Republic of South Sudan. Weekly Epidemiological Bulletin. Special focus on cholera. Highlights. Public Health Priorities. System performance

Transcription

1 Weekly Epidemiological Bulletin Integrated Disease Surveillance and Response (IDSR) Republic of South Sudan W14 3 rd to 9 th April 217 Highlights Completeness for weekly reporting was 6% IDSR sites and 81% for the IDP sites. Malaria remains the leading cause of morbidity in nonconflict areas while ARI is the leading cause of morbidity in the IDPs. A total of 4 suspect measles cases were reported from Gogrial West, Tonj North, Cueibet, Yambio, and Juba. Cholera outbreaks confirmed in Mayom and Fashoda. A total of 17 HEV cases reported from Bentiu POC in week 13. Suspect Guinea worm cases reported from Yambio and Tonj East. Special focus on cholera Cumulatively, 6,774 cholera cases including 221 deaths (7 facilities and 11 community) (CFR 3.2%) have been reported in South Sudan (Figs 19.2&19.3; Table 4.2) New cholera outbreak confirmed in Mayom and Kodok - with active transmission in Yirol East, Yirol West, Ayod, and Mingkaman (Figs 19.2&19.3; Table 4.2). A new cluster of suspect cholera cases reported in Tar cattle camp near Pagil in Ayod. A total of 18 counties in 1 (31%) of 32 states countrywide have confirmed cholera outbreaks (Figs 19.2&19.3; Table 4.2). Early Warning, Alert and Response Active responses TB/HIV/AIDS were the leading causes of mortality in the IDP sites Public Health Priorities Figure 1a IDSR Proportional morbidity WK 14, 217 1% AWD 2% ABD 26% Malaria 62% Measles Cholera Measles Kala azar Hepatitis E virus Active alerts: Guinea Worm Event based surveillance W14 of 217 In Week 14, only Wau state submitted event long data. Only one event involving six suspect measles cases was reported. Three blood samples were collected and shipped to Juba for testing. Investigation was initiated with 72 hours. Figure 1c Health Facility Functionality by county in W % Others Figure 1b Proportional morbidity in IDPs W % % Measles Malaria % 29% ARI AWD 1% 1% ABD Other System performance Out of the 1392 health faciltiies, 116 (84%) are currently functional and expected to report Figure 1c. Completeness for weekly reporting was 6% for the routine surveillance (IDSR sites) and 81% for the EWARS (IDP sites) (Table 1). Figure 1d IDSR Completeness by county in W During the week, 14 counties attained 1% reporting completeness. A total of 32 (4%) counties attained the target completeness of at least 8% (Figures 1c). Timeliness for weekly reporting stands at 43% for the routine reporting sites and 81% for the IDP sites (Table 1). Table 1 Surveillance performance in South Sudan as of W System Total Facilities Timelines Completeness Timeliness Completeness in week 14 of 217 Cumulative for 217 IDSR (43%) 647(6%) 413 (3%) 69 (41%) EWARN 47 38(81%) 38(81%) 37(77%) 37(77%)

2 IDSR and EWARN Reporting Performance by Partner and County in 217 Table 2 Reporting Performance [Timeliness and Completeness] by Partner and County as of W Partner Number of health facilities Completeness W This week, 22 hospitals (43%), 14 PHCCs (47%), and 471 PHCUs (46%) in 4 counties submitted their IDSR reports (Table 2). A significant improvement from the previous weeks Number of counties that did not submit any IDSR report decreased from 28 in Week 13 to 26 in week 14 (Table 2). However, six of these counties submit their data through EWARS (Table 2). Nine partner-supported health facilities in the IDP sites did