Health, Nutrition & HIV/AIDS Newsletter

A publication of the Health, Nutrition and HIV/AIDS Cluster December 2007 Volume 1 Issue 3

Editorial Epidemic of Ebola Viral Hemorrhagic By Dr. Olushayo Olu Health, Nutrition & HIV/AIDS cluster Fever Hits coordinator By Dr. Olushayo Olu

It is amazing how time flies; 2007 which ends in 2 weeks has been a very eventful and busy year for the cluster. The year witnessed many major epidemic outbreaks and natural disasters which include the meningitis out- break in west Nile region, cholera in (spill over from 2006), Marburg in Kamwenge, floods in Teso, Karamoja and northern Uganda, Hepatitis E in Kitgum and recently Ebola in Bundibugyo districts. The cluster involvement in the coordination, implementation, supervision, monitoring and evaluation of the emergency responses to all these outbreaks and disaster has fur- ther strengthened team building, partner- ships, joint planning and implementation and improved cohesion among its members. I believe that these and the lessons learned from the emergency response to these health events have laid a solid foundation for more A technical team visits the Ebola isolation unit in Bundibugyo Hospital. collaborations and joint programming with- in the cluster in 2008. Bundibugyo, a very rural, un- tacts of patients are especially at derdeveloped, and mountain- risk of contracting the disease. In this edition of the cluster newsletter, the ous district of western Uganda Of the total 131 cases, 12 are lead article is on the ongoing emergency has been hit by an epidemic of health workers who were at- response to the Ebola epidemic outbreak Ebola viral hemorrhagic fever. tending to the patients of whom in Bundibugyo district. We also bring you among others, articles on the emergency Ebola is a very infectious and 5 have died. Alert (suspected) flood response in Teso, malnutrition situa- deadly viral hemorrhagic fever cases have also been reported tion in the north and malaria control using caused by a virus belonging to in Kasese, , Kabarole, ITNs in Uganda. Of course we also fea- the filoviridae family. Adjumani, Mubende, Kanungu, ture the regular section on news and events Masaka, , Lira and within the cluster and provide links to useful websites. By the 2nd January 2008, 147 districts but these have been cases and 37 deaths with a Case ruled out by laboratory investi- During the year many actors within and Fatality Rate (CFR) of 25.3% gations confining the outbreak outside the cluster including all cluster due to the disease have been to Bundibugyo district. Follow- members too numerous to mention, hu- reported in 5 sub-counties of ing the laboratory confirmation manitarian partners, donors, Ministry of Health (MOH) and Uganda AIDS Com- the district. Due to the highly of the virus, the Government of mission (UAC) contributed immensely to infectious nature of the disease, Uganda (GoU) the successful implementation of all cluster health workers and close con- Cont. Page 2 activities; to everybody, I say thank you. I also seize this opportunity to welcome Mrs Inside this issue Pauline Ajello, the new Information Assist- ant for WHO Gulu to the editorial board of The emergency flood response in Teso the cluster newsletter. Finally, I wish you all Malnutrition situation in the north a very Merry Christmas and a very Happy Malaria control using ITNs in Uganda and Prosperous New Year! Regular section on news and events within the cluster.

