Republic of South Sudan EARLY WARNING and DISEASE

Early Warning and Disease Surveillance System Republic of South Sudan EARLY WARNING AND DISEASE SURVEILLANCE BULLETIN (IDP CAMPS AND COMMUNITIES) Week 47 17 – 23 November 2014 General Overview Completeness for weekly reporting increased from 92% to 98% while timeliness increased from 66% to 72% in week 47 when compared to week 46. Malaria remains the top cause of morbidity with Bor, UN House, Tongping, Melut, and Lankien reporting the highest incidence in week 47. During week 47, UN House had the highest incidence for ARI and ABD, while Bor PoC had the highest incidence for malaria and Melut had the highest incidence for AWD. A total of 12 suspect measles cases were reported from Melut (6 cases), Lankien (5 cases), and Bentiu (1 case) during week 47. There were no new HEV cases reported during week 47. The cumulative for HEV in Mingkaman remains at 124 cases including four deaths (CFR 3.23%). There were no new cholera cases reported during week 47. The cumulative now stands 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 47. During week 47, the majority of the deaths 5 (36%) were attributed to TB/HIV/AIDS. Seven suspect meningitis deaths have been reported from Chotbora PHCC in Longechuk County. Verification is underway with support from WHO and MedAir. Completeness and Timeliness of Reporting Completeness for weekly reporting increased from 46 (92%) in week 46, to 48 (98%) in week 47. Timeliness for weekly reporting increased from 33 (66%) in week 46 to 35 (72%) in week 47. Figure 1 Number of sites (clinics) reporting per week (n=49) 60 46484748 50 41 42 42 38 38 36 35 37 40 32 33 34 34 343334 29 2931 29 2626 26282726 28 30 24 2423 Number of sitesof Number 21 20 21 17 171718 1819 20 1315 6 8 10 5 0 0102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647 2014 Epidemiologic Week Early Warning and Disease Surveillance System In week 47, we did not receive reports from one facility (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 47, 2014 No. IDP site Health Facility/Partner 1 Mingkaman Kalthouk PHCU CCM Consultations (All patients seen at Outpatient and Inpatient facilities) The total number of consultations decreased from 19,006 in week 46 to 18,545 in week 47. During week 47, most of the consultations were reported from Bentiu, Awerial, Renk, and Melut (Figure 2). Figure 2 Consultations by IDP Camp & Partner, week 47, 2014 3500 3000 2500 1319 643 2000 66 509 1500 1125 1036 833 Number of consultationsof Number 1000 987 1366 1137 658 500 772 299 292 788 796 825 828 427 302 269 401 472 355 186 433 292 282 405 190 152 Lul Bor 0 50 50 0 Yuai Renk Ogod Melut Nyirol Akoka Akobo Kodok Bentiu Awerial Malakal Lankien Tongping Twic East Twic UN HOUSE UN Man-Awan 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, 698,246 consultations have been registered from all IDP sites with an overall annualised OPD utilization rate of 1.3 consultations per person per year (Figure 2.1). The site specific annualised OPD utilisation rates are shown in Figure 2.1. Figure 2.1 Annualised OPD Utilisation Rates by IPD site, week 1-47, 2014 6.0 5.0 4.0 5.5 3.0 4.0 Consultations 3.1 2.4 2.7 per person per year perperson per 2.0 2.0 1.6 1.9 1.7 1.6 1.3 0.3 0.3 0.6 1.2 0.5 0.6 0.4 0.1 0.5 0.2 0.1 0.1 1.3 1.0 - Annualised Utilization rate Threshold [1-1.5] 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). Early Warning and Disease Surveillance System Figure 3 Priority Disease Proportionate Morbidity - Week 1 - 47, 2014 45% 100% 40% 35% 80% 30% 60% 25% Completeness 20% 40% 15% Percent of allconsultations