republic of south sudan - who...1 republic of south sudan cholera situation and response updates 13...

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Republic of South Sudan

CHOLERASITUATIONANDRESPONSEUPDATES13OCTOBER2017

Epidemictrends

§ Choleratransmissionhascontinuedtodeclinecountrywidewithonlythreecounties[Juba,Budi,andFangak]reportingcholeracasesinthelastfourweeks[38-41,2017].

§ Inweek41,fouroutof13samplesfromJubatestedpositiveforVibriocholerae(table2).

Table 1: Cholera cases by county for weeks 38, 2017 to 41, 2017

CountyDatefirstreported

Casesreported Deaths

Newduring

reportingperiod

CumulativeNewduringreportingperiod

Cumulative

Numberofcases

(attackrateper10,000) Community Facility

Facility

CFR%Fangak 13-Oct-16 7 242 14 0 0 2 0.83

Juba 18-Jun-16 108 2726 47 0 25 10 1.28Budi 22-Jul-17 83 649 38 5 44 17 9.4

§ Duringthe last fourweeks, JubaandBudihavereportedthehighestnumberofcholeracases.Duringthesameperiod,fivedeathswerereportedfromBudi(Table1&Fig.1).

§ NonewcaseshavebeenreportedfromFangakinthelasttwoweeks(Table1&Fig.1).

44

34

0

23

46

716

21

00 7 00

5

10

15

20

25

30

35

40

45

50

Budi Juba Fangak

Num

bero

fcases

Epidemiologicalweekofonset

Fig.1|CholeracasesinJubaandBudifromweek38to41,2017

wk38 wk39 wk40 wk41

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§ Acumulativeof649casesincluding61deaths[CFR9.4%]havebeenreportedinBudisinceweek29,2017(Table1andFigure2).Malechildrenandyoungadultsaremoreaffectedthantheirfemalecounterpartsofcorrespondingage(Figure3).

§ TheoutbreakinBudistartedon28July2017withtheinitialtransmissionoccurringamonggold-minersinNgauro.

Cordaid and the County Health Department are supporting management in Ngauro CTU,KimotongCTU,KimotongPHCC,VakaORP,NagishotPHCC,andKakilaiPHCCinBudicounty.

0

20

40

60

80

100

120

140

26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41

Num

bero

fcases


Fig.2|Choleraepidemiccurve,Budicounty2017

Alive Died

11.00

4.00

4.00

6.00

8.00

6.00

8.00

3.00

2.00

2.00

2.00

0.20

0.00

0.30

0.00

0.30

6.00

3.00

3.00

6.00

4.00

4.00

4.00

3.00

4.00

2.00

2.00

1.00

1.00

0.00

0.20

0.00

12 10 8 6 4 2 0 2 4 6 8

3

There are ample cholera case management kits and the cholera treatment facilities areadequatelystaffedforthecurrentcase-loads.Inadditiontocasemanagement,surveillance,andWASH interventions,a choleravaccinecampaignmicroplanhasbeendevelopedand iscurrentlybeingreviewedbythenationalOCVworkinggroup.InJuba,108caseswerereportedinthelastfourweeks[week38-41].MostofthecasesseeninJubainthelastfourweeksoriginatedfromRejafandKator.Anoralcholeravaccinecampaignhas been completed in Juba targeting both high-risk locations and areas with activetransmission.

Overallcholeratrends

§ Sincethestartofthecurrentoutbreakon18June2016,atotalof21,097casesincluding418deaths(CFR1.98%)havebeenreportedfrom26counties.ThemostaffectedcountiesincludeAyod,TonjEast,YirolEast,Fashoda,KapoetaEast,andKapoetaSouth(Figure4).

§ Themostaffectedpopulationsintheselocationsinclude:Landingsites/townsalongRiverNile;cattlecampdwellers;populationslivingonislands-nosocialservices;andIDPs-recentlydisplacedwithinadequateaccesstoWASH.