Health, Nutrition and HIV/AIDS newsletter Health, Nutrition and HIV/AIDS newsletter 1 ...from page 1 investigation by community mobilization is CDC, WHO and being implemented to reduce AFENET, psy- risks of transmission of the chosocial support disease. An Ebola diagnostic and food sup- laboratory has also been es- ply by UNICEF, tablished in the Uganda Viral URCS, TPO, But- Research Institute (UVRI) in abika Hospital and Entebbe and so far 125 sam- WFP and medical ples have been tested out of supplies and logis- which 35 were found to be Ministry of Health officials visit Bundibugyo district to tics are being pro- positive. The establishment of assess the ebola situation. vided by all these the laboratory greatly facili- agencies including tated better definition of cases through its Ministry of Health ICRC, World Vision and IRC. and contributed immensely (MOH) officially declared an to improvements in case epidemic of the disease on the To support case management, management. Given the high 29th of November 2007. A com- two isolation facilities were es- CFR and traumatic nature of prehensive epidemic response tablished in Kikyo health centre the disease, psychosocial sup- which focused on establishing IV (which is the epi-centre of port of affected families and infection control at the health the outbreak) and Bundiguyo health workers is also being facility and community levels, hospital while the existing iso- carried out and discharge kits prompt identification of cases lation unit in Mulago hospital, containing essential materials and their contacts, establishment was reactivated to en- such as cloths, condoms, soap, of appropriate isolation facilities sure prompt and effective treat- food ration is being provided and effective treatment, commu- ment of patients using the best to discharged patients nity mobilization and education infection control procedure about the disease was immedi- available. Given that the disease Although the response to ately mounted in the district. is transferred from person-to- the epidemic has so far been person and that most of the cas- very good, there were major In neighboring districts and are- es of the disease cluster around challenges which hampered as where alert cases of the disease patients and health workers epidemic investigation and have been reported, epidemic treating them, infection control initial response efforts. The preparedness measures were causative virus responsible for instituted to prevent spread of this epidemic is a new strain the epidemic. Sequel to the offi- of Ebola which posed diag- cial declaration of the epidemic, nostic challenges and delayed multi sectoral and multi agency confirmation of the epidemic. national and district taskforces This was further compounded were established and meet reg- by the atypical clinical pres- ularly to review the epidemic entation of the patients with response efforts. The taskforce The Ebola isolation unit in Bundibugyo hospital most of them presenting with is chaired and co-chaired by malaria-like symptoms which MOH and WHO respectively at procedures including provision clouded clinical diagnosis of the national level and the RDC of guidelines, training of health the disease. Both of these and at the district level and strong workers and provision of Per- the highly infectious nature partnerships have been built sonal Protective Equipments of the disease contributed to among agencies involved in the (PPE) were rapidly put in place the high Attack Rate (AR) of response. Tasks were assigned in all the isolation units and all the disease among the health based on comparative advan- Regional Referral hospitals in workers which in turn re- tages of each organization; case the country. In addition active sulted in panic and abandon- management is being support- listing, tracing and follow-up of ment of duty by health work- ed by MOH, MSF and WHO, patient’s contacts using mobile ers. The resulting shortage of social mobilization by MOH, teams, Village Health Teams human resources especially UNICEF, WHO and URCS, (VHTs) and Community Medi- nursing staff in terms of num- epidemiology and laboratory cine Distributors and aggressive bers and experience in ebola Cont. to Page 3 Health, Nutrition and HIV/AIDS newsletter 2 Emergency Flood Response Strengthens Health Coordination in Uganda By Dr. Olushayo Olu been worst hit. Major conse- quences of the floods included destruction of crops, houses, population displacement and poor access (many link roads and bridges were washed away).

The floods destroyed many pit latrines and washed the contents into domestic sources of drink- ing water resulting in wide- spread contamination of water sources and lack of sanitation facilities; other health conse- Joint effort: Cluster members from UNOCHA, UNCEF,WFP, PILGRIM and WHO assess the health situation in Ngenge subcounty, , one quences of the floods included of the villages that were cut off due to floods. increases in number of cases of malaria and diarrhea diseases, Unusually heavy rains in the (Kitgum and Pader), 3 in Lango stock-out of essential drugs and northern, eastern and north (Lira, Amolatar and Apac), 6 in medical supplies, inadequate eastern start- Teso (Kumi, Amuria, , number of human resources ing from August to Novem- Bukedea, Kaberamaido and So- and lack of access to good qual- ber 2007 resulted in the heavy roti) and 6 in Bugisu (Bududa, ity basic health services as many flooding in these areas. Manafwa, Kapchorwa, Sironko, areas were cut-off. To ensure a Mbale and Bukwa) had been very effective and well coor- By September about 17 dis- affected with Teso sub-region dinated health response to the tricts, 2 in Acholi sub-region (Amuria and Katakwi districts) Cont. Page 11

Ebola Fever hits Bundibugyo...from page 2

response and inadequate logistics (med- Key points to remember about Ebola ical supplies especially Personal Pro- tective Equipments) initially posed the Ebola is a serious disease, and kills in a short time greatest challenges to effective response BUT can be prevented. to the epidemic but these have now be Ebola spreads from one person to another through addressed. Underlying weak health physical contact with body fluids of an infected per- systems, poor health infrastructure, son equipment and support services such as Ebola can be prevented through: electricity, water and sanitation and the i. Regular washing of hands with soap and water after difficult terrain of the district were also touching a suspected person major challenges which hampered re- ii. Proper protection using gloves, goggles and masks sponse efforts. Although the epidemic is where possible, when handling patients suffering currently under control and the number from Ebola. of cases is reducing, there is cautious iii. Prompt management of all persons suffering from optimism about predicting its course. Ebola, by seeking early medical help. To this end, all hands are on deck to en- iv. Proper burying of people who have died of Ebola sure that the current momentum of the immediately. epidemic response is sustained over the v. Reporting of any suspected case of Ebola to the near- holiday season. est health unit vi. Avoid communal washing of hands during funerals.

