Office for the Republic of South Sudan 1. Humanitarian situation Highlights In this week, humanitarian organizations continued scaling up emergency assistance to returnees who arrived in Juba. Since the response operation began on 14 May 7 150 returnees have been airlifted and are receiving humanitarian assistance in three transits in Juba. Aid agencies also continued focusing efforts on responding to displaced people in Jonglei, Northern Bahr el Ghazal, Warrap and Abyei areas, following a series of conflicts in the border areas. In Jonglei state where over 2,885 individuals were displaced from Ethiopia due to clashes with the military. The security situation in the border area between Northern Bahr el Ghazal and Sudan continued being tense this reporting week. There were reported cases of bombings in the disputed area of Warguet close to Aweil East on 21 May (UN Security). Fears of further possible attacks likely to cause displacement have also been reported. Humanitarian partners, however continued providing assistance to almost 10,000 people displaced in Jach, Gok Machar and Rumaker, following border fighting in April. The assistance provided to the displaced people included; distribution of food rations, hygiene kits and the medical supplies. In Northern Bahr el Ghazal,, An inter-agency assessment to the area identified 2,620 people to have been displaced in Aweil East and another 645 in Warlang, close to Rumaker. The immediate needs of the people identified were food, medical support and WASH need as stocks of medical supplies were exhausted at the time of the assessment. In Gok Machar, where 3,000 people are displaced, emergency relief services continue among these; WASH, shelter, tents for temporary learning and school supplies. Improved sanitation was also identified as a gap in the response. Partners are discussing ways to improve the situation. In week 21, 1. The Head of WHO South Sudan together with Deputy minister of Health Republic of South Sudan and other health partners conducted an assessment of a returnee site at the Teacher Training Institute in Juba 2. WHO team conducted supervision visits in Lakes and in Warrap states to confirm and verify the functional health facilities. 3. WHO conducted training of health workers on disease surveillance with integration of services in the states of Jonglei, Warrap and Wau 4. The organization also supported the State Ministry of Health (SMoH) of Lakes, Western Bahr el Ghazal and Warrap states to conduct an evaluation of the IDSR tools with the objective of having them revised. 5. Participated in the annual health summit in Upper Nile state. 1
2. Public Health threats and concerns 1. One suspected case of AFP was reported from Rubkona County, Nhialdiu payam. Specimen was collected and sent to Juba for further investigations, while in Agok, Warrap state 9 suspected cases of AFP were reported. The suspected case from Tonj East was investigated and stool specimen collected and sent for further investigations to Juba. In Pochalla County, Jonglei state, there was also one AFP case reported. Two stool specimens from the cases were collected and sent to WHO Juba. South Sudan has enhanced the AFP surveillance and is on course of being declared polio free. 2. Two suspected cases of neonatal tetanus were reported from MSF Agok Primary Health Care Center (PHCC) with one fatality. 3. A total of 37 measles cases were reported from Pibor County in Jonglei state. Thirty two were reported from Boma hospital while 5 cases were from Pibor MSF PHCC+. The total number of cases reported since the outbreak started in April is 259. Although the number of cases reported weekly has reduced from a high of over 40 cases in a week, these numbers are still high. WHO anticipates a reduction in the number of new cases detected weekly in the coming weeks after the ongoing vaccination is successfully completed. 4. The population build up at the teacher training institute and the influx of refugees in Maban county continues to be a worrisome factor for the health workers given the fact that the number of consultations continue to raise. With the anticipated rainy season around the corner, a potential outbreak of communicable disease is of great concern 3. Coordination, Emergency Preparedness and Response In week 21; 1. WHO together with the Ministry of Health Republic of South Sudan participated in an assessment of the returnee site located at the Teacher Training Institute Juba. The site hosts over 7,000 returnees from Sudan. The clinic managed by IMC, an international NGO working in South Sudan, receives drugs and supplies to treat patients from WHO country office. WHO also supported the returnee site with vaccines and incentives for the vaccinators to enable the immunization of all children from the north. Important to note is that, unlike Sudan, South Sudan is prone to disease outbreaks due to vaccine preventable disease with the country currently facing 2 The deputy minsiter of Health Republic of South Sudan, Dr. Yata, the Head of Office for WHO South Sudan and IMC partners receive a brief from the Surveillance Officer for Central Equatorial tate, during health assesment mission to a returnee site in Juba
