Highlights
More flood damage in Darfur Although the impact of the floods is significant due to the heavy rains during the past two weeks, no outbreak has been reported so far. The drinking water distribution system was damaged, affecting El Fasher Town and Abu Shoak IDP camp, in North Darfur. An estimated 800 houses and 500 latrines were destroyed in Abu Shoak and Al Salam IDP camps, and 800 households were damaged in El Fasher Town. An additional 200 shelters and approximately 900 latrines collapsed in Ardamata IDP camp in West Darfur. See sections on flood response in North Darfur and West Darfur. See photos of floods in North Darfur www.emro.who.int/sudan.
The 6th round of polio National Immunization Days (NIDs) started on August 20. In the SLA-controlled areas in North Darfur, the campaign was initiated earlier and was finalized this week.
The mass measles vaccination campaign in South Darfur started on August 14 and will continue until August 28.
Mortality and morbidity profile: Acute Respiratory Infections, Clinically Diagnosed Malaria and Bloody Diarrhoea remain leading causes of morbidity. The majority of categorized deaths was caused by Malaria.
WHO tasks and programmes
Improved access to hospital care and referral systems
North Darfur
Support to hospitals
WHO supports the Maternity Hospital in cleaning up the mud damage caused by the floods.
Results of an evaluation mission coordinated by the National Public Health Laboratory (NPHL) to the El Fasher Teaching Hospital laboratory confirm that biological tests for the cholera vibrio and Shigella bacteria can be carried out according to international standards.
A Cholera treatment centre has been identified and arranged in El Fasher Teaching Hospital.
South Darfur
Support to hospitals
Nyala Teaching Hospital is currently in the preparing for the installation of the X-ray machine.
WHO is designing an IDP cost tracking system for Nyala Teaching Hospital.
An assessment coordinated by the NPHL concludes that the reconstruction of the Nyala Teaching Hospital laboratory was performed satisfactorily.
A refresher training for laboratory technicians in Nyala is organized for next week.
Action points
WHO is looking into the sustained supply for reagents in the Nyala laboratory.
WHO is following up on the shipment of drugs to Elddain Hospital.
Communicable disease control and surveillance & outbreak response
North Darfur
Bloody Diarrhoea
Thanks to the constant efforts in improving the sanitary conditions and the rapid response to the floods, the weekly attack rate of Bloody Diarrhoea slightly decreased from 10.7/10,000 last week to 9.7/10,000 this week.
Cholera Preparedness
In response to the flood situation, emergency training was conducted by WHO, the Federal Ministry of Health (FMoH) and the State Ministry of Health (SMoH). 28 medical doctors and 27 medical assistants from health facilities in the IDP camps and El Fasher Town received further instructions on case definition, surveillance system and early management of Acute Watery Diarrhoea and other flood-related diseases.
Sixteen sentinel sites were selected for special surveillance during the post-flood period. Data are collected and analyzed on a daily basis in order to intervene as early as possible in case of an Acute Watery Diarrhoea outbreak.
Malaria
The weekly attack rate of clinically diagnosed Malaria has increased from 1.56/1,000 last week to 1.94/1,000 this week. Four deaths due to malaria were reported from Abu Shouk IDP camp (2) and from Kubum and Saraf Omra localities.
Action points
As part of the Cholera preparedness plan, WHO is looking into the positioning of transport means for biological samples from all locations in North Darfur to the El Fasher laboratory.
West Darfur
Bloody Diarrhoea
The weekly attack rate decreased further from 15.9/10,000 last week to 15/10,000 this week (in comparison: the weekly attack rate for week 31 was 20.2/10,000).
Malaria
The weekly attack rate for Malaria increased from 2.38/1,000 last week to 2.93/1,000 this week. Six deaths were reported from Kerindenk, El Ryad, Garsilla, Um Tagouk and Masteri IDP camps.
Measles
Three new cases of Measles were reported this week from Abu Zer, Abu Seroj and Um dukhn IDP camps, all in the under-5 years of age group.
Meningitis
One new case of suspected Meningitis was reported this week from Abu Seroj IDP camp.
Action points
WHO is following up on the Meningitis sample sent to the NPHL to ensure rapid feedback.
