የኢትዮጵያ የሕብረተሰብ ጤና ኢንስቲትዩት

ETHIOPIAN PUBLIC HEALTH

INSTITUTE

Address: Telephone: +251-112-765-340, Toll free: 8335, Fax: +251-112-758-634, Website: www.ephi.gov.et, P.O. Box 1242, Swaziland Street, Addis Ababa

NATIONAL PUBLIC HEALTH EMERGENCY OPERATION CENTER (PHEOC), ETHIOPIA

COVID-19 and Drought Related Public Health Emergency and Response in Ethiopia
BULLETIN
Epi-Week 13 (27 March – 02 April 2023) BULLETIN
No: 01

Highlights

▪ As of 02 April 2023, total of 5,521,480 COVID-19 tests conducted, whereas 500,595 total
confirmed case and 7573 total deaths reported.
▪ In Epi-week 13, 158 new COVID-19 confirmed cases were reported of the total of 7,272 tested.
Addis Ababa City contributed about 70%% and 88% of the total tests and cases of the Epi-
week respectively.
▪ A total of 2,757 cholera cases and 57 deaths (CFR =2.07%) were reported from 27 August
2022 to 02 April 2023. In Epi-week 13, 231 new cases and two deaths reported.
▪ A total of 15,023 measles cases and 154 deaths (CFR = 1.03%) were reported from 12 August
2021 to 02 April 2023. In Epi-week 13, 20 new cases and no death reported.
▪ A total of 548,035 malaria cases and 24 deaths were reported from 27 August 2022 to 02 April
2023. In Epi-week 13, 39,044 new cases and no death was reported.
▪ A total of 157 leishmaniasis cases and 18 deaths (CFR = 11.5%) were reported as of 02 April
2023.
▪ A total of 564,407 SAM cases and 734 deaths (CFR = 0.13%) were reported from 27 August
2022 to 02 April 2023. In Epi-week 13, 844 new cases and 12 deaths reported.
▪ The new EOC named as ‘’COVID-19 and Drought related Public Health Emergency
Response’’ was activated on 23 March 2023, to coordinate the multiple public health
emergency situation in Ethiopia.
Global Overview

▪ Globally, nearly 3.6 million new cases and over 25 000 deaths were reported in the last 28
days (27 February to 26 March 2023), a decrease of 27% and 39%, respectively, compared
to the previous 28 days (Table 1). Despite this overall downward trend, it is important to note
that several countries have recently reported significant increases in cases.
▪ As of 26 March 2023, over 761 million confirmed cases and over 6.8 million deaths have been
reported globally.
▪ Since mid-2021, the world is also facing an acute upsurge of the seventh cholera pandemic
characterized by the number, size and concurrence of multiple outbreaks, the spread to areas
free of cholera for decades and alarmingly high mortality rates.
▪ As of 20 March 2023, at least 24 countries continue to report cholera cases. The cholera
outbreak in the WHO African Region continues to evolve, with 13 countries currently affected.
▪ The average cholera CFR reported globally in 2021 was 1.9% (2.9% in Africa), a significant
increase above the accepted targeted rate (<1%) and the highest recorded in over a decade.

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National Situation

COVID-19 Epidemiological Situation

▪ As of 02 April 2023, a total of 5,521,480 COVID-19 tests were conducted, of which 500,595
(PR=9.1%) detected and 7,573 total death (CFR=1.5%) reported (Figure 1).
▪ Total of 7,272 COVID-19 tests were conducted, and 158 cases were detected with positivity
rate of 2.1% in Epi-week 13.
▪ One cases with severe condition was reported in Epi-week 13 (Figure 1).
▪ Addis Ababa City contributed about 70%% and 88% of the total tests and cases of the Epi-
week respectively (Figure 1).

▪ As of 02 April 2023, 37,808,535 people received full vaccination series, bringing coverage of
56.6% and 35.3% from target and total population respectively.

Figure 1: COVID-19 Epidemiological update as of 02 April 2023.

COVID-19 Response Activities

Since 2022, Covid-19 pandemic response strategies was shifted from acute emergency phase to
integration phase where all the COVID-19 services are intended to be provided within the existing
health system. In this case, Ethiopia has adopted the transition strategies in 2023, to ensure the
COVID-19 service integration in all the tiers of the health system. Currently, the continuous technical
and financial support is much more indispensable for the realization of the comprehensive COVID-19
service integration at each level of the health system.

