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Cholera and AWD Outbreaks Bulletin in Eastern and Southern Africa Region, as of 4 February 2019, 2 Issue

Highlights

7 out of the 21 countries in Eastern and Southern Africa Region (ESAR) have reported more than 941 cholera cases and 8 deaths with an average Case Fatality Rate of 0.9%, since the beginning of 2019. These countries include; Angola, Burundi, Kenya, Tanzania, Somalia, Uganda and Zimbabwe. Apart from Kenya, outbreaks from the rest of the countries spilled over from 2018. Kenya accounts for 60.8% (572) of the total cases reported this year, followed by Somalia at 21% (198). In 2019, highest Case Fatality Rate (CFR) has been recorded in Zimbabwe at 8.9%.


Of the 7 countries with reported cholera/ AWD outbreaks in ESAR since week 1 of 2019, 5 (Burundi, Kenya, Somalia, Uganda and Zimbabwe) have ongoing cholera outbreaks. During the week under review, Kenya reported the highest number of new cases (101 cases).


Kenya: Since the onset of the current outbreak on 2 January 2019, a total of 572 cases including 2 deaths (CFR, 0.3%) have been reported from three counties (Nairobi, Narok, Kajiado). 49.1% of these cumulative cases have emerged from Kajiado County (281 cases), 29% from Narok County (166 cases) and the remaining 21.9% from Nairobi County (125 cases). During week 5 (week ending 3 February 2019), 101 new cases were reported compared to 60 cases reported during week 4 (week ending 27 January 2019).


Somalia: 24 new cases of AWD/cholera were reported in week 3 (week ending 20 January 2019). This is a decline in the number of cases compared to the previous week (week 2) when 87 cases were reported. These cases emerged from across Somalia including Somaliland. Cumulatively a total of 7,050 cases including 45 deaths have been reported since December 2017. Of these, a total of 198 cases have been reported since the beginning of 2019.


Uganda: A decline in the epidemic trend has been noted in the last three weeks (week 2 to 4). For instance, during week 4, 5 new cases of AWD/cholera were reported compared to 8 cases reported in week 3.These new cases emerged from the overcrowded informal settlements of Sembabule zone and Katwe (Rubaga division) and Kisenyi (Central division) in Uganda’s capital, Kampala. Cumulatively, a total of 38 cases including 1 death have been reported since the onset of the latest wave of the cholera outbreak in December 2018. Lack of toilets and poor sanitation exacerbated by heavy rains are factors associated with the current outbreak.


Burundi: 10 new cases of cholera / AWD including 1 death (CFR, 10%) were reported during week 4 compared to 8 cases reported in week 3. New cases emerged from Bujumbura Mairie (8 cases) and Rumonge province (2 cases). Cumulatively a total of 169 cases including 2 deaths have been reported since the beginning of the outbreak in December 2018, with majority (69.2%, 45) of these cases emerging from Rumonge province. 38.5% (65 cases) of cumulative cholera / AWD cases and 50% of all reported cholera / AWD related deaths, have been reported since the beginning of 2019.


Zimbabwe: During week 5 (week ending 3 February 2019), 4 new cases were reported compared to 11 cases including 1 deaths (CFR,9.1%) reported in week 4. These new cases emerged from Murehwa and Mutoko districts in Mashonaland East province. Cumulatively, a total of 10,696 cases including 69 deaths have been reported since the beginning of the outbreak on 5 September 2018, with 93% (9,971) of these cases emerging from Harare and the remaining 7% emerging from 22 districts outside Harare. 0.4% (45 cases) of cumulative cholera / AWD cases and 5.8% (4 deaths) of all reported cholera / AWD related deaths, have been reported since the beginning of 2019.


Urban - Rural Disaggregation of Cholera Cases
An analysis of cholera cases reported since the beginning of 2019 from five countries (Angola, Kenya, Tanzania, Uganda and Zimbabwe) reveals that overall, rural areas account for 73.6 % (496 cases) of the total caseload while urban areas account for 26.4% (178 cases). Cases reported from rural areas are emerging from Kenya, Zimbabwe and Tanzania; while cases reported from urban areas are emerging from Uganda, Kenya and Angola. Kenya accounts for the highest number of cases reported in rural areas (90.1%, 447) and in urban areas (70.2%, 125).