Re: Republic of South Sudan: Humanitarian Bulletins
SOUTH SUDAN
Emergency preparedness and
Humanitarian Action (EHA)
Week 37 (10th -16th Sept) 2012
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Public Health threats and concerns
1. The Ministry of Health, Republic of South Sudan declared an outbreak of Hepatitis E (HEV) in Upper Nile
state. As of this reporting date, 382 cases had been reported since the index case was first identified in July
and the first confirmed case reported in August 24th.
2. Ten suspected cases of AFP were reported this week. Four were from Baliet, Mellut, Renk and Nasir in
Upper Nile state, one from Kangi Payam Jur River county Western Bahr el Ghazal state and five from Twic
County Warrap state. Specimen were collected from the suspects and sent to Juba for further analysis.
3. Twenty four cases of Khalazar patients were reported from four health facilities in Unity state. Currently
there is an upsurge of the disease in Koch county Unity state.
4. Suspected rabies has emerged as a major public health threat. Cases of animal bites continued to be on the
increase this week with reports of two deaths related dog bites reported in Maban county, Upper Nile. Forty
four other cases were reported from Agok area in Warrap state.
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Communicable Disease Update
1. The Republic of South Sudan (MOH) declared an outbreak of Hepatitis during this reporting period. This
followed reports of Hepatitis E Virus confirmed in the three Camps of Jamam Gendrassa and Yusuf Batil in
Maban County, Upper Nile state. In week 36 there two hundred twenty five suspected AJS cases were
reported with two (2) related deaths across the country (refer to figure 9 for AJS Epi- Curve). Over 98% (220) of the cases and two deaths were recorded in Maban refugee camps, especially Jamam, Batil and Gendrassa camps. The
cumulative AJS cases recorded as of week 36 was 384 (suspected and confirmed HEV) and 16 deaths (CFR 4.2 %). Of these cases, 66% were recorded in Jamam, 20% in Yusuf Batil and 13.5% in Gendrassa. Of the total
deaths, 81% were recorded in Jamam, 12% in Yusuf Batil and 6% in Gendrassa.
Forty one (41) blood specimens were referred to CDC/KEMRI in Nairobi for analysis, and 23 specimens
were PCR positive for Hepatitis E Virus, while seven preliminary results were still pending. The Ministry of
Health, RSS decelerated hepatitis E Virus outbreak in Jamam and Gendrassa refugee camps, and appealed to all UN and health partners to scale up the multisectorial response to contain the outbreak. Following the
confirmation, the Ministry of Health, Republic of South Sudan, in collaboration with other health partners
stepped up active case finding targeting the entire refugee population in the camps Most important, intensive
health and hygiene education and promotion activities are ongoing in all of the refugee camps in Maban
county, supported by partners and agencies running health, water, sanitation and hygiene services in these areas.The agencies are also collaborating with
the WASH cluster to increase provision of clean water as well conducting
active case finding in all the three camps. Surveillance had been enhanced
throughout the county and neighboring Counties. Yida camp in Unity State reported one suspected case of Acute Jaundice syndrome in week 36.
The The majority of the cases are children under 5years. No suspected cholera cases have been reported. The
trend of Acute Bloody diarrhea was fairly stable with most cases being reported among those above 5 years
except in Yusuf Batil camp where 60% of ABD cases were in children below five years. To strengthen the
epidemic response and further enhance the containment of the disease, WHO has deployed an epidemiologist
in Maban county to support the health partners and county health department to respond to the current
outbreak. The trend of epidemic prone diseases has also been declining in Yida camp for the past three
weeks except for the AJS.
