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

The objective of the meeting was to review the implementation of the VL control activities from 2011 to 2018; discuss the lessons learned and reporting formats as well as reporting on drug consumption at health facility level on monthly basis especially AmBisome.

Visceral Leishmaniasis also known as kala azar is one of the case managed Neglected Tropical Diseases (NTDs) causing immense human suffering and deaths in this sub-region 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.

In South Sudan, kala azar is endemic in four former states namely Upper Nile, Jonglei, Unity and Eastern Equatoria with over two million people 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 with its peak in 2011 where over 11 952 cases were recorded and it spread to other areas affecting more people, mainly children below 17 years of age. 

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 of 4%.  The outbreak was considered as a humanitarian emergency, and accordingly, a multi-sectoral intervention including provision nutritional supplement, food and nonfood items (NFI), health and WASH services has been undertaken to reduce the burden of the disease. 

In addition to the multi-sectoral approach, timely treatment, accessibility to treatment facilities, new treatment protocol (reduced treatment days from 30 to 17 days), and intensive health education campaign resulted in the reduction of cases from 5 015 cases in 2012 to 3 377 cases in 2013.

The country also experienced another outbreak in 2014, following the conflict in December 2013, where over 7,892 cases were reported. With the same interventions put in place, the cases gradually decline from 7,892 in 2014, 3251 in 2015, 4,601 in 2016, 4, 069 in 2017 and 1,990 in 2018. However, the disease trends are unpredictable.

Kala Azar and sleeping sickness are among the case managed neglected diseases in South Sudan, said Dr Richard Lino Lako, Director General Policy, Planning, Research, and Budgeting. There is a need to integrate management of kala Azar into other disease programs and the Boma Health Initiative (BHI), a strategy implemented by the Ministry of Health, South Sudan to strengthen community health systems. 

Dr Lako emphasized the need for strengthening information systems for documenting and reporting on the disease in the online District Health Information System (DHIS2); mobilize funds to expand coverage; transparency and accountability and improve 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 the disease have been reduced and the population access to diagnosis and treatment has been considerably diminished. 

The World Health Organization is providing strong technical and financial support to the Ministry of Health, 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 and the investigation and coordination of outbreak responses.

In 2015, South Sudan launched the NTD five year master plan on combating neglected tropical diseases that include kala azar, sleeping sickness, soil transmitted helminthes, guinea worm, trachoma, onchocerciasis, and lymphatic filariasis.

The broad-based strategic plan provides a roadmap for South Sudan to be free of some of the neglected tropical diseases and related morbidity and disabilities by the year 2020 and recommit the government and partners ton 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 health and social well-being of affected populations.  He also urged all partners to adhere to the WHO online portal where the country, the region and the global level can quickly monitor drug consumption level and needs to avoid any stock out.