South Sudan

Integrated Disease Surveillance and Response (IDSR)

Annexes W51 2017 (Dec 18-Dec 24)

Ministry of Health Printed: 18:19 Sunday, 31 December 2017 UTC Republic of

Contents

Access and Utilisation Acute Watery Diarrhoea (AWD) Slide 2 Map 1 Map of consultations by county (2017) Slide 8 Trend in AWD cases over time

Slide 9 AWD maps and alert management

Indicator-based surveillance Slide 3 Figure 1 Proportional mortality Bloody diarrhoea

Slide 4 Figure 2 Proportional morbidity Slide 10 Trend in bloody diarrhoea cases over time

Slide 5 Figure 3 Trend in consultations and key diseases Slide 11 Bloody diarrhoea maps and alert management

Disease trends and maps Measles Malaria Slide 12 Trend in measles cases over time Slide 13 Measles maps and alert management Slide 6 Trend in malaria cases over time

Slide 7 Malaria maps and alert management

Sources of data

1. Weekly IDSR Reporting Form 2. Weekly EWARS Reporting Form

1 W51 2017 (Dec 18-Dec 24)

Access and Utilisation | Map of consultations by county

Map 1 | Map of total consultations by county (W51 2017) Hub W51 2017

Aweil 2,787 786,757

Renk 6,796 989,471 Manyo Bor 4,042 441,376

Melut 4,642 517,038 Fashoda Maban Pariang Kwajok 5,110 874,587 Abiemnhom Panyikang Baliet Aweil North Aweil East RubkonGa uit Longechuk Twic Mayom FangakCanal Pigi Malakal 4,992 771,575 Aweil West Luakpiny Nasir Aweil South Maiwut Raja GogriaGl oWgerisatl East Koch Nyirol Ulang Aweil Centre 10,960 839,521 Tonj North MayenLdeiter 34 370,377 Tonj East Akobo Duk Uror Jur River Rumbek NPorathnyijiar Wau Wau 5,512 636,732 Pochalla Tonj SoCutuhReiubmetbek Centre Twic East Rumbek EaYstirol East 6,700 522,619 Nagero Yirol West Bor Pibor Wulu Awerial Tambura South Sudan 51,575 6,750,053 Mvolo Terekeka Ezo Nzara Mundri East Mundri West Lopa LaKfoanpoeta North Yambio Ibba Maridi East

Juba Kapoeta South Torit Budi Yei Lainya Morobo

Number of consultations

0 1 1,000 2,500 5,000

2 W51 2017 (Dec 18-Dec 24)

Proportional morbidity

Figure 2 | Proportional morbidity (2017) Syndrome W51 2017

# cases % morbidity # cases % morbidity

Malaria 15,277 48.0% 2,450,328 60.1%

ARI 5,316 16.7% 436,829 10.7%

AWD 3,616 11.4% 548,754 13.5%

Bloody 427 1.3% 84,989 2.1% diarrhoea

AJS 1 0.0% 1,603 0.0%

Measles 1 0.0% 1,179 0.0%

Other 7,208 22.6% 551,855 13.5%

Total cases 31,846 100% 4,075,537 100%

Malaria Acute Jaundice Syndrome (AJS)

Acute Respiratory Infection Measles

(ARI) Other

Acute Watery Diarrhoea

Bloody diarrhoea

4 W51 2017 (Dec 18-Dec 24)

Trend in consultations and key diseases Trend in consultations and key diseases IDSR trends in absolute counts

Figure 3 | Trend in total consultations and key diseases (W51) Figure 3 | Trend in total consultations and key diseases (W39)

200000 275000

2510705000

225000 150000

200000

125000 175000 r e b 100000 m 150000 r u e N b m u

N 125000 75000

100000

50000 75000

50205000

25000 0 7 7 7 6 7 7 7 7 7 7 7 7 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2