Mainly, strengthening of the surveillance system, expansion of the testing capacities (PCR,
professionally used Ag-RDT, self-testing Ag-RDT), strengthening of the SARI/ALI sentinel
surveillance, the Genomic surveillance, and waste-water surveillance are among the major activities
during the integration phase.

Challenges
▪ The low-risk perception among communities and even the health professionals
▪ Less attention at the health leadership and health worker level during the integration phase
▪ Perceiving COVID-19 service provision with incentive.
▪ Supply interruption, particularly the Ag-RDT and reagents
▪ The minimal attention to genomic sequencing could hide the effect of any possible new variant
of concern in Ethiopia.
▪ Budget deficiency for the strengthening of the COVID-19 service integration.

Way forward

▪ Advocacy at health leadership level and putting clear directions.

▪ Timely preparation for the supply procurement to fix the supply interruption problem.
▪ Budget mobilization for the integration phase of pandemic response
Cholera Outbreak Situation

▪ Ethiopia ongoing cholera outbreak in 23 woredas in Oromia (19) & Somali (4) since august 27, 2022.
The Index case was from Harena Buluk with assumed date of onset of August 27, 2022.
▪ From 27 August 2022 to 30 March 2023, a total of 2,757 cholera cases were reported from two
regions, Oromia, and Somali Region. A total of 57 deaths, with overall CFR of 2.07% reported since
27 August 2022 (Figure 2).
▪ Of the total cases, about 87.8% (2,422) were reported from Oromia Region, whereas the remaining
12.2% (335) cases were reported from Somali region.
▪ Of the total cases, 1567 (56.8%) and 802 (29.1%) were presented with severe dehydration and some
dehydration respectively, whereas 22 cholera cases were also presented with severe acute
malnutrition and the other 24 cases were presented as moderate acute malnutrition, that could
complicate the cholera case management.
▪ From the total case detected, one in five cases were also get treated as inpatient. Among all cases,
725 (26.3%) and 1310 (47.5%) were under-five children and under-fifteen age groups, whereas the
case was almost similar among both sexes.

Figure 2: Cholera case and death by Woreda from 27 August 2022 to 30 March 2023

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Figure 3: Cholera cases and deaths reported from 27 August 2022 to 30 March 2023 disaggregated by
age group.
Cholera Outbreak Response Activities

Case management:

▪ Totally 24 CTCs have been established in Oromia (20) & Somali (4).
▪ National cholera outbreak RRT is deployed in both regions to help the case management and
surveillance activities.
▪ Red Cross Ethiopia in collaboration to WHO and local gov provide training for 120 cholera outbreak
health volunteers on 21 March 2023 and these trained volunteers started cholera outbreak response
on 9 prioritized kebeles in Goro/Bale zone/Oromia.

Surveillance Activities:

▪ Case definitions are printed and distributed for HFs.

▪ Ongoing house to house active searching, contact tracing and disinfection & sensitization.
▪ Conducted investigation in Dolo Ado (Somali) and Goro (Oromia)
▪ RRT alert and rumor investigation at woreda level
▪ Verifying cholera rumors from drought affected areas.

WaSH Activities:

▪ Hygiene and sanitation materials were distributed.

▪ latrines were built and utilization monitoring is done, and ongoing.
▪ Water treatment chemicals were distributed.
▪ Water schemes maintenance and water trucking is done, and it is ongoing.
▪ Water schemes disinfection is done and ongoing.
▪ Water points were established.
▪ Six EMWAT kit is installed.

Vaccination:

▪ With limited OCV dose, Ethiopia cascaded campaign on prioritized kebeles having woredas having
highest case load with limited WaSH in Oromia & Somali regions.
▪ ICG approved new OCV dose 1,910,416 and campaign micro-plan is under preparation.

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Major gaps and Challenges

▪ Critical shortage of fluid (RL) for Moyale/Borena, Negele town & Liban/Guji, Oromia region
▪ Community movement which increase transmission
▪ High risk of spreading further in IDPs (Dolo Mena, Kersadula & Guradamole, insecurity induced)
▪ Insecurity in some part of Oromia and Somali region affects field response operations.

