Source: Health data: MoH/WHO Admin boundaries: UNOCHA Production date:

Transcription

1 The information shown on this map does not imply official recognition or endorsement of any physical, political boundaries or feature names by the United Nations or other collaborative organizations. The information shown on this map does not imply official recognition or endorsement of any physical, political boundaries or feature names by the United Nations or other collaborative organizations. Weekly Epidemiological Bulletin Integrated Disease Surveillance and Response (IDSR) Republic of South Sudan W1 6 th 12 th March 217 Highlights Completeness for weekly reporting was 49% IDSR sites and 84% for the IDP sites. Special focus on cholera A total of 31 new cholera cases reported from Awerial (31 cases) in week 11 of 217 (Figs 19.2&19.3; Table 4.2) Malaria remains the leading cause of morbidity in nonconflict areas while ARI is the leading cause of morbidity in the IDPs. A total of 33 suspect measles cases were reported from Rimenze- Yambio, Ezo, and Wau. Three meningitis cases were reported from Bentiu PoC - all positive for Streptococcus pneumoniae by rapid pastorex. Chickenpox cases continue to be reported from Wau PoC with the current response focusing on case management and health education. Complications of TB/HIV/AIDs was the leading cause of Mortality in IDPs sites in Week 1. Public Health Priorities Figure 1a IDSR Proportional morbidity WK 1, % 1% 2% 29%.1 AWD ABD Malaria Measles Others Cases continue to be reported from Yirol East with most cases reported from Guthom and Kaduwaw Islands. Main source of cases are the Islands (Pabulek and Kaduwaw) and cattle camps around Guthom. (Figs 19.2&19.3; Table 4.2). Cumulatively, 5,691 cholera cases including 14 deaths (63 facilities and 77 community) (CFR 2.46%) have been reported in South Sudan (Figs 19.2&19.3; Table 4.2). Early Warning, Alert and Response Active responses Cholera Measles Kala azar Hepatitis E virus Guinea worm Active alerts: Meningitis Event based surveillance W1 of 217 Central Equatoria hub submitted event-based data with Juba reporting one AFP case. Investigation was initiated within 72 hours. In Terekeka; 4 suspectcholera cases were reported from Tijor. The RRT investigations ruled out cholera and confirmed food poisoning as the cause. Figure 1c -d IDSR Completeness by county in W1 and Weeks Figure 1b Proportional morbidity in IDPs W1 217 Completeness of Health Facilities reporting by Counties, Week 1 Measles Sudan Manyo Renk Legend International Boundaries State Boundaries 52% % 11% 28% 1% 8% Malaria ARI AWD ABD Other CAR Melut Upper Nile Maban Fashoda Abyei Pariang Malakal Abiemnhom Panyikang Baliet Aweil North Aweil East Rubkona Twic Guit Longochuk Mayom Fangak Canal/Pigi Aweil West Unity Northern Bahr el Ghazal Luakpiny/Nasir Aweil South Maiwut Raga Gogrial WestGogrial East Koch Nyirol Ulang Aweil Centre Ayod Tonj North Warrap Mayendit Leer Tonj East Panyijiar Duk Uror Akobo Western Bahr el Ghazal Rumbek North Wau Jonglei Jur River Cueibet Twic East Pochalla Tonj South Rumbek Centre Yirol East Rumbek East Lakes Nagero Bor South Yirol West Pibor Wulu Awerial Tambura Mvolo Counties Boundaries NR 1-2% 21-4% 41-6% 61-8% 81-1% Ethiopia Terekeka System performance Completeness for weekly reporting was 46% for the routine surveillance(non IDP sites) and 84% for the EWARS (IDP sites) (Table 1). This week, Twelve (12) counties attained 1% completeness in reporting. Overall 23 counties attained the target completeness of at least 8% (Figures 1c) in week 1 compared to 29 and 25 in Weeks 9 and 8 respectively Timeliness for weekly reporting stands at 26% for the routine reporting sites and 84% for the IDP sites (Table 1). Table 1 Surveillance performance in South Sudan as of W1 217 Source: Health data: MoH/WHO Admin boundaries: UNOCHA Production date: Ezo µ Kilometers Western Equatoria Nzara Yambio Ibba DRC Sudan Mundri East Mundri West Maridi Yei Central Equatoria Juba Lainya Morobo Kajo-Keji Cummulative of Health Facilities reporting by Counties, Week 1-1 CAR Magwi Lafon Torit Kapoeta North Ikotos Eastern Equatoria Kapoeta South Budi Uganda Legend Kapoeta East Kenya International Boundaries State Boundaries Counties Boundaries NR 1-2% 21-4% 41-6% 61-8% 81-1% Ethiopia System Total Facilities Timelines Completeness Timeliness Completeness in week 1 of 217 Cumulative for 217 IDSR (26%) 521(46%) 394(28%) 543(39%) EWARN 45 38(84%) 38(84%) 33.8(69%) 36.1(74%) Source: Health data: MoH/WHO Admin boundaries: UNOCHA Production date: µ Kilometers DRC Uganda Kenya

