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Cholera and AWD Outbreaks in Eastern and Southern Africa Region, As of 2 May 2019, 8th Issue

Highlights

Almost half of the countries in Eastern and Southern Africa region (ESAR) have been affected by cholera outbreaks since the beginning of 2019. More than 9,494 cholera / AWD cases including 34 deaths have been reported in 10 countries in the region, with an average Case Fatality Rate of 0.4%, since the beginning of 2019. These countries include; Angola, Burundi, Kenya, Malawi, Mozambique, Tanzania, Somalia, Uganda, Zambia and Zimbabwe. Mozambique accounts for 67.2% (6,382) of the total case load reported this year, followed by Kenya at 18.3% (1,735).


Currently 4 out of the 10 countries with reported cholera / AWD outbreaks in ESAR since week 1 of 2019, have active transmission and they include; Mozambique, Somalia, Kenya and Tanzania. During the week under review, Mozambique reported the highest number of new cases (2,315 cases). Of the countries with active transmission, Tanzania has recorded the highest Case Fatality Rates (CFR) in 2019 at 1.4%.


Kenya: Since January 2019, Cholera outbreak has been reported in Narok, Kajiado, Nairobi, Garissa and Machakos Counties. Cumulatively a total of 1,735 cases have been reported out of which 91 were confirmed. There have been 11 deaths with a case fatality rate of 0.6%. Currently, the transmission is active in Machakos, Nairobi, Garissa, Kajiado and Mandera Counties. New cases reported in Kajiado County emerged from Ongata Rongai and Kajiado North sub county, while those reported in Nairobi county emerged from Embakasi East (Tassia, Pipeline, Kayole North), Embakasi West (Umoja 1 and Umoja 2) and pockets of Starehe, Ruaraka and Kibra sub counties. Garissa County cases emerged from Hagadera refugee camp while those of Mandera County are from Kutulo sub county. High risk areas are characterized by unavailability of potable water, poor sanitation and hygiene practices and the situation is likely to be exacerbated by upcoming long rains.


Mozambique: Since the declaration of the cholera outbreak on 27 March 2019, and up to 18 April 2019, a cumulative total of 6,382 cases and 8 deaths were reported (CFR 0.1%). These cases were reported from the four districts (Beira, Buzi, Dondo and Nhamatanda) of Sofala Province originally affected by this outbreak. Beira district continued to be the most affected district with an overall attack rate of 909 cases per 100,000 population.


Somalia: An increase in the epidemic trend has been noted in the last two weeks. During week 16 (week ending 21 April 2019), 41 new cases were reported from Banadir region compared to 30 cases reported in week 15 (week ending 14 April 2019). Cumulatively a total of 806 cases with no deaths have been reported since the beginning of 2019. Children under five years bear the brunt of the cholera outbreak, representing 57% of the total case load reported in week 15 and 56% in epidemiological week 16. During the week under review (week 16), the most affected districts in Banadir are Madina (12 cases), Hodan (10 cases) and Deynile (6 cases).


Tanzania: An increase in the epidemic trend has been noted in the last two weeks. During week 16, 26 new cases were reported compared to 11 cases reported in week 15. This raises the total number of cholera cases reported since the beginning of 2019 to 216, including 3 deaths (CFR, 1.4 %). All new cases emerged from Tanga region in the following areas; Pangani DC (24), Handeni DC (1) and Tanga city (1). Cumulatively a total of 33,537 cases including 553 deaths have been reported since the beginning of the outbreak in August 2015.


Urban - Rural Disaggregation of Cholera Cases

Overall, more cholera cases emerge from urban areas (75.9%; 5,897) as compared to rural areas (24.1%; 1,873). This is according to an analysis of cholera cases reported since the beginning of 2019 from seven countries (Angola, Kenya, Malawi, Mozambique, Tanzania, Uganda and Zimbabwe). Of the total number of cases reported in urban areas (5,897), Mozambique accounts for the majority (89.72%; 5,291), followed by Kenya (8.19%; 483), Uganda (0.90%; 53), Tanzania (0.83%; 49), Angola (0.32%; 19), Malawi (0.02%; 1) and Zimbabwe (0.02%;1). All cases reported in Uganda (53) and Angola (19) emerged from urban areas. Apart from Mozambique, Uganda and Angola; collectively, the remaining four countries (Kenya, Zimbabwe, Tanzania and Malawi) have more cholera cases emerging from rural areas (73.8%; 1,508) as compared to urban areas (26.2%; 534).