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Ending the neglect: eliminating worm infections as a public health problem in Somalia

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somalia-mass-drug-administration-campaignSchool-aged children receive essential medicines to tackle schistosomiasis and soil-transmitted helminth infections. WHOSomalia/Khurram Sajjad.29 May 2022 – Neglected tropical diseases affect people who lack regular access to adequate sanitation, basic health infrastructure and health services. These diseases can lead to significant morbidity, mortality, stigma and discrimination in communities. 

Prevalence of neglected tropical diseases                                                                                                                              

Of the 20 neglected tropical diseases listed by WHO as endemic in tropical countries, schistosomiasis and soil-transmitted helminth infections, along with leprosy and visceral leishmaniasis, are common in Somalia. About 5 to 6 million people in the country live in the areas that are highly endemic for these diseases.   

Between 2016 and 2017, WHO and the Ministry of Health and Human Services of Somalia conducted a mapping exercise to determine where neglected tropical diseases affect people. They found unexpected cases of intestinal schistosomiasis due to Schistosoma mansoni, or snails, in the South West state and in Banadir. Hookworms are known to be common in these locations too.

Communities living in South West Somalia, across the middle and lower valleys of the Shabelle and Juba rivers, reportedly suffer the most from these diseases. Additionally, internally displaced persons are also among the most affected, due to their living conditions. 

Reducing spread of infections 

To reduce prevalence of these diseases, the World Health Organization (WHO) has been providing support to the Federal Government of Somalia to conduct mass drug administration campaigns since 2017.

On 7 May 2022, the country embarked on an 18-day effort to provide essential medicines, namely praziquantel and metronidazole, to around 2.48 million school-aged children (aged between 5 and 14 years) and adults in 39 districts. Health care workers have been visiting schools and madrasas to reach children and using community-based initiatives to target adults. These efforts will reduce the reservoir of infection and interrupt disease spread.

The last campaign, conducted in 2020, administered these essential medicines to around 2.6 million school-aged children and over 300 000 adults in 41 districts. It covered around 91% of a targeted 3.18 million people. 

mda-campaignWHO is supporting the Government to conduct the fourth mass drug administration campaign in Somalia since 2017. WHOSomalia/Khurram Sajjad.In addition to offering medicines to control and eradicate schistosomiasis and soil-transmitted helminth infections, WHO has supported the federal and state governments to increase public awareness about them. They have reached out to the most vulnerable groups, including internally displaced persons. These interventions have been possible with support from the END Fund and Expanded Special Project for Elimination of Neglected Tropical Diseases (ESPEN). 

“These interventions of WHO are in line with the new WHO road map for neglected tropical diseases "Ending the neglect to attain the Sustainable Development Goals: a road map for neglected tropical diseases 2021–2030," which sets global targets and milestones to prevent, control, eliminate or eradicate 20 neglected tropical diseases and disease groups, now prioritized by WHO, and attain the SDGs,” said Dr Mamunur Rahman Malik, WHO Representative for Somalia.

“We also believe that whatever we do and whatever strategy we undertake to eliminate the risk of neglected tropical diseases from Somalia, our efforts should contribute to building a strong foundation for the primary health care system in such a fragile health system setting. Creating demand for eliminating this disease from school-aged children and making sure that the health system delivers such public good in real-time are all part of our work in this country, aiming to build resilience,” commented Dr Mamunur Rahman Malik, on the eve of the launch of the mass drug administration campaign for schistosomiasis and soil-transmitted helminthiasis.  

In line with the national action plan for Somalia, WHO and its partners, such as the ESPEN and END Fund, intend to support national health authorities to conduct mass drug administration campaigns with increased national coverage for schistosomiasis, including more than 75% of treatment coverage for school-aged children, to eliminate the disease as a public health problem by 2025. The campaigns will also treat soil-transmitted helminthiasis, including deworming coverage for at least 75% of eligible school-aged children and pre-school children by 2026.  

Both schistosomiasis and soil-transmitted helminth infections are spread due to a lack of hygiene, when people do not have access to water and sanitation facilities, or do not wash their hands often, particularly before meals or after excretion. 

For additional information, please visit:

ESPEN: ESPEN | Expanded Special Project for Elimination Neglected Tropical Diseases (who.int)

The END Fund: Home - The END Fund

WHO Regional Director officially launches emergency health response plan for drought in Somalia

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WHO Somalia/Fouzia BanoWHO Somalia/Fouzia BanoMogadishu, 11 May 2022 – During his 3-day visit to Somalia, the World Health Organization (WHO) Regional Director for the Eastern Mediterranean Dr Ahmed Al-Mandhari visited North Galkacyo in Puntland state of Somalia to oversee WHO’s ongoing drought response activities, see the work of community health workers in delivering integrated health and nutrition services to the people displaced by the recent drought in Somalia and visit one of the internally displaced population’s camps to see the challenges faced by the communities in meeting their health, nutrition, food and water and sanitation needs. 

