Republic of South Sudan: Humanitarian Bulletins 2012/ 2013

[Ronan Kelly]

Sharon, would it be possible to add "Republic of South Sudan" to the Africa forum?

Weekly Humanitarian Bulletin March 1 2012.

Highlights:
 Insecurity intensified in the border area between Unity State and Sudan’s Southern Kordofan State with
bombing reported along the western border of Pariang County and the Lake Jaw area.
 The government-led disarmament campaign for Jonglei State is not expected to take place before
15 March, according to the UN peacekeeping mission, UNMISS.
 Food security partners warn that Unity State and parts of Upper Nile, Jonglei, Warrap, Central Equatoria
and Northern Bahr El Ghazal states will experience an extended and more severe hunger season in 2012.



...
The full caseload of 44,600 people at the Doro refugee site was reached with food aid during the week. Food
deliveries to Maban County are underway to cover planned food distribution to refugees at the Jammam site.
Levels of watery diarrhea in Doro and Jammam remain high. Health partners have initiated pre-positioning of
cholera treatment centres to respond to a possible outbreak, and intensified preventive activities have begun.
Referral systems for moderate acute malnutrition in children are also being strengthened. The water, sanitation
and hygiene (WASH) situation in Doro, which has been a major concern of humanitarian partners, has improved
with the activation of a 75,000 litre-a-day water purifying system. This has raised the water supply in Doro to a
little above acceptable emergency standards. The water supply situation in Jamman is still of concern. No new
water sources have yet been found, so all water is supplied by truck from outside the settlement. A hydrological
assessment of the site continues, aiming to locate a water supply underground.
...
http://reliefweb.int/sites/reliefweb...eport_3600.pdf

[Ronan Kelly]

Weekly Humanitarian Bulletin March 8 2012.

Highlights:
• The continued influx of refugees into Upper Nile State is straining the humanitarian operation.
Currently there are 80,000 refugees from Sudan’s Blue Nile in the South Sudanese state.
• The UN Security Council views the recent cross-border violence between Sudan and South Sudan
as a threat to international peace and security.
• The Greater Equatoria region is likely to benefit from above normal rainfall over coming months.

...
http://reliefweb.int/sites/reliefweb...Report_644.pdf

[Ronan Kelly]

SOUTH SUDAN
Emergency and Humanitarian Action (EHA)
Week 11 (12th – 18th March) 2012

2. Public Health Concerns
The populaton continues to return to South Sudan posing public health risks. The health situation continues to be monitored to avoid any importation of potential outbreaks. Malaria remains a major public health risk
among the population of humanitarian concern with 45% of all consultations cases being reported as malaria.
A total of 26,789 public health events were recorded in the reporting week.Of these 67% are malaria,21%AWD and ABD accounted for 10.5%
Four suspected cases of Anthrax were reported by MSF Belgium in Gogreal Primary Health Care Centre form different locations in Gogreal County
Measles still remains a challenge in the majority states despite completion of the mop up campaigns to curb the situation. Main states reporting cases are Northern Bahergazel and Lakes among others

3. Coordination, Emergency preparedness and response
During the week;
1. WHO continued to support the SMoH to strengthen the response to access of services in the Pibor area. Support to the mobile clinic was sustained in the county.
A total of 8 areas are being served among which are Gurmuk Payam,Pibor
Payam,Lilot,Lukongule and kong kong river. WHO supported the County Health
Department with the deployement of the health workers and logistic support for the mainataince of the clinic. A total of 2063 consultations were seen in the mobile clincs during this week. WHO will continue to support the mobile
clinic in the next three months.

2. Following the arrival of over 2000 returnees from Khartoum, WHO coordinated and supported the treatment of the severly ill patients among the extremely vulnerable persons. A total of 22 patients were referrd to the
State hospital for further managemet,and 14 recieved the measles vaccine. In a similar activity to strengthen the EPI services,WHO supported the mop up campaing in Awiel. Two thousand five hundred and sixteen children were targeted and revieved measles vaccine.

3. During the week, WHO maintained its coordination with health partners in Maban county, with MSF,Releif International and GOAL continuing to offer health services in the payams in maban county. Reports from Maban indicate that malaria remined a public health problem in RI supported facilities. The top five diseases treated at the health facilities in Maban during the week included; malaria (27.4%) followed by Pneumonia (20.6%) and Bloody diarrhea (9%). Twenty children seen in the Out patient department received the
measles vaccine.

4. Communicable Disease updates
The data contained in this section of the report is for week 10;
The national weighted surveillance aggregate score of health facilities submitting weekly disease reports decreased this week from 61% in week 9 to 33% in week 10. Seven out of the ten states (70%) submitted
reports, 42 of the 80 counties showed a commendable increase from 49% (487) in week 10 to 61% (610) in week 9. Seven out out ten (70%) of states and 37/80(46%) Counties submitted their weekly reports on time,
(320/331) representing 96% of health facilities from the 37 counties submitted weekly reports on time, timeliness reporting have dramatically increased in the past two weeks.

A total of 14 466 health events and 16 deaths were recorded from health facilities that reported this week.
Malaria was the major reported event followed by acute watery diarrhea and bloody diarrhea. Three suspected measles cases were reported from Aweil East. The State Rapid Response Teams together with the WHO
technical officer and partners conducted investigation to verify to reported measles cases.
A total of 3 091 AWD cases were reported nationwide with 8 related deaths.
Children below five years of age accounted for 62% of all the reported
cases. Figure 2 shows a comparison of AWD cases reported since the year 2010-2012 by Epi-week. The trend of AWD among children below 5 years of age remains constant in the past 10 weeks of 2012 as compared to the same period in the previous years, but cases reported in week 7-10 decreased gradually due to poor reporting. The overall incidence rate of AWD across the county shows an increasing trend from week 2 to week 10 with a gradual
decrease in week 7-10, this could be attributed to poor reporting performance in week 7 and week 10. Western Bahr el Ghazal (WBGZ) and WES had the highest rates of AWD cases reported at 130 and 86 respectively per 100,000 people.

