MOGADISHU, Jan. 23 (Xinhua) -- Somalia and the United Nations partners said they have developed a six-month plan that requires 5.6 million U.S. dollars to scale up cholera response activities in the country.

The World Health Organization (WHO) said at least nine people died of acute watery diarrhea (AWD)/cholera and 474 cases were reported between Jan. 7-13 as the outbreak spreads in Somalia.

The deaths reflect a case fatality ratio (CFR) of 1.9 percent, which is above the WHO emergency threshold of 1 percent, the UN health agency said in its latest flash update issued Monday evening in Mogadishu, the capital of Somalia.

"The current cholera outbreak is attributed to limited access to safe water, proper sanitation, primary health care services and lowered immunity among children experiencing high levels of acute malnutrition which lowers their immunity to cholera infections," said the WHO.

It said most cases have been reported from Hiran and Middle Shabelle regions in central Somalia, particularly Beledweyne, Buloburto, Jalalaqsi, and Jowhar districts.

"The current outbreak is a continuation from 2023 when over 18,300 cases were reported, including over 10,000 children below five years (55 percent)," the WHO said.

Somalia has had uninterrupted AWD/cholera transmission since 2022 and in the Banadir region since the drought of 2017, according to the WHO.

In 2023, more than 18,304 cumulative cases and 46 deaths were reported in Somalia, including over 10,000 children below five years of age. Of the total, 499 cases were reported on Dec. 11-31 from 30 districts that were affected by drought earlier in the year, with an overall CFR of 0.3 percent.

"Partners have scaled up the implementation of response activities to control outbreaks in districts that were affected by floods from October to December 2023," the WHO said.

Cholera is an acute intestinal infection that spreads through food and water contaminated with bacteria, often from feces.

According to the WHO, risk communication and community education are ongoing, including the distribution of awareness materials to all high-risk districts, deployment of community health workers and outreach teams, and dissemination of radio preventive messages on safe water handling and hygiene practices.

"While the triggers for outbreaks -- like poverty and conflict -- are enduring, extreme climate events like floods and droughts reduce access to clean water and create an ideal environment for cholera to thrive," said the WHO. Enditem

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