South Sudan
Integrated Disease Surveillance and Response (IDSR)
Annexes W42 2017 (Oct 16-Oct 22)
Ministry of Health Republic of South Sudan Printed: 07:52 Sunday, 29 October 2017 UTC
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 Slide 12 Trend in measles cases over time Malaria 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 W42 2017 (Oct 16-Oct 22)
Access and Utilisation | Map of consultations by county
Map 1 | Map of total consultations by county (W42 2017) Hub W42 2017
Aweil 20,367 804,082
Renk Bentiu 29,188 901,169 Manyo Bor 12,559 353,946
Melut Juba 13,966 436,139 Fashoda Maban Abyei Pariang Malakal Kwajok 19,627 826,318 Abiemnhom Panyikang Baliet Aweil North Aweil East RubkonGa uit Longechuk Twic Mayom FangakCanal Pigi Malakal 9,193 700,125 Aweil West Luakpiny Nasir Aweil South Maiwut Raja GogriaGl oWgerisatl East Koch Nyirol Ulang Aweil Centre Rumbek 22,231 666,345 Tonj North Ayod MayenLdeiter Torit 4,693 328,355 Tonj East Akobo Duk Uror Jur River Rumbek NPorathnyijiar Wau Wau 12,998 547,791 Pochalla Tonj SoCutuhReiubmetbek Centre Twic East Rumbek EaYstirol East Yambio 7,156 430,683 Nagero Yirol West Bor Pibor Wulu Awerial South Sudan 151,978 5,994,953 Tambura Mvolo Terekeka Ezo Nzara Mundri East Mundri West Lopa LaKfoanpoeta North Yambio Ibba Maridi Kapoeta East
Juba Kapoeta South Torit Budi Yei Lainya Ikotos Kajo Keji Magwi Morobo
Number of consultations
0 1 1,000 2,500 5,000
2 W42 2017 (Oct 16-Oct 22)
Proportional morbidity
Figure 2 | Proportional morbidity (2017) Syndrome W42 2017
# cases % morbidity # cases % morbidity
Malaria 71,268 68.2% 2,054,389 59.9%
ARI 10,342 9.9% 364,728 10.6%
AWD 8,880 8.5% 486,962 14.2%
Bloody 1,152 1.1% 77,231 2.3% diarrhoea
AJS 1 0.0% 1,604 0.0%
Measles 4 0.0% 1,081 0.0%
Other 12,792 12.2% 444,039 12.9%
Total cases 104,439 100% 3,430,034 100%
Malaria Acute Jaundice Syndrome (AJS)
Acute Respiratory Infection Measles
(ARI) Other Acute Watery Diarrhoea
Bloody diarrhoea
4 W42 2017 (Oct 16-Oct 22)
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 (W42) Figure 3 | Trend in total consultations and key diseases (W39)
300000 275000
250000
250000 225000
200000 200000
175000 r
e 150000 r b e b m 150000 u m N u
N 125000
100000 100000
75000
50000
25000
0 6 7 7 7 7 7 7 7 6 7 6 7 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 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 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 2 2 2 2 2 2 2 2 2 2 2 2
8 3 5 5 8 9 9 1 2 2 4 6 9 9 8 4 8 3 2 6 2 5 1 9 5 4 1 3 1 0 3 0 3 5 2 4 2 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 W W W W W W W W W W W W
T Tootatal lc coonnssuultlatatitoionnss A Acuctuet eW Wataetreyr yD iDairarhrroheoaea Malaria Acute Jaundice Syndrome (AJS) Malaria Acute Jaundice Syndrome (AJS) Acute Respiratory Infection (ARI) Measles Acute Respiratory Infection (ARI) Measles
5 W3492 22001177 ((SOecpt 1265-Oct 0212)
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 1-42, 2017 275000 70% 160 250000 140 22500060% Consultations Malaria ARI AWD ABD
120 Thousands 20000050%
175000 100 40%
150000 80 r e b m
u 30%
N 125000 60 20% 1000Proportionate morbidity 00 40
7500010% 20 Number of consultations
50000 0% 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 25000 Epidemiological week of reporting 2017
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 Malaria is the top cause of morbidity countrywide that accounted for Total consultations Acute Watery Diarrhoea 52% of Malaria Acute Jaundice Syndrome (AJS) the consultations in week Acute Respiratory Infec42 tion (Awith a cumulative 40% in 2017. RI) Measles The malaria proportionate morbidity increased from an average of 30% prior to the malaria transmission season to nearly 50% 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) Fig. 2|IDP Proportionate morbidity trends, week 1-42, 2017 275000
250000 45% 50
225000 40% 45 Consultations Malaria ARI AWD ABD Measles 200000 40 35% Thousands
175000 35 30% 30 150000 r e
b 25% m
u 25 N 125000 20% 20 100000 15% 15 Proportionate morbidity 75000 10% 10 Number of consultations 50000 5% 5
25000 0% 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 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 Epidemiological week of reporting 2017 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, malaria surpassed ARI as the top cause of morbidity in week 25 and Malaria Acute Jaundice Syndrome (AJS) now accounts for 30% of the total consultations. ARI and AWD currently account Acute Respiratory Infection (ARI) Measles for 22% and 6% of the total consultations.
