Sudan Weekly Highlights Week 40 (2-8 October 2010)

Emergency Preparedness and Humanitarian Action (EHA) Sudan Weekly Highlights Week 40 (2-8 October 2010) Children in Darfur, which comprise almost half of Darfur s total population, are especially vulnerable. WHO and its health partners continue their work in in the 3 states by ensuring access to health services and protection from diseases. Highlights The overall security situation remained tense and unpredictable in most part of Darfur. In El Fasher and outside El Fasher town, heightened security was in place following the kidnapping of one UN international staff. Robberies and carjacking are on the rise in the State. WHO provided Saudi Red Crescent with essential drugs and medical supplies to cover the gaps in Altagwa health post established by the Saudi Red Crescent to cover a target population of about 50 000. Twenty five participants from the rural and state hospitals in South Darfur completed the two-day training workshop on hospital statistics (data recording, analysis and reporting). Twenty medical assistants from Mallet locality in North Darfur completed the training/workshop on AWD case detection and outbreak investigation. Acute conjunctivitis in Nyala, Adilla and Al Daen localities is still the main public health concern. Between 2 and 8 October, a total of 421 cases were notified to the epidemiology department of SMoH by the health sector partners. The total number of reported acute conjunctivitis has reached 1 252. WHO in collaboration with SMoH completed the 10-day training course for 22 counselors in South Darfur on VCT counseling and testing for HIV/AIDS. Five deaths were reported from Gedaref State, one death due to severe malaria and 4 deaths due to Kala-azar. WHO s Emergency Preparedness and Humanitarian Action (EHA) in Sudan is funded by: Government of Finland 1

Security The overall security situation remained tense and unpredictable in most part of El Fasher and outside El Fasher town, after the kidnapping of one UN international staff. Robberies and carjacking are on the rise in the State. During the reporting week, security situation in South Darfur remained stable, but unpredictable. Peace agreement signed between Liberals and Reform Movement (LRM) and West Darfur State Government. Security was high alert. No any major incidences have been reported so far. Security situation in Eastern region, including Kassala, Gedarif and Red Sea is, generally, calm. Public health concerns In South Darfur, acute conjunctivitis is still the main public health concern in Nyala, Adilla and Al Daen localities. Between 2 and 8 October, a total of 421 cases were notified to the epidemiology department of SMoH by the health sector partners. The total number of reported acute conjunctivitis has reached1 252. There was a downward trend in incidence of the cases reported from Adilla and Al Daen localities, and upward trend in Nyala, Shareia, and Tulus. Health messages for preventive care are aired on radio and television to raise the awareness regarding this disease In East Sudan, between 2 and 8 October 5 deaths were reported from Gedaref State, one death due to severe malaria and 4 deaths due to Kala-azar. F Malaria still remained the major cause of morbidity in East Sudan from 2 to 8 October. During the week, it was 20% of the total number of consultations. The incidence rate in Kassala during the week was 1.8 per 1 000 of population compared to 1.6 last week. In Gedaref State, it was 1.3 per 1000 of population compared to 1.7 last week. Coordination In South Darfur, WHO supported El Dain and Adela localities with waste management cleaning tools and advocate for cleaning campaigns in the main areas. This was the results of an ad hoc meeting called by SMoH to respond to the increase of pink eye cases in the State. In North Darfur, WASH partners updated the forum on the house to house hygiene education campaigns, garbage collection campaigns, latrine construction/rehabilitation, ORS corners, focus groups discussions at water points, school hygiene education. However, it was mentioned that people used to gather at water sources in Kabkabiya and Oxfam America planned to intervene by hygiene education messages in the area to raise awareness on water borne disease. In West Darfur, WASH task force meeting focused discussion on environmental health related diseases trends and members discussed on how to beef-up routine