WHO strengthens South Sudan’s disease detection and response

When a country has an outbreak of an infectious disease such as measles or cholera, a good system that can detect it early is essential to help prevent further spread, and save lives and resources.

Training health workers in disease detection

WHO is working with the Ministry of Health and partners to develop local skills and knowledge, including training more than 1300 health workers in such areas as disease detection, outbreak investigation and response.

"South Sudan is a challenging work environment because of insecurity and a limited ability to access some of the country’s most vulnerable people," said Dr Abdulmumini Usman, WHO Representative to South Sudan. "WHO is doing everything it can to detect and respond to multiple disease outbreaks and to ensure that the Ministry of Health and partners have the skills and knowledge to do their part as best they can with the limited resources available."

In South Sudan, infectious diseases pose a major public health challenge and cause significant levels of illness, disability and death for a country also caught in conflict. The country’s weak public health systems aggravate the situation to effectively respond to largely preventable disease outbreaks. Frequent disease outbreaks are driven by multiple factors, including conflict leading to displacement of people and overcrowding and poor environmental conditions.

WHO estimates that 12.3 million people in South Sudan are at risk due to disease outbreaks. In 2015 and 2016, WHO helped to identify, investigate and respond to 49 disease outbreaks, including outbreaks of cholera, measles, viral haemorrhagic fever, malaria and hepatitis E virus from multiple locations.

With nearly 3 million cases reported since 2015, malaria is one of the biggest causes of illness and death in South Sudan. Cholera is also a major public health concern with more than 4 500 cases reported since 2015. Measles and kala azar are also major concerns.

Getting a handle on disease outbreaks

Since 2006, WHO has been working in South Sudan to help set up an Integrated Disease Surveillance and Response (IDSR) system, thanks to funding from the United States Agency for International Development (USAID).

In 2013, WHO helped introduced the Early Warning Alert & Response System (EWARS) to complement and enhance the IDSR in South Sudan’s conflict-affected states.

Detecting diseases early helps WHO, the South Sudan Ministry of Health and Health Cluster partners to respond more effectively. For example, early detection of nearly 3 000 cholera cases reported so far this year has helped WHO and partners to target where to vaccinate as part of the response. WHO and partners have delivered over 69 000 oral cholera vaccinations as part of the response.

To build the capacity for disease surveillance and response in South Sudan, WHO trained over 1 300 healthcare workers on ISDR activities in 2015 and 2016. This includes:

• 231 trained on integrated disease surveillance and response
• 732 trained on reporting, preparedness and case management of infectious diseases
• 253 rapid response teams trained on outbreak investigation and response
• 34 trained on cholera sample collection, processing, packaging, shipment; and cholera rapid diagnostic testing

“We appreciate the commitments of our donors and other partners in this important endeavour,” says WHO’s Dr Usman.

Seeing results despite major operational challenges

WHO helped to strengthen the abilities of the national public health laboratory to confirm cholera, measles, meningitis, and bacterial pathogens like salmonella and shigella that can cause serious gastroenteritis.

WHO reports seeing improved reporting performance and data quality at county and facility levels. For example, completeness of IDSR reporting increased from 42% in 2014 to 50% in 2016. Timeliness increased from 27% in 2014 to 51% in 2016.

With improved case management capacities, WHO reports that the case fatality rate for cholera reduced from 2.6% in 2014 to 1.5% in 2016. In Juba, where two-thirds of the cases were reported in 2016, the case fatality rate fell to less than 1%.