Creation date: 5 October 2017 Sources: Ministries of Health and WHO
Bulletin: Cholera/ AWD Outbreaks in Eastern and Southern AfricaRegional Update - as at 5 October 2017HighlightsMore than 102,814 cholera / AWD cases and 1551 deaths (Case Fatality Rate: 1.5%) have been reported in 11 of 21 countries of Eastern and Southern Africa Region (ESAR) since the beginning of 2017. These countries include; Angola, Burundi, Kenya, Malawi, Mozambique, Rwanda, Somalia, South Sudan, Tanzania, Zambia and Zimbabwe. Somalia accounts for 76.6% of the total cases reported in 2017, followed by South Sudan at 15.9%.
In the past 4 weeks (Week 36-39), 6 out of the 21 countries in ESAR have reported active transmis-sion of cholera / AWD (Burundi, Malawi, Somalia, South Sudan, Kenya and Tanzania), with Tanzania reporting the highest number of new cases (125) in week 38. Cumulatively, South Sudan has recorded the highest CFR (1.9%) followed by Kenya (1.8%) and Tanzania (1.7%) in 2017. CFR for Somalia was above 2% at the beginning of 2017 but has since dropped to 1.4%.
Somalia: There has been a slight increase in the epidemic trend. During week 38 (week ending 24 September 2017), 92 new cases were reported in the country; compared to 61 cases reported in week 37 (Week ending 17 September 2017). All the 92 new cases reported in week 38 emerged from Somali land. Most affected regions areTogdheer, Awdal and Mjeex.
Kenya: 5 out of the 47 Counties (Nairobi, Garissa, Vihiga, Nakuru and Machakos) have an active cholera outbreak. During week 38, 37 new cases including 1 death (CFR 2.7%) were reported compared to 49 cases reported in week 37.
South Sudan: A declining trend in cholera cases has been noted over the past 3 weeks. 3 Counties have active transmission (Juba, Budi and Kapoeta South). During week 36 (Week ending 10 September 2017), 18 new cases were reported; compared to 21 cases reported in week 35 (week ending 3 September 2017).
Tanzania: A decrease in epidemic trend was noted in week 38, 125 new cases including 1 death (CFR 0.8%) have been reported; compared to 236 cases including 1 deaths (CFR 0.4%) in week 37. New cases emerged from Tanga, Mbeya, Iringa, Kigoma and Songwe regions.
Malawi: Current outbreak started within the catchment area of the Chikwawa Hospital. 7 new cases have been reported in Week 39 (week ending 1 October 2017); compared to 12 cases in week 38.
Burundi: During week 38, 3 new cases were reported; compared to 4 cases in week 37. These cases emerged from the city center of Nyanza Lac (Makamba) and Bubanza province.
