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 South Sudan 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 Bentiu 6,796 989,471 Manyo Bor 4,042 441,376 Melut Juba 4,642 517,038 Fashoda Maban Abyei Pariang Malakal 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 Rumbek 10,960 839,521 Tonj North Ayod MayenLdeiter Torit 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 Yambio 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 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 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 3 Total consultations Acute Watery Diarrhoea 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.