Health in South Sudan Issue 1. Volume 5.
WHO has begun a series of Oral Cholera Vaccination (OCV) Campaigns in parts of South Sudan as part of concerted efforts to prevent a potenal outbreak of the disease.
The campaigns, targeted for Bentiu and Juba 3 Protection of Civilians (PoC) sites in June 2015, aim to prevent more cases and will complement other measures already in place. This is crucial given the approach of the rainy season in the endemic country. “The threat of a cholera outbreak in the PoCs and other high risk areas is imminent hence it is imperative to implement effective cholera prevent on interventions. While numerous preventive measures have been put in place, they may not be adequate to avert a potential cholera outbreak in the PoCs which is why health partners decided to use OCV as supplementary preventive strategy,” says Dr. Allan Mpairwe, Head of Outbreaks and Disaster Management (ODM) at WHO South Sudan.
The campaign in Ben u began on 1 June and is expected to reach 73,360 people with two doses of the oral cholera vaccine (OCV) over a four day period. This will be followed by the campaign in Juba, which is scheduled to start on 15 June and aims to reach 33,565 people over four days.
A total of 146,720 doses have been released for Ben u, while another 67,129 have been set aside for Juba 3 PoC. The rationale behind the campaigns is derived from the outcome of OCV coverage surveys conducted by WHO, in collaboration with health partners in Malakal, Ben u and Juba 3 PoCs, to ascertain the number of displaced people living in these camps who had received two doses of oral cholera vaccine last year.
The surveys showed that less than 20% of current residents of Juba, Malakal and Ben u reported receiving two doses of oral cholera vaccine in 2014.
Since residents in these camps are highly mobile, these findings suggest that most of those currently residing in these PoCs are new arrivals, while most of those vaccinated last year may have le the camps. Cholera is endemic in South Sudan and historically, outbreaks have occurred along major rivers in the dry season as well as during the rainy season. South Sudan has suffered at least five major cholera outbreaks in 2006, 2007, 2008, 2009 and 2014. The outbreak in 2014, occurred within the context of an ongoing humanitarian crisis resulting in a total of 6,421 cases including 167 deaths (CFR2.6%) being reported from 16 counties in the five states of Central Equatoria, Eastern Equatoria, Western Equatoria, Upper Nile and Jonglei.
Risk factors for the spread of cholera still remain, placing the country at high-risk of another cholera epidemic.
These include increased population movement due to insecurity, crowded living conditions in the camps with inadequate basic services, low sanitation coverage, poor hygiene practices, malA monthly publication produced by WHO South Sudan. For more information contact us on: afwcosswho@who.int or visit http://www.afro.who.int/en/ssd/wco Averting Cholera Outbreaks through OCV WHO employees inspect a batch of the vaccines for the Oral Cholera Vaccination campaign.
WHO, in collaboration with health authorities and health cluster partners, initiated cholera preparedness ac vi es in March 2015, resulting in the activation of cholera task forces at national and state level, in the in the PoCs and at other major urban centers.
The state and national cholera task forces, comprised of representatives of health authorities, health and WASH partners as well as community members, have been coordinating cholera preparedness and response activities.
Preparedness measures put in place so far include refresher training on case management and infection control, enhanced disease surveillance, improving sanitation and hygiene practices in high risk areas, social mobilization and strategically prepositioning cholera case management supplies.
It is anticipated that the OCV campaigns will complement these measures, thereby averting a potentially large scale cholera outbreak in the country.
Partners working with WHO to implement the campaign the campaign include UNICEF, the International Organization for Migration (IOM) the International Medical Corps (IMC).
WHO provided the vaccines and technical support as well as monitoring and evaluating the campaign. WHO has stepped up cholera surveillance as well as preparedness and response activities in light of the rainy season. Key ac vi es include investigating alerts as soon as they are received. In May, six alerts were received from Juba 1 and 3 Protection of Civilian (PoC) sites. In addition, the Ministry of Health working with WHO, has reactivated the national cholera taskforce, together with stakeholders. Working sub-committees of the national cholera taskforce have been formed to coordinate extended epidemiological and laboratory investigations to identify additional suspected cases.
The committees will, in addition, work to enhance capacity for case management, access to safe water, sanitation and hygiene.
To complement the WASH interventions within the PoC, the first round of oral cholera vaccination targeting 73,360 individuals aged one year and above is planned for Ben u PoC star ng on 1 June, while a corresponding campaign targeting 33,565 people in the same age range is slated for 15 June at UN House PoC.
Temporary cholera treatment centers have been established in Juba Teaching Hospital and the International Medical Corps (IMC) clinic in UN House PoC to manage suspect and confirmed cholera cases.