not submit their reports (Table 2). Trends for top causes of Morbidity Table 4 Top causes of morbidity in 216 and 217 Timeliness # # % # % ARC 3 % % COSV % % GOAL 2 2 1% 2 1% HLSS 2 2 1% 2 1% IMA % % IMC 8 63% 63% IOM % 11 92% IRC 1 % % Medair 2 2 1% % MSF-E 2 2 1% 2 1% MSF-H 4 3 7% 3 7% SMC 6 6 1% 6 1% UNIDO % % UNKEA 2 2 1% 2 1% World Relief 1 1 1% 1% System IDSR Total % 38 81% Cumulative cases week 1 to New cases W14 Disease week 14 of Malaria 1,42 23,966 31,41 314,23 AWD 6,89 9,34 96,2 17,347 Meningitis ABD 1,143 1,487 22,22 16,84 Measles AJS IDSR IDSR No. Silent Counties W Silent Counties W Lainya Morobo Ikotos Kapoeta East Lofan Magwi Akobo Ayod Duk Fangak Nyirol Pibor Pochalla uror *Counties with EWARS reporting sites, Yirol East Yirol West Payinjiar Akoka Baliet Luakpiny/Nasir Maiwut Malakal Melut Panyikang Renk Ulang Jur River This week, the nine health facilities in the IDP sites that did not submit their reports are supported by IOM, IRC, MSF-H, IMC, and IMA (Table 2). The best performing partner-supported facilities during the week were GOAL, Medair, HLSS MSF-E, SMC, World Relief, and UNKEA Consultations Table 3 Consultations in South Sudan as of W Surveillance System Consultations in Week 14 of 217 Cumulative consultations for 217 < years years Total < years years Total IDSR 11,811 18,8 3,369 41, ,734 1,,48 EWARN 26,44 393,819 Total 6,773 1,444,277 Table 4 summarizes the consultations in the IDP and IDSR reporting sites. EWARN Total Malaria 17,699 2,463 6,746 2,713 AWD 4,64 2,17 4,629 36,18 ARI,68 7,674 8,82 16,77 ABD ,626 3,1 Measles AJS Meningitis 1 18 Malaria 22,198 26, ,74 366,716 AWD 1,923 11,1 142, , ARI,68 7,67 8,91 16,8 ABD 1,97 1,69 27,846 19,9 Measles AJS Meningitis 6,746 2,713 17,79 2,481 Overall morbidity trends for 217 Figure 6a IDSR priority disease morbidity trends W1 to W Malaria remains the top cause of morbidity in the IDSR reporting sites followed by Acute watery diarrhea while for the IDP sites ARI is the leading cause of morbidity followed by malaria.(figures 1a, 1b, 6a, 6b, Table 4). Figure 6b EWARN Priority Disease Proportionate Morbidity W2 213 to W cases per 1, population IDSR Priority Disease Morbidity trends from week 1 to week 14, of reporting in 21 Completeness ABD Malaria Measles AWD Completeness (%) Percentage of all consultations 8% 7% 6% % 4% 3% 2% 1% % %_Malaria %_ARI %_Measles %_AJS %_AWD %_ABD

3 Malaria This week malaria accounted for 26% and 1% of consultations in IDSR and IDP sites respectively (Fig. 1a, 1b). The incidence (cases per 1,) of malaria increased from 17. in week 13 to 284 in week 14. As the malaria season approaches, the incidence in week 14 of 217 is comparable to the corresponding periods in 214, 21 and 216. As seen from Figs. 8a-f, analysis of malaria trends at state level showed that malaria cases were within expected levels at state hub level.(fig 8ad). The malaria incidence in the IDP sites has remained within expected levels. (Figs. 1a-d) During the week, two malaria deaths were reported from Juba (Tables, 6). Cases per 1, Population Status: Urgent Figure 7 IDSR malaria trends by week, of reporting Malaria trends by state hub 1 Figure 8c IDSR trends for Malaria Aweil, Aweil East, Lol from week 1 to 14,217 1 Figure 8b IDSR trends for malaria Gogrial, Tonj, Twic, Wk 1 to Wk 14, cases per 1, cases per 1, Third quartile Epidemiological Week Third quartile Figure 8d IDSR trends for malaria in Western Lakes, Eastern Lakes, and Gok states, Wk 1 to Wk 14, Figure 8f IDSR trends for Malaria in Gbudwe, Maridi, and Amadi states from week 1 to 14, 217 cases per 1, Third quartile cases per 1, Third quartile Malaria 1 Figure 8a Malaria Incidence for Wau state, week 1 to 14, Malaria Incidence for Unity Northern Liech, Southern Liech, Ruweng stes from week 1 to 14, cases per 1, Third quartile Epidemiological Week 217 Third quartile *Actual disease trends may be masked by low reporting rates