Later on, he attended an event in Mogadishu where the WHO emergency health response plan for drought was officially launched, which was also attended by HE Dr Fawziya Abikar Nur, Minister of Health and Human Services of the Federal Government of Somalia, Mr Jocelyn Mason, the United Nations Resident Coordinator for Somalia ad interim and Mr Mugatte Guisse, the United Nations Humanitarian Coordinator for Somalia ad interim.

The ongoing drought in Somalia and across the Horn of Africa is known to be the region’s worst in the last four decades. In Somalia alone, an estimated 6.1 million people have been affected by the drought, of whom 759 400 have been displaced in search of water, food and pasture; 3.5 million lack sufficient access to water; and 6 million continue to face severe food shortages, with approximately 1.4 million children facing acute malnutrition, including 329 500 likely to become severely malnourished. So far, a total of 3675 suspected cases of cholera and 2720 cases of measles have been confirmed since January 2022 from the drought-affected areas.

WHO Somalia/Fouzia BanoWHO Somalia/Fouzia Bano“Whenever natural disasters strike, diseases inevitably follow, particularly in fragile contexts. At all levels, WHO is leaving no stone unturned to support the people of Somalia to cope with the effects of drought,” said Dr Al-Mandhari. “As one of the first responders on the ground, WHO is working with the government, donors and other UN agencies and health cluster partners to reduce the spread of diseases and complications related to malnutrition, while simultaneously rebuilding health systems to cope with similar calamities in the future." 

WHO’s emergency health response plan for drought in Somalia for 2022 urgently requires US $35 million over the next 10 months to deliver emergency life-saving operations to reach over 2.5 million vulnerable people in the worst-affected parts of the country. 

Dr Al-Mandhari explained that the drought response plan, which will serve as WHO’s blueprint for intensifying efforts to save more lives and cushion Somalis from severe forms of disease and malnutrition, was based on lessons learnt from past droughts in Somalia and would help to prevent epidemics, save lives, protect communities’ health and nutrition needs, and avert an additional health crisis. He praised the Federal Government and UN partners for their collaborative efforts, emphasizing that the true essence of the WHO's regional Vision 2023 of “health for all by all” was in the solidarity displayed in the ongoing drought response work. 

somalia-drought-planWHO Somalia/Fouzia Bano.“WHO is responding to Somali families’ most dire needs, and is working to ensure every Somali household, including the most vulnerable, can access emergency life-saving support especially during emergencies. The WHO emergency health response plan for drought in Somalia calls for early action on a no-regrets basis. It is imperative that WHO has access to flexible, smart and unearmarked funds to scale up our life-saving operations in hard-to-reach areas to protect the health and well-being of the people impacted by the drought” said Dr Mamunur Malik, WHO Representative to Somalia.

For additional information, please contact: 

Kyle DeFreitas, Lead
External Relations
WHO Somalia
Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir.

Fouzia Bano
Communications Officer/Chief of Staff a.i.,
WHO Somalia
Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir.

WHO Regional Director for the Eastern Mediterranean pays a visit to Somalia

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rd-visit-1Director of Business and Operations Services of the WHO Regional Office for the Eastern Mediterranean Dr Sussan Bassiri, WHO Regional Director for the Eastern Mediterranean Dr Ahmed Al-Mandhari, Federal Minister of Health and Human Services HE Dr Fawziya Abikar Nur, and WHO Representative in Somalia Dr Mamunur Rahman Malik. WHO Somalia/Fouzia Bano 

Mogadishu, 9 May 2022 – On 9 May 2022, the World Health Organization (WHO) Regional Director for the Eastern Mediterranean Dr Ahmed Al-Mandhari arrived in Somalia for a 3-day visit. He was accompanied by the Director of Business and Operations Services of the WHO Regional Office for the Eastern Mediterranean Dr Sussan Bassiri. 

