South Sudan

Annexes W5 2018 (Jan29 - Feb04)

Integrated Disease Surveillance andResponse (IDSR)

2

Contents

AccessandUtilization|Mapofconsultationsbycounty

Access and Utilisation

Slide 2 Map 1 Map of consultations by county (2018)

Indicator-based surveillance

Slide 3 Figure 1 Proportional mortality

Slide 4 Figure 2 Proportional morbidity

Slide 5 Figure 3 Trend in consultations and key diseases

Disease trends and maps

Malaria

Slide 6 Trend in malaria cases over time

Slide 7 Malaria maps and alert management

Acute Watery Diarrhoea (AWD)

Slide 8 Trend in AWD cases over time

Slide 9 AWD maps and alert management

Bloody diarrhoea

Slide 10 Trend in bloody diarrhoea cases over time

Slide 11 Bloody diarrhoea maps and alert management

Measles

Slide 12 Trend in measles cases over time

Slide 13 Measles maps and alert management

Sources of data

1. Weekly IDSR Reporting Form

2. Weekly EWARS Reporting Form

Contents

1 W2 2018 (Jan 08-Jan 14)

Map 1 | Map of total consultations by county (W5 2018)

Number of consultations

0 1 1,000 2,500 5,000

Hub W5 2018

South Sudan 113,362 572,000

Access and Utilisation | Map of consultations by county

2 W5 2018 (Jan 29-Feb 04)

Fashoda

Nyirol

Uror

Ayod

Rubkona

Mayendit

Panyijiar

Yirol West

LongechukFangak

Aweil Centre

Aweil SouthGogrial West

Aweil East

Ezo

Abyei

Nzara

Gogrial East

Pibor

Maiwut

Nagero

Mvolo

Wau

Canal PigiTwic

Morobo

Panyikang

Lopa Lafon

Kapoeta South

Kapoeta East

Kajo Keji

Kapoeta North

Maridi

Terekeka

Tonj South

Jur River

Akobo

Yambio

Pariang

Yirol East

Cueibet

Mundri East

Tonj East

Lainya

Tonj North

Abiemnhom

Mayom

Aweil North

YeiBudi

Magwi

Ulang

Aweil West

Twic EastRumbek Centre

Rumbek North

Manyo

Leer

Mundri West

Malakal

Luakpiny Nasir

TamburaWulu

Guit

Torit

Bor

Rumbek East

Juba

Ibba

Awerial

Pochalla

Koch

Baliet

Duk

Renk

Ikotos

Raja

Maban

Melut

Aweil 16,002 86,759

Bentiu 16,403 61,374

Bor 8,837 52,060

Juba 5,726 45,010

Kwajok 26,413 108,852

Malakal 5,462 34,838

Rumbek 13,337 75,125

Torit 3,713 18,922

Wau 5,481 32,095

Yambio 11,988

3

Proportionalmortality

Proportionalmorbidity

Figure 2 | Proportional morbidity (2018)

Malaria

Acute Respiratory Infection

(ARI)

Acute Watery Diarrhoea

Bloody diarrhoea

Acute Jaundice Syndrome (AJS)

Measles

Other

Syndrome W5 2018

# cases % morbidity # cases % morbidity

Malaria 32,683 55.9% 175,954 55.2%

ARI 7,517 12.8% 47,085 14.8%

AWD 8,106 13.9% 40,612 12.7%

Bloodydiarrhoea

1,319 2.3% 6,285 2.0%

AJS 0 0.0% 58 0.0%

Measles 4 0.0% 53 0.0%

Other 8,885 15.2% 48,966 15.3%

Total cases 58,514 100% 319,013 100%

Proportional morbidity

4 W5 2018 (Jan 29-Feb 04)

Data under review

4

Trendinconsultationsandkeydiseases

IDSRProportionatemorbiditytrends- inrelativelystablestates

In the relatively stable states, malaria is the top cause of morbidity accounting for 33.9% of the consultations in week 5 (representing a decline from 36.5% in week 1).

