republic of south sudan early warning and disease...

Early Warning and Disease Surveillance System

Republic of South Sudan

EARLY WARNING AND DISEASE SURVEILLANCE BULLETIN(IDP CAMPS AND COMMUNITIES)

Week 50 8 – 14 December 2014

General Overview

Completeness for weekly reporting increased from 89% to 96% while timeliness increased from 33% to 49%in week 50 when compared to week 49.During week 50, malaria re-emerged as the main cause of morbidity among IDPs with Malakal PoC havingthe highest malaria incidence followed by Lankien, Renk, Tongping, and UN House.During week 50, Malakal PoC had the highest incidence for Malaria and AWD while Bentiu had the highestARI incidence and Akoka had the highest ABD incidence.Eight suspect measles cases were reported from Lankien in week 50, representing an increase from the fivesuspect measles cases reported from the same site in week 49.Three new HEV cases were reported from Mingkaman in week 50. The cumulative for HEV in Mingkaman is128 cases including four deaths (CFR 3.23%) while the overall number of AJS cases from all the IDP sites hasrisen to 153 after two new AJS cases were reported in Bentiu during week 50.There are no new cholera cases reported since week 47. The cumulative remains at 6,421 cholera casesincluding 167 deaths (CFR 2.60%) from 16 counties in South Sudan.The under-five and crude mortality rates in all IDP sites were below the emergency threshold in week 50.

Completeness and Timeliness of Reporting

Completeness for weekly reporting increased from 46 (89%) in week 49, to 49 (96%) in week 50. Timeliness forweekly reporting increased from 17 (33%) in week 49 to 25 (49%) in week 50.

Figure 1

In week 50, we did not receive reports from two mobile outreach sites since they were not visited (Table1).

2 1 5 6 8 1315211720171718211819262632292426282726332423293134383436413542382829343434374246484848474749

0102030405060

515201020304050607080910111213141516171819202122232425262728293031323334353637383940414243444546474849502013 2014

Number of site

s

Epidemiologic Week

Number of sites (clinics) reporting per week (n=51)


Health facilities are requested to kindly submit their IDP reports for the preceding week, by 17:00 hrs onMonday.

Table 1: List of silent health facilities during week 50, 2014No. IDP site Health Facility/Partner1 Twic Man Awan GOAL2 Twic East DBLC/Bathoot mobile clinic SMC

Consultations (All patients seen at Outpatient and Inpatient facilities)The total number of consultations increased from 19,410 in week 49 to 20,662 in week 50. During week 50,most of the consultations were reported from Bentiu, Awerial, Malakal and UN House (Figure 2).

Figure 2

Since the onset of the crisis 759,198 consultations have been registered from all IDP sites with an overallannualised OPD utilisation rate of 1.0 consultation per person per year (Figure 2.1). The IDP site-specificannualised OPD utilization rates are shown in Figure 2.1.

Figure 2.1

Figure 2.2 shows the average consultations per IDP site by epidemiological week. The average consultationsper IDP site during week 50 were 422 consultations, which represents an increase from 441 consultations inweek 49.

292824 1191 1686 871844710

7631647

237323

400 70 325

1249788331

227731 96 402 465 323 318328

361 112 199527

168

1372 565 469 254 1194050010001500200025003000350040004500

Awerial Bentiu Bor Lankie

n Malakal Melut Nasir UN HO

USE Yuai Tongping

Man-Anguei Akoka Renk Kodok Lul Ogod Akobo Wau Sh

illuk Twic East Nyirol DUK Fangak

Number of con

sultations Consultations by IDP Camp & Partner, week 50, 2014

CCM IMC IOM IRC MSF-E CARE Medair HealthLink GOAL IMA SMC HLSS MSF OCA CMA

1.5 2.4 0.2 2.05.8 4.0 2.1 0.3 1.8 1.3 - 3.0 0.2 0.8 1.2 1.5 0.6 1.1 0.4 0.3 0.5 0.2 0.1 0.3 0.0 0.1 1.0 - 1.0 2.0 3.0 4.0 5.0 6.0

