Early Warning and Disease Surveillance System 1 Republic of South Sudan EARLY WARNING AND DISEASE SURVEILLANCE BULLETIN (IDP CAMPS AND SETTLEMENTS) Week 37 7 - 13 September 2015 General Overview Completeness for weekly reporting in week 37 of 2015 was 84%, which is higher when compared to 83% in week 36 of 2015 and 58% in week 37 of 2014. In week 37 of 2015, malaria was the top cause of morbidity among IDPs and registered a proportionate morbidity of 43.4% as compared to 41.2% in week 36 of 2015. The malaria incidence in week 37 of 2015 was highest in Bentiu PoC followed by Renk, Bor, Malakal PoC, Melut, and UN House PoC and consistent with a malaria upsurge that has reached epidemic proportions. In week 37 of 2015, 10 new measles cases have been reported from Bentiu PoC and one from Renk. Since the beginning of 2015, Bentiu has reported 433 measles cases including 13 deaths (CFR 3%). An integrated measles and polio vaccination campaign was conducted in Bentiu PoC reaching 84.8% (43,931) children aged six months to 15 years. Plans for reactive measles vaccination are underway in response to the measles outbreak in Renk. Cholera cases have risen to 1,743 including 46 deaths [CFR 2.64%] in Juba and Bor Counties. Following a coordinated and comprehensive response, a declining trend has been registered. Evaluation of the cholera response is underway. The findings will be used to update preparedness and contingency planning. In week 37 of 2015, 144 new cases of HEV have been reported from Bentiu PoC and one from Lankien. The total HEV is 1,342 cases including 13 deaths (CFR 0.97%) in Bentiu; 153 cases including seven deaths (CFR 4.6%) in Mingkaman; and 35 HEV cases including one death (CFR 2.9%) in Lankien. In week 36 of 2015, a Global Acute Malnutrition Rate (GAM) of 20.8% and Severe Acute Malnutrition (SAM) rate of 4.9% were registered in Bentiu with both rates exceeding the emergency threshold of 15% and 2% respectively. In week 37 of 2015, the under-5 mortality rate for Bentiu PoC is 1.760 deaths per 10,000 per day, which is below the U5MR emergency threshold of 2 deaths per 10,000 per day. The notable causes of death in children under five years in Bentiu during week 37 of 2015 included malaria, perinatal complications, and pneumonia. Editorial not This bulletin presents disease trends from data submitted through the Early Warning Alert and Disease Network (EWARN) by health partners providing health services to internally displaced persons in South Sudan. Additional integrated disease surveillance and response (IDSR) data is also presented for select diseases like cholera, Kala-azar and AFP. All other IDSR weekly reports are published through IDSR weekly bulletin of the EPR department in the MoH-RSS. Completeness and Timeliness of Reporting Figure 1 shows the completeness for weekly reporting from week 01 of 2014 to week 37 of 2015. During week 37 of 2015, weekly disease surveillance reports were expected from 63 health facilities. In week 37 of 2015, timeliness for weekly reporting is 35 (56%) as compared to 36 (57%) in week 36 of 2015 and 18/48 (38%) in week 37 of 2014. Figure 1 0 20 40 60 80 100 120 01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Completeness [%] Reporting Completeness for IDP Health Facilities, 2014 - 2015 2014 2015 Target
Transcript
Early Warning and Disease Surveillance System
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Republic of South Sudan
EARLY WARNING AND DISEASE SURVEILLANCE BULLETIN (IDP CAMPS AND SETTLEMENTS)
Week 37 7 - 13 September 2015
General Overview
Completeness for weekly reporting in week 37 of 2015 was 84%, which is higher when compared to 83% in week 36 of 2015 and 58% in week 37 of 2014.
In week 37 of 2015, malaria was the top cause of morbidity among IDPs and registered a proportionate morbidity of 43.4% as compared to 41.2% in week 36 of 2015. The malaria incidence in week 37 of 2015 was highest in Bentiu PoC followed by Renk, Bor, Malakal PoC, Melut, and UN House PoC and consistent with a malaria upsurge that has reached epidemic proportions.