Figure 3 | Trend in total consultations and key diseases (W5)

Total consultations

Malaria

Acute Respiratory Infection (ARI)

Acute Watery Diarrhoea

Acute Jaundice Syndrome (AJS)

Measles

Trend in consultations and key diseases

5 W5 2018 (Jan 29-Feb 04)

Nu

mb

er

W05 2

017

W09 2

017

W13 2

017

W18 2

017

W22 2

017

W26 2

017

W31 2

017

W35 2

017

W39 2

017

W44 2

017

W48 2

017

W01 2

018

W05 2

018

0

25000

50000

75000

100000

125000

150000

175000

200000

020406080100120140160

0

0.1

0.2

0.3

0.4

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0.6

0.7

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

2017 2018 Num

bero

fcon

sulta

tionsinTho

usan

ds

Morbidity%

Epidemiologicalweekofreportingin2017

Fig.1|IDSRProportionatemorbiditytrends,week1,2017to5,2018

Consultations Malaria ARI AWD ABD Measles

5

IDPProportionatemorbiditytrends- indisplacedpopulations

IDPProportionatemorbiditytrends- indisplacedpopulations

Among the IDPs, ARI and malaria accounted for 26.2% and 16.1% of consultations in week 5. The other significant causes of morbidity in the IDPs include AWD, skin diseases, and injuries.

The top causes of morbidity in the IDPs in 2018 include ARI, malaria, AWD, skin diseases, injuries, and ABD.

05,00010,00015,00020,00025,00030,00035,00040,00045,00050,000

0%5%

10%15%20%25%30%35%40%45%

1 2 3 4 5 6 7 8 9 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 52 1 2 3 4 5

2017 2018

Consultatio

ns

%ofM

obidity

Epiweek2017to2018

Fig.2|IDPProportionatemorbiditytrends,week01,2017,toweek5,2018

Consultations Malaria ARI AWD ABD Measles Skindiseases GSW Injuries

16.1%

26.2%

7.6%

0.8% 0.01%

4.11%

0.03%

2.58%

0

0.05

0.1

0.15

0.2

0.25

0.3

Malaria ARI AWD ABD Measles Skindiseases GSW Injuries

Prop

ortio

natem

orbidity[%

]

CausesofmorbidityamongtheIDPsweeks5,2018

6

Malaria|Trendsovertime

Malaria|MapsandAlertManagement

Malaria | Trends over time

6 W5 2018 (Jan 29-Feb 04)

Figure 4a | Trend in number of cases over time (South Sudan)

0

20000

40000

60000

80000

100000

120000

Graph legend

2018

−− · · −− · ·−−

2017

− · − · − · − − 2016

− − − − − − − 2015

· · · · · · · · · · 2014

175,954Cases

38Deaths

10Alerts

Key malaria indicators (2018) Figure 4b | % morbidity Figure 4c | Age breakdown

Jan Mar May Jul Sep Nov

Map 2 | Map of malaria cases by county (2018)

a. 2014 b. 2015 c. 2016

d. 2017 d. 2018

Malaria | Maps and Alert Management

7 W5 2018 (Jan 29-Feb 04)

Map 3 | Map of malaria alerts by county (2018)

Map legend

Number of malaria cases

0 1 10,000 20,000 50,000

Number of malaria alerts

0 1 10

Alert threshold

Twice the average number of cases

over the past 3 weeks. Source: IDSR

10Alerts

5Verified

0Low Risk

0Moderate Risk

0High Risk

0Very High Risk

Risk Assessment

7

AcuteWateryDiarrhoea|Trendsovertime

AcuteWateryDiarrhoea|MapsandAlertManagement

Acute Watery Diarrhoea | Trends over time

8 W5 2018 (Jan 29-Feb 04)

Figure 5a | Trend in AWD cases over time (South Sudan)