0 9 8 3 2 2 6 5 1 9 5 8 4 0 1 1 5 2 2 0 3 3 3 4 4 6 7 6 6 7 7 6 7 7 7 7 7 7 1 1 1 1 1 1 1 1 1 1 1 1 1 W W W W W W W W W W W W 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2

9 9 8 4 8 3 2 6 2 5 1 9 5 3 0 4 4 1 1 5 2 2 0 3 3 Total consultations Acute Watery Diarrhoea 3 W W W W W W W W W W W W W Malaria Acute Jaundice Syndrome (AJS) Total consultations Acute Watery Diarrhoea Acute Respiratory Infection (ARI) Measles Malaria Acute Jaundice Syndrome (AJS)

Acute Respiratory Infection (ARI) Measles

5 W51 2017 (Dec 18-Dec 24)

5 W39 2017 (Sep 25-Oct 01)

Trend in consultations and key diseases IDSR Proportionate morbidity trends

Figure 3 | Trend in total consultations and key diseases (W39)

275000 Fig. 1|IDSR Proportionate morbidity trends, week 1 to 51, 2017 250000 70.0% 160

225000 60.0% 140 200000 120 50.0% Thousands 175000 100 40.0% 150000 r

e 80 b m u

N 30.0% 125000 60 Morbidity %

100000 20.0% 40

75000 10.0% 20

50000 0.0% 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 Number of consultations 25000 Epidemiological week of reporting in 2017 0 6 7 6 6 7 7 6 7 7 7 7 7 Consultations Malaria ARI AWD ABD Measles 7 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2

9 9 8 4 8 3 2 6 2 5 1 9 5 3 0 4 4 1 1 5 2 2 0 3 3 3 W W W W W W W W W W W W W In the relatively stable states, Total consultations malaria is the top cause of morbidity accounting Acute Watery Diarrhoea Malaria Acute Jaundice Syndrome (AJS) for 36.6% of the consultations in week Acute Respiratory Infection (ARI) 51 M(representing easles an decline from 38% in week 50) and a cumulative 41.1% in 2017. Malaria has been on the decline since week 38 of 2017. 5 W39 2017 (Sep 25-Oct 01)

Trend in consultations and key diseases IDP Proportionate morbidity trends

Figure 3 | Trend in total consultations and key diseases (W39)

275000 Fig. 2|IDP Proportionate morbidity trends, week 01-51, 2017 2500045%0 50,000 45,000 2250040%0 40,000 2000035%0 35,000 30% 175000 30,000 25% 150000 25,000 r e b % of Mobidity Consultations

m 20%

u 20,000 N 125000 15% 15,000 1000010%0 10,000

75000 5% 5,000 0 50000 0% 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51

25000 Epi week 2017 Consultations Malaria ARI AWD ABD Measles Skin diseases GSW Injuries 0 6 7 6 6 7 7 6 7 7 7 7 7 7 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2

9 9 8 4 8 3 2 6 2 5 1 9 5 3 0 4 4 1 1 5 2 2 0 3 3 3 W W W W W W W W W W W W W

Total consultations Acute Watery Diarrhoea Among the IDPs, MaARI and malaria accounted for laria Acute Jaundice10.1 Syndrome% and (AJS) 18.0% of consultations in week Acute Respira51. tory InfecThe other significant causes of morbidity in the IDPs tion (ARI) Measles include AWD, skin diseases, and injuries.

5 W39 2017 (Sep 25-Oct 01)

Trend in consultations and key diseases IDP Proportionate morbidity trends

Figure 3 | Trend in total consultations and key diseases (W39)

275000 Causes of morbidity among the IDPs weeks 1 to 51, 2017 23.8% 250000 25.0% 21.0% 225000 20.0% 200000

175000 15.0% 150000 r e b m u

N 125000 10.0% 7.8%

100000 3.97% 75000

Proportionate morbidity [%] 5.0% 1.63% 0.7% 50000 0.02% 0.02% 0.0% 25000 Malaria ARI AWD ABD Measles Skin diseases GSW Injuries

0 6 7 6 6 7 7 6 7 7 7 7 7 7 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2 2 2 2 2 2 2 2 2 2 2 2 2

