Emergency and Humanitarian Action (EHA), Uganda Weekly Activity Report General Situation Political, Social and Security; Week 37, • 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. th th 7 to 13 September to • 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; • An outbreak of Influenza A (H1N1) in a school in Bushenyi has been confirmed. Eight (8) out of 10 samples taken randomly from the cohort have tested positive for A (H1N1). The school with a population of 400 students has just opened about a week ago. A national rapid response team has been dispatched to support the district response. • The government is working on a contingency plan for a possible El-Niño which is expected to start in October. Three possible scenarios have been developed by the national taskforce. In the best case scenario maximum 30 districts will be affected with limited damage to infrastructure to which the community could be able to manage without external support. The Mid case scenario anticipates 45 districts to be affected with 10 districts inaccessible and infrastructure damaged making the districts unable to manage the impact of the disaster. The worst case scenario expects over 50 districts (out of 80) to be affected, 15 of which will be inaccessible. 300,000 households will be affected with a serious impact on infrastructure. Analysis and Health Consequences (Health Problems and Needs of Affected Population) Malaria: Lango; The number of cases in wk37 has shown a further drop of 10.3% between wks36 & 37 for the 2nd consecutive week (there was a 6% drop between wks35 & 36 - and is still slightly higher than that of wk37 of 2008 by 11.8%. There were ten (10) deaths due to malaria in epiwk37 (6 from Lira, 3 from Apac & 1 from Oyam) cf. one (1) from Lira in wk36; seven (7) in wk35 (5 from Oyam & 2 from Lira); and three (3) in epiwk34. So far wk37 with 10 deaths has overtaken wk13 which had the highest reported malaria deaths of (8) from all the districts Fig. 1: Lango weekly malaria trends 2007 -2009 20000 100% 18000 90% 16000 80% Highlights 14000 70% 12000 60% An outbreak of 10000 50% 8000 40% H1N1 in Busheni 6000 30% No. of weekly malaria cases school 4000 20% of% completeness of reporting 2000 10% 0 0% 12345678910111213141516171819202122232425262728293031323334353637383940414243444546474849505152 Preparation for a Epi weeks Lango 2007 malaria Lango 2008 malaria Lango2009 Malaria possible El-Niño Completeness of reporting 2007 Completeness of reporting 2008 Completeness of reporting 2009 Acholi, Since week 19 the total number of cases for 2009 has remained high in Acholi region. This reporting week only Gulu district has a dramatic reduction in the number of cases by up to 18%. 6 deaths were reported from Gulu and Kitgum districts. Fig II Clinical malaria cases in Acholi region and completeness of reporting for the years 07-09 Acknowledgement Karamoja sub-region: the region has noted a moderate decline in malaria cases but still remain slightly Production of this weekly above the 2008 incidence. activity report has been Fig 1: Karamoja Region,Weekly Malaria Trends made possible by Week 37 contribution from the 14000 110 100 followings 12000 90 10000 80 70 g 8000 60 s reportin ber of Cases 50 U um 6000 H N % 40 4000 30 20 2000 10 0 0 13579111315171921232527293133353739414345474951 Epidemiological Week Number of cases 2009 %completeness 2008 %completeness 2009 Number of cases 2008 Dysentery: Acholi Sub-region; The number of cases of dysentery reported in Acholi sub-region in 2009 is comparable to that of 2008. However there is a slight increase in Pader district for the last two weeks. See figure IV below for details. Lango sub-region; There has been a significant rise in the reported cases of dysentery in the sub-region for the last four (4) epiwks34 to 37 as the rains return. The trends are significantly higher than those recorded in the same period in 2008 & 2007. Dokolo recorded high verified incidence in wk34 & 35 but has dropped in epiwks36 & 37. While the incidence showed a sharp rise in Lira and Oyam in epiwk37, it has remained low in Apac & Dokolo. Data has been verified. Laboratory tests are to be done in Lira Reg. Ref. Hospital for definitive diagnosis Hygiene promotion & health education is on- going. Fig. 3: Weekly Dysentery Trends in Lango Sub‐region: 2007‐2009 140 120 100 80 60 40 20 0 1 2 3 4 5 6 7 8 9 101112131415161718192021222324252627282930313233343536373839404142434445 Lango Dysentery 2009 Lango Dysentery 2007 Lango Dysentery 2008 Karamoja sub-region; The incidence of dysentery incidence remained high this week compared to the past year though some decline was noted this week. Kaabong & Moroto reported the highest cases in the region. In view of the prevailing suspected Hep E outbreak, this is a worrying indicator. Most districts in the region continue to battle with the challenge of low latrine availability, use and resistance amongst other poor sanitary conditions. Fig 3 below illustrates the situation Fig 3: Karamoja Region, Weekly Dysentry Trends, Week 37 500 120 450 100 400 350 80 300 250 60 Number of Cases of Number 200 % HUs reporting 40 150 100 20 50 0 0 13579111315171921232527293133353739414345474951 Epidemiological Week Number of cases 2009 %completeness 2008 %completeness 2009 Number of cases 2008 Hepatitis E; Kitgum district; 18 new cases of Hepatitis E were registered in Kitgum up from 13 last week bringing the cumulative total 10,455.cases and 167 deaths (CFR 1.6%). Pader district; No new case of Hepatitis E was registered in Pader district in epi-week 37. 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. Karamoja; A total of 9 new cases of suspected Hep E were reported this week compared to 5 in the past week. Of the cases 6 were from Kaabong & 3 in Kotido district. The result of the samples forwarded still waits. There was also one reported death due to suspected Hep E in Kotido See table I and figure VI below for details. District New cases New deaths Cumulative Cumulative deaths cases Kitgum 18 0 10,455 167 (1.6%) Gulu & 0 0 44 (9 positive) 0 (0) Amuru Pader 0 0 221 8 (3.6%) Kaabong 6 (suspected 0 10 (suspected 0 cases) cases) Kotido 3 (Suspected 1 4 (Suspected 1 cases) (suspected) cases) Total 27 1 10,734 175(1.6%) (suspected) Measles; 2 cases reported from Oyam and Lira Meningitis; No suspected cases reported in the week. AFP; one suspected case reported from Pader Cholera Busia district; 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; ♣ As of 22nd September a total of 28 confirmed cases were reported in Uganda with no death. The outbreak in Busheni School was investigated and 8 out of 10 samples taken randomly tested positive for H1N1. A team from MOH and WHO in the field for further analysis and investigation. Micronutrient deficiency; The micro nutrient deficiency in Karamoja district is still not under control; 4 new cases were reported from another sub county (Kakomongole) 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; and Hepatitis E Follow up on the epidemic of HEV in Kabong district of Karamoja. Supported the development of response plan for the district. Provided assorted essential supplies. Investigation of the causes of dysentery in Gulu and Amuru has started by the districts. It will take a period of four weeks. WHO will assist with transport of specimens collected weekly to UVRI. HINI; • Response; ♣ WHO participated in the investigation of the influenza outbreak in Busheni district ♣ Work on finalization of the Pandemic Preparedness and Response Plan ongoing ♣ Surveillance continues in all districts and health facilities. ♣ 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 Kasese district. 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, 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, Major activities by partners: • Supporting the implementation of the HIV / AIDS activities in the district plan; • Partners participating in the malaria control activities following the upsurge of clinical malaria; • Support to Malaria, TB and HIV/AIDS activities in the districts including training of CMDs for the new ant malarial treatment protocol.