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 W1 217 Partner Number of health facilities Completeness W1 217 This week, only 2 hospitals (39%), 133 PHCCs (41%), and 368 PHCUs (36%) in 5 counties submitted their IDSR reports (Table 2). Number of counties that did not submit any IDSR report decreased from 36 in week 9 to 3 in week 1 (Table 2). However eight of these counties submit their data through EWARS (Table 2). Seven partner-supported health facilities in the IDP sites did not submit their reports (Table 2). Trends for top causes of Morbidity Timeliness # # % # % COSV % % GOAL 2 2 1% 2 1% HLSS 3 3 1% 3 1% IMA 5 3 6% 3 6% IMC 6 6 1% 6 1% IOM % 11 1% IRC 1 % % Medair 2 2 1% 2 1% MSF-E 2 2 1% 2 1% MSF-H SMC % 5 83% UNIDO % % UNKEA 2 % % World Relief 1 1 1% 1 1% Total % 38 84% Table 4 Top causes of morbidity in 216 and 217 week1 of IDSR Malaria 21,623 18,54 24, ,66 AWD 7,593 6,74 63,339 69,465 Meningitis ABD 1,44 1,135 12,684 1,815 Measles AJS 6 13 EWARN Malaria 6, , AWD 3,5 2, ARI , ,418 ABD , System Disease New cases W1 Cumulative cases week 1 to Measles AJS Meningitis 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). IDSR IDSR No. Silent Counties W9 217 Silent Counties W9 217 Lainya Morobo Kapoeta North Magwi Akobo* Ayod Canal/Pigi Fangak Nyirol* Pibor Pochalla uror Awerial* Cueibet Baliet Luakpiny/Nasir* Maiwut *Counties with EWARS reporting sites, Malakal* Melut Panyikang Renk* Jur River Rumbek East Wulu Yirol East Aweil East Aweil West Guit Koch Akoka This week seven health facilities in the IDP sites that did not submit their reports are supported by SMC, UNKEA, IRC, MSF-H and IMA (Table 2). The best performing partner-supported facilities during the week were GOAL, MSF-E, MedAir, IMC, IOM, World Relief and HLSS. Consultations Table 3 Consultations in South Sudan as of W1 217 Surveillanc e System Consultations in week 1 of 217 Cumulative consultations for 217 <5 years 5 years Total <5 years 5 years Total IDSR ,369 65,2 261,12 413, ,433 EWARN 26,75 251,174 Total 91,77 925,67 Figure 4b Cumulative for top causes of morbidity as of week 1 of 216 and 217 Disease/Year Malaria ,219 AWD ,83 ARI* ABD ,832 AJS Measles Meningitis *ARI is only reported on from the IDP sites Overall morbidity trends for 217 Figure 6a IDSR priority disease morbidity trends W1 to W9 217 Figure 6b EWARN Priority Disease Proportionate Morbidity W to W 217 cases per 1, population IDSR Priority Disease Morbidity trends from week 1 to week 1, of reporting in 215 Completeness ABD Malaria Measles AWD Completeness (%) 8% 7% Percentage of all consultations 6% 4% 3% 2% 1% % %_Malaria %_ARI %_Measles

