Emergency and Humanitarian Action (EHA),

Weekly Activity Report General Situation Political, Social and Security; Week 42, • General: Somalia's hardline al Shabaab insurgents said they will attack Burundi and Uganda's capital cities in revenge for rocket attacks by peacekeepers from those countries that killed at least 30 people in Mogadishu. "We shall make their people cry. th th 12 – 18 October We'll attack Bujumbura and ... We will move our fighting to those two cities and we shall destroy them," Sheikh Ali Mohamed Hussein, a senior al Shabaab 2009 commander, told reporters late on Thursday in Mogadishu. (Reporting by Abdi Guled; Editing by Matthew Jones) • LRA: Government of Uganda, Sudan and Central African Republic (CAR) is continuing to pursue the Lord’s Resistance Army in Sudan and Central African Republic. • Acholi and Lango sub-region is calm • Karamoja sub-region; Disarmament of armed Karamojong by UPDF continues.

Main Events of Interest/Concern for Health; • CAP 2010; Process of developing CAP 2010 is complete. 16 project sheets were submitted under the Health and HIV/AIDS component and 11 project sheets under the nutrition component. The budgets were US $ 12,919,670 and 9,487,027 for Health and HIV/AIDS component and Nutrition component respectively. • Influenza A H1N1; WHO supported all 5 districts in Lango sub-region to develop Influenza A H1N1 preparedness & response plans & contingency plans for other disasters – sensitization of stakeholders done / session on specimen handling carried out in all districts; • Child days Plus activity (immunization, deworming and early infant diagnosis ongoing in ) • The outbreak of Influenza A(H1N1) continue to spread. The total confirmed cases have reached to more than 179 but not all cases are tested and hence the actual number is expected to be higher. To date 5 districts have reported confirmed cases and 14 schools have been affected by the outbreak. No deaths reported and the severity remains mild. Analysis and Health Consequences (Health Problems and Needs of Affected Population) Malaria: Lango; The number of cases of malaria reported in increased from 1,455 cases in epi-week 41 to 2,565 in epi-week 42 representing a 76% increase in the number of cases. See figure I below for details.

Highlights

CAP 2010; Process of developing CAP 2010 is complete. 16 project sheets were submitted under the Health and HIV/AIDS component and 11 project sheets under the nutrition Acholi, Acholi sub-region continues to report high number of cases of malaria in 2009 as component. compared

In district, the number of cases of malaria in 2009 has been much higher than that of 2008 for the same epi-week. Acknowledgement

Production of this weekly activity report has been made possible by contribution from the followings

Dysentery: Acholi Sub-region; The number of cases of dysentery reported in Pader district increased from 96 cases in epi-week 41 to 197 cases in epi-week 42 representing an increase of over 100%. See figure III below for details.

Lango sub-region; Dokolo district continue to register high number of cases of dysentery in 2009 as compared to 2008. See figure V below for details.

Hepatitis E; Kitgum district; 8 new cases of Hepatitis E were registered in Kitgum district in Epi week 42 of 2009 this number is up from 6 cases registered in epi-week 41.

Pader district; Two new cases were reported in Pader district in epi-week 42 up-from zero case registered in epi-week 41. See table I and figure VI below for details.

District New cases New Cumulative Cumulative deaths deaths cases

Kitgum 8 0 10,596 167 (1.6%)

Gulu & 0 0 44 (9 positive) 0 (0) Amuru

Pader 2 0 229 8 (3.6%)

Kaabong 7 (suspected 0 62 (suspected 0 cases) cases)

Kotido 2 (Suspected 0 9 (Suspected 1 (11%) cases) cases)

Total 19 0 10,940 176 (1.60%)

Karamoja sub-region; A total of 9 new cases of suspected Hep E were reported in epi-week 42. The cumulative number of cases reported is 71 with 1 death (CFR 1.4%).