4 Malaria in IDPs Acute Respiratory Infection (ARI) Percent of total consultations 3% 3% 2% 2% 1% 1% % % Figure 11 ARI trends in IDPs W1 213 to W of reporting Percent of all consultations 1% 9% 8% 7% 6% % 4% 3% 2% 1% % Figure 11b ARI Incidence by IDP Site in W MSF-H Bentiu PoC Hospital Medair Wonthow Clinic Medair Abayok Clinic GOAL Dethoma Camp 2 GOAL Koradar IDP clinic MSF-H Bentiu Town Clinic MSF-E Hospital IOM Gerger Mobile Clinic IOM Bentiu Sector 1 PoC SMC Arek Mobile Clinic IMC UN House Clinic 1 MSF-H Lankien PHCC IOM Bentiu Sector 3 PoC IOM Ramela Mobile Clinic SMC Malou IMC Akobo Hospital IMC Malakal PoC Clinic 2 IOM Cathedral IDP Camp IOM Wonthou Mobile Clinic IOM Bentiu Sector PoC IOM Malakal PoC Clinic MSF-E Malakal Town PHCC IOM Nazareth IDP Camp World Relief PHCC IOM Halaka Mobile Clinic IOM Wau PoC Clinic SMC Paktap Mobile Clinic Goa Medical Mobile Clinic SMC Padiet Mobile Clinic ARI proportionate morbidity increased from 26.9% in week 13 to 29.6% in week 14. Comparatively, the ARI proportionate morbidity in 217 is higher than the corresponding period in 214, 21, and 216. Figure 11b shows ARI morbidity by IDP site in Week 14 of 217

5 Meningitis (suspected) In week 14, there was one suspect meningitis case reported from Mayom. Even as the meningitis season is coming to an end, partners are still urged to maintain heightened surveillance, and to ensure that all patients meeting the suspect case definition for meningitis are investigated and where possible samples collected and notifications sent to the next level for prompt action. Cumulatively from week 47 of 216, a total of 18 rapid pastorex Streptococcus pneumoniae cases have been reported (Fig. 11c). Only one rapid pastorex Neisseria meningitidis Y/W13 case has been reported since week 47 of 216 (Fig. 11c). No. cases Suspect meningitis Epi-curve showing rapid pastorex results, Bentiu PoC, week 47 of 216 to week 12, 217 Week of onset H.Influenzae b N. meningitidis Y/W 13 Negative S.Pneumonlae Figure 11d shows the attack rates (cases per 1,) and case fatality rates by week for suspect meningitis cases in Bentiu PoC. While the alert threshold has been surpassed for at least four weeks since week 47, the epidemic threshold has not been reached. The current trends are still below the epidemic threshold. Surveillance for suspect cases of meningitis is high in Bentiu PoC and countrywide. Nearly 4% of the cases are below one year and 68% are below five years of age. Children and young adults constitute 3% of the cases. Males constitute 61% of the total cases reported (Table 4c). cases per 1, Suspect meningitis attack rates & CFR by week, Bentiu PoC Epi week of onset AR Alert threshold Action threshold CFR CFR [%] Heighten Surveillance for meningitis has been maintained across the country, especially in the high risk locations Like Malakal and Bentiu PoC. The second phase of the MenAfriVac preventive campaigns are slated for the fourth quarter of 217 targeting the states in the greater Upper Nile region. Table 4c: Suspect meningitis case age & sex distribution, Bentiu PoC, wk 47, 216 to wk 1, 217 Age Female Male Total Percenta <1yr % 1-4yrs % -14yrs % 1-29yrs % 3+yrs % Total %

