South Sudan

Annexes W27 2018 (Jul 02 – Jul 08)

Integrated Disease Surveillance andResponse (IDSR)

2

Contents

Access and Utilization| M ap of consultations by county

T he to ta l consu lta tion in the country s ince w eek 1 o f 2018 is 3 ,419,339 by hub, K w ajok reg is te red the h ighest num ber o f consu lta tions as ind ica ted in the tab le above. T he to ta l num ber o f consu lta tions by county is ind ica ted in the m ap above. S ee the key fo r m ore in fo rm ation .

3

Proportional m ortality

Proportional m orbidity

F igure 1 , above show s the proportiona l m orta lity fo r 2018, w ith m alaria be ing the m ain cause o f m orta lity accounting fo r 31 .2% of the deaths s ince w eek 1 o f 2018, fo llow ed by b loody d ia rrhoea, and acute w atery d ia rrhoea.

F igure 2 , ind ica tes the top causes o f m orb id ity in the country , w ith m alaria be ing the lead ing cause o f m orb id ity 1 ,904,816 (53 .9% ) fo llow ed by A R I, A W D and A B D respective ly s ince w eek 1 o f 2018. re fer to the figure above fo r m ore in fo rm ation .

4

Trend in consultations and key diseases

IDSR Proportionate m orbidity trends - in relatively stable states

In the relatively stable states, malaria is the top cause of morbidity accounting for 40% of the consultations in week 27 (representing an decrease from 41.5% in week 26).

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 3537

39 41 43 45 4749 51

1 3 5 7 911 13 15 17 19 21 23 25 27

201 7 201 8

Nu

mb

er o

f c

on

su

lta

tio

ns

in

Th

ou

sa

nd

s

Mo

rb

idit

y %

Ep id e m io lo g ica l w e e k o f re p o rtin g in 2 0 1 7

Fig. 1|IDSR Proportionate morbidity trends, week 1, 2017 to 27, 2018

Con su lt at ion s M al ari a AR I AWD AB D M eas l es

IDP Proportionate M orbidity trends – in displaced Population

IDP Proportionate M orbidity trends – in displaced Population

A m ong the ID P s, A R I and M alaria accounted fo r 23 .3% and 22.5% of the consu lta tions in w eek 27. T he o ther s ign ificant causes o f m orb id ity in the ID P s inc ludes A W D , S k in d iseases, and In ju ries .

T he top causes o f m orb id ity in the ID P s in 2018 inc lude A R I, M alaria , A W D , S k in d iseases, In ju ries and A B D .

0

5, 000

10, 000

15, 000

20, 000

25, 000

30, 000

35, 000

40, 000

45, 000

50, 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 3 4 5 6 7 8 9 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26

2017 2018

Cons

ulta

tions

% o

f Mob

idity

Epi week 2017 to 2018

Fig. 2|IDP Proportionate morbidity trends, week 01, 2017, to week27, 2018

Consul tat ions M alar ia ARI AWD ABD M easl es Skin diseases GSW I njur ies

22 .5%23.3%

7.9%

0.5% 0.00%

2.95%

0.00%1.83%

0. 0%

5. 0%

10 .0 %

15 .0 %

20 .0 %

25 .0 %

M al ar i a A RI A WD A BD M ea sl es S kindi sea ses

G S W I nj ur ie s

Pro

po

rtio

nat

e m

orb

idit

y [%

]

Causes of morbidity among the IDPs weeks 27, 2018

6

M alaria| Trends over time

M alaria| M aps and Alert M anagement

M alaria is the top course o f M orb id ity in the country , a to ta l o f 1 ,025,897 cases w ith 138 deaths reg is te red s ince w eek 1 o f 2018. m alaria trend fo r w eek 27 o f 2018 is above 2014, 2015, and 2016 as show n in the figure 4a , above.

S ince the beg inn ing o f the year, a to ta l o f 80 m alaria a le rts have been triggered, 44 o f those w ere verified . T he M aps above ind ica te the loca tion reporting m alaria a le rts from 2014, 2015, 2016, 2017, and 2018.

7

Acute Watery Diarrhoea| Trends over time

Acute Watery Diarrhoea| M aps and Alert M anagement

T he num ber o f A W D a lerts triggered s ince w eek 1 o f 2018 is 88 , ou t o f w h ich 52 w ere verified . M aps above h igh ligh t the areas reporting A W D a lerts from 2014 to 2018 .

A W D is one o f the top causes o f m orb id ity in the country w ith 275,921 cases reported s ince w eek 1 o f 2018 inc lud ing 14 deaths. A W D trend fo r 2018 is above 2014, and be low 2015, 2016 and 2017 as show n in figure 5a , above.

8

Acute Bloody Diarrhoea| Trends over time

Acute Bloody Diarrhoea| M aps and Alert M anagement

T ota l o f 100 a le rts w ere genera ted s ince w eek 1 o f 2018, o f w h ich 61 w ere verified by the county surve illance team . M aps ind ica ting areas triggering a le rts s ince 2014 to 2018 are show n above.

S ince w eek 1 o f 2018, a to ta l o f 38 ,890 cases o f A B D have been reported country w ide inc lud ing 14 death . A B D trend fo r 2018 is be low 2014, 2015, 2016, and 2017 respective ly . R efer to figure 6a, above.

9

M easles| Trends over time

M easles| M aps and Alert M anagement

Since the beginning of 2018, at least 436 suspect measles cases including 3 death (CFR 0.73%) have been reported. Of these, 84 suspect cases have undergone measles case-based laboratory-backed investigation with 68 samples collected out of which 14 measles IgM positive cases; 14 clinically confirmed cases; and 3 cases confirmed by epidemiological linkage.