The Federal Minister of Health and Human Services HE Dr Fawziya Abikar Nur other high-level government officials and the WHO Representative to Somalia Dr Mamunur Rahman Malik extended a warm welcome to Dr Al-Mandhari, who is visiting Somalia for the second time since 2019. He is visiting Somalia at a time when the country is rolling out an Essential Package of Health Services (EPHS 2020). The development and implementation of the EPHS 2020 is seen as the largest public sector project in the history of Somalia that aims to increase access to health care, improve health services delivery and coverage using the primary health care approach. WHO has supported the development of the EPHS 2020 of Somalia through a broad range of technical support involving its Regional Office and headquarters, which includes a burden of disease analysis costing, as well as design of cost-effective but high-impact interventions to be delivered at different levels of care. The EPHS 2020 will be financed by the World Bank and the Global Financing Facility over the next 5 years over a budget outlay of US$ 100 million. The EPHS 2020 will be the main driver of the country to achieve universal health coverage.    

The WHO country office will continue to support the Ministry of Health and Human Services of the Federal Government of Somalia to roll out the EPHS in the country, as well as the delivery of other impactful interventions to protect health, save lives and build a resilient health systems through its recently developed "Country Cooperation Strategy for WHO and Somalia 2021–2025".

rd-visit-2WHO Somalia/Fouzia Bano

As part of his programme, Dr Ahmed Al-Mandhari met HE Dr Fawziya Abikar Nur and other officials of the ministry at her office on 9 May 2022 and discussed the ongoing collaborative programme between her ministry and the WHO country office. The WHO Regional Director thanked the Minister for her leadership over the past 5 years and expressed appreciation of her key role in guiding health sector reforms in the country and working relentlessly to improve the health and well-being of the population in a most challenging, complex and fragile context. The WHO Regional Director recalled that these reforms that she initiated for the health sector will go a long way in achieving universal health coverage and support implementation of WHO's regional Vision 2023: Health for all by all.   

The WHO Regional Director also visited the De Martino Hospital in Mogadishu – the main public hospital that serves the capital city of the country and was the main hospital in the country treating COVID-19 patients. The WHO Regional Director lauded the health workers for their hard work in saving lives with limited resources and in the face of multiple challenges. 

rd-with-small-childWHO Somalia/Fouzia Bano

While addressing the health workers, Dr Al-Mandhari further reiterated that in line with the spirit of Vision 2023 “Health for all by all”, WHO would continue to support Somalia to strengthen the health system, infrastructure and health care workers’ skills, while concurrently preparing for and responding to any health emergencies that may arise. 

Later on, Dr Ahmed Al-Mandhari accompanied by HE Dr Fawziya Abikar Nur and other high-level government officials, visited 2 landmark achievements stemming from WHO's COVID-19 response activities. First, they visited the new Pressure Swing Adsorption (PSA) oxygen plant that was installed at the De Martino Hospital with support from WHO, which is helping to fill a large gap in high-grade medical oxygen availability in the country for COVID-19 and other health conditions. The containerized duplex PSA system is serving 25 intensive care unit beds  while concurrently refilling 100 40-litre oxygen cylinders per day. WHO plans to set up similar containerized duplex PSA plants in several other locations as part of the Organization’s vision to bridge medical oxygen access gaps in hospitals and primary level care. 

rd-visit-3WHO Somalia/Fouzia Bano

After viewing the PSA plant, the Minister and Dr Ahmed Al-Mandhari paid a visit to the National Public Health Reference Laboratory (NPHRL) in Mogadishu, where the Regional Director saw just how far Somalia had come with respect to laboratory testing and the newly developed capacity for genome sequencing. The NPHRL was supported by WHO in 2020 at the beginning of the COVID-19 pandemic to attain molecular diagnostic capacity for testing of SARS-COV-2 when there was no testing facility for COVID-19 in the country. The NPHRL using rt-PCR is now able to test and detect COVID-19, as well as other epidemic and pandemic-prone pathogens in real-time In March 2022, WHO supported the NPHRL to build genome sequencing capacity that will help the country to detect and monitor circulation of new variants of COVID-19, influenza viruses, map genomes of other bacteria and viruses of epidemic and pandemic potential. 

testing-image-3WHO Somalia/Fouzia Bano

“Our Regional Director’s second visit to Somalia is an honour for the WHO Somalia country office and for the country. It shows WHO’s commitment to Somalia in responding to emergencies, while re-establishing resilient health systems that can cope with the impact of calamities, as well as any future emergencies. WHO will continue to develop strong foundations in health across the country and strive to build a fairer and equitable health system that serves all and not just a few," said Dr Mamunur Rahman Malik, WHO Representative to Somalia.