Health, Nutrition and HIV/AIDS newsletter Health, Nutrition and HIV/AIDS newsletter 3 It is time to refocus attention in addressing the nutrition problem in Uganda By Dr. Eric-Alain Ategbo & Mrs. Brenda Kaijuka Muwaga - UNICEF

Since the mid-1980s, northern high as 30% in Gulu to current moving out of camps is limited, Uganda has been trapped in a rates below 5% in all northern compared to when they were in cycle of violence and suffer- districts except in Kitgum. IDP camps. Sustaining reduced ing due to conflict between the malnutrition rates requires a Government of Uganda (GoU) Overall, the downward trends change of focus and a change of and the Lords’ Resistance Army in malnutrition can be attrib- strategy. (LRA). uted to the effective humani- tarian response in addressing Till date, priority was given to In particular, the people of the hunger gap mainly through treatment of severe malnutrition Acholi land in northern Uganda food aid and emergency feeding through Therapeutic Feeding have been significantly affected, programmes on the one hand Centres (TFC) and more re- evidenced by the more than one and the effective management of cently through the Community million Acholis who have been severe acute malnutrition on the Based Therapeutic Care (CTC). forced to flee from their villages other hand. This is based in most cases, on of origin to Internally Displaced VHTs, involved in screening for Persons (IDPs) camps in search However, a reversal in the early identification and referral of relative peace and security. downward trend is being ob- of children with severe malnu- Thanks to progress made in the served (2006-2007) in Lira trition. In some cases, moder- peace talks, ately mal- the situation n o u r i s h e d of the IDP’s children are has evolved referred to with current- Supplemen- ly massive tary Feeding population Programme m o v e m e n t (SFP). It is out of camps, high time to to new settle- move out ments or to of the reac- their original tive mode to homestead. adopt a pro- district and to some extent in active way of preventing onset Significant reduction in malnu- Pader. This may be as a result of of malnutrition. trition rate in northern Uganda the return process spearheaded has been noted. United Nations there in 2006. With people settling in more or Children’s Emergency Fund less permanent areas, nutrition (UNICEF) and other humani- Progress made over the last 4 programme should be oriented tarian partners stepped in to roll years in reducing malnutrition towards community based pro- out an effective emergency re- rate is significant. The upward motion of adequate nutrition sponse plan following an elevat- trend depicted in Lira and Pader practices which include early in- ed prevalence of malnutrition in should be seen as warning signs. itiation of breastfeeding (within 2003 which coincided with the The situation is still fluid and it one hour after birth), exclusive peak of the insurgency in north- is therefore important to put in breastfeeding for the first six ern Uganda. place relevant plans and actions months, and timely initiation to sustain the gain. of adequate (quantity, quality, The Global Acute Malnutrition feeding frequency) complemen- (GAM) was above the emergen- Experience has shown that ac- tary feeding with breastfeeding cy level (15% GAM) in all con- cess to basic health and nutri- up to two years and beyond. flict affected districts from as tion services by populations This effort should be comple- Cont. Page 5 Health, Nutrition and HIV/AIDS newsletter 4 Ministry of Health Consults on a health recovery Strategy and Plan By Pauline Ajello Twenty-one years of war, de- organized a consultative meeting were to identify main linkages struction, and displacement of stake holders to discuss the with on going relevant planning of over 1.5 million people has modalities for operationalising process and existing coordina- turned northern Ugandan into the Peace Recovery and Devel- tion mechanisms and to agree a humanitarian disaster. Health opment Plan (PRDP) through on the overall process and the systems have been broken down, the development of a health re- immediate steps/activities and abandoned as others are closed covery strategy and plan. The responsibilities for taking the for fear of security risks. half day meeting which was held process forward. at Hotel Africana, was attended With the withdrawal of the LRA by Chief Administrative Offic- During the meeting, Dr. Sam to the Congo, security in north- ers and District Health Officers Zaramba the Director General ern Uganda has improved con- from Acholi, Lango, Teso and of Health Services urged district siderably resulting in popula- Karamoja regions of Uganda, leaders to provide a supportive tion movements close to original donor partners, key MOH offi- and peaceful environment that homes. With the improvement cials and cluster members drawn would encourage transition in security, the Government of from the United Nations and from emergency to peace and Uganda launched the Peace Re- Non-governmental Organisa- development. He stressed that covery and Development Plan tions. this strategy provides an oppor- (PRDP) which sets the pace tunity for all stake holders to for return and early recovery in The main objective of the meet- participate in the process. Northern Uganda. ing was to reach a common un- derstanding among key health In his speech, the WHO coun- On 2nd November 2007, the stakeholders on the purpose of try representative, Dr. Melville Ministry oh Health with support the health sector recovery strate- George, called for commitment from the Health, Nutrition and gy for northern Uganda, its chal- from the districts saying it is HIV/AIDS cluster led by WHO, lenges and opportunities. Others very crucial for the success of this program. He commended all stakeholders for showing It is time to refocus attention commitment and interest to this process. ....from page 4 He called on all those present mented by promotion of healthy moja and South Western Ugan- to work together to make the behavior including hand wash- da, with prevalence of stunting strategy a reality. He said that ing, use of latrine, use of clean reaching 50% in Southwest and all stakeholders are learning. water and promotion of health 54% in Karamoja. care seeking behavior. He also said that the PRDP will pose more challenges now that To significantly influence na- WHO and other partners are While significant improvement tional indicators and thus, con- moving to other districts. is being seen in Northern Ugan- tributing to achieving MDGs da, malnutrition rate in Karamo- 1 and 4, it is imperative for the During the meeting, the road ja sub-region has increased two nutrition community to careful- map for the health recovery folds between 2005 and 2007, in- ly target areas of high malnutri- strategy and plan was also pre- creasing from 5 – 10% to above tion and to roll out and support sented. The development of 15%, exceeding the emergency government to roll out relevant the strategy and plan are not threshold. strategies/programmes, not only one-off activities but a process aiming at cubbing prevalence which will take sometime. The Moreover, the recent UDHS of severe malnutrition, but also road map started in November (2006) has revealed high preva- designed to successfully prevent 2007 and will be concluded in lence of malnutrition in Kara- onset of under nutrition. June 2008.