In week 37 of 2015, 10 new measles cases have been reported from Bentiu PoC and one from Renk. Since the beginning of 2015, Bentiu has reported 433 measles cases including 13 deaths (CFR 3%). An integrated measles and polio vaccination campaign was conducted in Bentiu PoC reaching 84.8% (43,931) children aged six months to 15 years. Plans for reactive measles vaccination are underway in response to the measles outbreak in Renk.
Cholera cases have risen to 1,743 including 46 deaths [CFR 2.64%] in Juba and Bor Counties. Following a coordinated and comprehensive response, a declining trend has been registered. Evaluation of the cholera response is underway. The findings will be used to update preparedness and contingency planning.
In week 37 of 2015, 144 new cases of HEV have been reported from Bentiu PoC and one from Lankien. The total HEV is 1,342 cases including 13 deaths (CFR 0.97%) in Bentiu; 153 cases including seven deaths (CFR 4.6%) in Mingkaman; and 35 HEV cases including one death (CFR 2.9%) in Lankien.
In week 36 of 2015, a Global Acute Malnutrition Rate (GAM) of 20.8% and Severe Acute Malnutrition (SAM) rate of 4.9% were registered in Bentiu with both rates exceeding the emergency threshold of 15% and 2% respectively.
In week 37 of 2015, the under-5 mortality rate for Bentiu PoC is 1.760 deaths per 10,000 per day, which is below the U5MR emergency threshold of 2 deaths per 10,000 per day. The notable causes of death in children under five years in Bentiu during week 37 of 2015 included malaria, perinatal complications, and pneumonia.
Editorial not This bulletin presents disease trends from data submitted through the Early Warning Alert and Disease Network (EWARN) by health partners providing health services to internally displaced persons in South Sudan. Additional integrated disease surveillance and response (IDSR) data is also presented for select diseases like cholera, Kala-azar and AFP. All other IDSR weekly reports are published through IDSR weekly bulletin of the EPR department in the MoH-RSS.
Completeness and Timeliness of Reporting Figure 1 shows the completeness for weekly reporting from week 01 of 2014 to week 37 of 2015. During week 37 of 2015, weekly disease surveillance reports were expected from 63 health facilities. In week 37 of 2015, timeliness for weekly reporting is 35 (56%) as compared to 36 (57%) in week 36 of 2015 and
Reporting Completeness for IDP Health Facilities, 2014 - 2015
2014
2015
Target
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In week 37 of 2015, completeness for weekly reporting is 53 (84%) as compared to 52 (83%) in week 36 of 2015 and 28/48 (58%) in week 37 of 2014. This week 10 facilities have not their reports (Table 1).
Table 1: No. Health Facility Partner
1 HLSS Mingkaman PHCC site 2 HLSS
2 HLSS Site 1 Hospital HLSS
3 Malual PHCU IRC
4 Janglow PHCU IRC
5 Machar PHCU IRC
6 Kol PHCU IRC
7 Jiech PHCU COSV
8 Yuai MSF-OCA
9 Ruath PHCU CARE
10 Melut MSF-E
Consultations (All patients seen at Outpatient and Inpatient facilities)
In week 37 of 2015, the total consultations is 34,333 as compared to 32,430 in week 36 of 2015 and 12,065 in week 37 of 2014 (Figure 2). The cumulative consultations since week 01 of 2015 have risen to 707,756 (Figure 2.1)
The annualised outpatients department (OPD) utilization for 2015 is 1.2 consultations per person per year (Figure 2.2). The IDP site-specific annualised OPD utilization rates are shown in Figure 2.2.
Figure 2
Figure 2.1
Figure 2.2
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Cumulative Consultations by IDP Site from week 01 of 2015 to week 37 of 2015
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Consultations per person per year, week 37, 2015
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Overall Trends of Priority Epidemic-prone Diseases
Table 2 shows the top five causes of morbidity among IDPs with malaria being at the top, followed by Acute Respiratory tract Infections (ARI), Acute Watery Diarrhoea (AWD), Acute Bloody Diarrhoea (ABD) and measles.
