Health

The first 1000 days, the period from conception to 2 years of age, is a crucial time for early childhood growth and development. This period sets the basis for a child’s health and physical, social, cognitive, emotional and behavioural development and is when the child is most dependent on parental care and a healthy environment.

This helpdesk report reviews the lessons learned from the delivery of health programmes in a conflict-sensitive way including in South Sudan. Recommendations on conflict sensitivity and health programming identified in this review include: coordination between governments and implementing agencies, training for healthcare staff in conflict sensitivity, health and hygiene promotion for refugees and social cohesion activities for refugees and host communities involving children.

Meanwhile, lessons for achieving health outcomes in fragile and conflict-affected states include: political commitment and government ownership, participatory decision-making, evidence-based programming and refinement, reliable and sustained funding and strengthening of community structures that provide support in health. Programming experience in fragile and conflict-affected states also provides useful tips on: capacity building, contracting out, health pool funding, labour markets, different providers and gender

Background: A key part of treating and preventing malnutrition is the provision of effective nutrition education to the clients and caretakers so that they can self-manage their nutrition needs even after discharge from the hospital. For effective nutrition education,three factors are paramount; The successful transfer of knowledge and skills, client motivation to act on theacquired skills and knowledge and ensuring that the patient is able to understand and put to practice the educational messages given.

Methods: The study used cross sectional design with mixed method of data collection that involved 83 caretakers of admitted SAM children at Al-Sabah children hospital ITC, Sample size was determined using Cochran 1975, interviewer administered questionnaires and focus group discussion guide were the tools used in collecting data. Data set was generated using EPI info andanalyzed using SPSS version 21, the analyzed descriptive data was triangulated with the qualitative data collected using FGD.

Results: The majority of the caretakers were female 78 (94%) of which 68 (81.9%) were mothers to the children that were admitted. Only 8 (9.6%) of the respondents were found to have attained effective nutrition education and majority of the respondents were found not to be recalling the information they were given during the education session.Conclusion: As per the guidelinesadaptedby the ministry of health republic of South Sudan, the nutrition education sessions conducted was found not be effective as most of the clients could not even recall the information given.

This rapid review focusses on efforts to mitigate the educational impact of previous disease outbreaks, concentrating on school-age learners. It follows two companion papers that reviewed broader secondary effects and attempts to mitigate them (Rohwerder, 2020; Kelly, 2020). It aims to inform the education sector’s responses to the COVID-19 crisis, although there are important differences between previous disease outbreaks and the COVID-19 situation. For instance, unlike Ebola, transmission of COVID-19 is asymptomatic, and the outbreak is global. This review finds a limited range of quantitative evidence on the educational impact of disease outbreaks, and minimal evidence on mitigation measures or their impact. Although several ‘lessons learned’ documents include guidelines and recommendations (and now complemented by many education-focused COVID-responsive blogs), this review finds that these are rarely based on evidence of impact of particular interventions, or on evidence of the impact of different approaches to action, co-ordinations, funding or prioritisation. The review found four particular evidence gaps: First, how distance learning materials can support learners who do not have access to family members with the skills or time to help them. Second, a gap in the use of screen or internet-enabled technologies to support alternative education. Third (and related), a gap in remote teacher training and development during school closures. Finally, the review analysed gender and equity issues but did not find any literature that explored disability. The education in emergencies literature has an emerging evidence base across all four themes within refugee education contexts, but has not yet learnt from or applied this evidence to disease outbreak situations.

The trends reported in the Integrated Food Security Phase Classification (IPC) show a growing food security crisis in South Sudan, with a high proportion of people sliding into crisis and emergency food insecurity level. The underlying fears concern an emerging acute lack of food in almost all parts of the country, with millions of people, many of them rural women and children, affected. At the peak of the lean season in August to September 2016, Northern Bahr el Ghazal had 72% of its population facing crisis and emergency[1] level. It should also be noted that Northern Bahr el Ghazal’s food security indicators continue to be alarming with 62% of the population being severely food insecure (phase 3,4,5) by the peak of the lean season (July)[2]. In January 2017, the Sudd Institute, with generous support from Food and Agriculture Organization (FAO) of the United Nations, explored the proximal risk factors undermining food security resilience and triggering or perpetuating emergency level vulnerabilities in the former states of Warrap and Northern Bahr el Ghazal. Examining 6 major assumptions using Participatory Rural Appraisal (PRA) tools to draw important information from rural households, the results are instructive and in direction of our expectation. They provide insights into appropriate response options for combating food security vulnerability in the region that is nearly sliding into famine. We outline the key results as follows.

South Sudan has, up to the time of writing, avoided the worst effects of the global coronavirus pandemic. However, as the disease spreads further through the African continent, South Sudan—and other countries in the Greater Horn of Africa region—need to carefully calibrate their response to prevent a dangerous escalation. Of critical importance to this is the need to take into account local knowledge and expertise. Drawing on the RVI's network of South Sudanese researchers, this note reflects shared findings and recommended actions collated by a team of nine male and female researchers working in urban, rural and cattle camp locations across the country. It focuses on 6 key areas: public messaging; epidemic management; economic considerations; the politics of the response; risks of conflict; and international agency and donor tactics.

This document provides evidence of practical and affirmative options of people-centered, participatory forms of community organizing and engagement in diverse areas of prevention, care and wider social protection in responding to COVID-19. The 42 case studies from different regions intend to inspire, inform and support.

South Sudan has some of the worst health outcome indicators globally, in spite of modest
improvements over the last five years. Maternal mortality ratio has stagnated at 2054 per
100 000. Mortality rate for infants and children under five years declined from 102 and 135
in 2006 to 75 and 104 in 2012 per 1000 live births respectively. The significant disparity in
health status across socio-demographic factors and geographical location is well
documented.

Due to increasing cases and requests from many developing countries, the World Health Organization (WHO) designated snakebite as a neglected tropical disease of high priority in 2017. According to WHO, “bites by venomous snakes can cause acute medical emergencies involving severe paralysis that may prevent breathing, cause bleeding disorders that can lead to fatal haemorrhage, cause irreversible kidney failure and severe local tissue destruction that can cause permanent disability and limb amputation.”
The data coming out of the Médecins Sans Frontières (MSF)snakebite programme in Agok are a cause for concern for this medical emergency (See article on page 146).[2] With no centralized data on snakebites from across the country, this bellwether programme should be celebrated and replicated. Different states have varied rates and incidences of snakebites and one size fits interventions may not be relevant. However, a clear programme would put snakebite high on the agenda and help prevent needless deaths. When there are no specific integrated programmes, individuals resort to traditional and ineffective remedies for snakebites which could do more harm than good. This issue is compounded by the lack of anti-venoms, awareness by health workers, poor training and appropriate treatment guidelines and protocols. The Ministry of Health and all relevant NGOs should ramp up efforts to expand the snakebite programmes by integrating them into the primary healthcare system, developing awareness and training materials, as well as ensuring the availability of anti-venom as part of the essential drugs list. The MSF programme in Agok has shown that it can be done.