Health, Nutrition and HIV/AIDS newsletter Health, Nutrition and HIV/AIDS newsletter 5 US $ 374 million needed for humanitarian and recovery assistance to Uganda in 2008 By Sheila Gashishiri

gave away Information, Educa- tion and Communication mate- rials and showcased interesting pictorials capturing powerful moments of the cluster activities during the course of the year.

The humanitarian community, in cooperation with national and district – level government authorities, has developed the CAP 2008 as a combination of humanitarian and recovery programming that contributes to achievement of the strategic Health, Nutrition and HIV/AIDS cluster exhibit during the 2008 CAP launch objectives identified within the The Government and humani- ating at the launch at Hotel Af- Peace, Recovery and Develop- tarian community in Uganda on ricana said that it is hoped that ment Plan (PRDP) for north- 10th December 2007 launched the humanitarian community ern Uganda in order to ensure the 2008 Consolidated Appeal will provide assistance against a smooth transition from crisis for Uganda (CAP 2008), which the backdrop of the continued to recovery. The Consolidated seeks US$ 373,943,491 to address improvement in humanitarian Appeals Process is the principle emergency life saving needs and access and se- facilitate the recovery of vulner- curity resulting able groups, including displaced from the ongo- and formerly displaced popula- ing peace nego- tions, refugees and those affect- tiations between ed by natural hazards in Acholi, the Lord’s Re- Lango, Teso, and Karamoja re- sistance Army gions. (LRA) and the g o v e r n m e n t . “The consolidated Appeal 2008 “This improve- represents the humanitarian ment has en- community’s commitment to couraged a Prof. Tarsis Kabwegyere, Minister of Disastor provide appropriate assistance in steady stream of Preparedness and the Humanitarian Coordinator four areas: to IDPs and returnees Internally Dis- Mr. Theophane Nikyema iuspect stalls of exibiting in northern and north-eastern placed Persons clusters during 2008 CAP launch. Uganda, those suffering from the (IDPs) to move insecurity and extreme poverty out of the displacement camps tool by which the humanitarian, in Karamoja, those affected by into transit sites or villages of human rights and development disasters caused by natural haz- origin.” In order to showcase communities’ work in partner- ards and to the refugees seeking major highlights of activities that ship with the Government to shelter in Uganda from conflict have taken place during the year, plan, coordinate, fund, imple- in their own countries,” said the humanitarian clusters includ- ment and monitor humanitarian United Nations Humanitarian ing the Health, Nutrition and assistance for vulnerable popu- Coordinator Theophane Nikye- HIV/AIDS (H+N+H/A) clus- lations. As a planning and pro- ma, speaking, at the launch of ter exhibited during the launch. gramming tool, the CAP pro- the CAP 2008. The Minister The H+N+H/A cluster exhib- motes a strategic, coordinated, for Disaster Preparedness, Prof. ited documentaries of various effective and prioritised human- Tarsis Kabwegyere while offici- activities by cluster members, itarian response.