Figures 3 and 4 show the proportionate morbidity trends for Malaria, ARI, AWD, suspected measles and ABD.
Table 2
No. Disease
New cases for weeks Cumulative cases since week 01 of 2015 37 of 2014 37 of 2015
1 Malaria 3,081 14,905 167,343
2 AWD 869 1,719 64,281
3 ARI 1,953 5,245 133,910
4 ABD 185 230 8,315
5 Measles 3 11 499
Figure 3
Figure 4
During week 37 of 2015, malaria is the top cause of morbidity followed by ARI, AWD, ABD and suspect measles. During the corresponding week of 2014, malaria was the top cause of morbidity followed by ARI, AWD, ABD and
suspect measles. The proportionate morbidity for malaria increased while ARI, ABD, AWD, and measles decreased in week 37 of
2015 when compared to week 36 of 2015 (Figures 3 and 4).
Specific Priority Epidemic-Prone Diseases
Acute Respiratory Infection (ARI)
During week 37 of 2015, ARI registered the second highest proportionate morbidity of 15.3% (Figures 4 and 5) which is lower when compared to 16.2% in week 37 of 2014 and 18.4% in week 36 of 2015 (Figure 5).
During week 37 of 2015, UN House PoC registered the highest ARI incidence (cases per 10,000) of 267 followed by Bentiu (224), and Kodok (145).
In week 37 of 2014, the ARI incidence (cases per 10,000) was 141 in Bentiu, 138 in UN House, and 103 in Malakal PoC. (Figure 5.1).
Priority Disease Proportionate Morbidity from week 51 of 2013 to week 37 of 2015
Completeness ARI Bloody Diarrhea Malaria Suspected Measles Watery Diarrhoea
16.2% 15.3%
1.5%0.67%
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wk 37 of 2014 wk 37 of 2015
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ARI
Bloody Diarrhea
Malaria
Suspected Measles
Watery Diarrhoea
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Figure 5
Figure 5.1
Acute Watery Diarrhoea (AWD)
During week 37 of 2015, AWD registered the 3rd highest proportionate morbidity of 5.0% but it is lower when compared to 7.2% in week 37 of 2014 and 5.2% in week 36 of 2015. Despite the cholera outbreaks in Juba and Bor, the overall, the AWD trend among IDPs has remained stable since the beginning of 2015. (Figures 4 and 6)
During week 37 of 2015, Renk registered the highest AWD incidence (cases per 10,000) of 219, followed by Bor (125), and Melut (71). In the corresponding week of 2014, the AWD incidence (cases per 10,000) was 54 in Bentiu and 53 in UN House. (Figure 7)
AWD Proportionate Morbidity from week 51 of 2013 to week 37 of 2015
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2015
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5 4 23 1353
16 128 40
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Dysentery / Acute Bloody Diarrhoea (ABD)
During week 37 of 2015, ABD registered the 4th highest proportionate morbidity of 0.67% which is lower when compared to 1.5% in week 37 of 2014 and 0.79% in week 36 of 2015. Overall, the ABD trend has remained stable since the beginning of 2015 (Figure 4 and 8).
Figure 8
During week 37 of 2015, Renk registered the highest ABD incidence (cases per 10,000) of 35, followed by Melut (27), and Kadok (20). In week 37 of 2014, the ABD incidence (cases per 10,000) was 43 in Lankien, 14 in Akoka, and 5 in Bentiu (Figure 9). Figure 9
Measles
During week 37 of 2015, measles registered the 5th highest proportionate morbidity of 0.032% which is lower when compared to 0.034% in week 36 of 2015 but higher when compare 0.025% week 37 of 2014 (Figure 4 and 10).
During week 37 of 2015, 10 new measles cases have been reported from Bentiu PoC and one from Renk.
Since the beginning of 2015, a total of 433 measles cases including 13 deaths (CFR 3%) have been registered in
Bentiu PoC (Figure 10.1). Following a vaccination campaign in week 15 that reached 91% (21,361) of children aged
six months to 15 years, the cases declined significantly. However, with the new arrivals since June 2015, low-level
transmission persisted despite the ongoing measles vaccination on arrival. Consequently, a follow up integrated
Polio and measles vaccination campaign was conducted in week 36 reaching 84.8% (43,931) of the targeted 51,832
children aged 6 months to 15 years with measles containing vaccine.
