Threats to oral polio vaccine acceptance in Somalia: Polling in an outbreak

Background

Using a survey conducted during the 2013–2014 polio outbreak in Somalia, this study examines attitudinal and knowledge-based threats to oral polio vaccine acceptance and commitment. Findings address a key gap, as most prior research focuses on endemic settings.

Methods

Between November 19 and December 21, 2013, we conducted interviews among 2003 caregivers of children under 5 years in select districts at high risk for polio transmission. Within each district, sample was drawn via a multi-stage cluster design with random route household selection. We calculated the percentage of caregivers who could not confirm recent vaccination and those uncommitted to future vaccination. We compared these percentages among caregivers with varying knowledge and attitudes, focusing on variables identified as threats in endemic settings, using controlled and uncontrolled comparisons. We also examined absolute levels of threat variables.

Results

Only 10% of caregivers could not confirm recent vaccination, but 32% were uncommitted to future vaccination. Being unvaccinated or uncommitted were related to multiple threat variables. For example, compared with relevant counterparts, caregivers were more likely to be unconfirmed and uncommitted if they did not trust vaccinators “a great deal” (unconfirmed: 9% vs. 2%; uncommitted: 49% vs. 28%), which is also true in endemic settings. Unlike endemic settings, symptom knowledge was related to commitment while rumor awareness was low and unrelated to past acceptance or commitment. Levels of trust and perceptions of OPV effectiveness were high, though perceptions of community support and awareness of logistics were lower.

Conclusions

  As in endemic settings, outbreak responses will benefit from communications strategies focused on enhancing trust in vaccinators, institutions and the vaccine, alongside making community support visible. Disease facts may help motivate acceptance, and enhanced logistics information may help facilitate caregiver availability at the door. Quelling rumors early may be important to prevent them from becoming threats.

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Free fistula surgery in Borama hospital gives suffering Somali women their lives back

Khadra Ibrahim Ahmed can see a new future opening up in front of her after a successful operation at Borame hospital in Somaliland this month to repair the obstetric fistula that has marred the last 14 years of her life.

“Whenever I visited my relatives in their houses I was not allowed to sleep in their beds, I couldn’t ride in public vehicles, or go to weddings or other public gatherings.  I was under house arrest!  I couldn’t mix with other people, and my husband even left me because of it. People would only call me on my phone but nobody wanted to stand close to me,” said Khadra, 40, who lives in Bosaso.

A prolonged labour during her last pregnancy, which resulted in the death of her baby, caused the damage that meant Khadra was unable to control her urine and faeces.

She went to different hospitals with support from her husband in Addis Ababa, Mogadishu, and Bosaso. None of the treatments worked and in 2012, when her husband left her, she resigned herself to a life of hopelessness.

Recently, Khadra heard from a friend about the free treatment provided at Borama hospital by the Fistula Foundation. She immediately contacted the hospital and became one of 105 women to receive surgery this month.

“I have spent all my money trying to find doctors. When my money ran out I got handouts from my relatives. My mother sent me $40 a month to buy diapers and clothing,” Khadra said.  “Now I am recovering and when the doctors discharge me the first thing I hope to do is to get back my life and start up a business.”

Dr Nasra Ibrahim Sa’id, who conducted the surgery, said most women affected have suffered prolonged obstructed labour.

“The services given to the women including hospitalisation, food, medication, surgery and other extra treatment are all free. Sometimes the women bring others with them and we also treat them,” said Dr Nasra.

Women are encouraged to come to the hospital to benefit from the free services.  The hospital is supported by Fistula Foundation, World Vision, and Somaliland’s Ministry of Health.

Source 

WHO releases new International Classification of Diseases

Geneva – The World Health Organization (WHO) on 18 June released its new International Classification of Diseases (ICD-11).

The ICD is the foundation for identifying health trends and statistics worldwide and contains around 55,000 unique codes for injuries, diseases and causes of death. It provides a common language that allows health professionals to share health information across the globe.

“The ICD is a product that WHO is truly proud of,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “It enables us to understand so much about what makes people get sick and die, and to take action to prevent suffering and save lives.”

ICD-11, which has been over a decade in the making, provides significant improvements on previous versions. For the first time, it is completely electronic and has a much more user-friendly format. And there has been unprecedented involvement of health care workers who have joined collaborative meetings and submitted proposals. The ICD team in WHO headquarters has received over 10,000 proposals for revisions.