6 Acute watery diarrhoea (AWD) AWD remains among the top three causes of morbidity in the Country, this week it accounted for 1% and `1% of all consultations in the routine reporting(idsr) and IDP sites respectively (Fig. 1a, 1b). Overall from Week 7 of 217 the AWD incidence has been on upward trend. The Incidence [cases per 1,] increased from 79 in week 13 to 19 in week 14 from the IDSR reporting sites.(fig. 12). Cases per 1, Population Figure 12 IDSR AWD trends by week, In the IDP sites, AWD morbidity has increase over the last three consecutive weeks, this week the proportionate morbidity is higher than the corresponding period in 214 but lower than 21 and 216 (Fig. 13). Figure 14 shows AWD morbidity by IDP site in Week 13 of of reporting Acute watery diarrhoea (AWD) Percent of all consultations 2% 2% 1% 1% % % Figure 13 AWD trends in IDPs W1 213 to W Percent of all consultations 4% 3% 3% 2% 2% 1% 1% % % Figure 11b AWD Incidence by IDP Site in W MSF-H Bentiu Town Clinic SMC Dorok Mobile Clinic MSF-H Lankien PHCC Medair Abayok Clinic SMC Malou SMC Paktap Mobile Clinic Medair Wonthow Clinic IMC ER PoC 1 Gap Medical Mobile Clinic SMC Ayueldit Mobile Clinic Goa Medical Mobile Clinic SMC Padiet Mobile Clinic SMC Arek Mobile Clinic IOM Wonthou Mobile Clinic MSF-E Malakal Town PHCC IOM Nazareth IDP Camp UNKEA Mandeng PHCC IOM Cathedral IDP Camp UNKEA Jikmir PHCC IOM Gerger Mobile Clinic HLSS Bor Clinic GOAL Koradar IDP clinic GOAL Dethoma Camp 2 IOM Wau PoC Clinic World Relief PHCC IMC UN House Clinic 1 IOM Bentiu Sector PoC IMC Akobo Hospital MSF-E Hospital Acute bloody diarrhoea (ABD) For the fourth consecutive week, the ABD burden remained at 2% and 1% of all consultations in the IDSR and IDP sites respectively (Fig. 1a, 1b). For the routine reporting sites ABD incidence [cases per 1,] increased from 12.9 in week 13 to 17.9 in week 14 (Fig. 1). Among the IDPs, the current ABD proportionate morbidity decreased in week 14 and still remains low compared to the corresponding period in 214, 21 and 216 (Fig. 16 and 17). Figure 17 shows the number of ABD cases by IDP clinic in week 14 of 217. Cases per 1, Population Figure 1 IDSR ABD trend by week, of reporting Acute bloody diarrhoea (ABD) 6% Figure 16 ABD trends in IDPs W1 213 to W % Figure 17 ABD Incidence by IDP Site in W Percent of all consultations % 4% 3% 2% 1% % Percent of all consultations 1% 8% 6% 4% 2% % SMC Arek Mobile Clinic GOAL Koradar IDP clinic IOM Gerger Mobile Clinic Goa Medical Mobile Clinic MSF-H Bentiu Town Clinic IOM Halaka Mobile Clinic SMC Paktap Mobile Clinic IMC Malakal PoC Clinic 2 IOM Wonthou Mobile Clinic IOM Wau PoC Clinic IOM Cathedral IDP Camp Clinic IMC UN House Clinic 1 IOM Bentiu Sector PoC Clinic SMC Padiet Mobile Clinic IOM Bentiu Sector 3 PoC Clinic MSF-H Bentiu PoC Hospital IMC UNMISS PoC Clinic MSF-H Lankien PHCC