9 9 8 4 8 3 2 6 2 5 1 9 5 3 0 4 4 1 1 5 2 2 0 3 3 3 W W W W W W W W W W W W W

Total consultations Acute Watery Diarrhoea The top causes of morbidity in the IDPs in 2017 include ARI, malaria, AWD, skin Malaria Acute Jaundice Syndrome (AJS) diseases, injuries, and ABD. Acute Respiratory Infection (ARI) Measles

5 W39 2017 (Sep 25-Oct 01)

Proportional mortality

Figure 1 | Proportional mortality (2017) Syndrome W51 2017

# deaths % mortality # deaths % mortality

Malaria 3 50.0% 1,178 69.1%

ARI 0 0.0% 40 2.3%

AWD 0 0.0% 90 5.3%

Bloody 0 0.0% 44 2.6% diarrhoea

AJS 0 0.0% 1 0.1%

Measles 0 0.0% 12 0.7%

Other 3 50.0% 341 20.0%

Total deaths 6 100% 1,706 100%

Malaria Acute Jaundice Syndrome (AJS)

Acute Respiratory Infection Measles

(ARI) Other

Acute Watery Diarrhoea

Bloody diarrhoea

3 W51 2017 (Dec 18-Dec 24)

Acute Watery Diarrhoea | Trends over time

Figure 5a | Trend in AWD cases over time (South Sudan)

20000

17500

15000

12500

10000

7500

5000

2500

0 Jan Mar May Jul Sep Nov

Graph legend Key AWD indicators (2017) Figure 5b | % morbidity Figure 5c | Age breakdown

2017 − · − · − · − − 2016 548,754 90 77 − − − − − − − 2015

· · · · · · · · · · 2014 Cases Deaths Alerts

8 W51 2017 (Dec 18-Dec 24)

Acute Watery Diarrhoea | Maps and Alert Management

Map 4 | Map of AWD cases by county (2017) Map 5 | Map of AWD alerts by county (2017) a. 2014 b. 2015

c. 2016 d. 2017

Map legend Risk Assessment Number of AWD cases

0 1 5,000 10,000 20,000

Number of AWD alerts 77 30 0 0 0 0

0 1 10 Alerts 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

9 W51 2017 (Dec 18-Dec 24)

Acute Bloody Diarrhoea | Trends over time

Figure 6a | Trend in bloody diarrhoea cases over time (South Sudan)

3500

3000

2500

2000

1500

1000

500

0 Jan Mar May Jul Sep Nov

Graph legend Key bloody diarrhoea indicators (2017) Figure 6b | % morbidity Figure 6c | Age breakdown

2017 − · − · − · − − 2016 84,989 44 142 − − − − − − − 2015

· · · · · · · · · · 2014 Cases Deaths Alerts

10 W51 2017 (Dec 18-Dec 24)

Acute Bloody Diarrhoea | Maps and Alert Management

M(2a0p1 76) | Map of bloody diarrhoea cases by county Map 7 | Map of bloody diarrhoea alerts by county (2017) a. 2014 b. 2015

c. 2016 d. 2017

Map legend Risk Assessment Number of bloody diarrhoea cases

0 1 500 1,000 2,000

Number of alerts 142 59 1 0 0 0

0 1 10 Alerts 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

11 W51 2017 (Dec 18-Dec 24)

Measles | Trends over time

Figure 7a | Trend in number of cases over time (South Sudan)

300

250

200

150

100

50

0 Jan Mar May Jul Sep Nov

Graph legend Key measles indicators (2017) Figure 7b | % morbidity Figure 7c | Age breakdown

