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Department of Epidemiology, Ministry of Health, Khartoum, Sudan.

The epidemic occurred in Western Equatoria Province of the Southern Sudan.

Official news of the outbreak reached the Regional Ministry of Health in Juba on the 15th of September 1976. Immediate measures were initiated and help was asked from the Central Ministry of Health, Khartoum, and the World Health Organization.

The Director of the Epidemiology Department there, Dr. Ali Idris, was asked to proceed to the area to investigate the outbreak, help in the diagnosis of the disease and the implementation of control measures. He left Khartoum for Juba on the 3rd of October and was in Maridi the next day.

I would like to mention briefly some of the activities, which have played an important role in the control and prevent further spread of the disease.

1. Compulsory and prompt notification

Information about the disease was distributed to all health points in the Southern Region and also throughout the country. The disease was made notifiable. Health points in the area were instructed to report any suspected cases to the epidemic centre in Maridi and if possible to H/Qs of the Regional Ministry of Health in Juba. All available means of communication and transport were to be utilized for this purpose. From the Regional Ministry of Health the information was passed to the Central Ministry of Health in Khartoum and both Ministries collaborated and organized control activities. The information was also regularly conveyed to the concerned international agencies, mainly the W.H.O.

2. Detection of cases

Teams were formed mainly of students and headed by sanitary overseers or public health officers. These were asked to search the area, house by house, and detect cases in order to organize their prompt removal to the quarantine.

Special teams were formed to inspect the area along the borders to detect those moving in or out of the area. The health workers in all the health points in the area were asked to visit all the houses in their areas for case detection and contact tracing, and to report this information to the epidemic centre.

3. Contact tracing and follow-up

Some teams were instructed to trace the contacts. These were put under surveillance for two weeks, during which they were visited regularly by the surveillance teams.

4. Closure of the area

The affected areas were closed from the other Provinces, and the borders with the neighbouring countries were closed. Movement inside the Southern Provinces was limited and communication between the Southern Region and the rest of the country restricted, except for special circumstances.

5. Complete registration

The information system between the affected districts and the Regional H/Qs of the Ministry of Health in Juba, and between the latter and the Central Ministry of Health, Khartoum, was organized.

Special forms were provided for the registration of cases, suspected cases, and contacts. These forms contained all the necessary information.

6. Health education

This was widely used. All the different types of media were utilized. These included the newspapers, radio and T.V., mobile teams and village chiefs. People were asked not to panic, to report cases to the nearest health points and take the necessary precautions.

1. Transport

This was the major constraint. The lack of cars and the acute shortage of fuel in the area and in the Southern Region were real obstacles in the way of carrying out many activities. Many of the surveillance teams were asked to roam about in the area on foot. There were difficulties in transporting personnel, supplies and equipment from Khartoum to Juba and from there to the affected areas. A few planes were provided for short periods by the Sudanese Air Force, UNDP and some friendly countries.

2. Communications

Radio communications were deficient and postal services were almost nonexistent especially after closure of the area. Use was made of the available radio communication sets belonging to some voluntary organizations.

3. Runaways

The running away of the nursing and auxiliary staff of the hospitals in the affected districts, and the similar attempts by the patients and their relatives and contacts constituted one of the main problems. It took quite an effort to persuade these people to return to the hospital.

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