VZCZCXRO5958
PP RUEHMA RUEHROV
DE RUEHKH #1828/01 2121537
ZNR UUUUU ZZH
P 311537Z JUL 06
FM AMEMBASSY KHARTOUM
TO RUEHC/SECSTATE WASHDC PRIORITY 3962
INFO RUCNFUR/DARFUR COLLECTIVE PRIORITY
RUEHRN/USMISSION UN ROME

UNCLAS SECTION 01 OF 02 KHARTOUM 001828 
 
SIPDIS 
 
AIDAC 
SIPDIS 
 
STATE FOR AF/SPG, PRM, AND ALSO PASS USAID/W 
USAID FOR DCHA SUDAN TEAM, AFR/SP 
NAIROBI FOR USAID/DCHA/OFDA, USAID/REDSO, AND FAS 
GENEVA FOR NKYLOH 
NAIROBI FOR SFO 
NSC FOR JBRAUSE, NSC/AFRICA FOR TSHORTLEY 
USUN FOR TMALY 
BRUSSELS FOR PLERNER 
 
E.O. 12958:  N/A 
TAGS: EAID PREF PGOV PHUM SOCI SU
SUBJECT: STATUS OF ACUTE WATERY DIARRHEA IN SUDAN 
 
KHARTOUM 00001828  001.2 OF 002 
 
 
-------- 
Summary 
-------- 
 
¶1.  According to the Department of Epidemiology in the Sudanese 
government's Federal Ministry of Health (MOH), the first case of 
acute watery diarrhea (AWD) was identified in the Southern Sudan 
earlier this year, and AWD has now spread to several northern 
states.   There is danger of AWD spreading to other states and 
internally displaced persons (IDP) camps.  The MOH is implementing 
control measures which seem to reduce the attack rate, but the case 
fatality rate (CFR) still remains high.  The U.N. World Health 
Organization (WHO), the U.N. Children's Fund (UNICEF), the MOH, and 
the National Water Corporation have submitted a proposal to donors 
for an emergency response to the AWD outbreak in Northern Sudan. 
End summary. 
 
---------- 
Background 
---------- 
 
¶2.  In March 2006, health authorities reported an outbreak of AWD in 
Yei, Southern Sudan.  The disease soon spread to Juba and other 
towns in Southern Sudan.  Though the outbreak was controlled at some 
locations, the disease continues to spread to other states.  In 
April 2006, AWD cases were reported in Khartoum, and the disease 
spread to other northern states.  According to the MOH, between 
April 21 and July 3, 2006, 10 of the 15 northern states reported 
cases of AWD, with a total of 3,377 cases and 123 deaths.  The CFR 
was 3.6 percent. 
 
¶3.  According to the MOH, Northern Kordofan reported 852 cases with 
a CFR of 3.3 percent, followed by Khartoum with 845 cases and a CFR 
of 4.4 percent.  The highest CFR of 11.3 percent was reported in 
Kassala.  Though there is currently a decline in AWD in most states, 
WHO still reports a weekly incidence of 200 cases of AWD. 
 
--------------- 
Risk Assessment 
--------------- 
 
¶4.  The number of cases of AWD reported from the northern states may 
not yield an accurate representation of the spread of the disease. 
The actual number of cases in Sudan may be much higher due to 
under-reporting.  During the rainy season, environmental concerns 
deteriorate, and the incidence of AWD might increase in some states. 
 The control measures taken by health authorities have resulted in 
the maintenance of a low attack rate of 0.01 percent, but the CFR 
remains high and ranges from 2 to 11 percent, indicating that early 
detection and case management has not been attained.  The MOH 
reports that if the attack rate increases to 0.2 percent, it is 
estimated that approximately 29,873 cases could be expected in the 
following weeks.  If the CFR increases to 1 percent, 140,000 cases 
may be reported. 
 
¶5.  The possibility of the disease spreading due to poor 
environmental conditions and the quality of drinking water exists. 
In many areas, people obtain water from shallow wells or "haffirs," 
which are water catchments where rain water is kept during the rainy 
season.  In many communities living along the river banks, water is 
collected directly from the river.  The potential of the disease 
spreading to IDP camps, where more than two million IDPs live in 
Khartoum alone, is a concern. 
 
------------------------- 
MOH Response to Outbreak 
------------------------- 
 
¶6.  The MOH's response to the AWD outbreak focuses upon improving 
the surveillance system, raising awareness among the population 
about AWD, taking measures to reduce the risk of getting the 
disease, improving case management, improving the environmental 
conditions, and ensuring availability of safe water for drinking. 
The long distances patients must travel before arriving at treatment 
centers, the bad roads, and poor case management capacity at 
treatment centers accounts for the high CFR. 
 
---------------------------- 
Proposal to Respond to AWD 
---------------------------- 
 
¶7.  WHO, UNICEF, the MOH, and the National Water Corporation have 
 
KHARTOUM 00001828  002.2 OF 002 
 
 
submitted a proposal to donors for an emergency response to the AWD 
outbreak in Northern Sudan.  The main components of the emergency 
response are coordination, surveillance, case management 
strengthening environmental control measures, social mobilization, 
and health education campaigns.  The duration of the emergency 
response proposal is seven months and is divided into two phases. 
The first phase will cover the first three months, and the second 
phase will cover the remaining four months. 
 
¶8.  Implementation of the project will be conducted with the MOH, 
with technical support from WHO and UNICEF.  WHO will focus on 
technical guidance for surveillance and case management.  UNICEF 
will be responsible for the environmental control and social 
mobilization.  Other partners, including some international 
non-governmental organizations (INGOs), will be involved in some of 
the control activities.  The total budget required is USD 5,622,723. 
 The MOH will contribute USD 1,017,540, the Common Humanitarian Fund 
contributed USD 1,000,000 and the Government of Norway contributed 
USD 120,000. 
 
STEINFELD