Cholera Situation and Response Updates 17 November 2017

CHOLERA SITUATION AND RESPONSE UPDATES 17 NOVEMBER 2017

Epidemic trends

§ Cholera transmission reported in two counties [Juba and Budi] in the last four weeks [43- 46, 2017]. § Out of the 26 samples tested in the week, 16 (62%) were positive by culture. All positive samples were from New Bongo (a new focus of transmission in Juba) (Table 4).

Table 1: Cholera cases by county for weeks 43, 2017 to 46, 2017 Cases reported Deaths Cumulative Cumulative New Date first (attack New during County during Facility+ reported Number rate per reporting reporting Community Facility Community of cases 10,000) period period CFR% Juba 18-Jun-16 113 2,922 50.40 2 28 10 1.33 Budi 22-Jul-17 42 850 49.70 1 62 20 9.95

§ In the last four weeks, cholera cases have been reported from Juba and Budi (Fig.1 and Table 1). During this period, a new focus of transmission emerged in New Bongo, Luri payam in Juba county (Fig.2 and 3). The initial cases were reported from New Bongo on 10 November 2017. At least 40 cases including 16 confirmed cases have been reported from New Bongo (Figure 3).

Fig.1|Cholera cases by county, week 43-46, 2017 60 54 50 Budi Juba 40

30 27

20 18

Number of cases 14 10 17 13 12 0 43 44 45 460 Epidemiological week of onset

1 § Two assessment missions to New Bongo were undertaken during the week. The affected population is using two shallow wells as drinking water source after the sole borehole in the area broke down. There are no improved sanitation facilities in the area and the population has no access to a primary health care facility. New Bongo and the surrounding areas have an estimated population of 11,000. Following the assessment missions, an oral rehydration point has been set up by HLSS; bucket chlorination has been initiated; plans are underway to repair the borehole; a roadshow is planned in the area; and a reactive vaccination campaign using oral cholera vaccines will be implemented on 23 and 24 November 2017.

Fig.2|Cholera Epidemic Curve for Juba County, week 23, 2016 to week 46, 2017 350 8% 300 Alive Died CFR% 250 6% 200 4%

150 CFR% 100 2% 50 Number of cases/deaths 0 0% 21232527293133353739414345474951 1 3 5 7 9 111315171921232527293133353739414345 2016 Epidemiological week of onset 2017

Fig.3|Cholera cases by village in Juba county, week 45-46, 2017 45 40 40 35 30 25 20 15 10 5 3 3 3 4 Number of cases 5 1 1 1 1 2 2 2 0

Name of vilage in Juba county

§ In Budi, the cases have continued to decline with only sporadic transmission reported in Kimotong, Ngauro, and Lorema. A reactive oral cholera vaccination is already underway in the county. § A cumulative of 850 cases including 82 deaths [CFR 9.65%] have been reported in Budi since week 29, 2017 (Table 1 and Figure 4). Overall, males (54.6%) are more affected than females (43.9%) in Budi county. Male children and male young adults are more affected than their female counterparts of corresponding age (Figure 5). § The outbreak in Budi started on 28 July 2017 with the initial transmission occurring among

2 gold-miners in Ngauro.

Fig.4|Cholera Epidemic Curve for Budi County, week 23, 2016 to week 46, 140 2017 120% 120 100% Alive Died CFR% 100 80% 80 60%

60 CFR% 40 40% 20%

Number of cases/deaths 20

0 0% 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 2017 Epidemiological week of onset

Cordaid and the County Health Department are supporting management in Ngauro CTU, Kimotong CTU, Kimotong PHCC, Vaka ORP, Nagishot PHCC, Lorema CTU, and Kakilai PHCC in Budi county.

Figure 5|Cholera case distribution by age and sex in Budi, June 2016 - Nov 85-89yrs 2017 0.10 0 80-84yrs 0.000 75-79yrs 0.20 0 70-74yrs 0.20 0.1 65-69yrs 0.40 0 60-64yrs 0.10 0.6 55-59yrs 0.20 1.1 50-54yrs 2.40 2.7 45-49yrs 2.50 2.7 40-44yrs 2.50 3.8 35-39yrs 2.70 2.7 30-34yrs 8.10 3.9 25-29yrs 5.40 4.5 20-24yrs 6.60 4.7 15-19yrs 5.40 5.8 10-14yrs 3.40 2.6 5-9yrs 4.20 3.2 0-4yrs 10.00 5.6

12 10 8 6 4 Percentage %2 0 2 4 6 8

There are ample cholera case management kits and the cholera treatment facilities are adequately staffed for the current case-loads. In addition to case management, surveillance, and WASH interventions, and a cholera vaccine campaign is underway.