activities and proper response to diseases. In West Darfur, Concern disposed 32 dead animals and conducted clean-up campaigns in Morni. In West Darfur, Islamic Relief and WHO discussed the action plan on hygiene promotion and cholera prevention for collaborative actions/implementation. Training courses are also being prepared for hygiene promoters in Kringding 1. In West Darfur, a meeting with the Wali (Governor) of West Darfur State on 6 October focused on Darfur s development plan for 2010. During the meeting, the Wali shared the strengthening of 3 rural hospitals ( Habila, Nertati and Mukjar) and opening of new 4 BHUs at Umkhair, Misteri, Beida and Bendsi. A joint team from WHO and SMoH visited Mukjar to respond to the reported increase in the number of malaria cases. During the visit, the team found the pools of stagnant water covered with mixture of oil /fuel. MoH, IMC and UNAMID are working for the re-back filling of pools of water. WHO activities linked to the health sector objectives *Strategic Objective: Contribute towards better access for vulnerable populations to quality health care services that include a basic health package and emergency referral services. Primary health care South Darfur WHO provided Saudi Red Crescent with essential drugs and medical supplies to cover the gaps in Altagwa health post established by the Saudi Red Crescent to cover a target population of about 50 000 for health services. WHO in collaboration with SMoH completed a refresher training course for 22 counselors in South Darfur on VCT counseling and testing for HIV/AIDS. The ten-day training course covered the following subjects: AIDS and STIs situation analysis, facts about HIV\AIDS, medical history technique and test, syndromic classification, diagnosis and treatment, prevention and control of 2

sexually transmitted diseases, health education and psychological counseling, ethical issues, STIs monitoring tools and the STIs reporting system. WHO will conduct on the job training session and follow up activities on the VCTs, inside and around Nyala city. In addition to the capacity building in the area of HIV/AIDS, 3 counselors were sent to El Fasher to attend the basic training on VCT counseling techniques for 21 days. North Darfur Preparations were completed for a training workshop on sexually transmitted infections (STIs) targeting 30 medical doctors schedule during the next weeks West Darfur The STIs training course in West Darfur with support from WHO will commence in El Geneina from 25 October targeting 20 medical doctors as participants. The same course will also be conducted in Zalingei on 27 October for 20 medical assistants. South Kordofan State WHO donated essential medical drugs and supplies for 10 health facilities. The supplies will cover 20 000 population for 3 months. East Sudan WHO/ SMOH with partners will conduct measles vaccination campaign from 9 to 14 October in East Sudan targeting 702867 children from 9 months to 59 months. During the 6 days campaign, 1 416 teams will be deployed in different areas in East Sudan. Between 2 and 8 October, WHO team leader and NMO jointly with SMoH visited 2 primary health care (PHC) units and 1 dispensary (Fato heath unit, Amarah heath Unit and Lafa dispensary) in Rural Kassala locality. The aim of the visit was to supervise health activities in rural areas and identify the gaps. The team was also to provide technical support to heath staff on ground. The joint team also visited Lafa dispensary in Alfa area, the entry point between Eritrea and Sudan border, to monitor the surveillance system for travelers between Sudan and Eritrea. In Sudan border point, screening for communicable diseases and vaccination facilities are not available. WHO in collaboration with SMoH will develop plan for strengthening the integrated diseases surveillance system at the entry point. Strategic Objective: Contribute to reduction in maternal and child morbidity focusing on safe motherhood and child survival interventions Secondary Health Care In North Darfur, a supervisory monitoring visit was conducted in Mallet Rural Hospital. Assessment of the rural hospital includes: o Almost all of the beds were empty during the time of visit. o Shortage in drugs, staff and even equipment. o The hospital continues to provide free services to. In North Darfur, WHO supported Mallet and El Fasher maternity hospitals with assorted essential drugs and consumable