South Sudan. Integrated Disease Surveillance and Response (IDSR) Annexes W (Mar 12 March 18)

Transcription

1 South Sudan Integrated Disease Surveillance and Response (IDSR) Annexes W 28 (Mar 2 March 8)

2 Contents Access and Utilization Map of consultations by county Map Map of total consultations by county (W 28) Hub W 28 Raja Renk Manyo Melut Fashoda Maban Abyei Pariang Malakal Abiemnhom Panyikang Baliet Aweil North Aweil East Rubkona Longechuk Twic Guit Mayom FangakCanal Pigi Aweil West Luakpiny Nasir Aweil South Maiwut Gogrial Gogrial West East Koch Nyirol Ulang Aweil Centre Tonj North Mayendit Leer Ayod Tonj East Akobo Jur River Rumbek North Panyijiar Duk Uror Wau Tonj South Cueibet Rumbek Centre Twic East Pochalla Rumbek East Yirol East Nagero Yirol West Bor Pibor Tambura Wulu Awerial Mvolo Terekeka Ezo Nzara Mundri East Lopa Lafon Kapoeta North Yambio Mundri West Ibba Maridi Kapoeta East Juba Kapoeta South Yei Lainya Torit Budi Kajo Keji Magwi Ikotos Morobo Aweil 6,75 77,832 Bentiu 9,57 84,56 Bor 2,778 27,385 Juba 7,39 93,74 Kwajok 2,56 264,376 Malakal 2,263 6, Rumbek 7,883 7,84 Torit 2,42 52,5 Wau 8,893 82,224 Yambio 2,5 7,8 South Sudan 3,472,386,328 Number of consultations, 2,5 5, The total consultation in the country since week of 28 is,386,328, by hub, Bentiu registered the highest number of consultations as indicated in the table above. The total number of consultations by county is indicated in the map above. See the key for more information. 2

3 Proportional mortality Figure Proportional mortality (28) Syndrome W 28 # deaths % mortality # deaths % mortality Malaria % % ARI 9 6.% 3.9% AWD.% 4.4% Bloody diarrhoea 6.7% 5.8% AJS.% 2.7% Measles.%.4% Other 6.7% % Total deaths 5 % 28 % Malaria Acute Respiratory Infection (ARI) Acute Watery Diarrhoea Bloody diarrhoea Acute Jaundice Syndrome (AJS) Measles Other Figure, above shows the proportional mortality for 28, with malaria being the main cause of mortality accounting for 22.% of the deaths since week of 28, followed by ARI, and acute bloody diarrhoea. Proportional morbidity Figure 2 Proportional morbidity (28) Syndrome W 28 # cases % morbidity # cases % morbidity Malaria 37, % 4, % ARI,85 4.8% 9,64 4.3% AWD 2,53 6.% 9, % Bloody diarrhoea,65 2.% 6,287 2.% AJS 3.% 65.% Measles 8.% 9.% Other 2, % 7,6 5.3% Total cases 75,533 % 764,426 % Malaria Acute Respiratory Infection (ARI) Acute Watery Diarrhoea Bloody diarrhoea Acute Jaundice Syndrome (AJS) Measles Other Figure 2, indicates the top causes of morbidity in the country, with malaria being the leading cause of morbidity 4,634 (53.8%) followed by ARI, AWD and ABD respectively since week of 28. refer to the figure above for more information. 3

4 Trend in consultations and key diseases Figure 3 Trend in total consultations and key diseases (W) Number W3 27 W8 27 W22 27 W26 27 W3 27 W35 27 W39 27 W44 27 W48 27 W 28 W5 28 W9 28 Total consultations Malaria Acute Respiratory Infection (ARI) Acute Watery Diarrhoea Acute Jaundice Syndrome (AJS) Measles IDSR Proportionate morbidity trends - in relatively stable states Morbidity % Fig. IDSR Proportionate morbidity trends, week, 27 to, Epidemiological week of reporting in 27 Consultations Malaria ARI AWD ABD Measles Number of consultations in Thousands In the relatively stable states, malaria is the top cause of morbidity accounting for 32.7% of the consultations in week (representing an increase from 24.% in week ). 4

