Enhancing active acute flaccid paralysis surveillance in South Sudan

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Akol Kuol Magiir is one of the community champion informants in Kuac South Payam, Gogrial West County of Warrap State. Mr Magiir since his involvement as a community informant for Auto-Visual AFP Detection and Reporting (AVADAR) has sent in a countless number of alerts of suspected Acute Flaccid Paralysis (AFP) cases out of which four AFP cases were found to be true AFP cases. When asked, what motivated him to work so enthusiastically, his answer was “I am doing it for the love of my community, and I don’t want to see any child left behind in the fight against polio”.  

Since 2018, AVADAR has been able to contribute to the surveillance system in Juba and Terekeka Counties in Central Equatoria State and Gogrial West County in Warrap state with the detection of over 80 AFP cases.  

AVADAR is a mobile-based application that enables the health system to notify any suspected AFP cases by community informants and share community-level AFP surveillance information from Payams, the lower-level administrative division.

In October 2020, 19 AFP cases were reported from Gogrial West County, of which five were confirmed to be circulating Vaccine-Derived Poliovirus type 2 (cVDPV2). Gogrial West County is one of the Counties that has seen tremendous change in detection, reporting and investigation of new AFP cases.

The network of community informants continues to play an important role in identifying and reporting AFP cases to ensure no undetected circulation of the virus and the reduction of needless illness and paralysis from poliovirus.

Given the increased vulnerability posed, the Ministry of Health with support from WHO and BMGF stepped up surveillance through community informants in the high-risk counties to ensure that no case was left unreported. This has led to early detection and containment of the outbreak; thus, reducing death and illness in the community.

Since the introduction of AVADAR, there has seen an increase in early detection, notification, investigation of AFP cases within 48 hours of notification by 98%.  The AVADAR application is also helping to detect other vaccine-preventable diseases, and this was possible by strong community and youth involvement throughout the project implementation period. Furthermore, regular refresher training and periodic review of the project improved the involvement of the community informants to keep vigilance in their village. The support by the communities and innovative ideas generated enhanced the active case search and reporting including other diseases as part of the AFP surveillance system.

“Maintaining a sensitive AFP surveillance system and high-level population immunity is critical at all levels to eradicate polio and prevent other vaccine-preventable disease outbreaks, and timely detection and response”, said Dr Fabian Ndenzako, WHO Representative a.i for South Sudan. “WHO works closely with the Ministry of Health to ensure that the AVADAR community surveillance system reduces all bottlenecks so that AFP surveillance achieved its target”.

The implementation of AVADAR improved community involvement and ownership of AFP surveillance activities and the widespread of these informants increases the sensitivity of the system.

Since the beginning of the outbreak in September 2020, the AVADAR community network detected 13 cVDPV2 cases without any delay indicating the sensitivity of the system. The country has since responded to the cVDPV2 outbreak with two rounds of the monovalent vaccine including one mop up in selected counties.

On 25 August 2020, South Sudan along with the other four African countries was declared polio-free as there had not been any wild poliovirus in the country for more than 12 years. However, due to insecurity, emergencies of different nature and population displacement, the country is at risk high risk of cVDPV2 and other vaccine-preventable diseases, and it is important to maintain surveillance sensitivity and improve immunization activities to reach all unvaccinated children, particularly at the sub-national level.

Distributed by APO Group on behalf of World Health Organization (WHO) – South Sudan.