Somalia + 22 more

WHO EMRO Weekly Epidemiological Monitor: Volume 14; Issue no 10; 7 March 2021

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Situation Report
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Current major event

Cholera outbreak in Lower Shabelle region, Somalia

On week 7 (8-14 February) 2021, the Federal Ministry of Health in Somalia reported a new outbreak of cholera in Afgoi district of Lower Shabelle region. With the support of health and WASH cluster, the ministry has been implementing control activities to contain the outbreak.

Editorial Note

Lower Shabelle, an administrative region in southern Somalia, hosts more than 100 000 internally displaced people (IDPs) of which 80% are dwelling in the rural areas, making it the third region in Somalia with the highest concentration of IDPs after Banadir and Galgaduud. IDP camps are usually under-serviced with inadequate clean water and sanitation, and limited access to health care. Security and inaccessibility are also major concerns in Lower Shabelle.

Cholera is endemic to Somalia with seasonal and recurring outbreaks (see graph). As of 21 February 2021, a total of 42 suspected cholera cases were reported from Lower Shabelle with no associated deaths. The new cholera outbreak started in Afgoi in week 7 where 23 suspected cholera cases with no associated deaths were reported from IDP camps. The outbreak was confirmed after one of the four collected stool samples tested positive by culture for Vibrio Cholerae. The outbreak then spread to the adjacent district of Merka as a result of high population movement due to insecurity, where 10 suspected cholera cases were reported with no associated death in week 8. Ten samples were collected from Merka, 7 of which yielded positive results for Vibrio Cholerae.

The cholera alert was captured through the early warning and alert response network (EWARN), a disease surveillance system for epidemic-prone disease that is implemented in Somalia to ensure timely alerts to detect, prevent and respond to disease outbreaks.

Despite the challenges resulting from the security situation, the ministry has implemented control measures to contain the outbreak. New cases were managed at the cholera treatment centre (CTC) in Merka. WHO and health cluster partners provided cholera kits for the management of the reported cases. Health care workers at CTC were trained on proper case management and infection prevention and control. Community social mobilizers were deployed through communication for development (C4D) activities by UNICEF to promote good hygiene and sanitation and to prevent cholera infection through correct health-seeking behaviour. The water, sanitation and hygiene (WASH) cluster started prevention and control interventions through the distribution of hygiene kits to displaced populations.

Different gaps in response interventions were identified. The evolving situation of COVID-19 pandemic and increased number of reported cases and deaths have over-stretched the already limited capacity to respond to the cholera alerts. Resources to support response activities, especially outbreak response, sample collection and medical supplies are limited. Insecurity limits the movement of rapid response teams (RRTs) to investigate alerts reported in remote areas. Inadequate inter-cluster coordination in districts affected by this current outbreak has also affected response activities.