Despite reports of high incidence rates of AWD this week, case fatality was very low across all the health facilities in week 10 with the exception of WES at 0.84% (of the 837 cases reported 7 died) and Jonglei states at 0.17% (of the 574 cases reported 1 died).

A total of 1396 cases of Acute Blood Diahrrea with no related deaths were reported this week. The overall incidence rate of ABD across the county shows unpredictable trends from week 6 to week 10 though the
cases remained constant through the year. Western Equaitoria
State reported the highest incidence rate of 83.8 per
100,000 populations respectively. Central Equatoria State, EES and
Unity could not be measured due to unavailability of data, which
had not reached the central level. Poor reporting was recorded this
week compared to the previous weeks and this could be attributed to the travel of Surveillance Officers out of their duty station in the past two
weeks. Although the incidence rate for ABD was high, case fatality in
all states was zero in all states of south Sudan - refer to Table 3 for
details. Figure 3 shows a comparison of ABD trend by EPiweek
from 2010 to 2012.

A total of 9 960 suspected malaria cases with 8 related deaths were
reported this week as compared to 19 113 and 16 death in week 9. Of
these, 42% of the cases and 37% (3) of deaths were in children
below five years of age. Table 4 shows a detailed analysis by state
including incidence and case fatality rate of malaria cases
recorded during the week. The overall incidence rate remained
high in the past 10 weeks as compared to the same period in 2010 and 2011. Western Bahr el Ghazal, WES and Warrap states accounted for
the majority of cases this week. Counties that recorded malaria deaths included; Renk (1) and Wau (7). Figure 4
shows comparisons of malaria trends by Epi-week in 2010-12.

...

http://reliefweb.int/sites/reliefweb...8march2012.pdf

[Ronan Kelly]

SOUTH SUDAN
Emergency and Humanitarian Action (EHA)
Week 12 (19th – 25th March) 2012

2. Public Health Concerns


1. Malaria represents the highest cause for morbidity across the states. For instance in Upper Nile state this
week, malaria cases reported were at 58 % of all out patient department reported cases. This was followed by
Acute Respiratory Tract infection constituted at 36% (1101).
2. Forty five 45 measles suspected cases were reported from Marobo (2), kajo keji (3), Magwi (9), Rumbek
center (3), Aweil East (4), Aweil South (1), Aweil West (2), Gograil West (13), Tonj south (2), Panyinjar (3)
and Manyo (3). The State Rapid Response Team together with the WHO technical officers and health
partners conducted an investigation exercise to verify the measles cases and collect specimen.
3. Three (3) guinea worm cases- were reported from Manyo (1), Twic East (1) and Rumbek North (1).
4. Nine (9) Influenza like Illness (ILI) reported cases were reported in Fashoda County in Upper Nile states.
5. Two (2) suspected Cholera cases reported at Aweil Centre, NBGZ. Samples taken tested positive vabrio
Cholera by rapid test. Samples have been sent to KEMRI for further Laboratory confirmation.

...
4. Communicable Disease updates

In week eleven,
1. The national weighted surveillance aggregate scor of health facilities submitting weekly disease events reports increased from 33% in week 10 to 36% in week 11. All the states 10/10 (100%) submitted the weekly reports,
67/80 counties also submitted their reports. (524/540) representing 97% of health facilities from the 64 counties submitted their weekly reports on time,
timeliness reporting have dramatically increased in week 11. All the states recorded good surveillance performance compared with last week, Western Equatoria State (WES) had the best reporting performance with 167 of the expected 214 health facilities reporting on time. It was also noted that Unity
states reporting improved when compared with the previous weeks, with 46% completeness.

2. A total of 26 884 heath events and 55 deaths were recorded from health facilities that reported this week. Malaria was the major events followed by acute watery diarrhea and bloody diarrhea events. There were
unusual malaria related deaths reported at Morobo county during the week and investigation were carried out.

3. Nine out of ten (10/10) states in the country submitted timely reports to the central level in week 10 with only Warrap states submitting 48% of its total reports late. The average state timeliness rate in week 11 was 95%, while the average completeness rate was 34%. The average completeness of
reporting by state was maintained below the minimum acceptable value of 50 percent from all the states, except WES and Unity states with 78% and 46%
consecutively.
Only health facilities in WES state consistently maintained timeliness and completeness of reporting above the minimum acceptable percentage of 70% in the past 11 weeks. However, there were 15/33(48%) health facilities from Warrap state that did not submit timely reports. Many health facilities
in Western Bahr el Ghazal state (WBGZ), Jonglei state and Upper Nile State (UNS) were silent for many weeks. There is a need to further strengthen surveillance for the above mentioned states to improve
completeness of reporting. Upper Nile State (5) recorded the most silent counties followed by Jonglei (4) counties, Eastern Equatoria State (EES) (2) counties, WBeG (2) counties and WES (1) county. Figure 1 elaborates further comparison of timeliness and completeness rates by states.

