Cholera in South Sudan

Transcription

1 Republic of South Sudan Cholera in South Sudan Situation Report # 9 as at :59 Hours, 5- September 4 Situation Update As of September 4, a total of 6,8 cholera cases including 9 (CFR.7%) had been reported in South Sudan as summarized in Tables and. Table. Summary of cholera cases reported in Juba County, April September 4 Reporting Sites admisions 5- Sept 4 discharges 5- Sept 4 5- Sept 4 cases currently admitted facility community cases discharged JTH CTC Gurei CTC (changed to ORP) Closed 8 July Tongping CTC Closed August cases 69 7 Jube /UN House CTC Closed August Nyakuron West CTC Closed 5 July 8 8 Gumbo CTC Closed 5 July Nyakuron ORP Closed 5 July Munuki ORP Closed 5 July 8 8 Gumbo ORP Closed 5 July 67 7 Pager PHCU Other sites N.B. To prevent double counting of patients, transferred cases from ORPs to CTCs are not counted in the ORPs. Table : Summary of cholera cases reported outside Juba County, April September 4 States CES Reporting Sites admisions 5- Sept 4 discharges 5- Sept 4 5- Sept 4 cases currently admitted facility community cases discharged Kajo-Keji civil hospital Yei Hospital WES Lanyi- Mundri East -- Jonglei Kolmanyang, Bor -- Nimule Hospital 6 6 OTC PHCC, Magwi Magwi PHCC 5 8 Pajok PHCC, Magwi -- Nyolo CTC, Magwi 5 5 Idali PHCU, Lafon Lwala PHCU, Pachidi payam, Lafon -- Longiro PHCU,Lafon cases EES Lalanga PHCU, Lafon 6 65 Torit Hospital Bur Mutram PHCU, Bur Ohiri PHCC, Bur Ohila PHCC, Bur Imurok PHCU, Imurok Hiyala PHCC, Torit Olere PHCU, Imurok Osito PHCU, Bur payam, Torit

2 States Reporting Sites Ileu PHCU, Hiyala payam, Torit Hileu PHCC, Himodonge Payam, Torit Ofiri PHCU, Kudo Kudo PHCC, Kudo Moti PHCU, Ifwotu, Torit Riwoto PHCC, Kapoeta North SSRCORPs, Nyong St. Theresa, Isohe, Ikotos Ibahure PHCC, ibahure Payam, Lopa/Lafon admisions 5- Sept 4 discharges 5- Sept 4 5- Sept 4 cases currently admitted facility community cases discharged Other sites -- 4 cases Kaka -- Upper Nile Wau Shilluk, Malakal Malakal PoC Other sites x: Facilities not reporting; -- no cases reported for at least two weeks Figure : South Sudan Cholera Epidemic Curve, week 7-8, 4 No Cases Epidemiological week 4 WES UNS EES CES Figure : Cholera Case Distribution by Age, Sex and State week CES EES CES EES <5yrs 5YRS Female Male

3 Figure : Cholera Cases in Juba County during week 8, 4 Lologo Jebel Dinka Karpeto Kelang Jibi/Karpeto Gwadiang Gumbo Munuki Kator Northern Bari Lobonok Rejaf Munuki Figure 4: Cholera Cases in Magwi County during week 8, 4 Malakia East Motoyo East Malakia West Nimule Figure 5: Cholera Cases in Kapoeta North County during week 8, 4 Natil Najie (Natil) Malibakanyit Karakamoge

4 Table. Cholera alerts reported between 5, August 4 Date of Details of the alert Area Action notification 4/8/4 Pager PHCU reported a cluster of nine Lobonok - Verification conducted by the county (9) acute watery diarrhoea cases Payam, Juba, surveillance team including five (5 ) community. The cases have been reported from two () villages (Karpeto & Pager) in CES - The WHO has supplied case management supplies and a tent to accommodate the suspect cases Lobonok Payam, Juba County. By September 4; the cases had risen - WASH interventions at the community level are still pending to 48 including six (6) [five community & one death in the health facility]. - A joint mission of MoH and partners visited Lobonok during week 7 assess the outbreak and support the response Surveillance and laboratory A total of new cholera cases were reported in Juba County in week 8 with the majority being reported in Juba 4 (%), while the rest were reported from Torit (4 cases), Kapoeta North ( cases), and Magwi ( cases) as illustrated in Figures to 5. There were no new cholera cases reported from the rest of the counties in week 8. As seen from Figure, the cholera trend is on the decline in all the five states where cholera has been confirmed. Overall, 87 (4.4%) of the samples tested have been positive for cholera by culture. Due to the declining cholera trend, it is recommended that all new suspect cholera cases have samples obtained for laboratory confirmation. Case management Management of new cholera cases is ongoing in Juba, Nimule, Torit, and Kapoeta North where new cases were reported during week 8. Adequate supplies have been availed to support case management activities in the cholera treatment centres where the cases are being treated. Social mobilization Social Mobilization efforts and responses are ongoing in Central Equatorial states, Eastern Equatorial State, Jonglei and Upper Nile where some AWD/Cholera cases are still being reported in some areas. In Central Equatoria State, Mumuki and Gudele in Juba town, Lobonok payam and Kajo-Keji continue to be affected by cholera. SMOH, CRS and ACF social mobilizers and hygiene promoters are distributing aquatabs and cholera information, education and communication (IEC) materials in the villages. In Eastern Equatoria State, Save the Children continues with social mobilization on the prevention of cholera and other diarrheal disease in Torit and Lopa-Lafon. Altogether 45 households comprising,68 people were reached with 45 bars of soap; 49 sachets of oral rehydration salts (ORS); and,45 tablets of pur. In Jonglei State social mobilization volunteers reached,84 people with non-food items (NFI) and cholera prevention messages. Three community meetings took place and were attended by 8 community leaders including religious, local chiefs, youth and women group leaders. - A video play was screened at Royal Junior School and reached pupils and four teachers. IEC materials comprising banners and stickers were produced and four solar radios given to the teachers. - Radio Jonglei MF95 continues to play cholera awareness campaign messages in English, Arabic, Dinka and Nuer. - A radio talk with the Bor municipality health officer took place last Friday, during which teachers were educated on cholera control and prevention. The children also practiced and demonstrated hand washing with water and soap. - Radio Jonglei FM 95.9 continues with Radio spot messages on cholera prevention and control broadcast six times daily after every program. The messages reach listeners within Bor county. - To date 69, 5 households and schools have been reached countrywide with cholera prevention and control messages. Community skills are being strengthened on safe drinking water and rehydration through ORS and sugar salt solution (SSS) with the help,9 social mobilizers. WASH WASH efforts and responses are ongoing in Central and Eastern Equatoria states where some AWD cases are still being reported in some areas. Central Equatoria State Juba County Interventions by WASH partners continue and include: Provision of safe drinking water in markets for hand washing. Community mobilization, hygiene promotion, cholera awareness and prevention messages. Distribution of Aqua tablets to 76 restaurants. Lobonok County 4