0

5000

2500

7500

10000

12500

15000

17500

20000

Graph legend

2018

−− · · −− · ·−−

2017

− · − · − · − − 2016

− − − − − − − 2015

· · · · · · · · · · 2014

40,612Cases

2Deaths

19Alerts

Key AWD indicators (2018) Figure 5b | % morbidity Figure 5c | Age breakdown

Jan Mar May Jul Sep Nov

Map 4 | Map of AWD cases by county (2018)

a. 2014 b. 2015 c. 2016

d. 2017 d. 2018

Acute Watery Diarrhoea | Maps and Alert Management

9 W5 2018 (Jan 29-Feb 04)

Map 5 | Map of AWD alerts by county (2018)

Map legend

Number of AWD cases

0 1 5,000 10,000 20,000

Number of AWD alerts

0 1 10

Alert threshold

Twice the average number of cases over

the past 3 weeks. Source: IDSR

19Alerts

6Verified

0Low Risk

0Moderate Risk

0High Risk

0Very High Risk

Risk Assessment

8

AcuteBloodyDiarrhoea|Trendsovertime

AcuteBloodyDiarrhoea|MapsandAlertManagement

Acute Bloody Diarrhoea | Trends over time

10 W5 2018 (Jan 29-Feb 04)

Figure 6a | Trend in bloody diarrhoea cases over time (South Sudan)

0

500

1000

1500

2000

2500

3000

3500

Graph legend

2018

−− · · −− · ·−−

2017

− · − · − · − − 2016

− − − − − − − 2015

· · · · · · · · · · 2014

6,285Cases

1Deaths

28Alerts

Key bloody diarrhoea indicators (2018) Figure 6b | % morbidity Figure 6c | Age breakdown

Jan Mar May Jul Sep Nov

Map 6 | Map of bloody diarrhoea cases by county (2018)

a. 2014 b. 2015 c. 2016

d. 2017 d. 2018

Acute Bloody Diarrhoea | Maps and Alert Management

11 W5 2018 (Jan 29-Feb 04)

Map 7 | Map of bloody diarrhoea alerts by county (2018)

Map legend

Number of bloody diarrhoea cases

0 1 500 1,000 2,000

Number of alerts

0 1 10

Alert threshold

Twice the average number of cases over the

past 3 weeks. Source: IDSR

28Alerts

5Verified

0Low Risk

0Moderate Risk

0High Risk

0Very High Risk

Risk Assessment

9

Measles|Trendsovertime

Measles|MapsandAlertManagement

Data under review

Map 7 | Map of measles cases by county (2018)

a. 2014 b. 2015 c. 2016

d. 2017 d. 2018

Measles | Maps and Alert Management

13 W5 2018 (Jan 29-Feb 04)

Map 8 | Map of measles alerts by county (2018)

Map legend

Number of measles cases

0 1 50 100 250

Number of measles alerts

0 1 10

Alert threshold

1 case.

Source: IDSR

17Alerts

7Verified

0Low Risk

0Moderate Risk

0High Risk

0Very High Risk

Risk Assessment

10

AcuteFlaccidParalysis|SuspectedPolio

MortalityintheIDPs

In week 5, 2018, six new AFP cases were reported from Lakes and Upper Nile hubs. This brings the cumulative total for 2018 to 22 AFP cases.

The annualized non-Polio AFP (NPAFP) rate (cases per 100,000 population children 0-14 years) in 2018 was 2.78 per 100,000 population of children 0-14 years (target ≥2 per 100,000 children 0-14 years).

Stool adequacy was 95% in 2018, a rate that is higher than the target of ≥80%.

Environmental surveillance ongoing sinceMay 2017; with 23 samples testingpositive for non-polio enterovirus.

Source: South Sudan Weekly AFPBulletin

Table 6 | Proportional mortality by cause of death in IDPs W5 2018

Among the IDPs, mortality data was received from Akobo, Juba 3 PoC, BentiuPoC in week 5. (Table 6). A total of 21 deaths were reported during the week.Bentiu PoC reported 17 (81%) deaths in the week. During the week, 9 (43%)deaths were recorded among children <5 years in (Table 6).

The causes of death during week 5 are shown in Table 6.

