South Sudan -High priority areas / Hotspots
HIGH RISK POPULATION
- IDPs as well as military or armed groups in various counties
2014: cholera incidence higher among IDPs compared with non-IDPs outside of Juba (Wau Shilluk)
- Displaced and host communities living on islands of the Sudd Swamp during 2016-2017
- Nomadic pastoralist communities especially in cattle camps during 2016-2017
- Goldming site in Budi and Kapoeta states
Risk factors
- Conflict and population displacement
1970s and 1980s: refugee displacement from Uganda and Ethiopia following political turmoil and famine
2005-2013: returnees from Kenyan, DRC and Ugandan refugee camps
Since the onset of the civil war in Dec. 2013:
- massive population movement in and out of crowded IDP and refugee camps (> 2M IDPs);
- Security concerns hindering timely and comprehensive response
- Structural factors
Restricted access to safe drinking water and adequate sanitation facilities
- Straying away from Home
- Damaging of facilities
- Increase cost of fuel
Restricted access to Health services
- Poor road network and insecurity (hard to reach)
- Population displacement in the Sudd
- Cattle camps
Protracted crisis coupled with drought led to food shortages and famine in some areas
- Environmental factors
The Sudd, one of the world’s largest swamps stretch from Bor to Malakal
- Thousands of IDPs settled on floating vegetation islands in overcrowded conditions
- Use the swampy water for drinking, cooking, bathing and defecating
- Low water table prevents from building pit latrines
- High-risk practices
61% of the population practice open defecation and are less likely to wash hand with soap after defecation
Case control studies in Juba 2007-2014: using a water source close to the place of residence, eating outside of the home, and traveling or living in Juba for less than one year
Case investigations in 2006 – 2017: cholera transmission during funeral rituals, around affected households and in a facility that receives cholera cases
Recommendations
- The priority strategic actions should include early detection, community-based surveillance, cross-border activities, and preparedness plans and actions in 17 identified cholera hotspots (Type 1 to 4)
- Mid-term WASH and social mobilization activities (1-3 years) should be implemented in priority counties regularly affected with significant outbreak duration: Type 1 and Type 2
- The priority hotspots (Type 1 and Type 2) comprise 12 counties with both urban and rural features which account for two-thirds of the disease burden. Those cholera foci host approximately 2,280,000 people (18% of the total estimated population)
- An identification of transmission foci at a finer geographical scale (e.g., city section, boma, village) within the priority counties is necessary to better target the at-risk population.