3 Malaria Malaria remains the leading cause of morbidity across the country, accounting for 28 % and 11% of all consultations in the IDSR and IDP sites respectively (Fig. 1a, 1b). The incidence (cases per 1,) of Malaria decreased from in Week 9 to Comparatively, the incidence in week 9 of 217, is similar to the same period in 214 and As seen from Figs. 8a-f, analysis of malaria trends at state level showed that malaria cases were within expected levels in some of the states*.(fig 8a-d). The malaria incidence in the IDP sites has remained within expected levels. (Figs. 1a-d) A total of Nine (9) malaria deaths were reported from Aweil west (2); Torit(3) and Mundri West(4) (Tables 5, 6). Cases per 1, Population Status: Urgent Figure 7 IDSR malaria trends by week, of reporting Malaria trends by state hub cases per 1, Figure 8c IDSR trends for Malaria Aweil, Aweil East, Lol from week 1 to 1,217 cases per 1, Figure 8b IDSR trends for malaria Gogrial, Tonj, Twic, Wk 1 to Wk 1, Third quartile Epidemiological Week Third quartile Figure 8a Malaria Incidence for Wau state, week 1 to 1, Figure 8f IDSR trends for Malaria in Gbudwe, Maridi, and Amadi states from week 1 to 1, 216 cases per 1, 1 5 cases per 1, Third quartile Third quartile Malaria cases per 1, Figure 8d IDSR trends for malaria in Western Lakes, Eastern Lakes, and Gok states, Wk 1 to Wk 1, Malaria Incidence rate for Upper Nile State from week 1 to 1, Third quartile Epidemiological Week 217 Third quartile *Actual disease trends may be masked by low reporting rates

4 Malaria in IDPs 1, Figure 1a Malaria trend for IDPs in Bentiu PoC 215 to 217 1, Figure 1b Malaria trend for IDPs in Malakal PoC 215 to 217 cases per 1, Week of reporting incidence 217 Third quartile incidence 215 incidence 216 cases per 1, Week of reporting incidence 215 incidence 217 Third quartile incidence Figure 1c EWARN trends for Malaria in UN House PoC 215 to Figure 1 EWARN trends for Malaria in Renk, 215 to 217 cases per 1, Week of reporting incidence 217 incidence 215 incidence incidence 215 incidence 216 incidence 217 Third quartile Acute Respiratory Infection (ARI) Percent of total consultations 3 3% 2 2% 1 1% % Figure 11 ARI trends in IDPs W to W of reporting Percent of all consultations 4 4% 3 3% 2 2% 1 1% % Figure 11b ARI Incidence by IDP Site in W1 217 SMC Malou IOM Ramela Mobile Clinic IMC UN House Clinic 1 MSF-H Bentiu Town Clinic IMC Malakal PoC Clinic 1 IMC Malakal PoC Clinic 2 GOAL Koradar IDP clinic IMA Kodok Mobile Clinic IOM Gerger Mobile Clinic IOM Bentiu Sector 5 PoC Clinic IOM Malakal PoC Clinic IRC Sector 4 Clinic IOM Cathedral Church IDP GOAL Dethoma Camp 2 IMA Delal Ajak Mobile Clinic IOM Bentiu Sector 1 PoC Clinic IOM Wonthou Mobile Clinic IOM Nazareth IDP Camp Clinic HLSS Bor Clinic IMC ER PoC 1 MSF-E Malakal Town PHCC IOM Bentiu Sector 3 PoC Clinic SMC Padiet Mobile Clinic SMC Arek Mobile Clinic World Relief PHCC IOM Wau PoC Clinic IOM Halaka Mobile Clinic Aburoc PHCU MSF-E Hospital The ARI proportionate morbidity increased from 23% in week 9 to 28% in Week 1. Overall the ARI trend in 217 is still high compared to same period in 214, 215 and 216. Figure 11b shows ARI morbidity by IDP site in week 1 of 217, the reporting site with the highest Proportionate morbidity of ARI is Malou SMC Clinic with ARI constituting 46% of all consultations.

