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South Sudan IDSR Annex

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South Sudan IDSR Annex • Overall, malaria is the top cause of morbidity accounting for 55.5% of the total consultations in week 47; followed by ARI (12.2%), and AWD (9.1%). Trend in consultations and key diseases IDSR trends in absolute counts Figure 3 | Trend in total consultations and key diseases (W39) 275000 250000 225000 200000 175000 150000 r e b m u N 125000 100000 75000 50000 25000 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 Malaria Acute Jaundice Syndrome (AJS) Acute Respiratory Infection (ARI) Measles 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) Fig. 1|IDSR Proportionate morbidity trends, week 1 to 47, 2017 275000 70% 160 250000 140 60% 225000 Thousands 120 200000 50% 100 175000 40% 80 150000 r e b 30% Morbidity % m u 60 N 125000 20% 40 100000 10% 20 Number of consultations 75000 0% 0 50000 1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829303132333435363738394041424344454647 Epidemiological week of reporting in 2017 25000 0 Consultations Malaria ARI AWD ABD Measles 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 In the relatively stable states, Total consultations malaria is the top cause of morbidity accounting Acute Watery Diarrhoea Malaria Acute Jaundice Syndrome (AJS) for 44.4% of the consultations in week Acute Respiratory Infection (ARI) 47 Mwith a cumulative easles 41.3% in 2017. The malaria proportionate morbidity increased from an average of 30% prior to the malaria transmission season to nearly 44.4% currently. 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 01-47, 2017 250000 45% 50,000 45,000 225000 40% 40,000 35% 200000 35,000 30% 175000 30,000 25% % of Mobidity 25,000 Consultations 150000 r 20% e b 20,000 m u N 15% 125000 15,000 10% 10,000 100000 5% 5,000 75000 0% 0 1 2 3 4 5 6 7 8 9 1011121314151617181920212223242526272829303132333435363738394041424344454647 50000 Epi week 2017 25000 Consultations Malaria ARI AWD ABD Measles 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 In the IDPs, ARI surpassed malaria as the top cause of morbidity in week Malaria Acute Jaundice Syndrome (AJS) 45. Hence ARI and malaria accounted for Acute Respiratory Infection (ARI) 24.9% Measlesand 20.5% of consultations in week 47. 5 W39 2017 (Sep 25-Oct 01) Since the beginning of 2017, at least 1,131 suspect measles cases including at least 11 deaths (CFR 0.97%) have been reported. Of these, 616 suspect cases have undergone measles case-based laboratory-backed investigation. At least 323 samples have been collected, with a total of 84 measles cases being laboratory confirmed, while 321 cases and 26 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 eight state hubs where 1,639,947 children six to 49 months (87%) were reached with measles vaccine. Rainfall experience for October 2017 • Maps show rainfall for October 2017 percentage of average( less than 25% bellow is bellow normal, 75-125% is normal , greater than 125% is above normal) and standardized precipitation index(SPI) • In October 2017; all counties received either normal or below normal rains apart from Kapoeta South; Kapoeta North; Kapoeta East; and Budi that were extremely wet (SPI - map). • Projections for November 2017 show that the Southern States are likely to receive >300mm of rainfall; areas of central South Sudan will likely receive 10mm-100mm of rainfall; while northern South Sudan will receive the least (<10mm) of rain fall. • Most malaria cases are occurring in counties in IPC crisis phase • Two counties with high malaria cases are in IPC emergency phase - • Many of the counties in Jonglei are in IPC crisis phase but malaria surveillance data is not available for those locations Counties with malaria cases exceeding the third quartile in week 45 of 2017 Malaria trends by county 1,800 Malaria trends for Terekeka county in 2017 1,600 o At least 23 countries - Awerial, Cueibet, 1,400 1,200 3rd Quartile C-sum 2017 1,000 Rumbek East, Rumbek North, Wulu, Yirol 800 600 East, Yirol West, Aweil East, Aweil North, 400 200 - Aweil South, Jur River, Gogrial East, Tonj Weeks North, Tonj South, Rubkona, Twic East, Duk, 600 Malaria trends for Kapoeta East county in 2017 Kapoeta North, Ikotos, Kapoeta East, & 500 400 Terekeka have reported increasing trends at 3rd Quartile C-sum 2017 300 or above the