Awerial Bentiu Bor Lankie

n Malakal

Man-Awan Melut Nasir UN HOUSE Yuai (blank) Tongpi

ng Walgak Man-Anguei Akoka Renk Kodok Lul Ogod Akobo Wau Sh

illuk Twic East Nyirol DUK Ayod Fangak Overal

l

Utilisation rate

Utilization rate per person per year, week 51-2013 to 50-2014


Figure 2.2

Overall Trends of Priority Epidemic-prone Diseases

Figures 3 and 4 show the proportionate and incidence morbidity trends for Malaria, Acute RespiratoryInfection (ARI), Acute Watery Diarrhoea (AWD), suspected measles and Acute Bloody Diarrhoea (ABD).

Figure 3

Malaria, ARI, and AWD were the top three causes of morbidity among IDPs in week 50 (Figure 3 and 4).During week 50, malaria re-emerged as the top cause of morbidity among the IDPs (Figure 3 and 4).The overall incidence for malaria, AWD, and suspect measles increased, while the incidence of ARI and ABDdecreased in week 50 when compared to week 49 (Figure 4).The weekly number of cases for the current and preceding week, and cumulative number of cases for thetop five causes of morbidity are presented in Table 2.

Table 2

No. DiseaseNew cases for weeks Cumulative cases since week

51 of 201349 501 Malaria 3,074 3319 147,4902 AWD 1,584 1718 65,9333 ARI 3,173 2904 114,3544 ABD 268 213 10,8305 Measles 5 8 1,529

020406080100120

- 200 400 600 800 1,000 1,200 1,400 1,600 1,800

515201020304050607080910111213141516171819202122232425262728293031323334353637383940414243444546474849502013 2014

Completeness

[%]

Number of Con

sultations

Epidemiological week

Average consultations per health facility, week 51 of 2013 - week 50 of 2014

Completenes [%] Adj. Average consultations

0%10%20%30%40%50%60%70%80%90%100%

0%5%10%15%20%25%30%35%40%45%

01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49Co

mpl

eten

ess

Percent of all

consultations

Epidemiologic Week

Priority Disease Proportionate Morbidity - Week 1 - 50, 2014

Completeness ARI Bloody Diarrhea Malaria Suspected Measles Watery Diarrhoea


Figure 4

Specific Priority Epidemic-Prone Diseases

Acute Respiratory Infection

ARI registered the second highest proportionate morbidity of 14.1% and incidence of 45 cases per 10,000population) in week 50 (Figure 5). The highest ARI incidence (cases per 10,000) was reported from Bentiu(241) followed by Malakal (160), UN House (159), Awerial (49), and Lul (50) (Figure 5.1).

Figure 5

Figure 5.1

- 20 40 60 80 100 120 140

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

Case

s per

10,

000

Epidemiological Week 2014

Incidence for Priority Diseases, week 1 - 50, 2014

ARI Bloody Diarrhea Malaria Suspected Measles Watery Diarrhoea

0.9%

24.7%

6.2%4.6% 7.1%2.6%14.6%

24.3%15.0%20.9%16.2%

28.3%34.7%

20.5%

39.3%33.3%21.2%

32.0%23.4%21.0%18.1%13.2%16.7%

26.8%15.6% 13.7%

21.9%15.8%14.3%15.6%14.1%0%10%20%30%40%50%60%70%80%90%100%

0%5%10%15%20%25%30%35%40%45%

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

Completeness

[%]

Percent of tota

l consultation

s

Epidemiologic Week

ARI Proportionate Morbidity , for week 1 - 50 2014

- 200 400 600 800 1,000 1,200 1,400

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

Cases per 10,0

00

Epidemiological week 2014

ARI, by Camp, for week 1 - 50, 2014

Bentiu Malakal Lul Awerial UN House


Acute Watery Diarrhoea

As seen from Figure 6, the AWD proportionate morbidity increased from 8.30% to 8.31% while the overall AWDincidence (cases per 10,000) increased from 25 to 27 in week 50 when compared to week 49 (Figure 4).Overall, the AWD trend has been on the decline since the beginning of the year.