31- 4

- 11108

- 35

- - -

101-

10- -

40

- 70

1- - - -

74189

538

347

7131

1288

6687

- - 1

1304

380

22-

1441

14315

- 20 40 60 80 100 120 140 160 180 200Awerial

Ayod

Bor

Budi

CanalPigi

Duk

Fangak

Fashoda

Juba

KapoetaEast

KapoetaNorth

KapoetaSouth

Leer

Magwi

Malakal

Mayendit

Mayom

Nyirol

Panyijiar

Renk

Rubkona

Terekeka

TonjEast

TonjNorth

YirolEast

YirolWest

choleracasesper10,000population

Figure4|Choleracasesper10,000bycountyinSouthSudan,2016and2017

2017 2016

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Choleracasefatalityrateswerehighestincountieswithpooraccesstohealthcareespeciallyinpopulationslivingintheislandsandcattlecamps(Figure5).Overall,ahigherproportionoffemales(52%)areaffectedthanmales(48%).Figure6showstheageandsexdistributionofcases.

1% 2%

3% 9% 1%

2%

3% 3%

3%

3%

1% 33%

1% 1%

3% 9%

0% 6% 1%

2% 1% 1%

0% 1%

0% 2% 44%

3% 7%

0% 0% 2%

0% 4%

0%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% AwerialAyodBorBudi

CanalPigiDuk

FangakFashoda

JubaKapoetaEast

KapoetaNorthKapoetaSouth

LeerMagwiMalakal

MayenditMayomNyirol

PanyijiarRaja

RubkonaTerekekaTonjEast

TonjNorthYirolEastYirolWest

choleracasefatalityrate- CFR[%]

Figure5|Choleracasesfatalityrate(%)bycountyinSouthSudan,2016and2017

2017 2016

11.008.00

6.003.003.00

4.003.003.00

2.002.001.001.001.000.300.270.130.100.01

0.00

10.007.00

5.004.004.00

5.005.00

3.002.002.001.001.001.000.430.290.100.080.010.00

15 10 5 0 5 10 15

0-45-9

10-1415-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-8485-8990+

Percentage%

Figure6|Choleracasedistributionbyageandsex,June2016- Sept2017

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AsseeninTable2,choleracaseshavebeenconfirmedeveryyearsincetheonsetoftheSouthSudan crisis in 2013. The 2016/17 outbreak is the longest and largest in magnitude andgeographical extent. Due to the protracted crisis, displacements, insecurity, and declininginvestment in WASH, access to safe drinking water and sanitation facilities has declinedsignificantly. Access to improved sanitation facilities is less than 10% while access to safedrinkingwaterfromimprovedwatersourcesisestimatedat60%.

TABLE2|CHOLERAOUTBREAKSINSOUTHSUDAN2014-2017

Summarymeasure 2014 2015 2016/17

No.cases 6,421 1,818 21,097

No.deaths 167 47 418CFR% 2.60% 2.59% 1.98%

No.countiesaffected 16 3 26

Duration(weeks) 29 19 (70)Ongoing

Outbreakstartdate 24/04/2016 18/05/2016 18/06/2016

Dateoflastcase 13/11/2016 24/09/2016 Ongoing

Attackrate[per10,000] 27 17 45.4CoordinationofcholeraresponseTheNational cholera task force is coordinating theoverall cholera response.The task forcemeetingsconveneweeklyonWednesdaysfrom2pmintheWHOconferencehallinJuba.CholeraresponseupdatesTheoverallresponsetocholerainSouthSudaniscoordinatedbythenationaltaskforcethatis

0

500

1000

1500

2000

23 26 28 30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40

2016 2017

Num

bercases/deaths


Fig.7|Choleratrendsweek23,2016towk41,2017

Alive Died

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ChairedbyMoHwithsupportfromWHO,Unicef,andpartners(HealthandWASHclusters).TheweeklycholerataskforcemeetingsareongoinginJubaduringwhich,thecholerasituationandtheongoingcholerapreventionandresponseactivitiesintheaffectedandhigh-riskareasarereviewed.South Sudan was represented at the just concluded Global Cholera Taskforce on CholeraControl (GTFCC)oralcholeravaccineworkinggroupmeetingthatwasorganizedbyWHOinLagos,Portugal from12th to13thOctober2017.SouthSudanwas representedby theWHOCountryOfficeandMedAir.Twopresentationsweremade(byWHOSouthSudanandMedAir)totheworkinggrouptoshow-caseSouthSudan’sprogress,experiences,andlessonslearntinusingoralcholeravaccinestocomplementcholerapreventionandresponsein2017.Thisyear,SouthSudanhassecuredthehighestnumberoforalcholeravaccinedoseswhencomparedtoothercountries.ThisfollowsthecholerariskanalysisconductedinMarch2017duringwhichcholeratransmissionhotspotsweremappedandprioritizedfororalcholeravaccinationinthenexttwoyears.Table3:Dosesoforalcholeravaccinesdeployedin2017bysite

