Emergency and Humanitarian Action (EHA),

Weekly Activity Report General Situation Political, Social and Security; Week 36, • LRA: Government of Uganda is continuing to support the government of Sudan and Central African Republic (CAR) to pursue the Lord’s Resistance Army in Sudan and Central African Republic. st th 31 August 6 September • Acholi and Lango sub-region is calm

• Karamoja sub-region; Disarmament of armed Karamojong by UPDF continues. 2009

Main Events of Interest/Concern for Health;

• Four new cases of Influenza A HINI confirmed in the week • A conflict between the Uganda police and rioters in and trading centers resulted in a death of close to 15 people and arrest of more than 300 rioters, the situation is under control

Analysis and Health Consequences (Health Problems and Needs of Affected Population) Malaria: Lango; The number of cases of malaria reported in Amotalar district reduced from 1077 in epi-week 35 to 815 in epi-week 36 representing a 24% reduction. The rest of the districts in Lango sub-region registered similar number of cases of malaria in 2009 as compared to 2008.

Highlights

Four new cases of Influenza A HINI confirmed in the week.

Acholi, Over the last three weeks, the number of cases of malaria increased in all districts in Acholi sub-region. See figure II below for details. .

Marked increase was noted in Pader, and Kitgum district where the weekly incidence of malaria increased from 3,976, 4969 and 4,444 cases in ei-week 34 to 6066, 6646 and Acknowledgement 5,466 cases in epi-week 36 representing a 52%, 34% and 22% increase respectively. The weekly malaria incidence for Gulu and has remained high in 2009 as Production of this weekly activity compared to 2008. report has been made possible by contribution from the followings Karamoja sub-region: For 12 consecutive weeks now, the number of cases of malaria reported in in 2009 is on average 88% higher than that of 2008. See figure III below for details.

Dysentery: Acholi Sub-region; The number of cases of dysentery reported in Acholi sub-region in 2009 is comparable to that of 2008. See figure IV below for details.

Lango sub-region; The number of cases of dysentery in reduced from 29 in epi-week 34 to 18 in epi-week 36 of 2009 representing a 37% reduction. See figure V below for details.

Karamoja sub-region; The number of cases of dysentery reported in increased from 46 in epi-week 35 to 80 in epi-week 36.

Hepatitis E;

Kitgum district; 13 new cases of Hepatitis E were registered in Kitgum district in Epi week 36 of 2009 same number as that of epi-week 35. The cumulative number of cases registered since the beginning of the epidemic in October 2007 is 10,437 with 167 deaths (CFR 1.6%). Sub counties that registered cases in Epi week 36 of 2009 were; Lokung [7]; Mucwini [4]; PalabekGem [1]; Akwang [1].

Pader district; Two new case of Hepatitis E were registered in in epi-week 36 up-from one case registered in epi-week 35. The cumulative number of cases to date registered in Pader district is 221 with 8 deaths (CFR 3.6%). 16 of the 19 Sub Counties have reported at least one case.

4 suspected cases of hepatitis E have been reported from Karamoja sub-region. Samples have been sent to UVRI for confirmation. See table I and figure VI below for details.

District New cases New Cumulative Cumulative deaths deaths cases

Kitgum 13 0 10,437 167 (1.6%)

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

Pader 2 0 221 8 (3.6%)

Kaabong 3 (suspected 0 3 (suspected 0 cases) cases)

Kotido 1 (Suspected 0 1 (Suspected 0 cases) cases)

Total 19 0 10,706 174(1.62%)

Measles, AFP and 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%)

Kasese district; 12 cases in admission. Cumulative number of cases is 477 with 10 deaths (CFR 2.1%).

HINI; ƒ 4 new confirmed cases started on treatment at home. Follow up of their contacts initiated. Cumulative number of confirmed cases is now 20 with no deaths. ƒ A report of suspected Influenza outbreak in a school in has been received at National level; an investigation team to visit the district. 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; WHO is supporting the districts to respond to the high number of cases of malaria. Note that most districts in Acholi, Lango and Karamoja sub-regions have low stock of anti- malarial drugs at health facilities.

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

HINI; • Response; ƒ Regional Training workshop for health workers in Mbarara region (6 districts) ongoing in Mbarara town. ƒ A sentinel site for Influenza was established in Mabarara regional hospital ƒ Work on finalization of the Pandemic Preparedness and Response Plan ongoing ƒ Surveillance continues in all districts and health facilities. ƒ Major challenge to the response is o Lack of fund to implement the national preparedness and response plan.

Hepatitis E; Response to Hepatitis E in Kitgum and Pader district include; • Water chlorination ongoing in some sub counties in Kitgum district • Community mobilization and sensitization is ongoing on the local FM radios • Repair and maintenance of water sources activities are ongoing in some sub counties

AFP; Results for stool samples sent to UVRI in epi-week 33, 34 and 35 have not yet been received.

Cholera Case management ongoing at one treatment centre in Busia district and three treatment centres in . Community mobilization and sensitization ongoing in all districts.

Mini UDHS in Acholi and Karamoja sub-region; • Data collection complete in 8 of the 9 district • Data capture ongoing • Preliminary result expected in November

Other partners Partners active in the region include; ASB, CESVI, Concern, MTI, IMC, IMC, IRC, ACF, AVSI, AIS and Mercy Corps, UNFPA, GOAL, Malaria consortium (MC), AMREF, MEDAIR, , AVSI, MTI, ICRCS, NUMAT, Visions in Action, Health Alert, ARC and CUAMM 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]