77,774
6
125
16, 372
19
2122
389
103 128
4
3223
92
2,99637
7
18
2,697
1
1 / 55 0 / 1118
0 / 305
3
4
1 / 45
191
South Sudan EthiopiaSomalia
KenyaUganda
Rwanda
Burundi
Tanzania
AngolaZambia
Malawi
Mozambique
Zimbabwe
BotswanaNamibia
South Africa
Lesotho
Swaziland
Madagascar
Eritrea
New cholera cases (last 1 week)2017 Cumulative cases
Cholera DeathsNumber of new cholera deaths (Week 38) / 2017 Cumulative deaths
Distribution of new cases: Week 36 to Week 39No data
No. of new cases reported in Week 36 - 39 1 to 500 cases > 500 cases
Legend
No outbreak reported in 2017
Table: Summary of Cholera / AWD Outbreaks by CountryCountry Start Date Cumulative no. of cases Cumulative no. of deaths StatusSomalia March 2016 93,474 1,666 OngoingTanzania August 2015 26, 697 417 OngoingSouth Sudan June 2016 20,547 386 OngoingKenya October 2016 3,096 59 OngoingMozambique January 2017 2122 4 ControlledZambia February 2016 1482 33 ControlledAngola December 2016 490 26 ControlledBurundi December 2016 223 0 OngoingMalawi March 2017 128 1 OngoingZimbabwe November 2016 16 4 ControlledRwanda January 2017 4 0 Controlled
11Countries
102,814 Cases
1551 deaths
1.5% CFR
Country Priorities and Response Interventions
-Strengthen coordination of cholera preparedness and response-Preposition cholera buffer stocks and other medical supplies -Enhance surveillance and case investigation at all levels -Improve adherance to case management and infection control protocols at treatment sites-Complementary use of safe and effective oral cholera vaccines in identified hotspot areas-Community Mobilization and hygiene promotion-Provision of WASH supplies
Country Priorities Response Interventions
South Sudan
-Increase access to adequate amounts of safe water and appropriate sanitation-Conduct cholera vaccinations in hotspot areas-Engage community based integrated emergency response team in early detection-Adopt standardized case management and infection prevention and control protocols -Provide integrated training in WASH and health at treatment sites-Provide infection control materials at treatment sites -Targeted regular water quality testing-Behaviour change that integrates WASH and Health messages-Orientation of food handlers to adhere to public health standards
Somalia
-Enhance multi-sector co-ordination through existing structures and resources-Strengthen district capacity for prompt case detection, confirmation and management-Ensure the availability of safe water and safe human waste disposal -Strengthen cholera prevention and health promotion in high risk areas
Kenya
1,800,000
817,221
72,000
49,000
17,600
2500
1073
70
70
No. of people reached with cholera prevention messages throughmass media, supported by UNICEF
No. of children 1-5yrs immunized with OCV btwn Feb and Aug 2017
No. of households reached with cholera prevention messages
No. of school children and teachers reached with cholera preventionmessages
No. of community leaders, food and water vendors reached withcholera prevention messages
No. of pastoralist reached with cholera prevention messages
No. of social mobilizers and hygiene promoters trained since end ofJune 2017
No. of cholera treatment centres operational
Proportion of cholera treatment centres supported by UNICEF
221,660
17,252
10,460
3,300
153
29
19
16
No. of people reached with safe drinking water byUNICEF
No. of households received WASH NFIs
No of households received water treatmentproducts
No. of people provided with access to safesanitation
No. of rehabilitated boreholes
No of participants from WASH partner organizationstrained by UNICEF on cholera prevention
No. of boreholes constructed
No. of latrine stances constructed
• UNICEF supported the Government with an Interagency Emergency kit that contains medicines and medical devices for 10,000 people
• 1,340 cholera cases have been treated in Nairobi County
• 4 CTCs are currently operational in Nairobi County
800,000
42,275
40,000
52
No. of people reached with cholera prevention andcontrol messages through IEC materials
No of AWD/Cholera patients benefitting frommedical kits and supplies provided by UNICEF
No of people expected to benefit fromprepositioned cholera medical kits and supplies
No of cholera facilities supported by UNICEF
• A planned epidemiological study on cholera hotspots and epidemiological basins in the East and Southern Africa Region (ESAR). The objective of the study is to gain a thorough understanding of the epidemiological information on cholera epidemics in the East and South Africa Region, with an initial focus on Horn of Africa basin (South Sudan, Kenya and Somalia) and the Zambezi Basin (Mozambique, Angola, Malawi, Zambia and Zimbabwe) • UNICEF, WHO and Government of Zanzibar are planning to develop a Multi-Sectoral Cholera Elimination Plan 2018-2027. The effort will be led by WHO and MoH with UNICEF supporting the community component