4. A total of 5 888 cases of Acute Watery Diarrhea (AWD) were reported nationwide this week with 14 related deaths. Children below five years of age accounted for 60% of all the reported cases. Figure 2
shows a comparison of AWD cases reported since the year 2010 -2012 by Epi-week and by age group.
The trend of AWD among children below 5 years of age remains constant in the past 11 weeks of 2012 as compared to the same period in the previous years. The overall incidence rate of AWD across the county shows an increasing trend from week 2 to week 11 with a gradual decrease in week 7-10, this could be attributed to poor reporting performance. Unity states and WES had the highest rates of AWD cases reported at 143% and 144% respectively per 100,000 populations. Despite reports of high incidence
rates of AWD this week, fatality rate was very low across all the health facilities on week 11 with the exception of Upper Nile State which was at 1.1%

5. A total of 2 815 cases of Acute Bloody Diarrhea (ABD) with 2 related deaths were reported this week. The overall incidence rate of ABD across the county shows unpredictable trend from week 6 to week 11 though this remains constant through the year. WES and lakes states
reported the highest incidence rate of 79% and 56% per 100,000 populations respectively. Ayod County in Jonglei states reported the highest cases of ABD during the week.

6. A total of 18 026 suspected malaria cases with 39 related deaths were reported this week as compared to 9 960 and 8 death in week 10. Of these, 44% of the cases and 69% (27) of deaths were in children below
five years of age. The overall incidence rate remained high in the past 11 weeks as compared to the sameperiod in 2010 and 2011. WES and CES accounted for the majority of cases reported during the reporting
week. Counties that recorded malaria deaths include; Khorflus (1), Renk (3), Raga (1), Yirol West (1),Rumbek center (1), Ikotos (2), Lopa Lofan (5), Torit (3) and Morobo (22). There is unusual Malaria related death reported at Yeribe PHCU in Morobo county investigation is being carried. Figure 4 shows
comparisons of malaria trends by Epi-week in 2010-12.

...
http://reliefweb.int/sites/reliefweb...5march2012.PDF

[Ronan Kelly]

Humanitarian Bulletin
South Sudan
16-22 July 2012

...
Acute diarrhea causes refugee deaths
In Unity State, where some 57,000 refugees are located, acute diarrhea continues to be of high concern. The under-five mortality rate in the Yida
settlement is currently 2.75/10,000, according to the UN Refugee Agency (UNHCR), implying that two out of ten thousand children are dying per
day. The overall crude mortality rate is 0.92, according to
UNHCR. During the third week of July alone, 23 deaths from acute
diarrhea were recorded. Humanitarian agencies have stepped up hygiene and health outreach capacities to tackle the outbreak of acute diarrhea and
other communicable diseases in all camps in Unity and Upper Nile
state. Meanwhile, lower respiratory tract infection and malnutrition are also highly prevalent. With the increase in rainfall there has been an increase in malaria cases.
Nearly 400 cases of malaria were reported at health facilities since the beginning of July, according to health partners.
...

9 children die daily in Jemam camp
Saturday, 07 July 2012 05:13 Muna Tesfai

Medicine Sans Frontiers (MSF) said nine children die everyday in Jemam refugee camp in Upper Nile State. The common cause of the deaths was diarrhea.


Jeose Hulsenbek, MSF's Head of Mission in South Sudan told Radio Miraya that the situation of refugees from the Sudanese Blue Nile state, is dire.

She said the mortality rates have doubled the threshold for a camp.
...
http://www.mirayafm.org/index.php/he...jemam-camp-msf

Malaria cases reported in Jonglei state
Wednesday, 11 July 2012 08:28 Muna Tesfai Health >>>

A malaria outbreak has been reported in Uror County, Jonglei State.

On average, 150 cases are treated at Uror County Primary Health Center Unit in Yuai, every day.
...
http://www.mirayafm.org/index.php/he...-jonglei-state

[Ronan Kelly]

Humanitarian Bulletin
South Sudan
30 July – 5 August 2012

...

Upsurge of malaria cases requires concerted response
In the first seven months of 2012, health facilities have recorded an increase of malaria
with high case fatality rate, according to the Health Cluster. The cluster reports that one of
the contributing factors to the increase is the increased population movements including
returnees, refugees and internal displaced people. A total of 565,505 malaria cases
(incidence rate 6,846 per 100,000 people) and 651 related deaths (case fatality rate 0.1
per cent) were recorded between January and July 2012 compared to 446,858 cases in
the same period in 2011. In 2012, the malaria attack rate (the number of new people
infected or exposed) and case fatality rate are the highest in the past four years,
according to health partners. Some counties reporting high malaria cases in the past
seven months include Juba, Terekeka and Kajo-Keji in Central Equatoria, Maban and
Malakal in Upper Nile, Wau in Western Bahr el Ghazal and Rumbek East in Lakes.
In response to the upsurge, the Ministry of Health, together with partner organizations,
has mounted a concerted response focused on scaling up malaria prevention, diagnosis
and treatment interventions – especially for pregnant women and children under five
years. In the past seven months, severe shortages of anti-malaria drugs have been
reported in health facilities across the country, and health partners have responded by
procuring over 1 million anti-malaria doses to the Ministry of Health for distribution. Some
health facilities have already received the anti-malaria drugs, but many facilities are still
lacking the life saving drugs due to logistics difficulties of distributing the drugs to the
target facilities.
Malaria is highly endemic in South Sudan, and it is aggravated by the rainy season,
increased population movement and a poor health system. Malaria is leading cause of
morbidity and mortality among young children and pregnant women, and the most
frequently reported disease from health facilities through the weekly and monthly
surveillance reports.