5 IDP Proportionate morbidity trends - in displaced populations % of Mobidity 45% 4% 35% 3% 25% 2% 5% % 5% % Fig. 2 IDP Proportionate morbidity trends, week, 27, to week, , 45, 4, 35, 3, 25, 2, 5,, 5, Consultations Epi week 27 to 28 Consultations Malaria ARI AWD ABD Measles Skin diseases GSW Injuries Among the IDPs, ARI and malaria accounted for 26.2% and 5.7% of consultations in week. The other significant causes of morbidity in the IDPs include AWD, skin diseases, and injuries. IDP Proportionate morbidity trends - in displaced populations Proportionate morbidity [%] Causes of morbidity among the IDPs weeks to, % 2.6% 7.9% 3.85%.7%.2%.2%.72% Malaria ARI AWD ABD Measles Skin diseases GSW Injuries The top causes of morbidity in the IDPs in 28 include ARI, malaria, AWD, skin diseases, injuries, and ABD. 5

6 Malaria Trends over time Malaria Trends over time Figure 4a Trend in number of cases over time (South Sudan) Jan Mar Graph legend May Jul Sep Key malaria indicators (28) Nov Figure 4b % morbidity Figure 4c Age breakdown ,634 Cases Deaths 6 W 28 (Mar 2-Mar 8) Malaria is the top course of Morbidity in the country, a total of 4,634 cases with 62 deaths registered since week of 28. malaria trend for 28 is above 26 and 27 as shown in the figure 4a, above. Malaria Maps and Alert Management Malaria Maps and Alert Management Map 2 Map of malaria cases by county (28) a. 24 b. 25 d. 27 d. 28 Map 3 Map of malaria alerts by county (28) c. 26 Map legend Risk Assessment Number of malaria cases, 2, 5, Number of malaria alerts 23 3 Verified Low Risk Moderate Risk High Risk Very High Risk Alert threshold Twice the average number of cases over the past 3 weeks. Source: IDSR 7 W 28 (Mar 2-Mar 8) Since the beginning of the year, a total of 23 malaria alerts have been triggered, 3 of those were verified. The Maps above indicate the location reporting malaria alerts from 24, 25, 26, 27, and 28. 6

7 Acute Watery Diarrhoea Trends over time Acute Watery Diarrhoea Trends over time Figure 5a Trend in AWD cases over time (South Sudan) Jan Mar Graph legend May Jul Key AWD indicators (28) Sep Figure 5b % morbidity Nov Figure 5c Age breakdown ,529 Cases Deaths W 28 (Mar 2-Mar 8) AWD is one of the top causes of morbidity in the country with 9,529 cases reported since week of 28 including 4 deaths. AWD trend for 28 is below 26 and 27 as shown in figure 5a, above. Acute Watery Diarrhoea Maps and Alert Management Acute Watery Diarrhoea Maps and Alert Management Map 4 Map of AWD cases by county (28) a. 24 b. 25 d. 27 d. 28 Map 5 Map of AWD alerts by county (28) c. 26 Map legend Risk Assessment Number of AWD cases 5,, 2, Number of AWD alerts 39 9 Verified Low Risk Moderate Risk High Risk Very High Risk Alert threshold Twice the average number of cases over the past 3 weeks. Source: IDSR W 28 (Mar 2-Mar 8) The 9number of AWD alerts triggered since week of 28 is 39, out of which 9 were verified. Maps above highlight the areas reporting AWD alerts from 24 to 28. 7

8 Acute Bloody Bloody Diarrhoea Trends over time Acute Diarrhoea Trends over time Figure 6a Trend in bloody diarrhoea cases over time (South Sudan) Jan Mar Graph legend May Jul Key bloody diarrhoea indicators (28) Sep Nov Figure 6b % morbidity Figure 6c Age breakdown , Cases Deaths Wweek 28 (Mar 8) a total of 6,287 cases of ABD have been reported country wide including 5 death. ABD Since 2-Mar of 28, trend for 28 is below 25, 26, and 27 respectively. Refer to figure 6a, above. Acute Bloody Diarrhoea Maps and Alert Management Acute Bloody Diarrhoea Maps and Alert Management Map 6 Map of bloody diarrhoea cases by county (28) a. 24 b. 25 d. 27 d. 28 Map 7 Map of bloody diarrhoea alerts by county (28) c. 26 Map legend Risk Assessment Number of bloody diarrhoea cases 5, 2, Number of alerts 5 9 Verified Low Risk Moderate Risk High Risk Very High Risk Alert threshold Twice the average number of cases over the past 3 weeks. Source: IDSR Total of 5 were W 28alerts (Mar 2-Mar 8) generated since week of 28, of which 9 were verified by the county surveillance team. Maps indicating areas triggering alerts since 24 to 28 are shown above. 8