S ince w eek 1 o f 2018, 78 a le rts o f m eas les w ere triggered and 57 o f those have been verified a t county leve l. M aps o f

a reas ra is ing a le rts from 2014 to 2018 are show n above.

10

Acute Flaccid Paralysis| Suspected Polio

M ortality in the IDPs

In week 26, 2018, Twenty four (24) new

AFP cases were reported from Lakes, Northern Bahr el Ghazal, Upper Nile,

Unity, Jonglei, and Warrap hubs. This brings the cumulative total for 2018 to 228

AFP cases.

The annualized non-Polio AFP (NPAFP) rate (cases per 100,000 population

children 0-14 years) in 2018 is 5.6 per 100,000 population of children 0-14 years

(target ≥2 per 100,000 children 0-14

years).

Stool adequacy was 84% in 2018, a rate

that is higher than the target of ≥80%.

Environmental surveillance ongoing sinceMay 2017; with 23 samples testing

positive for non-polio enterovirus (NPEV)in 2017 and Twenty four (24) NPEV

positive sample in 2018.

Source: South Sudan Weekly AFP

Bulletin

Table 6 | Proportional mortality by cause of death in IDPs W 27 2018

Among the IDPs, mortality data was received from Bentiu PoC, & UN House PoC

in week 27. (Table 6). A total of 20 deaths were reported during the week. Bentiu

PoC report 13 deaths (65%) in the week. During the week, 5 (25%) deaths were

recorded among children <5 years in (Table 6).

The causes of death during week 27 are shown in Table 6.

C au se o f D eath b y ID P site B en tiu Ju b a 3 T o tal d eath s

< 5 yrs ≥ 5 yrs ≥ 5 yrsH e art Fa ilu re 1 1

m alaria 4 4

N e o n ata l Se p sis 1 1

p e rin ata l d e ath 2 2

p n e u m o n ia 1 1

R e sp irato ry arre st 1 1

SA M 1 1

TB /H IV /A ID S 1 1

H IV /A ID S 1 1

TB 1 1

U n ko w n 2 2

B irth A sp h yx ia 1 1

Po st O p e ratio n 1 1

P.V au lce r 1 1

H B P 1 1

T o tal d eath s 5 8 7 2 0

M ortality in the IDPs - Crude and Under five mortality rates

The U5MR in all the IDP sites that submitted mortality data in week 27 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 27 of 2018 were below the emergency threshold of1 death per 10,000 per day (Fig. 21).

M ortality in the IDPs - Overall mortality in 2018

A total of 420 deaths have been reported from the IDP sites in 2018Table 7.The top causes of mortality in the IDPs in 2018 are shown in Table 7.

Table 7 | Mortality by IDP site and cause of death as of W27, 2018

0.0

1.0

2.0

3.0

1 4 7 101316192225283134374043464952 3 6 9 121518212427

2017 2018deat

hs p

er 1

0,00

0 pe

r day

Epidemiological week

Figure 20 | EW ARN U 5M R by Site - W 1 2017 to W 27 of 2018

B e nt iu Ju b a 3 M a la k al Wa u P o C A k ob o T hr e sh o ld

0.00.20.40.60.81.01.21.41.6

1 4 7 101316192225283134374043464952 3 6 9 121518212427

2017 2018deat

hs p

er 1

0,00

0 pe

r day

Epidemiological week

Figure 21 | EWARN Crude Mortality Rate for W1 2017 to W27 of 2018

B e nt iu Ju b a 3 M a la k al A k ob o Wa u P o C T hr e sh o ld

IDP site

acut

e w

ater

y di

arrh

oea

canc

er

GSW

Guns

hot w

ound

Hear

t Fai

lure

Kala

-Aza

rm

alar

iaM

enin

gitis

perin

atal

dea

th

pneu

mon

iaRa

bies

SAM

Seps

isTB

/HIV

/AID

STr

aum

a HI

V/AI

DS TB

Oth

ers

Gran

d To

tal

Bentiu 7 1 2 2 1 2 18 3 20 10 1 12 16 11 1 15 7 164 293Juba 3 1 1 2 7 4 2 1 6 7 48 79Malakal 1 3 1 1 1 2 17 26Akobo 1 2 4 2 1 2 1 1 7 21Wau PoC 1 0 1Grand Total 8 3 2 3 6 5 30 3 21 17 1 15 18 13 2 21 16 236 420Proportionate mortality [%] 2% 1% 0% 1% 1% 1% 7% 1% 5% 4% 0% 4% 4% 3% 0% 5% 4% 56% 100%

For more help and support,please contact:

Dr. Pinyi Nyimol MawienDirector General Preventive Health ServicesMinistry of HealthRepublic of South SudanTelephone: +211 955 604 020

Dr. Mathew Tut MosesDirector Emergency Preparedness and Response (EPR)Ministry of HealthRepublic of South SudanTelephone: +211 916 010 382

Notes

WHO and the Ministry of Health gratefully acknowledge health cluster and health pooled fund (HPF)partners who have reported the data used in this bulletin. We would also like to thank ECHO and USAID for providing financial support.

The data has been collected with support from the EWARS project. This is an initiative to strengthen early warning, alert and response in emergencies. It includes an online, desktop and mobile application that can be rapidly configured and deployed in the field. It is designed with frontline users in mind, and built to work in difficult and remote operating environments. This bulletin has been automatically published from the EWARS application.

More information can be found at http://ewars-project.org