Health, Nutrition and HIV/AIDS newsletter 6 WFP empowers youth in northern Uganda with Life skills reduction of HIV/ AIDS amongst vul- nerable young people in the target areas by creating a support- ive environment for the initiation and im- plementation of the HIV/AIDS interven- tions in the two dis- tricts and enhance the capacity of selected communities to initi- ate and manage HIV/ AIDS behaviour change interventions for the target group.

In order to meet the youths’ expecta- Young mothers attend a mobilisation activity tions, WFP plans to carry out mobiliza- The precariuos situation in Uganda developed a project in tion meetings and which many adolescents grow the four northern districts of workshops for key stakehold- up in the Internally Displaced Uganda to enhance ‘Life-Skills’ ers. Twenty – four community People’s (IDP) camps and re- among the youth. The purpose groups of young people of in turn area of northern Uganda of the project was to build ca- and out of school in the dis- contributes to risky behaviours pacity among the youth towards tricts of Kitgum, Pader, Lira and such as; alcoholism, drug abuse, HIV Prevention Programs Amuru will benefit from the life domestic violence, sexual abuse (CBHP). The program is be- skills development programs. and prostitution. This predis- ing implemented by Ma-PLAY poses the young population with funding from DFID . The WFP will also train district in the north and north-eastern districts having the target young youth friendly trainers and Uganda highly vulnerable to people are being provided with equip them with facilities that STDs/HIV/AIDS and un-in- food from WFP. would enable them support club tended pregnancies among oth- activities. There is commitment ers. Under this project, youth clubs from the district and communi- were formed with the objective ty leaders as evidenced from the A recently concluded survey of educating young people who way 24 community clubs vol- among young people out of remain vulnerable to STDs/HIV untarily mobilized themselves school conducted by the World and other adolescent health and are carrying out activities Food Programme (WFP) dem- challenges with adequate knowl- amongst their peers in the camps onstrated that, 67.2% were sex- edge, positive attitudes and life and nearby villages. ually active and 29.8% were ei- skills to assist them understand The gaps in knowledge, atti- ther married or living with their and appreciate who they are, tudes and practices amongst the partners. For those young peo- what they are going through and target group and trained 104 ple in school, only 13.6% out of how better they can achieve their Youth friendly teachers and out 53.6% sexually active were liv- goals and dreams in life. of school Volunteers in Training ing with their partners. of Trainers have also been as- WFP expects that the project sessed. To address this problem, WFP will broadly contribute to the

Health, Nutrition and HIV/AIDS newsletter Health, Nutrition and HIV/AIDS newsletter 7 Health Services Availability Mapping Survey concluded in Lango By Dr. Micheal Lukwiya