Upcoming Activities
Country Priorities and Response Interventions
-Prepositioning of cholera supplies-Training, supervision and mentoring of health workers in CTUs-Monitoring and maintaining adequate stock levels of cholera supplies in Chikwawa district-Orientation of health workers and district Teams (DHMTs) on data management-Ensure quality case management in CTUs -Conduct mass hygiene promotion and cholera prevention campaign in Chikwawa district-Conduct Oral Cholera Vaccine (OCV) Immunization in hot spot areas-Provide WASH supplies in CTCs, health centers, communities and schools-Construct appropriately located diarrhea /vomit disposal pits-Promote construction and use of community latrines through CLTS
Response interventions in Nyanza Lac include:
• Water tank of 10,000 liters with 4 taps provided in the CTC • Water trucking • Water supply system repaired • Social mobilization in the affected areas
Country Priorities Response Interventions
Malawi
Tanzania
-Improve case management -Improve water supply
Burundi
-Develop a cholera elimination plan for Zanzibar-Advocacy and partnerships for resource mobilization -Capacity building of medical personnel on cholera case management-Provision of critical supplies like chlorine products, ORS and IEC materials in most at risk regions-Social Mobilisation to prevent and control cholera- Follow up on construction of toilets
3000
2700
500
400
360
300
300
200
5
No. of ORS sachets provided
No of kg of chlorine (HTH) provided byWorld Vision and other partners
No of 100g bars of soap provided
No. of boxes of ringers lactate provided
No of 1kg bars of soap provided
No. of 20L buckets with tap provided
No. of 20L buckets without tap provided
No. of 60L buckets provided forhandwashing
No. of tarpaulins provided by UNICEF
• UNICEF has supported five regions with 2,112,000 water guard tablets, 1 Wagtech (Potatest+) field test kit and 40 boxes Jumbo agua tabs for bulky chlorination
• Medical supplies given include giving set, ringer’s lactate, gumboots and aprons
• UNHCR has contributed ORS to support Kigoma municipal council
The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations.
Creation date: 5 October 2017 Sources: Ministries of Health and WHO
Annex 1: Distribution of Cholera/AWD outbreaks in the Horn of Africa - 5 October 2017
117
Tana
1
1
GarissaKerichoNakuru
161794
Mombasa
1
5
4
29
Wajir
NarokRiver
Turkana
Sool
Banadir
Bari
Bay
Galgaduud
Gedo
Hiraan
Lower Juba
Lower Shabelle
Mudug
Nugaal
Sanaag
Togdheer
Awdal
Middle Shabelle
Central Equatoria
Eastern Equatoria
Jonglei
Unity
Lakes
WarrapUpper Nile
CFR: 16.7% Murang’aKiambuNairobi
2722
3084
5599
24852399
735
64239
790
12934
SomaliOromia
Amhara
South Sudan
EthiopiaSomalia
Kenya
Legend
Status of outbreakOutbreak containedOutbreak active
No outbreak reported
Cholera / AWD Cases
XXNew cases
Cumulative cases 2017
No data
Afar
Tigray
Beneshangul Gumuz
Gambela
SNNPR
7050
2587
656
Uganda
Addis AbabaHareri
Dire Dawa
491739
1684
4106
2491
5622
Bakool3880
14913
Western Equatoria
Western Bahr el Ghazal
Northern Bahr el Ghazal1
185
Kajiado
19
56
37
Siaya
Machakos
382
364338
12,052
131
52
13
22Kilifi
Vihiga
CFR: XX%: Calculated based on new deaths reported
4687
335
60 5474
Homa Bay
Kisumu
Siaya
- Sub-optimal coordination in responding to outbreaks- Limited resources such as water treatment chemicals- Limited capacity in response as majority of the Rapid Response Teams especially at county level are not trained on outbreak response- Limited resources for health promotion and community engagement- Insecurity in various parts of the country reporting cholera outbreak
Kenya: Challenges
- Insecurity in Bay, Bakol, Gedo and Lower Shabelle- Despite decreasing epidemic trend, drivers of the current epidemic include limited access to safe water and poor sanitation in IDP settlements in all the affected regions
Somalia: Challenges
- Inadequate funding for most of the WASH cluster partners to conduct outbreak response activities in Juba- Ongoing fuel crisis is likely to result to malfunctioning of water treatment plants- A significant section of the cholera affected populations are nomadic pastoralist and communities living in remote, hard to reach villages and cattle camps- Poor road networks and lack of phone connectivity in some affected areas- Unpredictable movement of cattle keepers- Prolonged conflict and insecurity- Population displacements into crowded IDP camps and islands with limited humanitarian access to optimize interventions
South Sudan: Challenges
The boundaries and names shown and the designations used on this map do not imply official endorsement or acceptance by the United Nations.
