Visceral Leishmaniasis Outbreak in South Sudan 2009–2012: Epidemiological Assessment and Impact of a Multisectoral Response
Bibliographic record
Abstract
The humanitarian situation in South Sudan is dire, with over two million returnees since 2005 and another 300,000 expected to return by the end of 2013. In 2012, 170,000 refugees settled in five camps in Unity and Upper Nile states, endemic areas of visceral leishmaniasis (VL) (Office for the Coordination of Humanitarian Affairs Sudan Humanitarian Update 1st Quarter 2012). VL in South Sudan is endemic in four states, namely Upper Nile, Unity, Jonglei, and Eastern Equatoria, where 2.7 million people in 28 counties are considered to be at risk. It is an anthroponosis caused by Leishmania donovani, and the vectors are Phlebotomus orientalis and P. martini. South Sudan is suffering from recurrent epidemics in areas previously considered to be nonendemic [1]. VL in South Sudan was first described in a child from Bahr-el-Ghazal in 1904 [2]. Since then, outbreaks have been reported in several different areas, namely Jonglei state in the 1930s and 60s [3], [4], the former Blue Nile province in the 50s [5], and Unity state (formerly Western Upper Nile) in the 80s, until by the 90s it was claimed that almost one-third of the population had been affected between 1984 and 1994 [6]–[8]. In 1994 and in 2002 there were two further outbreaks in northern Jonglei and Eastern Upper Nile states, resulting in 17,000 cases reported. Since 2002, the number of cases reported has progressively decreased to reach 582 in 2008. From 2004 to 2008, an average of 1,756 cases were reported annually, although the actual number of cases was estimated to be between 7,400 and 14,200 cases [9]. Until 2004, VL treatment services were provided almost exclusively by Medecins Sans Frontieres-Holland (MSF-H), after which time part of the VL-treatment activities were handed over to the Southern Sudan Secretariat of Health. In addition to this, the World Health Organization (WHO) supported eight health facilities run by nongovernmental organizations (NGOs), and in 2009, that network was expanded to 12. Another VL outbreak was declared in 2009 and it is still ongoing. This publication provides a detailed report on the epidemiology of and the response to this outbreak.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".