Measles Outbreak Situation

▪ The currently ongoing measles outbreak was started from 28 January 2021 and continued occurring
at various part of the Country.
▪ As of 02 April 2023, a total of 15,023 measles cases and 154 deaths (CFR=1.03%) was reported
from eight regions, including Somali, Oromia, Amhara, SNNP, Afar, SWEPR, and Harari Regions.
▪ Of the total cases, 40.5% (6,083) were detected among under-five years children.
▪ Among the total cases Somali region, Oromia, and Amhara Regions shared maximum cases report
of about 40%, 23.4% and 20.1% respectively.
▪ In Epi-week 13, twenty (20) new cases were reported across the country. But no death due to
measles reported in the week 13.
▪ Among the total cases, nearly one out of three cases received valid doses (more than one) measles
vaccine (Figure 5).

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Figure 4: Measles cases report and trends from 28 January 2021 to 02 April 2023.

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Figure 5: Measles vaccination status among the reported cases as of 02 April 2023

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Measles Outbreak Response Activities

▪ Nationwide measles preventive SIA has been conducted in all areas of the country except
conflict affected areas in december
▪ Vaccination campaign in epi center areas in Oromia and Afar Regions is being conducted.
▪ Team is being deployed to conduct root cause analysis and detail investigation to all affected
Regions.
▪ Vaccination campaigns conducted in 55 affected and high-risk woredas of Amhara, Oromia,
SNNPR, and Somali Regions since February 2022.
Challenges

▪ The outbreak is keep expanding even though nationwide preventive campaign has conducted.
▪ Drought with malnutrition exacerbate the measles outbreak particularly in Somali and SNNP Regions
▪ No vaccine and operational cost available in the country for outbreak response vaccination

Emergency Nutrition
During the week, 8,441 cases (7,483 (88.75%) OPD, and 958 (11.25%) IPD) with 12 deaths were reported.
In Epi-week 12. Oromia region reported the highest number of cases 33.37% all cases (2,817 cases) followed
by Somalia region 20.86% of all cases (1,761 cases), and Sidama region 14.5% of all cases (1,224 cases)
during the week.

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Figure 6: Severe acute malnutrition cases in Ethiopia by region from Epi-week 9-12, 2023

Figure 7: Trends of SAM by week in Ethiopia from 2020-2023

Challenges in emergency nutrition

o Shortage of treatment supplies like: Therapeutic Milk (F-100/75), Essential & emergency
drugs, SC treatment & opening kit
o Shortage of TSFP Supplies to address all beneficiaries.
o Elders affected by drought.
o Population Movement
o Weak coordination
o Under reporting

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Malaria Outbreak Situation

During the week a total of 176,523 health facilities visitors were suspected and examined for malaria of which
21.67% (39,044 cases) were treated as malaria in Epi-week 12. No death was reported in the week.
Plasmodium falciparum the highest portion of the cases reported during the week, 25,040 cases (65.4%) of
the confirmed cases. The slide positivity rate was 21.67% in the week.

The highest malaria cases were reported from the Amhara region 28% of all cases (10, 926). Oromia region
reported 23% of all cases (8, 817) cases and the SNNP region reported 13% of all cases (5,075 cases) during
the week. Malaria cases in the last four consecutive weeks are indicated in figure below.

Figure 8: Malaria cases distribution in Ethiopia by regions, Epidemiological week 9 to 12, 2023

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As indicated in figure below, the number of cases reported in 2023 is more than the number of cases
reported in the last five consecutive years.

Figure 9: Malaria (clinical and confirmed) trends of the Malaria cases by week in Ethiopia from 20217-2023

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Visceral Leishmaniosis

Visceral Leishmaniosis cases are being reported currently from lowland areas of South Omo zone. Seven (7)
new cases of visceral leishmaniasis were reported in South-Omo with 4 new deaths in Epi-week 11, 2023. A
total of 157 cases and 18 deaths reported in 2015 E.C with case fatality of 11.46. Besides increment in
magnitude cases are expanding spatially.

Table 1: Visceral Leishmaniosis cases in SNNPR region from 2011 to 2015 EC

# of VL cases
Year (E.C) # of VL Deaths CFR
treated
2011 49 5 10%
2012 61 1 2%
2013 39 2 5%
2014 160 3 2%
2015 (7-Months) 156 18 12%

Response Activities
• Capacity building to 50 health workers on surveillance and case management

• Assessment of the risk factors in the areas

• RCCE

• Engaged partner like MSF to support the treatment activity.