an upsurge of measles cases. This will therefore help provide some immunity to the children against some immunizable diseases. During the assessment the two teams noted that the facility at the site had enough stocks of medical supplies in the health facility with fairly good hygiene facilities. There is however a need for more toilet facilities and health education and promotion activities to promote good hygiene practices so as to reduce on the high risks of diarrheal diseases (outbreak). 2. WHO state teams continued to receive returnees from the north and offer health services. In warrap state, 24% of the children who arrived received measles vaccine before they received onward travel assistance. In Awiel, WHO supported the IRC run mobile clinic with drugs and supplies to support case management of the patients. The clinic is located in Jaac s hosting about 3265 IDPs. Further to an assessment done earlier, WHO will support management of illness for the case load in Warlang and Rumakeer IDP camp. In Juba,WHO continues to support the IMC run mobile clinic with medical supplies and inputs for the management of the mobile clinic. The two clinics at the TTI and way station continue to provide essential care for the returnees. At the way station in Juba a total of 584 patients were seen this reporting week, 25% of those seen were under the age of five. Respiratory Tract The Minster of State for Health for Eastern Equatoria state, Dr. Margrate Itto, vaccinates a child against polio. Infections topped the cause of morbidity with 35.4% followed by malaria at 22% and AWD at 9%. At the TTI, a total of 1371 patients were seen of which 29% were under five. Of the consultations RTI accounted for 22.8%,followed by AWD at 13.7% and malaria at 1.6% 3. Support supervision visits were conducted in all the states of South Sudan during the week. In Warrap state, a team from the state ministry of health and WHO visited Twic and Akok counties, while in Lakes, the teams visited Ayei, Mabui, Abeer and Mathiang Primary Health Care Units (PHCUs)in Rumbek Central County this week. In Warrap state, the teams visited six (6) health facilities in Agok. These included Wunpeth PHCU, Ganga PHCU, Awal PHCU, Juljok PHCC,MSF-CH Agok PHCC and MOH Agok PHCC, Five other health facilities were also in Twic County, among them: Ajong PHCU, Mayen Abun PHCC, Panyok PHCU, Akak PHCC and Akoc PHCC were also visited. Discussions were held with facility staff to improve disease surveillance and reporting. In Lakes states the visit was meant to confirm and verify functioning health facilities in District Health Information System for AFP surveillance, the team noted two non function health facilities of Ayei and Abeer which had never been identified, while other function one were only open half day. 3
Office Office for for the the Republic Republic of of South South Sudan Sudan 4. Measles response vaccination campaigns continued in Pibor County. This was completed in the four Payams covered by Merlin i.e. Boma, Kassingor, Mewun and Marwou. Vaccination in 3 Payams on the Pibor operational side of the county also started during the reporting week. The vaccination teams covered children in Lekuangole, Gumruk and Pibor. However the exercise was affected by rains with only children in areas near towns vaccinated. Five thousand, three hundred and sixteen children on the Boma side and 6052 on the Pibor side were vaccinated by the end of week 21, however is way below the target. The exercise will therefore continue during week 22. Other partners besides WHO supporting the measles response in the county include; UNICEF, SMoH, County Health department, MSF B, Merlin and other local partners. 5. Support supervision visits to the way station and transit sites in Malakal were also conducted by a combined team of WHO and IOM in Upper Nile state. Meetings were held at the site with program managers of IMC, INTERSOS and the health team of IOM on how best to deliver health services at the two transit sites. The main challenge identified was lack of health workers to support the delivery of services at the way station. Bilateral discussions are currently ongoing on how to ensure that IOM delivers the services. WHO is providing drugs and paying incentives for the health workers providing services at the transit point in Malakal as support towards the mobile clinic. 