A total of seven measles cases have been reported from Renk since 12 June 2015. In week 31 of 2015, one of four
samples tested from Renk was confirmed as measles IgM positive. Preparations are underway for reactive measles
vaccination targeting children aged six months to five years.
Since the beginning of 2015, 440 suspect measles cases have been registered countrywide as part of the measles
case based and laboratory backed surveillance system, of which 204 (46%) were clinically confirmed, 79 (18%)
epidemiological link, 127 (29%) laboratory negative, 28 (6%) laboratory confirmed as measles and results of 2
ABD Proportionate Morbidity from week 51 of 2013 to week 37 of 2015
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The 28 confirmed measles cases were from Duk (3), Wulu (2), Rubkona (14), Maridi (1), Tambura (1), Wau (1), Kajo Keji
(2), Yei (2) Morobo (1), and Renk (1) counties.
Since the beginning of 2015, a total of 41 Rubella cases have been confirmed from Central Equatoria (15), Eastern
Equatoria (12), Lakes (3), Unity (1), Upper Nile (6), Western Bahr el Ghazal (2), and Western Equatoria (2).
Figure 10
Figure 10.1
Malaria
During week 37 of 2015, malaria registered the highest proportionate morbidity of 43.4% which is higher when compared to 25.5% in week 37 of 2014 and 41.2% in week 36 of 2015. (Figures 4 and 11)
The malaria trend was stable from the beginning of 2015 up to week 19 of 2015 when it started rising steadily. The rising malaria trend is largely driven by transmission in Bentiu PoC, Malakal PoC, UN House PoC, Renk, and Mingkaman (Figures 11.1, 11.2, 11.3, 11.4, and 11.5).
During week 37 of 2015, Bentiu PoC registered the highest malaria incidence (cases per 10,000) of 714, followed by Renk (536), Bor (386), Malakal (262), Melut (194), and UN House PoC (181) as seen in Figure 12.
As seen from Figures 12.1, 12.2, 12.3, and 12.4 showing the malaria incidence by IDP site for 2014 and 2015; the malaria incidence in week 37 of 2015 shows that Bentiu PoC, Malakal PoC, UN House PoC, and Renk are experiencing a malaria upsurge that is consistent with a malaria epidemic.
In response to the current malaria trends in Bentiu PoC, health-implementing partners have increased from three to five to improve access to primary health care services. Hence, MSF, IOM and World Relief have opened additional clinics in response to the increased caseload. Malaria diagnostics and medicines have been enhanced and integrated community case management of malaria is ongoing. In addition, the malaria mass presumptive treatment campaign of all fever cases at household level was conducted from 10-16 September 2015. Children were treated during based on history of fever, current fever, and history malaria treatment. The preliminary results revealed that 14,000 out of the targeted 30,000 children under-five years were reached.
To interrupt transmission at community level, the first round of vector control interventions [distribution of Long Lasting Insecticide Treated Nets (LLINs), larviciding, and indoor residual spraying (IRS) was conducted in Bentiu PoC. The second round is planned for a week after the first one and the third round will be implemented two weeks after the second round. Advocacy is on-going to extend to other IDP sites where malaria upsurges have been
Hepatitis E Virus trends in Mingkaman, Bentiu, and Lankien, week 10, 2014 - week 37, 2015
Awerial Lankien Bentiu
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A comprehensive HEV response strategy has been developed to guide the response with priority interventions being supportive case management, targeted preventive interventions during antenatal visits, soap distribution, shock chlorination of boreholes, as well as house-to-house hygiene and sanitation promotion.
Nutrition in Bentiu PoC_source Nutrition Cluster in Bentiu
In week 36, the total number of Severe Acute Malnutrition (SAM) cases U5 admitted in Outpatient Therapeutic Programs (OTP) was 504, marking a consistently increase compared to 332 in week 35 and 335 in week 34. Admissions in OTP are registering a significant escalation since week 27 of 2015, especially if compared to the same epidemiological weeks in 2014 (Figure 15).
