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 spread to other counties with the recent outbreak reported in Mandera and Tana River counties. At the same time Mandera County had been experiencing an increase of 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 the case. After laboratory tests were conducted 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 the country. 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, with the last episode being in March 2015, while the other diarrhoea is the leading cause of morbidity especially during the dry season when water is scarce and wet season when water sources are contaminated.
In this current wave of outbreak, Cholera was first reported in Mandera 2016, and up to 894 cases were reported, on 12 April 2016. As at reporting time, 1629 cases had been reported with 18 deaths recorded - Case Fatality Rate (CFR) of 1.1%. KRCS has since closed the Cholera Treatment Center (CTC) and is supporting in the running of the Government CTC (which was handed over by the MSF). During the operation, KRCS reached a total of 391, 941 people through awareness sessions conducted in house to house visits including revisits, demonstration of Handwashing and Handwashing facilities. This represented over 200% of the target population due to revisits and the huge population affected by the outbreaks. The cases admitted at the CTCs were given a discharge package which included sensitization and distribution of soaps, buckets and water treatment chemicals. The response by the KRCS, MoH and other partners helped contain the outbreak within Mandera East Sub County.
Chikungunya outbreak
Chikungunya fever was confirmed in Mandera East sub-county on 20 May 2016. As at reporting time, 1574 cases had been documented with no deaths reported. Cases with severe debilitating joints pains were managed as short stay inpatients for five days. Majority of the cases were however treated as outpatients. KRCs deployed a surge team and backup who were on standby due to the high risk of personnel getting infected with the Chikungunya virus. Measures were however put in place through provision of mosquito repellents to protect the staff from bites by infected mosquitoes. Since the beginning of the response period, 6 of the KRCS personnel deployed in the operation were infected with the virus. This was however, a minimal number and did not affect the overall response plans.
The County and National Government of Mandera held meetings with the neighbouring Somalia which had similar outbreaks of Cholera and Chikungunya, to discuss on means of containing the outbreak. The borders were closed resulting in reduced number of cases.