Figure 6

During week 50, a total of 1,718 AWD cases were reported with the highest AWD incidence (cases per 10,000)being reported in Malakal (100), followed by Bentiu (88), Melut (48), UN House (46), and Renk (45) as illustratedin Figure 7.

Figure 7

Dysentery / Acute Bloody Diarrhoea

The overall ABD trend has been on the decline since the beginning of the crisis with successively shorterpeaks in weeks 2, 21 and 37 (Figure 8).The incidence (cases per 10,000) of ABD decreased from four to three, while the proportionate morbidity(%) decreased from 1.4 to 1.0 in week 50 when compared to week 49.During week 50, 213 ABD cases were reported with the highest ABD incidence (cases per 10,000) beingreported in Akoka (21) followed by Malakal (15), Renk (14), Lul (9) and Melut (8) see Figure 9.

28.2%27.4%

12.8%8.7%16.2%14.2% 14.2%14.4%14.2%16.5% 13.8%10.8%12.9%

6.4%7.4% 5.4%7.5%11.9%8.1%7.2% 8.0%8.1%8.4%8.3%0%10%20%30%40%50%60%70%80%90%100%

0%10%20%30%40%

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

Completeness

Percent of tota

l consultation

s

Epidemiologic week

AWD Proportionate Morbidity, for week 1 - week 50, 2014

- 100 200 300 400 500 600 700

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

Cases per 10,0

00


AWD Incidence, by IDP site, for week 1 - 50, 2014

Bentiu Renk Akoka Malakal UN House Melut


Figure 8

This trend highlights the need for continued hygiene and sanitation promotion in all IDP camps.

Figure 9

Measles

The measles trend peaked at the beginning of the crisis with the highest peak occurring in week 3, followedby a decline with subsequent shorter peaks in week 5 and 13 (Figure 10).

Figure 10

2.7%

7.0%

3.6%1.2%1.7%1.9%1.1%1.8% 1.6%2.3%2.5% 3.5%

1.6%2.4% 1.7%2.0%1.2%1.7% 2.5%1.0% 1.3%0.9%1.3%1.0%1.0%

0%10%20%30%40%50%60%70%80%90%100%

0.0%1.0%2.0%3.0%4.0%5.0%6.0%7.0%8.0%

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

Completeness

Percent of tota

l consultation

s

Epidemiologic Week

ABD Proportionate Morbidity , for week 1 - 50, 2014

- 20 40 60 80 100 120 140 160 180 200

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

Cases per 10,0

00


ABD Incidence, by IDP site, for week 1 - 50, 2014

Malakal Akoka Bentiu Renk Lul

0%10%20%30%40%50%60%70%80%90%100%

0.0%0.5%1.0%1.5%2.0%2.5%3.0%

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

Completeness

Percent of tota

l consultation

s

Epidemiologic week

Suspected Measles Proportionate Morbidity, for week 1 - 50, 2014

Completeness Suspected Measles Adj. Linear (Suspected Measles Adj.)


This trend is attributed to a series of reactive measles vaccination campaigns conducted to contain theoutbreaks in UN House, Tongping IDP camp, Bor, Yuai, Lankien, Cueibet and in Thol Payam, Nyirol County inJonglei State.During week 50 a total of eight suspect measles case were reported from Lankien, representing an increasefrom the five cases reported in week 49 from the same location.Three measles samples from Melut were confirmed as measles in September 2014, while in Lankien, sevensamples were confirmed as measles in October 2014. Integrated measles campaigns are planned for thetwo locations.