For additional information, please contact:

Kyle DeFreitas, Lead – External Relations, WHO Somalia < Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir. >

Fouzia Bano, Communications Officer / Chief of Staff a.i., WHO Somalia < Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir. >

Note to editors

Please see the link below for additional information on the WHO Regional Director’s last mission to Somalia, in September 2019, where Dr Ahmed Al-Mandhari launched the country’s roadmap to universal health coverage, together with the Federal Minister of Health and Human Services and WHO Representative to Somalia.

WHO EMRO | WHO Regional Director for the Eastern Mediterranean concludes visit to Somalia | News | Media centre

 

WHO and the Italian Agency for Development Cooperation seek to improve resilience of Somalia’s health system by enhancing essential health services for hospitals in under-served states

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launch-cermony-1WHO Somalia/Khurram Sajjad.

Mogadishu, 9 May 2022 – In their continued and collective efforts to improve health system resilience, the Ministry of Health and Human Services of the Federal Government of Somalia, World Health Organization (WHO) and the Embassy of Italy have joined forces and officially launched a €3 million multi-year project entitled ‘Improving essential health services in Somalia using a secondary hospital-based care approach.’ 

The project is designed to improve delivery of essential health services at the secondary level care in Somalia by focusing on building strong and resilient hospital-based care at Hudur General Hospital in South West state and Dhusamareb General Hospital in Galmudug state – both of which are currently unable to meet the health care demand and needs of populations within their respective catchment areas. Developed under the leadership of the Federal Ministry of Health, in close partnership with WHO and the Italian Agency for Development Cooperation (AICS), the project aims to achieve universal health coverage (UHC) through strengthening hospital-based care for integrated delivery of secondary and critical care services, as well as improving hospital management system for better stewardship and effective service delivery. 

“We would like to express our sincere thanks to the Government of Italy for their very valuable support as they are a key donor supporting secondary care and hospital management in Somalia. This support will help Somalia to make strides in the provision of critical care for patients and strengthening of referral systems, as well as for improving the overall credibility of and trust in the public health facilities –a crucial goal for Somalia’s health system,” said HE Dr Fawziya Abikar Nur, Federal Minister of Health and Human Services.   

“In 2019, only 27% of Somalia’s population had access to essential health services,” said Dr Mamunur Rahman Malik, WHO Representative and Head of Mission to Somalia. “Thanks to the support from the Government of Italy and AICS, with this project we will have the opportunity to change this narrative by offering crucial, life-saving services to more Somalis, particularly those who are vulnerable and live in remote locations. Moreover, the services offered are aligned to the revised essential package of health services for Somalia.”  

“The project will contribute to the humanitarian-development-peace nexus (HDPN) in Somalia, by linking the short-term goal of improving secondary level care to the long-term development goal of the government-to improve essential health services. It will also foster peace and development among the communities being served by contributing to addressing the root causes of tension and marginalization, and increasing health equity,” said HE Alberto Vecchi, Ambassador of Italy to Somalia. 

Over a 2-year period, among other things, this project will aim to: optimize basic primary care services; fill in existing gaps in the provision of specialized, secondary health care (e.g. emergency, critical, surgical care); offer referral services to at least 5 districts in each state; use solar power to deliver oxygen; refine waste management systems; ensure gender balance in capacity development and employment; improve hospital management and ownership by the local health authorities; and improve the capability of health personnel to better respond to emergencies. Overall, and in addition to being in line with the new Essential Package of Health Services (EPHS) 2020 for Somalia, this project will complement efforts towards achieving the target of UHC and ensuring health for all. 

The official announcement follows a previous signing ceremony and a high-level commitment ceremony held on 21 April and 11 January 2022, respectively, in Mogadishu. During the latter, the Federal Ministry of Health, WHO, Embassy of Italy and Mr Luca Maestripieri, Director of AICS and Minister Plenipotentiary, Ministry of Foreign Affairs and International Cooperation, collectively agreed to work together in ‘Improving essential health services in Somalia using a secondary hospital-based care approach’ into the future across Somalia. 

launch_cermony-2WHO Somalia/Khurram Sajjad.

Note to editors 

This new and vital multi-year project stems from a continued partnership established between WHO, the Embassy of Italy in Mogadishu and AICS Somalia, whereby a total of €1.4 million has been provided to WHO since 2019 to support emergency response activities, as well as mental health and psychosocial support services for vulnerable populations and victims of improvised explosive devices at Hudur General Hospital. 

