Neglected tropical diseases

South Sudan intensifies measures against visceral leishmaniasis to improve health and social well-being of affected populations

22 November 2018 | Juba −− The Ministry of Health of South Sudan, the World Health Organization (WHO) and partners have concluded a two-day consultative meeting to review the implementation of activities to control visceral leishmaniasis (VL) in South Sudan for the past seven years (2011–2018).

The objective of the meeting was to review the implementation of VL control activities from 2011 to 2018 and discuss the lessons learnt and reporting formats, including monthly reporting on drug consumption at the health facility level, especially on liposomal amphotericin B (AmBisome).

Visceral leishmaniasis, also known as kala-azar, is one of the case-managed neglected tropical diseases (NTDs). It causes immense human suffering and deaths in this subregion, especially in South Sudan, Sudan, Ethiopia and Kenya. As such, kala-azar – like many NTDs – is a serious impediment to poverty reduction and socioeconomic development.

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In South Sudan, kala-azar is endemic in four former states, namely Upper Nile, Jonglei, Unity and Eastern Equatoria, where more than two million people are at risk of contracting the disease.

In September 2009, an outbreak of kala-azar started with increased incidence in Upper Nile and Northern Jonglei. The outbreak continued for five consecutive years, peaking in 2011 and recording more than 11 952 cases; it spread to other areas and affected more people, mainly children aged below 17 years.

Since the beginning of the outbreak in 2009, over 32 000 new cases have been recorded in Upper Nile, Jonglei, Unity and Eastern Equatoria, with an overall case-fatality rate of 4%. The outbreak was considered a humanitarian emergency and, accordingly, a multisectoral intervention including provision of nutritional supplements, food and nonfood items (NFI), and safe water, sanitation and hygiene (WASH) services has been deployed to reduce the burden of the disease.

In addition to the multisectoral approach, timely treatment, accessibility to treatment facilities, a new treatment protocol (reducing the duration of treatment from 30 to 17 days) and an intensive health education campaign have contributed to reducing the number of cases from 5015 cases in 2012 to 3377 cases in 2013.

South Sudan also experienced another outbreak in 2014, following the conflict in December 2013, where over 7892 cases were reported. With the same interventions put in place, the numbers of cases gradually declined from 7892 in 2014, 3251 in 2015, 4601 in 2016, 4069 in 2017 and 1990 in 2018. However, the disease trends are unpredictable.

“Kala-azar and sleeping sickness (human African trypanosomiasis) are among the case-managed NTDs in South Sudan”, said Dr Richard Lino Lako, Director General of Policy, Planning, Research, and Budgeting. “There is a need to integrate management of kala-azar into other disease programmes and the Boma Health Initiative (BHI), a strategy implemented by the Ministry of Health of South Sudan to strengthen community health systems.

Dr Lako emphasized the need for strengthening information systems to document and report on the disease in the online District Health Information System (DHIS2); mobilizing funds to expand coverage; increasing transparency and accountability; and improving access to care through partnerships.

Inaccessibility to health facilities due to insecurity and bad or lack of roads directly affects disease control interventions; as such, treatment centres providing services for patients with the disease have been reduced and the access of populations to diagnosis and treatment has been considerably diminished.

“WHO is providing strong technical and financial support to the Ministry of Health and national visceral leishmaniasis control programmes”, said Dr Moses Mutebi Nganda, who represented Dr Olushayo Olu, WHO Representative for South Sudan. This includes capacity-building through training of health personnel, provision of medical supplies for diagnosis and treatment, and strengthening the surveillance response as well as the investigation and coordination of outbreak responses.

In 2015, South Sudan launched the NTD five-year master plan to combat diseases including kala-azar, sleeping sickness, soil-transmitted helminthiases, dracunculiasis (guinea-worm disease), trachoma, onchocerciasis and lymphatic filariasis. This broad-based strategic plan provides a roadmap for South Sudan to be free of some of these NTDs and their associated morbidity and disabilities by the year 2020 and to recommit the government and partners to working to achieve this goal.

Dr Nganda emphasized WHO’s continued commitment to support the Ministry of Health in South Sudan to intensify measures against NTDs and to plan investments to improve the health and social well-being of affected populations. He also urged all partners to adhere to the WHO online portal from which the country, the region and the global level can rapidly monitor drug consumption levels and needs in order to avoid any stock-outs.

Pita Jane
Telephone: +211 924 726 347

Dr Moses Mutebi Nganda
Telephone: +211955045050

Ms Jemila M. Ebrahim
Communications Officer
Telephone: +211 921 647 859