5 Meningitis (suspected) There were three new meningitis cases from Bentiu PoC in week 1. Two of the cases were positive for Streptococcus pneumoniae by rapid pastorex. Since 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/W135 case has been reported since week 47 of 216 (Fig. 11c). 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. No. cases Fig. 11c: Suspect meningitis Epi-curve showing rapid pastorex results, Bentiu PoC, week 47 of 216 to week 1, 217 Week of onset H.Influenzae b N. meningitidis Y/W 135 Negative S.Pneumonlae Nearly 4% of the cases are below one year and 68% are below five years of age. Children and young adults constitute 53% of the cases. Males constitute 61% of the total cases reported (Table 4c). Heighten Surveillance for meningitis has been maintained across the country, especially in the high risk locations Like Malakal and Bentiu PoC. This being the meningitis Season all health facilities and Partners have been urged to increase their index of suspicion, 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. 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. cases per 1, Fig. 11d: Suspect meningitis attack rates & CFR by week, Bentiu PoC Epi week of onset AR Alert threshold Action threshold CFR Table 4c: Suspect meningitis case age & sex distribution, Bentiu PoC, wk 47, 216 to wk 1, 217 Count of SN Column Labels Age Female Male Total Percentage <1yr % 1-4yrs % 5-14yrs % 15-29yrs % 3+yrs % Total % CFR [%]

6 Acute watery diarrhoea (AWD) In week 1 AWD accounted for 1% and `1% of all consultations in the routine reporting(idsr) and IDP sites respectively (Fig. 1a, 1b). In Week 1, the overall AWD incidence [cases per 1,] decreased from 64.3 in Week 9 to 54.8 in the IDSR reporting sites.(fig. 12). In the IDP sites, AWD morbidity in week 1 is lower than the same in 214, 215 and 216 (Fig. 13). Figure 14 shows AWD morbidity by IDP site in week 9 of 217 Cases per 1, Population Figure 12 IDSR AWD trends by week, of reporting Acute watery diarrhoea (AWD) Percent of all consultations 2 2% 1 1% % Figure 13 AWD trends in IDPs W to W Percent of all consultations 3 3% 2 2% 1 1% % Figure 11b AWD Incidence by IDP Site in W1 217 MSF-H Bentiu Town Clinic GOAL Dethoma Camp 2 IMC ER PoC 1 SMC Malou Gap Medical Mobile Clinic SMC Padiet Mobile Clinic IMC Malakal PoC Clinic 1 SMC Paktap Mobile Clinic Aburoc PHCU HLSS Bor Clinic MSF-E Hospital IMC Malakal PoC Clinic 2 IOM Bentiu Sector 1 PoC MSF-E Malakal Town PHCC GOAL Koradar IDP clinic IOM Ramela Mobile Clinic IOM Gerger Mobile Clinic IRC Sector 4 Clinic IOM Wonthou Mobile Clinic IOM Nazareth IDP Camp IOM Bentiu Sector 5 PoC IOM Halaka Mobile Clinic IOM Cathedral Church IDP IOM Bentiu Sector 3 PoC IMC UN House Clinic 1 Goa Medical Mobile Clinic IMA Delal Ajak Mobile Clinic IOM Wau PoC Clinic IMA Lul Mobile Clinic Acute bloody diarrhoea (ABD) In Week 1 ABD accounted for 1% and 2% of all consultations in the IDSR and IDP sites respectively (Fig. 1a, 1b). For the routine reporting sites ABD incidence [cases per 1,] in the reporting increased from 7.8 in Week 9 to 9.3 in week 1 (Fig. 15). Among the IDPs, the current ABD burden declined in Week 1 and is lower than the corresponding period in (Fig. 16 and 17). Cases per 1, Population Figure 15 IDSR ABD trend by week, of reporting Figure 17 shows the number of ABD cases by IDP clinic in week 8 of Percent of all consultations Acute bloody diarrhoea (ABD) 6% 4% 3% 2% 1% % Figure 16 ABD trends in IDPs W to W % 8% 7% 6% 4% 3% 2% 1% % Percent of all consultations IMA Lul Mobile Clinic GOAL Koradar IDP clinic Goa Medical Mobile Clinic IMA Delal Ajak Mobile Clinic Figure 17 ABD Incidence by IDP Site in W1 217 Aburoc PHCU IOM Cathedral Church IDP MSF-H Bentiu Town Clinic IMC ER PoC 1 SMC Paktap Mobile Clinic IOM Nazareth IDP Camp IOM Bentiu Sector 1 PoC IOM Malakal PoC Clinic IOM Wonthou Mobile Clinic IMC UNMISS PoC Clinic IOM Bentiu Sector 5 PoC IMC Akobo Hospital IOM Ramela Mobile Clinic IMC Malakal PoC Clinic 1