ICD-11 will be presented at the World Health Assembly in May 2019 for adoption by member States and will come into effect on 1 January 2022. This release is an advance preview that will allow countries to plan how to use the new version, prepare translations, and train health professionals all over the country. The ICD is also used by health insurers whose reimbursements depend on ICD coding; national health programme managers; data collection specialists; and others who track progress in global health and determine the allocation of health resources.

The new ICD-11 also reflects progress in medicine and advances in scientific understanding. For example, the codes relating to antimicrobial resistance are more closely in line with the Global

Antimicrobial Resistance Surveillance System (GLASS). ICD-11 is also able to better capture data regarding safety in healthcare, which means that unnecessary events that may harm health – such as unsafe workflows in hospitals - can be identified and reduced.

The new ICD also includes new chapters, one on traditional medicine: although millions of people use traditional medicine worldwide, it has never been classified in this system. Another new chapter on sexual health brings together conditions that were previously categorized in other ways (e.g. gender incongruence was listed under mental health conditions) or described differently. Gaming disorder has been added to the section on addictive disorders.

“A key principle in this revision was to simplify the coding structure and electronic tooling – this will allow health care professionals to more easily and completely record conditions,” says Dr Robert Jakob, Team Leader, Classifications Terminologies and Standards, WHO.

Dr Lubna Alansari, WHO’s Assistant Director-General for Health Metrics and Measurement, says: “ICD is a cornerstone of health information and ICD-11 will deliver an up-to-date view of the patterns of disease.”

ICD-11 is linked to the WHO non-proprietary names of pharmaceutical products, and it can be used for cancer registration. ICD-11 has been designed to be used in multiple languages: a central translation platform ensures that its features and outputs are available in all translated languages. Transition tables from and to ICD-10 support migration to ICD-11. WHO will support countries as they move towards implementation of the new ICD-11. – WHO

. . . Launches Global action plan on physical activity

The World Health Organization (WHO) has on 4 June 2018 launched the new “WHO Global action plan on physical activity and health 2018-2030: More active people for a healthier world.”

“Being active is critical for health. But in our modern world, this is becoming more and more of a challenge, largely because our cities and communities aren’t designed in the right ways,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “We need leaders at all levels to help people to take the healthier step. This works best at city level, where most responsibility lies for creating healthier spaces.”

Worldwide, one in five adults, and four out of five adolescents (11-17 years) do not do enough physical activity. Girls, women, older adults, poorer people, people with disabilities and chronic diseases, marginalized populations, and indigenous people have fewer opportunities to be active.

WHO advised that regular physical activity is key to preventing and treating noncommunicable diseases (NCDs) such as heart disease, stroke, diabetes and breast and colon cancer. NCDs are responsible for 71% of all deaths globally, including for the deaths of 15 million people per year aged 30 to 70.

The action plan shows how countries can reduce physical inactivity in adults and adolescents by 15% by 2030. It recommends a set of 20 policy areas, which combined, aim to create more active societies through improving the environments and opportunities for people of all ages and abilities to do more walking, cycling, sport, active recreation, dance and play.

It also calls for support to, for example, training of health care workers and other professionals, stronger data systems, as well as the use of digital technologies.

Dr Tedros added: “You don’t need to be a professional athlete to choose to be active. Taking the stairs instead of the elevator makes a difference. Or walking or using the bike instead of driving to your neighbourhood bakery. It’s the choices we make each and every day that can keep us healthy. Leaders must help make these choices the easy ones.” 

To support national efforts to implement the plan, WHO is launching an advocacy campaign to promote physical activity, Let’s Be Active: Everyone, Everywhere, Everyday. This new drive, launched at the Portuguese Football Association’s iconic Cidade do Futebol (City of Football), aims to encourage governments and city authorities to make it easier for people to be more physically active, and healthier.

It follows the first WHO Walk the Talk: The Health for All Challenge event that attracted more than 4000 people to promote movement and activity for health on 20 May in Geneva, on the eve of the World Health Assembly.

In line with WHO’s drive to promote physical activity to beat NCDs, Portugal launched its own national media campaign to promote physical amongst the population.

“This national campaign arises from our drive to inform the Portuguese of the benefits of having healthier lifestyles in order to fight NCDs,” said Mr Costa. “The Portuguese Government is highly committed to implementing a systemic approach to promote physical activity and is honoured to receive the launch of the Global Action Plan on Physical Activity.”

Physical inactivity is more than a health challenge: the financial costs are also enormous. Globally, physical inactivity is estimated to cost US$54 billion in direct health care, of which 57% is incurred by the public sector and an additional US$14 billion is attributable to lost productivity.

