Sudan Weekly Highlights Week 36 (4 10 September 2010)

Emergency Preparedness and Humanitarian Action (EHA) Sudan Weekly Highlights Week 36 (4 10 September 2010) Essential and life saving drugs are regularly replenished in Kutum hospital. Regular provision of drugs and supplies including surgical supplies in far flung health facilities in Darfur is one of WHO Sudan s priority activities. Highlights The security situation in all Darfur states, the Eastern region, Kassala, Gedaref and Red Sea, South Kordofan, and Abyei has remained calm. The situation in some areas of Darfur has been unpredictable with reports of banditry and armed robbery incidents. In North Darfur, Jebel Eisa has been opened to humanitarian activities. A mission is planned for East Jebel Mara lead by WHO along with UNICEF and SMOH. The purpose of this mission is to jointly assess the area, urgently identify health needs and supply essential life saving medicines, vaccines and nutrition related supplies. In West Darfur, WHO and SMoH conducted a training course on case management of AWD for 30 medical assistants, nurses and health worker in El Geneina. In addition, 20 medical assistants, nurses, and health workers were trained on EWARS case definitions and case management. The training session was conducted by WHO and SMoH in Nertiti. In Kassala State, one AFP case have been reported case from rural Kassala locality. The case was investigated and samples were taken and sent to Khartoum laboratory for investigation. In Gedaref state, two deaths due to Kalazar were reported. SMoH in South Kordofan reported conjunctivitis epidemic in the western area of the State. A total of more than 45 cases were reported from Miram and Muglad area with no fatality reported. 1

Public health concerns In Darfur, Blue Nile, South Kordofan and Eastern states, the health situation was stable. Morbidities reported during the week were within the normal limits if compared the same period last year. The regular Health Coordination Meeting was not conducted in some of the states due to Eid Holidays. However the weekly mortality and morbidity bulletin for the week 35 was prepared and shared with partners electronically. In South Darfur, the health situation was stable, however the malaria cases which showed increase in trend. In West Darfur, rumor of acute watery diarrhoea (AWD) cases from Masteri area was investigated. Results showed that there was no death due to the diarrheal disease though there were reports of other diarrhoea which was seen and treated in the health facility. In West Darfur, WHO and SMoH conducted a training course on case management of AWD for 30 medical assistants, nurses and health worker in El Geneina. In addition, 20 medical assistants, nurses, and health workers were trained on EWARS case definitions and case management. The training session was conducted by WHO and SMoH in Nertiti. In Kassala State, one AFP case have been reported case from rural Kassala locality. The case was investigated and samples were taken and sent to Khartoum laboratory for investigation. Between 4 and 10 September, no new case of heat stroke was reported from the Red Sea State. Areas of concern There are 30 areas still considered as no go areas in East Sudan. This is based on a UN Mine Action report which highlighted that security and mine problems in Hamkorab and Talkuk localities. Due to security reasons, no humanitarian access has been allowed to Jebel Marra and Jebel Moon areas in West Darfur. The security situation in Kalma camp was calm during the week. government organizations started working in the camp. Reports were received from Merlin, American Refugee Committee International (ARC), and Sudanese Red Crescent Society (SRCS). In addition, the International Medical Corps (IMC) started a mobile clinic in the camp. WHO is supporting the health clinic with medical drugs and supplies. Coordination WHO collaborative programs in Kassala State were presented during an orientation for the newly installed Director General for Health in the state. Issues presented and discusses were WHO s support for primary health care, secondary health care and the expansion of surveillance in the next 3 months and the implementation of HeRAMS. WHO and the Ministry of Health in South Kordofan conducted a meeting with health partners regarding the reported conjunctivitis cases. Action points were identified and shared with partners. The increasing trend of bloody and other diarrhoea cases in North Darfur was discussed with partners. Strategic Objective: Contribute to reduction in maternal and child morbidity focusing on safe motherhood and child survival interventions Secondary Health Care North Darfur As a result of the conflict between militias and in Tabarat area, around 31 kilometers west southwest of Tawilla, El Fasher teaching hospital received around 18 gunshot wound cases. Two of the injured had to undergo exploratory laparotomy. WHO has been supporting the El Fasher teaching hospital with essential life saving drugs and consumable items. WHO has extended its commitment to support Kabkabyia rural hospital and address the identified gaps and constraints in service delivery. Initial support includes assorted essential medicines and consumables estimated to cover around 500. South Darfur WHO in collaboration with SMoH and Nyala Teaching Hospital Directorate conducted an assessment of the paediatric care in the hospital. A report which described limitations and recommendations was already submitted to SMoH and WHO for appropriate action. Essential and life saving drugs were provided by WHO to Tulus hospital. West Darfur The Medical Director of Zalengei hospital initiated discussion with WHO and health partners on preparations with regards to receiving casualties in the on-going Darfur conflict. 2