Influenza A(H1N1) The outbreak of Influenza A(H1N1) continue to spread. The total confirmed cases have reached to more than 179 but not all cases are tested and hence the actual number is expected to be higher. To date 5 districts have reported confirmed cases and 14 schools have been affected by the outbreak. No deaths reported and the severity remains mild

A regional table top exercise was organized by the Governemtn of Uganda in collaboration with the US army. 5 countries (Burundi, Rwanda, Tanzania, Kenya, and Uganda) have participated in the training.

Measles, Two (2) cases of suspected clinical measles recorded in epi-week 42 from Apac &

Oyam - samples taken to UVRI for confirmation.

AFP Three (3) cases of suspected AFP reported epi-week 42 from Lira samples sent to UVRI for confirmation.

Meningitis; No suspected cases reported in the week.

Cholera ; Last case admitted on 5th September 2009. Cumulative number of cases is 106 with 8 deaths (CFR 7.5%)

Kamwenge district; 4 new cases in admission. Cumulative number of cases is 142 with 7 deaths (CFR 4.9%). Actions (WHO response, Sida grant)

Epidemic Response

Disease surveillance; WHO continues to support all districts in Acholi, Lango and Karamoja sub-region financially and technically in disease surveillance. Weekly epidemiological reports depicting disease trends are shared with all the districts and partners.

Malaria; Preparation for IRS ongoing in Pader and Kitgum district. This activity is planned for late October or early November

Diarrheal disease; WHO is supporting district to investigate the apparent increase in the number of cases of dysentery.

HINI; One severe case of flu due to influenza A (H1N1) admitted to Kampala International hospital is getting an intensive care because of poor renal function following the infection. The patient an 11 years old school girl acquired the infection from her school but has an underling medical illness (Nephrotic syndrome). Further investigation and follow up is going on.

Hepatitis E; Karamoja sub region; • Active case search and line listing of all suspected cases • Training of VHTs to support social mobilization ongoing in all sub-counties. • Community sensitization on food hygiene • Parish Action Committees attached to Medair has been reactivated & trained on Hep E • IEC materials have been distributed to some sub counties • MSF Spain conducted training of Health workers in all 27 health facilities on clinical management of Hep E using the MOH treatment protocol. • Began borehole repair and disinfection in Karenga sub county

Kitgum and Pader district • Community mobilization and sensitization ongoing

AFP; Preparation for another round of mass Polio vaccination ongoing in Acholi sub-region

Cholera Case management ongoing at one treatment centre in Kamwenge and Community mobilization and sensitization ongoing in all districts.

Mini UDHS in Acholi and Karamoja sub-region; • Data collection complete in all district • Data capture ongoing • Preliminary result expected in November

Other partners • UNICEF is supporting the implementation of HIV / AIDS activities & HBMF training in Lira districts • Partners are supporting response to the malaria upsurge in . • NUMAT continues to fund the Malaria, TB and HIV/AIDS activities in the districts including training of CMDs for the new antimalarial treatment protocol. • CUAMM continues to support Oyam in implementing comprehensive maternal and child health services (staff development, EmoC, ambulance systems for referrals, immunizations, radio talk shows, support supervision); other CSOs active in Health & HIV / AIDS activities; • WHO FO is supporting Lira & the other 4 districts to prepare for the H+N+H+A sector meetings – Lira held their meeting on 15/10/09:- • UNICEF supported ORS / Zinc TOT training following Comments and Conclusions;

Plan for Coming Week • Support MOH to respond to Influenza A H1N1 pandemic • Support hepatitis E epidemic response in Kitgum and Pader district • Support Busia and Kasese district to respond to epidemic outbreak of cholera • Provide technical and financial support to the DHOs in strengthening HMIS/IDSR • Provide technical and financial support to MoH and UBoS in conducting mini- Demographic and Health Survey For further information, please contact:

Dr. Joaquim Saweka, WHO Representative Uganda: Tel. +256 41 335500, Mobile +256 752 728 257, Email: [email protected]