Republic of South Sudan EARLY WARNING and DISEASE
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Early Warning and Disease Surveillance System Republic of South Sudan EARLY WARNING AND DISEASE SURVEILLANCE BULLETIN (IDP CAMPS AND COMMUNITIES) Week 48 24 – 30 November 2014 General Overview Completeness for weekly reporting decreased from 98% to 92% while timeliness decreased from 72% to 50% in week 48 when compared to week 47. Malaria remains the top cause of morbidity in week 48 with Malakal PoC having the highest incidence followed by Tongping, Bentiu, Bor and Lankien. During week 48, Malakal PoC had the highest incidence for malaria and ABD, while Bentiu PoC had the highest incidence for ARI and AWD. A total of three suspect measles cases were reported from Melut (1 case) and Lankien (2 cases) during week 48. There are no new HEV cases reported since week 47. The cumulative for HEV in Mingkaman remains at 124 cases including four deaths (CFR 3.23%). There are no new cholera cases reported since week 47. The cumulative remains at 6,421 cholera cases including 167 deaths (CFR 2.60%) from 16 counties in South Sudan. The under-five and crude mortality rates in all IDP sites were below the emergency threshold in week 48. Seven suspect meningitis deaths have been reported from Chotbora PHCC in Longechuk County. The preliminary verification report indicates no new suspect cases since 18 November 2014. Completeness and Timeliness of Reporting Completeness for weekly reporting decreased from 48 (98%) in week 47, to 46 (92%) in week 48. Timeliness for weekly reporting decreased from 35 (72%) in week 47 to 25 (50%) in week 48. Figure 1 Number of sites (clinics) reporting per week (n=50) 60 4648474846 50 41 42 42 38 38 36 35 37 40 32 33 34 34 343334 29 2931 29 2626 26282726 28 30 24 24 21 21 23 Number of sites of Number 20 17 171718 1819 20 1315 6 8 10 5 0 010203040506070809101112131415161718192021222324252627282930313233343536373839404142434445464748 Epidemiologic Week 2014 Early Warning and Disease Surveillance System In week 48, we did not receive reports from four facilities (Table1). Health facilities are requested to kindly submit their IDP reports for the preceding week, by 17:00 hrs on Monday. Table 1: List of silent health facilities during week 48, 2014 No. IDP site Health Facility/Partner 1 Nyirol Chuil PHCU 2 Twic Man Awan GOAL 3 Bor PoC Bor IRC 4 Renk IOM Prayer Consultations (All patients seen at Outpatient and Inpatient facilities) The total number of consultations increased from 18,545 in week 47 to 19,704 in week 48. During week 48, most of the consultations were reported from Bentiu, Awerial, Malakal, and Renk (Figure 2). Figure 2 Consultations by IDP Camp & Partner, week 48, 2014 5000 4500 4000 3500 2021 3000 435 2500 408 2000 572 364 Number of consultationsof Number 1500 1201 643 1000 1401 849 1344 1168 526 1231 798 811 846 500 460 678 386 400 469 312 504 337 341 232 Lul 283 240 214 Bor 87 143 Yuai 0 DUK Renk Ayod Ogod Melut Akoka Akobo Kodok Bentiu Awerial Malakal Lankien Tongping Twic East Twic UN HOUSE UN Wau Shilluk Wau Man-Anguei CCM IMC IOM IRC MSF-E MSF-OCA CARE Medair HealthLink GOAL IMA SMC Since the onset of the crisis, 718,746 consultations have been registered from all IDP sites with an overall annualised outpatients department (OPD) utilisation rate of 1.2 consultations per person per year (Figure 2.1). The IDP site-specific annualised OPD utilisation rates are shown in Figure 2.1. Figure 2.1 Annualised OPD Utilization Rates by IPD site, week 1-48, 2014 6.0 5.0 4.0 3.0 5.6 3.9 2.0 3.1 2.5 2.7 2.0 1.7 2.0 1.0 1.6 1.3 1.6 0.3 0.3 0.6 1.2 0.5 0.6 0.4 0.2 0.5 0.2 0.1 0.2 0.04 1.2 Consultations per person per year per personper Consultations - Annualised Utilization rate Threshold [1-1.5] Early Warning and Disease Surveillance System Overall Trends of Priority Epidemic-prone Diseases Figures 3 and 4 show the proportionate and incidence morbidity trends for Acute Respiratory Infection (ARI), Malaria, Acute Watery Diarrhoea (AWD), suspected measles and Acute Bloody Diarrhoea (ABD). Figure 3 Priority Disease Proportionate Morbidity - Week 1 - 48, 2014 45.0% 100% 40.0% 90% 35.0% 80% 30.0% 70% 60% 25.0% 50% Completeness 20.0% 40% 15.0% Percent of allconsultations of Percent 30% 10.0% 20% 5.0% 10% 0.0% 0% 01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 Epidemiologic Week Completeness ARI Bloody Diarrhea Malaria Suspected Measles Watery Diarrhoea Malaria, ARI and AWD were the top three causes