The Ministry of Health with be low in HC IIIs in Amolatar to nurses/midwives ranges from funding from DFID and in col- and Apac and worse in all HC 1:2,158 in to 1:5,398 laboration with Uganda Bureau IIs in all districts of the Sub- in . Distribution of Statistics (UBoS) and WHO region. Only 50% of HC IVs of the few doctors available in conducted a Health Service were offering ART services and the sub-region was skewed with Availability Mapping (SAM) provision of PMTCT services most of the doctors, nurses and survey in all health facilities in at HC III level is poor ranging midwives located either in the the five districts of Lango sub- from 25% to 54%. The regional regional referral hospital or the region from March to August hospital, HC IVs and IIIs in general hospitals. 2007. The survey whose objec- Dokolo and Oyam districts and tive was to identify critical gaps all general hospitals except the Although data collected at the in health services delivery with one in were community level showed that a view to defining priority in- found to be offering TB serv- most community interventions terventions for health recovery ices. However, generally there like general food distribution, in the area was conducted us- is a low coverage of TB testing Home based care for AIDS pa- ing a descriptive cross sectional services ranging from 25% to tients, Community based TB- survey methodology with col- 54% in HC IIIs in Amolatar, DOTS and Adolescent friendly lection of both quantitative and Apac and Lira Districts. Less services were being offered in qualitative data. than 80% of HC IIIs were IDP camps and settlement sites found to be offering in-patient the coverage of these services Highlights of the survey results services in the area. The provi- were very low. For instance, less indicate that there are 131 health sion of Family Planning (FP) than 10% of camps in Lira and facilities out which 18 (13.7%) and antenatal (ANC) services is Oyam had home-based care for are non-functional in sub-re- generally poor in all HC IIs in AIDS patients while less than gion, of the 18 non-functional the five distrcts. All sub-coun- 20% of IDP camps had under- health facilities, 15 (83%) are ties in Amolatar, Dokolo and gone Indoor Residual Spraying health centres II and 13 (72%) Apac except Ayer sub-county (IRS). are located in Lira district. Al- were offering delivery services. though all the 113 functional In Oyam and Lira district, Recommendations of the survey health facilities offer Out-Pa- normal delivery services were include the need to functional- tient Department (OPD) serv- available in all except in five (5) ize all health facilities in the area ices, the per-capita utilization sub-counties. Basic Emergency and address the major causes is between 0.5 and 0.9 whose and Obstetric Care (EmOC) of poor OPD utilization. Vac- figure is below the national av- services were absent in all HC cination services should also be erage of 1. Almost all health fa- IVs in Apac, Dokolo and Oyam scaled up in all health facilities cilities surveyed reported stock- districts while only fifty percent especially in HC IIs in Amolatar out of at least one of the tracer of HC IVs in Lira district were District where the provision of drug in the last 3 months. More offering these services. the above services is 0% for HC than half of the health facilities IIs. Furthermore there is need in Apac and No HC III in the entire sub- to scale up the provision of re- had infrastructure defect in at region was offering basic productive health services in all least one site in the building. EmOC services. Comprehen- health facilities through deploy- Pope Paul XXIII hospital in sive EmOC was lacking in all ment of appropriate staff and Aber had a major crack in the HC IVs and Lira regional re- provision of drugs and equip- wall, floor and roofing of OPD, ferral hospital. The survey also ments. HIV/AIDS services such maternity and theatre. Access to showed a huge gap in human re- as HCT, ART and PMTCT safe water and latrines was poor sources for health with the ratio must be scaled up appropriately in health centres in Lira, Oyam of doctors to population rang- to be able to reach the popula- and . ing from 1:25,272 in Lira Dis- tion in return sites and ensure HIV/AIDS counseling and trict to 1:110,617 in Amolatar testing services were found to District. The ratio of population Cont. Page 9

Health, Nutrition and HIV/AIDS newsletter 8 Uganda scores higher in consumption of iodised salt

