Health Update October 2005

HEALHEALTTH UPDH UPDAATETE WHO SOUTH SUDA WHO SOUTH SUDA WHO SOUTH SUDAN N N

World Health Organization Southern Sudan Office

Warwick Centre

UN Avenue

P.O.Box 63565

Phone: +254 (20) 622832;623197 Fax: 623640

www.who.int

www.emro.who.int/sudan

POLIO POLIO POLIO ERADICATIONERADICATIONERADICATION

Special coverage with pictures (including

frontpage cover)by

WHO/Philip van de Graaf

P.8

October 2005 OUTBREAKOUTBREAKOUTBREAK CONTROLCONTROLCONTROL WHO to provide EWARN

orientations in South Sudan

training schools. P. 3. P. 3. P. 3. P. 3

EMERGENCYEMERGENCYEMERGENCY ACTIONACTIONACTION WHO undertakes inventory

of health staff both Suda-

nese and expatriate. P. 4

PAKIPAKIPAKISTANSTANSTAN EARTHQUAKEEARTHQUAKEEARTHQUAKE Mickey Richer back from

Balakot, Northwest Frontier

province of Pakistan affected

by the earthquake. P.5

MEASLES MEASLES MEASLES CAMPAIGNCAMPAIGNCAMPAIGN

4.5 million children to be vaccinated against the disease

in South Sudan.P.8

Health Update October 2005 OOOOUTBREAKUTBREAKUTBREAKUTBREAK P P P PREPAREDNESSREPAREDNESSREPAREDNESSREPAREDNESS ANDANDANDAND R R R RESPONSEESPONSEESPONSEESPONSE

There was no outbreak confirmed dur-

ing the month of October by EWARN South Sudan program. Two rumors of

Cholera outbreak reported, one from Aweil West and the other from Central

Equatoria could not be verified. To-wards the end of the month the office

received reports of confirmed Dengue Hemorrhagic fever (DHF) in Southern

Khordofan. The Federal Ministry of Health, WHO Khartoum and NGOs are

reported to have responded to the out-

break.

Acute JaundiceAcute JaundiceAcute JaundiceAcute Jaundice Syndrome Syndrome Syndrome Syndrome

Following the lab confirmations of 23 cases of hepatitis E , 5cases of Dengue

fever and 5 cases of Q-fever from specimens collected from Wadaga SBN

in September and tested at NAMRU-3 in Cairo, WHO and partners organized two

separate response teams to the area in October. The first team comprised of

MEDAIR, GOAL and SRRC was in Wa-

daga from October 18th – 26th, 2005.

At the end of their mission the team

found and accomplished the following:

� High % of malaria seen--all 4 of the

severely unwell jaundiced patients as well as 50% (116 of 232) of all pa-

tients tested by GOAL in the PHCU were RDT positive for falciparum ma-

laria.

� CHW reported 40 deaths in the past

month—all women of child bearing

age but he was not certain if all deaths had preceding jaundice.

� 38 cases of jaundice presenting to

the PHCU were assessed and man-

aged—4 severely ill.

Page Page Page Page 2222 Health Update October 2005Health Update October 2005Health Update October 2005Health Update October 2005

� 31 community hygiene promoters

trained and 2547 people in 34 villages reportedly reached with

disease prevention messages

� 1920 people reached with health

promotion via PHCU and distribu-

tions

� Weekly reporting set-up with

CHWs and Chief in conjunction with GOAL

� Blood samples were obtained from

20

� jaundiced patients

� 1200 insecticide treated nets were

distributed as part of vector con-trol

� The only hand pump well in the

area was repaired

The second team comprised

CDC/Kenya, and SRRC, was in the

area from October 22nd – 27 th, 2005.

They carried out an epidemiological

assessment of the Dengue fever and

collected specimens for further labo-

ratory tests and characterization of

the outbreak. The team found that

the number of cases of fever had

reduced in the community consid-

erably. In Wadaga, they saw and

collected blood specimens from

about 12 cases meeting the case

definitions for Dengue fever.

Forecasting and Forecasting and Forecasting and Forecasting and PreparednessPreparednessPreparednessPreparedness

As part of outbreak preparedness in

Southern Sudan, the EWARN pro-gram ordered emergency outbreak

response kits for targeted outbreak prone diseases. The drugs and sup-

plies will be pre-positioned in Loki, Juba, Yambio, Rumbek and Nyal.

Plans are also underway to upgrade and equip one laboratory to support

outbreak investigations in the South.

These projects are funded by DFID.