ProgressoforalcholeravaccinecampaignsAspartoftheongoingcholeraresponse,choleravaccineshavebeendeployedtocomplementcholeraresponseinseveralhigh-riskpopulationsandlocations.TheseareasincludeLeer,BorPoC,Malakal Town, Bentiu PoC,Mingkaman IDP settlement, Aburoc IDPs, Bentiu/RubkonaTown,Ayod(Pagil,Tar,Jiech,Karmun,Padek,andKandak),Juba(DonBoscoIDPsandadditionalhigh-risk locations), Tonj East and Marial Lou payam, Kapoeta North, Kapoeta South, andKapoetaNorth.Outofthe1,440,358dosessecuredbyWHOin2017,atotalof1089942doseshavebeendeployed(seeTable3).

Novaccinated

%coverage

Novaccinated

%coverage

1 Leer(oneround) 44731 30,772 69% 0% 22/02/2017 MedAir,WHO,UNICEF

2MalakalTown(pending2nd

round)16500 10,499 64% 0% 18-24Mar2017 MSF-E,WHO,UNICEF

3 BorPoC 2265 1,926 85% 1,885 83%3-4Apr2017;2nd

Rnd26-29Apr2017HLSS,WHO,UNICEF

4 Mingkaman 111,278 68,512 62% 42,296 38%

26Apr-5May2017;

2ndRnd:12-26May

&10-21Jun

MedAir,WHO,UNICEF

5 AyodTar(oneround) 19,400 15,649 81% 0% 9-22May MedAir,WHO,UNICEF

6 AyodPagil(oneround) 4,850 3,943 81% 0% 9-22May2017 MedAir,WHO,UNICEF

7 BentiuPoC 112,924 72,514 64% 77,603 69% 5-10May2017 IOM,WHO,Unicef

8 Rubkona&Bentiutowns 35204 31,908 91% 38,388 109%19-23Jun2017&11-

15Jul2017IOM,WHO,Unicef

9AburojIDPs(pending2nd

round)11,640 10,723 92% 0% 20-22May2017 MSF-E,WHO,UNICEF

10Ayod(Jiech,Karmun,Padek,

Kandak)18,550 13,756 74% 9,337 50%

20-26Jun2017&18-

23Jul2017IOM,CMD,WHO,UNICEF

11 JubaDonBoscoIDPs 5,940 4,536 76% 3,309 56%3-6Jul2017;24-27

Jul2017

MSF-CH;WHO,UNICEF,

HLSS

12 TonjEast(pending2ndround) 189,058 160,862 85% 6-10Aug2017 IOM,WHO,Unicef

13 KapoetaNorth 141,520 83,197 59% 71,406 50%29Jul-4Aug2017&

17-25Aug2017;11-SCI,WHO,UNICEF

14KapoetaSouth(pending2nd

round)97,000 78,863 81% 29Jul-4Aug2017; ARC,WHO,UNICEF

15KapoetaEast(pending2nd

round)97,000 85,058 88% 29Jul-4Aug2017 ARC,WHO,UNICEF

16 Juba(selectlocations) 200,000 173,000 87% 9Sep-6Oct2017 MSF-CH;WHO,UNICEF

Totaldosesdeployedin2017 1,107,860 845,718 76% 244,224 22%

PartnersFirsround Secondround

No SiteTarget

populationDates

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Table2:CholeraculturetestresultsJun2016-Sept2017 Week41 Cumulative(2016-2017)