5 Mobilization and selection of community hygiene promoters have been conducted successfully. Ten community hygiene volunteers were trained to disseminate key cholera messages to the community. Awareness on cholera was undertaken in the community of Kelang area with 87 individuals reached. Two hundred households in Kelang area were registered for NFI distribution. Eastern Equatoria State Torit County House to house hygiene promotion continues in efforts to create awareness of water handling and hand-washing at critical times among the community. This is complemented by hygiene promotion through a weekly radio talk show. Safe water supply through the water treatment units and repair of hand pumps is ongoing. Additional collection points have been set up through water trucking in order to increase safe water supply to the communities who are far from the collection points at treatment units. Magwi County Rehabilitation of wells and water systems at health facilities; Distribution and demonstration on proper use of water treatment reagents; House to house hygiene promotion; Distribution of Jerri cans and soap; and Training of hygiene promoters continue. Ikwoto County Partners continue to conduct hygiene promotion awareness, repair of water schemes and distribution of the relevant WASH NFIs. In Lopa-Lafon, hygiene promotion was conducted and supplemented with the distribution of WASH NFIs comprising soap, aqua tabs and ORS in Lohutok and Hejuhiteng payams. Altogether 4,6 households received soap and water treatment tablets. Kapoeta South County Rehabilitation of wells and hygiene promotion targeting cholera hot spots is on-going, including distribution of soap for hand washing and water treatment tablets for household use. Gaps and needs Case management, surveillance and laboratory Submission of updated cholera line lists to the Ministry of Health needs to be strengthened. Cholera treatment centres should submit samples from new cases for laboratory testing. This will guide decisions on the end of outbreak declarations in the affected counties. Social mobilization Access to counties outside Bor remains a challenge due to poor road condition and insecurity. There are huge gaps in monitoring and supervision activities as well as dissemination cholera messages to reach target beneficiaries in locations outside Bor County and Twic East. In Central Equatoria State, gaps include overall lack of knowledge on cholera prevention and good hygiene practices; lack of access to clean water and sanitation; lack of soap for hand washing and lack of solid waste disposal options. In Lobonok Payam, inaccessibility of some villages due to the poor road network; inadequate health facilities; a shortage of health workers (Karpeto PHCU has only one community health worker); lack of toilets in many villages resulting to open defecation; and a high rate of illiteracy are putting the population at a high risk of cholera. Conclusions and Recommendations Overall, cholera is on the decline countrywide. The following are the key recommendations: Rollout targeted and comprehensive interventions to the affected villages in Lobonok Payam in Central Equatorial state and to Magwi & Kapoeta North Counties in Eastern Equatoria. Sustain interventions to the other affected counties in the areas of case management, surveillance and laboratory, social mobilization and WASH. Evaluate the overall response to the cholera outbreak so as to document experiences and lessons learnt for improving future response. Update development plans to ensure that areas at high-risk for cholera are prioritised for risk communications and other evidence based interventions for improving the construction and use of appropriate sanitary facilities and improving access to safe water. Many thanks to the staff at CTCs, MoH at national level and state levels, especially the Department of IDSR, who have helped to gather the information presented here. Situation Reports are posted on the WHO website: as well as on the Humanitarian Info webpage: The MoH/WHO surveillance team welcomes feedback and data provided by individual agencies. Given the fast evolving nature of this epidemic, errors and omissions are inevitable: we will be grateful for any information that helps to rectify 5

6 these. Send any comments and feedback to: The Toll free numbers for alerts are: Gemtel: 9999, Vivacell: 9598 and Zain: 998. Contacts For more information please contact: Dr. John P. Rumunu Director General - Preventive Health Services MoH, Republic of South Sudan Tel: Dr. Thomas Akim Ujjiga Ag. Director - IDSR MoH, Republic of South Sudan Tel: