A. Situation analysis
Description of the disaster
Kenya has reported cholera outbreak in 30 of its 47 counties since 26 December 2014, when it was first reported in Nairobi County. The outbreak was later reported in other counties and the recent outbreak reported in Mandera and Tana River counties. At the same time Mandera County had been experiencing an increase of a febrile illness presenting with joint pains since the beginning of May 2016. The County has also experienced dengue fever outbreaks in the past and health officials suspected this to be another dengue fever outbreak, although the joint pain presentation showed this wasn’t that case. After laboratory tests were done in KEMRI, it was confirmed that the disease was Chikungunya fever.
Situation in Mandera
Cholera outbreak
Mandera County is located in the North Eastern Region of Kenya. It is the latest county to report cholera outbreak.This is an ongoing transmission which was first reported in December 2014. Cholera outbreaks occurred in several waves in most of the counties. It has also been occurring inform of acute watery diarrhoea in recent past in Mandera county, with the last episode being in March 2015, while the other diarrhoea have been the leading cause of morbidity especially during the dry season when water is scarce and the wet season when water sources are contaminated.
In this current wave of outbreak, Cholera was first reported in Mandera on 12 April 2016, and as of 28 May 2016, up to 894 cases were reported, with a total of 14 deaths (1 confirmed, 0 probable and 13 suspected), with Case Fatality Rate (CFR) of 1.57%. This second spike led to a call for additional support in the response from IFRC.
Most of the cases are within Mandera East, which hosts Mandera town, the county headquarters. Mandera East sub-county has an estimated population of 200,000 people. Although most of cases are from Mandera East, there are new cases reported in Mandera North and Banisa sub-counties.
While the healthcare workers from the county government and partner agencies were responding to the cholera outbreak the Chikungunya fever outbreak was reported.
Chikungunya outbreak
Chikungunya fever was confirmed in Mandera East sub-county on 20 May 2016. So far 500 cases have been documented with no deaths reported. With the high attack rate of the disease (one-third of the population at risk of getting the disease), thousands of chikungunya cases are expected in Mandera. Cases with severe debilitating joints pains are being managed as short stay inpatients for 1-2 days. Majority of the cases are getting treatment as outpatients. However , there is poor documentation of cases and thus the true magnitude of the problem remain unknown.
According to the health department of the Mandera County Government, 104 of its 270 healthcare workers (HCWs) at the County Referral Hospital have contracted Chikungunya. Based on this projection, approximately 50% of the HCWs are currently ailing from Chikungunya. This complicates the current cholera outbreak response due to unavailability of staff.
Both Cholera and Chikungunya outbreaks have also been confirmed in the neighbouring countries of Ethiopia and Somalia in the areas that border Mandera County.