Responding to cholera outbreaks in Somalia in 2017–2019

Background: Somalia reported repeated cholera outbreaks between 2017 and 2019. These outbreaks were attributed to multiple risk factors which made response challenging. Aims: To describe lessons from the preparedness and response to the cholera outbreaks in Somalia between 2017 and 2019. Methods: We reviewed outbreak response reports, surveillance records and preparedness plans for the cholera outbreaks in Somalia from January 2017 to December 2019 and other relevant literature. We present data on cholera-related response indicators including cholera cases and deaths and case fatality rates for the 3 years. Qualitative data were collected from 5 focus group discussions and 10 key informant interviews to identify the interventions, challenges and lessons learnt from the Somali experience. Results: In 2017, a total of 78 701 cholera cases and 1163 related deaths were reported (case fatality rate 1.48%), in 2018, 6448 cholera cases and 45 deaths were reported (case fatality rate 0.70%), while in 2019, some 3089 cases and 4 deaths were reported in Somalia (case fatality rate 0.13%). The protracted conflict, limited access to primary health care, and limited access to safe water and proper sanitation among displaced populations were identified as the main drivers of the repeated cholera outbreaks. Conclusions: Periodic assessment of response to and preparedness for potential epidemics is essential to identify and close gaps within the health systems. Somalia’s experience offers important lessons on preventing and controlling cholera outbreaks for countries experiencing complex humanitarian emergencies

Willingness by people living with HIV/AIDS to utilize HIV services provided by Village Health team workers in Kalungu district, central Uganda.

BACKGROUND: Less than one quarter of people in need have access to HIV services in Uganda. This study assessed willingness of people living with HIV/AIDS (PLWHAs) to utilize HIV services provided by Village Health Teams (VHTs) in Kalungu district, central Uganda. METHODS: A cross-sectional study conducted in two health facilities providing anti-retroviral therapy enrolled 312 PLWHAs. Pre-tested semi-structured questionnaires were administered to participants at household level. A forward fitting logistic regression model computed the predictors of willingness of PLWHAs to utilize services provided by VHTs. RESULTS: Overall, 49% were willing to utilize HIV services provided by VHTs increasing to 75.6% if the VHT member was HIV positive. PLWHAs who resided in urban areas were more likely to utilize HIV services provided by VHTs (AOR 0.24, 95%CI 0.06-0.87). Barriers to utilizing HIV services provided by VHTs were: income level > 40 USD (AOR 6.43 95%CI 1.19-34.68), being a business person (AOR 8.71 95%CI 1.23-61.72), peasant (AOR 7.95 95%CI 1.37-46.19), lack of encouragement from: peers (AOR 6.33 95%CI 1.43-28.09), spouses (AOR 4.93 95%CI 1.23-19.82) and community leader (AOR 9.67 95%CI 3.35-27.92). CONCLUSION: Social support could improve willingness by PLWHAs to utilize HIV services provided by VHTs for increased access to HIV services by PLWHA

Willingness by people living with HIV/AIDS to utilize HIV services provided by Village Health team workers in Kalungu district, central Uganda

Background: Less than one quarter of people in need have access to HIV services in Uganda. This study assessed willingness of people living with HIV/AIDS (PLWHAs) to utilize HIV services provided by Village Health Teams (VHTs) in Kalungu district, central Uganda. Methods: A cross-sectional study conducted in two health facilities providing anti-retroviral therapy enrolled 312 PLWHAs. Pre-tested semi-structured questionnaires were administered to participants at household level. A forward fitting logistic regression model computed the predictors of willingness of PLWHAs to utilize services provided by VHTs. Results: Overall, 49% were willing to utilize HIV services provided by VHTs increasing to 75.6% if the VHT member was HIV positive. PLWHAs who resided in urban areas were more likely to utilize HIV services provided by VHTs (AOR 0.24, 95%CI 0.06-0.87). Barriers to utilizing HIV services provided by VHTs were: income level > 40 USD (AOR 6.43 95%CI 1.19-34.68), being a business person (AOR 8.71 95%CI 1.23-61.72), peasant (AOR 7.95 95%CI 1.37-46.19), lack of encouragement from: peers (AOR 6.33 95%CI 1.43-28.09), spouses (AOR 4.93 95%CI 1.23-19.82) and community leader (AOR 9.67 95%CI 3.35-27.92). Conclusion: Social support could improve willingness by PLWHAs to utilize HIV services provided by VHTs for increased access to HIV services by PLWHA

Progress and experiences of implementing an integrated disease surveillance and response system in Somalia; 2016–2023