2017 − · − · − · − − 2016 1,179 12 66 − − − − − − − 2015

· · · · · · · · · · 2014 Cases Deaths Alerts

Since the beginning of 2017, at least 1,179 suspect measles cases including at least 12 deaths (CFR 1.02%) have been reported. Of these, 832 suspect cases have undergone measles case12 W51 2017 (Dec 18-Dec 24) -based laboratory-backed investigation. At least 297 samples have been collected, with a total of 84 measles cases being laboratory confirmed, while 321 cases and 240 cases were epidemiologically and clinically confirmed respectively. Consequently, measles outbreaks were confirmed in nine counties – Panyijiar, Aweil South, Gogrial East, Gogrial West, Wau, Juba, Torit, Yambio, and Jur River. Measles follow up campaign implemented from May 2017 in 10 state hubs where 1,742,725 children six to 59 months (75%) were reached with measles vaccine. Measles | Maps and Alert Management

Map 7 | Map of measles cases by county (2017) Map 8 | Map of measles alerts by county (2017) a. 2014 b. 2015

c. 2016 d. 2017

Map legend Risk Assessment Number of measles cases

0 1 50 100 250

Number of measles alerts 66 21 0 0 1 1

0 1 10 Alerts Verified Low Risk Moderate Risk High Risk Very High Risk Alert threshold 1 case. Source: IDSR

13 W51 2017 (Dec 18-Dec 24)

Malaria | Trends over time

Figure 4a | Trend in number of cases over time (South Sudan)

120000

100000

80000

60000

40000

20000

0 Jan Mar May Jul Sep Nov

Graph legend Key malaria indicators (2017) Figure 4b | % morbidity Figure 4c | Age breakdown

2017 − · − · − · − − 2016 2,450,3281,178 77 − − − − − − − 2015

· · · · · · · · · · 2014 Cases Deaths Alerts

6 W51 2017 (Dec 18-Dec 24)

Malaria | Maps and Alert Management

Map 2 | Map of malaria cases by county (2017) Map 3 | Map of malaria alerts by county (2017) a. 2014 b. 2015

c. 2016 d. 2017

Map legend Risk Assessment Number of malaria cases

0 1 10,000 20,000 50,000

Number of malaria alerts 77 32 1 0 0 0

0 1 10 Alerts 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 W51 2017 (Dec 18-Dec 24)

o At least 3 countries - Awerial, Yirol East, and Twic East continue to register increasing trends at or above the third quartile. o The malaria trends in the other 20 counties are returning to normal off- transmission season levels Malaria trends by county

16,000 Malaria trends for Aweil East County in 2017

14,000 2,500 Malaria trends for in 2017 12,000

10,000 3rd Quartile C-sum 2017 2,000 3rd Quartile C-sum 2017 8,000

6,000 1,500

4,000 1,000 2,000

- 500 Weeks - 4,000 Malaria trends for Aweil North County in 2017 Weeks 3,500 3,000 7,000 Malaria trends for Yirol West County in 2017 2,500 3rd Quartile C-sum 2017 6,000 2,000 3rd Quartile C-sum 2017 1,500 5,000

1,000 4,000

500 3,000 -

2,000 Weeks 1,000 - 3,500 Malaria trends for Aweil South County in 2017

Weeks 3,000 2,500 3rd Quartile C-sum 2017 2,000

1,500

1,000

500

-

Weeks

2,500 Malaria trends for Awerial County in 2017

2,000

1,500 3rd Quartile C-sum 2017

1,000

500

-

Weeks Malaria trends by county

2,500 Malaria trends for Cueibet County in 2017

3,000 Malaria trends for Jur River County in 2017 2,000

2,500 3rd Quartile C-sum 2017 1,500 3rd Quartile C-sum 2017 2,000

1,000 1,500

500 1,000

500 -

- Weeks Weeks

500 Malaria trends for in 2017 450 600 Malaria trends for in 2017

400 500 350 3rd Quartile C-sum 2017 3rd Quartile C-sum 2017 300 400 250

200 300

150 200 100

50 100

- -

Weeks Weeks

5,000 Malaria trends for Gogrial East County in 2017 800 Malaria trends for in 2017 4,500 700 4,000

