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EPIDEMICS,

CEREBRO SPINAL MENINGITIS.

This disease was again epidemic in Mongalla Province. 335 cases occurred during the year with 274 deaths, as against 426 cases last year with 242 deaths.

In the rest of the Sudan three cases occurred with three deaths.

Mongalla Province. The main incidence of the disease was in the Latuka district where famine conditions prevailed in 1927. A number of cases also

occurred among the workmen on the Juba-Dikala road and a few cases in Yei district. Kajo-Kaji and Meridi districts were exempt.

The predisposing causes in this province appear to have been :—

(i) Deficient nourishment. This was particularly the case in the Latuka area.

(ii) Bad housing; the huts throughout the"greater part of the province are small, badly constructed, and overcrowded.

In Meridi district, and in particular in the western part of this district inhabited by the large Zande tribe, conditions are better. Food is more plentiful owing to the fertility of the soil and the greater industry of the people. The huts are better built and separate huts are occupied by the man and by each of his wives, and thus overcrowding is avoided. It is noticeable that the Zande tribe as a whole has not been seriously affected by cerebro-spinal meningitis since it has come under effective administration.

(iii) Exposure to infection from across the border. The province marches with Abyssinia, Uganda and the Belgian Congo. In the first of these countries no effective health administration exists.

This disease used to occur in epidemic form throughout the Sudan, but for many years now has failed to reach epidemic proportions. It is hoped that the further development of an organised medical service, the raising of the general standard of life, and in particular the better nourishment and the better housing of the people, will have the effect of eliminating this disease as an epidemic factor in the outlying and less developed provinces.

DENGUE.

No outbreak of dengue occurred in the Sudan; a few cases occurred in per¬ sons freshly arrived in the Sudan in which the infection had presumably taken place in Egypt. As dengue was epidemic in Egypt and Greece, with both of wh'ch countries communication is frequent, this freedom would appear to be attribu¬

table to a low stegomyia index. Dengue was seasonably endemic in Port Sudan up to 1908. It was epidemic in Kordofan, White Nile and Berber Provinces in

1924, but since then no cases have been reported.

The following list shews the number of collections of mosquito larvae and pupae found during each month at Port Sudan, and the distribution of the collections of larvae found among Anopheles, Stegomyia and Culex.