Disease Surveillance and Control After a Flood: Khartoum, Sudan, 1988

Following a flood in Khartoum, Sudan, emergency disease surveillance was implemented to monitor the health status of the population. Simple, symptom-oriented case definitions for diarrheal disease, measles, respiratory disease, malaria, and jaundice were included on the report form used to collect daily counts of outpatients in a sample of both temporary and permanent clinics located in areas of the city most affected by the flood. Data collected from major teaching hospitals allowed comparison of pre- and post-disaster levels of morbidity and mortality. In addition, special surveys collected information unobtainable from health facilities. Sentinel clinic surveillance data indicated that diarrheal disease accounted for the greatest number of clinic visits, while malaria was the second most common reason for seeking medical attention. Malaria blood smear surveys showed that the parasitemia prevalence ranged from 11% to 19% in the general population and from 21% to 46% among febrile clinic patients. Hospital admission data demonstrated an increase in morbidity from diarrhea and malaria in August 1988, when compared to previous months and August of the previous year, although it is uncertain whether this increase was due to the flood. Nutrition surveys demonstrated that 23% of young children were moderately or severely undernourished, with substantial variation by area of the city. No major outbreaks of communicable disease were detected in the 4 weeks after the flood. Disease surveillance provided data useful in identifying public health problems, setting priorities, targeting interventions and controlling rumors. Disease control measures taken by the Ministry of Health included provision of potable water, standardization of medical care, and distribution of immunizations, oral rehydration salts, and vitamin supplements to children.