materials to support hospitals in their efforts to continue provision of free services to. During the reporting week, WHO supported Kutum rural hospital in North Darfur with examination gloves, safety boxes and job aid posters to strengthen self precautions and infection prevention in the hospital. In South Darfur, several meetings were conducted to strengthen health information system, monitoring and supervision, and on the job training sessions in hospitals. In South Darfur, a two-day training workshop on hospital statistics (data recording, analysis and reporting) was completed during the reporting week. Twenty five participants from the rural and state hospitals participated in the workshop. The trainee recommended supervisory visits and refresher training sessions to strengthen to HIS at the secondary care level. In West Darfur, monitoring and coordination activities are ongoing in state hospitals while in El Geneina teaching hospital there is a need to look into the problem of irregular electrical supply at the outpatient department. In West Darfur, issues on the Central Ambulance System and means of facilitation of referral to Garsilla hospital were discussed. 3

Summary of outputs from supported hospitals: Week Outpatient Inpatient Total No. of Operations Deaths Male Gender Female North Darfur 403 668 78 144 13 17 3 5 453 618 South Darfur 693 767 113 131 19 41 3 3 651 809 West Darfur 414 368 122 115 6 12 4 3 381 401 Between 18 and 24 September, the total number of women who underwent caesarean section (C/S) operation reached 23 with 6 cases from North Darfur, 14 cases from South Darfur and 3 cases from West Darfur. Strategic Objective: Strengthen local capacity to predict, prepare for, respond to, mitigate and manage health risks that include communicable diseases and seasonal emergencies Reporting timeliness and completeness Between 25 September and 1 October, 90% of the sentinel sites completed EWARS reports in Greater Darfur. A total of 72 991 consultations were attended during the week from the 2 834 965 population under surveillance. Diseases of public health importance Acute respiratory infections (ARI), bloody diarrhoea (BD), clinical malaria (MAL), remained the leading causes of morbidity. From 25 September to 1 October, 27 cases of acute jaundice syndrome (AJS) were reported (6 cases from South Darfur, 16 cases from West Darfur, and 5 cases from North Darfur. During the week, 5 deaths were notified through the EWARS system from West Darfur. From these cases, 3 deaths were related to malnutrition (SMN) and 2 deaths due to other causes. Incidence rate (IR) per 10000 population of ARI, loody Diarrhoea & Malaria reported in Greater Darfur in week 36 to week 39, 2010. State Disease IR W 36 IR W 37 IR W 38 South Darfur ARI 0 16.7 19.8 16.7 BD 0 4.4 4.2 3 MAL 0 11.5 13.4 9.3 West Darfur ARI 23.2 31.5 38.9 34 IR W 39 BD 6.2 7.7 8.8 7.5 MAL 15.5 16.6 22.4 19 North Darfur ARI 0 22.2 36.8 31.9 BD 0 3 3.5 3.2 MAL 0 5.4 8.7 9.1 Outbreak preparedness and response Disease morbidity in East Sudan Please refer to table 2 below comparing incidence rate/1000 population in the 3 eastern states. 4

Comparison of incidence rate (IR) per 1000 population of common diseases reported in East Sudan Week 36 to 39, 2010. State Red Sea Gedaref Kassala Disease IR W IR W IR W IR W 34 35 36 37 MAL 1.2 1.1 1.2 1.1 PT 0.011 0.009 0.005 0.1 TF 0.026 0.03 0.01 0.03 DYS 0.4 0.2 0.2 0.17 BILH 0.021 0.03 0.03 0.004 MAL 1.05 1.08 1.43 1.01 PT 0.001 0.002 0.01 0.01 TF 0.04 0.07 0.08 1.05 Kala 0.03 0.03 0.04 0.05 DYS 0.18 0.17 0.25 0.2 VH 0.003 0.001 0.01 0.01 MAL 0.13 0.18 0.2 0.08 PT 0.00 0.00 0.00 0.00 VH 0.00 0.00 0.00 0.00 DYS 0.018 0.027 0.02 0.02 Between 25 September and 1 October, 5 deaths were reported from Gedaref State, one death due to severe malaria and 4 deaths due to Kala-azar. Other activities : A team of FMoH is currently in Jonglei state of south Sudan to respond to the ongoing outbreak of Leishmaniasis. The outbreak that started late last year subsided in the mid-2010, but is currently reporting many more cases. A total of more than 6 000 cases and 300 deaths have been reported since the outbreak started. WHO-Juba, with GOSS and other health partners is engaged in responding to the outbreak. The FMOH teams of doctors, assistants, laboratory technicians, etc are equipped with essential drug supplies and diagnostic reagents. FMoH Epidemiology Department has planned a workshop