South Sudan confronts rise in Neglected Tropical Diseases; urgent action needed

South Sudan confronts rise in Neglected Tropical Diseases; urgent action needed

South Sudan faces a daunting challenge with one of the highest prevalences of Neglected Tropical Diseases (NTDs) globally, which demands immediate action. Progress has been slow, posing severe threats to public health and overall well-being despite efforts to combat these diseases since 2008. The country grapples with a staggering burden, hosting 19 out of the 21 NTDs endemic to Africa, potentially making it one of the most affected regions on the continent. 

NTDs such as trachoma, onchocerciasis, and lymphatic filariasis significantly contribute to the nation’s health challenges. Trachoma, a pervasive eye infection leading to blindness if untreated, remains a pressing concern in South Sudan. According to health ministry officials, trachoma affects a significant percentage of the population, posing a threat to people’s vision and productivity, necessitating immediate attention.

Yak Yak Bol, the National Coordinator for Preventive Chemotherapy for Neglected Tropical Diseases of South Sudan’s Ministry of Health, says, “Trachoma mapping is now almost complete. Preventive chemotherapy treatment and surgical interventions for patients with trachomatous trichiasis were provided in Unity State and Eastern Equatoria.”

An estimated 3.6 million people are in need of access to the SAFE strategy—a comprehensive approach developed by the World Health Organization (WHO) for trachoma control. This strategy includes surgery, antibiotics for active trachoma infection, facial cleanliness, and environmental improvement. Certain regions in South Sudan are hyperendemic for trachoma, with alarming prevalence rates observed, particularly in Upper Nile, Unity, and Jonglei states. These areas exhibit rates as high as 80.1 per cent for trachomatous inflammation-follicular (TF) in children (an early stage of trachoma) and 14.6 per cent for trachomatous trichiasis (TT) in adults, underscoring the urgent need for intensified efforts and resources. 

Onchocerciasis, or river blindness, is endemic in all 10 states of South Sudan, putting nearly half of the population at risk. Progress has been made in onchocerciasis and lymphatic filariasis, elimination efforts in South Sudan. Yak Yak Bol observes, “Despite the prevalence rates, there has been great progress towards the elimination of onchocerciasis and lymphatic filariasis through the treatment of populations in 32 counties.”

Gap in healthcare

The transmission of lymphatic filariasis primarily occurs through mosquito bites, exacerbated by environmental conditions such as stagnant water bodies and poor sanitation. Limited access to mass drug administration (MDA) programs due to conflict and logistical challenges further complicates control efforts. Additionally, South Sudan’s healthcare system is faced with a scarcity of healthcare facilities, medical equipment and qualified healthcare professionals, making it difficult to provide comprehensive care for lymphedema and conduct hydrocele surgeries. 

Yak Yak emphasizes the various challenges faced in their work towards elimination, among which insecurities in South Sudan take the forefront. He says, “Because of the level of insecurity, we are in a unique position that has required us to tighten the relationship and the coordination level with different government and non-government organs. That’s how we stay abreast of where we can go, where it is safe to travel to and the like. Without the regular updates we get from them, we would not have been able to achieve much, all the while ensuring the safety of our staff.” 

Yak Yak continues, “At the moment, except for the salary payments of staff at the national, sub-national and district level, it is really hard for the Ministry of Health to currently allocate more resources on the work that we do. For the past two years, we have been experiencing major funding gaps, and we are currently not receiving the needed amount of funding from external sources. Domestic resource mobilisation is turning out to be difficult. Depending on external funding is a challenge when we can’t fill the gaps as needed because we are limited in the amount, the areas of intervention and sometimes even the diseases that we can work on. For example, in 2023, close to 14 counties were not treated for LF due to the lack of funding.” 

Recognising the gravity of the situation, the South Sudanese government has prioritised NTD control and engaged in discussions with key partners to chart a path forward. However, financial and resource challenges hinder broader initiatives. The END Fund through the ARISE Fund in addition to previous and ongoing END Fund investments known as RLMF and the Flagship Fund has been instrumental in filling the gaps in NTD programming since 2015. Recent interventions include mapping trachoma incidence and training health workers to handle trachoma operations across counties. The initiative also targets eliminating the lymphatic filariasis threat by 2030. 

According to Yak Yak, the support South Sudan has been getting from both local and international partners has enabled them to fill certain gaps that is propelling the country’s efforts towards the progress they have registered so far. He says, “In 2022, for the first time in the history of South Sudan, we had managed to conduct mass drug administration and implement treatment in all 48 counties.

“Unfortunately, due to the lack of funding in 2023, we only managed to treat 40 counties, with a gap of 8 counties for onchocerciasis we have yet to fill. The ARISE Fund has taken a positive step in supporting our NTD elimination programs and now we hope that the cross-border collaboration with our neighboring countries like Uganda and Ethiopia can find the support required. We share the same people on either border with Ethiopia and with the movement of people as well as that of the vector we need to ensure collaboration is strengthened going forward”.  

Combating NTDs, with a focus on trachoma, onchocerciasis, and lymphatic filariasis, in South Sudan is a pressing humanitarian priority that requires urgent action and collaborative efforts from all stakeholders.

-Denis Galava contributed to this news report.