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 -------------- Summary -------------- ¶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. -------------- Background -------------- ¶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. -------------- Risk Assessment -------------- ¶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. -------------- MOH Response to Outbreak -------------- ¶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. -------------- Proposal to Respond to AWD -------------- ¶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