Health Action in Crisis, : Weekly Epidemiological Report – Week 3, January 2008

1. Completeness of Reporting

F ig u re I: C o m p le te n e ss o f ID SR re p o rtin g in n o rth e rn U g a n d a & Improvement in weekly IDSR Karam oja

reporting still continues. All 120 regions had over 90% in completeness of reporting. 10 100 out of 20 districts had 100% 80

completeness of reporting. The 60 improvement in reporting could

% completeness 40 be attributed to among others health workers reporting to 20 duty station. See Figure I on 0 44 45 46 47 48 49 50 51 52 1 2 3 completeness of IDSR Week

reporting. Acholi Teso Lango Karam oja Mt Elgon

2. Disease Trends

2.1 Malaria Diseases All regions except Acholi sub-region showed a slight decrease in the number of cases of malaria. The number of cases of malaria in Acholi

sub-region increased by 970 Fig u re II: Re p o rte d c a se s o f m a la ria in N o rth e rn U g anda & (10%). See figure II. The Karam oja

increase in number of cases of 25,000 malaria in Acholi sub region could be partially explained by 20,000

the increase in completeness of 15,000 reporting in Acholi sub-region from 82% in epi week 2 to 93% # cases 10,000

in epi-week 3. Other 5,000 explanations are stock out of 0 community coartem leading to 44 45 46 47 48 49 50 51 52 1 2 3 people seeking treatment at Week

health facility. Teso-region still Acholi Teso Lango Karam oja Mt Elgon consistently recorded the highest incidence of malaria cases.

2.2 Diarrhoea disease

Figure III: Reported cases of dysentery in Northern Uganda & Karam oja Acholi sub-region still reported 700 the highest number of cases of dysentery in epi-week 3. See 600 500 figure III. Acholi region is the s only region that showed 400 300

increase in number of cases of # of case dysentery. The number of cases 200 in the rest of the district 100 remained relatively constant 0 despite increase in 44 45 46 47 48 49 50 51 52 1 2 3 Week completeness of reporting. Acholi Teso Lango Karam oja Mt Elgon

For further information, please contact: Page 1 Dr Melville George, WHO Representative Uganda; Tel. +256 41 335500, Mobile +256752760214, Email: [email protected]

Further analysis of IDSR data from Acholi sub-region in epi-week 3 revealed that overall there is 11% increase in number of cases of dysentery. See figure IV. Looking at individual district dysentery number, recorded 46% increase in numbers of dysentery, recorded 22% increase in incidence of dysentery. The increase in dysentery incidence could be partially explained by increase in completeness of reporting in those districts as seen in figure V below or water source contamination by faecal matter1. The office of the DHO and WHO sub-office in Gulu is consulting the district water office to see how best the issue of water source contamination can be addressed.

Figure IV; Weekly incidence of Dysentry in Acholi sub-region Figure V; Reported cases of dysentery by district in Acholi sub- region

700 100% 300 90% 600 80% 250 500 70% 60% 200 400 50% 300 150 40% Incidence

200 30% 100

20% Number of cases

100 reporting HU of Proportion 10% 50 0 0% Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk Wk 0 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 Epi-week Ep i- w e e k

Incidences Completeness in reporting Kitgum Amuru Gulu Pader

2.3 Meningitis

Figure VI; Epi-curve of Meningitis cases, district

The epidemic outbreak of Meningitis in West 30

region is declining (See figure VI). Cumulative 25 number of cases as of epi-week 3 is 298 with 15 20 deaths (CFR 5%). 111 new cases were admitted in epi-week 3 of 2008. WHO is providing technical 15 assistant to the office of the DHO, supporting the 10

district to train health workers and supporting of cases Number 5 surveillance activities. Vaccines for mass vaccination have arrived in the district. Case 0 c c c n n n Jan Ja an an De -Dec -De De - -J J 3--5 1- 2- 4-Ja 6-Jan 8 4- management, and community mobilization is on- 1 15-Dec17-Dec19-Dec21 23-Dec25-Dec27 29-Dec3 10 12-Jan1 16-Jan18-Ja 20-Jan Date of admision going in the districts. Mass vaccination is planned for epi-week 4.

2.4 Other priority diseases Epi curve of Hepatitis E cases in Madi Opei sub-county Kitgum Epidemic outbreak of Hepatitis E is still on-going in district Madi Opei Sub-county, . The 25 cumulative number of cases has reached 199 as of 20 25 January 2008, with 7 deaths – giving a CFR of 3.5% (See figure VII). 21 new cases have been 15 registered during week 3 and most of the cases 10 originated from 1 satellite camp called Wanglango. # ofcases Intervention measures have been intensified in the 5 past 3 weeks, which should result in interruption of 0 transmission of infections shortly. However, due to 15- 19- 23- 27- 1- 5- 9- 13- 17- 21- 25- 29- 2- 6- 10- 14- 18- 22- 26- Nov Nov Nov Nov Dec Dec Dec Dec Dec Dec Dec Dec Jan Jan Jan Jan Jan Jan Jan the prolonged incubation period of the disease, a -5 Date of registration

1 Gulu district report on water quality assessment in Aswa district, DDHS Gulu/WHO, September 2007 For further information, please contact: Page 2 Dr Melville George, WHO Representative Uganda; Tel. +256 41 335500, Mobile +256752760214, Email: [email protected]

couple more cases are expected to continue reporting in the coming weeks.

3. Conclusion The IDSR reporting for all regions improved. 10 out of 21 districts had 100% completeness in IDSR reporting in epi-week 3. The weekly incidences of malaria seem to be increasing in Teso sub-region. Acholi sub-region still reports high incidences of dysentery as compared to other region. Epidemic outbreak of Hepatitis E in Kitgum district is still on-going. Epidemic outbreak of meningitis in Arua district is being contained. Response to the epidemic is in full gear in all the epidemic affected districts.

4. Acknowledgements

Production of this weekly update has been made possible by contributions from the following partners:

For further information, please contact: Page 3 Dr Melville George, WHO Representative Uganda; Tel. +256 41 335500, Mobile +256752760214, Email: [email protected]