IntroductionIn 2021, a regional strategy for integrated disease surveillance was adopted by member states of the World Health Organization Eastern Mediterranean Region. But before then, member states including Somalia had made progress in integration of their disease surveillance systems. We report on the progress and experiences of implementing an integrated disease surveillance and response system in Somalia between 2016 and 2023.MethodsWe reviewed 20 operational documents and identified key integrated disease surveillance and response system (IDSRS) actions/processes implemented between 2016 and 2023. We verified these through an anonymized online survey. The survey respondents also assessed Somalia’s IDSRS implementation progress using a standard IDS monitoring framework Finally, we interviewed 8 key informants to explore factors to which the current IDSRS implementation progress is attributed.ResultsBetween 2016 and 2023, 7 key IDSRS actions/processes were implemented including: establishment of high-level commitment; development of a 3-year operational plan; development of a coordination mechanism; configuring the District Health Information Software to support implementation among others. IDSRS implementation progress ranged from 15% for financing to 78% for tools. Reasons for the progress were summarized under 6 thematic areas; understanding frustrations with the current surveillance system; the opportunity occasioned by COVID-19; mainstreaming IDSRS in strategic documents; establishment of an oversight mechanism; staggering implementation of key activities over a reasonable length of time and being flexible about pre-determined timelines.DiscussionFrom 2016 to 2023, Somalia registered significant progress towards implementation of IDSRS. The 15 years of EWARN implementation in Somalia (since 2008) provided a strong foundation for IDSRS implementation. If implemented comprehensively, IDSRS will accelerate country progress toward establishment of IHR core capacities. Sustainable funding is the major challenge towards IDSRS implementation in Somalia. Government and its partners need to exploit feasible options for sustainable investment in integrated disease surveillance and response

DATASET_SMC.xlsx

Safe Male Circumcision dataset and questionnair

Determinants of patient survival during the 2014 Ebola Virus Disease outbreak in Bong County, Liberia

The unprecedented size of the 2014 Ebola Virus Disease (EVD) outbreak in West Africa has allowed for a more extensive characterization of the clinical presentation and management of this disease. In this study, we report the trends in morbidity, mortality, and determinants of patient survival as EVD spread into Bong County, Liberia.An analysis of suspected, probable, or confirmed cases of EVD (n = 607) reported to the Liberian Ministry of Health and Social Welfare (MOHSW) between March 23rd and December 31st 2014 was conducted. The likelihood of infection given exposure factors was determined using logistic regression in individuals with a definitive diagnosis by RT-PCR (n = 321). The risk of short-term mortality (30\ua0days) given demographic factors, clinical symptoms, and highest level of treatment received was assessed with Cox regression and survival analyses (n = 391).The overall mortality rate was 53.5\ua0% (95\ua0% CI: 49\ua0%, 58\ua0%) and decreased as access to medical treatment increased. Those who reported contact with another EVD case were more likely to be infected (OR: 5.7), as were those who attended a funeral (OR: 3.9). Mortality increased with age (P

Prioritization of zoonoses for multisectoral, One Health collaboration in Somalia, 2023

Background The population of Somalia is vulnerable to zoonoses due to a high reliance on animal husbandry. This disease risk is exacerbated by relatively low income (poverty) and weak state capacity for health service delivery in the country as well as climate extremes and geopolitical instability in the region. To address this threat to public health efficiently and effectively, it is essential that all sectors have a common understanding of the priority zoonotic diseases of greatest concern to the country. Methods Representatives from human, animal (domestic and wildlife), agriculture, and environmental health sectors undertook a multi-sectoral prioritization exercise using the One Health Zoonotic Disease Prioritization tool developed by the US CDC. The process involved: reviewing available literature and creating a longlist of zoonotic diseases for potential inclusion; developing and weighting criteria for establishing the importance of each zoonoses; formulating categorical questions (indicators) for each criteria; scoring each disease according to the criteria; and finally ranking the diseases based on the final score. Participants then brainstormed and suggested strategic action plans to prevent, and control prioritized zoonotic diseases. Results Thirty-three zoonoses were initially considered for prioritization. Final criteria for ranking included: 1) socioeconomic impact (including sensitivity) in Somalia; 2) burden of disease in humans in Somalia); 3) availability of intervention in Somalia; 4) environmental factors/determinants; and 5) burden of disease in animals in Somalia. Following scoring of each zoonotic disease against these criteria, and further discussion of the OHZDP tool outputs, seven priority zoonoses were identified for Somalia: Rift Valley fever, Middle East respiratory syndrome, anthrax, trypanosomiasis, brucellosis, zoonotic enteric parasites (including Giardia and Cryptosporidium), and zoonotic influenza viruses. Conclusions The final list of seven priority zoonotic diseases will serve as a foundation for strengthening One Health approaches for disease prevention and control in Somalia. It will be used to: shape improved multisectoral linkages for integrated surveillance systems and laboratory networks for improved human, animal, and environmental health; establish a multisectoral public health emergency preparedness and response plans using One Health approaches; and enhance workforce capacity to prevent, control and respond to priority zoonotic diseases