south sudan idsr annex - w2 2018 jan 8-jan 14

South Sudan

Annexes W2 2018 (Jan 8-Jan 14)

Integrated Disease Surveillance andResponse (IDSR)

2

Contents

AccessandUtilization|Mapofconsultationsbycounty

Access and Utilisation

Slide 2 Map 1 Map of consultations by county (2018)

Indicator-based surveillance

Slide 3 Figure 1 Proportional mortality

Slide 4 Figure 2 Proportional morbidity

Slide 5 Figure 3 Trend in consultations and key diseases

Disease trends and maps

Malaria

Slide 6 Trend in malaria cases over time

Slide 7 Malaria maps and alert management

Acute Watery Diarrhoea (AWD)

Slide 8 Trend in AWD cases over time

Slide 9 AWD maps and alert management

Bloody diarrhoea

Slide 10 Trend in bloody diarrhoea cases over time

Slide 11 Bloody diarrhoea maps and alert management

Measles

Slide 12 Trend in measles cases over time

Slide 13 Measles maps and alert management

Sources of data

1. Weekly IDSR Reporting Form

2. Weekly EWARS Reporting Form

Contents

1 W2 2018 (Jan 08-Jan 14)

Map 1 | Map of total consultations by county (W2 2018)

Number of consultations

0 1 1,000 2,500 5,000

Hub W2 2018

South Sudan 106,782 189,451

Access and Utilisation | Map of consultations by county

2 W2 2018 (Jan 08-Jan 14)

Nyirol

Uror

Ayod

Rubkona

Fashoda

Mayendit

Panyijiar

Yirol West

LongechukFangak

Aweil Centre

Aweil SouthGogrial West

Aweil East

Ezo

Abyei

Nzara

Gogrial East

Pibor

Maiwut

Nagero

Mvolo

Wau

Canal PigiTwic

Morobo

Panyikang

Lopa Lafon

Kapoeta South

Kapoeta East

Kajo Keji

Kapoeta North

Maridi

Terekeka

Tonj South

Jur River

Akobo

Yambio

Pariang

Yirol East

Cueibet

Mundri East

Tonj East

Lainya

Tonj North

Abiemnhom

Mayom

Aweil North

YeiBudi

Magwi

Ulang

Aweil West

Twic EastRumbek Centre

Rumbek North

Manyo

Leer

Mundri West

Malakal

Luakpiny Nasir

TamburaWulu

Guit

Torit

Bor

Rumbek East

Juba

Ibba

Awerial

Pochalla

Koch

Baliet

Duk

Renk

Ikotos

Raja

Maban

Melut

Aweil 19,294 32,970

Bentiu 7,585 16,228

Bor 6,881 14,893

Juba 9,004 15,356

Kwajok 19,438 30,946

Malakal 6,904 12,971

Rumbek 17,202 29,073

Torit 3,804 5,082

Wau 6,036 11,386

Yambio 10,634

3

Proportionalmortality

Proportionalmorbidity

Figure 1 | Proportional mortality (2018)

Malaria

Acute Respiratory Infection

(ARI)

Acute Watery Diarrhoea

Bloody diarrhoea

Acute Jaundice Syndrome (AJS)

Measles

Other

Syndrome W2 2018

# deaths % mortality # deaths % mortality

Malaria 46 93.9% 53 91.4%

ARI 1 2.0% 1 1.7%

AWD 1 2.0% 2 3.4%

Bloodydiarrhoea

0 0.0% 0 0.0%

AJS 0 0.0% 0 0.0%

Measles 1 2.0% 1 1.7%

Other 0 0.0% 1 1.7%

Total deaths 49 100% 58 100%

Proportional mortality

3 W2 2018 (Jan 08-Jan 14)

Figure 2 | Proportional morbidity (2018)

Malaria

Acute Respiratory Infection

(ARI)


Bloody diarrhoea


Measles

Other

Syndrome W2 2018

# cases % morbidity # cases % morbidity

Malaria 33,033 54.8% 58,523 52.2%

ARI 9,897 16.4% 17,807 15.9%

AWD 7,296 12.1% 13,167 11.7%

Bloodydiarrhoea

1,174 1.9% 1,966 1.8%

AJS 1 0.0% 3 0.0%

Measles 9 0.0% 22 0.0%

Other 8,849 14.7% 20,589 18.4%

Total cases 60,259 100% 112,077 100%

Proportional morbidity

4 W2 2018 (Jan 08-Jan 14)

4

Trendinconsultationsandkeydiseases

IDSRProportionatemorbiditytrends- inrelativelystablestates

Figure 3 | Trend in total consultations and key diseases (W2)