Malaria

As seen from Figure 11, since the beginning of the year, three peaks of malaria transmission have beenregistered with the highest occurring at the beginning of the crisis (weeks 1-3), while the other peaks wereregistered in weeks 20, 25, 31 and 37. The malaria trend has been on the decline since week 37 (Figure 11).During week 50, malaria re-emerged with the highest proportionate morbidity of 16.1%, representing anincrease from 15.4% in week 49. Similarly, the malaria incidence (cases per 10,000) increased from 49 inweek 49, to 51 in week 50.

Figure 11

During week 50, a total of 3,319 malaria cases were reported with the highest malaria incidence (cases per10,000) being reported in Malakal (240), followed by Lankien (133), Tongping (113), Renk (111), and UNHouse (105) as seen in Figure 12.

Figure 12

32.2%25.5%30.1%

12.4%14.4%10.4%18.3%13.9% 13.5%18.8%15.4%13.2%17.2%22.1%

35.1%24.4%20.5%

31.6%17.3%19.5%22.5%26.4%20.6%

28.6%19.3%22.2%

37.0%31.4%27.8%25.5%22.9% 20.0%18.3%16.1%

0%10%20%30%40%50%60%70%80%90%100%

0%5%10%15%20%25%30%35%40%

01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49Comple

teness

Percent of tota

l consultation

s

Epidemiologic week

Suspected Malaria Adjusted Proportionate Morbidity , week 1 - 50, 2014

Completeness Malaria Adj. Linear (Malaria Adj.)

- 200 400 600 800 1,000 1,200 1,400 1,600 1,800

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

Cases per 10,0

00


Malaria Incidence, by IDP site, for week 1 - 50, 2014

Malakal UN House Renk Tongping Bentiu


Hepatitis E Virus (HEV)

As seen in Figure 14, Acute Jaundice Syndrome (AJS) cases were first reported in week 10 in Mingkamanand after reaching the highest peak in week 24, the cases have been declining steadily. At least eight caseswere confirmed through laboratory testing (ELISA/PCR).Three new HEV cases were reported from Mingkaman in week 50; hence the cumulative has now increasedto 128 cases including four deaths (CFR 3.13%). Three (75%) deaths occurred among pregnant women(Figure 13).

Figure 13

Two new AJS cases were reported from Bentiu PoC during week 50. Overall, 153 AJS cases have beenreported from the various IDP sites as shown in Figure 14.Several interventions including supportive case management, targeted preventive interventions duringantenatal visits, soap distribution, shock chlorination of boreholes, as well as house-to-house hygiene andsanitation promotion visits are being conducted by partners in response to the HEV trends.

Figure 14

Cholera

The Ministry of Health, working in collaboration with partners, rolled out a comprehensive response to thecholera outbreak that started in Juba in week 17 of 2014. The national cholera taskforce is coordinating theimplementation of comprehensive interventions for cholera prevention and control. There were no new

0 0 1 20 0 0 0 0

3 2

53

6

35

11

2

11

5

13 4

7 7 75 6

4 4 3

64

0 0 1 2 1 1302

468101214

3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49

No. cases


Hepatitis E Virus trends in Mingkaman, week 10-50, 2014

Cases Deaths

0246810121416

3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49

No. cases


Acute Jaundice Syndrome cases by IDP site, week 3-49, 2014

Awerial Bor Malakal Lul Juba 3 Lankien Bentiu Tongping


cases of cholera reported in week 50. Table 3 shows the cholera cases reported through the EWARNreporting network for the internally displaced populations and through the IDSR reporting system for therest of affected populations living outside the IDP settlements. The cumulative for cholera in South Sudan is6,421 cases including 167 deaths (CFR 2.60%) from five states and 16 counties (Table 3). There are no newcholera cases reported since week 47.