The Health Cluster has mobilized necessary requirements for a cholera treatment centre in UN House PoC in the event of a full-scale outbreak. The Ministry of Health has advised the public to take measures to avert the spread of cholera and to report any suspect cholera patients to the nearest health facility.
Useful links: h p://www.who.int/mediacentre/factsheets/fs107/ en/ Health in South Sudan Issue 1. Volume 5. 31 May 2015 A team from WHO conducts contact tracing following an alert of a suspected cholera case. Photo: WHO. A Laboratory Scientist at WHO South Sudan conducts a rapid test on a stool sample as part of increased surveillance efforts. Photo: WHO.
Partners at a Cholera Preparedness and Response meeting at UN House PoC . Photo: WHO. Averting Cholera Outbreaks through OCV WHO Steps Up Cholera Surveillance 3 Health in South Sudan Post-graduate students will benefit from an enriched library following a donation of medical textbooks by WHO on 5 May 2015.
The assorted books, covering a broad range of topics, were handed over to the Postgraduate College of Physician and Surgeon Studies in Juba. The college is the first postgraduate school established by the Ministry of Health since the country seceded in 2011. Presenting the books, acting Officer in Charge for WHO Dr. Abdinasir Abubakar, pledged the organization’s continued commitment and support to the Ministry of Health.
“These assorted books are worth over US$200,000 and it is our sincere hope that they will assist students in their research work and quest for knowledge.” Among the topics covered are Medical Anatomy, Physiology, Pathology and Communicable Diseases. Addressing guests at the ceremony, Undersecretary in the Ministry of Health, Dr. Makur Matur Kariom expressed appreciation for the donation and promised to ensure that the books are used for the intended purpose.
“We sincerely appreciate WHO for always coming to meet our needs,” Dr. Kariom said, adding that he hoped the books would be useful in helping practitioners to alter negative disease trends in South Sudan.
He noted that this was the second donation of medical text books from WHO in the last four years. Receiving the books, Dr. Richard Brejazzi, Dean at the college, expressed gratitude to both WHO and the Ministry of Health for the donation and continued support.
The books, he said would help to address the challenge of limited resources. “As you can see we haven’t started using the library due to lack of text books, however we can do so now and we also have computers available that will help students with research work,” he said.
The college was established and launched in March 2015 and is currently hosted at Juba Teaching Hospital. Presently, 22 students with basic medical training are enrolled.
It is anticipated that the first intake of students will graduate in December 2017, Dr. Brejazzi said.
WHO Boosts Medical Library with US$200,000 Book Donation Issue 1. Volume 5. 31 May 2015 Undersecretary in the Ministry of Health Dr. Makur Matur Kariom (right), addressing WHO Acting Officer in Charge Dr. Abdinasir Abubakar (le ), Dean at the College, Dr. Richard Brejazzi and guests a er receiving the books.
Photo: WHO. WHO employees help to offload some of the books that were donated. Photo: WHO. 4 Progress in reducing maternal deaths in developing countries as espoused in the Millennium Development Goals (MDG) has been slow due to some constraints.
This is largely due to challenges such as the shortage of blood and blood products for mothers in need of urgent transfusion during obstetric emergencies as recent reports from hospitals in South Sudan aest. In the first half of 2015 reports of mothers who lost their lives due to lack of blood were received from Kajokeji, Torit and Wau.
The challenge cuts across health facilities in various states. Health workers reported that patients in urgent need of blood were not receiving it because of cultural beliefs that inhibit transfusion.
Women by culture are not supposed to donate blood, yet they are the ones who usually a end to patients in hospital. Further, the absence of a functioning blood banks at field level results in many missed opportunities for blood transfusion that would help to reduce deaths.
A Chronicle of Tragedies Kajo Keji: In early 2015, three mothers requiring urgent blood transfusion succumbed to death mainly due to lack of blood at the health facility.
Wau Hospital: A very anemic pa ent with severe bleeding was referred from Tonj Hospital, Warrap State to Wau on 24 March. Efforts to get blood to take the pa ent to theatre failed, resulting in death due to hemorrhaging.
Torit Hospital: A patient who had delivered one twin and retained the other was admitied and prepared for an emergency Caesarian sec on. The doctor requested two units of blood to be transfused from the family but they were not forthcoming.
The patient died of anemia later that day. A Timely Intervention On 20 May, the health facility in Torit received a report that a mother had been admitied with severe anemia and needed an urgent blood transfusion, although there was no emergency blood in stock.