5 W39 2017 (Sep 25-Oct 01)
Proportional mortality
Figure 1 | Proportional mortality (2017) Syndrome W42 2017
# deaths % mortality # deaths % mortality
Malaria 6 75.0% 346 33.9%
ARI 1 12.5% 41 4.0%
AWD 1 12.5% 253 24.8%
Bloody 0 0.0% 70 6.9% diarrhoea
AJS 0 0.0% 1 0.1%
Measles 0 0.0% 17 1.7%
Other 0 0.0% 292 28.6%
Total deaths 8 100% 1,020 100%
Malaria Acute Jaundice Syndrome (AJS)
Acute Respiratory Infection Measles
(ARI) Other Acute Watery Diarrhoea
Bloody diarrhoea
3 W42 2017 (Oct 16-Oct 22)
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
− − − − − − − 2015 486,962 253 58
· · · · · · · · · · 2014 Cases Deaths Alerts
8 W42 2017 (Oct 16-Oct 22)
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 58 19 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 W42 2017 (Oct 16-Oct 22)
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
− − − − − − − 2015 77,231 70 106
· · · · · · · · · · 2014 Cases Deaths Alerts
10 W42 2017 (Oct 16-Oct 22)
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 106 43 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 W42 2017 (Oct 16-Oct 22)
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
− − − − − − − 2015 1,081 17 51
· · · · · · · · · · 2014 Cases Deaths Alerts
Since the beginning of 2017, at least 1,081 suspect measles cases including at least 17 deaths (CFR 1.57%) have been reported. Of these, 611 suspect cases have undergone measles case-based laboratory-backed investigation. At least 328 samples have been 12 W42 2017 (Oct 16-Oct 22) collected, with a total of 84 measles cases being laboratory confirmed, while 321 cases and 23 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. 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 51 17 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 W42 2017 (Oct 16-Oct 22)
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
− − − − − − − 2015 2,054,389 346 62
· · · · · · · · · · 2014 Cases Deaths Alerts
6 W42 2017 (Oct 16-Oct 22)
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 62 19 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 W42 2017 (Oct 16-Oct 22)
Malaria trends by county and rainfall patterns
1,800 Weekly malaria trends for Terekeka county, 2012-2017 1,600 o At least 15 countries - Awerial, 1,400 1,200 Cueibet, Rumbek East, 3rd Quartile C-sum 2017 1,000 800 Rumbek North, Wulu, Yirol
Number of cases 600 400 East, Yirol West, Aweil Center, 200 - Aweil East, Aweil North, Aweil Weeks South, Jur River, Gogrial East, Tonj North, & Tonj South have 2,500 Weekly malaria trends for Awerial county, 2012-2017
2,000 reported increasing trends at
1,500 or above the third quartile
3rd Quartile [2012-2016] 1,000 [see next four slides]. Number of cases 500 o All the 15 counties apart from - Aweil South and Wulu Weeks received rains in Sept. 2017
2,500 Weekly malaria trends for Cueibet county, 2012-2017 that exceed the third quartile
2,000 for the period (2013-2016). 1,500 3rd Quartile C-sum 2017 o Four of the counties - Aweil
1,000
Number of cases South, Aweil East, Aweil 500 North, & Aweil West are in IPC - phase 4 (emergency). Weeks Malaria trends by county and rainfall patterns 1,200 Weekly malaria trends for Rumbek North county, 2012-2017 In September 2017; at least 19 1,000 counties received rainfall that 800
600 exceed the third quartile of the 3rd Quartile [2012-2016]
Number of cases 400 rainfall for period 2013-2016. 200 These counties should be - monitored for potential increase Weeks in malaria cases (see table)
800 Weekly malaria trends for Wulu county, 2012-2017
700 600 Bor Kapoeta East 500
400 3rd Quartile [2012-2016] 300 Morobo Lainya Number of cases 200 100 Yei Magwi
-
Weeks Pibor Mundri West Mundri East Pochalla 2,500 Weekly malaria trends for Yirol East county, 2012-2017
2,000 Maridi Mvollo 1,500 3rd Quartile C-sum 2017 Lafon Maiwut 1,000
Number of cases Budi Kapoeta North 500 Awerial Ikotos - Pigi Weeks Malaria trends by county and rainfall patterns
3,500 Weekly malaria trends for Yirol West county, 2012-2017 • During 2017, the mean rainfall 3,000
2,500 in millimeters increased from 2,000 2.7 and 13 in January and 1,500 3rd Quartile [2012-2016]