• Expansion of rapid testing (RK 39) testing facilities

Challenges in intervention of VL

• Weak community-based surveillance because of security issues

• Health workers skill gap on diagnostic, surveillance, and case management
• Poor health seeking behavior of the pastoral community.
• In accessibility of the areas/villages with the routine transport system
• Poor collaboration of stakeholders
• Shortage of supplies
• Triple burden in those affected woredas Malaria, SAM (including adult malnutrition)

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 Coordination and Leadership

▪ Emergency Operation Center was activated on 23 March 2023, to coordinate the overall response
activities towards the COVID-19 and drought related Public Health Emergency Situation. The new
EOC activation is mainly aimed at organizing the multiple outbreaks and utilizing the limited resource
at national and subnational levels.
▪ Current Incident Management System was organized under eight sections and twenty Unit.

Figure: 10- COVID 19 & Drought related IMS, National PHEOC EPHI, 23 March 2023.

Picture 1: Picture taken While orientation given to IMS staff, 23 March 2023.

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 • Emergency Preparedness and Response plan as well as Incident Action Plan is initially
developed for the coming four months, enabled to capture all the currently existing public
health emergencies.
• Since the activation, the national PHEOC is collaboratively working with stakeholders:
government agencies like MOH, EPSA, Regional/Zonal/Woreda EOC, Disaster Risk
Management Office, Partner organizations, UN agencies, Health Facilities, and others.
• The emergency situation report brief is being planned to be conducted twice a week for all
the Incident Manager, IMS staff and key Partners.
• The daily situation report and weekly bulletins for the currently ongoing PHE will be
conducted and shared to all responsible government bodies and key partners.
• Cluster meeting is being conducted to organize and evaluate the partners engagement.
• Joint meeting is ongoing once in two weeks, among the national and regional
Emergency Operations Centers COVID-19 and drought related PHE response IMS
(Incident Management System) to evaluate weekly PHE situations, progress of response
strategies, challenges faced and way forwards.

Picture 2: Cluster meeting with partner April 03/2023 EPHI, Addis Ababa

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Public Health Policy Recommendation
Advice for the Public:
• For any individual confirmed to have COVID-19 and who is candidate for Home Based
Isolation and Care:

▪ Properly isolate from other family members.

▪ Take full responsibility in prevention of transmission.
▪ Strictly adhere to the National Directive of Home-Based Isolation & Care.
▪ Provide reliable information during regular follow up either by phone or home visit.
▪ Report to nearest health facilities/follow up team in case of any emergency,
appearance of new symptoms or worsening of existing symptoms.

▪ Get vaccinated against COVID-19.

• For most people, COVID-19 infection will cause mild illness however, it can make some people
very ill, and in some people, it can be fatal.

• Older people, and those with pre-existing medical conditions (such as cardiovascular disease,
chronic respiratory disease, or diabetes) are at risk for severe disease.

• It is important to be informed of the cholera situation and act appropriately to protect yourself
and your family.

▪ Wash hands frequently after and before

• Before Eating

• Before food preparation

• Before breast feeding

• After toilet use

• After cleaning baby

• If anybody had rumor on any public health emergency, he/she should call 8335 or report to
regional toll-free lines or to the nearby health facilities.

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National/Regional official websites, social media pages and toll-free hotline for PHEOC information