Total consultations

Malaria

Acute Respiratory Infection (ARI)



Measles

Trend in consultations and key diseases

5 W2 2018 (Jan 08-Jan 14)

Num

ber

W05 2

017

W09 2

017

W13 2

017

W18 2

017

W22 2

017

W26 2

017

W31 2

017

W35 2

017

W39 2

017

W44 2

017

W48 2

017

W01 2

018

0

50000

25000

75000

100000

125000

150000

175000

200000

0

20

40

60

80

100

120

140

160

0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%

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 51 1

2017 2018 Num

bero

fcon

sulta

tionsinTho

usan

ds

Morbidity%

Epidemiologicalweekofreportingin2017

Fig.1|IDSRProportionatemorbiditytrends,week1,2017to2,2018

Consultations Malaria ARI AWD ABD Measles

In the relatively stable states, malaria is the top cause of morbidity accounting for 34.9% of the consultations in week 2 (representing a decline from 35.8% in week 1).

5

IDPProportionatemorbiditytrends- indisplacedpopulations

IDPProportionatemorbiditytrends- indisplacedpopulations

05,00010,00015,00020,00025,00030,00035,00040,00045,00050,000

0% 5%

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

1 2 3 4 5 6 7 8 9 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2

2017 2018

Consultatio

ns

%ofM

obidity

Epiweek2017to2018

Fig.2|IDPProportionatemorbiditytrends,week01,2017,toweek2,2018

Consultations Malaria ARI AWD ABD Measles Skindiseases GSW Injuries

Among the IDPs, ARI and malaria accounted for 28% and 17.3% of consultations in week 2. The other significant causes of morbidity in the IDPs include AWD, skin diseases, and injuries.

17.3%

28.0%

7.8%

0.6% 0.00%

3.81%

0.01% 2.03%

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

Malaria ARI AWD ABD Measles Skindiseases GSW Injuries

Prop

ortio

natem

orbidity[%

]

CausesofmorbidityamongtheIDPsweeks2,2018

The top causes of morbidity in the IDPs in 2018 include ARI, malaria, AWD, skin diseases, injuries, and ABD.

6

Malaria|Trendsovertime

Malaria|MapsandAlertManagement

Malaria | Trends over time

6 W2 2018 (Jan 08-Jan 14)

Figure 4a | Trend in number of cases over time (South Sudan)

0

20000

40000

60000

80000

100000

120000

Graph legend

2017

− · − · − · − − 2016

− − − − − − − 2015

· · · · · · · · · · 2014

58,523Cases

53Deaths

3Alerts

Key malaria indicators (2018) Figure 4b | % morbidity Figure 4c | Age breakdown

Jan Mar May Jul Sep Nov

Map 2 | Map of malaria cases by county (2017)

a. 2014 b. 2015

c. 2016 d. 2017

Malaria | Maps and Alert Management

7 W2 2018 (Jan 08-Jan 14)

Map 3 | Map of malaria alerts by county (2017)

Map legend

Number of malaria cases

0 1 10,000 20,000 50,000

Number of malaria alerts

0 1 10

Alert threshold

Twice the average number of cases

over the past 3 weeks. Source: IDSR

3Alerts

2Verified

0Low Risk

0Moderate Risk

0High Risk

0Very High Risk

Risk Assessment

7

Malaria|Trendsbycounty

MalariatrendsinselectIDPsites

Malariatrendsbycounty

-

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Weeks

MalariatrendsforAweilEastCountyin2017

3rdQuartile C-sum 2017

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Weeks

MalariatrendsforAweilNorthCountyin2017


-

500

1,000

1,500

2,000

2,500

3,000

3,500

Weeks

MalariatrendsforAweilSouthCountyin2017


-

500

1,000

1,500

2,000

2,500

Weeks

MalariatrendsforAwerialCountyin2017


-

500

1,000

1,500

2,000

2,500

Weeks

MalariatrendsforYirolEastCountyin2017


-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Weeks

MalariatrendsforYirolWestCountyin2017


-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Weeks

MalariatrendsforYirolEastCountyin2017


-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Weeks

MalariatrendsforAwerialCountyin2017


Malaria trends returned to normal in thecounties that registered high transmissionduring the rain season

Malaria trends in select IDP sites

Malaria trends in four of the large IDP sites - Bentiu Poc; UN House Poc; Malakal PoC; and Renk are below the thirdquartile