World leaders will meet later this year to take action on physical inactivity and other causes of NCDs, and mental disorders, when they take part in the Third United Nations General Assembly High-level Meeting on NCDs, being held on 27 September in New York. 

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Disease burden haunts Somalia as multiple outbreaks spread

The World Health Organization (WHO) has reported an increase in cholera, acute watery diarrhoeas, measles, undiagnosed influenza-like illnesses and severe acute respiratory illness in Somalia in 2018.

In its latest epidemiological country report, the WHO said of the 4,835 disease outbreak alerts received since December last year, 671 were confirmed as true.  

“The highest numbers of diseases reported in week 23 were other acute diarrhoeas (3,402 cases), influenza-like illness (1,808 cases) and severe acute respiratory illness (1,464 cases).

“A total of 343 new cases of suspected AWD/cholera, including 4 deaths were reported in week 23 compared to 396 AWD cases including 1 death in week 22,” the report said.

At least 4,643 AWD/cholera cases and 32 deaths have been reported since December 2017 while the number of measles cases had increased to 130 by June 10. Of the 5 866 suspected cases reported to date, 2 563 are 2 563 children under 5 years of age.

Following heavy rains that resulted in flooding in across the Shabelle and neighbouring coastal regions, bloody diarrhoea and acute respiratory illnesses are on the rise in Somalia.  

Whooping cough, acute jaundice, meningitis, diphtheria neonatal tetanus as well as acute flaccid paralysis and viral haemorrhagic fever are increasingly common throughout the country.

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Chinese envoy tours health facility for Somali Malnourished children in Mogadishu

MOGADISHU, June 12 (Xinhua) -- Chinese Ambassador to Somalia Qin Jian on Tuesday visited China-funded health facility in Mogadishu's Wadjir district where about 15,000 Somali children are receiving medical care. The Mother to Child Care project run by the UN children's fund (UNCIEF) benefited from 2 million U.S. dollar donation from the Chinese government. Speaking during the tour, Qin reiterated his government's support to Somali people, adding that Beijing has also given donations worth 1.5 million dollars to people whose lives were affected by floods in the country in May. The Chinese envoy commended UNICEF officials in the country for effectively utilizing the money. "We are supporting Somali development projects, humanitarian assistance, peace and also giving out scholarships," Qin said during the tour of the facility. UNICEF Deputy Representative to Somalia Jesper Moller thanked the Chinese government for the donation towards the construction of the health facility. Moller noted that the project has benefited 1,500 children who were initially suffering from malnutrition since inception. "We are very happy and proud of our relationship with the Chinese government that will go a long way in helping save lives of children in the country," he said and appreciated the good working relationship with the Chinese government. According to Mohamed Ahmed, a Medical Coordinator at the health facility, the newly refurbished center treated 35,356 children last year. "We screened a total of 34,784 children, 1,422 children were treated with severe malnutrition and 74 were hospitalized last year," Ahmed said. Source

WHO certifies Paraguay malaria-free

   The World Health Organization (WHO) today certified Paraguay as having eliminated malaria, the first country in the Americas to be granted this status since Cuba in 1973.

“It gives me great pleasure today to certify that Paraguay is officially free of malaria,” said Dr Tedros Adhanom Ghebreyesus, WHO Director General, in a recorded statement. “Success stories like Paraguay’s show what is possible. If malaria can be eliminated in one country, it can be eliminated in all countries.”

In this video message, WHO Director-General Dr Tedros Adhanom Ghebreyesus commends Paraguay on its achievement and briefly outlines the success factors that enabled the country to become malaria-free. 

In 2016, WHO identified Paraguay as one of 21 countries with the potential to eliminate malaria by 2020. Through the “E-2020 initiative,” WHO is supporting these countries as they scale up activities to become malaria-free. Other E-2020 countries in the Americas include Belize, Costa Rica, Ecuador, El Salvador, Mexico and Suriname.   

“I take pride in saying that PAHO has accompanied Paraguay in the crusade of malaria elimination since the beginning,” said Dr Carissa F Etienne, Director of the Pan American Health Organization (PAHO), WHO regional office for the Americas. “This is a powerful reminder for the region of what can be achieved when countries are focused on an important goal, and remain vigilant after achieving that goal. We are hopeful that other countries will soon join Paraguay in eliminating malaria”.  

Achieving malaria-free status in Paraguay 

From 1950 to 2011, Paraguay systematically developed policies and programmes to control and eliminate malaria, a significant public health challenge for a country that reported more than 80 000 cases of the disease in the 1940s. As a result, Paraguay registered its last case of Plasmodium falciparum malaria in 1995, and P. vivax malaria in 2011.