on 13-14 October 2010 in Khartoum to evaluate response to the outbreak of gastroenteritis earlier this year. In South Darfur, WHO supported SMOH epidemiology department in covering communication costs for 20 reporting units over the last three months to help maintain the EWARS coverage in the state. In North Darfur, WHO supported SMoH in the one day refresher training workshop on AWD case detection and outbreak investigation targeting 20 medical assistants from Mallet locality. On job the training on surveillance, case definition and management was conducted targeting 2 medical doctors and 5 medical assistants working in Mallet rural hospital and Alabasi IDP camp, in order to strengthen the surveillance system. Environmental health activities Water quality South Darfur Between 2 and 8 October, water quality monitoring was conducted in Nyala and Kass, in Nyala and a total of 3 692 samples from different water sources were collected. From the total samples collected, 76% were within the required level, 18% of the samples showed free residual chlorine (FRC) below the range (0.1mg/l) while 6% of the samples were nil of chlorine. In Kass, out of 78 samples taken from donkey carts, 61 samples were found within the normal range of FRC. Additionally, 55 samples from storage containers at household level showed normal FRC level. The reports showed improvement in water safety at household due to the house to house campaigns and hygiene promotion messages were distributed while the disinfection of some wells was also conducted. 5

North Darfur Water quality monitoring is on-going in Nyala, Kass and IDP camps around Nyala. Water quality improved despite the interruptions in activities during Eid holidays. So far, 4 375 samples were analyzed from different sources (HH, donkey carts and tankers). Out of the samples, 7% were found out to be without residual chlorine. The Nyala North sector has reached 92% coverage with chlorination. Water quality activities were conducted last week in IDP camps and El Fasher town. In Zamzam camp, 28 samples were tested for free residual chlorine (FRC) while in El Fasher town, 121 samples were tested from open dug wells. Sixty percent of the samples tested in El Fasher town were within WHO standard for safe drinking water. WHO supported SMoH in its routine water quality control activities (source monitoring/sanitary survey, treatment processes optimization, distribution and storage) within 3 IDP camps around Elfasher Kutum, Mallet and Malha localities. Blue Nile State In the Blue Nile State, Ed Damazine locality started distribution of chlorine to households and jointly with house to house hygiene promotion campaign. In addition, the Sudan Red Crescent Society (SRCS) started distribution of soaps to households while WES has repaired and installed two hand pumps in Aroma sector and Hai Sikka Hadid. East Sudan In Kassala State, 32 937 600 meters cubic of water were chlorinated out of the urban net works. Moreover, 403 water sources (private wells, dug wells, etc) out of the 491 (82.1%) were covered by chlorination activities. During the week, 55 samples were collected randomly and checked for FRC - 53 samples shown results between 0.2 0.5 ppm. The remaining showed no FRC. In Gedaref State, 45 samples were collected for bacteriological tests, using Rapid test (H 2 S), 18 samples showed contamination with total coli form while 27 showed no contamination. Furthermore, 247 samples were collected randomly for FRC. From those tested, 221 samples showed residual chlorine b etween 0.2 to 0.5 ppm while the remaining samples showed no residual chlorine. In the Red Sea State, routine in door larviciding activities stopped last week due to the lack of workers. Meanwhile, ULV spraying as knock-down activity started in Port Sudan targeting house flies. Vector control A 3-day training course on community based waste management was conducted in Kutum, North Darfur was attended by 45 persons. An action plan was developed for solid waste management. In addition, WHO supported local communities and the Kutum environmental health office with waste management tool and personal protective tools. For more information please visit WHO Website www.emro.who.int/sudan For further information please contact: Mrs. Christina Banluta Communications and Advocacy Officer, WHO Sudan banlutac@sud.emro.who.int Dr. Iman Shankiti EHA Coordinator, WHO Sudan shankitii@sud.emro.who.int 6