7 Measles In Week 14, a total of 4 new suspect measles cases were reported Gogrial West (), Tonj North (3), Cueibet (1), Yambio (3) and Juba (1) (Table 4.1). Cumulatively, in 217 a total of least 61 suspect measles cases including 4 deaths (CFR.71%) have been reported from 19 counties.. Most of the cases have been reported from Wau, Gogrial East, Gogrial West and Yambio counties (Figure 18.1). The majority of the cases are under five years of age (Figure 18.3). Since the beginning of 217, measles outbreaks have been confirmed in five counties - Wau, Aweil South, Gogrial West, Gogrial East, and Juba (Table 4.1 and Figure 18.2). At least 46 measles IgM positive and 36 rubella IgM cases have been confirmed in 217 (Table 4.1 and Figure 18.2). Most counties have not attained the non-measles febrile/rash illness rate of at least 1/1, (Figure 18.4). This highlights the need to enhance measles case-based investigation and sample collection. The follow-up measles campaign is scheduled for the first and second week of May 217. County Table 4.1 Measles cases by location and status as at W14 of 217 New suspect cases W14, 217 Suspect cases in 217 Confirmed Measles 217 Confirmed Rubella 217 Samples tested in 217 Outbreak status in 217 Wau IDPs Confirmed Malakal PoC 2 2 Alert Gogrial East 43 8 Alert Gogrial West Confirmed Tonj North 3 11 Alert Aweil South Confirmed Yambio Alert Cueibet 1 1 Alert Mayom 1 Alert Nzara 3 Alert Ezo 1 Alert Aweil West 9 Aweil Center 1 Alert 1 Alert Kajo-keji Alert Juba Alert Torit 2 39 Alert Duk 1 Alert Jur River 2 2 Alert Mundri West 1 1 Alert Total Fig 18.2 Counties with confirmed measles outbreaks as at W14 of 217 Measles cases by and county, week 1-14, 217 Number of cases in 217 Juba Gogrial West Aweil South Aweil Center Malakal Wau Jur River Yambio Torit Gogrial East Fig 18.3 Measles case distribution by age group and country, week 1-14, 217 Fig 18.4 Non-measles cases Febrile/Rash illness per 1, by county as at W14 of 217 Measles case distribution by age group and county, week 1-14, 217 1% 9% 8% 7% Age distrib. % 6% % 4% 3% 2% 1% % Juba Gogrial West Aweil South Aweil Center Malakal Wau Jur River Yambio Torit Gogrial East <1yr 1-4yrs -9yrs 1-14yrs 1+yrs

8 Visceral Leishmaniasis Kala-azar In week 14, six health facilities reported 3 cases, 26 new cases, 8 relapses and 1 PKDL including 1 death and 2 defaulters reported. Since the beginning of 217, a total of 926 cases including 19 deaths (CFR 2.1%) and 6(.6%) defaulters have been reported from 16 treatment centers though only 12 treatment centers are reporting currently. Of the 926 cases reported, 761 (82.2%) were new cases, 6(6%) PKDL and 19(11.8%) relapses. In the corresponding period in 216, a total of 31 cases including 27 deaths (CFR.1%) and 2(4.7%) defaulters were reported from 21 treatment centers. Majority of cases were reported from Lankien (332), Old Fangak (313), Kurwai (11), Malakal IDP (3), Walgak (3), KCH (31) and Ulang (16). The most affected groups include, males [328 cases (4.7%)], those aged - 14years [264(29.3%) and 1years and above [23 cases (28.%)]. A total of 93 cases (1.%)] occurred in children <years. The number of cases reported in 217 is higher than those reported in 216 despite the fact that the 217 transmission is yet to start season. Hepatitis E Virus (HEV) A total of 17 HEV cases reported from Bentiu PoC (Fig. 19) were reported in Week 14. Cumulatively, a total of 19 HEV cases have been reported from Bentiu PoC in 217. The transmission is linked to sub-optimal access to safe water and sanitation. Multi-sectoral response has made some progress in reducing the incident but control is yet to be attained due to a multiplicity of factors. (Fig. 19) Cumulatively, from the beginning of the crisis, 3,443 HEV cases including 2 deaths (CFR.73%) reported in Bentiu; 174 cases including seven deaths (CFR 4.4%) in Mingkaman; 38 cases including one death (CFR 2.6%) in Lankien; 3 confirmed HEV cases in Melut; 3 HEV confirmed cases in Guit;1 HEV confirmed