*As of epidemiological week 5/2018

By County 2016

2017

*As of epidemiological week 49/2017

week5

Akobo<5yrs <5yrs ≥5yrs <5yrs ≥5yrs

Asthma 1 1 5

Hypoxia 1 1 5

Kala-Azar 1 1 5

Malaria 1 1 2 10

Perinataldeath 1 1 5

Pneumonia 1 1 5

Respiratoryarrest 1 1 5

SAM 1 1 5

Shock 1 1 5

Unknown 3 3 14

TB 1 1 5

Burns 1 1 5

Heartfailure+ 1 1 5

Hypolycaemia 2 2 10

SuspTB 1 1 5

Suspectmeningitis 1 1 2 10Totaldeaths 1 7 10 1 2 21 100

Totaldeaths

Proportionatemortality[%]

CauseofDeathbyIDPsite

Bentiu Juba3

11

MortalityintheIDPs- CrudeandUnderfivemortalityrates

MortalityintheIDPs- Overallmortalityin2018

The U5MR in all the IDP sites that submitted mortality data in week 5 of 2018 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 submittedmortality data in week 5 of 2018 were below the emergency thresholdof 1 death per 10,000 per day (Fig. 21).

Table 7 | Mortality by IDP site and cause of death as of W5, 2018

l A total of 80 deaths have been reported from the IDP sites in 2018Table 7.

l The top causes of mortality in the IDPs in 2018 are shown in Table 7.

0.0

0.5

1.0

1.5

2.0

2.5

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

2017 2018

deathsper10,000perday

Epidemiological week

Figure20|EWARNU5MRbySite- W12017toW5of2018

Bentiu Juba3 Malakal Threshold WauPoC

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

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

2017 2018

deathsper10,000perday

Epidemiological week

Figure21|EWARNCrudeMortalityRateforW12017toW4of2018

Bentiu Juba3 Malakal Akobo Threshold WauPoC

week5

IDPsite acutewaterydiarrhoe

a

Asthma

cancer

HeartF

ailure

Kala-Azar

LiverC

irrho

sis

malaria

Men

ingitis

perin

ataldeath

pneu

mon

ia

Rabies

SAM

Sepsis

TB/H

IV

Trau

ma

HIV/

AIDS

TB

SuspTB

Suspectm

eningitis

Others

Grand

Total

Bentiu 1 1 1 1 1 1 7 3 1 1 2 1 2 4 1 2 23 53Juba3 1 1 1 1 2 1 1 3 1 2 14Malakal 1 2 1 1 2 3 10Akobo 1 1 1 0 3GrandTotal 1 2 3 3 3 1 4 1 8 4 1 2 2 1 1 5 7 1 2 28 80Proportionatemortality[%] 1% 3% 4% 4% 4% 1% 5% 1% 10% 5% 1% 3% 3% 1% 1% 6% 9% 1% 3% 35% 100%

Formorehelpandsupport,pleasecontact:

Dr.Pinyi Nyimol MawienDirectorGeneralPreventiveHealthServicesMinistryofHealthRepublicofSouthSudanTelephone:+211955604020

Dr.MathewTutMosesDirectorEmergencyPreparednessandResponse(EPR)MinistryofHealthRepublicofSouthSudanTelephone:+211955295257

Notes

WHOandtheMinistryofHealthgratefullyacknowledgehealthclusterandhealthpooledfund(HPF)partnerswhohavereportedthedatausedinthisbulletin.WewouldalsoliketothankECHOandUSAIDforprovidingfinancialsupport.

ThedatahasbeencollectedwithsupportfromtheEWARSproject.Thisisaninitiativetostrengthenearlywarning,alertandresponseinemergencies.Itincludesanonline,desktopandmobileapplicationthatcanberapidlyconfiguredanddeployedinthefield.Itisdesignedwithfrontlineusersinmind,andbuilttoworkindifficultandremoteoperatingenvironments.ThisbulletinhasbeenautomaticallypublishedfromtheEWARSapplication.

Moreinformationcanbefoundathttp://ewars-project.org