Creation date: 5 October 2017 Sources: Ministries of Health and WHO
Annex 2: Distribution of Cholera/AWD outbreaks in Southern Africa - 5 October 2017
303300
83Pwani
188
35816
215
Dodoma
CFR: 2.9%
108
7
52
Singida
Mbeya46
344140 Dar es Salam
MorogoroIringa
Kigoma
Dodoma
Mara
Tabora
Singida
Tanga
Rukwa
Unguja
1
Nsanje
Chikwawa
Mwanza
7108
19
Masvingo1
Manicaland4
Harare1
Nampula
597
Maputo 510
Tete1015
Cabinda 232
Zaire236
5Luanda
- Cross border movements between Mozambique and Malawi influence the evolution of outbreaks- Poor access to safe water- Low sanitation coverage- Poor hygiene practices especially hand washing with soap at critical times- Boreholes in Kasisi and Katunga locations are saline
Challenges: Malawi
- Some communities do not use the aqua tabs distributed to them because they dont like the taste and smell as well as misconception that the tabs might impair fertility- Inadequate access to safe water in most of the affected areas- Delays in outbreak surveillance and reporting leading to increased spread- Treatment of water by boiling or using aqua tabs is not a common practice to over 80% of households - Huge issues on water quality. Water from deep wells and pipelines has tested positive for vibrio cholerae - Low coverage on improved sanitation facilities and practicing open defecation in most of the affected areas- Rampant street food vending in Zanzibar
Challenges: Tanzania
- Continuous threat of transmission of cholera infections along the lower Congo River Basin that is shared by both Angola and the Democratic Republic of Congo - Limited stocks of RDT in Lunda Norte, where there is presence of refugees from DRC- Gaps in infection control in Soyo and Cabinda
Challenges: Angola
- Cross border movements between Burundi and DRC- Low Sanitation coverage- Insuffcient access to safe water in the city centre
Challenge: Burundi
Legend
Status of outbreak
Outbreak containedOutbreak active
No outbreak reported
Cholera / AWD Cases
XXNew cases
Cumulative cases 2017
CFR: xx% - Calculated based on new cases and deaths reported
Angola
South Africa
Tanzania
Burundi
Mozambique
Namibia Botswana
Zimbabwe
ZambiaMalawi Malawi
Rwanda
Rwanda
82Luapula21
Northern Province
2246
Katavi
Njombe10
Cibitoke 172
Bubanza
Bujumbura rural 2
8Makamba Province 1
27
2144
93
WesternProvince
4
Creation date: 5 October 2017 Sources: WHO / UNICEF Joint Monitoring Programme, Ministries of Health and WHO
Annex 3: An overlay of Sanitation Facilities and Number of Cholera/ AWD Cases and Deaths Reported between January and September 2017
6
19
2122
389
103
4
3223
77,774
92
2,99637
1287
16, 372
18
1252,697
1
1 / 55 0 / 1118
0 / 305
3
4
1 / 45
191
South Sudan EthiopiaSomalia
KenyaUganda
Rwanda
Burundi
Tanzania
AngolaZambia
Malawi
MozambiqueZimbabwe
BotswanaNamibia
South Africa
Lesotho
Swaziland
Madagascar
Eritrea
New cholera cases (last 1 week)2017 Cumulative cases
Cholera DeathsNumber of new cholera deaths (Week 36) / 2017 Cumulative deaths
Legend
0 to 25% 25 to 50% > 50%Percentage of population using unimproved sanitation facilities
South Sudan
Ethiopia