Case investigation is ongoing into the Measles cases in Abu Seroj IDP camp.
South Darfur
Acute jaundice syndrome
South Darfur continues to report the highest percentage of Acute jaundice syndrome cases in the whole of Darfur. This week 58% (247 out of 427cases) of the caseload was reported from South Darfur, compared to 61% (287 out of 464 cases) of last week.
Bloody Diarrhoea
The weekly attack rate decreased further from 18.5/10,000 to 16.7/10,000 (compared to 19.4/10,000 in week 31. Kalma IDP camp reported 29% of the total number of cases for the entire State.
Cholera preparedness
As part of the Cholera preparedness plan, WHO and FMoH conducted a training seminar on case management for acute diarrhoeal diseases.
WHO carried out a mission to Kass to ensure appropriate implementation of the Cholera preparedness plan.
Malaria
The weekly attack rate of clinically diagnosed Malaria decreased from 4.96/1,000 last week to 4.74 cases per 1,000 this week. However, the weekly attack rate for South Darfur remains the highest among all three States in Greater Darfur in South Darfur as 61% of all cases of Malaria in Greater Darfur were reported from South Darfur.
Action points
An investigating mission into the Acute Jaundice Syndrome cases by the WHO Collaborating Centre NAMRU3 in Cairo, Egypt, is planned for September.
WHO is supporting all health organizations with Cary Blair medium for collection of stool samples, currently available at the WHO office in Nyala.
Improved access to primary health care and environmental health
North Darfur
Access to Primary Health Care
The assessment of medical doctors working in health facilities for the conflict-affected population who were previously trained in Integrated Management of Child Illness (IMCI) continues: this week six health facilities were visited and results were highly satisfactory.
A one day training was conducted on the National Guidelines on HIV/AIDS Post Exposure Prophylaxis (PEP) for Survivors of Sexual Assaults for medical students of El Fasher University by SMoH with the support from UNFPA and WHO.
A reproductive health evaluation was conducted in Mhalit by SMoH, UNFPA and WHO.
Action points
WHO is supporting the elaboration of the final version of the Sudan National AIDS Program (SNAP) Guidelines on HIV/AIDS PEP for Survivors of Sexual Assaults.
WHO is following up on the results of the reproductive health evaluation mission to Mhalit.
Flood response
The chlorination of pit wells in El Fasher Town to ensure safe drinking water for the population after the damage of the drinking water system due to the floods is ongoing. WHO is supporting the Sudanese Red Crescent (SRC) with chlorine powder, plastic boots and gloves and financial support to the volunteers carrying out the work.
The damage of the drinking water distribution system in El Fasher Town has affected Abu Shoak IDP camp, as all three pipelines connecting the camp's drinking water network to El Fasher Town were damaged by the floods. Five mobile water tankers were mobilized to supply the camp with safe drinking water. WHO is providing 75 drums of water in a daily basis to assist health facilities affected by the destruction of the city water pipe.
250 community health workers conducted a door-to-door sensitization campaign for five days in El Fasher Town, reaching 25,000 persons with messages on individual hygiene, chlorination of water and the importance of draining stagnant water: the preferred breeding places of Malaria mosquitoes.
Action points
Because of the high risk of water contamination in Abu Shoak and Al Salam IDP camps after the floods, WHO set up a drinking water quality unit for constant monitoring and chlorination.
WHO are working on a distribution program to supply health organisations working in Abu Shoak and Al Salam IDP camps with chlorination materials to ensure continuous chlorination.
WHO and SMoH are preparing for an intensive sanitation program in El Fasher Town simultaneously with a sanitation campaign in the IDP camps focusing on Malaria control.
WHO is advocating for rapid reparation of the collapsed latrines and chlorination of all hand pumps in close collaboration with health partners working in the flood-affected IDP camps.
West Darfur
Access to Primary Health Care
21 medical assistant working in IDP camps in West Darfur were trained on IMCI modified case management. The instructors were SMoH medical doctors skilled in IMCI.
WHO assisted Training of medical assistant and nutritional assistant on management of severe malnutrition in collaboration with UNCEF and SMOH on 8-13 August 2005 WHO provide technical support (annexed some pictures taken during the training).