2. A total of 34,658 health events and 77 deaths were recorded from all health facilities across the country in
week 36. Over 78% of all reported health events and 70% of all deaths were due to malaria, followed by
acute watery diarrhea and bloody diarrhea events. WHO continued supporting the Kalazar response with
only four (4) health facilities of Ayod, Jiech, Lankien and Leer. This week twenty six (26) cases were
reported, twenty four (24) were new cases, (0 from Ayod, 9 from Jiech, 13 from Leer and 2 from Lankien
and two (2) relapses/PDKL from Lankien while two (2) deaths were reported, one from Ayod and the other
from Koch County. Accessibility challenges have had an impact on the reporting rate (completeness) of the
reports from the Kalazar treatment centers. Koch county has reported an upsurge in the admissions of Kalazar patients and following a joint assessment by the response team(WHO and SMOH),case management
has been strengthened and technical teams are closely monitoring the situation at county level
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Re: Republic of South Sudan: Humanitarian Bulletins
Humanitarian Bulletin
South Sudan
30 July ? 5 August 2012
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Upsurge of malaria cases requires concerted response
In the first seven months of 2012, health facilities have recorded an increase of malaria
with high case fatality rate, according to the Health Cluster. The cluster reports that one of
the contributing factors to the increase is the increased population movements including
returnees, refugees and internal displaced people. A total of 565,505 malaria cases
(incidence rate 6,846 per 100,000 people) and 651 related deaths (case fatality rate 0.1
per cent) were recorded between January and July 2012 compared to 446,858 cases in
the same period in 2011. In 2012, the malaria attack rate (the number of new people
infected or exposed) and case fatality rate are the highest in the past four years,
according to health partners. Some counties reporting high malaria cases in the past
seven months include Juba, Terekeka and Kajo-Keji in Central Equatoria, Maban and
Malakal in Upper Nile, Wau in Western Bahr el Ghazal and Rumbek East in Lakes.
In response to the upsurge, the Ministry of Health, together with partner organizations,
has mounted a concerted response focused on scaling up malaria prevention, diagnosis
and treatment interventions ? especially for pregnant women and children under five
years. In the past seven months, severe shortages of anti-malaria drugs have been
reported in health facilities across the country, and health partners have responded by
procuring over 1 million anti-malaria doses to the Ministry of Health for distribution. Some
health facilities have already received the anti-malaria drugs, but many facilities are still
lacking the life saving drugs due to logistics difficulties of distributing the drugs to the
target facilities.
Malaria is highly endemic in South Sudan, and it is aggravated by the rainy season,
increased population movement and a poor health system. Malaria is leading cause of
morbidity and mortality among young children and pregnant women, and the most
frequently reported disease from health facilities through the weekly and monthly
surveillance reports.
Survey results indicate high malnutrition rates in Upper Nile camp
Preliminary results of an MSF survey in the Yusuf Batil camp, which hosts many new
refugee arrivals, show the global malnutrition rate among children at 27.7 per cent, and
the rate of severe acute malnutrition at 10.1 per cent ? five times above the emergency
threshold. About 44 per cent of children under the age of two were found to be
malnourished, 18 per cent of them with severe acute malnutrition. The full break-down
and analysis of the survey is still pending.
To address the situation in the refugee camps, decentralized health structures and mobile
clinics have been established in all sites and water, sanitation and hygiene services are
being scaled up including outreach activities, according to the UN Refugee Agency,
UNHCR. Health surveillance systems have also been put in place with regular samples
sent to Nairobi for analysis. The blanket feeding programme has been expanded to
children from six months up to five years instead of the previous six months to three
years. A blanket distribution was completed in Yusuf Batil this week and will be followed
by a targeted supplementary feeding programme for malnourished children and pregnant
and lactating women.
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Re: Republic of South Sudan: Humanitarian Bulletins
Humanitarian Bulletin
South Sudan
16-22 July 2012
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Acute diarrhea causes refugee deaths
In Unity State, where some 57,000 refugees are located, acute diarrhea continues to be of high concern. The under-five mortality rate in the Yida
settlement is currently 2.75/10,000, according to the UN Refugee Agency (UNHCR), implying that two out of ten thousand children are dying per
day. The overall crude mortality rate is 0.92, according to
UNHCR. During the third week of July alone, 23 deaths from acute
diarrhea were recorded. Humanitarian agencies have stepped up hygiene and health outreach capacities to tackle the outbreak of acute diarrhea and
other communicable diseases in all camps in Unity and Upper Nile
state. Meanwhile, lower respiratory tract infection and malnutrition are also highly prevalent. With the increase in rainfall there has been an increase in malaria cases.
Nearly 400 cases of malaria were reported at health facilities since the beginning of July, according to health partners.
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9 children die daily in Jemam camp
Saturday, 07 July 2012 05:13 Muna Tesfai
Medicine Sans Frontiers (MSF) said nine children die everyday in Jemam refugee camp in Upper Nile State. The common cause of the deaths was diarrhea.
Jeose Hulsenbek, MSF's Head of Mission in South Sudan told Radio Miraya that the situation of refugees from the Sudanese Blue Nile state, is dire.
