JUBA: Akol Kuol Magiir is one of the community champion informants in Kuac South Payam, Gogrial West County, 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 help with the surveillance system in Juba and Terekeka Counties in Central Equatoria State and Gogrial West County in Warrap State. Over 80 AFP cases have been found in these three counties.
AVADAR is a mobile app that lets the health system get information about possible AFP cases from people in the community and share that information with 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 is still very important in identifying and reporting AFP cases so that the virus doesn’t spread and people don’t get sick or become paralysed from polio.
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 deaths and illness in the community.
Since the introduction of AVADAR, there has been an increase in early detection, notification, and 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 made 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 in keeping vigilance in their village. The support by the communities and innovative ideas generated enhanced the active case search and reporting, including 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, as well as 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 achieves its target.”
The implementation of AVADAR improved community involvement and ownership of AFP surveillance activities, and the widespread use of these informants increases the sensitivity of the system.
Since the beginning of the outbreak in September 2020, the AVADAR community network has 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 August 25, 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. Due to insecurity, emergencies of different natures, and population displacement, the country is at high risk of cVDPV2 and other vaccine-preventable diseases, and it is important to maintain surveillance sensitivity and improve immunisation activities to reach all unvaccinated children, particularly at the sub-national level.