9 Measles Trends over time Measles Trends over time Figure 7a Trend in number of cases over time (South Sudan) Jan Mar Graph legend May Jul Key measles indicators (28) Sep Nov Figure 7b % morbidity Figure 7c Age breakdown Cases Deaths Since the(marbeginning of 28, at least 9 suspect measles cases including death (CFR 2 W 28 2-Mar 8).92%) have been reported. Of these, 84 suspect cases have undergone measles case-based laboratory-backed investigation with 68 samples collected out of which 4 measles IgM positive cases; 4 clinically confirmed cases; and 3 cases confirmed by epidemiological linkage. Measles Maps and Alert Management Measles Maps and Alert Management Map 7 Map of measles cases by county (28) a. 24 b. 25 d. 27 d. 28 Map 8 Map of measles alerts by county (28) c. 26 Map legend Risk Assessment Number of measles cases 5 Number of measles alerts Verified Low Risk Moderate Risk High Risk Very High Risk Alert threshold case. Source: IDSR 3 W 28 (Mar 8) 36 alerts of measles were triggered and 25 of those have been verified at county level. Since week of2-mar 28, Maps of areas raising alerts from 24 to 28 are shown above. 9

10 Acute Flaccid Paralysis Suspected Polio In week 9, 28, Thirteen (3) new AFP cases were reported from Jonglei, Lakes, Northern Bahr el Ghazal, Upper Nile, Western Bahr el Ghazal, and Western Equatoria hubs. This brings the cumulative total for 28 to 5 AFP cases. The annualized non-polio AFP (NPAFP) rate (cases per, population children -4 years) in 28 is 3.58 per, population of children -4 years (target 2 per, children -4 years). Stool adequacy was 96% in 28, a rate that is higher than the target of 8%. Environmental surveillance ongoing since May 27; with 23 samples testing positive for non-polio enterovirus (NPEV) in 27 and one NPEV positive sample in 28. Mortality in the IDPs Source: South Sudan Weekly AFP Bulletin week Table 6 Proportional mortality by cause of death in IDPs W 28 Proportionat Cause of Death Bentiu Juba 3 Malakal Wau Po Total e mortality by IDP site <5yrs 5yrs 5yrs <5yrs 5yrs 5yrs deaths [%] Aspiration 7 Malaria 7 Pneumonia 7 SAM 7 Sepsis Unknown 2 4 TB 2 4 Burns 2 4 Anaemia 7 Chronic Hepatitis C 7 Total deaths Among the IDPs, mortality data was received from Bentiu PoC, Wau PoC, Malakal PoC, & UN House PoC in week. (Table 6). A total of 4 deaths were reported during the week. Bentiu PoC reported 7 (5%) deaths in the week. During the week, 2 (4%) deaths were recorded among children <5 years in (Table 6). The causes of death during week are shown in Table 6.

11 Mortality in the IDPs - Crude and Under five mortality rates deaths per, per day Figure 2 EWARN U5MR by Site - W 27 to W of Epidemiological week Bentiu Juba 3 Malakal Wau PoC Akobo Threshold deaths per, per day Figure 2 EWARN Crude Mortality Rate for W 27 to W of Epidemiological week Bentiu Juba 3 Malakal The U5MR in all the IDP sites that submitted mortality data in week of 28 is below the emergency threshold of 2 deaths per, per day (Fig. 2). The Crude Mortality Rates [CMR] in all the IDP sites that submitted mortality data in week of 28 were below the emergency threshold of death per, per day (Fig. 2). Mortality in the IDPs - Overall mortality in 28 Table 7 Mortality by IDP site and cause of death as of W, 28 Acute watery diarrhoea Cancer Gunshot wound Heart Failure Kala-Azar Malaria Meningitis Perinatal death IDP site Bentiu Juba Malakal Akobo Wau PoC Grand Total Proportionate mortality [%] 3% 2% 2% 2% 2% 5% 2% 8% 3% % 3% 6% 4% % 7% 8% 42% % l A total of 8 deaths have been reported from the IDP sites in 28 Table 7. l The top causes of mortality in the IDPs in 28 are shown in Table 7. Pneumonia Rabies SAM Sepsis TB/HIV/AIDS Trauma HIV/AIDS TB Others Grand Total

12 For more help and support, please contact: Dr. Pinyi Nyimol Mawien Director General Preventive Health Services Ministry of Health Republic of South Sudan Telephone: Dr. Mathew Tut Moses Director Emergency Preparedness and Response (EPR) Ministry of Health Republic of South Sudan Telephone: 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