Table 3: Cholera cases and deaths by county week 17 – 50, 2014No. State County New cases by Epidemiological week Total cases

2014Totaldeaths

CFR[%]

38 39 40 41 42 43 44 45 46 47 48 49 50

1 CES(IDP)

Tongping PoC 0 0 0 0 0 0 0 0 0 0 0 0 0 72 3 4.2

2 Juba 3 PoC 0 0 0 0 0 0 0 0 0 0 0 0 0 97 0 0

3 CES Juba 4 3 0 8 3 2 0 0 0 0 0 0 0 2,091 43 2.1

4 Kajo-Keji 0 0 0 0 0 0 0 0 0 0 0 0 0 93 7 7.5

5 Yei River 0 0 0 0 0 0 0 0 0 0 0 0 0 47 2 4.36 JS Bor 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0

7 EES Torit 3 0 0 0 0 0 0 0 0 0 0 0 0 2,032 36 1.88 Lopa-Lafon 0 0 0 0 53 3 4 0 0 0 0 0 0 264 16 69 Kapoeta North 3 7 1 0 0 0 0 0 0 0 0 0 0 83 1 1.210 Kapoeta South 0 0 0 0 0 0 12 2 0 0 0 0 0 14 0 011 Ikotos 25 19 19 5 41 30 31 4 10 0 0 0 0 297 27 912 Magwi 2 0 0 0 0 0 0 0 0 0 0 0 0 301 11 3.713 Budi 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 014 UNS Manyo 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 015 Malakal 0 0 0 0 0 0 0 0 0 0 0 0 0 1,024 21 2.116 WES Mundri East 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 0

Total South Sudan 37 29 20 13 97 35 47 6 10 0 0 0 0 6,421 167 2.60Source of data: Ministry of Health Integrated Disease Surveillance & Response (IDSR); EWARN reporting

Acute Flaccid Paralysis (AFP)

During week 48, seven new AFP cases were reported making cumulative of 287 cases since the beginning of2014 (Table 4). The annualized non-Polio AFP (NPAFP) rate is 3.78 cases per 100,000 population children 0-14 years (target ≥2 per 100,000 children 0-14 years). All states with the exception of three (30%), (Jonglei,Upper Nile, and Unity), have attained the targeted NPAFP rate of ≥2 per 100,000 children 0-14 years (Table4). The non-Polio Enterovirus (NPEV) isolation rate (a measure of the quality of the specimen cold chain) is17%, which is above the global threshold of ≥10%. Stool adequacy is 93%, a rate that is higher than theglobal target of ≥80% (Table 4). However active surveillance continues to be hampered by insecurity in thethree states that are directly affected by the current crisis.

Table 4: Summary of AFP indicators by state as of week 48, 2014


Other diseases of public health importance

Guinea worm (Dracunculiasis)

One suspect Guinea worm case was reported from Malakal PoC by IMC clinic 2 during week 50. The caseinvestigation form has been submitted to the National Guinea worm eradication program to facilitatefollow-up investigations.

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 anational Ebola/Marburg contingency plan.No Ebola/Marburg cases have been confirmed in South Sudan but five alerts have been investigated in Ezo,Nzara, Terekeka (Tali), and Juba (Hai Jalaba and Gudele).Community sensitization on Ebola prevention and control is ongoing through radio messages, talk shows onradio and television as well as the distribution of IEC materials (posters and brochures).

Visceral Leishmaniasis (Kala-azar)

