The major disease outbreaks in Sudan for the past decades are grouped into three categories based on type of transmission: water-borne, vector-borne and vaccine-preventable diseases. This is mainly attributed to low access to and coverage of safe drinking water, and sanitation, environmental sanitation and low vaccination coverage; exacerbated by weak health and WASH infrastructures. The country experienced the worst flooding since 2015 creating favourable ground for emergence and aggravation of water-borne and vector-borne diseases such as cholera, dysentery, dengue fever, malaria, etc. The most affected states by the flooding were While Nile, Kassala, Khartoum, Gezira, and North Kordofan.
On 9 September 2019, the Federal Ministry of health (FMoH) announced the outbreak of cholera in Blue Nile State. As of 25 September 2019, seven localities in Blue Nile and Sennar states had reported 187 suspected cholera cases, including eight deaths, according to FMoH and World Health Organization (WHO). In Blue Nile State, the currently affected localities are: El Roseries (87 cases), Damazine (40 cases), Wad Amahi (2 case) and Bau (1 case). In Sennar State, the affected localities are: Abu Houjar (43 cases), Singa (4 cases) and El Souki (9 cases). The current case fatality rate (CFR) in Sudan is 4.3 per cent. With proper treatment, the case fatality rate for cholera should remain below 1 per cent
The outbreak is spreading to neighbouring and adjacent localities and states despite the prompt and initial control measures put in place by health and WASH partners under the leadership of the government. Without timely and intensive scale up of control measures in high risk and adjacent states, the outbreak is likely to spread to other states. The pattern of spread during the last AWD outbreak attested the same evolution by engulfing one adjacent State after another due to population movement, poor WASH situation and other vulnerabilities. According to FMOH and WHO, eight states are at high risk; Blue Nile, Sennar, Gezira, Khartoum, Gadaref, White Nile, Kassala, and River Nile.
The Federal Ministry of Health has requested over 3 million doses of the Oral Cholera Vaccine (OCV) in order to conduct a vaccination campaign. The aim of the campaign is to contain the outbreak and prevent the spread to adjacent areas. The initial reactive campaign will target over 1.6 million people living in high risk communities in Blue Nile and Sennar states who will receive two doses of the vaccine.
To support government efforts to contain the disease and prevent further spread, humanitarian partners have developed a cholera readiness and response plan and are seeking US$ 20,300,039 for the next three months.
This plan is built on 6 main pillars in line with global multi-sectoral interventions to control cholera and the Sudan National AWD Response Plan 2018-2019:
Leadership and Coordination
Surveillance and Reporting
Water, Sanitation, Hygiene and food safety
Use of Oral Cholera Vaccine
Health System Strengthening/HSS (case management and IPC)
In addition, given the overall prevalence of malnutrition in the targeted states, nutrition response has been included under the HSS to support the case-management and IYCFC of children with malnutrition and pregnant and lactating women affected by cholera. Consistent with the national and international strategies, guidelines and protocols the proposed activities will contribute to respond and contain further spread and reduce mortalities due to water-borne (with a focus on Cholera) and vector-borne disease outbreaks in the targeted 8 States over 3 months. As per its core mandate of health security of communities, WHO will protect health and ensure health security.
Overall, partners will target 13,000 for cholera case management, 1,016,006 people (including refugees in camps at risk) with provision of direct health services, 2.5 million people who will benefit from WASH interventions, 300,000 severely malnourished children and 546,000 mothers and caregivers to access infant and young child feeding counselling. Refugees living in camps in Kassala, Gedaref and White Nile States, and in Khartoum ‘Open Areas’ sites will also be targeted through a multi-sector response. Activities will also include mitigating underlying causes of high mortality like severe malnutrition in children under 5 years of age and targeting schools with WASH activities and hygiene campaigns.