Somalia
KenyaUganda
Rwanda
Burundi Tanzania
Angola
Zambia
Malawi
MozambiqueZimbabwe
BotswanaNamibia
South Africa Lesotho
Swaziland
Madagascar
Eritrea
39%
15%13%
33%
50%36%11% 50%
11%
36%3%
60%8%
15%
17%
11%5%8%
76%
7%7%
59%
27%
30%
21%37%
12%
44%
17%9%
30%
10%14%
32%
44%
23%5%
36%
36%
44%
23%
27%6%
34%
11%5%
50%
62%14%
22%2%
14% 2%11%
34%
39%
73%17%
8%2%
10%9%20%61%
58%24%7%11%
24%
13%52%
11%
19%
15%60%
6%
31%
12%42%
15%
39%
24%11%
26%
Legend
Sanitation LadderBasic serviceSafely Managed Limited serviceNo service
Unimproved service
0 to 25% 25 to 50% > 50%Percentage of population using unimproved sanitation facilities
Sanitation ladder• Safely managedUse of improved facilities which are not shared with other households and where excreta are safely disposed in situ or transported and treated off-site• BasicUse of improved facilities which are not shared with other households• LimitedUse of improved facilities shared between two or more households• UnimprovedUse of pit latrines without a slab or platform, hanging latrines or bucket latrines• Open defecation / No serviceDisposal of human faeces in fields, forests,bushes, open bodies of water, beaches and other open spaces or with solid waste
3 of the 21 countries in Eastern and Southern Africa have over 50% of their population using unimproved sanitation facilities and they include; Tanzania, Ethiopia and Uganda. Cumulatively, Tanzania has reported 2697 cases since the beginning of 2017. Countries which have 25 to 50% of their population using unimproved sanitation facilities include: Somalia, Kenya, Burundi, Malawi, Mozambique, Zambia and Madagascar. Cumulatively, these countries have reported 83, 346 cases in 2017, and majority of these cases emerging from Somalia. 10 countries have less than 25% of their population using unimproved sanitation facilities, and mostly located in the Southern Africa region
Coverage of Sanitation Facilities Coverage of Sanitation Facilities and Cholera / AWD
Creation date: 5 October 2017 Sources: WHO / UNICEF Joint Monitoring Programme, Ministries of Health and WHO
Annex 4: An Overlay of Drinking Water Supply Systems and Number of Cholera / AWD Cases and Deaths Reported Between Jan and Sept 2017
6
19
2122
389
103
4
3223
77,774
92
2,99637
7128
16, 372
18
1252,697
1
1 / 55 0 / 1118
0 / 305
3
4
1 / 45
191
South Sudan EthiopiaSomalia
KenyaUganda
Rwanda
Burundi
Tanzania
AngolaZambia
Malawi
MozambiqueZimbabwe
BotswanaNamibia
South Africa
Lesotho
Swaziland
Madagascar
Eritrea
New cholera cases (week 36 to 39)2017 Cumulative cases
Cholera DeathsNumber of new cholera deaths (Week 38) / 2017 Cumulative deaths
Legend
Percentage of population using an unimproved water source1% to 10% > 20%11% to 20%
South Sudan
EthiopiaSomalia
KenyaUganda
Rwanda
Burundi Tanzania
Angola
Zambia
Malawi
MozambiqueZimbabwe
BotswanaNamibia
South AfricaLesotho
Swaziland
Madagascar
Eritrea
41%
16%19%
24%
56%20%
17%7%
79%
18%1%2%
19%
43%16%
22%
10%
29%
25%
25%
11%
58%9%
10%
23%
71%12%
16%1%
50%
3%
31%
16%
47%
14%
25%
14%
67%20%
10%3%
79%
6%5%10%
57%21%14%
8%
40%
19%
29%
12%
85%