County Positive Positive Negative TotaltestedAbyei 1 1Akobo 2 2Awerial 55 63 118Ayod 2 6 8Bor 4 4 8Budi 2 1 3Duk 11 6 17Fangak 0 31 50 81Fashoda 7 14 21Juba 3 256 278 534KapoetaEast 8 8Kodok 1 2 3Lankien 3 1 4Leer 9 13 22Magwi 7 1 8Malakal 2 21 23Mayendit 4 6 10Mayom 4 7 11Panyijiar 1 1Pibor 5 5Pigi 2 4 6Renk 2 2Rubkona 30 91 121Terekeka 2 2TonjEast 8 8 16Torit 5 5Uror 2 2Wau 6 6YirolEast 10 12 23YirolWest 4 4KapoetaSouth 12 12 24Nyirol 3 1 4Totaltested 3 482 620 1,096

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WASHCLUSTERRESPONSEUPDATES

Beneficiaries reached by WASH cluster partners in week 40

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SOCIALMOBILISATIONUPDATES Social Mobilization, Communication and Hygiene Promotion Reporting Format (7-13 October, 2017)

Locations with ongoing outbreak and hot spots (Payam level)

Partners present Ongoing Action with number of population reached with Cholera interventions

Gaps and recommended action

TonjEast:MostaffectedMakuac,Pariang,PawengPayam,TonjSouthandMarial-Lou-TonjNorth.(Warrap)

- CCM,THESO,UNICEF,WHOandSMOH

Noreportshared

Bor,TwicEast,DukandPibor CDNF UNICEFsupportedpartnerCDNFcontinuewithcommunityengagementactivitieswhichincludehouseholdvisitswithcriticaldemonstrations,communitymeetings,water-pointandmarketawareness,schoolandcattlecampsinterventioninareasofBor,DukandTwicEast.- HousetoHousemobilization:From 6th – 12th October,

2017,70trainedmobilizersconductedhouse-to-housemobilizationreachingthetotal1,582HHs(6,326Individuals)withbehaviorchangeinterventiononintegratedcholeracontroldiarrhealdiseasepreventionandimmunization

- Atotalof9schoolsand1,933pupilsbenefitedfrom

school-basedinterventionsonintegratedcholeraawarenessandimmunizationsessioncarryoutbysocialmobilizersatdifferentschools,Bor,TwiceastandDukcounties

- CommunitysensitizationMeetings:Inthisperiod,thesocialmobilizersconductedcommunitymeetingsatdifferentpayamofBor,TwicEastandDukcounties.Atotalof7communitymeetingswereconducted

- Insecurity in the whole ofgreater Jonglei state has

made it difficult for social

mobilizers move to those

areas of Anyidi, Makuac,

Lith,Duk,etc.

- Lack of rain coats andgumboots for social

mobilizersasitisnowrainy

season.

- Lack of mobility such asmotorbikes, Bicycles for

supervisors and social

mobilizers to facilitate

theirmovementtothefield

site.

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withover423communityleaderswhichincludelocalchiefs,religiousleadersandwomenandyouthleadersparticipating.

- Marketsawarenessinterventions: Socialmobilizers

alsocarriedout9marketsessionsreaching327individualsduringthemarketsessionswhichincludefoodvendorsinthementionedcountiesofJonglei

• School Interventions:A totalof10schoolsand2,416pupilsbenefitedfromschool-basedinterventionsonintegrated cholera awareness and immunizationsession carryout by social mobilizers at differentschoolsinBor,TwicEastandDukcounties.

• Interventionatwaterpoints: IntheremotevillagesofBor,TwicEastandDukcounties,thesocialmobilizersconducted6waterpointawarenessreachingatotalof359peopleincludingwatervendorswithCholeraanddiarrhealdiseaseeducativemessages. ThewatervendorswereorientedonCholeraanddiarrhealdiseasemessages including demonstration on hand washing,water treatment and safe water storage at householdlevel.