She said the mortality rates have doubled the threshold for a camp.
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Malaria cases reported in Jonglei state
Wednesday, 11 July 2012 08:28 Muna Tesfai Health >>>
A malaria outbreak has been reported in Uror County, Jonglei State.
On average, 150 cases are treated at Uror County Primary Health Center Unit in Yuai, every day.
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Re: Republic of South Sudan: Humanitarian Bulletins
SOUTH SUDAN
Emergency and Humanitarian Action (EHA)
Week 12 (19th ? 25th March) 2012
2. Public Health Concerns
1. Malaria represents the highest cause for morbidity across the states. For instance in Upper Nile state this
week, malaria cases reported were at 58 % of all out patient department reported cases. This was followed by
Acute Respiratory Tract infection constituted at 36% (1101).
2. Forty five 45 measles suspected cases were reported from Marobo (2), kajo keji (3), Magwi (9), Rumbek
center (3), Aweil East (4), Aweil South (1), Aweil West (2), Gograil West (13), Tonj south (2), Panyinjar (3)
and Manyo (3). The State Rapid Response Team together with the WHO technical officers and health
partners conducted an investigation exercise to verify the measles cases and collect specimen.
3. Three (3) guinea worm cases- were reported from Manyo (1), Twic East (1) and Rumbek North (1).
4. Nine (9) Influenza like Illness (ILI) reported cases were reported in Fashoda County in Upper Nile states.
5. Two (2) suspected Cholera cases reported at Aweil Centre, NBGZ. Samples taken tested positive vabrio
Cholera by rapid test. Samples have been sent to KEMRI for further Laboratory confirmation.
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4. Communicable Disease updates
In week eleven,
1. The national weighted surveillance aggregate scor of health facilities submitting weekly disease events reports increased from 33% in week 10 to 36% in week 11. All the states 10/10 (100%) submitted the weekly reports,
67/80 counties also submitted their reports. (524/540) representing 97% of health facilities from the 64 counties submitted their weekly reports on time,
timeliness reporting have dramatically increased in week 11. All the states recorded good surveillance performance compared with last week, Western Equatoria State (WES) had the best reporting performance with 167 of the expected 214 health facilities reporting on time. It was also noted that Unity
states reporting improved when compared with the previous weeks, with 46% completeness.
2. A total of 26 884 heath events and 55 deaths were recorded from health facilities that reported this week. Malaria was the major events followed by acute watery diarrhea and bloody diarrhea events. There were
unusual malaria related deaths reported at Morobo county during the week and investigation were carried out.
3. Nine out of ten (10/10) states in the country submitted timely reports to the central level in week 10 with only Warrap states submitting 48% of its total reports late. The average state timeliness rate in week 11 was 95%, while the average completeness rate was 34%. The average completeness of
reporting by state was maintained below the minimum acceptable value of 50 percent from all the states, except WES and Unity states with 78% and 46%
consecutively.
Only health facilities in WES state consistently maintained timeliness and completeness of reporting above the minimum acceptable percentage of 70% in the past 11 weeks. However, there were 15/33(48%) health facilities from Warrap state that did not submit timely reports. Many health facilities
in Western Bahr el Ghazal state (WBGZ), Jonglei state and Upper Nile State (UNS) were silent for many weeks. There is a need to further strengthen surveillance for the above mentioned states to improve
completeness of reporting. Upper Nile State (5) recorded the most silent counties followed by Jonglei (4) counties, Eastern Equatoria State (EES) (2) counties, WBeG (2) counties and WES (1) county. Figure 1 elaborates further comparison of timeliness and completeness rates by states.
4. A total of 5 888 cases of Acute Watery Diarrhea (AWD) were reported nationwide this week with 14 related deaths. Children below five years of age accounted for 60% 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 remains constant in the past 11 weeks of 2012 as compared to the same period in the previous years. The overall incidence rate of AWD across the county shows an increasing trend from week 2 to week 11 with a gradual decrease in week 7-10, this could be attributed to poor reporting performance. Unity states and WES had the highest rates of AWD cases reported at 143% and 144% respectively per 100,000 populations. Despite reports of high incidence
rates of AWD this week, fatality rate was very low across all the health facilities on week 11 with the exception of Upper Nile State which was at 1.1%
5. A total of 2 815 cases of Acute Bloody Diarrhea (ABD) with 2 related deaths were reported this week. The overall incidence rate of ABD across the county shows unpredictable trend from week 6 to week 11 though this remains constant through the year. WES and lakes states
reported the highest incidence rate of 79% and 56% per 100,000 populations respectively. Ayod County in Jonglei states reported the highest cases of ABD during the week.