of Percent 10% 20% 5% 0% 0% Epidemiologic Week 01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 Completeness ARI Bloody Diarrhea Malaria, ARI and AWD were the top three causes of morbidity among IDPs in week 47 (Figure 3 and 4). During week 47, malaria had the highest proportionate morbidity and incidence (Figure 3 and 4). The overall incidence for malaria, ARI, AWD, and suspect measles, decreased, while the ABD incidence increased in week 47 when compared to week 46 (Figure 4). The weekly number of cases for the current and preceding week, and 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 46 47 51 of 2013 1 Malaria 4058 3829 136,708 2 AWD 1486 1462 60,860 3 ARI 2524 2521 105,073 4 ABD 235 264 10,136 5 Measles 15 12 1,513 Figure 4 Incidence for Priority Diseases, week 1 - 47, 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 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). Early Warning and Disease Surveillance System Figure 5 ARI Adjusted Proportionate Morbidity , for week 1 - 47 2014 35% 100% 90% 30% 30% 26.4% 80% 25% 25% 24% 24% 70% 21.5% 21% 20% 60% 20% 18.8% 19% 18.5% 18% 18% 17% 50% 15.9% 16% 16% 16% 15% 14.3% 14% 40% [%] Completeness 13% 12% 12% 11.1% 11.4% 11% 11% 11% 10% 10% 30% Percent of total consultations total of Percent 20% 0 5.4% 5.0% 5% 3.5% 2.0% 10% 0.7% 0% 0% 01 03 05 07 09 11 13 15 17 19 21Epidemiologic23 25 27 Week29 31 33 35 37 39 41 43 45 47 ARI registered the second highest proportionate morbidity of 13.6% and incidence (44 cases per 10,000 population) in week 47 (Figure 5). During week 47, a total of 2,521 cases of ARI were reported with the highest ARI incidence (cases per 10,000) being reported in UN House (269), Bentiu (160), Bor (89), Melut (69), and Ogod (63). Acute Watery Diarrhoea As seen from Figure 6, the AWD proportionate morbidity increased from 7.9% to 8.0% while the overall AWD incidence (cases per 10,000) decreased from 26.3 to 26.1 in week 47 when compared to week 46 (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 47, 2014 30% 100% 90% 23% 21% 21% 80% 70% 20% 60% 12% 13% 50% 11% 11% 11% 11% 10% 10% 9.8% 9% 9% 9% 9.1% 40% 9% 8% Completeness 10% 8% 7% 7% 6.1% 6.1%6.3%6.3% Percent of total consultations total of Percent 5.7% 30% 4.9%5.6%5.4% 5.5% 4.1% 20% 10% 0% Epidemiologic week 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 During week 47, a total of 1,488 AWD cases were reported with the highest AWD incidence (cases per 10,000) being reported in Melut (83), UN House (81), Bentiu (79), Tongping (77), and Bor (58) as illustrated in Figure 7). Early Warning and Disease Surveillance System Figure 7 AWD Incidence, by IDP site, for week 1 - 47, 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 UN House 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 47, 2014 200 100% 180 90% 160 80% 140 70% 120 60% 100 50% Completenes cases per 10,000per cases 80 40% 60 30% 40 20% 20 10% 0 0% 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 Completenes ≥5 yrs <5 yrs Dysentery / Acute Bloody Diarrhoea Figure 8 ABD Proportionate Morbidity , for week 1 - 47, 2014 7.0% 6.4% 100% 90% 6.0% 80% 5.0% 70% 60% 4.0% 3.3% 3.2% 50% Completeness 2.5% 2.3% 3.0% 2.1% 2.2% 2.1% 1.9% 40% 1.7% 1.8% 1.6% 1.5% 1.6% 1.5% 1.5% 1.6% 2.0% 1.4%1.4% 1.3% 1.4% 30% Percent of total consultations total of Percent 1.2% 1.2% 1.1% 1.1% 1.0% 1.1% 1.0% 1.1%1.0% 1.1%1.1% 0.8% 0.8% 0.7% 20% 1.0% 10% 0.0% 0% 01 03 05 07 09 11 13 15 17 19Epidemiologic21 23 25 Week27 29 31 33 35 37 39 41 43 45 47 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).

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