Survey results indicate high malnutrition rates in Upper Nile camp
Preliminary results of an MSF survey in the Yusuf Batil camp, which hosts many new
refugee arrivals, show the global malnutrition rate among children at 27.7 per cent, and
the rate of severe acute malnutrition at 10.1 per cent – five times above the emergency
threshold. About 44 per cent of children under the age of two were found to be
malnourished, 18 per cent of them with severe acute malnutrition. The full break-down
and analysis of the survey is still pending.
To address the situation in the refugee camps, decentralized health structures and mobile
clinics have been established in all sites and water, sanitation and hygiene services are
being scaled up including outreach activities, according to the UN Refugee Agency,
UNHCR. Health surveillance systems have also been put in place with regular samples
sent to Nairobi for analysis. The blanket feeding programme has been expanded to
children from six months up to five years instead of the previous six months to three
years. A blanket distribution was completed in Yusuf Batil this week and will be followed
by a targeted supplementary feeding programme for malnourished children and pregnant
and lactating women.
...

[Ronan Kelly]

SOUTH SUDAN
Emergency preparedness and
Humanitarian Action (EHA)
Week 37 (10th -16th Sept) 2012
...
Public Health threats and concerns
1. The Ministry of Health, Republic of South Sudan declared an outbreak of Hepatitis E (HEV) in Upper Nile
state. As of this reporting date, 382 cases had been reported since the index case was first identified in July
and the first confirmed case reported in August 24th.
2. Ten suspected cases of AFP were reported this week. Four were from Baliet, Mellut, Renk and Nasir in
Upper Nile state, one from Kangi Payam Jur River county Western Bahr el Ghazal state and five from Twic
County Warrap state. Specimen were collected from the suspects and sent to Juba for further analysis.
3. Twenty four cases of Khalazar patients were reported from four health facilities in Unity state. Currently
there is an upsurge of the disease in Koch county Unity state.
4. Suspected rabies has emerged as a major public health threat. Cases of animal bites continued to be on the
increase this week with reports of two deaths related dog bites reported in Maban county, Upper Nile. Forty
four other cases were reported from Agok area in Warrap state.
...
Communicable Disease Update
1. The Republic of South Sudan (MOH) declared an outbreak of Hepatitis during this reporting period. This
followed reports of Hepatitis E Virus confirmed in the three Camps of Jamam Gendrassa and Yusuf Batil in
Maban County, Upper Nile state. In week 36 there two hundred twenty five suspected AJS cases were
reported with two (2) related deaths across the country (refer to figure 9 for AJS Epi- Curve). Over 98% (220) of the cases and two deaths were recorded in Maban refugee camps, especially Jamam, Batil and Gendrassa camps. The
cumulative AJS cases recorded as of week 36 was 384 (suspected and confirmed HEV) and 16 deaths (CFR 4.2 %). Of these cases, 66% were recorded in Jamam, 20% in Yusuf Batil and 13.5% in Gendrassa. Of the total
deaths, 81% were recorded in Jamam, 12% in Yusuf Batil and 6% in Gendrassa.

Forty one (41) blood specimens were referred to CDC/KEMRI in Nairobi for analysis, and 23 specimens
were PCR positive for Hepatitis E Virus, while seven preliminary results were still pending. The Ministry of
Health, RSS decelerated hepatitis E Virus outbreak in Jamam and Gendrassa refugee camps, and appealed to all UN and health partners to scale up the multisectorial response to contain the outbreak. Following the
confirmation, the Ministry of Health, Republic of South Sudan, in collaboration with other health partners
stepped up active case finding targeting the entire refugee population in the camps Most important, intensive
health and hygiene education and promotion activities are ongoing in all of the refugee camps in Maban
county, supported by partners and agencies running health, water, sanitation and hygiene services in these areas.The agencies are also collaborating with
the WASH cluster to increase provision of clean water as well conducting
active case finding in all the three camps. Surveillance had been enhanced
throughout the county and neighboring Counties. Yida camp in Unity State reported one suspected case of Acute Jaundice syndrome in week 36.
The The majority of the cases are children under 5years. No suspected cholera cases have been reported. The
trend of Acute Bloody diarrhea was fairly stable with most cases being reported among those above 5 years
except in Yusuf Batil camp where 60% of ABD cases were in children below five years. To strengthen the
epidemic response and further enhance the containment of the disease, WHO has deployed an epidemiologist
in Maban county to support the health partners and county health department to respond to the current
outbreak. The trend of epidemic prone diseases has also been declining in Yida camp for the past three
weeks except for the AJS.

2. A total of 34,658 health events and 77 deaths were recorded from all health facilities across the country in
week 36. Over 78% of all reported health events and 70% of all deaths were due to malaria, followed by
acute watery diarrhea and bloody diarrhea events. WHO continued supporting the Kalazar response with
only four (4) health facilities of Ayod, Jiech, Lankien and Leer. This week twenty six (26) cases were
reported, twenty four (24) were new cases, (0 from Ayod, 9 from Jiech, 13 from Leer and 2 from Lankien
and two (2) relapses/PDKL from Lankien while two (2) deaths were reported, one from Ayod and the other
from Koch County. Accessibility challenges have had an impact on the reporting rate (completeness) of the
reports from the Kalazar treatment centers. Koch county has reported an upsurge in the admissions of Kalazar patients and following a joint assessment by the response team(WHO and SMOH),case management
has been strengthened and technical teams are closely monitoring the situation at county level
...

[Ronan Kelly]

South Sudan
Emergency humanitarian situation report
Issue 1
31 December – 06 January 2013

...
PUBLIC HEALTH CONCERNS


Over 8,000 people remain displaced in the state of Northern Bahr el Ghazal state. Availability of health
services have been identified as an urgent need.


