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Ethiopia: Acute Watery Diarrhoea (AWD) Outbreak - May 2016

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AWD outbreak is still ongoing in 10 woredas in six zones of Oromia and Somali regions. By week 20, a total of 1,884 AWD cases and 19 deaths had been reported. During the same week, a new area, Dolo Bay woreda in Somali region was affected. (WHO, 27 May 2016)

Since the Federal Ministry of Health confirmed the first two AWD cases on 9 June, the number of confirmed cases are increasing. The Ethiopian Public Health Institute reported about 2,145 (nationally) and 25 (in Addis Ababa) suspected AWD cases as of 12 June 2016. The Addis Ababa Health Bureau and partners launched an AWD response plan to curb the spread of the outbreak. OCHA, 20 Jun 2016

In week 15 (week ending 16 April 2017), a total of 2,388 suspected cases of AWD/cholera were reported in Afar, Amhara and Somali regions of the country. While some decline has been observed in the trend in the last weeks [4,200 cases in week 14; 4,104 cases in week 13; 4,358 cases in week 12], it is still premature to deduce overall improvement in the situation on the ground, especially with the weak surveillance system. Somali region remains the most affected, accounting for 99% of the new cases reported in the reporting week. On 20 April 2017, WHO elevated the outbreak of AWD/cholera and the humanitarian crisis in Ethiopia to grade 3 emergency. This new grading enables the organization to leverage its global capacity and scale up the response to the outbreak and the humanitarian crisis. (WHO, 21 Apr 2017)

There was a decrease in the number of AWD cases reported in week 24 (week ending 18 June 2017): a total of 661 cases were reported from the three regions compared to 1,080 cases reported in week 23 (week ending 11 June 2017). Since the beginning of 2017, a total of 37,459 cases including 784 deaths (case fatality rate 2.1%) have been reported from six regions of Somali, Oromia, Amhara, Afar, SNNP and Tigray. Eighty-nine percent of the reported cases and 96% of the deaths were reported in Somali Region alone. (WHO, 23 Jun 2017)

The AWD outbreak situation continues to improve. During week 27 (week ending 9 July 2017), 275 new AWD cases were reported from the three regions of Somali (149), Oromia (68) and Amhara (58). Since the beginning of 2017, 38,715 cases including 797 deaths (case fatality rate 2.1%) have been reported from the seven regions of Somali, Oromia, Amhara, Afar, SNNP, Tigray, and Benshangul Gumuz. Eighty-eight percent of the cases and 94% of the deaths were reported in Somali Region alone. (WHO, 17 Jul 2017)

A 27 per cent increase in the number of [AWD] cases was reported nationwide last week, mainly due to spikes in new cases reported in Amhara and Tigray regions and a resurgence of the outbreak in Afar region where community transmission of the disease is widespread. Currently, the major risk factors for the spread of the outbreak are holy water sites where large numbers of Christian pilgrims congregate from around the country, especially in Amhara and Tigray, and seasonal mobility of daily laborers to commercial farms. The high risk for further spread of the AWD outbreak continues due to the degradation of health determinants on the back drop of overburdened local health systems, including inadequate access to safe drinking water and internal and cross-border movements. (OCHA, 03 Sep 2017)

[AWD] cases continue to be reported from Afar, Amhara, Tigray and Oromia regions mainly from religious sites and commercial farms that have poor sanitation facilities and limited access to clean water. Somali region also continues to report AWD cases although at a reduced rate. With the ongoing rains, increased numbers of AWD cases are expected in the coming weeks; particularly in Amhara, Benishangul-Gumuz, Oromia and SNNP regions. (UNICEF, 20 Sep 2017)

The outbreak is showing a downward trend. Only 61 new cases have been reported this week from 4 regions, and the majority of new cases are from Amhara and Somali regions. As of now, 9 regions in Ethiopia have been affected, and 73.6% of the total cases are from Somali region. (WHO, 09 Dec 2017)

Only 11 new cases have been reported this week from 4 regions: Amhara, Somali, Diri Dawa and B.Gumuz regions. Nine regions in Ethiopia have been affected, and 73.6% of the total cases are from Somali region. (WHO, 05 Jan 2018)

Between January and December 2017, a cumulative total of 48 814 cases and 880 deaths (CFR 1.8%), have been reported from 9 regions. In 2018 only, a total of 98 cases have been reported from two regions, Somali and Dire Dawa regions. (WHO, 02 Mar 2018)

In most parts of the country, the situation has stabilized, however, Afar region is experiencing an increase in cases which began since week 18. In week 23, 233 cases were reported, all of which are from Afar region. From week 1 to 23 2018, a total of 728 cases with 18 deaths (CFR-2.5%) has been reported from the following regions: Somali (136 cases), Afar (537 cases with 18 deaths), Tigray (38 cases), and Dire Dawa City Administration (17 cases). (WHO, 29 Jun 2018)

A total of 1407 cases of [AWD] have been reported since June 2018 in Tigray region, affecting some 34 woredas. Currently the number woredas reporting AWD cases is reduced to 16 and 80 per cent of the cases are from four woredas. Central zone and Mekelle have the majority of cases but now it is shifting to Western zone. This week there were 64 patients of which 43 per cent are from Western zone, 35 per cent in Mekelle. Risk factors are mainly due to untreated water consumption which accounts to 70 per cent of the total factors. Government and partners are distributing water treatment chemicals and health supplies, but needs surpass resources being availed. High operational cost for response, low involvement of sectors and low level of response by most partners are among the critical challenges to AWD response in the region. Meanwhile trend of AWD cases is decreasing in all Woredas of Afar region. However, the regional AWD command post identified that provision of safe drinking water remains a major gap in all affected woredas. (OCHA, 19 Sep 2018)

In 2018, cases have been reported from five regions, namely; Oromia, Dire Dawa,Somalia, Tigray and Afar. There has been a general decline since the peak in week 33 when more than 500 cases were reported. In week 41(ending 14 October 2018), 48 cases of AWD were reported from two regions: Oromia (7) and Tigray (41). (WHO, 19 Oct 2018)

No new cases of AWD were reported in the existing hotspots on weeks 46 and 47. In total, 3 090 cases have been reported in 2018. (WHO, 30 Nov 2018)