Emergency and Humanitarian Action (EHA),

Weekly Activity Report I. General Situation i. Political, Social and Security; • Acholi and Lango sub-region: is calm Week 30, • Karamoja sub-region; Disarmament of armed Karamojong by UPDF continues. Cattle raids by armed Karamojongs reported II. Main Events of Interest/Concern for Health; 20th – 26th July • Preparations for implementation of Polio campaign in 12 high risk districts of

Uganda is progressing well. The 4 days campaign is scheduled to begin on the 14th 2009 August 2009

• Mass drug administration with Ivermectin, albendazole & praziquental was successfully conducted in . The objective of the exercise is to control/prevent/reduce the prevalence of NTDs especially onchocerciasis & filiariasis. . Of the 364,406 targeted populations, about ¾ were covered. II. Analysis and Health Consequences (Health Problems and Needs of Affected Population) Malaria: Lango; continues to report high number of cases of malaria in 2009 as compared to 2008. See figure I below for details

Highlights

• There is an epidemic outbreak of cholera in Busia district in Acholi, For three consecutive weeks, the number of cases of malaria registered in all districts Eastern Uganda. in Acholi sub-regions continue to decline. However, the number of cases of malaria registered in 2009 is higher than that of 2008 for the same epi-week. See figure II below for details.

Cholera; • Epidemic outbreak of Cholera in Busia district Acknowledgement o Cumulative number of cases since the begging of the outbreak is 83 with 6 deaths (CFR 8.7%). 5 of the 6 death occurred at HU at the beginning of the Production of this weekly activity epidemic. report has been made possible by o 16 patients are on admission in CTC currently contribution from the followings o Response; ƒ Rapid response team has been reactivated ƒ CTC opened at Busia HC II ƒ Community mobilization using radios and VHTs ongoing ƒ Major challenge to the response is resistance of the community to behavior change.

Dysentery: Acholi and Lango sub-region; Incidence in Lango and Acholi sub-region in 2009 remains low as compared to 2008. Karamoja sub-region; The number of cases of dysentery registered in decreased from 143 cases in epi-week 29 to 70 cases in epi-week 30 representing a 51% decrease. Preliminary investigations indicate that the steep raise in epi-week 29 was a result of data collection error. See table IV below for details. WHO is continuing to support the district to strengthen surveillance.

Hepatitis E; 32 new cases of Hepatitis E were registered in in epi-week 30 up from 27 cases registered in epi-week 29 representing an increase of 18.5%. The 32 cases were registered from 10 sub-counties with Lukung and Padibe sub-counties registered 50% of the cases. See table I and figure IV below for details.

District New cases New deaths Cumulative cases Cumulative deaths

Kitgum 32 1 10,337 165 (1.59%)

Gulu & Amuru 1 0 43 (9 positive) 0 (0)

Pader 3 0 211 8 (3.8%)

Lango 0 0 3 0

Total 36 1 10,594 173(1.63%)

Three new cases of Hepatitis E were registered in Pader district in epi-week 30 up from one new case registered in epi-week 29. The cumulative number of cases of Hepatitis E registered in Pader district is 211 with 8 deaths. (CFR 3.8%).

One suspected cases of hepatitis E was reported in in epi-week 30. Samples from the suspects have been sent to UVRI for confirmation. UVRI has not been able to analyze the samples due to lack of reagents.

HAT and AFP; No suspected case reported in the week Measles; One suspected case was reported from Meningitis; One suspected case was registered from Gulu district. The suspect died and was buried before investigation.

HINI: • One new case was confirmed in the week. III. Actions (WHO response, Sida grant)

Epidemic Response

Disease surveillance; WHO continues to support districts financially and technically in disease surveillance. Weekly epidemiological reports depicting disease trends have been shared with all the districts and partners.

Malaria; • Trained 120 health workers in Gulu district on RDT use • Community mobilization using radios, community mobilization using VHTs is ongoing • The districts are expected to receive anti-malarial drugs from NMS next week.

Diarrheal disease; Community mobilization on latrine construction and improve hygiene is ongoing in all district.

HINI; • A total of 33 suspected cases of HINI have been investigated in Uganda of which 8 were positive for HINI. Of the eight positive cases 4 are imported, 3 are household contact of the imported case and 1 is community transmission. No death has so far been registered in Uganda. • Gaps o Inadequate funding for the response o Supplies (gloves, mask and other protective gears) low

Hepatitis E; • Water quality surveillance was done for 127 water sources in 15 of the 19 sub- counties in Kitgum district of which 17 were found contaminated (13.4%) and recommended for disinfection. • WHO has deployed water and sanitation officer to Kitgum district to support district response • WHO supported Kitgum district to relocate environmental staff to most affected sub counties to assist in community mobilization for improved environmental sanitation • The office of the RDC, Local government and police is supporting enforcement of public health act • Water chlorination is ongoing in some sub-counties • Inadequate funds still remains a big challenge to the response.

AFP; WHO field office in Pader continues to provide technical support to the district to conduct 60 days of follow up of suspected AFP cases. So far 14 days have elapsed. Meningitis; WHO is supporting the office of the DHO Gulu to follow up on the close contact of the suspected meningitis case. Mini UDHS in Acholi and Karamoja sub-region; • Data collection ongoing in all districts in Acholi and Karamoja sub-region • Data capture ongoing IV. Comments and Conclusions Busia district is one of the district in Uganda which reports epidemic outbreak of cholera every year. Low latrine coverage, poor access to safe water and resistance of the community to change behavior are some of the reasons for the outbreak. WHO and partners will continue to mobilize the community towards behavior change. V. Plan for Coming Week i. Support MOH to respond to Influenza A H1N1 pandemic ii. Support hepatitis E epidemic response in Kitgum and Pader district iii. Support Busia district to respond to epidemic outbreak of cholera iv. 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]