Number of cases 1,000 February to a peak of 180-185 500 in July, August, and - September). Weeks • During the corresponding 2,500 Weekly malaria trends for Aweil Center county, 2012-2017 period of 2016, the mean 2,000 rainfall peak of 181 millimeters 1,500 3rd Quartile C-sum 2017 was reached in July but 1,000
Number of cases declined to 140 millimeters in 500 August; and 114 millimeters in - September. Weeks • This shows that in 2017; we are 16,000 Weekly malaria trends for Aweil East county, 2012-2017 experiencing sustained peak 14,000
12,000 rains for a longer duration. This 10,000 3rd Quartile C-sum 2017 may potentially result increase 8,000 6,000 floods with sustained and long Number of cases 4,000 malaria transmission season 2,000
-
Weeks Malaria trends by county and rainfall predictions for October to December 2017 7,000 Weekly malaria trends for Aweil North county, 2012-2017 The rainfall outlook for Oct-Dec 6,000
5,000 2017 as shared by the IGAD 3rd Quartile C-sum 2017 4,000 climate prediction & application 3,000
Number of cases center (ICPAC) shows that: 2,000 1,000 • Southwestern parts the country -
Weeks will likely receive normal to above normal rainfall (near to 3,000 Weekly malaria trends for Aweil South county, 2012-2017 below normal rains in rest of 2,500 country) 2,000 3rd Quartile C-sum 2017 1,500 • Above normal temperatures Number of cases 1,000 countrywide 500
- • The above normal rains in the Weeks southwest will likely lead to flooding, a protracted malaria 3,000 Weekly malaria trends for Jur River county, 2012-2017 transmission season, increased 2,500 risk of waterborne diseases 2,000 3rd Quartile C-sum 2017 1,500 • In the rest of country, low rains
Number of cases 1,000 will likely reduce quality of water 500 thus a possibly exaggerated risk - of waterborne diseases Weeks Malaria trends by county and proposed mitigation measures
5,000 Weekly malaria trends for Gogrial East county, 2012-2017 4,500 Proposed mitigation measures for 4,000 3,500 areas expected to receive normal 3,000 3rd Quartile C-sum 2017 2,500 or above normal rain: 2,000 Number of cases 1,500 • Contingency planning, risk 1,000 500 communication - Weeks • Preposition kits for malaria, waterborne diseases 4,500 Weekly malaria trends for Tonj North county, 2012-2017 4,000 • Enhance surveillance for malaria, 3,500 3,000 AWDs 3rd Quartile C-sum 2017 2,500 2,000 • Preventive vaccination where
Number of cases 1,500 1,000 applicable 500 - As for areas expected to have less Weeks than normal rains, the recommended measures entail: 3,000 Weekly malaria trends for Tonj South county, 2012-2017 2,500 • Enhance WASH, water quality 2,000 3rd Quartile C-sum 2017 testing, water trucking, & water 1,500 treatment
Number of cases 1,000 500 • Nutrition surveillance & - prepositioning of SAM kits 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 either at or below the third quartile
IMA/KalaCore in collaboration with WHO/MOH have launched the KA Information, Education and Communication materials in Paloch on the 11/10/2017 at the Payam Visceral Leishmaniasis | Kala-azar headquarters. The Director General for preventive health services, Dr. Pinyi attended and was the master of ceremony. Kala-azar is endemic in Upper Nile, Unity, 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 2,447 cases including 52 deaths (CFR 2.1%); 23 (0.9%) defaulters; 2,073 (84.7%) new cases; 117(4.8%) PKDL; and 257(10.5%) relapses - all reported from less than half of the 23 treatment centers.
In the corresponding period of 2016, a total of 3,074 cases including 79 deaths (CFR 2.6%) and 63(2.0%) defaulters were reported from 21 treatment centers. nd th Graph:1Cummulative number of VL new cases by 40 (2 OCT 2017 – 8 OCT 2017). The majority of cases in 2017 have been reported from Lankien (907), 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 [1,196 cases (49.5%)], those aged 5 - 14years [999(41.3%) and ≥15years and above [819 cases (33.8%)]. A total of 460 cases (19.0%)] 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 40
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 452 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, 3,692 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 42, 04 new AFP cases were reported with date of onset in 2017 from Northern Bahr el Ghazal (1), Upper Nile (1), Western Bahr el Ghazal (1), and Western Equatoria (1).