A five-year plan to consolidate the gains, prevent re-establishment of transmission and prepare for elimination certification was launched in 2011. Activities focused on robust case management, engagement with communities, and education to make people more aware of ways to prevent malaria transmission, and about diagnosis and treatment options. 

“Receiving this certification is a recognition of more than five decades of hard work in Paraguay, both on the part of public sector workers, as well as the community itself, who have collaborated time and time again in order to achieve the elimination of malaria,” said Dr Carlos Ignacio Morínigo, Minister of Health of Paraguay.

“Reaching this goal also implies that we must now face the challenge of maintaining it. Therefore, Paraguay has put in place a solid surveillance and response system in order to prevent the re-establishment of malaria.” 

In 2016, in the next phase of the elimination drive, the Ministry of Health launched a three-year initiative to build Paraguay’s front-line health workers’ skills. Backed by The Global Fund to Fight AIDS, Tuberculosis and Malaria, the country strengthened its capacity to prevent disease, identify suspected malaria cases, accurately diagnose malaria and provide prompt treatment – key strategies to tackle the on-going threat of malaria importation from endemic countries elsewhere in the Americas and sub-Saharan Africa. 

“Paraguay’s success demonstrates the importance of investing in robust, sustainable systems for health, and I’m very pleased that the Global Fund supported this achievement,” said Peter Sands, Executive Director of the Global Fund. “We need to remain vigilant and prevent resurgence, but we also need to celebrate this victory.”

In April 2018, the independent Malaria Elimination Certification Panel  concluded that Paraguay had interrupted indigenous malaria transmission for the requisite 3 years and had the capacity to prevent the re-establishment of transmission. The Panel recommended the WHO Director-General certify the country malaria-free. 

They highlighted factors such as the quality and coverage of health services, including malaria awareness among front-line health workers, the universal availability of free medical treatment, and a strong malaria surveillance system. 

Between 1960 and 1973, seven countries and territories from the Americas were certified malaria-free: Cuba, Dominica, Grenada, Jamaica, Saint Lucia, Trinidad and Tobago, and the northern part of Venezuela. In the Region of the Americas, malaria cases declined by 62%, and malaria-related deaths decreased by 61% between 2000 and 2015. However, the rise of malaria cases reported in several countries in 2016 and 2017 show that major challenges remain, including the diagnosis, treatment, and investigation of malaria cases, particularly in remote areas.  

Further information on malaria elimination progress 

The official certification announcement will be made today at the Second annual global forum of malaria-eliminating countries, convened by WHO in San José, Costa Rica from 11-13 June. 

WHO is also releasing a progress update on elimination efforts in E-2020 countries, providing – for the first time – preliminary malaria case numbers for 2017. Ten more countries are on track to eliminate malaria by 2020. However, eight other E-2020 countries saw increases in indigenous malaria cases in 2017, reflecting the global malaria trends reported in the latest WHO World malaria report. WHO is publishing country briefs for the 21 eliminating countries, offering an overview of progress, key malaria data and an assessment of what is needed to reach the 2020 elimination target. 

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UN: 1.25 million Somali children face acute malnourishment after floods

The UN Children's Agency (UNICEF) said on Friday more than 1.25 million children are expected to be acutely malnourished this year because of flooding in Somalia.

Chief UN spokesman Stephane Dujarric told reporters here at UN Headquarters during a regular briefing that flooding since April is being blamed.

He said the agency reported about half of children under five years old, or "more than 1.25 million are expected to be acutely malnourished this year. That includes up to 232,000 children who will suffer severe acute malnutrition, which requires specialized lifesaving care."

"Many of the flood-impacted areas are in the path of an ongoing measles outbreak, and a spike in acute watery diarrhea/cholera cases is a major threat," Dujarric said.

"The rains spread diseases that are particularly deadly for malnourished children with exhausted, fragile immune systems," said Christophe Boulierac, UNICEF spokesman in Geneva.

"The flooding has damaged water points, sanitation facilities and other critical infrastructure, and 22 nutrition centers treating over 6,000 acutely malnourished children in areas hosting Internally Displaced Persons (IDPs) have had to shut down," he said.

Boulierac said short-term UNICEF funding is running out, and "it will hurt water, health and nutrition services."

UNICEF has received 24.3 million U.S. dollars this year of its 154.9 million dollar appeal which, along with funds carried over, leaves a gap of 110.3 million dollars, or 71 percent, he said. 