-

10

20

30

40

50

60

70

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 51

Proportionatemorbidity%

EpiWeek

Figure10a|MalariatrendforIDPsinBentiuPoC2017

Thirdquartile Propmob 2017

- 10

20

30

40

50

60

70

80

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 51 53

Proportio

natemorbidity%

Weekofreporting

Figure10b|MalariatrendforIDPsinMalakalPoC,2017


- 5

10

15

20

25

30

35

40

45

50

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 51

Proportionatemrobidity%

Epiweek

Figure10c|EWARNtrendsforMalariainUNHouse,2017


- 5

10

15

20

25

30

35

40

45

50

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 51

Proportio

natem

orbidity%

Figure10d|EWARNtrendsforMalariainRenk,2017


8

AcuteWateryDiarrhoea|Trendsovertime

AcuteWateryDiarrhoea|MapsandAlertManagement

Acute Watery Diarrhoea | Trends over time

8 W2 2018 (Jan 08-Jan 14)

Figure 5a | Trend in AWD cases over time (South Sudan)

0

2500

5000

7500

10000

12500

15000

17500

20000

Graph legend

2017

− · − · − · − − 2016

− − − − − − − 2015

· · · · · · · · · · 2014

13,167Cases

2Deaths

6Alerts

Key AWD indicators (2018) Figure 5b | % morbidity Figure 5c | Age breakdown


Map 4 | Map of AWD cases by county (2017)

a. 2014 b. 2015

c. 2016 d. 2017

Acute Watery Diarrhoea | Maps and Alert Management

9 W2 2018 (Jan 08-Jan 14)

Map 5 | Map of AWD alerts by county (2017)

Map legend

Number of AWD cases

0 1 5,000 10,000 20,000

Number of AWD alerts

0 1 10

Alert threshold

Twice the average number of cases over

the past 3 weeks. Source: IDSR

6Alerts

2Verified

0Low Risk

0Moderate Risk

0High Risk

0Very High Risk

Risk Assessment

9

AcuteBloodyDiarrhoea|Trendsovertime

AcuteBloodyDiarrhoea|MapsandAlertManagement

Acute Bloody Diarrhoea | Trends over time

10 W2 2018 (Jan 08-Jan 14)

Figure 6a | Trend in bloody diarrhoea cases over time (South Sudan)

0

500

1000

1500

2000

2500

3000

3500

Graph legend

2017

− · − · − · − − 2016

− − − − − − − 2015

· · · · · · · · · · 2014

1,966Cases

0Deaths

11Alerts

Key bloody diarrhoea indicators (2018) Figure 6b | % morbidity Figure 6c | Age breakdown


Map 6 | Map of bloody diarrhoea cases by county(2017)

a. 2014 b. 2015

c. 2016 d. 2017

Acute Bloody Diarrhoea | Maps and Alert Management

11 W2 2018 (Jan 08-Jan 14)

Map 7 | Map of bloody diarrhoea alerts by county (2017)

Map legend

Number of bloody diarrhoea cases

0 1 500 1,000 2,000

Number of alerts

0 1 10

Alert threshold

Twice the average number of cases over the

past 3 weeks. Source: IDSR

11Alerts

2Verified

0Low Risk

0Moderate Risk

0High Risk

0Very High Risk

Risk Assessment

10

Measles|Trendsovertime

Measles|MapsandAlertManagement

Measles | Trends over time

12 W2 2018 (Jan 08-Jan 14)

Figure 7a | Trend in number of cases over time (South Sudan)

0

50

100

150

200

250

300

Graph legend

2017

− · − · − · − − 2016

− − − − − − − 2015

· · · · · · · · · · 2014

22Cases

1Deaths

8Alerts

Key measles indicators (2018) Figure 7b | % morbidity Figure 7c | Age breakdown


Since the beginning of 2018, at least 22 suspect measles cases including at least 1 death (CFR 4.5%) have been reported. Of these, 10 suspect cases have undergone measles case-based laboratory-backed investigation.

Map 7 | Map of measles cases by county (2017)

a. 2014 b. 2015

c. 2016 d. 2017

Measles | Maps and Alert Management

13 W2 2018 (Jan 08-Jan 14)

Map 8 | Map of measles alerts by county (2017)

Map legend

Number of measles cases

0 1 50 100 250

Number of measles alerts

0 1 10

Alert threshold

1 case.

Source: IDSR

8Alerts

5Verified

0Low Risk

0Moderate Risk

0High Risk

0Very High Risk

Risk Assessment

11

AcuteFlaccidParalysis|SuspectedPolio

MortalityintheIDPs

By County 2016

2017

*As of epidemiological week 49/2017

During 2017, a cumulative of 387 AFP cases were reported countrywide. The annualized non-Polio AFP (NPAFP) rate (cases per 100,000 population children 0-14 years) was 4.71 per 100,000 population of children 0-14 years (target ≥2 per 100,000 children 0-14 years).