case in Leer; and Mayom/Abyei [7 cases including 13 deaths with 7 HEV PCR positive cases. No, cases in other sites Figure 19 HEV trends in Mingkaman, Bentiu & Lankien W1 214 to W Awerial Lankien Bentiu No. cases in Bentiu Other diseases of public health importance Acute Flaccid Paralysis Suspected Polio In Week 14, eleven (11) new AFP cases were reported with date of onset in 217 from Eastern Equatoria (2), Jonglei (1), Lakes (2), Northern Bar Ghazal(2), Unity(2), and Upper Nile (2). Table. Non Polio AFP rate by county as of Week 14 of During 217, a cumulative of 82 AFP cases have been reported countrywide. the annualized non-polio AFP (NPAFP) rate (cases per 1, population children -14 years) is 3.7 per 1, population of children -14 years (target 2 per 1, children -14 years). Stool adequacy was 9% in 217, a rate that is higher than the target of 8%. Guinea Worm Dracunculiasis During the week, suspect Guinea worm cases were reported from Yambio and Tonj East and are being investigated. More than 3, alerts have been investigated in 217 with three samples collected out of which two were negative while the third is still pending. Cumulatively in 216; six (6) confirmed Guinea worm cases were reported compared to Four (4) cases in 21. The Ministry of Health through the South Sudan Guinea Worm Eradication Program(SSGWEP) continues to offer cash reward of, SSP. for reporting a Guinea worm. Viral Haemorrhagic Fever No new suspect hemorrhagic fever cases reported from Country in the week. Animal bites Suspected rabies There were no suspect rabies cases in the week. across the

9 Cholera Figure 19.2 Cholera Epidemic curve in South Sudan as of 21 Apr 217 Cumulatively, 6,774 cholera cases including 221 deaths (7 facilities and 11 community) (CFR 3.2%) have been reported in South Sudan (Figs 19.2&19.3; Table 4.2) New cholera outbreak confirmed in Mayom and Kodok - with active transmission in Yirol East, Yirol West, Ayod, and Mingkaman (Figs 19.2&19.3; Table 4.2). Number of cases CFR [%] A new cluster of suspect cholera cases reported in Tar cattle camp near Pagil in Ayod. A total of 18 counties in 1 (31%) of 32 states countrywide have confirmed cholera outbreaks (Figs 19.2&19.3; Table 4.2). The transmission in Awerial (Dor), Yirol East (Tharnuar), and Ayod (Buol and Tar) is largely attributed to disease spread in affected cattle camps Readers are referred to the cholera situation report for details on the ongoing cholera response in South Sudan of onset Jonglei Jubek Terekeka Imatong Eastern Lakes Fangak Northern Liech Southern Liech Central Upper Nile CFR[%] Table 4.2 Cholera cases and deaths by county as of 21 April 217 Reporting sites Total cases Total Facility deaths Total community deaths Total deaths Juba county 2, Duk county Bor county Terekeka county Awerial county 1, Yirol East Yirol West 17 Pageri county Fangak county Ayod county Rubkona county Mayom county Leer county Panyijiar county Figure Mayendit county 1.: Cholera 226incidence (cases per 1,) and case fatality Pigi county rate (%) as183 of 13 October 216 Kodok Malakal 19 Total 6, Figure 19.3 Cholera incidence (cases per 1,) and case fatality rate (%) as of 21 Apr 217