- Massmediaintervention:cholerakeymessagesandradiospotsarebeingbroadcastedonMingkaman100FM,andRadioJonglei95.9FM,6timesdailyinDinka,EnglishandArabicreachingpopulationinremotelocationsandvillageslifesavingmessagesoncholerapreventionandcontrol

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• Religiousengagement:Socialmobilizersreachedpeoplewitheffectivecholeramessagesinover7churchesduringthelastSundayinthecountiesofBor,Twiceast,andDuks.In Payam of Pibor county of Lekuangole, Verteth andGumuruk,andPochallacountyofAkoye,Akila,Adongoand Burator from 5th – 12 Oct 2017, CDNF conductedsocialmobilization activities and reached the total 436HHsand4,236Individualsthrough23trainedvolunteerssocial mobilizers/home health promoters) educatingcommunityonsocialandbehaviorchange interventionon integrated cholera control diarrheal diseasepreventionandimmunization.Themobilizers also carried on school intervention in 7schoolswith1,249pupilsbenefitedonintegratedcholeraawarenessandimmunizationsession,inPayamsofPibor,Lekuangole,VertethandGumuruk.• In this period, the social mobilizers conducted

community meetings at different payams of Pibor,Lekuangole, Verteth and Gumuruk, number ofmeeting was 7 and 614 people inclusive ofcommunity leaders which comprise of local chiefs,religiousleadersandwomenandyouthleaders.

• Socialmobilizersmarketsessionreached8and1240individuals through market sessions including foodvendorsinthementionedcountiesofBoma.

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• InhardtoreachvillagesofPibor,Lekuangole,Vertethand Gumuruk, payams the social mobilizersconducted 6 water point sessions reached total of650peopleincludingwatervendorswithCholeraanddiarrhealdiseaseeducativemessages.

Jonglei(Akobo,UrorandAkobo NileHopeandCHD

No updates shared -

AwerialCounty(Payams:Alel,Dor,Puluk,Bunangok,NileMagok,Abuyong)

CHADOandCHDs

CHADOcontinuewithcommunityinteractionsessionssuchashouseholdvisitswithcriticaldemonstrations,communitymeetings,water-pointandmarketawareness,schoolandcattlecampsinterventioninhotspotsareasinEasternLakesInAwerial,657households(2100individuals)havebeenreachedwithcholeramessagesby28trainedsocialmobilizers.Atotalof23and2850pupilsbenefitedfromschool-basedinterventionsoncholeraawarenesssessioncarryoutbysocialmobilizersatdifferentschoolsinAwerialThesocialmobilizersconducted38waterpointsessionsreachedtotalof310peopleincludingwatervendorswithCholeraanddiarrhealdiseaseeducativemessagesincludingdemonstrationonwatertreatmentandproperstorageAlso,Socialmobilizersconducted35marketawarenesssessionsandreached447individualsincludingfoodvendorsinthementionedcountiesAtthesameweek,thesocialmobilizersconducted27communitymeetingsandattendedby398peopleinclusiveofcommunityleaderswhichcompriseoflocalchiefs,religious

-

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leadersandwomenandyouthleadersatdifferentPayamsofEasternLakes.Religiousleaderswereengagedandatthetimechurchservices,Socialmobilizersreachedpeoplewitheffectivecholeramessagesinover8churches/parishesinthecountiesofEasternreachingpopulationwithlifesavingmessagesoncholeracontrolandpreventionCHADOconductedsocialmobilizationoutreachactivitiesin30Cattlecampswithtotalof1041individual

YirolEast(Payams:Adior,Malek,Lekakedu,YaliPagarauTin-agauandNyang)

CHADOandCHDs

CHADOtrained27Socialmobilisers/healthpromotershaveconductedarangeofcommunityengagementactivitiesinallPayamsofYirolEast,whichincludeAdior,Malek,Lekakedu,Yali,PagarauTin-agauandNyang.Asofthisweekbelowwereachievements; 28trainedSocialmobilisers/healthpromotersinYiroleast,havereached,670householdsand2834peoplewithkeymessagesoncholerapreventionandcontrolonthesamenotetheyhaveconducted45communitymeetingsand700peopleparticipated,36marketsessionconductedwithtotalof400individualsreached.Also,thetrainedcommunitymobilizersreached39schoolswithtotalof696pupils,73watersessionsconductedwithtotalof643individualsreachedwithkeymessagesoncholerapreventionandcontrolTheReligiousleaderswerealsoengaged:Duringreligiousservicesandcholerakeymessagesinthechurches/parisheswithlifesavingmessagesoncholera

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controlandpreventionwereconveyedin13parishesinthecounty

YirolWest(Payams:Abang,Anuol,YirolCentre(Town),Geng-Geng,Geer,AluakLuak,Mapuordit)

CHADOandCHD

InYirolWest, CHADOhad28trainedSocialmobilisers/healthpromotershavereached791households2134people)withkeymessagesoncholerapreventionandcontrol.