The Uganda Demographic babies in the country are also and Uganda Revenue Authority Health Survey (UDHS, 2006) protected against brain damage (URA), in collaboration with reveals that ninety-six per- caused by lack of iodine in their the Ministry of Health (MOH), cent (96%) of households in mother’s diet. Iodine deficiency technical and financial support Uganda are consuming iodized is the largest single cause of ir- from UNICEF has helped make salt as compared to the inter- reversible brain damage in the substantial progress in the coun- national cut-off point of 90%. world. It is a problem of public try. The proportion of households health importance in Uganda in Uganda therefore consum- and as a result, all edible salt is According to a study carried out ing iodized salt is higher than to be iodized. The Universal Salt in 2005 by the School of Public the international cut off point. Iodization (USI) strategy for Health (Mulago Hospital), the The UDHS-2 (2006), further the control of Iodine Deficiency Urinary Iodine Excretion (UIE) explains that 96% of newborn Disorders (IDD) has been under trend in the country is high. The implementation study indicates that the higher Table 1: Table 1 below reveals that in all in Uganda since median (UIE) is at 463.8 mcg/l. regions, the proportion of households 1994. To support However, in 1999/2000 the uri- consuming adequately iodized salt is equal the strategy, a leg- nary excretion in Uganda was as or higher than the international cut off islation to make high as 310mcg/1. point. However West Nile, Southwest and production and Western regions deserve special attention. import of edible It is therefore necessary to initi- salt compulsory ate dialogue to revise the iodine Nil Inadequate Adequate was passed in 1997. content of salt. It is also impor- Iodine (<15 ppm) (> 15 ppm) The effective qual- tant to sustain high proportion of ity control of salt households consuming iodized Central 1 0.0 1.1 98.8 carried out at ma- salt. This can be done through Central 2 0.2 1.4 98.4 jor entry points by awareness creation in poor per- the Uganda Na- forming districts by building on Kampala 0.0 0.4 99.6 tional Bureau of the power of school children as East Central 0.1 2.0 97.9 Standards (UNBS) effective change agents. Eastern 0.0 2.2 97.8 97.8 ...from page 8 North 0.1 2.7 97.2 97.2 SAM results West Nile 0.1 8.3 91.6 continuity of services especially for those on ARVs. The survey report also recommend the Western 7.2 2.9 89.9 need for the district local government to de- Southwest 2.8 5.4 91.8 velop long-term strategies to attract and retain National average 1.5 2.8 95.6 health staff in the area. Lastly, community- based interventions which hitherto focuses on IDP population should be re-designed to fol- Table 2: level of Urinary Iodine Excretion in low-up the IDP population to return areas. In Uganda (UIE) this way continuity of service provision will be % with % with assured to the IDPs especially during the ear- Median % with UIE UIE UIE ly phase of return and recovery programmes UIE Region < 100mcg/l 300 – 500 > 500 where provision of services by government to Mcg/l mcg/l mcg/l return populations are still lacking.

Central 437.3 3.9 27.0 43.6 In conclusion, as an operational plan for the Eastern 467.6 2.9 28.8 45.9 implementation of the health component of the Northern 564.2 1.2 25.0 59.2 PRDP, is being developed, MoH and the dis- tricts must ensure that the recommendations Western 388.3 7.7 26.9 35.5 of the SAM survey in Lango sub-region are National 463.8 3.9 27.0 45.9 reflected and addressed in the health recovery * For population iodine nutrition to be considered adequate, plan and strategy. the median UIE should be 100 mcg/l. Health, Nutrition and HIV/AIDS newsletter Health, Nutrition and HIV/AIDS newsletter 9 The Common wealth youth forum provided an opportunity to enhance young people’s potential for development

ing youth devel- opment through support to pro- grammes such as Universal Educa- tion, Universal Secondary Educa- tion, Youth En- trepreneurship Scheme and their representation of youth in all or- gans of decision- making including the .

Youths from Commonwealth countries meet during the youth forum at Imperial Botanical hotel The outgoing Sec- in Kampala retary General to the Common- The Commonwealth Youth Fo- their potential. wealth, Rt. Hon. Don Mckin- rum, 2007 (CYF), which was non, said that the Youth Forum hosted by Uganda between 13 The Commonwealth Youth to 20th November 2007 provid- Forum was a ed an opportunity to enhance great opportunity young people’s potential for de- for the youth in velopment. Uganda and East Africa as a whole The United Nations family to share experi- participated in the meeting and ence and best used the opportunity to exhibit practices with the and re-affirm its commitment youth from the to ensuring youth development Commonwealth in all aspects of life especially family particular- Some of the exhibition stalls at the Commonwealth their participation in the social ly on how to real- Youth Forum. and economic development of ize and enable the potential’s of the provides the platform for de- youth be turned bate and exchange, which offers into meaningful a vision of active citizenship, as reality. young adults start to play im- His Excellency, portant roles in their communi- Gen. Yoweri ties. Museveni while opening the Despite it being a Common- conference said wealth forum for young people, that the govern- it was attended by representa- ment of Uganda tives from 42 countries out of Youths consult at the UN exhibition stall. has since 1986, 52, which signifies that youths’ been encourag- contribution is highly valued.

Health, Nutrition and HIV/AIDS newsletter 10 In and Out

Pauline Ajello, Public Information Assistant Pauline Ajello replaces Ida-Marie Ameda as the new Public Information Assistant for Health Action in Crisis program of WHO Uganda. She joined in November 2007. She worked at Straight Talk Foundation for 5 years and holds a bachelor of Mass Communication from MUK. Pauline is a Ugan- dan

Francesca Akello Programme Coordinator Francesca Akello has joined Malaria consortium as programme coordina- tor communicable diseases for northern Uganda, west Nile and Karamoja. Before joining Malaria consortium, Francesca worked with UPHOLD as the Field technical coordinator in Northern Uganda in the areas of HIV/ Aids, Education and health. She has a masters in Business Administration and is a Ugandan.