First ORLT

Training

World Health Organization Southern

Sudan EWARN program was repre-sented in the first Outbreak Response

Leadership Training (ORLT) organized by WHO/HQ, Global Outbreak Alert

and Response Network (GOARN). The training was organized at the Red

Cross Training Center (Ecogia) in Versoix, Switzerland from September

25th – 30th, 2005. Twenty-nine par-ticipants representing GOARN part-

ners from 16 institutions (governments , NGOs, UN agencies

etc.) attended. Over 10 experts on topics related to outbreak investiga-

tions and response facilitated the

training.

This is the first such training and the

specific objectives were:

� To describe the relationship among

the main actors of the United Na-tions system in the context of re-

sponse to outbreaks and emer-gency situations

� To explain GOARN rationale, struc-

ture and nature of partnership

� To coordinate with GOARN part-

ners in a respectful and efficient way, compatible with GOARN phi-

losophy

� To coordinate with national au-

thorities in a respectful and effi-cient way, taking into account local

cultural, social and economical specificities

� To report and communicate with

WHO CO, RO and HQ in a timely, concise and efficient manner

� To identify the specificities of na-

tional and international NGOs op-

erations in the field.

Demonstration session on the use of PPE

during ORLT training at Ecogia, Switzerland

Extending EWARN Extending EWARN Extending EWARN Extending EWARN

to medical to medical to medical to medical

Schools Schools Schools Schools

WHO/EWARN and ICRC-Lop ding Hospital Training School have

agreed to include EWARN training into ongoing basic training and re-

fresher courses in the school. As a result of this agreement, WHO and

ICRC have since 2002 organized and conducted EWARN orientations

during existing training programs in the school. The orientation usually

lasts for three days.

Starting October 31st, a total of 27

health workers , including Chows, lab assistants and nurse aids at-

tending an ICRC health course, field officers , and teaching staff partici-

pated at an EWARN orientation jointly organized by ICRC-Loki

training school and WHO.

The health workers were drawn from 13 locations in southern Sudan

and representing 8 non-

governmental organizations (NGO).

The training included lectures , dis-

cussions , studies of outbreak case

scenarios and video shows.

OOOOUTBREAKUTBREAKUTBREAKUTBREAK P P P PREPAREDNESSREPAREDNESSREPAREDNESSREPAREDNESS ANDANDANDAND R R R RESPONSEESPONSEESPONSEESPONSE

Page Page Page Page 3333 Health Update October 2005Health Update October 2005Health Update October 2005Health Update October 2005

The Human Resources Develop-

ment (HRD) component of the EHA office’s ‘First Steps ’ project

moved from preparation to im-plementation phase on 17 Octo-

ber 2005 with the arrival of an

HR consultant, Mark Beesley.

The first task of a 17-strong team with members from the

Federal Ministry of Health for the Government of South Sudan,

AMREF, The Capacity Project and led by WHO, will be to complete

before 05 December an inven-tory of health staff, both Suda-

nese and expatriate, currently working in South Sudan. The

collated data will be pre-requisites for the team’s later tasks of making a quantitative

assessment, describing a situa-tion analysis and formulating

recommendations for the Minis-try’s HRD Plan. The information

gathered will also double up as a provisional personnel filing sys-

tem for the Ministry and be used at a later date as a starting point

for accreditation.

The team defined thirteen areas

of inquiry, which cover details of the individual (name, gender,

age bracket, language), their work (category, functional level,

employer, salary, nature and location of workplace) and the

certificates they hold. In sixteen working days , the team has

been able to design and test the tools , brief 52 collaborating or-

ganizations and collect data on

1 ,350 staff.

Midwifery Midwifery Midwifery Midwifery Training Training Training Training

The midwifery training component proceeds with the training on the job

for female nurses of the Rumbek hospital involved in maternity and

MCH services. This component of the project s till suffers from lack of ma-

terial support (training materials , communication facilities ). Despite the difficulties , the training seems to

be effective: the personnel involved in the training, according to the re-

port of the trainer Margaret Aguti, are now capable of conducting safe

deliveries and perform some emer-gency obstetric procedures (including

episiotomy).

HealthHealthHealthHealth Managers’Managers’Managers’Managers’ TrainingTrainingTrainingTraining

The health managers ’ training com-ponent of the project is under-way.

The team from the Instituto Superi-ore Sanita (ISS) met with Senior

Health Managers and conducted an assessment in the field (Rumbek,

Maridi). Questionnaires were circu-lated and are being filled to gauge

the level of capacity of future train-ees . Due to the short duration of the

mission it was necessary to rec ruit another data collector to assist in

obtaining additional information from

the field.

EMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITARIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTION

Human Human Human Human Resources Resources Resources Resources DevelopmentDevelopmentDevelopmentDevelopment

Page Page Page Page 4444 Health Update October 2005Health Update October 2005Health Update October 2005Health Update October 2005

Immediate HealthImmediate HealthImmediate HealthImmediate Health Assistance toAssistance toAssistance toAssistance to ReturneesReturneesReturneesReturnees

WHO is purchasing emergency drug kits and basic equipment to be pre-

positioned when the process for sub-contracting NGOs is finalized. How-

ever little progress has been regis-tered in October regarding way-

stations; division of responsibilities; procedures to select and sub-

contract implementing partners.

CoordinationCoordinationCoordinationCoordination

The Health and Nutrition Consulta-

tive Group was formally launched, on October 28th. This first gathering

saw the participation of all key stakeholders, with strong ownership

and chairmanship of the MOH. Dis-cussions focused on issues of sector-

wide significance. Terms of refer-ence for the HNCG were proposed to

the MOH and are now being re-viewed by the Desk for External As-

sistance. WHO has been formally asked to support the Secretariat in

the new coordination mechanism. Meanwhile the health sector recov-

ery matrix, an instrument for map-ping and monitoring the implemen-

tation of activities , was formally

adopted as a tool for the new HNCG.

InfrastructureInfrastructureInfrastructureInfrastructure RehabilitationRehabilitationRehabilitationRehabilitation

Rehabilitation works of the first

building inside the hospital are ap-proaching completion. The hand-

over of the building from the con-tractor is expected to take place in

November. Regarding the construc-tion of the new training center a first

plan was discussed with counter-parts and Comitato Collaborazione

Medica (CCM). Meanwhile the proc-ess for bidding and tendering has

been clarified. The main outstanding point at this stage is the allocation

of a plot of land for the construction

of the training center.

EMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITAEMERGENCY & HUMANITARIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTIONRIAN ACTION

Page Page Page Page 5555 Health Update October 2005Health Update October 2005Health Update October 2005Health Update October 2005

Our communicable diseases technical officer, Mickey

Richer traveled to Balakot, Northwest Pakistan to support

Emergency and Humanitarian actions in this greatly af-

fected region. She arrived in Pakistan only eight days

after the earthquake (7.6 on the Richter scale) hit north-

east Islamabad.

According to Dr. Richer, WHO served as the interface be-

tween the humanitarian and relief agencies and the gov-

ernment. She and other colleagues from WHO assisted

the ministry of health in coordinating and liaising with the

tremendous number of international aid agencies, donors

and NGOs working in the affected areas. With the

amount of aid flowing in, she contributed in providing

guidance on the best ways to utilize these contributions .

WHO is working with health authorities and other aid

agencies to restore health services and provide shelter to

millions of homeless before winter.

WHO South Sudan support to Pakistan earthquake

Photo credits

Mickey Richer

REGIONSREGIONSREGIONSREGIONS SNID 1SNID 1SNID 1SNID 1STSTSTST ROUND ROUND ROUND ROUND 2222ND ND ND ND ROUNDROUNDROUNDROUND

WEQ, EEQ October 3-6 Oct. 31- Nov. 3

BEG, Lakes October 10-13 Nov. 7-10

UNJ, S.JONGLEI & NUBA October 14-20 Nov.14-17

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Sub National

Immunization

Days

The first round of two Sub-National

Immunization Days (SNID) planned for 2005 was conducted in October

throughout South Sudan. The target was to cover with Oral Polio Vaccine

(OPV) at least 95% of the targeted population of children under five in all

payams.

Training was conducted in all regions from September to the first weeks of

November. The training involved field supervisors , field assistants and team

supervisors . These core groups in turn trained vaccinators prior to the launch

of SNIDs .

SNIDs are part of a plan to stop the

outbreak of polio in South Sudan de-tected in June 2004, in Darfur, rees-

tablishing the transmission of wild po-liovirus in the whole of Sudan. SNIDs

and other supplementary immuniza-tion activities have been intensified

since to prevent thousand s of children

from being paralyzed.

The campaign in Upper Nile was par-

ticularly affected by unusual heavy rains in the region delaying the start of

the campaign by almost a week in

some areas .

According to the external AFP surveil-

lance review, conducted from 6-16 September 2005 , some wild cases

could be missed despite the well de-veloped AFP surveillance system be-

cause of on-going insecurity, inacces-sibility in some areas and logistical

and infrastructural constraints. The regions cited by the review team

where the surveillance system could miss cases are: Upper Nile, Lakes and

Baher El-Ghazal.

