Seasonal variation of the three leading diagnoses over fifty months at the Duk Lost Boys Clinic, South Sudan

Author(s): Reed, William[1] , Dannan, Tom[2], Friedman Daniel, MD[3], Manyok Gabriel[4], Connor Barbara, MD[5], Reed David, MD[6]

[1] Cornell University ,
[2] Syracuse University; 
[3] Department of Internal Medicine, Massachusetts General Hospital; 
[4] Duk Lost Boys Clinic, Data Manager; 
[5] Duk Lost Boys Clinic, Medical Director;
[6] Department of Emergency Medicine, SUNY Upstate Medical University.

Correspondence: David Reed  [email protected]


The Duk Lost Boys Clinic, a Primary Health Care Clinic in Duk Payuel, is the only Duk County clinic in continuous operation during the study period, serving an estimated 70,000 to 100,000 South Sudanese in Jonglei State. (Figure 1) Maternal Child Health capabilities include prenatal care, immunizations and transfusion capability, HIV/TB/Leishmaniasis testing and treatment, nutrition, ultrasound, and midwife attended delivery. Obstacles to clinic access include lack of roads and commercial transportation, political insecurity, and heavy flooding during the wet season, typically April-November. The objective of this study was to describe seasonal variation of monthly patient visits, and totals of the leading three primary diagnoses over the first fifty months of operation.


 Figure 1: Duk Lost Boys Clinic



Monthly Clinic Activity Reports were analyzed for number of total patients, and number of patients with diagnoses of malaria, diarrheal disease, and respiratory illness--the three leading primary diagnoses at the clinic. These data were analyzed for correlation with wet and dry season. A t-test (p<0.05) was used to determine correlation between the incidence of the three leading diagnoses and wet versus dry season.


Figure 2. The percentage of all patients who presented with Respiratory Illness, Diarrhea, or Malaria



Total patient visits: 59,915; monthly mean: 1198 (range 471-2457). Respiratory Illness mean: 173 (range 6-393); Malaria mean: 114 (range 12-332). Diarrheal Illness mean: 230 (range 46-644). (Figure 2 and 3)




It is very likely that patients’ inability to travel and access the clinic due to flooding, political instability, as well as potentially, cultural stigmas are major factors influencing how many patients present to the clinic when, and with what disease symptoms. However, these preliminary results offer insight into complexities of planning for surge-capacity, staffing, and medication requirements during seasonal variations.

Figure 3. Children at playing in Duk village



 Monthly data reports do not demonstrate a statistically significant seasonal difference between wet and dry season incidence of total visits or the three leading primary diagnoses at the clinic during the study period.



Inaccurate or incomplete data in several monthly reports required estimation and averaging to complete the data set for analysis. Varied interpretation of final primary diagnosis associated with staff turnover was also a potential confounder



Special thanks to the many who have supported the John Dau Foundation in its quest to help develop sustainable health care at the Duk Lost Boys Clinic. Above all, thanks to the staff at the clinic who work tirelessly towards this goal.