7 Measles A total of 15 new suspect measles cases were reported from Rimenze IDP camp (Yambio); one suspect case from Ezo and 17 cases from Wau PoC in week 1. (Table 4.1). The case cluster in Rimenze-Yambio was investigated by the SMOH and MSF Spain. Samples collected for confirmation. During the week of 27 February 217; there were 8 measles IgM positive cases confirmed in Gogrial west; 2 measles IgM positive cases in Juba; and 1 measles IgM positive cases from Wau PoC. There were 19 confirmed rubella IgM positive cases from Wau PoC. With Ongoing Intervention in Wau IDP site, the measles cases continue to decline. The follow-up measles campaign is scheduled for 17 to 28 April 217. Table 4.1 Measles cases by location and status as at W9 of 217 County New suspect cases W1, 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 42 8 Alert Gogrial West Confirmed Tonj North 3 Alert Aweil South Confirmed Yambio Alert Nzara 1 Alert Ezo 1 1 Alert Aweil West 1 1 Alert Kajo-keji 5 Alert 14 Figure 18.1 Measles cases, Wau, 216 and 217 Juba Alert Duk 15 Alert Mundri West 1 1 Alert Total Number of cases Week of rash onset 217 Aive Deaths Table 4.2 New Laboratory updates released in the week of 27 Feb 217 CounAes Measles Rubella Pending IgM -ve IgM +ve IgM -ve IgM +ve WBG (Wau) County Nzara County Gogrial West 8 8 County Juba County Mundri West County 1 1 2

8 Visceral Leishmaniasis Kala-azar In week 1, four (4) health facilities reported 26 cases, 24 new cases, 1 relapses and 1 PKDL. No death or defaulters reported. Since the beginning of 217, a total of 695 cases including 11 deaths (CFR 1.6%) and 1 (.1%) defaulters have been reported from 15 treatment centers. Of the 695 cases reported, 588(84.6%) were new cases, 44(6.3%) PKDL and 63(9.1 %) relapses. In the corresponding period in 216, a total of 45 cases including 16 deaths (CFR 4.%) and 17(4.2%) defaulters were reported from 21 treatment centers. Majority of cases were reported from Old fangak (262) Lankien (232), Kurwai (79), Malakal IDP (29) Walgak (28), and Ulang (14) etc The most affected groups included, males [241 cases (54.7%)], those aged 15years and above [197 (45.) and 5-14years [177 cases (41.3)]. A total of 67 cases (15.7%)] occurred in children <5years. Hepatitis E Virus (HEV) Eighteen (18) HEV cases reported from Bentiu PoC (Fig. 19) were reported in week 1. Since the beginning of 217, a total of 138 HEV cases have been reported from Bentiu PoC. The transmission of HEV is also reported in Bentiu town and all have been linked to sub-optimal access to safe water and sanitation.. Cumulatively, from the beginning of the crisis, 3,386 HEV cases including 25 deaths (CFR.74%) 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 [57 cases including 15 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 Table. Non Polio AFP rate by county as of week 1 of 217 In Week 9, Two (2) new AFP cases were reported with date of onset in 217 from Northern Bar Ghazal (2) and Western Equatoria Hub (1). During 217, a cumulative of 3 AFP cases have been reported countrywide. the annualized non-polio AFP (NPAFP) rate (cases per 1, population children -14 years) is 2.1 per 1, population of children -14 years (target 2 per 1, children -14 years). Stool adequacy was 89% in 217, a rate that is higher than the target of 8%. Guinea Worm Dracunculiasis In week 1, there was no report of any suspected Guinea worm from across the Country. Cumulatively in 216; six (6) confirmed Guinea worm cases were reported compared to Four (4) cases in 215. The Ministry of Health through the South Sudan Guinea Worm Eradication Program(SSGWEP) continues to offer cash reward of 5, SSP. for reporting a Guinea worm. Viral Haemorrhagic Fever No new suspect hemorrhagic fever cases reported from Country in week 1. Animal bites Suspected rabies There were no suspect rabies cases in the week 1. across the

