STATUS OF ACUTE WATERY DIARRHEA IN SUDAN

UNCLAS SECTION 01 OF 02 KHARTOUM 001828

SIPDIS

AIDAC
SIPDIS

STATE FOR AF/SPG, PRM, AND ALSO PASS USAID/W
USAID FOR DCHA SUDAN TEAM, AFR/SP
NAIROBI FOR USAID/DCHA/OFDA, USAID/REDSO, AND FAS
GENEVA FOR NKYLOH
NAIROBI FOR SFO
NSC FOR JBRAUSE, NSC/AFRICA FOR TSHORTLEY
USUN FOR TMALY
BRUSSELS FOR PLERNER

E.O. 12958: N/A
TAGS: EAID PREF PGOV PHUM SOCI SU
SUBJECT: STATUS OF ACUTE WATERY DIARRHEA IN SUDAN

KHARTOUM 00001828 001.2 OF 002


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Summary
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1. According to the Department of Epidemiology in the Sudanese
government's Federal Ministry of Health (MOH),the first case of
acute watery diarrhea (AWD) was identified in the Southern Sudan
earlier this year, and AWD has now spread to several northern
states. There is danger of AWD spreading to other states and
internally displaced persons (IDP) camps. The MOH is implementing
control measures which seem to reduce the attack rate, but the case
fatality rate (CFR) still remains high. The U.N. World Health
Organization (WHO),the U.N. Children's Fund (UNICEF),the MOH, and
the National Water Corporation have submitted a proposal to donors
for an emergency response to the AWD outbreak in Northern Sudan.
End summary.

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Background
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2. In March 2006, health authorities reported an outbreak of AWD in
Yei, Southern Sudan. The disease soon spread to Juba and other
towns in Southern Sudan. Though the outbreak was controlled at some
locations, the disease continues to spread to other states. In
April 2006, AWD cases were reported in Khartoum, and the disease
spread to other northern states. According to the MOH, between
April 21 and July 3, 2006, 10 of the 15 northern states reported
cases of AWD, with a total of 3,377 cases and 123 deaths. The CFR
was 3.6 percent.


3. According to the MOH, Northern Kordofan reported 852 cases with
a CFR of 3.3 percent, followed by Khartoum with 845 cases and a CFR
of 4.4 percent. The highest CFR of 11.3 percent was reported in
Kassala. Though there is currently a decline in AWD in most states,
WHO still reports a weekly incidence of 200 cases of AWD.

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Risk Assessment
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4. The number of cases of AWD reported from the northern states may
not yield an accurate representation of the spread of the disease.
The actual number of cases in Sudan may be much higher due to
under-reporting. During the rainy season, environmental concerns
deteriorate, and the incidence of AWD might increase in some states.
The control measures taken by health authorities have resulted in
the maintenance of a low attack rate of 0.01 percent, but the CFR
remains high and ranges from 2 to 11 percent, indicating that early
detection and case management has not been attained. The MOH
reports that if the attack rate increases to 0.2 percent, it is
estimated that approximately 29,873 cases could be expected in the
following weeks. If the CFR increases to 1 percent, 140,000 cases
may be reported.


5. The possibility of the disease spreading due to poor
environmental conditions and the quality of drinking water exists.
In many areas, people obtain water from shallow wells or "haffirs,"
which are water catchments where rain water is kept during the rainy
season. In many communities living along the river banks, water is
collected directly from the river. The potential of the disease
spreading to IDP camps, where more than two million IDPs live in
Khartoum alone, is a concern.

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MOH Response to Outbreak
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6. The MOH's response to the AWD outbreak focuses upon improving
the surveillance system, raising awareness among the population
about AWD, taking measures to reduce the risk of getting the
disease, improving case management, improving the environmental
conditions, and ensuring availability of safe water for drinking.
The long distances patients must travel before arriving at treatment
centers, the bad roads, and poor case management capacity at
treatment centers accounts for the high CFR.

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Proposal to Respond to AWD
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7. WHO, UNICEF, the MOH, and the National Water Corporation have

KHARTOUM 00001828 002.2 OF 002


submitted a proposal to donors for an emergency response to the AWD
outbreak in Northern Sudan. The main components of the emergency
response are coordination, surveillance, case management
strengthening environmental control measures, social mobilization,
and health education campaigns. The duration of the emergency
response proposal is seven months and is divided into two phases.
The first phase will cover the first three months, and the second
phase will cover the remaining four months.


8. Implementation of the project will be conducted with the MOH,
with technical support from WHO and UNICEF. WHO will focus on
technical guidance for surveillance and case management. UNICEF
will be responsible for the environmental control and social
mobilization. Other partners, including some international
non-governmental organizations (INGOs),will be involved in some of
the control activities. The total budget required is USD 5,622,723.
The MOH will contribute USD 1,017,540, the Common Humanitarian Fund
contributed USD 1,000,000 and the Government of Norway contributed
USD 120,000.

STEINFELD