One suspected case of Viral haemorrhagic fever was reported from Terekeka County, central equatorial
state this reporting period. Blood sample was collected from the patient and sent to a reference laboratory in
Nairobi Kenya. The patient continues to be cared for in isolation with strict barrier nursing as results are
being awaited.


Three suspected cases of acute flaccid paralysis (AFP) were reported this week, one from Equatorial state,
one from Gogrial west in Warrap state and one from Pochalla in Jonglei state. WHO together with the state
ministry of health state teams are investigating and following up with these cases.


Suspected cases of measles resulting to some death were recorded in Northern Bahr el Ghazal during this
period, (county health department). The WHO hub in the state in collaboration with the ministry of health
sent a technical team to investigate reports of suspected cases. The outcome of the investigations will be
shared in the next issue.
...

[Ronan Kelly]

Humanitarian Bulletin
South Sudan
14-20 January 2013

...
Jonglei State
...
Medical supplies in the local health centre are reportedly depleting rapidly as demand for
services increased. According to health partners, an average of 40 malaria, 35 diarrhea and 72 acute respiratory infection cases per week were reported. Aid agencies are mobilizing support to respond to the needs of the people displaced.

...
Reported increase in Hepatitis E in Upper Nile
Humanitarian organizations are concerned about a reported increase of suspected Hepatitis E cases in refugee camps in Upper Nile State. While the number of cases was on the decline towards the end of 2012, MSF reported an increase in cases since mid-December in Jamam and Gendrassa refugee sites. In Yusuf Batil site, MSF recorded 742 new suspected cases in the first two weeks of January, with 87 admissions to the hospital and 17 deaths. In the reporting week in Doro settlement, MSF identified 18 suspected Hepatitis E cases. Following reports of an increase in suspected cases, the Ministry of Health, the World Health Organization and the UN refugee agency (UNHCR) are carrying out an investigation to assess the health situation and to ensure an appropriate response.
...

[Ronan Kelly]

Humanitarian Bulletin
South Sudan
21-27 January 2013

...
Hepatitis E surge confirmed in Upper Nile settlements
A surge in the number of cases of Hepatitis E in the four refugee camps has affected 3,319 people and led to 69 deaths since July 2012, the Ministry of Health, UNHCR and WHO confirmed on 26 January.
The increase in the number of cases and suspected cases has mainly affected the Yusuf Batil site, which alone accounted for over 1,900 cases, including 39 deaths, or 71 per cent of all reported new cases. The camp currently holds over 36,000 refugees.
The increase in Hepatitis E in Yusuf Baitl was confirmed during a registration exercise in early December which, according to UNHCR, could have been caused by the growth in population due to refugee influx from Sudan’s Blue Nile State.
While there is no treatment or WHO-approved vaccine for Hepatitis E, the risk of infection can be significantly reduced by improving water and sanitation conditions and avoiding eating uncooked fruits and vegetables. In response to the spike, aid agencies are accelerating the construction of 700 latrines and additional boreholes in Yusuf Batil, including the distribution of soap and replacement of 22,000 jerry cans suspected to be a source of infection if filled with contaminated water. An additional 5,000 buckets are expected to arrive in the settlement in the coming days. Enhanced disease surveillance, water chlorination, and a health and hygiene promotion campaign in markets, schools, and at the household level are underway.
...

[Ronan Kelly]

South Sudan
Emergency humanitarian situation report
Issue 5
28 January – 03 February 2013
...
Public Health Concerns


Hepatitis E is still ongoing in Upper Nile state. As of this reporting week, a total of 810 cases of Hepatitis E were reported from Maban and Pariang Counties hosting refugee camps alone. This brings the total number of cases
reported since the outbreak to of 5,892 and 107 death.


Surveillance data shows an increase in measles cases across the ten states of South Sudan.


Rabies remains a public health concern. The increasing number of dog bites in Raja and Abeinom areas in Unity state is a worrying situation in the state.


Five cases of cutaneous anthrax were reported from Jur River this reporting period, while in Wau and Deim Zubeir, two suspected cases of Acute Jaundice Syndrome were reported. One sample was collected and sent to Juba for further analysis.

Communicable Diseases

During week 4, the completeness and timeliness level of reporting from health facilities across the country
slightly increased as compared to the previous weeks in 2013. In week 4, the average completeness rate of
reporting in all the states was 57% (562 out 993 facilities), while average timeliness was at 48% (477 out of 993
facilities). None of the health facilities in Lakes state submitted the weekly surveillance report during this period,
while only seven (7) facilities from Jonglei submitted their weekly reports for week 4.


A total of eight hundred ten (810) Hepatitis E cases and eight (8) related deaths were reported from the refugee camps in Maban and Yida in epidemiological week 5. Of these cases, 76% and 100% of the deaths were
reported from Yusuf Batil camp in Maban, where the upsurge of the disease has been recorded since early December 2012. As seen in figure 1, a total of 5,892 hepatitis E cases and 107 related deaths have been reported since the outbreak began in the refugee camps in Maban and Pariang Counties, Upper Nile and Unity States respectively. Cases and deaths recorded in Yusuf Batil
camp in the past 9 weeks also increased four folds as compared to the cumulative cases recorded since the beginning of the outbreak.
Jamam, Gendrasa and Doro equally recorded increased cases in the past 9 weeks. UNHCR together with health and WASH partners have taken steps to contain the surge of cases in all camps, Yusuf Batil in particular.