10 Mortality Table Mortality from IDSR reports countrywide W Total deaths COUNTY AWD <yrs ABD <yrs Malaria <yrs <yrs Total deaths yrs Juba 2 2 Terekeka 1 1 Aweil East 1 1 Total deaths Table 6 Proportional mortality by cause of death in IDPs W Cause of Death by IDP site Akobo Bentiu Juba 3 <yrs yrs <yrs yrs <yrs yrs Acute watery diarrhoea Asthma 1 1 Sepsis 1 1 TB/HIV/AIDS Grand Total Proportionate mortality [%] 14% 7% 7% 21% In week 13 four deaths were reported through IDSR, with two deaths attributed to malaria while bloody diarrhoea and acute watery diarrhoea accounted for one death each in Terekeka and Aweil East respectively (Table ). Among the IDPs, mortality data was received from Juba 3, Bentiu, and Akobo in week 14. (Table 6). Fourteen deaths were reported from the IDP sites. Bentiu PoC reported seven deaths, the highest among the IDPs in the week. Overall, six out of the 14 deaths were children < years (Table 6). This week, TB/HIV.AIDS were the leading causes of death in the IDP Sites (Table 6). The UMR in all the IDP sites that submitted mortality data in Week 14 of 217 is below the emergency threshold of 2 deaths per 1, per day (Fig. 2). Unknown Pneumonia Aclohol 1 1 Grand Total The Crude Mortality Rates [CMR] in all the IDP sites that submitted mortality data in Week 14 of 217 were below the emergency threshold of 1 death per 1, per day (Fig. 21). The other causes of mortality in the week are shown in Tables and 6. 29% 14% 7% 1% Note: Mortality rates are calculated for PoC sites only and are based on the latest available population data from OCHA. They are reported from line lists and should include community and facility-based deaths. However, due to rapid in/out migration from the PoC sites, and possible under-reporting of community-level deaths, they should be interpreted carefully. Crude and under five mortality rates in IDPs deaths per 1, per day Figure 2 EWARN UMR by Site - W1 216 to W 14 of Overall mortality in Bentiu Juba 3 Malakal Mingkaman Melut Akobo Wau Shiluk Threshold Table 7 Mortality by IDP site and cause of death W deaths per 1, per day Figure 21 EWARN Crude Mortality Rate for W1 216 to W 14 of Bentiu Juba 3 Malakal Mingkaman Melut Akobo Wau Shiluk Threshold Wau PoC IDP site Acute watery diarrhoea GSW Heart Failure Kala-Azar malaria maternal death Meningitis Bentiu Juba Kodok Malakal Akobo Wau PoC perinatal death pneumonia SAM Septicemia Stroke TB/HIV/AIDS Cancer cholera Hypertention Others Grand Total A total of 23 deaths have been reported from the IDP sites in 217 Table 7. The top causes of mortality in the IDPs in 217 are shown in Table 7. Grand Total Proportionate mortality [%]

11 Data sources This bulletin presents disease trends from the Integrated Disease Surveillance and Response (IDSR) System and the Early Warning Alert and Disease Network (EWARN). The respective data is submitted by public health facilities serving host communities (non-conflict affected states or non IDP sites) and partner-supported facilities serving internally displaced persons (IDP) in the Republic of South Sudan. Editorial Editorial: Dr. Alice L. Igale, Dr. Abraham Adut, Korsuk L. Scopus, Robert M. Lasu, Rose A. Dagama, Jane Pita, Dr. Patrick, R. Otim, Gabriel Waat, Dr. Allan M. Mpairwe, Dr. Joseph F. Wamala, Dr. John P. Rumunu Acknowledgements MoH and WHO gratefully acknowledge the support of all MoH staff in the states, WHO Field Officers, and implementing-health cluster partners in collecting and reporting the data used in this bulletin. Contact For more information, please contact: Department of Epidemics, Preparedness and Response MoH Republic of South Sudan Outbreak toll-free line using vivacell:1144 This bulletin is produced by the Ministry of Health with technical support from the WHO Supported by the Global EWARS project