Implementation of Health Initiatives During a Cease-Fire -- Sudan, 1995

In 1994, Sudan (1994 population: 27 million) reported to the World Health Organization (WHO) one third of the global total of cases of dracunculiasis (i.e., Guinea worm disease), which is targeted for eradication by the end of 1995 (1,2). On March 27, 1995, the government of Sudan announced a cease-fire of 2 months' duration in the 12-year-old civil war in the southern part of the country--both sides agreed to the cease-fire primarily to permit acceleration of efforts to eradicate dracunculiasis and to promote treatment of other health problems including onchocerciasis (i.e., river blindness), administration of childhood vaccines, and distribution of vitamin A. This report summarizes the status of dracunculiasis and onchocerciasis in Sudan and provisional information on activities undertaken by the government of Sudan and other organizations during the cease-fire.

In 1994, the national Guinea Worm Eradication Program in Sudan reported to WHO a total of 780 villages with endemic drancunculiasis and 53,271 cases. The states with the highest prevalence of disease were Upper Nile, Bahr Al-Jabal, Eastern Equatoria, Western Bahr Al-Ghazal, and Northern Bahr Al-Gazal states Figure_1. As of 1995, the prevalence of onchocerciasis in Sudan was estimated to be 620,000. Southern Sudan also includes the most highly endemic foci for blinding onchocerciasis; the main endemic foci are located in Western Equatoria, Northern Bahr Al-Ghazal, and Western Bahr Al-Ghazal States Figure_2.

Immediately after the cease-fire was announced, the Carter Center and CDC began providing technical assistance to complement preexisting activities conducted by the United Nations Children's Fund (UNICEF), bilateral donors, and nongovernmental organizations. During the cease-fire, health workers from several organizations (including the Sudan Guinea Worm Eradication Program, the onchocerciasis and vaccination programs, and nongovernmental organizations), in collaboration with UNICEF's Operation Lifeline Sudan, trained approximately 1265 additional community health volunteers and deployed about 30 mobile teams of health workers. On April 27, health leaders from both sides met in Juba, Sudan, to exchange information, including maps showing the location of villages with endemic drancunculiasis to help ensure maximum coverage for investigation and interventions. Accelerated interventions began in late April.

From late April through June 13, a total of 2028 villages were visited, including at least 651 villages in which dracunculiasis was first documented during the visit. Health workers identified 8922 new cases of dracunculiasis and distributed 87,703 cloth filters to households in villages with endemic disease. Through June 13, a provisional total of 9454 cases of dracunculiasis had been reported during 1995, including the cases newly identified during the cease-fire. In comparison, during January-May 1994, 15,798 cases were reported.

During the same period, mass oral treatment for onchocerciasis with ivermectin was initiated for the first time in many of the areas in the country with the highest prevalence of disease. Treatment was administered to a total of 25,499 persons from 84 villages in parts of Bahr Al-Ghazal and Equatoria zones, in which prevalences in 28 villages exceeded 40%, and to most eligible persons in the area around Raga, Western Bahr Al-Ghazal state. Assessments are continuing in other areas of the two zones with suspected endemic disease.

As of June 13, at least 30,865 children had received oral poliovirus vaccine, 35,996 were vaccinated against measles, and 19,204 had received bacille Calmette-Guerin (BCG) vaccination. In addition, 29,349 children had received vitamin A, and oral rehydration treatment had been administered to at least 5475 children with diarrhea. Health workers also had conducted health-education sessions to promote prevention of dracunculiasis, onchocerciasis, and diarrhea and to promote vaccination of children. Reported by: Federal Ministry of Health, Khartoum, Sudan. Global 2000, Inc, The Carter Center; Task Force for Child Survival and Development; Mectizan Donation Program, Atlanta. World Health Organization Collaborating Center for Research, Training, and Eradication of Dracunculiasis, Div of Parasitic Diseases, National Center for Infectious Diseases; International Health Program Office; National Immunization Program, CDC.

Editorial Note

Editorial Note: The cease-fire in Sudan permitted rapid development and implementation of activities to address dracunculiasis and other priority health problems. Interventions against dracunculiasis and onchocerciasis were expanded substantially from earlier levels and should accelerate the control of these diseases in Sudan and aid the global eradication effort. In 1994, control measures for dracunculiasis had been provided to approximately 50% of the villages with known endemic disease, and distribution of ivermectin to treat onchocerciasis in the southern part of the country had been restricted to only a limited number of clinics.

Because of this "Guinea worm cease-fire" in Sudan, the global campaign to eradicate dracunculiasis now encompasses all countries with endemic disease. In addition, this cease-fire is an unprecedented opportunity for Sudan to intensify efforts to eradicate poliomyelitis and to control onchocerciasis, measles, and vitamin A deficiency. Efforts to address health problems during negotiated periods of tranquility in civil and military strife have been conducted previously in Lebanon, El Salvador, Sudan, and other countries; however, the duration of these efforts has been substantially shorter than the current program in Sudan. On May 25, the government of Sudan and opposing forces announced their willingness to extend the cease-fire for an additional 2 months through late July to enable continued disease-control efforts.

References

1. World Health Organization. Dracunculiasis eradication: update--Sudan. Wkly Ep

2. World Health Organization. Dracunculiasis: global surveillance summary, 1994. Wkly Epidemiol Rec 1995;70:125-32.

+------------------------------------------------------------------- --+ | Erratum: Vol. 44, No. 23 | | ======================== | | SOURCE: MMWR 44(25);479 DATE: Jun 30, 1995 | |             | | In the article "Implementation of Health Initiatives During a | | Cease Fire -- Sudan, 1995" one of the areas in Figures 1 (page 434) | | and 2 (page 435) was mislabeled. In Figure 1, the area labeled "Red | | Sea" should have been labeled Red Sea state. In Figure 2, the area | | labeled "Red Sea" should not have been labeled. | +------------------------------------------------------------------- --+
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