Assessments conducted by MSF Holland and Belgium in Yusuf Batil and Doro respectively on water and
sanitation conditions in the camps indicated that there are major gaps in sanitation and hygiene situation at
household and Sheikdom levels. There are very few hand-washing facilities at the households levels, while
decommissioning full latrines is a major problem in all camps. Waste management at the camps and market
place is also a major gap that requires urgent attention. UNHCR and other partners are fully committed to scaling
up water and sanitation interventions to address existing identified gaps during the assessments.


In this reporting week, thirty three (33) suspected measles cases were reported from Juba, Budi, Kapoeta East,
Wau, Maridi and Yambio counties. State Rapid Response teams and health partners are currently investigating
the reported cases, and blood samples are expected to be collected and sent to Juba for further investigations.
Measles surveillance was enhanced across the country, and all state surveillance officers have been equipped
with required materials for investigations.


While in Guit County, Unity State one suspected case of meningitis case was recorded in, a child under five
years of age. Since the start of the year, a total of eleven (11) suspected meningitis cases have been recorded.


Malaria remained the leading cause of morbidity and mortality reported 5 contributing to 72% of all cases, and
48% of all reported death. In this period, a total of 24,015 suspected malaria cases and 19 related deaths were
reported across the country. Of these cases and deaths, 39% and 24% were in children below five years of age
respectively.
...

[Ronan Kelly]

REFUGEE SURVEILLANCE UPDATE
(MABAN AND YIDA)
Epidemiological Week 10 11th-16th March 2013
http://reliefweb.int/sites/reliefweb...0Week%2010.pdf

Highlights
 The proportion of health facilities in Maban submitting weekly reports to the state and central level remained at 77% (17 out of 22) for third week in a row. (See list of health facilities in Maban and supporting partners in page 2). All the seven facilities serving the refugees in Maban reported in week 10, while reporting from facilities serving the host communities remained stable this week at 10 out of 15 facilities for the second consecutive week
 Only one out of the three health facilities serving Yida refugee camp reported on time this week.
 In week 10, Acute watery diarrhea was the leading priority diseases recorded in the refugee camps (76%), followed by acute jaundice syndrome (12%) and Malaria (9%)
 Two hundred and sixty one (262) suspected Acute Jaundice Syndrome (AJS) cases (or Hepatitis E cases) and five (5) related deaths were recorded from Maban and Yida. Of these cases and deaths, 97% of cases and 100% of deaths were reported from Maban refugee camps; only 2.7% of cases was reported from Yida refugee camp and for the first time 0.3% was reported from the host community in Maban. Of these cases from Maban, 39.4% of the cases were reported from Yusuf Batil, followed by Gendrasa (35.0%), Jamam (19.7%) and Doro (5.5%) and 0.4% from the host community(Jamam PHCC)
The cumulative AJS cases recorded from Maban refugee camps was 8428 and 138 related deaths, while 197 AJS cases and 5 related deaths were recorded in Yida from the beginning of the outbreak till week 10
 Gendrassa refugee camp reported one suspected cases of meningitis and one measles case.
 There was no report of suspected cholera, VHF cases reported from all the refugee camps.
...
Acute Watery Diarrhea (AWD)
A total of 1640 AWD cases were reported in Maban and Yida Refugee camps during this reporting week with no related deaths. Proportion of cases below five years remained at 67% of all reported AWD
...
Dysentery (ABD)
A total of 59 cases of ABD with no related deaths were reported in week 10. Proportion of cases in children below five years increased to 41% of all reported ABD cases. Figure 2 Above shows a comparison of ABD cases reported by Epi-week and year 2012 – 2013 in Maban and Yida camps. The ABD trend reported from the refugee camps in Maban and Yida decreased slightly this week
The ABD incidence among the host community in Maban decreased from 198 in week 9 to 38 cases in week 10, with 42% of the cases reported in children below five years.

Malaria
A total of 200 malaria cases were reported in week 10 from Yida and Maban, with no related deaths. Out of all the cases, 57% were reported in children below five years of age. In Maban County 614 cases of malaria with no related deaths were reported from facilities serving the host community.
There has been significant reduction in the cases being reported from Yida majorly due to that two facilities have not been reporting, while the cases being reported from Maban reduced slightly this week.

Acute Jaundice Syndrome (AJS)
A total of Two hundred and sixty two (262) suspected Acute Jaundice Syndrome (AJS) cases (or Hepatitis E cases) and five (5) related deaths were recorded from Maban and Yida in week 10. As has been the trend for the pas one month 97% of new AJS cases were recorded in Maban refugee camps (figure 4 and 5 for AJS Epi-Curve in Maban and Yida). Six deaths were recorded in Yusuf Batil and one more in Yida camp. As shown figure 4, a total of 8424 AJS/Hepatitis E cases and 151 related deaths were reported since the beginning of the outbreak in the refugee camps in Maban and Pariang Counties, Upper Nile and Unity States respectively. For the first time in six weeks Yusuf Batil has reported less than 50% of the overall cases. Cases from Gendrassa are continuing to increase and this week 35% of the cases and 40% of the deaths were recorded in Gendrassa. But overall there is good progress being made as for the total cases this week was below the “300” mark for the first time since week 1 of 2013.

Measles: One suspected case of Measles and One meninigitis case was reported in Gendrassa camp with no related death. Samples have been collected for laboratory confirmation.