3 Fig.6|Cholera cases per 10,000 by county in South Sudan, 2016 and 2017 15 Yirol West - 143 Yirol East - 1 Tonj North - 144 Tonj East - Terekeka 1 - Rubkona 22 70 0 Renk - Panyijiar 38 40 4 Nyirol - Mayom 0 - 13 Mayendit 10 2017 2016 1 Malakal - Magwi -1 Leer - 10 87 Kapoeta South - 66 Kapoeta North - 88 Kapoeta East - Juba 15 35 Fashoda 131 - 8 Fangak 8 Duk 10 47 Canal Pigi 3 11 50 Budi - 4 Bor 5 189 Ayod - Awerial 31 74

- 20 40 60 80 100 120 140 160 180 200 cholera cases per 10,000 population

Overall cholera trends

§ Since the start of the current outbreak on 18 June 2016, a total of 21,530 cases including 461 deaths (CFR 2.14%) have been reported from 27 counties (Table 2). The most affected counties include Ayod, Tonj East, Yirol East, Fashoda, Kapoeta East, and Kapoeta South (Figure 6). § The most affected populations in these locations include: Landing sites/ towns along River Nile; cattle camp dwellers; populations living on islands - no social services; and IDPs - recently displaced with inadequate access to WASH.

4 Fig.7|Cholera cases fatality rate (%) by county in South Sudan, 2016 and 2017 Yirol West 0.0% Yirol East 0.0% 4.5% Tonj North 0.0% Tonj East 2.5% Terekeka 33.3% Rubkona 1.1% Renk Panyijiar 2.9% 7.0% Nyirol 2.8% Mayom 44.4% Mayendit 1.5%3. 1% Malakal 2017 2016 Magwi 3.4% Leer 3.2% Kapoeta … 1.0% Kapoeta … 0.1% Kapoeta East 1.2% Juba 0.8% 1.5% Fashoda 1.6% Fangak 0.8% 0.8% Duk 6.2% 8.7% Canal Pigi 3.0% 9.6% Budi 2.1% Bor 3.0% Ayod 1.0% Awerial 1.1% 1.1%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% cholera case fatality rate - CFR [%]

Cholera case fatality rates were highest in counties with poor access to health care especially in populations living in the islands and cattle camps (Figure 7). Overall, a higher proportion of females (51.8%) are affected than males (47.6%). Children and young adults are more affected. Figure 8 shows the age and sex distribution of cases. There are no significant sex differences after adjusting for age (marginally higher number of cases in females).

Fig. 8|Cholera case distribution by age and sex, June 2016 - Nov 2017 0.000 80-84yrs 0.10 0.1 0.10 0.1 70-74yrs 0.30 0.3 0.30 0.4 60-64yrs 0.80 1.1 0.60 0.6 50-54yrs 1.40 1.5 1.50 1.8 40-44yrs 1.90 2.4 2.60 3.3 30-34yrs 3.30 4.5 3.60 5 20-24yrs 3.10 4 3.50 4.3 10-14yrs 5.70 5.4 7.50 6.5 0-4yrs 11.10 10.2

15 10 5 Percentage %0 5 10 15

Fig.9|Cholera Epidemic Curve for South Sudan, week 23, 2016 to week 46, 2017 2000 20%

Alive Died CFR% 1500 15%

1000 10% CFR%

500 5% Number of cases/deaths 0 0% 21232527293133353739414345474951 1 3 5 7 9 111315171921232527293133353739414345 2016 Epidemiological week of onset 2017

Figure 9 shows the overall cholera epidemic curve for South Sudan. The highest transmission peaks were associated with outbreaks that affected cattle camps in the following counties – Awerial, Yirol East, Duk, Bor, Uror, Ayod, Kapoeta East, Kapoeta South, and Kapoeta North. The same locations also reported high CFR due to poor access to health care especially at the onset of the outbreak

As seen in Table 2, cholera cases have been confirmed every year since the onset of the South Sudan crisis in 2013. The 2016/17 outbreak is the longest and largest in magnitude and geographical extent. Due to the protracted crisis, displacements, insecurity, and declining investment in WASH, access to safe drinking water and sanitation facilities has declined significantly. Access to improved sanitation facilities is less than 10% while access to safe drinking water from improved water sources is estimated at 60%.