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Charities from Qatar to raise more than 16m USD to help Somalians

A joint campaign to support Somalia will be launched in Qatar on Sunday by four Qatari humanitarian organisations, namely Qatar Red Crescent Society, Qatar Charity, Silatech and Education Above All Foundation. The campaign is under the supervision of Regulatory Authority for Charitable Activities and supported by Qatar Fund for Development.

Announced at a press conference yesterday, the campaign aims to raise more than QR60mn to meet the humanitarian and development needs of the Somali people and provide water, health, education and economic empowerment services, as well as humanitarian intervention in flood-affected areas to provide shelter, food and medical supplies. 
The projects’ list will include the drilling and rehabilitation of wells, rehabilitation of water systems, livelihood projects, support for the agricultural sector, children’s education, building and rehabilitation of schools and health centres, treatment of patients, distribution of food baskets, establishment of social centres, and rehabilitation of roads.

Somalia is suffering from acute crises, perhaps the most serious of which is the famine that threatens 6.2mn people, nearly half of the population, because of water shortages, according to statistics from international organisations and United Nations institutions. There are up to 2.5mn displaced persons, and more than 400,000 who need urgent medical assistance, these statistics indicated, adding that Somalia has low enrolment rates in education, where the rate of enrolment in primary education is 30% and 26% in secondary education.
At the press conference, representatives of the Qatari humanitarian organisations stressed that this campaign is a reflection of the spirit of solidarity between the Qatari and Somali peoples and the official and popular stance of the State of Qatar in support of Somalia in all circumstances and in response to the humanitarian situation in this brotherly country, as a result of recurrent drought and unstable situations due to conflicts. 

Qatar Charity’s Executive Director of International Development Department Mohamed Ali al-Ghamdi said that this joint campaign is a religious, humanitarian and moral duty towards Somalia, stressing his confidence in the people of Qatar to support the campaign to meet part of the humanitarian needs of the Somali people in the areas of water, health, education, food, shelter and other relief and development projects.
He pointed to the deteriorating situation of various sectors of education and health services in Somalia and poor infrastructure and lack of food and medicine, as well as the problems of displacement as a result of disasters, floods and conflicts, adding that reports of international organisations reveal the difficulty of the humanitarian situation in this country, which is trying to recover. 

Executive Director of Qatar Red Crescent Society (QRCS) Youssef Abdullah al-Sada said that recent floods have displaced nearly 700,000 people to double the suffering of this Somali people, stressing that this humanitarian campaign aims to alleviate their suffering. He explained that the QRCS will work through this campaign in various areas of Somalia in the sectors of healthcare, food security, water, sanitation, education and emergency relief intervention.
The QRCS, which has been operating in Somalia since 2000, had managed to implement quality projects over the past years for nearly 900,000 people directly, and for about 4.5mn people indirectly, he said.

CEO of Silatech Sabah al-Haidous said the humanitarian situation in Somalia requires the co-operation of institutions concerned with humanitarian work, and the support of all sectors as well as the donations from the people of Qatar to alleviate the suffering of Somalis through this campaign, which seeks to extend relief assistance to those affected by drought, famine and poverty in Somali regions. 
She added that Silatech’s participation in the campaign is a continuation of its hard work in combating poverty and youth unemployment, which are one of the most urgent problems in Somalia. “We are trying to invest the energies of young people in the development of this country and to protect this enormous human wealth from falling prey to extremist groups,” she said.

SOURCE

Dr. Qasim of Imperial Healthcare provides honorary sight-saving double corneal transplants to an underprivileged 5-year-old child from Somalia.

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Meet Dr Sivaramakrishna Iyer Padmavati, who turns 101 this month, and still goes to the National Heart Institute in Delhi every day, which she founded in 1977.

Stent, heart bypass surgery, heart attack…all of us have heard these painful terms amongst our loved ones at one time or another. But these were uncommon a generation ago.

So, what happened? How did we reach here?

In an attempt to understand the status of heart disease in India, Priyamvada Chugh reached out to India’s first and oldest cardiologist.

Born in 1917, Dr Padmavati fled with her family from Burma to Coimbatore in 1941 during World War II. With the passion to make a difference, she studied medicine at Johns Hopkins Hospital and Harvard Medical College in the USA with cardiology pioneers Dr Helen Taussig and Dr Paul Dudley White, respectively.

While returning to India in 1952 was a personal decision, it was the turning point for cardiology in India.