Other Disease: No suspected case of Viral Haemorrage fever or Influenza like illness was reported during this week.
...
http://reliefweb.int/sites/reliefweb...0Week%2010.pdf

[Ronan Kelly]

South Sudan
Emergency humanitarian situation report
Issue 9
17 March - 24 March 2013
WHO

...
PUBLIC HEALTH CONCERNS
Health Situation

 Health needs of the displaced continue to rise across the country. To date an estimated 12,433 new
displacements have been reported across south Sudan. In this reporting week 1,500 new displacements were
reported in Jaac in Northern Bahr el Ghazal state. High impact health interventions are planned for to respond to
potential public health threats in the areas with displaced persons.

 The hepatitis E outbreak is still ongoing in the refugee camps of Maban and Yida. In this reporting week, a total
of 394 cases were recorded in the two refugee camps. Health Partners continue to carry out interventions to
contain the outbreak. Both Yida and Maban counties host over 180,000 refugees that fled the north.

 Four suspected cases of AFP were reported this week. One was reported from Raja, Western Bahr el Ghazal
state, one from Northern Bahr el Ghazal state, one from Sakure, Nzara County, and one from Ibba payam, Ibba
County, both in Western Equatoria state. Investigations were conducted and samples collected and sent to Juba
for further investigations, results will be shared later.

 Eighteen (18) suspected measles cases were reported this week. Thirteen were reported from Yambio hospital,
2 from Ibba hospital, Ibba County and 3 from Tambura hospital, Tambura County.

 The potential outbreak of measles in Fangak county, is raising high concern among health partners working in
the area. According to health partners on ground, a total of 11 deaths were reported by community leaders in
Mareang and Nyadine villages this reporting period.

Health Situation

Communicable Diseases

 The overall completeness and timeliness of reporting from health facilities across the country reminded high in
week 11 of 2013. The average completeness rate of reporting from health facilities across the states this
reporting period was 65% (649 out 993 facilities), while average timeliness from various health facilities across
the states was at 56% (552 out of 993 facilities). Northern Bahr el Ghazal state and Central Equatoria State
performed poorly during these reporting periods.

 A total of three hundred and forty nine (349) suspected Acute Jaundice Syndrome (AJS) cases (or Hepatitis E
cases) and seven (7) related deaths were recorded from Maban and Yida this period. Of these, 95.6% were
reported from Maban refugee camps; 3.3% from Yida refugee camp and 1.1% from the host community in
Maban. From the 95.6% of the cases reported from Maban camps, 37.3% were reported from Yusuf Batil, followed by Gendrasa
(32.7%), Jamam (24%), Doro (4.9%) and (1.1%) from the host community
(Jamam PHCC). Of the deaths recorded in Maban camps, one was recorded
from Doro, three from Batil, one from Jamam camp and another two from Yida. As seen in figure 1 and 2, the cumulative AJS cases
recorded from Maban refugee camps were 8,790 and 150 related deaths,
while 206 AJS cases and 8 deaths have been recorded from Yida since the beginning of the outbreak. New cases recorded in Maban refugee camps continued to decline in week fifty as compared to the previous weeks, although there was an increase in the number of cases in week 11 as compared to week 10. There was a
marked decline of cases from Batil camp this period which for over two months had been contributing more than half of the new cases and 70% of the deaths. Three cases were reported from a facility serving the host community (Jamam PHCC supported by GOAL). This brings the number of cases to 4 in two weeks. Follow up visits are being made to ascertain the actual origin of the cases and to conduct active search for more possible cases in the
community.

 A total of Thirteen (13) suspected measles cases (incidence rate of 0.16 per 100,000 populations) with zero related death (CFR 0.0 %) were reported in week 11. Of these, 77% cases were in children below five years of age. The suspected measles cases were reported from Juba, Torit, Kapoeta East, Budi and Yirol West counties.

 Twenty four thousand, five hundred and twenty one (24,521) suspected malaria cases (incidence rate of 296.8 per 100,000 populations) with twenty three (23) related deaths (CFR 0.09%) were reported in week 11. Of these, 43% of the cases and 70% of deaths were in children below five years of age. The overall incidence rate slightly decreased in week 11 as compared to week 10. Unity state, Western Bahr el Ghazal state and Upper Nile states accounted for the highest malaria incidence rate in week 11, while the twenty three deaths reported were from Rumbek Center, Rubkona, Yirol West and Maban Counties. The malaria cases recorded in a refugee camp in Yida tripled this week while those from the camps in Maban remained stable.

 Five (5) suspected meningitis cases and one (1) related death were recorded from Gogrial West and Abyei Counties. The State Rapid Response team in Warrap state are investigating the suspected meningitis cases and CSF specimen will be collected and sent to Juba for onward transmission to the reference laboratory in Nairobi for analysis.
...

[Ronan Kelly]

Refugee Surveillance Update (Maban and Yida) Epidemiological Week 15 (8th - 14th April 2013)

Highlights
 The proportion of health facilities in Maban that submitted the weekly reports to the state and central level reduced to 15 bringing completeness to 68.2% (15 out of 22). (See list of health facilities in Maban and supporting partners on page 2). Only 4 facilities serving the refugees in Maban reported on time in week 15, while reporting from facilities serving the host communities reduced to 11 out of 15 facilities.

 Only one health facility serving Yida refugee camp reported on time this week.

 Acute watery diarrhea was the leading priority disease recorded in the refugee camps (72.9%), followed by AJS (11.9%), Malaria (8.3%), and Acute Bloody Diarrhea (7.0%).