- InAnuolpayamthehealthfacilityneedstobesupportedwithsomeNFIsmaterials,andhandwashingfacilities,safedrinkingwater,andhygienepromotion

JubaGurei,Kator,Lologo,Gumbo,Nesitu

Healthlink,SMoHandCHD

AspartofMassmedia,atotalof14FMstationscontinuewithairingofradiospotsandtalk-showsinJubaandYei.Asof6-13October,2017,980 times radio jingleshavebeenbroadcastedreachingover2millionpeopleacrossthecountry.Also,partofcommemorationofGlobalHandWashing,1talk-show was conducted on Radio Miraya joint byUNICEFDeputyRepresentativeandDGNationalMinistryof Water Cooperation and Irrigation. Radio jinglesproducedin9languagesarebeingbroadcastedbylocalradiostationsacrossthecountry

Thisweek,streetannouncementofcholeramessageshasbeenongoingthroughFive(5)PublicAddressSystems(PAs)infivemainareasoftheCitynamely;Rejaf,Kator,Juba,MunukiandNyar-kenyi/Northern

-

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Bari.ThePAsconducts5hours’announcementsperday(3hr.morningand2hrsevening).

UpperNile(Maban,MelutandRenk)

MobileTheaterTeamandCHD

• MabanSocialMobilizersarecontinuedwithsocialMobilizationforintegratedcommunitymobilizationincludingmeaslesandhygienepromotioninBunjtowntogetherwithC4DteaminMaban

• CholerapreventionawarenesscampaignwereconductedinHaiKhartoumMarketandHai,were85girls,122boys,43women19men.

• Four(4)sessiononhygienepromotionwereconductedthroughhousetohouseandinschoolinBankumaprimary,HaiNeemwere102girls,98boys,34women24men

• InMelutSocialMobilizershadconducted2hygienepromotionssessionsinHai-ShamalTrarawere30boys,45girls,22womenand17men.Thatgivethetotalnumberof114reached.

• CholerapreventionawarenesscampaignwereconductedinHai-Salamthroughhousetohousewere56girls,46boys,34women22men.Thatgivethetotalnumberof160reached.

• OneSessionsoncholerapreventionwasconductedinHai-BigMarketwere26girls,33boys,17men23women.Thatgivethetotalnumberof103reached.

• OnesessiononhygieneinSchoolmessageswasconductedinweredemonstrationofhandwashingwasshowtochildren

-

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• Meanwhile in Renk, social mobilizers conducted two meeting with local community leaders in Girwa and Hai-Thoma on Cholera, Polio, Measles and Hygiene promotion. Population reached in two communities with the same messages were 12 men, 23 women attend during the sessions.

• The mobilizers had also conducted four sessions on hygiene and immunization in Girwa and Thoma in Renk town were 25 women, 53 boys, 41 girls 9 men were reach. The partner also conducted two (2) Focus Group Discussions with women group in Sawary on Cholera prevention and Hygiene Promotion messages, 31 women group were attend the session and benefited.

UNICEF supported partner, Community Development Network Forum (CDNF) carrying out series of community engagement activities in Bor, Twic East, Duk, Pibor and Pochall

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CHADOsocialmobilizersconductinghouseholdawarenessandwaterpointsensitization

MTTsocialmobilizersdoinghygienepromotionsinMelutandRenk

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ContactsDr. Mathew Tut Director, Emergency Preparedness and Response Ministry of Health, Ministerial Complex Juba, Republic of South SudanEmail: [email protected]

Dr. Joseph F. Wamala EpidemiologistWorld Health Organization Ministerial Complex Juba, Republic of South Sudan Email: [email protected]

republic of south sudan - who...1 republic of south sudan cholera situation and response updates 13...

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