Summary of outputs from supported hospitals: Week Outpatient Inpatient Total no. of Operations Deaths Gender Male Female North Darfur 495 624 84 115 16 22 3 4 420 699 South Darfur 644 759 75 142 55 12 1 2 617 786 West Darfur 337 250 109 157 8 23 7 5 276 311 Total 1476 1633 268 414 79 57 11 11 1313 1796 Between 4 and 10 September, the total number of women who underwent caesarean section (C/S) operation reached 24 with 8 cases from North Darfur, 13 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 28 August and 3 August, 84% of the total number of sentinel sites submitted EWARS reports in Greater Darfur. There were 54 588 visits in health facilities. The total population under surveillance was 2 514 418. Diseases of public health importance Acute respiratory infections (ARI), bloody diarrhoea (BD), clinical malaria (MAL), remained the leading causes of morbidity. From 28 August to 3 September, 17 cases of Acute Jaundice Syndrome (AJS) were reported (13cases from South Darfur, 4 cases from West Darfur). Incidence rate () per 10000 population of ARI, bloody diarrhoea & malaria reported in Greater Darfur in week 32 to week 35, 2010. State Disease W 32 W 33 W 34 W 35 South Darfur ARI 16.1 16.1 20.4 20.4 BD 4.6 5.2 5.9 4.1 MAL 8.4 8.4 11.3 11.3 West Darfur ARI 28.8 28 27.4 35.3 BD 8.1 9.9 6.9 17.6 MAL 13.9 15.3 14.7 9.1 North Darfur ARI 25.5 29 32.1 26.6 BD 3 3.9 3.7 3.2 MAL 4.8 6.4 5.1 6.4 3

Outbreak preparedness and response Flood and rain fall in 2010 It is noted that the rainfall this year is generally less than that reported in 2007 and less than the long term mean. Rains and floods have affected major parts of Sudan putting states situated along the River Nile and its tributaries at an increased risk. As of September 2010, information released by Government (HAC) indicates that recent rains and floods have affected a total of 13 states in North Sudan. At least 11226 houses have been totally destroyed while 4715 have been partially destroyed. Among this, six states are the worst affected (Khartoum, Gezira, Sennar, Red Sea, White Nile (Jebalain and Salam localities) and River Nile (Atbara and Shendi localities) {Source: Health Cluster Office-WHO Khartoum}. Conjunctivitis epidemic in South Kordofan SMoH in South Kordofan reported conjunctivitis epidemic in the western area of the State. A total of more than 45 cases were reported from Miram and Muglad area with no fatality reported. The SMoH team, who investigated this matter, suggested a relationship of this outbreak with the one reported earlier from Aweil in south Sudan (about 40 Km from Miram). Epidemiology department, SMOH received information about spreading of the epidemic to other localities in the state. The investigating team recommended training of health cadres, intensify health education activities, organizing mobile team for active surveillance/field diagnosis and treatment of cases and availing of drugs. Environmental health activities Water quality In South Darfur, water quality monitoring was conducted in Nyala North sector. During the monitoring activity, 1 315 samples were analyzed from different sources (households, donkey carts and tankers) showed that free residual chlorine are ranging between 83% and 100% while only 8% of the samples showed zero reading. In North Darfur, water quality monitoring activities were simultaneously conducted in camps. In Kassab camp, 20 samples were tested for bacteriological analysis where 50% showed contamination. Moreover, 1 of the 4 samples tested from hand pumps was contaminated. Chlorination and disinfection activities were conducted in the camp. In Kabkabiya camp, KSCS/Oxfam America tested 10 water samples for bacteriological analysis (3 contaminated) and cleaned and chlorinated 11 open wells. WHO supported the Water Quality Laboratory of Academic College with kits and re-agents for regular testing of Geneina hospital water supply. Samples taken from the inlet and the tower of Geneina hospital were tested for FRC and results showed nil, total coli form was 110 while faecal coli form was 8. In line with this, MoH was requested to nominate a focal point for chlorinating all water sources at theel Geneina hospital. WASH partners started household water treatment in Shangli tobia and Kabakabiya camps where 100 persons were trained as community mobilizers while 29 persons were trained for water quality monitoring. The trained persons are expected to provide technical support to communities in targeted areas. Capacity building In Gereida (South Darfur), a 3-day training session on safe health care waste management in Gereida was conducted targeting 30 medical doctors, medical assistants, laboratory assistants, nurses and midwives from SMoH, MERLIN and ARC. In Zalengei (West Darfur), 30 persons were trained on health care waste management. Participants were from NCA, MoH and the teaching hospital. The training course was supported by WHO. EPRP for rainy season To support the health care waste management in secondary care settings, WHO provided Tulus hospital with 20 waste containers which are properly colour coded to ensure proper disposal of potentially infectious wastes. To improve access to safe drinking water in rural areas in North Darfur, SMOH distributed chlorine and FRC monitoring tools (pool testers). To strengthen this, WHO supported the training of 6 public health officers on acceleration of water and sanitation activities. Coordination In North Darfur, ORS corners in IDP camps and rural areas were reactivated after concerns on the rise of number of cases of water and sanitation related diseases were raised during a Watsan coordination meeting. WHO is coordinating with SMoH and UNAMID to improvement of the general waste management system in Elfasher town. 4

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 5