Acute flaccid paralysis surveillance performance from 2011 to 2020 in Jonglei State, South Sudan: progress and challenges encountered.

Introduction: South Sudan reported the last indigenous wild poliovirus (WPV) in 2001 in Unity State, while the country was part of Sudan. In addition, the country reported an imported case of WPV in 2004-2005 and 2008-2009. The WPV circulation in the state was interrupted in 2009 and the last case was reported in Ayod county. The country continues to be at risk of importation of circulating vaccine-derived poliovirus type 2 (cVDPV2). In 2014 and 2020 the country experienced an outbreak of cVDPV2, in which Jonglei state was one of the affected states. Four out of 50 (8%) cVDPV2 cases in 2020 were reported from Jonglei State. The purpose of this study is to review surveillance performance indicators of Jonglei and compare them with the WHO surveillance performance standard and other country´s surveillance performances. Methods: retrospective secondary data analysis was conducted using the Jonglei state Acute Flaccid Paralysis (AFP) surveillance case-based database from 2011 to 2020. The reason for selecting Jonglei is because it is one of the poor performing states and is chronically hit by flood and internal conflicts. Data analyses were carried out using the Microsoft Excel (2016) program, where descriptive analysis frequencies, tables, and graphs were generated. Results: the study revealed that 346 AFP cases were reported in the counties of Jonglei state from 2011 through 2020. Out of 11 counties, 11 (100%) of them have reported suspected AFP cases. Children under five years accounted for 275 (79%) of all cases. The male gender accounted for 175 (51%) of all cases. A total of 249 (72%) had received three or more doses of Oral Polio Vaccine (OPV). Non-Polio Acute Flaccid Paralysis (NPAFP) rate varies from 1.2 in 2014 to 4.4 cases per 100,000 children under 15 years in 2018. The stool adequacy ranges from 58% in 2020 to 100% in 2011. Conclusion: the performance of Jonglei´s AFP surveillance system did not meet the WHO recommended target for both major AFP surveillance indicators (non-polio AFP rate and stool adequacy) during the study period.