3,500 600 3rd Quartile C-sum 2017 3rd Quartile C-sum 2017 3,000 500

2,500 400 2,000 300 1,500 200 1,000

500 100

- -

Weeks Weeks

1,200 Malaria trends for in 2017 1,600 Malaria trends for in 2017

1,400 1,000 3rd Quartile C-sum 2017 1,200 3rd Quartile C-sum 2017

800 1,000

600 800

600 400 400

200 200

- -

Weeks Weeks Malaria trends by county

1,400 Malaria trends for Rubkona County in 2017 4,500 Malaria trends for Tonj North County in 2017

4,000 1,200

3rd Quartile C-sum 2017 3,500 3rd Quartile C-sum 2017 1,000 3,000

800 2,500

600 2,000

1,500 400 1,000 200 500

- -

Weeks Weeks

9,000 Malaria trends for Rumbek East County in 2017 3,000 Malaria trends for Tonj South County in 2017 8,000

2,500 7,000 3rd Quartile C-sum 2017 3rd Quartile C-sum 2017 6,000 2,000 5,000

1,500 4,000

3,000 1,000 2,000

1,000 500

- -

Weeks Weeks

1,200 Malaria trends for Rumbek North County in 2017 600 Malaria trends for Twic East County in 2017

1,000 500 3rd Quartile C-sum 2017 3rd Quartile C-sum 2017 800 400

600 300

400 200

200 100

- -

Weeks Weeks

1,800 Malaria trends for Terekeka County in 2017 1,200 Malaria trends for Wulu County in 2017 1,600

1,400 3rd Quartile C-sum 2017 1,000

1,200 3rd Quartile C-sum 2017 800 1,000

800 600

600 400 400

200 200

-

- Weeks Weeks Malaria trends by county

2,500 Malaria trends for Yirol East County in 2017

2,000 3rd Quartile C-sum 2017

1,500

1,000

500

-

Weeks

7,000 Malaria trends for Yirol West County in 2017

6,000

3rd Quartile C-sum 2017 5,000

4,000

3,000

2,000

1,000

-

Weeks

Malaria trends in select IDP sites

Figure 10a | Malaria trend for IDPs in Bentiu PoC 2017 70 Figure 10b | Malaria trend for IDPs in Malakal PoC, 2017

60 80

70 50 60 40 50

30 40

30 20 20 Proportionate morbidity %

10 Proportionate morbidity % 10

- - 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 Week of reporting Epi Week Third quartile Prop mob 2017 Third quartile Prop mob 2017

Figure 10c | EWARN trends for Malaria in UN House, 2017 50 Figure 10d| EWARN trends for Malaria in Renk, 2017 50 45 45 40

40 35

35 30 30 25 25 20 20

Proportionate mrobidity % 15 15 Proportionate morbidity % 10 10 5 5

- - 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51

Epi week Third quartile Prop mob 2017 Third quartile Prop mob 2017

Malaria trends in four of the large IDP sites - Bentiu Poc; UN House Poc; Malakal PoC; and Renk are below the third quartile

patients. Currently one team is in Kapoeta South and Kapoeta East the next teams will travel to Malakal and Fangak

IMA/KalaCore in collaboration with WHO/MOH have responded to two suspected cases (both are children) of KA at Alshaba Hospital in Juba. One of the cases is positive, currently on treatment and the other negative. Strengthening coordination amongst partners, there will be KA coordination meeting on the 3rd of Nov 2017. Conduct training on the use of IEC materials and conduct KA awareness using the IEC materials in KA endemic areas. Visceral Leishmaniasis | Kala-azar

Kala-azar is endemic in Upper , , Jonglei, & Kapoeta. Response interventions have been complicated by insecurity, population displacement, poor living conditions, increasing food insecurity, closure of treatment facilities; and low treatment completion rates.

Since the beginning of 2017, a total of 2,722 cases including 56 deaths (CFR 2.1%); 23 (0.8%) defaulters; 2,339 (85.9%) new cases; 119(4.4%) PKDL; and 264(9.7%) relapses - all reported from less than half of the 23 treatment centers.