Kala-azar cases have been on the decline in recent weeks. Given the high number of cases reported thisyear when compared to last year, the decline in Kala-azar cases in the recent weeks is largely attributed tounder reporting and poor access to endemic areas.During week 49 (no update for week 50), four (21%) treatment centres reported 52 new Kala-azar cases andone death. Of the 52 new cases reported this week, 23 cases were reported from Rom, 19 cases fromWalgak, two cases from Malakal IDP, and eight cases including one death from Melut.Since the beginning of the year 7,204 Visceral Leishmaniasis (Kala-azar) cases and 199 deaths (CFR 2.76%)have been reported from 19 treatment centres. Of these 6,738 were new cases and 446 relapses or PostKala-azar Dermal Leishmaniasis (PKDL), while 228 were defaulters. In comparison 2,992 cases and 88 deathswere reported during the same period in 2013, of which 2,772 were new cases, 220 relapses/PKDL and 42defaulters.During 2014, most of the Kala-azar cases have been reported from Lankien (4,282 cases), Chuil (1,239cases), Walgak (648 cases), Melut (241 cases) and Malakal IDP (206 cases).Most of the cases reported this year are male 3,930 (54.6%) while the most affected age group is 5-17 years3,064 (42.52%) followed by 17 years and above 2,501 (34.72%) and less than 5 years 1569 (21.78%).A higher number of Kala-azar cases have been reported this year in comparison to last year and this isattributed to several factors including displacement of non-immune populations to endemic areas,congregation of populations in settlements, malnutrition, poor housing, and reduced access to treatmentcentres leading to late detection and diagnosis of cases.WHO is supporting implementing partners with case management supplies and adequate stockpiles havebeen assembled in endemic states.Training of health workers in Visceral Leishmaniasis case management, prevention and control is ongoing.

Meningitis

There were no new suspect meningitis cases reported during week 50.


All-Causes Mortality Data

During week 50, mortality lists were received from Bentiu PoC, Bor PoC, Mingkaman IDP settlement,Malakal PoC, Melut, and Juba 3 PoC.A total of 21 deaths were reported this week, with the majority being reported from Malakal PoC 5 (24%)see Table 5. Four (19%) deaths occurred in children under five years with the majority dying frompneumonia - 2 (50%) – in Malakal PoC. The causes of death during week 50 are listed in Table 5.

Table 5: Causes of death by IDP camp during week 50 of 2014

Cause of death by IDP siteDeaths by age-group

Total deaths<5yrs ≥5yrsBentiu 7 7

Heart failure 2 2Unknown 1 1Chronic illness 1 1

Severe illness 1 1Chronic disease 1 1Coma 1 1

Bor 1 1Renal failure & OI 1 1

Juba 3 1 3 4Malaria 1 1Persistent watery diarrhoea 1 1Chronic gastritis 1 1Alcohol intoxication 1 1

Malakal 3 2 5Acute watery diarrhoea 1 1

Pneumonia 2 2Renal failure 1 1Unknown disease 1 1

Melut 1 1Kala-Azar 1 1

Mingkaman 3 3Severe Anaemia 1 1TB/HIV/AIDS 2 2

Total deaths 4 17 21

Under-five Mortality RateThe under-five mortality rates (U5MR) per 10,000 per day from week 51 of 2013 to week 50 of 2014 areshown in Figure 15.The under-five mortality rates for all the six IDP sites that reported in week 50 were lower than theemergency threshold of 2 deaths per 10,000 per day.During week 50, two children under five years died from severe pneumonia in Malakal PoC.

Figure 15

0

2

4

6

8

10

12

14

16

18

52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50

Rate

per

10,

000

Epidemiologic Week

Under-5 Mortality Rate per 10,000 per day by Site - week 51 of 2013 to week 50 of 2014

Bentiu Bor Juba 3 Malakal Mingkaman Tongping Melut Threshold


Crude Mortality Rate

The crude mortality rates (CMR) for week 50 are shown in Figure 16. During this week the CMRs werebelow the emergency threshold for the six IDP sites that submitted mortality data.During week 50, two deaths attributed to TB and HIV/AIDS were reported form Mingkaman IDP settlement.

Figure 16

Disease specific mortality

Acute watery diarrhoea related deaths

Figure 17 shows mortality due to AWD from week 52 in 2013 to week 50 in 2014. AWD has caused thehighest number of deaths with a cumulative of 152 deaths since the onset of the crisis.The majority of AWD related deaths have been reported from Mingkaman, Tongping, Malakal and Bentiu(Figure 17).