 One hundred and ninety two (192) suspected Acute Jaundice Syndrome (AJS) cases (or Hepatitis E cases) and two (2) related deaths were recorded from Maban and Yida in week 15. Of the total cases, 83.9% were reported from Maban refugee camps, 15.1% from Yida refugee camp and 1.0% from the host community. Four suspected cases were reported to have come from the host community and were seen by MSF in Gendrassa (2), Batil (1), and Jamam (1). Of the cases from Maban, 37.9% of the cases were reported from Jamam, followed by Batil (32.9%), Gendrassa (21.1%), and Doro (8.1%).
The cumulative AJS cases recorded from Maban refugee camps was 9,592 and 171 related deaths, while 269 AJS cases and 12 related deaths were recorded in Yida from the beginning of the outbreak till week 15.

 One suspected meningitis case was reported in Doro camp.

 No Measles, Cholera, or VHF cases were reported from all the refugee camps and host community.
...
Acute Watery Diarrhea (AWD)
A total of 1167 AWD cases were reported in Maban and Yida Refugee camps during this reporting week with no related deaths. Proportion of cases below five years was at 63.9% of all reported AWD cases in all the camps.
...
Dysentery (ABD)
A total of 112 cases of ABD with no related deaths were reported in week 15 from the refugee camps. Proportion of cases in children below five years dropped from 40.3% the previous week to 37.5% this week.
...
Malaria
A total of 133 malaria cases were reported in week 15 from Yida and Maban refugee camps, with no related deaths. Out of all the cases, 29.3% were reported in children below five years of age. Malaria incidence rate in children has remained the same in three consecutive weeks. In Maban County, 672 cases of malaria with no related deaths were reported from facilities serving the host community. Malaria cases increased slightly compared to those recorded in the previous week (646). The under 5 years old in the host community had a higher incidence of malaria (48.7%) than those in the refugee camps (29.3%).
...
Acute Jaundice Syndrome (AJS)
A total of one hundred and eighty eight (192) suspected Acute Jaundice Syndrome (AJS) cases (or Hepatitis E cases) and six (2) related deaths were recorded from Maban in week 15. No death was reported in Yida this week. As has been the trend, 83.7% of new AJS cases were recorded in Maban refugee camps (figure 4 and 5 for AJS Epi-Curve in Maban and Yida). Of the deaths, one was recorded in Batil and another in Gendrassa. As shown figure 4 and 5 below, a cumulative AJS cases recorded from Maban refugee camps was 9,592 and 171 related deaths, while 269 AJS cases and 12 related deaths were recorded in Yida from the beginning of the outbreak till week 15.
...

[Ronan Kelly]

Humanitarian Bulletin
South Sudan
29 April - 5 May 2013

...

Meningitis outbreak declared in Upper Nile State
On 30 April, the Ministry of Health declared an outbreak of meningitis in
Malakal County, Upper Nile State. As of 5 May, 73 cases had been reported, with three related deaths. Those who have contracted the disease have been between four and 20 years old.
Health partners are mobilizing to carry out a vaccination campaign
targeting over 150,000 people, out of the 220,000 living in Malakal County.
A community outreach campaign will also be rolled out, to increase
communities’ awareness of meningitis and help identify new cases as early as
possible. Partners are boosting capacity at the Malakal hospital, including by establishing an isolation ward, and are monitoring
neighbouring counties for an eventual further spread of the outbreak.
...

[Ronan Kelly]

WHO Health Emergency Highlights
Emergency Risk Management and Humanitarian Response April 2013
http://reliefweb.int/sites/reliefweb...ril%202013.pdf

The Republic of South Sudan
Situation highlights
The health situation across the Republic of South Sudan remains fragile and unpredictable. There are high risks of communicable diseases, floods and drought, low access to safe drinking water, food insecurity, and poor sanitation. Environmental factors contribute to the spread of diseases such as water and vector-borne diseases like diarrhoeal diseases, hepatitis, malaria and dengue fever.
Population displacements and movements secondary to internal and external conflict compound the public health threats. According to UNHCR there are 223 888 registered refugees in the Republic of South Sudan. Since the start of January, about 4700 people returned to the Republic of South Sudan from the Sudan (OCHA, February 2013).
Measles, meningitis and hepatitis E were the most common epidemic-prone diseases recorded in April. The hepatitis E outbreak was mainly concentrated in refugee camps in Upper Nile and Unity states with 662 cases and 12 deaths registered. In April, 154 cases of measles (no deaths) were registered across the country.
...

[Ronan Kelly]

South Sudan Humanitarian Update
January-April 2013
...
Controlling Hepatitis E

Health organizations working in refugee camps in Upper Nile State
have been working to control a Hepatitis E outbreak which was
announced by the Ministry of Health in July 2012. Since the disease
broke out in Maban County, over 8,800 people have been infected
and about 200 people have died. Maban hosts about 116,000
refugees. Hepatitis E spiked in January and February 2013, leading
to a scale-up of water and sanitation activities. Health officials of the
UN refugee agency (UNHCR) indicated that the population growth in
Maban was a key reason for the spread in the disease.

A water, sanitation and hygiene campaign was implemented across
all four refugee sites in Upper Nile; 700 new latrines were constructed
in Yusuf Batil settlement, where the disease was most prevalent, and
water containers were replaced and soap was distributed. Hygiene
promoters continued to spread messages to educate people about
the disease. Consequently Hepatitis E was brought under control
in Maban by the end of March, but it will be some time before the
disease is expected to be eliminated. Partners remain vigilant for
new cases and health and hygiene activities continue.

In neighbouring Unity State, the disease has reportedly stabilized,
with 270 people infected and 15 deaths since the outbreak was
announced in August 2012.

...
http://reliefweb.int/sites/reliefweb...ril%202013.pdf