10%2%
3%
50%30%
13%7%
68%7%10%
15%
50%
13%
24%
13%
61%6%
21%
12%
67%10%16%
7%
LegendPercentage of population using an unimproved water source
1% to 10% > 20%11% to 20%
Safely ManagedDrinking Water Ladder
Basic Service
Limited ServiceUnimproved
No service
Drinking Water Ladder• Safely managedDrinking water from an improved water source which is located on premises, available when needed and free from faecal and priority chemical contamination• BasicDrinking water from an improved source, provided collection time is not >30 minutes queuing• LimitedDrinking water from an improved sourcefor which collection time exceeds 30 minutes for a roundtrip including queuing• UnimprovedDrinking water from an unprotected dug well or unprotected spring• Surface waterDrinking water directly from a river, dam, lake, pond, stream, or irrigation canal
6%
33%
38%
15%8%
6 of the 21 countries in Eastern and Southern Africa have over 20% of their population using an unimproved water source and they include; Ethiopia, Somalia, Tanzania, Zambia, Mozambique and Madagascar. Of these countries, Somalia has recorded the highest number of cholera cases and deaths. Countries which have 11 to 20% of their population using unimproved water sources include; South Sudan, Uganda, Rwanda, Burundi, Eritrea, Angola, Zimbabwe and Lesotho. 5 of these countries (South Sudan, Rwanda, Burundi, Angola and Zimbabwe) have reported outbreaks in 2017.
Drinking Water Supply Systems Drinking Water Supply Systems and Cholera / AWD
Country Wk 1 to Wk 34
Week 35 Week 36 Week 37 Week 38 Week 39 2017 Cumulative Cumulative since the beginning of the outbreak
Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths Cases Deaths CFR Cases Deaths CFR
Somalia 59,610 834 137 2 22 0 61 0 92 0 77,774 1118 1.4% 93,474 1,666 1.8%
Kenya 1,096 12 183 0 46 3 49 1 37 1 2996 55 1.8% 3096 59 1.9%
South Sudan 6,263 187 21 0 18 0 16,372 305 1.9% 20, 547 386 1.9%
Tanzania 2,347 33 116 3 148 1 236 1 125 1 2,697 45 1.7% 26,697 417 1.6%
Burundi 42 0 0 0 5 0 4 0 3 0 223 0 0 223 0 0
Malawi 103 1 2 0 2 0 2 0 12 0 7 0 128 1 0.8% 128 1 0.8%
Zimbabwe 6 3 0 0 0 0 0 0 0 0 0 0 6 3 50% 16 4 25%
Mozambique 0 0 0 0 0 0 0 0 0 0 0 0 2,122 4 0.2% 2,122 4 0.2%
Angola 374 16 0 0 0 0 0 0 0 0 0 0 389 19 4.9% 490 26 5.3%
Zambia 101 0 0 0 0 0 0 0 0 0 0 0 103 1 1% 1482 33 2.2%
Rwanda 0 0 0 0 0 0 0 0 0 0 0 0 4 0 0% 4 0 0.0%
Uganda 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0% 0 0 0%
Madagascar 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Comoros 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
Swaziland 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0% 0 0 0%
Botswana
Eritrea
Lesotho
Namibia
South Africa
TOTAL 102, 814 1551 1.5 127,732 2596 2.0%
For further information Contact:
Georges Tabbal Ida Marie Ameda Maureen Khambira
Regional WASH Emergencies Specialist Health Emergencies Specialist Information Management Specialist Email: [email protected] Email: [email protected] Email: [email protected]
Annex 5: Weekly Reported Cholera / AWD Cases and Deaths for Countries in Eastern and Southern
Africa