Real-time monitoring of a circulating vaccine-derived poliovirus outbreak immunization campaign using digital health technologies in South Sudan

Introduction: the use of digital health technologies and geographical information systems (GIS) in the conduct of immunization campaigns had proven to be a success story, and is gaining acceptance towards improving supervision, accountability, and real-time access to quality information. The demand for real-time information by policymakers and stakeholders in the polio eradication programme is increasing towards ensuring a world free from all polioviruses. This study aims to develop a tool that monitor and evaluate the circulating vaccine-derived poliovirus (cVDPV) campaign processes in real-time using open data kits (ODK) to collect data, analyze and visualize using an interactive dashboard in Power BI, towards improving timeliness and completeness of data reporting and providing real-time quality information to stakeholders. Methods: electronic checklists were developed using open data kits (ODK) and uploaded onto android-based smartphones for data collection during a round of cVDPV outbreak response immunization. Supervisors were deployed to the field and the checklists were utilized at both stages of the campaign activities. A Power BI data visualization tool was used for reporting, analysis, and monitoring the activities of the campaign. Results: an interactive dashboard was developed, providing real-time information that supports stakeholders during the campaign processes with improved timeliness and completeness of data reporting. The usage of the tool during the campaign enhanced close supervision, and increased transparency in data availability and accessibility by all partners. Conclusion: the study had shown that real-time information has significantly improved the smooth conduct of the immunization campaign processes through identifying gaps, and challenges in the field and can be utilized in similar resource settings including complex and humanitarian. It has demonstrated the capability of mobile phones using ODK for data collection and linked to a Power BI dashboard for enhanced supervision and transparency, and we encourage further studies to assess the effects of the tools on the campaign results

Methanol poisoning in South- South Nigeria: Reflections on the outbreak response

The methanol poisoning outbreak in Rivers State in May 2015, involved 84 persons in five local government areas. An incident management system comprised of an Emergency Preparedness and Response (EPR) committee and the Local Government Area Rapid Response Teams in an Emergency Operations Centre (EOC). The EOC teams conducted case finding activities, line listing, and descriptive analysis, a retrospective cohort study and collection of local gin samples for laboratory investigation. They also coordinated community mobilization and sensitization activities, intervention meetings with local gin sellers, trace back activities and case management. Those affected were male (72; 85.7%) aged between 20 and 79 years. Of the 55 persons whose socio-demographics were obtained, forty-one persons (74.6%) were married, and 23 (41.8%) had primary education. Case fatality rate was 83.3% with an attack rate of 16 per 100,000 persons. Those exposed to ingestion of adulterated gin were six times more likely to develop methanol poisoning than those not exposed RR=6 (1.0-38.5); P=0.0078. It is hoped that this experience has positioned the state for better preparedness towards future outbreaks

Bridging the humanitarian-development divide in a protracted crisis: a case study of the use of a central plant to supply oxygen for COVID-19 case management in South Sudan

The rising demand for medicinal oxygen due to the COVID-19 pandemic exacerbated an underlying chronic shortage of the commodity in Africa. This situation is particularly dire in protracted crises where insecurity, dysfunctional health facilities, poor infrastructure and prohibitive costs hinder equitable access to the commodity. Against this backdrop, the Ministry of Health of South Sudan, with the guidance of its partners, procured and installed a pressure swing adsorption central oxygen supply plant to address the shortfall. The plant aimed to ensure a more sustainable and technologically appropriate medicinal oxygen supply system for the country and to bridge the humanitarian and development divide, which had always been challenging. This article discusses the key issues, challenges and lessons associated with the procurement and installation of this plant. The major challenges encountered during the procurement and installation of the plant were the time it took to procure and install in the face of urgent needs for medicinal oxygen and its short and long-term sustainability. Lessons learnt include the need for exhaustive and evidence-based considerations in deciding on which source of medicinal oxygen to deploy in protracted crisis settings. The successful installation and operationalization of the plant demonstrated that it is possible to bridge the humanitarian-development divide amidst the complexities of a protracted crisis and an ongoing pandemic. The Ministries of Health, with the support of its partners, should assess and document the impact of this and other similar central oxygen production plants in protracted crisis settings regarding their sustainability, cost, and effectiveness on medicinal oxygen supply. The Ministry of Health of South Sudan should expedite the finalization and operationalization of the longer-term public-private partnership and continue to monitor the quality of oxygen produced by this plant

123-128Outcomes of Management of Cholera outbreak among IDPs and Non-IDPs in a Complex Emergency Setting of South Sudan

Abstract Displaced communities barely have access to safe drinking water and sanitation, therefore the risk of communicable diseases like cholera, acute watery diarrhea, and acute bloody diarrhea increasing exponentially. Since the outbreak of the conflict in 2013 in South Sudan, an estimated 1.87 million people have been displaced and are living in Internally Displace Persons Camps (IDPs). Consequently, outbreaks which include cholera have been reported in 2014 and 2015. We retrospectively analyzed the data from these two outbreaks to compare risks and other characteristics among the IDPs and non-IDPs. It was noted that the risk of cholera was higher among the IDPs compared to non-IDPs. Cholera cases in IDPs were more likely to be children under five years compared to older persons from non-displaced populations. Even though cases of cholera in IDPs were 1.45 times likely to seek care after 48hrs, this was not statistically different from Non-IDPs. Cholera cases in the IDPs were more likely than those in the host communities to have received zero doses of oral cholera vaccine. The burden of cholera cases among sexes, duration of admission of admission and survival rates were not significantly different among IDPs and Non IDPs. In the context of timely response to protect vulnerable populations and coupled with the limitations of the global oral cholera vaccines stockpile management, it is recommended that children less than five years in IDPs should be prioritized for oral cholera vaccination

Pattern of the meningococcal meningitis outbreak in Northern Nigeria, 2009

Objectives: Despite the availability of vaccines, children are the people most often affected by epidemic meningococcal meningitis. The pattern of the epidemic meningococcal meningitis outbreak in Northern Nigeria in 2009 and the Neisseria meningitidis strains responsible for this epidemic are described here. Methods: A retrospective cross-sectional study was conducted in 16 states, involving 48 local government areas (LGAs), 91 health facilities, and 96 communities. Data collection involved in-depth interviews with key informants from the federal to the community level, a review of records, and a solution-oriented national workshop with participants from all states of the Federation. Cerebrospinal fluid (CSF) samples were collected from some of the suspected cases at the start of the outbreak and were tested using the rapid Pastorex latex agglutination kit. Results: Kastina (11153, 20.4%), Jigawa (8643, 15.8%), Bauchi (8463, 15.5%), Kano (6811, 12.4%), and Gombe (6110, 11.2%) were the states with the highest prevalence of meningitis. The states of Nasarawa (11.0%), Adamawa (8.0%), and Borno (7.6%) recorded the highest percentage of deaths, while the Shongom (Gombe State 12.5%), Illela (Sokoto State 9.8%), and Ikara (Kaduna State 9.1%) LGAs recorded the most deaths amongst cases seen. Conclusions: The testing of CSF samples during meningitis outbreaks is recommended in order to monitor the occurrence of the multiple meningitis serotypes during these outbreaks and to direct serotype-specific vaccination response activities