Similarly in week 36 of 2015, the inpatient admission trend of severely malnourished children with medical complications is increasing, with 42 children admitted in the stabilization centre, as compared to 34 admitted in week 35 of 2015 (Figure 15.1).
In week 36, the Global Acute Malnutrition (GAM) rate remains 20.8%, exceeding the WHO emergency threshold of 15%, with associated SAM of 4.9% which is above the WHO emergency threshold of 2% for SAM (SMART Survey 2014). The situation in Bentiu PoC remains critical.
Figure 15
Source: Nutrition cluster Bentiu Poc
Figure 15.1
Source: Nutrition cluster Bentiu Poc
Cholera
As of 12 September 2015, a total of 1,743 cholera cases including 46 deaths (CFR 2.64%) have been reported in Juba County and in Bor, Jonglei State. In Juba County 1,605 cases including 45 deaths (CFR 2.80%) have been reported from seven Payams. In Bor, 138 cases including one death (CFR 0.72%) were reported from Malou and other areas around the county. Evaluation of the cholera response is underway. The findings are expected to inform better preparedness and contingency planning.
The initial cases in Juba were traced back to 18 May 2015 in UN House PoC where the first cholera case was confirmed on 1 June 2015 (Figure 15.2). Most of the cholera cases in Juba have been reported from Gumbo followed by New site, Juba3 PoC, Gudele 2, Atlabara B, and Munuki. In Bor County, the majority of the cases originated from Malou 41 (36%) and Langbar 12 (10.4%) in Makuach Payam.
National and state level cholera taskforce committees are coordinating the ongoing cholera preparedness and
SAM with Medical Complications Admissions at MSF stabilisation Center in Bentiu PoC in 2015
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response activities. As a result, a drastic decline in cases has been registered in the affected counties. Figure 15.2
JS: Jonglei State; CES: Central Equatoria State; CFR: Case Fatality Rate
Acute Flaccid Paralysis (AFP)
A cumulative of 221 AFP cases have been reported countrywide since the beginning of 2015 (Table 5). The annualized non-Polio AFP (NPAFP) rate (cases per 100,000 population children 0-14 years) is 3.99 per 100,000
population of children 0-14 years (target ≥2 per 100,000 children 0-14 years) (Table 5). All but three states (Jonglei, Unity, and Upper Nile) have attained the targeted NPAFP rate of ≥2 per 100,000
children 0-14 years. The non-Polio Enterovirus (NPEV) isolation rate (a measure of the quality of the specimen cold chain) is 13.9% (target ≥10%) (Table 5).
Stool adequacy stands at 95%, a rate that is higher than the target of ≥80% (Table 5). The cumulative for circulating Vaccine Derived Poliovirus type 2 (cVDPV2) cases now stands at three cases with only
one case reported in 2015. Table 5
Other Diseases of Public Health Importance
Guinea worm (Dracunculiasis)
There was no new suspect Guinea worm disease case reported during week 37 of 2015.
Viral Haemorrhagic Fever
The Republic of South Sudan continues to enhance its readiness capacities for Ebola/Marburg virus disease. The national Ebola/Marburg taskforce is coordinating the implementation of interventions guided by a national
No Ebola/Marburg cases have been confirmed in South Sudan but six alerts have been investigated in Ezo, Nzara, Terekeka (Tali) and Juba (Hai Jalaba and Gudele) since 2014.
Visceral Leishmaniasis (Kala-azar)
In week 37 of 2015, three health facilities (Ulang, Walgak, and Kajo-keji County Hospital) reported 10 cases (8 new and 2 secondary cases).
From week 1 to date, a total of 2,631 cases (2,088 [79.4%] new cases; 543 [20.6%] relapses/PKDL; 98 [3.7% defaulters]; and 88 [3.3%] deaths) have been reported from 21 treatment centres. In week 37 of 2014, a total of 4,023 cases (3,692 new cases; 331 relapses/PKDL; 174 defaulters and; 138 deaths (CFR 3.4%) were reported from 15 treatment centres.