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Kenya Must Wake Up to the Threat of an Outbreak of Rift Valley Fever

Heavy rainfall in Kenya has left a trail of destruction in parts of the country, leading to deaths and rendering roads impassable. Some rivers have burst their banks and dams have overflown for the first time in many years.

The heavy rains present an additional danger: a higher chance of outbreaks of Rift Valley fever, a mosquito borne disease caused by a virus that infects both animals and humans and eventually results in death.

Heavy rainfall leads to low-lying grasslands, known as dambos, becoming flooded which in turn leads to Rift Valley fever infected mosquito eggs hatching. The emerging infected female adults then initiate transmission to nearby animals which serve as amplifiers, infecting more mosquitoes resulting in outbreaks.

Rift Valley Fever spreads in a number of ways. Firstly people and animals can get it from being bitten by an infected mosquito bite. But the most infections happen when people come into contact with infected animals’ blood, secretions or tissue. This can happen when animals are slaughtered, when they’re being helped to give birth, during veterinary procedures or when food is being prepared.

In the last Kenya Rift Valley fever outbreak in 2006 more than 150 people died and another 700 were hospitalised in the North-Eastern region of the country, placing a significant strain on the already overstretched public health resources. There were also economic costs – an estimated US$ 32 million for vaccinations, trade bans and the loss of livestock.

The outbreak lasted for close to a year before authorities were able to get it under control.

As the rainfall continues it’s important that national and county governments put various measures in place to prevent an outbreak. This includes controlling mosquitoes that spread Rift Valley fever, vaccinating livestock and educating the public on the importance of safe practises when they’re slaughtering or handling sick animals.

Action that needs to be taken

If steps aren’t taken urgently, Kenya will struggle to contain an outbreak when it happens.

The steps that need to be taken include:

• Using forecasting and climatic models to predict the climatic conditions linked to the increased risk of an outbreak. This was done in 2006. Satellite images and weather forecasting data was used to predict the outbreak.
• Ensuring that warning as well as animal health surveillance systems are in place for people and animals. This would ensure that new cases in animals were detected early, which in turn could improve disease control.
• Vector control: using insecticides that target mosquitoes at their breeding sites. This is important because mosquitoes are the initial source of infections. The challenge during floods is that there are too many breeding sites to do this feasibly.
• Animal vaccination programmes. The challenge is that, to be effective, animals must be vaccinated before an outbreak. If this is left too late it can in fact intensify the outbreak. This is because animals that are infected don’t always show symptoms. If they’re treated and multi-dose vials and re-used needles and syringes are then used on other animals, the virus can be spread.
• Restricting livestock movement to slow down the spread of the virus.

Measures to prevent the outbreak must be accompanied by public health education initiatives.

The messages should focus on teaching people how to reduce the risk of animal-to-human transmission by safe animal husbandry and slaughtering practices. This includes washing hands, wearing gloves and other protective equipment when handling sick animals or their tissues as well as when they slaughter animals.

It should also discourage people from eating unsafe and partially cook fresh blood, raw milk or animal tissue.

In addition, health care workers caring for patients should implement standard safety precautions. This includes handling blood (including dried blood), all other body fluids, secretions and excretions (excluding sweat), regardless of whether they contain visible blood, and contact with non-intact skin and mucous membranes.

Not the first

The pending threat of a Rift Valley fever outbreak is not the first in Kenya. There have been 11 outbreaks between 1951 and 2007.

Some, like the 1997 outbreak stretched from Kenya to Somalia and Tanzania. In Kenya it killed more than 450 people and affected another 100 000 people.

In the 1950s the outbreak was initially confined to one district in Rift Valley province that is prone to flooding and where livestock were raised close to wildlife. But by the time the 2006 outbreak hit the outbreak had spread to 33 of 69 districts in the province.

This expansion has been driven by several environmental factors including rainfall and temperature, the density and movement of livestock and the presence of competent vector species.

This significantly complicates efforts to prevent an outbreak.

Beyond East Africa there have also been severe Riftvalley fever outbreaks in other parts of Africa, including South Africa in 1951 where 100 000 sheep died and close to 500 000 livestock had forced abortions, Egypt between 1977 to 1979 where more than 600 people died and more than 200 000 others were affected, Mauritania, Senegal, Sudan, Madagascar, and Saudi Arabia and Yemen in the Middle East.

Time is running out for Kenya: if the country wants to avoid another outbreak, national and local authorities need to act urgently.

By: Eunice Anyango Owino

Medical Entomologist at the School of Biological Sciences, University of Nairobi

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