4. Communicable Disease updates In week twenty, 1. The national weighted surveillance aggregate scoree of health facilities submitting weekly disease events reports increased from 59% in week 19 to 60 % in week 20. All the ten states (100%) submitted the weekly reports, 70/80 counties also submitted their reports. Three hundred and forty out of Five hundred and ninety six health facilities from the 70 counties submitted their weekly reports on time. Timeliness of reporting in week 20 from the states was averaged at 40% while completeness was at 60%. Eastern Equatorial state, Northern Bahr el Ghazal state and Unity state reporting were below the minimum acceptable rate. 2. A total of 29,863 heath events and 80 deaths were recorded from health facilities that reported this week. Malaria was the major events followed by acute watery diarrhea and bloody diarrhea events. 4
3. A total of 6 849 cases of Acute Watery Diarrhea (AWD) were reported nationwide this week with 8 related deaths. Children below five years of age accounted for 58% of all the reported cases. Figure 2 shows a comparison of AWD cases reported since the year 2010-2012 by Epi-week and by age group. The trend of AWD among children below 5 years of age continued to increase in the past 19 weeks of 2012 compared to the same period the previous years. The overall incidence rate of AWD across the county shows an increasing trend. There was however decrease in weeks 7, 10, 16, 17 and 18 which could be attributed to poor reporting performance. Unity states, Western Bahr el Ghazal and WES had the highest rates of AWD cases reported at 130%, 263%, and 128% respectively. Despite reports of high incidence rates of AWD this week, fatality rate was very low across all the health facilities 1nn week 20 with the exception of Jonglei State which was at 0.5%. 4. A total of 2 028 cases of Acute Bloody Diarrhea (ABD) with 29 related deaths were reported this week. The overall incidence rate of ABD across the county shows an increasing trend through the year with Western Equatorial State reporting the highest incident rate of 62% per 100,00 population. Silent counties could not be measured due to unavailability of data. Maban County in Jonglei states reported the highest cases of ABD during the week. 5. A total of 20 781 suspected malaria cases with 39 related deaths were reported this week as compared to 21 159 and 61death in week 20. Of these, 45% of the cases and 97% (37) of deaths were in children below five years of age. Counties that recorded malaria deaths include; Juba (3), Morobo (1), Khorflus (6), Ayod (27) and Nyirol (1).. The 5
figure annexed to this text shows a comparison of malaria related death in the past three years by age groups. 5. Partnerships During the week, WHO participated in the 2 nd State Health Summit, titled Reaching out to the community for better health for all. The summit that was attended to by other partners focused on achieving the MDG targets through effective implementation of the Dry Season Campaign (DSC). The DSC was aimed at creating productive communication between the county health department, health facilities, and the communities in order to address and raise awareness and improve coverage of high impact priority health indicators. The key intervention priorities of the DSC include; Immunization for under five,vitamin A supplementation and deworming, Promotion of prenatal care and safe deliveries, HIV/AIDS awareness (BCC,VCT,PMTCT),Health Education on Wash AND Nutirtion,Malaria Prevention, response, communicable disease control and prevention. 6. Capacity Building WHO supported Western Bahr el Ghazal and Jonglei SMoHs to conduct Integrated Disease Surveillance and Response training. This was attended by 91 participants from 10 counties in the state among them; Jau, Wau, Raja, Akobo west, Nyirol, Wuror, Duk, Ayod, Twic East and Bor South counties. The participants included field supervisors, county surveillance officers, EPI managers, CHDs, and field assistants. Participants from the other counties were not able to participate due to transport challenges resulting from ongoing rains. 7. Acknowledgments: The progress achieved by WHO/EHA South Sudan was made possible through contributions from the following partners: For further information, please contact: Dr. Allan Mpairwe, Emergency Coordinator, Email: mpairwea@nbo.emro.who.int or Ms Pauline Ajello, Communication Officer, Email:ajellopa@nbo.emro.who.int 6