Southern Sudan Guinea Worm Eradication Program 2009: Countdown to Extinction

2008 Program Review MeetingThe Carter Center, Atlanta, Georgia

October 16th – 17th, 2008

Makoy Samuel YibiDirector, SSGWEP

Ministry of Health – Government of Southern Sudan

PART II: INTERVENTIONS

The SSGWEP TeamDirectorate of Preventive Health, Ministry of Health – Government of Southern Sudan

17,427 Village Volunteers in 15,590 villages under active surveillance in 2008

1420 Area Supervisors

151 County Field Officers

12 National Program Officers

14 Technical Advisors

6 State MOH Field Coordinators

Partnerships between GOSS Ministries, local government, traditional leaders, multi-lateral donors, NGO partners, and Civil Society Groups ( through the SSGWETF)

Status of Interventions 2006-2008

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Overall Case Containment Rate

Overall Reporting Rate

% Evs w ith 100% Monthly Reporting

% EV w / 1+ Trained Village Volunteer

% EV w / access to 1+ Safe Water Sources

% EV w / 100% Monthly Cloth Filter Coverage

% EV w / 100% Pipe Filter Coverage for Eligible Persons

% EV w / 1+ Health Education for the Year

% EV w / Monthly Health Education

% EV w / 100% Monthly Supervisory Visits

% EV w / 1+ Abate Applications This Year

% EV w / GPS Points

Indi

cato

r

% Coverage

2008

2007

2006

Reporting Rates, Endemic Vilages 2004-2008

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

JanuaryFebruary

March

Apri l May

June

July

AugustSep tember

Octobe r

NovemberDecember

Month

% E

Vs re

port

ing EV Reporting Rate 2008

EV Reporting Rate 2007

EV Reporting Rate 2006

EV Reporting Rate 2005

EV Reporting Rate 2004

January Through August2008: 87% Reporting Rate2007: 70% Reporting Rate

Progress Towards Containment Condition Targets, 2008 (n=3102)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Overall Containment Rate

Staying out of the w ater w ith hangingw orm(s)

Detected w ithin 24 hours

Bandaged w ithin 24 hours

Worm(s) are completely removed

Confirmed by a supervisory w ithin 7 days

Con

tain

men

tCon

ditio

ns

% Compliance

% of Cases Satisfying Condition

Interventions: Case Containment

Case containment rate: 49% (1520/3102)

100% (3102/3102) of cases detected had complete patient records.

83% (2596/3102) of cases were detected within 24 hours of worm emergence, an improvement from 76% in 2007.

12% of these cases (376/3102) contaminated the water, a reduction from the 22.6% recorded in 2007 and the 23% recorded in 2006 –addressing this contamination rate is the NUMBER ONE priority for the SSGWEP.

Interventions: Case Containment

Remaining challenges: Late detection, Poor case management

practices due to de-motivated and unskilled volunteers & Area Supervisors, and

Traditional practices for removal of Guinea worms,

Defaulting of care for mobile cases ( cattle camps, Soldiers, traders etc.)

Cases/Contained, Top 10 Endemic Counties, Jan-August, 2008 (93% of all Cases, 2879/3102)

0 100 200 300 400 500 600

Tonj South

Juba

Terekeka

Jur River

Aw erial

Tonj East

Kapoeta North

Kapoeta South

Kapoeta East

Tonj North

Cou

nty

Cases/Contained

Contained

Not Contained48.5% of cases in the top 10 Counties were contained; of those not contained, 23% contaminated the water in 2008 (336/1482)

161148TONJ SOUTH

20107JUBA

3626121TEREKEKA

341144JUR RIVER

512297AWERIAL

2934354TONJ EAST

4545402KAPOETA NORTH

11419416KAPOETA SOUTH

12996490KAPOETA EAST

9392500TONJ NORTH

# Not Detected Within 24 Hours

# who contaminated waterCasesCOUNTY

Ranked Counties and Number of Critical Containment Failures

Interventions: Cloth Filters

464,115 Cloth Filters Distributed in Endemic Villages

68% of EVs had 100% cloth filter coverage in 2008, an increase from the 37.8% of EVs with 100% coverage in 2007.

Failure to meet 100% targets can be attributed to weak replacement by volunteers and

breakdowns in the logistics pipeline, supervisory challenges, and weak reporting/documentation on

interventions.

INTERVENTIONS: Pipe Filters

41% of all EVs had 100% of eligible population (80% of total) covered with pipe filters, an improvement from 38.4% in 2007

Other challenges to Pipe filers includes; Inconsistent use and poor care in

many communities, undermining the effectiveness of the intervention.

Poor attitude towards the filters, A weak nylon string for fastening the

pipe around necks Documentation challenges

Interventions: Health Education

94% of endemic villages received monthly health education activities.

Health Education: Evening Rallies

Health Education Videos produced and shown during evening health education rallies throughout Greater Tonj and Greater Kapoeta

These events also include traditional singing and dancing, skits, slide shows, and games.

Health Education, Radio Programming

Ongoing production of “Let’s Fight Disease” to radio listening groups in all endemic communities in Toposa, Dinka, Bari and Mundari

Radio Listening Groups being trained

Interventions: Chemical Control

1406 stagnant water sources treated in 2008 vs. 806 water sources treated in 2007 and 263 in 2006.

This represent a coverage of 28% of EVs with 1+ abate treatments.

Of these EVs treated, their combined caseload was 48% (1452/3102) vs. 37% (2165/5815) of the 2007 total.

Cases Who Contaminated Water and Abate Coverage, Top 10 Endemic Counties, 2008

0

20

40

60

80

100

120

TONJ SOUTH

JUBA

TEREKEKAJU

R RIVERAWERIAL

TONJ EAST

KAPOETA NORTHKAPOETA SOUTH

KAPOETA EASTTONJ N

ORTH

County

No.

0%

10%

20%

30%

40%

50%

60%

70%

%

Cases who contaminated water% Evs with 1+ Abate Treatments

Abate Application Challenges

Identifying and accessing the infective, measurable water sources

Establishing competent abate teams and resourcing them properly.

Multiple, homestead level of farms within the same village making use of Abate, without clarity as to which water source is actually infected, a tedious effort.

Interventions: Safe Water Provision

Only 15% of EVs have 1+ safe water sources

Significant gains made in Kapoeta North County, where safe water coverage in EVsimproved from 25% to 58% between 2007-2008 105 new boreholes has already been

drillied in GW-endemic villages in Eastern Equatoria with support from UNICEF

16 additional wells drilled in AyodCounty, Jonglei State, including LuacKuoth, the most endemic village in Jonglei State.

PACT and AAR have drilled 20 and 8 wells, respectively, in GW-endemic areas of the three Kapoeta Counties.

Active case searches and verifications of rumors and cross-border notifications

Verification of notifications of cases by EDEP in Pochalla

Follow up training of health workers in Pochallacounty to enhance surveillance

Active case searches for guinea worm disease in Magwi county.

Verification on rumors in Mvolo county (WEQ)

Challenges

Challenges

Poor road infrastructure to endemic areas

INSECURITY

Challenges

Insufficient numbers of supervisory staff ( AS, FOs, TAs) coupled with inconsistent placement of Field officers miles away from areas of high infestation due to poor data from other areas.

High Turn-over of Volunteers and Area Supervisors

Challenges

Absolute illiteracy and customs in most endemic areas, limits overall compliance in filtering drinking water from unsafe water sources especially in KapoetaCounties.

The population dynamics associated with excessive mobility by populations in cattle camps and soldiers

Challenges

Snakes.

THANK YOU!!!