For additional information, please contact: 

Khadar Hussein Mohamud, Head of Coordination and Communications, Ministry of Health, Federal Government of Somalia < Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir. >   Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir. >

Massimiliano Bertollo, Deputy Head of Mission, Embassy of Italy in Mogadishu < Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir. Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir. >

Santa Molè, Director, AICS Somalia <  Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir.  >

Kyle DeFreitas, Lead – External Relations, WHO Somalia < Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir. Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir. >

Fouzia Bano, Communications Officer / Chief of Staff a.i., WHO Somalia < Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir. > Cette adresse email est protégée contre les robots des spammeurs, vous devez activer Javascript pour la voir. >

‘No fly zone’ for mosquitoes: controlling malaria in Somalia

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mosquito-netsIn Somalia, long-lasting insecticidal mosquito nets are one measure used to keep mosquitoes away. Credit: WHO/Somalia

24 April 2022 – On 25 April 2022, World Malaria Day will be commemorated under the theme “Harness innovation to reduce the malaria disease burden and save lives.” Recognizing that the world needs a suite of approaches and tools to reduce the prevalence of malaria, WHO is calling for investments and innovation that bring new vector control approaches, diagnostics, antimalarial medicines and other tools to speed the pace of progress against malaria.

Prevalence in Somalia

In Somalia, malaria is endemic across the country, particularly in the south and central parts of the country.  In 2021, the country confirmed 8101 malaria cases and 2 related deaths, which was a remarkable reduction compared to 31 021, 22 665 and 27 333, in 2018, 2019 and 2020, respectively, owing to the impact of the malaria control programme supported by WHO in the country.

The national malaria programme in Somalia did not observe any significant negative impact on malaria activities in 2020 due to the COVID-19 pandemic – the programme ran 253 172, 217 206, 337 965 and 295 475 malaria tests in 2018, 2019, 2020 and 2021, respectively. Despite this, joint urgent action is required to meet the 2030 targets outlined in the WHO global malaria strategy.

Malaria control

The malaria control programme in Somalia relies on early testing and identification of cases, effective case management using the right anti-malarial drugs, and distribution of insecticide-treated bed nets and indoor residual spraying (IRS) for preventing mosquito bites.

In Bossaso, 52-year-old Sahra Yusuf Ali, had a headache, fever, vomiting and joint pain. On visiting a local health facility, she was diagnosed with malaria after she took a rapid diagnostic test.

Sahra expressed her gratitude to the Ministry of Health, UNICEF and WHO, and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) for their support to health facilities. It was thanks to their support that Sahra could get tested and treated with antimalarial drugs. After her experience, Sahra requests Somali communities to clean all sources of mosquitoes, use insecticide-treated nets and get tested as soon as they have symptoms of malaria, to avoid complications.   

Acknowledging the support that partners have lent malaria reduction efforts, Dr Mamunur Malik, WHO Representative said, “We would like to thank the federal and state governments of Somalia, UNICEF, the GFATM and other partners for their collaboration in controlling and eliminating malaria. In line with the theme for World Malaria Day this year though, we collectively need to think critically about how to use innovative approaches and tools to test for malaria and prevent any additional cases of malaria.”

The Federal Government of Somalia, in collaboration with WHO Somalia and partners, have developed ‘Guidelines for the Diagnoses and Treatment of Malaria in the Somali Context 2016’ to help health personnel manage malaria cases and identify symptoms in a timely manner. They have also introduced malaria elimination activities in targeted districts. 

bannerWHO works with the government and partners to strengthen the skills of health workers, to improve surveillance for and management of malaria cases. Credit: WHO/Somalia

Modifying berkits to reduce larva in Bossaso 

In 2017, the national malaria control programme conducted an assessment to determine the main factors contributing to the malaria burden in Somalia. This assessment found that manmade berkits or well-like containers used to store water, made of mud or cement, accounted for 89% of breeding sites for mosquitoes.

Additionally, the malaria control programmes in Puntland and Somaliland found that the Anopheles stephensi vector found in Bossaso in 2019 and in Berbera and Hargeisa in 2020 were breeding in the berkits, which shows the malaria burden in Somalia has been magnified due to this method of water storage.

As next steps, in January 2021, the national malaria control programme, with support from WHO and funding from GFATM through UNICEF, implemented a pilot project as a larval source management effort, to modify 200 berkits in Bossaso, which are ubiquitous due to the limited piped water supply in the city. The programme covered the sides of the containers permanently to shield stagnant water from mosquitoes.   

After 12 months of the project, between December 2021 and January 2022, an assessment was conducted in 132 households in two locations in Bossaso city, one where berkits had been modified, and another where no modifications were made. A screening conducted in both districts noted a four-fold reduction in malaria positivity rate in the district where berkits had been modified to keep mosquitoes out.

Noting this success, this assessment recommended that this larval source management intervention should be extended to other villages and cities affected by malaria.

 

 

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