Sascha Von Lieven-Knapp Field Coordinator Sascha Von Lieven-Knapp is the new Field coordinator for MSF spain in Gulu. She replaces Patricia Parra. Sascha was formerly working in sudan before she came to work in Gulu Uganda.

Flood Response Strengthens Health Coordination ...from page 3 III and poor access to the opera- 130,000 from Italian Govern- tional health facilities as the im- ment) was raised toward this floods, the health, nutrition and mediate health challenges. appeal. The flood response pro- HIV/AIDS cluster was acti- To fill these gaps, many part- vided an excellent opportunity vated in Teso region and a com- ners within the cluster provided for cluster members to jointly prehensive emergency response drugs, medical supplies, emer- assess, plan, mobilize resources plan focusing on ensuring ac- gency health and cholera kits and and implement activities togeth- cess to good quality basic health logistics support to the affected er in real time; these contrib- services in the affected areas and districts. Technical and financial uted immensely to building of epidemic preparedness espe- support was also provided to all partnerships and more cohesion cially for malaria and diarrhea affected districts to strengthen within the cluster which in turn diseases was jointly developed Integrated Disease Surveillance strengthened the coordination by cluster members working in and Response (IDSR) and ac- capacity of the cluster. the area. tivate active surveillance which resulted in increase in weekly Furthermore, development of Several joint rapid health assess- reporting from 68% to 98% in collaboration and critical links ments were conducted to ascer- Teso sub-region and IDSR data with other clusters such as tain the true health situation in were used to regularly monitor WASH guided decision making the affected areas. In addition, disease trends. and response and fostered inter drug stock inventory taking cluster cooperation. The clus- and malaria epidemic risk as- To address funding gaps, a joint ter will draw from the lessons sessments were conducted in health, nutrition and HIV/AIDS learned from this response to Teso. These assessments identi- flood flash appeal worth about ensure more effective collabora- fied drug stock-out, inadequate 3.3m USD was launched by the tion among cluster members in health staff, non-functionality health cluster and about 880,000 future. of many health centres II and USD (750,000 from CERF and

Health, Nutrition and HIV/AIDS newsletter Health, Nutrition and HIV/AIDS newsletter 11 Call for Applications

Fourth Public Health Pre-Deployment Course (PHPD4)

The World Health Organisation is organizing the next Public Health Pre-Deployment Course start- ing from 30 March to 12 April 2008 in Hammamet, Tunisia The main objective of the course is to prepare professionals with experience in public health and related fields to design, implement, manage and/or coordinate health sector emergency response and early recovery programmes in crises situations effectively, efficiently and safely.

The course will be organized in three modules as follows: i. Humanitarian context ii. Public health issues: Assessment and planning for health action iii. Operational and personal effectiveness

At the end of the course, participants will be expected to participate in a two-day field simulation exercise that will provide them with an opportunity to apply learned knowledge and skills in a series of emergency-like scenarios. The cost of the course is US$ 3250 per participant. This includes tuition and all course materials, accommodation and board and the journey from and to the Tunis airport and the course venue. Par- ticipants are expected to cover their travel costs from their place of residence or work to Tunis and back, including medical and travel insurance, out-of-pocket and other incidental expenses. WHO will be able to provide some full or partial scholarships to deserving applicants thanks to the gener- ous support of the Swiss and Russian Governments. Deadline for the submission of applications is 15 January 2008. For more information and submission of applications, please visit: http://www.who.int/hac/techguidance/training/predeployment/phpd4/en/index.html

Editorial board members Dr. Olushayo Olu, Dr. Godfrey Bwire, Pauline Ajello, Health Nutrition and HIV/ Ministry of Health Public Information Assistant AIDS Cluster for Health Action in Crisis coordinator Dr. Eric Alain Ategbo, program of WHO Uganda Nutritionist, Dr. Filippo Ciantia, UNICEF Uganda Country Director, AVSI Uganda

For more information regarding the Health, Nutrition and HIV/AIDS newsletter please contact Dr. Olushayo Olu, WHO Country Office, P.O. Box 24578 Kampala, Email: [email protected] Mobile: +256 772 721962

This publication has been made possible by the following partners

Health, Nutrition and HIV/AIDS newsletter 12