Regions 1st round 2nd round

WEQ, EEQ October 3-6 Oct. 31- Nov. 3

BEG, Lakes October 10-13 Nov. 7-10

UNJ, S.JONGLEI & NUBA October 14-20 Nov.14-17

Page Page Page Page 6666 Health Update October 2005Health Update October 2005Health Update October 2005Health Update October 2005

Photo credits Philip van de Graaf

Page Page Page Page 7777 Health Update October 2005Health Update October 2005Health Update October 2005Health Update October 2005

TABLE 2 INDICATORS OF AFP SURVEILLANCE AT THE END OF OCTOBER

2005

Region

Ade-quate

stool

Inade-quate

stool

to-

tal

Stool ade-quacy

Rate

Annual-ized non-polio AFP

rate

BEG 28 8 36 77.8% 1.88

Equatorias 19 5 24 79.2% 2.4

Nuba 0 2 2 0% 1.2

Upper Nile 27 8 35 77.1% 2.65

TotalTotalTotalTotal 74747474 23232323 97979797 76.3%76.3%76.3%76.3% 2.182.182.182.18

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In both eastern and western Equatoria insecurity

limited access in Yei, Juba/Terekeka, Kajokeji and Mundri counties . Due to delays in the first round in

UNJ, the second round will start on the 21st of No-

vember.

AFP surveillance

As shown in the table 2 the detection of AFP cases in all regions is going on well as reflected by non-

polio AFP rate of 2 .18. However collection of ade-quate stool specimen has gone below the expected

standard of 80% but may improve till the end of the year. The frequent rounds of SIA activities this

year might have affected the early detection part

of the surveillance activity.

A joint WHO-UNICEF mass measles

campaign will be launched on Novem-

ber 21st in the Equatoria region and

later extended to the rest of South

Sudan.

The campaign aims to vaccinate 4.5

million children to reduce morbidity

and mortality from measles ; to estab-

lish/strengthen the national Expanded

Programme on Immunization (routine

immunization) and to estab-

lish/strengthen vaccine preventable

diseases (measles ) surveillance sys-

tem.

The organization of a mass measles

campaign is very complex as it re-

quires a massive cold-chain, and a

large number of skilled health person-

nel.

South Sudan is prone to outbreaks of

measles and the disease is a leading

cause of death among children. In-

depth investigations of 2 outbreaks in

2 counties alone detected 922 and

673 cases respectively. However the

exact prevalence of the disease is un-

known due to the inexistence of sys-

tematic data collection.

The campaign is costing an estimated

USD 12 million shared between WHO

and UNICEF.

A national steering committee com-

posed of the secretariat of health,

WHO, UNICEF, major donors and par-

ticipating NGOs was established to run

the campaign. Technical committees

have also been formed at national re-

gional, county and payam levels. At

the operational level in the field

teams include one supervisor, two

vaccinators, 1 recorder, 1 mobilizer

and one crowd controller.

Campaign

Strategy

� Strong routine EPI of ≥ 80%

� Provide 2nd opportunity. (catch-

up campaign)

� Strong surveillance.

� Improved case management.

Campaign

Challenges

� Inaccurate population data

� Lack of health infrastructure and

system.

� Shortage of trained health person-

nel.

� Accessibility (poor road network,

natural barriers , security).

� Scattered and mobile population

� Vast geographical areas .

� IDPS and returnees.

UUUPCOMING EVENTSPCOMING EVENTSPCOMING EVENTS

� Joint Programme Review Mission

(Khartoum,16-19 November)

� Sudan vision 2020 meeting

(Khartoum, 26 November 2005)

� Mass measles Campaign ( November

28 2005)

� 2nd round of polio SNIDs

Lakes region (November 7-11)

Upper Nile, Jonglei, Nuba Mountains

and Southern Blue Nile ( November

14-18)

� Kala-Azar on-site training in Kreich-

kuon (November 6-16)

NEW ARRIVALSNEW ARRIVALSNEW ARRIVALS

International staff (names and programs)

Dr. Navaratnasamy Paranietharan – EHA

Dr. Mark Beesley – EHA

Dr. Patrick Abok – HIV/AIDS

Dr. Zewde Tesfaye Beyene – Measles

Dr. Amos Bassi – Measles

National staff

Peter Kayier Dak – Measles

Stephen Chol Garang – Measles

Mary Nyoka Simon – Measles

Christopher W. Bunyasi – Measles

Joseph W. Wafula – Measles

MEASLES CAMPAIGNMEASLES CAMPAIGNMEASLES CAMPAIGNMEASLES CAMPAIGNMEASLES CAMPAIGNMEASLES CAMPAIGNMEASLES CAMPAIGNMEASLES CAMPAIGNMEASLES CAMPAIGNMEASLES CAMPAIGNMEASLES CAMPAIGNMEASLES CAMPAIGN

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