughter who was recently diagnosed with measles. She explains that although her 6 children have received vaccines before, she isn't sure if they received measles vaccines at all.
"It is important for parents to be informed of the vaccination schedule and its usefulness in protecting their children's lives. We should also use innovative solutions in such challenging settings to keep track of those who have been vaccinated and children who are missing out. Children should not be denied access to vaccines whatever the operating challenges could be. This is the best way to protect them from preventable diseases," says Dr Mamunur Malik, WHO Somalia Representative. "This matters for every Somali child, but even more so for the vulnerable ones living in difficult-to-reach locations."
Meanwhile, Khadijo asks to share a key message with other Somali mothers and fathers: to avoid what she went through in life, by ensuring all children receive vaccines and seek timely treatment when they are sick.
New laboratory set up for measles confirmation in Kismayo General Hospital
In response to the surge in measles cases in the recent past, WHO provided support to the State Ministry of Health of Jubaland to establish a measles testing laboratory in the Kismayo General Hospital. The laboratory is equipped with the supplies required and an ELISA machine. Around 23 health workers were trained in case management and 3 laboratory personnel were trained to test for measles cases.***\
Note to editors:
The measles campaign was conducted in Kismayo in October 2020 with the generous financial support from the United Nations (UN) Central Emergency Response Fund (CERF) Anticipatory Funding.