During 2017, a cumulative of 298 AFP cases have been reported countrywide. The annualized non-Polio AFP (NPAFP) rate (cases per 100,000 population children 0-14 years) is 4.49 per 100,000 population of children 0-14 years (target ≥2 per 100,000 children 0-14 years).
Stool adequacy was 90% in 2017, a rate that is higher than the target of ≥80%. *As of epidemiological week 42/2017 Environmental surveillance ongoing since Number & Percentage of Counties by categories of NPAFP rates: Summary from above thematic maps # of Counties / NPAFP rates in 2017*
May 2017; with 15 samples testing positive State Hubs =0 >0<1 >1<2 >2 Total for non-polio enterovirus. CENTRAL EQUATORIA HUB 3 0 1 2 6
EASTERN EQUATORIA HUB 1 0 1 6 8
Source: South Sudan Weekly AFP Bulletin JONGLEI HUB 4 0 2 5 11
LAKES HUB 0 0 0 8 8
NORTHERN BAHR EL GHAZAL HUB 0 0 0 5 5
UNITY HUB 3 0 1 5 9
UPPER NILE HUB 6 0 2 4 12
WARRAP HUB 0 2 1 4 7
WESTERN BAHR EL GHAZAL HUB 0 0 0 3 3
WESTERN EQUATORIA HUB 0 0 0 10 10
Number 17 2 8 52 79
Percent 22% 1% 11% 66% 100%
*As of epidemiological week 42/2017 Mortality in the IDPs week 42 Cause of Death by Bentiu Juba 3 Total Proportionate Table 6 | Proportional mortality by cause of death in IDP site <5yrs ≥5yrs <5yrs ≥5yrs deaths mortality [%] IDPs W42 2017 Acute watery 9 diarrhoea 1 1 Malaria 2 2 18 Perinatal death 3 1 4 36 Pneumonia 1 1 9 Unknown 1 1 9 Head Trauma 1 1 9 Post Op. 9 complications 1 1 Total deaths 5 3 1 2 11 100
Prospective mortality surveillance is ongoing in the large internally displaced population camps that are principally located in the UN Protection of Civilian sites in Bentiu, Malakal, Wau, and Juba.
Among the IDPs from these locations, mortality data was received from Bentiu and UN House PoC in week 42. (Table 6). Eleven (11) deaths were reported during the reporting week. Bentiu PoC reported 8 (73%) deaths, the highest among the IDPs in the week. During the week, 6 (55%) deaths were recorded among children <5 years in (Table 6).
The causes of death in the IDP sites during the current week are shown in Table 6. The top causes of mortality in the week were perinatal complications and malaria accounting for 36% and 18% of the respective deaths in the week. Crude and under five mortality rates in IDPs
Figure 20 | EWARN U5MR by Site - W1 2016 to W 42 of 2017 Figure 21 | EWARN Crude Mortality Rate for W1 2016 to W 42 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 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 2016 2017 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 42 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 42 of 2017 were below the emergency threshold of 1 death per 10,000 per day (Fig. 21). Overall mortality in the IDPs in 2017
week 42Table 7 | Mortality by IDP site and cause of death as of W42, 2017
IDP site Acute watery diarrhoea GSW Heart Failure Kala-Azar Malaria Maternal death Meningitis Perinatal death Pneumonia Rabies SAM Stroke TB/HIV/AIDS Cancer Cholera HIV/AIDS Hypertention Susp. TB TB Others Total deaths Bentiu 20 8 14 2 37 4 3 27 18 1 54 3 7 10 2 8 24 20 216 478 Juba 3 3 5 13 11 17 1 1 2 15 1 2 14 29 114 Kodok 1 2 3 Malakal 1 2 7 5 5 6 1 1 6 59 93 Akobo 3 2 2 16 8 1 1 1 13 47 Wau PoC 9 1 1 1 1 6 19 Total deaths 35 10 20 4 67 6 3 46 48 2 54 9 8 19 2 25 2 29 40 325 754 Proportionate mortality [%] 4.6 1.3 2.7 0.5 8.9 0.8 0.4 6.1 6.4 0.3 7.2 1.2 1.1 2.5 0.3 3.3 0.3 3.8 5.3 43.1 100 • A total of 754 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