6. A total of 18 026 suspected malaria cases with 39 related deaths were reported this week as compared to 9 960 and 8 death in week 10. Of these, 44% of the cases and 69% (27) of deaths were in children below
five years of age. The overall incidence rate remained high in the past 11 weeks as compared to the sameperiod in 2010 and 2011. WES and CES accounted for the majority of cases reported during the reporting
week. Counties that recorded malaria deaths include; Khorflus (1), Renk (3), Raga (1), Yirol West (1),Rumbek center (1), Ikotos (2), Lopa Lofan (5), Torit (3) and Morobo (22). There is unusual Malaria related death reported at Yeribe PHCU in Morobo county investigation is being carried. Figure 4 shows
comparisons of malaria trends by Epi-week in 2010-12.
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Re: Republic of South Sudan: Humanitarian Bulletins
SOUTH SUDAN
Emergency and Humanitarian Action (EHA)
Week 11 (12th – 18th March) 2012
2. Public Health Concerns
The populaton continues to return to South Sudan posing public health risks. The health situation continues to be monitored to avoid any importation of potential outbreaks. Malaria remains a major public health risk
among the population of humanitarian concern with 45% of all consultations cases being reported as malaria.
A total of 26,789 public health events were recorded in the reporting week.Of these 67% are malaria,21%AWD and ABD accounted for 10.5%
Four suspected cases of Anthrax were reported by MSF Belgium in Gogreal Primary Health Care Centre form different locations in Gogreal County
Measles still remains a challenge in the majority states despite completion of the mop up campaigns to curb the situation. Main states reporting cases are Northern Bahergazel and Lakes among others
3. Coordination, Emergency preparedness and response
During the week;
1. WHO continued to support the SMoH to strengthen the response to access of services in the Pibor area. Support to the mobile clinic was sustained in the county.
A total of 8 areas are being served among which are Gurmuk Payam,Pibor
Payam,Lilot,Lukongule and kong kong river. WHO supported the County Health
Department with the deployement of the health workers and logistic support for the mainataince of the clinic. A total of 2063 consultations were seen in the mobile clincs during this week. WHO will continue to support the mobile
clinic in the next three months.
2. Following the arrival of over 2000 returnees from Khartoum, WHO coordinated and supported the treatment of the severly ill patients among the extremely vulnerable persons. A total of 22 patients were referrd to the
State hospital for further managemet,and 14 recieved the measles vaccine. In a similar activity to strengthen the EPI services,WHO supported the mop up campaing in Awiel. Two thousand five hundred and sixteen children were targeted and revieved measles vaccine.
3. During the week, WHO maintained its coordination with health partners in Maban county, with MSF,Releif International and GOAL continuing to offer health services in the payams in maban county. Reports from Maban indicate that malaria remined a public health problem in RI supported facilities. The top five diseases treated at the health facilities in Maban during the week included; malaria (27.4%) followed by Pneumonia (20.6%) and Bloody diarrhea (9%). Twenty children seen in the Out patient department received the
measles vaccine.
4. Communicable Disease updates
The data contained in this section of the report is for week 10;
The national weighted surveillance aggregate score of health facilities submitting weekly disease reports decreased this week from 61% in week 9 to 33% in week 10. Seven out of the ten states (70%) submitted
reports, 42 of the 80 counties showed a commendable increase from 49% (487) in week 10 to 61% (610) in week 9. Seven out out ten (70%) of states and 37/80(46%) Counties submitted their weekly reports on time,
(320/331) representing 96% of health facilities from the 37 counties submitted weekly reports on time, timeliness reporting have dramatically increased in the past two weeks.
A total of 14 466 health events and 16 deaths were recorded from health facilities that reported this week.
Malaria was the major reported event followed by acute watery diarrhea and bloody diarrhea. Three suspected measles cases were reported from Aweil East. The State Rapid Response Teams together with the WHO
technical officer and partners conducted investigation to verify to reported measles cases.
A total of 3 091 AWD cases were reported nationwide with 8 related deaths.