Stool adequacy was 87% in 2017, a rate that is higher than the target of ≥80%.

Environmental surveillance ongoing sinceMay 2017; with 23 samples testingpositive for non-polio enterovirus.

Source:South Sudan Weekly AFP Bulletin

By County 2016

2017

*As of epidemiological week 49/2017

Table 6 | Proportional mortality by cause of death in IDPs W2 2018

CauseofDeathbyIDPsiteBentiu Juba3 Total

deathsProportionatemortality[%]<5yrs ≥5yrs <5yrs

Acutewaterydiarrhoea 1 1 10Meningitis 1 1 10Perinataldeath 1 1 10Pneumonia 2 2 20SAM 1 1 10Shock 1 1 10Unknown 1 1 10TB/HIV 1 1 10UpperLRTIBleeding 1 1 10Totaldeaths 5 4 1 10 100

Among the IDPs, mortality data was received from Bentiu PoC, and UN HousePoC in week 2. (Table 6). A total of 10 deaths were reported during the week.Bentiu PoC reported 9 (90%) deaths in the week. During the week, 5 (50%)deaths were recorded among children <5 years in (Table 6).

The causes of death during week 2 are shown in Table 6.

12

MortalityintheIDPs- CrudeandUnderfivemortalityrates

MortalityintheIDPs- Overallmortalityin2018

0.0

0.5

1.0

1.5

2.0

2.5

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 51 1

2017 2018

deathsper10,000perd

ay

Epidemiological week

Figure20|EWARNU5MRbySite- W12017toW2of2018

Bentiu Juba3 Malakal Threshold WauPoC

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

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 51 1

2017 2018

deathsper10,000perd

ay

Epidemiological week

Figure21|EWARNCrudeMortalityRateforW12017toW2of2018

Bentiu Juba3 Malakal Melut

The U5MR in all the IDP sites that submitted mortality data in week 2 of 2018 is below the emergency threshold of 2 deaths per 10,000 per day (Fig. 20).

The Crude Mortality Rates [CMR] in all the IDP sites that submittedmortality data in week 2 of 2018 were below the emergency thresholdof 1 death per 10,000 per day (Fig. 21).

Table 7 | Mortality by IDP site and cause of death as of W2, 2018

IDPsite acutewaterydiarrhoe

a

Asthma

cancer

HeartFailure

Kala-Azar

LiverC

irrho

sis

malaria

Men

ingitis

perin

ataldeath

pneu

mon

ia

SAM

Sepsis

Shock

Trau

ma

TB/H

IV

Unk

own

LRTIBleed

ing

Grand

Total

Bentiu 1 1 1 3 2 1 1 3 1 3 1 18

Juba3 1 1 1 1 1 5Akobo 1 1 2

GrandTotal 1 1 1 1 1 1 2 1 3 2 1 1 3 1 1 3 1 25Proportionatemortality[%] 4.0 4.0 4.0 4.0 4.0 4.0 8.0 4.0 12.0 8.0 4.0 4.0 12.0 4.0 4.0 12.0 4.0 100.0

l A total of 25 deaths have been reported from the IDP sites in 2018Table 7.

l The top causes of mortality in the IDPs in 2018 are shown in Table 7.

Formorehelpandsupport,pleasecontact:

Dr.Pinyi Nyimol MawienDirectorGeneralPreventiveHealthServicesMinistryofHealthRepublicofSouthSudanTelephone:+211955604020

Dr.MathewTutMosesDirectorEmergencyPreparednessandResponse(EPR)MinistryofHealthRepublicofSouthSudanTelephone:+211955295257

Notes

WHOandtheMinistryofHealthgratefullyacknowledgehealthclusterandhealthpooledfund(HPF)partnerswhohavereportedthedatausedinthisbulletin.WewouldalsoliketothankECHOandUSAIDforprovidingfinancialsupport.

ThedatahasbeencollectedwithsupportfromtheEWARSproject.Thisisaninitiativetostrengthenearlywarning,alertandresponseinemergencies.Itincludesanonline,desktopandmobileapplicationthatcanberapidlyconfiguredanddeployedinthefield.Itisdesignedwithfrontlineusersinmind,andbuilttoworkindifficultandremoteoperatingenvironments.ThisbulletinhasbeenautomaticallypublishedfromtheEWARSapplication.

Moreinformationcanbefoundathttp://ewars-project.org

south sudan idsr annex - w2 2018 jan 8-jan 14

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