In the corresponding period of 2016, a total of 3,513 cases including 85 deaths (CFR 2.6%) and 65(2.0%) defaulters were reported from 21 treatment centers. rd th Graph:1Cummulative number of VL new cases by 43 (23 Oct 2017 – 29 Oct 2017). The majority of cases in 2017 have been reported from Lankien (1,181), Old Fangak (733), Kurwai (201), Chuil (103), Walgak (122), Pagil (62), Malakal IDP (96), Kapoeta (42), and Bunj (45).

The most affected groups include, males [1,322 cases (48.6%)], those aged 5 - 14years [1,112(40.9%) and ≥15years and above [922 cases (33.9%)]. A total of 519 cases (19.1%)] occurred in children <5years.

We are currently in the peak transmission season [September to December]. Hence current efforts by the taskforce entail training of health workers, and stocking ample supplies of diagnostics and medicines at all designated treatment centers.

In recent years, we have seen more than expected transmission from September to December in areas affected by conflict, displacement, severe food insecurity, and poor living conditions.

Graph: 2 Cumulative numbers of VL new cases and total cases by facilities – Week 1- to 43

3

Hepatitis E Virus (HEV)

Hepatitis E virus transmission continues to be reported in 16 350 displaced populations. Genotype 1 has been isolated 14 300 from these outbreaks since 12 250 2012. This therefore suggests 10 sub-optimal access to safe 200 water and sanitation as 8 150 transmission drivers. 6 4 100

Cumulatively, a total of 454 2 50 No. cases in Bentiu No, cases in other sites HEV cases have been reported 0 0 from Bentiu PoC in 2017 [one 3 9 152127333945515 11172329354147536 121824303642482 8 1420263238 case reported in the week]. (Fig. 19). Current response entails 2014 2015 2016 2017 behavior change communication to improve Epidemiological week hygiene, access to safe water, Awerial Lankien Bentiu and sanitation. Since the beginning of the crisis, 3,694 HEV cases including 25 deaths (CFR 0.68%) reported in Bentiu; 174 cases including seven deaths (CFR 4.4%) in Mingkaman; 38 cases including one death (CFR 2.6%) in Lankien; 3 confirmed HEV cases in Melut; 3 HEV confirmed cases in Guit;1 HEV confirmed case in Leer; and Mayom/Abyei [75 cases including 13 deaths with 7 HEV PCR positive cases. 2016 By County

2017 Acute Flaccid Paralysis | Suspected Polio In week 47, nine new AFP cases were reported [five in Eastern ; one in Unity; one in ; one in ; and one in ].

During 2017, a cumulative of 340 AFP cases have been reported countrywide. The annualized non- Polio AFP (NPAFP) rate (cases per 100,000 population children 0-14 years) is 4.57 per 100,000 population of children 0-14 years (target ≥2 per 100,000 children 0-14 years).

Stool adequacy was 89% in 2017, a rate that is higher than*As of the epidemiological target of ≥80 week%. 47/2017 Environmental surveillance ongoing since May # of Counties / stool adequacy rates in 2017* 2017; with 20 samples testing positive for non- polio enterovirus. State Hubs =0 >0<80 80-89% >90 Total HUB 3 0 1 2 6 Source: South Sudan Weekly AFP Bulletin HUB 1 0 0 7 8 JONGLEI HUB 3 1 0 7 11 HUB 0 0 1 7 8