A WHO staff member rushed to donate blood and helped to save the mother’s life. Getting mothers off the road to maternal death It is imperative that everyone – be they government, stakeholders, implementing agencies, civil society groups and the media – rally together to raise awareness among the citizens of South Sudan on the importance of blood donations to encourage regular blood donations.
In addition, sensitizing communities about the benefits of donating blood will help to dispel myths and contribute to changing socio-cultural perceptions about blood donation.
This is key to saving more lives while increasing stocks at blood banks. Properly Equipping Blood Transfusion Services Equally it is essential to establish fully equipped blood banks at national, state and county level wherever blood transfusions are conducted.
Lack of a constant electricity power supply and appropriate blood cold chain equipment is a hindrance, preventing most state level and hospital blood banks from collecting and storing blood for emergencies. When it comes to life saving blood transfusions, me is of essence.
Each hospital should have an emergency stock of blood units for timely responses to requests for blood in life threatening emergencies. To address the electricity supply issue, solar power is the best option.
In addition to solar power, special blood cold chain refrigerators, freezers and transport boxes (cooler boxes) are also needed to ensure that blood is well preserved even when there are periods of more than 20 hours with no electricity power supply. Rallying call to all Everyone can play their part in saving lives by simply donating blood regularly.
Health in South Sudan Issue 1. Volume 5.
31 May 2015 A Rallying call to Avert Maternal Deaths in South Sudan The twin who survived a er both the mother and second twin died. If blood had been available, both the mother and twin would probably be alive today. Photo: WHO. “Lack of blood is a sure ticket on the road to maternal death, but you can make a difference by giving your blood!” 5 No Guinea Worm Cases Reported in South Sudan in First 4 Months of 2015 The year 2015 is crucial on the Millennium Development Goals (MDG) calendar. Of importance is the need to highlight the role of midwives in progress towards achieving MDG 4 and 5 – improving newborn and maternal health. This is crucial as the MDGs come to an end in September 2015 and the world moves towards UN Sustainable Development Goals. As the Global Strategy for Women’s, Children’s and Adolescents’ Health is being updated, the role of midwifery in preven ng maternal and newborn deaths and morbidity is gaining prominence. It was with this in mind that WHO teamed up with the State Ministry of Health in Eastern Equatoria State (EES) to commemorate Interna onal Day of the Midwife on 5 May 2015 under the Internaonal Confedera on of Midwives (ICM) theme: “Midwives for a be er tomorrow.” The celebra on, which took place in Torit County, Eastern Equatoria State, included a walk through the streets to raise awareness on the importance of increasing the number of midwives for a “be er tomorrow.” The colorful procession was led by the State Minister of Health Dr. Margaret I o and included a police band carrying banners with key maternal health messages. Addressing guests at the event, Dr. I o commended the efforts of partners in improving maternal health. In particular she noted that WHO through the funding from the Government of Canada, was putting up a new maternity ward at the hospital.
She reiterated her commitments in ensuring that more midwives were availed to provide women with more accessible and quality obstetric care for a “be er tomorrow.” She indicated that through close collaboration between the ministries of health at central and state level and partners, midwifery schools will soon begin opened in Torit.
Health in South Sudan Issue 1. Volume 5. 31 May 2015 Towards MDG 4&5: Reducing Maternal and Child Mortality State Minister of Health for Eastern Equatoria, Dr. Margaret I o, led the procession that marched through Torit to mark the day .
Photo: WHO. A guinea worm being extracted from a pa ent. Photo: WHO South Sudan has not reported a single confirmed case of Guinea Worm Disease (GWD) in the first four months of 2015. This is the first me that the country has not had confirmed cases of the disease during the same period since 2006 when the South Sudan Guinea Worm Eradication Programme (SSGWEP) was formed. However, rumours and suspected cases continued to be registered and investigated. Between 1 and 31 May, 82 suspected Guinea worm specimen have been reported to the SSGWEP and some of them sent to the Centres for Disease Control (CDC) Laboratory in Atlanta, USA for confirmation.
The remaining specimen will follow. All the 39 suspected specimen analyzed by the CDC Laboratory between January and April 2015 tested negative of Dracunculiasis Medinensis (Guinea Worm) disease.
The peak transmission season for Guinea Worm Disease in South Sudan is from June to September, during which the actual transmission status of the disease in this country will be known. However, so far there have been no confirmed cases between January and April 2015, compared to seven cases reported during the same period in2014. This reflects significant progress made by the Ministry of Health through the SSGWEP in figh ng the disease, which is for targeted for elimination in South Sudan by the end of 2015. The MOH is working closely with other partners:
The Carter Center, WHO and UNICEF to strengthen countrywide surveillance and increase the level of awareness on Guinea worm disease, market the cash reward programme for reporting Guinea worm cases and increase access to safe drinking water. 6 Upcoming Health Days in June 2015 14 June – World Blood Donor Day You’re invited! Join us at the Na onal Blood Transfusion Services (near Mobil Roundabout) in Juba on 13 June from 8am to 5pm as we mark this important day.