TABLE 2|CHOLERA OUTBREAKS IN SOUTH SUDAN 2014-2017

Summary measure 2014 2015 2016/17 No. cases 6,421 1,818 21,530

No. deaths 167 47 461 CFR% 2.60% 2.59% 2.14%

No. counties affected 16 3 27 Duration (weeks) 29 19 (76) Ongoing

Outbreak start date 24/04/2016 18/05/2016 18/06/2016 Date of last case 13/11/2016 24/09/2016 Ongoing

Attack rate [per 10,000] 27 17 46.31

6 Coordination of cholera response The National cholera task force is coordinating the overall cholera response. The task force meetings convene weekly on Wednesdays from 2 pm in the WHO conference hall in Juba.

Cholera response updates The overall response to cholera in South Sudan is coordinated by the national taskforce that is Chaired by MoH with support from WHO, Unicef, and partners (Health and WASH clusters).

The weekly cholera taskforce meetings are ongoing in Juba during which, the cholera situation and the ongoing cholera prevention and response activities in the affected and high-risk areas are reviewed.

During week 46, the cholera taskforce meeting was convened in Juba on 15 November 2017 to review the current cholera situation and status of outbreak response activities.

During the week, two assessment missions to New Bongo were conducted. The affected population is using two shallow wells as drinking water source after the sole borehole in the area broke down. There are no improved sanitation facilities in the area and the population has no access to a primary health care facility. New Bongo and the surrounding areas have an estimated population of 11,000. Following the assessment missions, an oral rehydration point has been set up by HLSS; bucket chlorination has been initiated; plans are underway to repair the borehole; a roadshow is planned in the area; and a reactive vaccination campaign using oral cholera vaccines will be implemented on 23 and 24 November 2017.

The oral cholera vaccine campaign in Budi county is already underway with support from IOM and CORDAID. The campaign targets to reach at least 150,000 individuals aged one year and above with oral cholera vaccines.

Fig.10: Oral cholera vaccine administrative coverage by round and site for 2017

Fig. 10|Administrative coverage (%) for OCV by site in 2017 200 First Round Second Round 150 83 100 56 38 58 Coverage % 50 92 98 85 81 81 76 85 81 88 69 64 62 74 59 0

Progress of oral cholera vaccine campaigns As part of the ongoing cholera response, cholera vaccines have been deployed to complement cholera response in several high-risk populations and locations. These areas include Leer, Bor PoC, Malakal Town, Bentiu PoC, Mingkaman IDP settlement, Aburoc IDPs, Bentiu/Rubkona

7 Town, Ayod (Pagil, Tar, Jiech, Karmun, Padek, and Kandak), Juba (Don Bosco IDPs and additional high-risk locations), Tonj East and Marial Lou payam, Kapoeta North, Kapoeta South, and Kapoeta North. Out of the 1,440,358 doses secured by WHO in 2017, a total of 1 123 023 doses have been deployed (see Figure 10).

Following an oral cholera vaccine working group meeting conducted on 14 November 2017 in Juba; a total of 737,819 doses of oral cholera vaccines have been requested from the GTFCC Global stockpile (Table 3). The vaccines will be used for second round campaigns in areas listed in table 3.

Table 3| OCV doses requested from the Global Stockpile Sno. County OCV doses 1 Kapoeta South 97,000 2 Kapoeta North 141,520 3 Kapoeta East 97,000 Tonj East 164,900 4 Juba 200,000 5 Aburoc 20,797 6 Malakal Town 16,602 7 Total 737,819

Laboratory updates This week, 16 samples from New Bongo, Juba county were positive for Vibrio cholerae by culture. A total of 26 samples (23 from Juba; 2 from Rubkona; and 1 from Torit) were tested in the week. The samples from the other sites were all negative for cholera. Overall, at least 1,145 samples have been tested out of which at least 509 (44.5%) have teste positive for Vibrio Cholerae O1 Inaba by microbiological culturing (Table 4).

A total of 33 Vibrio cholerae isolates have been shipped for genetic sequencing; typing; and antimicrobial sensitivity testing by Institute Pasteur, Paris.