Of the 2,631 cases, majority of cases [1,470 (55.9%)] are male and aged 15 years [1171 (44.5%)] followed by 5-14 years [1072 (40.7%)] and <5years [382 (14.5%)].
During 2015, Lankien has reported the highest number of cases (1,226); followed by Walgak (306); Ulang (163); Akobo (133), Chuil (126); Pagil (108), Melut IDP (110); Narus ([MOH/ARC)] (106); and Rom (64).
Generally the number of cases reported in 2015 is lower when compared to 2014 which could be attributed to the low reporting completeness, withdrawal of some partners from health facilities due to insecurity, and the tail end of the transmission season.
WHO and partners continue to support enhanced surveillance, case management and interventions to interrupt transmission through the following: supporting implementing partners with case management supplies; training frontline healthcare workers on Kala-azar case management; support supervision of treatment facilities; supporting community sensitisation on Kala-azar; and distribution of LLITNs in affected and high-risk areas.
Meningitis
One suspect meningitis death (involving a neonate) was reported from Nyal, Panyijiar in week 37 of 2015. A cumulative of four suspect meningitis cases including one death have been reported among under-fives in Nyal since 18 August 2015.
Animal bites (suspect rabies)
There was no new suspect rabies case reported in week 37 of 2015.
All-Causes Mortality Data
During week 37 of 2015, mortality lists were received from Bentiu PoC, Juba 3 PoC, Akobo, and Malakal PoCs. A total of 45 deaths were reported during week 37 of 2015, with 38 (84%) deaths being reported from Bentiu PoC;
while 32 (71%) occurred in children under five years of age see Table 6. During the corresponding week of 2014, a comparatively lower number of deaths (26) were reported as seen in Table 6.
Table 6: Number of deaths by IDP camp during week 37 of 2015 and 2015 Cause of Death by IDP site
2014 2015
<5yrs ≥5yrs <5yrs ≥5yrs
Bentiu 3 8 29 9
Juba 3 2 4 2 1
Malakal 1 3 1 3
Melut 0 2 0 0
Mingkaman 2 1 0 0
Grand Total 8 18 32 13
During week 37 of 2015, malaria registered the highest proportionate mortality of 37.8% (36.1% in week 36 of
2015), followed by perinatal deaths (8.9%), TB/HIVAIDS (6.7%), and pneumonia (6.7) (Table 6.1).
Of the 17 malaria deaths reported in week 37 of 2015, 16 (94%) occurred in Bentiu PoC with the majority 12 (71%)
occurring in children under five years of age (Table 6.1).
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Table 6.1: Proportionate mortality by cause of death in week 37 of 2015 and 2015
Cause of Death by IDP site
Bentiu Juba 3 Malakal
Grand Total Proportionate mortality [%] <5yrs ≥5yrs <5yrs ≥5yrs <5yrs ≥5yrs
Chronic illness 0 1 0 0 0 0 1 2.2
Malaria 12 4 0 0 0 1 17 37.8
Perinatal death 3
0 0 1 0 4 8.9
Pneumonia 1 1 1 0 0 0 3 6.7
SAM 1 0 0 0 0 0 1 2.2
Sepsis 1 0 0 0 0 0 1 2.2
TB/HIV/AIDS 1 0 1 1 0 0 3 6.7
Unknown 8 3 0 0 0 1 12 26.7
Heart failure 1 0 0 0 0 0 1 2.2
Kala azar 1 0 0 0 0 0 1 2.2
Acute viral hepatitis 0 0 0 0 0 1 1 2.2
Grand Total 29 9 2 1 1 3 45 100.0
Under-five Mortality Rate (U5MR)
In week 37 of 2015, with a total population of 117,669 and 29 new deaths among under-fives in Bentiu PoC, the under-5 mortality rate is 1.760 deaths per 10,000 per day, which is below the U5MR emergency threshold of 2 deaths per 10,000 per day (Figures 16 and 16.1).