WHO Contributes Equipment to Enhance NBTS Operations Health in South Sudan Issue 1. Volume 5. 31 May 2015 WHO on 29 May 2015 handed over office equipment comprising a laptop, printer, photocopier and scanner to the National Blood Transfusion Services (NBTS) centre in Juba.
The equipment, was officially presented to the NBTS Director Mr Malei Ayuel Akot, will enhance the performance of the centre and will be most useful in documentation, records and data management. The laptop will also be very useful in maintaining the blood donor register even on mobile blood drives. “A computerized database is much easier to store and retrieve donor records, facilitating recalling of donors that are due to give blood.
The quality management system requires adequate documentation of all procedures, forms and records all of which can now be conveniently produced within the center,” said Mr. James Chitsva, NBTS Technical Officer at WHO South Sudan as he handed over the equipment.
Acknowledging the contribution from WHO, Mr. Akot noted that a new establishment, the NBTS which was officially opened in July 2014, lacked office equipment which affected operations.
Previously, staff had to walk to the Public Health Laboratory to print documents like standard opera ng procedures, forms and registers, correspondence, meeting minutes, training materials and this was hindering the unit’s performance. “We are really happy that the NBTS will save both me and money as we can now operate normally. Previously we had to go to another office for such facili es, but now we can do it here so we are really grateful to WHO for this support,” Mr. Akot said. WHO Technical Officer for Blood Safety, Mr. James Chitsva (second from le ) and staff from the National Blood Transfusion Services, with some of the donated equipment.
Photo: WHO 7 South Sudan Marks World Malaria Day Health in South Sudan Issue 1. Volume 5. 31 May 2015 On 25 April 2015, South Sudan joined the rest of the World to commemorate World Malaria Day under the theme: “Invest in the Future: Defeat Malaria.” This year’s celebration drew a en on to the community with special focus on Gurei Primary Health Care Center (PHCC) in Northern Bari Payam, Juba County. A four-day Test, Treat and Prevent Malaria campaign was held at PHCC for people in the payam. Northern Bari is one of the six payams in Juba county Central Equatorial State and located on the outskirts of the capital Juba, approximately 10km from the city center with a population of about 62,662 people. The payam hosts returnees hence its geographical landscape continues to expand with new homes coming up biweekly.
The Ministry of Health, in collaboration with WHO, UNICEF and other partners organized the Test, Treat and Prevention campaign from 27 to 30 April in efforts to raise awareness, sensitize, diagnose and provide treatment for the population. An -malaria interventions during the campaign included rapid diagnostic testing for malaria, prompt treatment for those testing positive and insecticide treated bed net distribution. Because of the awareness raising carried out prior to the campaign, community members turned up in thousands to receive free testing, treatment and mosquito nets.
Over 6,880 people were tested with Rapid Diagnostic Test (RDT), out of which 3,406 cases were positive for malaria and were treated with ACTs. Over 6,880 community members received insecticide– treated mosquito nets. Josephine Dodo, a community member from the extreme end of the payam who got to know about the campaign through megaphone announcements by community social mobilizers said she was pleased with the initiative as it was an effective way to curb malaria.
“I am happy about the distribution of nets because I have learnt that the best and most effective way to prevent malaria is by cleaning around our houses and sleeping under bed nets,” she said. Malaria is a mosquito borne communicable disease caused by the parasitic protozoa plasmodium, which is transmitted via the bites of infected mosquitoes. Around 3.3 billion people in 106 countries including South Sudan are at risk of this life-threatening disease.
According to Dr. Lincoln Charimari, WHO focal point for Malaria in South Sudan, incidence of the disease has been on the increase with cases rising from 887,365 in 2011 to 1,359,998 (2012); 1,622,785 (2013); and 2,109,131 in 2014 in this country.
WHO continues to provide technical and financial support to the Ministry of Health and contributed tents, medicines and personal protective equipment towards the campaign.
Read more about malaria on: h p://www.who.int/topics/ malaria/en/ Patients wait to be a ended to during the Test, Treat and Prevent Malaria campaign to mark World Malaria Day. Photo: WHO. WHO Malaria Focal Point, Dr. Lincoln Charimari at the entrance of the venue for the campaign. Photo: WHO. Patients wait for treatment after being tested during the campaign. Photo: WHO
The Peoples' Bridge 