Table 4: Cholera laboratory culture test results June 2016 - November 2017 Week 46 Cumulative (2016-2017) County Positive Positive Negative Total tested Abyei 1 1 Akobo 2 2 Awerial 55 63 118 Ayod 2 6 8 Bor 4 4 8 Budi 2 1 3 Duk 11 6 17 Fangak 31 50 81 Fashoda 7 14 21 Juba 16 281 295 576 Kapoeta East 10 10 Kodok 1 2 3 Lankien 3 1 4 Leer 9 13 22

8 Week 46 Cumulative (2016-2017) County Positive Positive Negative Total tested Magwi 7 1 8 Malakal 2 21 23 Mayendit 4 6 10 Mayom 4 7 11 Panyijiar 1 1 Pibor 5 5 Pigi 2 4 6 Renk 2 2 Rubkona 0 30 95 125 Terekeka 2 2 Tonj East 8 8 16 Torit 0 0 6 6 Uror 2 2 Wau 6 6 Yirol East 10 12 23 Yirol West 4 4 Kapoeta South 12 12 24 Nyirol 3 1 4 Total tested 16 509 642 1,145

9 WASH CLUSTER RESPONSE UPDATES

Beneficiaries reached by WASH cluster partners in week 43

10 SOCIAL MOBILISATION UPDATES Social Mobilization, Communication and Hygiene Promotion Reporting Format (4-10 November, 2017) Locations with ongoing Partners present Ongoing Action with number of population reached Gaps and recommended outbreak and hot spots with Cholera interventions action (Payam level) Tonj East: Most affected THESO and CHDs UNICEF Implementing partner, The Health Support Makuac, Paliang, Paweng Organization (THESO) has been carrying on integrated Payam, Tonj South and Marial- community engagement activities covering critical health Lou-Tonj North. (Warrap) and nutrition lifesaving messaging. The thematic areas include cholera intervention, WASH, immunization, Malaria and best feeding practices. The partner also engaged communities at household level with critical demonstrations, community meetings, water-point and market awareness, school and cattle camps intervention in cholera hotspots and all other Payams and Bomas of Tonj East, Tonj North, Tonj South, Twic, Abyei and Gogrial.

As of this week, 254 community mobilizers conducted household visits and reached 72,932 households (about 229,744 people reached) with cholera and immunization messages.

A total of 10 schools with 2891 school children were sensitized on cholera prevention and control and important of immunization. 7 community meetings conducted in which 500 community leaders participated and 4 FGD session was conducted with 8 participants in Tonj North, 15 in Gogrial East and 15 in Tonj East, Tonj South 10 were selected from different groups representing; women group, youth groups, teachers, and religious leaders

11 Locations with ongoing Partners present Ongoing Action with number of population reached Gaps and recommended outbreak and hot spots with Cholera interventions action (Payam level) 4 market sessions were conducted educating 500 people including water vendors and ten (10) round of public announcements have also been conducted in public places reaching an estimate of about 10,000 people.

Two (2) cattle camps reached with health education messages and about 300 people were sensitized.

1. Bor County: - Bor CDNF UNICEF supported partner CDNF continue with community Municipality, Anyidi engagement activities which include household visits with Payam, Makuac Payam, critical demonstrations, community meetings, water-point Kolnyang Payam, Baidit and market awareness, school and cattle camps Payam and Jalle payam. intervention in areas of Bor, Duk and Twic East. 2. Twic East: - Lith Payam,

Kongor payam, Nyuak - 150 community mobilizers reached people visiting payam, Ajuong payam, 13,500 households (40,500 individual) with

and PakeerPayam, messages. 3. Duk: - Poktap payam, - 6750 students were oriented on cholera Dukpayuel payam, Padiet prevention in 15 school sessions. payam and Ayueldit - 810 community members have attended 27 payam community meetings. 4. Pibor County: Pibor, - 8,54people were oriented on cholera through Lekuangole, Verteth, market and water point intervention sessions. Gumuruk and Boma - 10 public announcements have reached 15,000 5. Pocalla County: Pochalla, people. Ojangbai Akoye, Akila, - Religious engagement: Social mobilizers reached people with effective cholera messages in over 27 Akwara, Adongo and churches during Sunday in the counties Burator

12 Locations with ongoing Partners present Ongoing Action with number of population reached Gaps and recommended outbreak and hot spots with Cholera interventions action (Payam level) - Mass media intervention: cholera key messages and radio spots are being broadcasted on Mingkaman100 FM, and Radio Jonglei 95.9FM to reach population remote villages. - 60 social mobilizers from CDNF received refresher training on basic interpersonal communication skills in Bor and Twic east counties

Jonglei (Old Fangak, Akobo and FCDI and CHDs UNICEF supported partner Fangak Community - Pigi Development Initiative (FCDI) continue with community engagement activities which include household visits with critical demonstrations, community meetings, water-point and market awareness, school and cattle camps intervention in areas of Fangak, Pigi and Khorflous. - 91 community mobilizers reached 24,570 people visiting 8190 households. - 4,050 students were oriented on cholera prevention in 9 school sessions. - 525 community members have attended 15 community meetings. - 524 people were oriented on cholera through 5 market and water point intervention.

