Final Country Report

By Dr Abuzar Taizai

It gives me great pleasure and satisfaction to write down a few words to appreciate theserenity and fortitude of those who helped me in my STOP Mission.I would like to say thanks first to Ms Virginia Swezy who was my Atlanta basedsupervisor, who through her simple, and encouraging e-mails kept my moral up and mymission on the move. Jason Roathbird, Andrea Masters Yinka Kerr, and DanielleChekaraou, La Chandra Murphy and Felicia Betancourt were amongst the prominentcoordinators who guided me in the initial phases of my mission and they deserve mysincere thanks, they gave me the chance and opportunity to exercise my skills and effortsin the noble and global cause of Polio Eradication. I will be in debt if I don’t say thanksto Dr M.Abdur Rab WR Sudan who was the first to say well come to me and arrangedvehicle for me to take me from the air port to the Hotel in Sudan. The help and support provided by Dr Salah Haithamei my in country supervisor is of course much andunforgettable. I am also very much thankful to Ms Kelly Ronan and Ms Leila Kadri of WHO headquarter – Geneva, for their sincere and enormous administrative support and processing my UNLP which enabled me to get smoothly on the board and through myassignment in Sudan.I am very grateful to the Government of the republic of Sudan and it’s Federal Ministryof Health for their hospitality and giving me the opportunity to work as part of the PolioEradication team in this country, especially Dr El Tayyeb El Sayed National EPI manager Sudan, and his team. I am really thankful to Dr Mehboob Badini STC Khartoum state,Wisal, and Mai for administrative supports and useful information they gave me duringorientation and briefing at Khartoum.Dr Hassan Khan STC of course deserves a lot of thanks for his regular calls from Darfur to help me in the understanding of the Sudansecurity situations and work related details.I am also thankful to the Minister Health Sennar state Engineer Mr. Abu-Almaali, DGHealth Sennar Dr Abdullah Yaqoob, Mr. Atta Ahmed Abdullah the state operationalofficer Mr. Ahmed Mansoor commissioner Dinder locality and Dr Saif Ali Azal Director Primary Care for their cooperation and hospitality in their state.I am very much grateful to the provincial ministry of health NWFP Pakistan for grantingme permission to be on the STOP Mission in Sudan.

Introduction:

Sudan gained independence from British-Egyptian rule on 01 January 1956. Sudan is thelargest country in the African Continent both population wise as well as territory/landwise because its territory is covering about 2.5 million square kilometers and 40 millionis its total population which is more than any other African country.

Bordering countries of Sudan:

Northern Border: The northern border of Sudan is touching with Egypt.Eastern Border: There are two countries and one famous sea namely Eritrea, Ethiopiaand the Red Sea.Southern Border: Ugunda, Kenya and democratic republic of Congo lie on its southern border.

Western Border: Chad, Libya and Central African Republic touch its Western Side.Sudan has a total population of around 40 million. Most of the Sudanese are living in therural setup (68%) the remaining 32 % are Urban Dwellers. About 7 % people here are the Nomads. In South there are some Christians and Animists but Islam is the predominantreligion in Sudan.

About the Sudan Government:

Sudan since her inception enjoyed only ten years of Democracy the rest of the periodremained under military regimes.

The Sudan is a republic with a federal system of Government. There are multiple levels of administrations, with 25 states which are inturnsubdivided into approximately 120 provinces.

Sudanese People:

The Sudanese are very friendly and hospitable people but their national identity is very complex to define but fairly they can be called Afro-Arabic. Theyspeak more than 130 dialects but Arabic language is spoken in most of the Sudan regions. Now they have started taking interest in English language especially in the young studentstratum of the Sudan.

Economy and World Ranking of Sudan:

In 2004 Sudan was the least developed country (LDC) andwas ranking 139 according to UNDP’s Human Development Index but now it has gonefurther down two places in 2005 and its number is now 141.There is no adequate nationalroad grid which connects the country. The largest parts of Sudan rely on agriculture and pastoral economy. Long fiber cotton sorghum and can sugar are its main crops.Commercial agriculture industrial development, limited exploitation of the naturalresources specially following the discovery of oil in central and southern parts of Sudanhave developed in the recent years.

Internal Conflicts of Sudan

The internal conflict erupted in 1983 between North and SouthSudan. Its impact was significant on Sudan in many ways. It was the longest conflict inAfrica, involving serious human rights abuses and humanitarian disasters. During theconflict more than 2 million persons died and 4.5 million people were forcibly displacedfrom their homes. However due to increase international pressure the conflict wasresolved and on 31 December 2004 the two sides agreed on the outstanding issue of power sharing, wealth sharing and ceasefire.

Endemic/Common Diseases in Sudan

The commonest amongst the Sudan endemic diseases is the Malaria especially the plasmodium Falciparum, TB, Bacterial Meningitis, Intestinal amoebiasis GiardiasisDengue fever and Leishmaniasis are the common diseases in Sudan.In addition to the above mentioned diseases Malnutrition is also very common especiallyamongst the children and women of Sudan.

The seasonal Catastrophes and Environmental Disasters

Sudan has the most common environmental Problem of (HABOOB) the dust Stormit has also a season of heavy rains starting from May up to September. The other important disasters are the periodic droughts.

The Climate and Terrain

The climate of Sudan is tropical in the Southern part, it is a desert in theNorth, and therainy season has no specification for the states but is almost universal for the whole

Sudan. The rainy season starts from May and lasts up to November. The Sudan hasmainly a flat terrain without any specific features, except sparsely spread naturally growntrees the Sudan is dominated by the deserts. The mountains are mainly situated in Far South, Northeast and in the Western Sudan.

Main Activities of the STOP 24 Team

Meeting with the National EPI Manager, Sennar State Minister Health and DG Health to seek their permission to work in their State and taking their commitment.

1.Ensuring the weekly reports including the zero reports from all the reporting sites2.Updating the Micro planning for NIDs and AFP surveillance in Sennar State2. NIDs trainings for the supervisors and teams3. NIDs campaign monitoring and post campaign evaluations4. Detail case investigations (DICs) of AFP reported cases5.Data analysis and 60 days follow-ups of AFP cases6.AFP sensitization and health facilities records review7.Orientations for Polio field supervisors and assistants8.Strengthening the routine EPI activities

Sudan and Polio Virus the overall Perspectives

The epidemiological Study of the Sudan in the perspective of Polio Virus transmission iscomplex however the following factors can be easily separated and studied for the better understanding of the situation and it a will also help the Polio Eradicators bystrengthening the positive factors and abolishing, minimizing or controlling the negativefactors.

Negative factors for the Polio Eradication Programme

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Sudan is bordering a large number of countries (9) most of which or not Polio freeand there is a continuous influx of refugees which is one of the most important factorsin the Polio virus transmission. This was the only one factor which imported Poliovirus to Sudan after it was Polio free for a few years.

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Low literacy rate and unawareness of the community about the importance of immunization.

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Poverty and hence malnutrition especially the protein energy malnutrition whichmakes the immune system to respond sub optimally to the vaccines.

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In most of the regions of Sudan the drinking water is from the rivers or canals whichis unsafe and helps the virus to be transmitted to the other regions downstream.