third quartile [see next four 200 100 slides]. - Weeks 1,200 Malaria trends for Ikotos county in 2017 1,000 800 3rd Quartile C-sum 2017 600 400 200 - Weeks 700 Malaria trends for Kapoeta North county in 2017 600 500 3rd Quartile C-sum 2017 400 300 200 100 - Weeks Malaria trends by county and rainfall patterns Counties with malaria cases exceeding the third quartile in week 45 of 2017 500 Malaria trends for Duk county in 2017 450 In October 2017; 4 counties 400 350 300 3rd Quartile C-sum 2017 received rainfall that exceed the 250 200 third quartile of the rainfall for 150 100 50 period 2013-2016. These - Weeks counties should be monitored for potential increase in malaria 600 Malaria trends for Twic East county in 2017 500 cases (see table) 400 3rd Quartile C-sum 2017 300 200 County 100 - Weeks Budi 2,500 Malaria trends for Awerial county in 2017 Kapoeta East 2,000 1,500 3rd Quartile C-sum 2017 Kapoeta South 1,000 500 Kapoeta North - Weeks 2,500 Malaria trends for Cueibet county in 2017 2,000 1,500 3rd Quartile C-sum 2017 1,000 500 - Weeks Malaria trends by county and Counties with malaria cases exceeding the third quartile in week 45 of 2017rainfall patterns 4,000 Malaria trends for Rumbek Center county in 2017 3,500 • During 2017, the mean rainfall 3,000 2,500 3rd Quartile C-sum 2017 in millimeters increased from 2,000 1,500 2.7 and 13 in January and 1,000 500 - February to a peak of 158-185 Weeks in July, August, and 9,000 Malaria trends for Rumbek East county in 2017 September). 8,000 7,000 6,000 3rd Quartile C-sum 2017 5,000 • The mean precipitation 4,000 3,000 reduced from 158 millimeters 2,000 1,000 - in September 2017 to 85.5 Weeks millimeters in October 2017 1,200 Malaria trends for Rumbek North County in 2017 1,000 800 3rd Quartile C-sum 2017 600 400 200 - Weeks 1,200 Malaria trends for Wulu County in 2017 1,000 800 3rd Quartile C-sum 2017 600 400 200 - Weeks Counties with malaria cases exceeding the third quartile in week 45 of 2017 Malaria trends by county and rainfall predictions for October to December 2017 2,500 Malaria trends for Yirol East County in 2017 The rainfall outlook for Oct-Dec 2,000 1,500 3rd Quartile C-sum 2017 2017 as shared by the IGAD 1,000 climate prediction & application 500 center (ICPAC) shows that: - Weeks • Southwestern parts the country 7,000 Malaria trends for Yirol East County in 2017 will likely receive normal to 6,000 5,000 above normal rainfall (near to 3rd Quartile C-sum 2017 4,000 3,000 below normal rains in rest of 2,000 1,000 country) - Weeks • Above normal temperatures 2,500 Malaria trends for Aweil Center County in 2017 countrywide 2,000 • 3rd Quartile C-sum 2017 The above normal rains in the 1,500 1,000 southwest will likely lead to 500 flooding, a protracted malaria - Weeks transmission season, increased risk of waterborne diseases 16,000 Malaria trends for Aweil East County in 2017 14,000 12,000 • In the rest of country, low rains 10,000 3rd Quartile C-sum 2017 8,000 will likely reduce quality of water 6,000 4,000 thus a possibly exaggerated risk 2,000 - of waterborne diseases Weeks Malaria trends by county Counties with malaria cases exceeding the third quartile in week 45 of 2017and proposed mitigation measures 3,500 Malaria trends for Aweil North County in 2017 3,000 Proposed mitigation measures for 2,500 3rd Quartile C-sum 2017 areas expected to receive normal 2,000 1,500 or above normal rain: 1,000 500 - • Contingency planning, risk Weeks communication 1,400 Malaria trends for Rubkona County in 2017 1,200 • Preposition kits for malaria, 1,000 3rd Quartile C-sum 2017 800 waterborne diseases 600 400 • Enhance surveillance for malaria, 200 - AWDs Weeks • Preventive vaccination where 3,000 Malaria trends for Jur River County in 2017 2,500 applicable 2,000 3rd Quartile C-sum 2017 1,500 As for areas expected to have less 1,000 500 than normal rains, the - recommended measures entail: Weeks • Enhance WASH, water quality 5,000 Malaria trends for Gogrial East County in 2017 4,500 4,000 testing, water trucking, & water 3,500 3,000 3rd Quartile C-sum 2017 2,500 treatment 2,000 1,500 1,000 • Nutrition surveillance & 500 - prepositioning of SAM kits Weeks Counties with malaria cases exceeding the third quartile in week 45 of 2017Malaria trends by county and proposed mitigation measures 3,000 Malaria trends for Tonj East County in 2017 2,500
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