Jonglei (Akobo, Nyirol, Uror) Nile Hope and CHDs Nile Hope in partnership with UNICEF C4D continue with - community engagement activities which include household

13 Locations with ongoing Partners present Ongoing Action with number of population reached Gaps and recommended outbreak and hot spots with Cholera interventions action (Payam level) visits with critical demonstrations, community meetings, water-point and market awareness, school and cattle camps intervention in areas of Akobo, Nyirol and Uror. Below are some of the achievements;

- Door to Door mobilization: This week, 115 Social mobilizers conducted house to house visit and reached 820 Households (4,100 peoples) who were sensitized on behavior change on integrated emergency response including Malaria, cholera, diarrheal control and routine immunization on both Counties of Uror, Akobo and Nyirol - Cholera awareness at School: A total of 4 schools reached and 940 pupils benefited from school- based interventions on integrated cholera awareness and routine immunization session carryout by social mobilizes at different counties of Uror, Akobo and Nyirol. - Community sensitization Meetings: Nile Hope social mobilizers conducted community meetings at different Payam of Akobo, Nyirol and Uror counties, Numbers of 3 meetings were held and 770 peoples including of community leaders which comprise of local chiefs, religious leaders and women and youth leaders.

- Markets awareness interventions: 8 sessions were held at the market places and 2,780 reached

14 Locations with ongoing Partners present Ongoing Action with number of population reached Gaps and recommended outbreak and hot spots with Cholera interventions action (Payam level) individuals through market sessions including food vendors in Akobo, Uror and Nyirol - Intervention at water points: The social mobilizers/home health promoters from carried out 11 Sessions on cholera awareness interventions reaching 6,430 peoples on Cholera and diarrheal disease messages including demonstration on hand washing, water treatment and proper water storage.

- Public Awareness: Nile Hope Socials mobilizes had conducted 2 public awareness on cholera key messages around the town of Akobo, and Nyirol Counties using megaphones, announcing the key messages for prevention of cholera and diarrheal disease in their residential areas and reached 4,570 peoples.

- Religious engagement: Social mobilizers reached people with effective cholera messages in over 6 churches during Sunday praying services in the counties of Uror, Nyirol and Akobo and reached 3350 peoples including Children, women, men in different churches

15 Locations with ongoing Partners present Ongoing Action with number of population reached Gaps and recommended outbreak and hot spots with Cholera interventions action (Payam level)

Rubkona county Nile Hope and CHD Nile Hope in partnership with UNICEF C4D continue with - community engagement activities which include household visits with critical demonstrations, community meetings, water-point and market awareness, school and cattle camps intervention in Rubkona. Below are some of the achievements;

• 2 health facilities are visited in Bentiu 850 individual benefited from hygiene promotion and sanitation messages. • 5 water points are visited in Rubkona town and 267 individuals benefited from hygiene promotion and sanitation messages. • 1 school visited in Rubkona and 200 individuals benefited from hygiene promotion and sanitation.

• 7 health facilities and 8 water point are visited in PoC and 2290 individuals benefited from hygiene promotion and sanitation messages. Therefore, the total number of people benefited from hygiene and sanitation messages 3,607

16 Locations with ongoing Partners present Ongoing Action with number of population reached Gaps and recommended outbreak and hot spots with Cholera interventions action (Payam level) 1. Awerial County CHADO and UNICEF support communities in eastern - (Payams: Alel, Dor, lake with continued community interaction sessions Puluk, Bunangok, Nile Magok, Abuyong) such as household visits with critical demonstrations,

community meetings, water-point and market 2. Yirol East (Payams: Adior, Malek, awareness, school and cattle camps intervention in Lekakedu, Yali, hot spots areas in Eastern Lakes Pagarau Tin-agau and Nyang) CHADO had trained 83 social mobilizers to reached people in different community sessions in Eastern

Lakes. 2016 HHs reached and 7712Individuals through 3. Yirol West (Payams: door to door mobilization for community on social Abang, Anuol, Yirol Centre (Town), Geng- and behavior change intervention on cholera control Geng, Geer, Aluak and diarrhea disease prevention in Eastern Lakes Luak, Mapuordit)

In Awerial, 615 households and 2121 individuals have been reached with cholera messages by 28 trained social mobilizers. A total of 23 and 2163 pupils benefited from school- based interventions on cholera awareness session.