Children below five years of age accounted for 62% of all the reported
cases. Figure 2 shows a comparison of AWD cases reported since the year 2010-2012 by Epi-week. The trend of AWD among children below 5 years of age remains constant in the past 10 weeks of 2012 as compared to the same period in the previous years, but cases reported in week 7-10 decreased gradually due to poor reporting. The overall incidence rate of AWD across the county shows an increasing trend from week 2 to week 10 with a gradual
decrease in week 7-10, this could be attributed to poor reporting performance in week 7 and week 10. Western Bahr el Ghazal (WBGZ) and WES had the highest rates of AWD cases reported at 130 and 86 respectively per 100,000 people.
Despite reports of high incidence rates of AWD this week, case fatality was very low across all the health facilities in week 10 with the exception of WES at 0.84% (of the 837 cases reported 7 died) and Jonglei states at 0.17% (of the 574 cases reported 1 died).
A total of 1396 cases of Acute Blood Diahrrea with no related deaths were reported this week. The overall incidence rate of ABD across the county shows unpredictable trends from week 6 to week 10 though the
cases remained constant through the year. Western Equaitoria
State reported the highest incidence rate of 83.8 per
100,000 populations respectively. Central Equatoria State, EES and
Unity could not be measured due to unavailability of data, which
had not reached the central level. Poor reporting was recorded this
week compared to the previous weeks and this could be attributed to the travel of Surveillance Officers out of their duty station in the past two
weeks. Although the incidence rate for ABD was high, case fatality in
all states was zero in all states of south Sudan - refer to Table 3 for
details. Figure 3 shows a comparison of ABD trend by EPiweek
from 2010 to 2012.
A total of 9 960 suspected malaria cases with 8 related deaths were
reported this week as compared to 19 113 and 16 death in week 9. Of
these, 42% of the cases and 37% (3) of deaths were in children
below five years of age. Table 4 shows a detailed analysis by state
including incidence and case fatality rate of malaria cases
recorded during the week. The overall incidence rate remained
high in the past 10 weeks as compared to the same period in 2010 and 2011. Western Bahr el Ghazal, WES and Warrap states accounted for
the majority of cases this week. Counties that recorded malaria deaths included; Renk (1) and Wau (7). Figure 4
shows comparisons of malaria trends by Epi-week in 2010-12.
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Re: Republic of South Sudan: Humanitarian Bulletins
Weekly Humanitarian Bulletin March 8 2012.
Highlights:
? The continued influx of refugees into Upper Nile State is straining the humanitarian operation.
Currently there are 80,000 refugees from Sudan?s Blue Nile in the South Sudanese state.
? The UN Security Council views the recent cross-border violence between Sudan and South Sudan
as a threat to international peace and security.
? The Greater Equatoria region is likely to benefit from above normal rainfall over coming months.
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Republic of South Sudan: Humanitarian Bulletins 2012/ 2013
Sharon, would it be possible to add "Republic of South Sudan" to the Africa forum?
Weekly Humanitarian Bulletin March 1 2012.
Highlights:
Insecurity intensified in the border area between Unity State and Sudan?s Southern Kordofan State with
bombing reported along the western border of Pariang County and the Lake Jaw area.
The government-led disarmament campaign for Jonglei State is not expected to take place before
15 March, according to the UN peacekeeping mission, UNMISS.
Food security partners warn that Unity State and parts of Upper Nile, Jonglei, Warrap, Central Equatoria
and Northern Bahr El Ghazal states will experience an extended and more severe hunger season in 2012.
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The full caseload of 44,600 people at the Doro refugee site was reached with food aid during the week. Food
deliveries to Maban County are underway to cover planned food distribution to refugees at the Jammam site.
Levels of watery diarrhea in Doro and Jammam remain high. Health partners have initiated pre-positioning of
cholera treatment centres to respond to a possible outbreak, and intensified preventive activities have begun.
Referral systems for moderate acute malnutrition in children are also being strengthened. The water, sanitation
and hygiene (WASH) situation in Doro, which has been a major concern of humanitarian partners, has improved
with the activation of a 75,000 litre-a-day water purifying system. This has raised the water supply in Doro to a
little above acceptable emergency standards. The water supply situation in Jamman is still of concern. No new
water sources have yet been found, so all water is supplied by truck from outside the settlement. A hydrological
assessment of the site continues, aiming to locate a water supply underground.
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