Figure 17

Overall Mortality

Since the onset of the crisis, at least 1,326 deaths have been reported from the IDP sites. Children underfive years account for 631 (47.6%) of the deaths. The majority of the deaths occurred in Bentiu, Tongping,

0

1

2

3

4

5

6

7

8

51 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49

Rate

per

10,

000

Epidemiologic week

Crude Mortality Rate per 10,000 persons per day, week 51 of 2013 to week 50 of 2014

Bentiu Bor Juba 3 Malakal Mingkaman Tongping Threshold Melut

0510152025

51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 18 19 20 21 22 23 24 25 26 27 28 35 37 43 45 46 49 502013 2014

Number of dea

ths

Epidemiological week

Mortality due to AWD by camp, week 51 of 2013 to week 50 of 2014

Bentiu Bor Juba 3 Malakal Mingkaman Tomping


Malakal, Mingkaman and Bor. The top causes of mortality during the period include AWD, severepnuemonia, measles and malnutrition (Table 6).

Table 6: Overall mortality by settlement, week 51 of 2013 to week 50 of 2014

IDP site Acu

te J

aund

ice

Synd

rom

e

Acu

te w

ater

ydi

arrh

oea

Blo

ody

diar

rhoe

a

Can

cer

Gun

shot

wou

nd

Hea

rt d

isea

se

Hyp

erte

nsio

n

Kal

a-A

zar

Mal

aria

Mat

erna

l dea

th

Mea

sles

Per

inat

al d

eath

Pne

umon

ia

SAM

Sept

icem

ia

Stro

ke

TB

/HIV

/AID

S

Tra

uma

Oth

ers

Gra

nd T

otal

Agok 1 2 3Bentiu 48 2 1 9 3 2 14 1 8 2 46 47 14 1 25 6 119 348Bor 2 1 1 1 42 2 10 3 1 2 59 124Juba 3 1 8 4 1 2 10 1 1 33 8 5 1 2 18 21 116Kodok 1 0 1Malakal 1 30 1 38 14 1 13 12 12 5 15 7 1 18 6 84 258Melut 1 2 13 7 2 2 5 5 1 6 13 57Mingkaman 6 30 4 2 1 1 18 1 4 8 9 3 8 1 8 2 43 149Tomping 33 2 4 6 11 1 10 37 15 24 16 1 3 4 1 98 266(missing) 1 1 2 4Grand Total 8 152 8 13 54 34 7 26 72 5 92 74 108 94 34 8 81 15 441 1326

General recommendations

Malaria preventive interventions including the use of Long Lasting Insecticide Treated Nets (LLITN), indoorresidual spraying (IRS) and prompt case management should be sustained.Promote ARI prevention and control by sensitizing communities on respiratory hygiene, regular handwashing with soap and water, prompt recognition and treatment of pneumonia in children under five years,and routine vaccination of children as per infant vaccination schedule.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 emergingoutbreaks of measles, acute jaundice syndrome, bloody diarrhea and cholera.Interventions for cholera prevention should be sustained countrywide with a major focus on identifyinglong-term strategies to improve access to safe drinking water and sanitation in at-risk areas.Lankien and other sites like Melut where measles outbreaks have been confirmed in the recent weeksshould be prioritized for integrated measles campaigns.In response to the HEV cases in Mingkaman and AJS cases in the other IDP sites, the following interventionsshould be prioritized: household sanitation and hygiene promotion; improve access to safe water; andtargeted interventions to prevent new infections in pregnant women.The ongoing integrated response to Kala-azar that entails enhanced surveillance, improved access todiagnosis and treatment facilities, refresher training of healthcare workers on Kala-azar case management,replenishing of drug stocks in endemic areas, and communication on Kala-azar prevention and controlshould be sustained.Support the implementation of the Ebola preparedness and response so as to enhance capacities for casedetection, investigation, response and community awareness on Ebola prevention and control.Please send all disease surveillance information and any outbreak rumours [email protected] reports and mortality line lists should be submitted by COB Monday after the close of eachepidemiologic week.

For comments or questions, please contactDepartment of Epidemics, Preparedness and Response, MoH-RSS

E-mail: [email protected],HF radio frequency: 8015 USP; Selcall: 7002

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