MOH/EPHI/Region Facebook page Toll-free Email address

hotline (PHEOCs email)
Ethiopian Public Health Institute https://www.ephi.gov.et/ 8335 ephieoc@gmail.com
Main Website
Ethiopian Public Health Institute https://covid19.ephi.gov.et/
COVID-19 Website
Ethiopian Public Health Institute https://www.facebook.com/ephipa
Facebook Page ge/
Ethiopian Public Health Institute https://twitter.com/EPHIEthiopia
Twitter Page
Ethiopian Public Health Institute https://t.me/EPHI
Telegram Channel
Ethiopian Public Health Institute https://www.youtube.com/channel/
YouTube Channel UCvvTzeY-IJiQfEFBULH9Mkw
Ministry of Health, Ethiopia www.moh.gov.et 952
Website
Ministry of Health, Ethiopia https://www.facebook.com/Ethiopi
Facebook Page aFMoH/
Afar Regional Health Bureau https://www.facebook.com/afarrhb 6220 afarpheoc@gmail.com
.org/
Amhara Regional Health https://www.facebook.com/Amhar 6981 aphieoc@gmail.com
Bureau a-Healthbureau-
682065755146948/
Benishangul Gumuz Regional https://www.facebook.com/Benish 6016 bgpheoc@gmail.com
Health Bureau angul-Gumuz-Health-Bureau-
1676282159265517/
Gambela Regional Health https://fb.me/gambellaregionhealth 6184 gambellapheoc@gmail.c
Bureau bureau om
Harari Regional Health Bureau https://www.facebook.com/Harari- 6864 hrhbpheoc@gmail.com
Regional-Health-Bureau-
1464182130355007/
Oromia Regional Health https://www.facebook.com/Oromia 6955 oromiapheoc@gmail.co
Bureau Health/ m
Somali Regional Health Bureau https://www.facebook.com/srhbdot 6599 somalipheoc@gmail.com
com/…
SNNP Regional Health Bureau https://www.facebook.com/snnprh 6929 snnppheoc@gmail.com
ealthbureau/?ref=br_rs

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 Tigray Regional Health Bureau
Sidama PHEM
Dire Dawa city Administration
Health Bureau
Addis Ababa City
Administration Health Bureau
https://www.facebook.com/tigrayrh 6244 tigraypheoc@gmail.com
b/
7794 sidaamapheoc@gmail.co
m
https://www.facebook.com/Dire- 6407 ddpheoc@gmail.com
Dawa-Administration-Health-
Bureau-1371606266279524/
https://www.facebook.com/aahb.g 6406 aapheoc@gmail.com
ov.et/

Sources of evidence:
Source
WHO Coronavirus (COVID-19) dashboard
Africa CDC Situation Report
WHO Weekly situation reports
WHO Academy mobile learning app for
health workers, COVID-19 information
Link
https://covid19.who.int/
https://au.int/en/covid19
https://www.who.int/emergencies/diseases/novel-coronavirus-
2019/situation-reports
Android-
https://play.google.com/store/apps/details?id=org.who.WHOA
Apple- https://apps.apple.com/us/app/who-
academy/id1506019873

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 8335

Contact Centers
FOR MORE INFO and
ALERT NOTIFICATION on
PHEOC

The above presented Quick Reader (QR) code takes you to a portal that you can access updates and all COVID-19 related information available.
(https://covid19.ephi.gov.et/covid-19/)
DISCLAIMER
This weekly bulletin is produced based on figures pulled from official releases of the World Health Organization and activities and reports of all the sections
under the Incident management System.
This Weekly Bulletin series of publications is published by the Ethiopian public health Institute (EPHI), public health emergency operation center (PHEOC). The
aim of this bulletin is to inform decision makers within the institute and FMOH, UN agencies and NGOs about COVID-19 preparedness and response activities.
All interested health and other professionals can get this bulletin at the Institute website; www.ephi.gov.et

PREPARED BY
Assegid Tesfaye (BSc, MPH) –Situational Update Unit
Mark Merga (BSc, MPH)- Situational Update Unit
Tegegne Mulu (BSc, MPH in Epidemiology) – Data Manager

CONTRIBUTORS

Dr Gizew Teka (MD, MPH)-Outbreak & surveillance section chief

Dr Tigist Belete (MD)- COVID 19 Surveillance & response section chief
Mikias Aleyu (MPH)- VPD unit team Lead
Yeshambel Worku (MPH)-Cholera Unit Team Lead
Ebise Abose (MPH)-Vector Borne Unit Team Lead
Shibiru Kalbessa (MPHN)- Emergency Nutrition Section chief

REVIEWED BY

Dr. Zerihun Kassa (MD, MPH) – Situation Unit Lead

Muluken Moges (MPH) – Planning Section Chief
** Mesfin Wossen (MPH) –Incident Manager

National Emergency Operation Center

FOR MORE INFORMATION and NOTIFICATION
Web: www.ephi.gov.et
Follow us on Twitter: @EPHIEthiopia
Facebook: https://www.facebook.com/ephipage/
Telegram: https://t.me/EthPHI
Call: 8335 (TOLL FREE LINE) or 011 276 5340
Email: ephieoc@gmail.com or phemdatacenter@gmail.com

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