The notable causes of death in children under five years in Bentiu during week 37 of 2015 included malaria, perinatal complications, and pneumonia.
Figure 16
Figure 16.1
Crude Mortality Rate
The crude mortality rates (CMR) from week 51 of 2013 to week 37 of 2015 are shown in Figure 17. During week 37 of 2015, the CMRs were below the emergency threshold for the four IDP sites that submitted
mortality data. The CMR for Bentiu PoC in week 37 of 2015 was 0.461 deaths per 10,000 per day.
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Figure 17
Disease specific Mortality Mortality due to Acute Watery Diarrhoea
Since the beginning of 2015, a total of 58 AWD deaths have been reported. Out of the 58 AWD deaths reported in 2015, 36 (62.1%) occurred in Bentiu, 9 (15.5%) in UN House, 4 (6.9%) in Wau Shiluk, 3 (5.2%) in Akobo, 3 (5.2%) in Mingkaman, and 3 (5.2%) in Malakal PoC. Overall, 210 AWD deaths have been reported since the onset of the crisis with Bentiu PoC having the highest number of AWD deaths (Figure 18).
During week 37 of 2015, a total of 16 malaria deaths were reported from Bentiu PoC. Overall, Bentiu PoC has reported the highest number of deaths (590 deaths) since the beginning of the year with 119 (20%) of the deaths attributed to malaria (Figure 18.1 and Table 7).
Figure 18
Figure 18.1
Overall Mortality
Since the beginning of 2015, a total of 999 deaths have been reported from the IDP sites of which 473 (47%) were children under-5 years. The majority of the deaths occurred in Bentiu, Malakal, Juba 3 PoC and, Wau Shiluk.
Since the beginning of 2015, malaria has registered the highest proportionate mortality of 14.9% followed by malnutrion (7.8%), TB/HIVAIDS (7.8%), acute watery diarrhoea (5.8%), perinatal deaths (5.3%), and pneumonia (5.2%) (Table 7).
In response to the current malaria trends in Bentiu PoC, Malakal PoC, UN House PoC, and Renk a coordinated response has been initiated to improve access to treatment, interrupt transmission, and engage communities. This includes mass presumptive treatment of fever cases for malaria, distribution of LLINs, larviciding, indoor residual spraying, and behavioral change communication.
Consistent and sustained implementation of a comprehensive HEV response is already underway and includes supportive case management for symptomatic cases, targeted preventive interventions during antenatal visits; improving access to safe drinking water and improved sanitation facilities; instituting interventions for a safe water chain; preventive vaccination using HEV vaccine for groups with a high risk for adverse clinical outcomes including mortality; and house-to-house hygiene and sanitation promotion including distribution of NFIs like soap and jerry cans.
An integrated measles and polio vaccination campaign was conducted in Bentiu PoC in week 36 and in addition, vaccination on arrival and routine vaccination at existing fixed and outreach units is ongoing.
Enhanced nutrition screening at designated clinics, mobile clinics, and during the house-to-house visits are underway to identify and initiate early treatment for malnourished cases.
The national and state level cholera taskforce committees should continue implementing cholera response interventions to control the outbreaks in Juba and Bor.
Integrate TB/HIV/AIDS prevention and control into the routine healthcare services in all the IDP sites.
Biological samples should be obtained and shipped to Juba to allow laboratory confirmation of emerging outbreaks of measles, AJS, bloody diarrhea, and cholera.
The ongoing integrated response to Kala-azar that entails enhanced surveillance, improved access to diagnosis and treatment facilities, refresher training of healthcare workers on Kala-azar case management, replenishing of drug stocks in endemic areas, as well as communication on Kala-azar prevention and control should be sustained.
Support the implementation of the Ebola preparedness and response so as to enhance capacities for case detection, investigation, response and community awareness on Ebola prevention and control.
Please send all disease surveillance information and any outbreak rumours to [email protected]. IDSR reports should be submitted by COB Monday after the close of each epidemiologic week.
For comments or questions, please contact
Department of Epidemics, Preparedness and Response, MoH-RSS E-mail: [email protected],
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