NORTHERN BAHR EL GHAZAL HUB 0 1 2 2 5

UNITY HUB 3 3 0 3 9 UPPER NILE HUB 5 3 1 3 12 WARRAP HUB 0 0 1 6 7

WESTERN BAHR EL GHAZAL HUB 0 2 0 1 3

WESTERN EQUATORIA HUB 0 0 0 10 10

Total number 15 10 6 48 79

Percent 20% 16% 8% 56% 100% *As of epidemiological week 47/2017 Mortality in the IDPs week 51 Akobo Bentiu Juba 3 Table 6 | Proportional Cause of Death by Total Proportionate mortality by cause of IDP site <5yrs <5yrs ≥5yrs <5yrs ≥5yrs deaths mortality [%] death in IDPs W51 2017 Acute Abdomen 1 1 5 Cancer 1 1 5 Liver Cirrhosis 1 1 5 Malaria 1 1 2 11 Perinatal death 1 1 2 11 pneumonia 1 1 5 Unknown 2 2 4 21 HIV/AIDS 1 1 5 Susp. TB 1 1 5 TB 2 2 11 Bowel perforation 1 1 5 Rabies (Dog Bite) 1 1 5 Neurosepsis 1 1 5 Grand Total 1 5 8 2 3 19 100

Among the IDPs from these locations, mortality data was received from Akobo, Bentiu PoC, and UN House PoC in week 51. (Table 6). A total of 19 deaths were reported during the week. Bentiu PoC reported 13 (68%) deaths in the week. During the week, 8 (42%) deaths were recorded among children <5 years in (Table 6).

The causes of death during week 51 are shown in table 6. Crude and under five mortality rates in IDPs

Figure 20 | EWARN U5MR by Site - W1 2016 to W 51 of 2017 Figure 21 | EWARN Crude Mortality Rate for W1 2016 to W 51 of 2017 1.6 2.5 1.4 2.0 1.2 1.0 1.5 0.8 1.0 0.6 0.4 0.5 deaths per 10,000 per day

deaths per 10,000 per day 0.2 0.0 0.0 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 2016 2016 2017 2016 2016 2017 Epidemiological week Epidemiological week Bentiu Juba 3 Malakal Melut Bentiu Juba 3 Malakal Threshold Wau PoC Akobo Wau Shiluk Threshold Wau PoC

The U5MR in all the IDP sites that submitted mortality data in week 51 of 2017 is below the emergency threshold of 2 deaths per 10,000 per day (Fig. 20).

The Crude Mortality Rates [CMR] in all the IDP sites that submitted mortality data in week 51 of 2017 were below the emergency threshold of 1 death per 10,000 per day (Fig. 21). Overall mortality in the IDPs in 2017

Table 7 | Mortality by IDP site and cause of death as of W51, 2017 week 51

IDP site Acute watery diarrhoea cancer Gunshot wound Heart Failure Hepatitis E hypertension Kala-Azar malaria maternal death Meningitis Perinatal death Pneumonia Rabies SAM Stroke Cholera HIV/AIDS Susp. TB TB MDR-TB + HIV Injuries Others Grand Total Bentiu 21 10 10 14 1 3 43 4 5 37 23 3 56 3 2 12 27 26 1 3 260 564 Juba 3 3 3 5 1 23 13 21 1 16 2 15 1 36 140 Kodok 1 2 3 Malakal 6 2 3 7 5 2 5 1 1 6 64 102 Akobo 3 1 2 3 19 11 1 1 15 56 Bor POC 1 2 1 11 15 Wau PoC 9 1 1 1 1 4 17 Grand Total 36 20 12 22 1 2 6 88 7 5 58 61 4 58 9 2 30 32 47 1 4 392 897 Proportionate mortality [%] 4.0 2.2 1.3 2.5 0.1 0.2 0.7 9.8 0.8 0.6 6.5 6.8 0.4 ## 1.0 0.2 3.3 3.6 5.2 0.1 0.4 43.7 100.0

• A total of 897 deaths have been reported from the IDP sites in 2017 Table 7.

• The top causes of mortality in the IDPs in 2017 include malaria, medical complications of malnutrition, pneumonia, perinatal complications, and TB are shown in Table 7. For more help and support, please contact:

Dr. Pinyi Nyimol Mawien Director General Preventive Health Services Ministry of Health Republic of South Sudan

Telephone: +211 955 604 020

Dr. Mathew Tut Moses Director Emergency Preparedness and Response (EPR) Ministry of Health Republic of South Sudan

Telephone: +211 956 420 189 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 http://ewars-project.org

Ministry of Health Republic of South Sudan