17 Locations with ongoing Partners present Ongoing Action with number of population reached Gaps and recommended outbreak and hot spots with Cholera interventions action (Payam level) The mobilizers also conducted 34 water point sessions reaching a total of 345 people including water vendors with Cholera and diarrheal disease educative messages including demonstration on water treatment and proper storage. 28 market awareness sessions were also conducted reaching 234 individuals including food vendors. At the same week, the social mobilizers conducted 25 community meetings and attended by 293 people inclusive of community leaders which comprise of local chiefs, religious leaders and women and youth leaders at different payams of Eastern Lakes

Religious leaders’ engagement with key messages done during religious service days (Friday, Saturday and Sunday). 7 churches /parishes in the counties of Eastern reaching population with lifesaving messages on cholera control and prevention.

18 Locations with ongoing Partners present Ongoing Action with number of population reached Gaps and recommended outbreak and hot spots with Cholera interventions action (Payam level) CHADO conducted social mobilization outreach activities in 26 Cattle camps with total of 564 individual

In Yirol East, 28 trained mobilisers/health promoters reached, 643 households 2861 people) with key messages on cholera prevention and control on the same note, 23 community meetings were conducted with (354 people participated), 19 market sessions with total of 456 individuals reached, 36 schools with total of 5871 pupils, 54 water sessions conducted with total of 456 individuals reached. The Religious leaders were also engaged: During religious services, to reach people with effective cholera messages in the churches /parishes with lifesaving messages on cholera control and prevention. and have reached 10 churches/parishes in the county

19 Locations with ongoing Partners present Ongoing Action with number of population reached Gaps and recommended outbreak and hot spots with Cholera interventions action (Payam level) In Yirol West, 758 households 2730 people) with key messages on cholera prevention and control by 28 trained mobilisers. 33 community meetings (460 people participated). 24 market session with total of 274 individuals reached. 21 school with total of 2510 pupils reached and 34 water sessions conducted with total of 350 individuals reached. The engagement of religious leaders: During religious services, Social mobilizers reached people with effective cholera messages in over 9 churches /parishes in the counties of Eastern lake reaching population with lifesaving messages on cholera control and prevention. Juba Health link, SMoH - Gurei, Kator, Lologo, Gumbo, and CHD As part of Mass media, a total of 14 FM stations continue Nesitu with airing of radio spots and talk-shows in Juba and Yei. As of 29-10 October, 2017, 1,680 times radio

20 Locations with ongoing Partners present Ongoing Action with number of population reached Gaps and recommended outbreak and hot spots with Cholera interventions action (Payam level) jingles have been broadcasted reaching over 2 million people across the country.

This week, street announcement of both cholera and immunization messages has been ongoing through Five (5) Public Address Systems (PAs) in five main areas of the City namely; Rejaf, Kator, Juba, Munuki and Nyar-kenyi/Northern Bari. The PAs conducts 5 hours’ announcements per day (3 hr. morning and 2hrs evening).

UNICEF partner Health Link South Sudan continue with social mobilization activities in the catchment areas of the nine (9) ORPs in Juba City and Lokiliri. As of week 45, trained community mobilizers reached a cumulative total of 44,248 households, 141,304 Females, 121,364 Males, 13 Community meetings with 932 people, 10 Schools with 3,514 with cholera messages in cholera hotspots areas that include Gurei, Kator, Lologo, Gumbo, Munuki, Khor William, Nyakuron and Nesitu. There were also 63,687 Aquatabs, 24,626 PuR, 1,048 tabs of soaps, 33,177 ORS given out. Also, this week, 94 IEC materials were distributed at social places including private clinics.

UNICEF supported partner, CDNF Mobilizers conducting IPC at household level and water point session in Marol and community meeting in Pariak

FCDI mobilizers in Fangak engaging with community members at different levels in Fangak

CHADO Community mobilizers conducting several community engagement activities in Awerial, Yirol East and Yirol West

Nile Hope social mobilizers making cholera awareness session at Karam IDP areas, Uror and school intervention in Padoi Village, Diror Payam, Akobo

23 Contacts Dr. Mathew Tut Dr. Joseph F. Wamala Director, Emergency Preparedness and Response Epidemiologist Ministry of Health, Ministerial ComplexJuba, Republic of South Sudan World Health Organization Email: [email protected] Ministerial Complex Juba, Republic of South Sudan Email: [email protected]