An assessment of the health facilities in Al Ryad IDP camp (5 km. from El Geneina Town) was conducted concluding a good coverage of primary health care for the entire population of a total of 22,000 IDPs, refugees as well as host community. Several gaps were identified, such as the absence of water sources inside two of the health units; the unavailability of some of the essential drugs; and a weak presence of reproductive health services.
Action points
WHO is looking into strengthening reproductive health presence in Al Ryad IDP camp.
Flood response
- Drinking water quality
Heavy rains resulted in severe damage of sanitation facilities at several IDP camps. The most affected camp is Ardamata IDP camp (approximately 35,000 inhabitants) where more than 200 shelters and 900 latrines collapsed. A plan for resettling the IDPs to a higher level within the camp has been elaborated in collaboration with the State Ministry of Housing.
Analysis of water samples collected from households, tankers and hand pumps indicated that 71.4% of water samples were contaminated with bacteria (E. coli) and were not chlorinated, while 28.5% showed no contamination (hand pumps). Water samples collected from households and line taps were found to be contaminated and had no chlorine. To avoid any outbreak of diseases, the NGOs present in the camp will intensify water chlorination activities. WHO and partners are providing the necessary reagents and chlorine for water tests and chlorination.
WHO and SMoH mobilized a microbiological testing kit to Ardamata camp for continuous monitoring of the drinking water quality.
Because of the contamination of drinking water at household level WHO is planning hygiene promotion activities in the camp with respect to water handling at the household level.
- Vector control
Vector control activities in the flood-affected Ardamata IDP camp will be focusing specifically on the control of malaria vectors. The control of adult mosquitoes is achieved through space spraying using motorized sprayer pumps and ultra low volume machine (known as ULV machine). Larval control on the other hand is accomplished by spreading used engine oil on mosquito breeding places. The space spraying, indoor fumigation and larviciding activities are ongoing and will be followed by Indoor Residual Spraying (IRS).
WHO and SMoH carried out training of almost 40 sprayers in Ardamata IDP camp and provided the equipment (motorized sprayer pumps, hand sprayer pumps) and insecticide (Ancothrin1 and Deltamethrin 2.5% WP [Ancothrin is the trade name of permethrin 2.5% EC.]
A proper monitoring tool of ongoing vector control activities in the camp was put in place.
Action points
WHO and SMoH are planning to carry out IRS activities in Ardamata IDP camp.
South Darfur
Access to Primary Health Care
A PHC and IMCI assessment was conducted at health facilities in Bilail IDP camp by SMoH and WHO. Gaps were identified in the provision of reproductive health services because of absence of delivery beds and examination couches and unhygienic use of instruments. Recommendations were also made to improve the sanitation situation at the health facilities.
Action points
WHO and the NGO Human Appeal International handed over fifty wheel chairs to disabled patients in Nyala Town.
WHO is following up on the recommendations made at Bilail IDP camp to improve the quality of PHC services and reproductive health, together with the UNFPA.
Environmental health
WHO and SMOH continued coordination to launch the cleaning up campaign in the Nyala Teaching Hospital to minimize accumulation of solid waste
The third round of the vector control campaign started in Kalma IDP camp and will last for two weeks. The campaign is organized by WHO and UNICEF, the NGOs OXFAM, CARE, and the Sudanese Red Crescent (SRC) and will covers Kalma and Bilal IDP camps.
Overall Malaria control activities for South Darfur are divided into two phases. Phase I covers Kalma, Belail & Dareej and Phase II covers the rest of the State. WHO is developing a proposal for Phase II in collaboration with the PHC and the Malaria departments of SMoH and UNICEF.
Action points
WHO is following up on the shipment of insecticides to Kass and Zalingei.
Further information: Sacha Bootsma, Communication Officer bootsmas@sud.emro.who.int
WHO Country Office in Sudan - Othman
Digna Street, Nile Avenue side - P.O. Box 2234 - Khartoum, Sudan
Tel. + (249) 183 - 776 471; 780 190; 760 406 Fax: + (249) 183 - 776 282
http://www.emro.who.int/sudan