of morbidity among IDPs in week 48 (Figure 3 and 4). During week 48, malaria had the highest proportionate morbidity and incidence (Figure 3 and 4). The overall incidence for malaria, ABD and suspect measles decreased, while the ARI and AWD incidence increased in week 48 when compared to week 47 (Figure 4). The weekly number of cases for the current and preceding week, and the cumulative number of cases for the top five causes of morbidity are presented in Table 2. Table 2 New cases for weeks Cumulative cases since week No. Disease 47 48 51 of 2013 1 Malaria 3,928 3,911 140,792 2 AWD 1,488 1,586 62,524 3 ARI 2,521 3,006 108,209 4 ABD 264 184 10,338 5 Measles 12 3 1,516 Figure 4 Incidence for Priority Diseases, week 1 - 48, 2014 140 120 100 80 60 Cases per 10,000per Cases 40 20 - Epidemiological Week 2014 01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 ARI Bloody Diarrhea Malaria Suspected Measles Watery Diarrhoea Early Warning and Disease Surveillance System Specific Priority Epidemic-Prone Diseases Acute Respiratory Infection ARI remains a leading cause of morbidity among IDPs and has registered an increasing trend since the beginning of the year (Figures 3 and 5). Figure 5 ARI Adjusted Proportionate Morbidity , for week 1 - 48 2014 40% 100% 37.7% 90% 35% 33.3% 31.9% 30.7% 30.6% 80% 30% 27.1% 70% 26.4% 25.7% 25% 23.7% 24.2% 23.3% 22.9% 22.5% 60% 21.0% 20% 20.0% 19.6% 20.3% 20.1% 50% 18.0% 17.3% 16.0%14.9% 15.2% 15.3% 40% [%] Completeness 15% 14.0% 14.3% 13.8% 13.9% 12.7% 13.4% 30% 10% Percent of total consultations total of Percent 20% 6.0% 6.8%6.3% 5% 4.4% 2.5% 10% 0.9% 0% 0% 01 03 05 07 09 11 13 15 17 19 21 Epidemiologic23 25 27 29 Week31 33 35 37 39 41 43 45 47 ARI registered the second highest proportionate morbidity of 15.3% and incidence of 53 cases per 10,000 population) in week 48 (Figure 5). During week 48, a total of 3,006 cases of ARI were reported with the highest ARI incidence (cases per 10,000) being reported in Bentiu (219) followed by Malakal (186), UN House (147), Melut (61) and Wau Shilluk (56). Acute Watery Diarrhoea As seen from Figure 6, the AWD proportionate morbidity increased from 8.02% to 8.05%, while the overall AWD incidence (cases per 10,000) increased from 26.1 to 28.8 in week 48 when compared to week 47 (Figure 4). Overall, the AWD trend has been on the decline since the beginning of the year. Figure 6 AWD Adjusted Proportionate Morbidity, for week 1 - week 48, 2014 28% 30% 27% 26% 100% 90% 80% 70% 20% 16% 16% 60% 14% 14% 14% 14% 13% 12% 12.3% 12% 11% 11.4% 50% 11% 11% 10% 9% 9% 8% 8.0% 40% 7.7% Completeness 10% 7.1% 7.2% 6.9% 7.7% 6.1% 6.8% 30% Percent of total consultationstotalof Percent 5.2% 20% 10% 0% 0% 01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 Epidemiologic week During week 48, a total of 1,586 AWD cases were reported with the highest AWD incidence (cases per 10,000) being reported in Bentiu (99), Tongping (86), Malakal (85), Bor (35) and Melut (35) as illustrated in Figure 7. Early Warning and Disease Surveillance System Figure 7 AWD Incidence, by IDP site, for week 1 - 48, 2014 700 600 500 400 Cases per 10,000 per Cases 300 200 100 - 01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 Epidemiological week 2014 Bentiu Malakal Melut Bor Tongping Figure 7.1 shows the AWD trends by age-group. The incidence (cases per 10,000) of AWD is higher in children under five years of age. These trends indicate that the background risk for acute watery diarrhoea is high, especially in children under-five. Figure 7.1 AWD incidence by age group, for week 1 to 48, 2014 200 100% 180 90% 160 80% 140 70% 120 60% 100 50% Completeness Cases per 10,000 per Cases 80 40% 60 30% 40 20% 20 10% 0 0% 01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 Epidemiological week 2014 Completenes ≥5 yrs <5 yrs Dysentery / Acute Bloody Diarrhoea Figure 8 ABD Proportionate Morbidity, for week 1 - 48, 2014 8.0% 100% 6.7% 7.0% 90% 80% 6.0% 70% 5.0% 60% 4.0% 3.4% 3.4% 50% Completeness 2.6% 2.4% 2.4% 40% 3.0% 2.2% 2.2% 2.3% Percent of total consultationstotalof Percent 1.8% 1.9% 1.6% 1.6% 1.7% 1.6% 1.6% 1.7% 1.6% 1.7% 1.6% 30% 1.3% 1.5%1.4% 1.3% 1.4%1.3% 1.4%1.4% 2.0% 1.2% 1.2% 1.0% 1.1% 0.8% 1.0% 0.9% 0.9% 20% 1.0% 10% 0.0% 0% 01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 Epidemiologic Week Early Warning and Disease Surveillance System The overall ABD trend has been on the decline since the beginning of the crisis with successively shorter peaks in weeks 2, 21, and 37 (Figure 8).