9 Cholera Figure 19.2 Cholera Epidemic curve in South Sudan as of 22 Mar 217 A total of 31 new cholera cases reported from Awerial (31 cases) in week 11 of 217 (Figs 19.2&19.3; Table 4.2) Cases continue to be reported from Yirol East with most cases reported from Guthom and Kaduwaw Islands. Main source of cases are the Islands (Pabulek and Kaduwaw) and cattle camps around Guthom. (Figs 19.2&19.3; Table 4.2). Cumulatively, 5,691 cholera cases including 14 deaths (63 facilities and 77 community) (CFR 2.46%) have been reported in South Sudan (Figs 19.2&19.3; Table 4.2). Number of cases of onset Jonglei Jubek Terekeka Imatong Eastern Lakes Western Bieh Northern Liech Southern Liech Central Upper Nile CFR[%] CFR [%] Table 4.2 Cholera cases and deaths by county as of 22 Mar 217 Readers are referred to the cholera situation report for details on the ongoing cholera response in South Sudan Reporting sites Total cases Total Facility deaths Total community deaths Total deaths Juba county 2, Duk county Bor county Terekeka county Awerial county Yirol East Pageri county Fangak county Rubkona county Leer county Panyijiar county Mayendit county Pigi county Figure Malakal 1.: Cholera16incidence (cases per 1,) and case fatality Total rate (%) as5,691 of 13 October Figure 19.3 Cholera incidence (cases per 1,) and case fatality rate (%) as of 22 Mar 217

10 Mortality Table 5 Mortality from IDSR reports countrywide W1 217 Table 6 Proportional mortality by cause of death in IDPs W1 217 Malaria <5yrs Malaria 5yrs Total deaths <5yrs Total deaths 5yrs County Juba 2 2 Mayendit 1 1 Aweil North 1 1 Total Four (4) deaths were reported through IDSR in Week 1, All were attributed to malaria (Table 5). One out of the four deaths were in children aged 5 years or younger. Mortality data was submitted from Akobo, Bentiu, Juba 3, Malakal and Kodok IDP sites. (Table 6), Nineteen (19) deaths were reported from these sites in Week 1. Bentiu PoC continues to report the highest mortality with 11 out of the 19 deaths reported. Overall 5 out of the 19 deaths were children aged <5 years (Table 6). This week TB/HIV/AIDS was the leading cause of Mortality in the IDP Sites(Table 6). The U5MR in all the IDP sites that submitted mortality data in week 1 of 217 is below the emergency threshold of 2 deaths per 1, per day (Fig. 2). Akobo Bentiu Juba 3 Kodok Malakal Cause of Death by IDP site 5 <5yrs 5 5 <5yrs 5 5 Grand Total Proportionate mortality [%] chronic illness Renal failure Severe malaria TB/HIV/AIDS Unknown severe pneumonia CA stomach Prematurity Still birth Grand Total The Crude Mortality Rates [CMR] in all the IDP sites that submitted mortality data in week 1 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 5 and 6. 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 U5MR by Site - W1 216 to W1 of deaths per 1, per day Figure 21 EWARN Crude Mortality Rate for W1 216 to W 1 of Bentiu Juba 3 Malakal Mingkaman Melut Akobo Wau Shiluk Threshold Bentiu Juba 3 Malakal Mingkaman Melut Akobo Wau Shiluk Threshold Wau PoC Overall mortality in 217 Table 7 Mortality by IDP site and cause of death W1 217 IDP SITE TB/HIV/AIDS Unknown Severe malaria severe pneumonia SAM AWD Chronic illness Cardiac arrest Sepsis Heart Failure Meningitis chronic illness CA stomach IUFD Renal failure Kala-Azar GSW maternal death Bentiu Juba Kodok Malakal Akobo others Grand total A total of 189 deaths have been reported from the IDP sites from since Week 1 of 217. (Table 7). The top causes of mortality in the IDPs in 217 are shown in table 7. Wau PoC 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