Somalia Cholera Fact Sheet

CHOLERA OVERVIEW

Seventh pandemic cholera was first reported in Somalia in 1970. Since 1990, the largest outbreaks were reported in 1994-1996, 1999, 2003, 2007, 2011-2012 and 2016-2017. Large-scale epidemics have increased over the past two decades (Fig. 1)

During 2012 and 2016-2018, epidemiological surveillance reported 112,736 suspected cholera cases. South-Central Somalia accounted for 77% of all reported cholera cases (Table I). In South-Central, the regions of Banadir and Bay, were most affected with a combined 32.3% of all suspected cases during the near four-year period (Fig. 2, Table II).

The country has been affected by recent cross-border cholera outbreaks involving Ethiopia, Kenya and likely Yemen.

CHOLERA DISTRIBUTION

In South-Central Somalia, Banadir Region (coterminous with the city of Mogadishu) reported cholera outbreaks every year of the study period and accounted for the highest percentage of cholera cases among all regions (17.6%). Bay Region reported 14.7% of all suspected cases, of which 90.2% were reported during the recent outbreak in 2017 (Fig. 4, Table II)

Lower Juba Region, which borders Garissa County and Wajir County in Kenya, reported 9.2% of all suspected cases. Lower Juba consistently reported cholera outbreaks all four years. Lower Shabelle Region, which borders Banadir Region, reported 7.1% of all suspected cases. Lower Shabelle also experienced cholera outbreaks every year, although 70% were notified in 2017. Gedo Region, which borders Somali Region in Ethiopia and Mandera County in Kenya, reported 6.6% of all suspected cases (Fig. 4, Table II).

Cholera outbreaks often started following the Deyr rains (October to December) and peaked during the Gu rains (late-March to June), characterized by monsoon-like rain and flash flooding. Flash floods hit the Juba River and Shebelle River valleys, affecting the regions of Middle Juba, Lower Juba and Lower Shabelle. During the 2016 El-Niño, the number of cholera cases increased throughout South-Central Somalia.2,4 Drought also aggravated cholera outbreaks, as observed in 2016-2017.3 From 2012 to early-2018, the lulls in cholera outbreaks occurred from August to November (Fig. 3).

Strategic Recommendations

Somalia has been periodically affected by cross-border cholera outbreaks involving Ethiopia, Kenya and likely Yemen,3 thus highlighting the importance of coordinating response efforts with neighboring countries.

Preparedness and response plans should be developed and implemented including: (1) strengthening early detection and rapid response including community-based surveillance and cross-border alerts; (2) establishing multisectoral and cross border coordination mechanisms; (3) building outbreak management capacity; (4) targeting pre-positioning of supplies and (5) developing risk communication, social mobilization and community engagement plans with harmonized approaches and messaging. Sustainable Water, Sanitation, Hygiene (WASH) and social mobilization activities should be implemented in heavily affected regions in South-Central (Table II)

During the study period, cholera was diffused throughout Somalia, especially in South-Central. Facility and community surveillance should be enhanced, including adherence to the cholera standard case definition (WHO).

Identification of transmission foci over an extended timeframe and at a finer geographical scale (e.g., district level), is necessary to clearly understand the cholera dynamics in the country, identify cholera hotspots, optimize resources, and maximize the impact of WASH and social mobilization interventions.