Emergency and Humanitarian Action (EHA),

Weekly Activity Report General Situation Political, Social and Security; Week 44, • Al Shabaah Islamic Threats; Uganda security is on high alert following threats from Al Shabaah Islamic group. • LRA: Pursuit of the Lord’s Resistance Army in Central African Republic continues. 26th October – 1st November • Acholi, Lango & Karamoja sub-region is calm, disarmament of armed Karamojong by

UPDF continues. 2009 Main Events of Interest/Concern for Health;

th th • The four days 5 round of mass Polio vaccination campaign started on the 30 October 2009 ended on 2nd November 2009. The coverage achieved were 104%, 151%, 120 and 163% for the districts of Kitgum, Gulu, Pader and Amuru respectively. • 9 People died in of suspect methanol poisoning. Samples have been taken for confirmation of the cause. • A suspected case of hemorrhagic fever was reported from Mytyana hospital, sample has been delivered to Uganda Virology Institute at Entebbe. A team from MOH and WHO has been sent to make additional investigation and assessment. Analysis and Health Consequences (Health Problems and Needs of Affected Population) Malaria: Lango; Dokolo and continues to report high number of cases of malaria in 2009 as compared to 2008. See figure I below for details.

Highlights

1. The 5th round of mass Acholi, Acholi sub-region continues to report high number of cases of malaria in 2009 as Polio immunization compared to 2008 for the same epi-week. Most of the cases are being reported from the campaign achieved districts of Gulu, Kitgum and Amuru. See figure II below for detail coverage of over 100% in all district despite poor turn up at the beginning of the exercise. 2. district continues to report high number of cases of dysentery. There is risk of this trend to continue as access to safe water and sanitation in the region is poor.

Acknowledgement Dysentery: Acholi Sub-region; The number of cases of dysentery reported in dropped Production of this weekly activity from 197 cases in epi-week 42 to 90 cases in epi-week 44. See figure III below for details. report has been made possible by The rest of the districts in Acholi sub-region continue to report comparable number of contribution from the followings cases of dysentery for 2009 and 2008.

Lango sub-region; The number of cases of dysentery registered in all districts in Lango sub- region declined in epi-week 44 as compared to epi-week 43. This follows an initial rise between epi-week 33 and 40 of 2009. See figure IV below for for details.

Hepatitis E; ; 6 new cases of Hepatitis E were registered in Kitgum district in Epi week 44 of 2009, same number as that of epi-week 43. Note that over the last 5 weeks Kitgum district have been registering less than 10 cases per week.

Pader district; No case of Hepatitis E was reported in epi-week 44 as compared to one suspected case registered in epi-week 43. See table I and figure VI below for details.

District New cases New Cumulative cases Cumulative deaths deaths

Kitgum 6 0 10,624 167 (1.57%)

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

Pader 0 0 230 8 (3.6%)

Kaabong 44 (suspected 0 117 (suspected 5 cases) cases) Kotido 1 (Suspected 0 10 (Suspected 1 (11%) cases) cases)

Total 51 0 11,025 181 (1.64%)

Kaabong; A total of 44 new cases of suspected Hep E were reported in Kaabong district in epi-week 44 up from 22 suspected cases reported in epi-week 43.

Kotido; One suspected case of Hepatitis E was registered in in epi-week 44.

Measles, AFP and Meningitis; No suspected case registered in the week.

H1N1: WHO continues to support MoH to conduct training of health workers on H1N1 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; 5th round of IRS to be conducted in Kitgum and Pader district beginning mid (16th) November 2009. Training of supervisors & IRS sprayers and distribution of logistics completed. All districts continue to report either low stock or stock out of first line anti- malarial drug (ACT)

Diarrheal disease; The number of cases of diarrheal disease keeps on fluctuating in most districts in Acholi,

Lango and Karamoja sub-region. This could be due to seasonal variation. Not that latrine coverage and access to safe water in all this regions is below 40%. WHO continues to support the government of Uganda in health education on sanitation & hygiene practices and promotion of water chlorination

Hepatitis E; Karamoja sub region;

• Active case search and line listing of all suspected cases ongoing • Community mobilization and sensitization on improved food hygiene ongoing

Kitgum and Pader district • Community mobilization and sensitization ongoing Cholera; Kasese: 2 new cases registered in the week and are admitted at CTC. The cumulative number of cases is 584 with 10 deaths (CFR 1.7%).

AFP; Results from UVRI were negative for Polio virus.

Mini UDHS in Acholi and Karamoja sub-region;

• Data analysis and report writing ongoing • Preliminary result expected either at the end of November or early December

Other activities • Trained 7 health workers from both Amuru and Gulu district on the management of rape survivors Comments and Conclusions; 1. The just concluded mass Polio campaign in Acholi sub-region achieved coverage of over 100% in all districts. High coverage achieved during campaigns as this often gives a false impression of success. However it is worth noting that the figures used during this exercise are extrapolated from the 2002 census figure from UBoS. There is need to update the figures in light with the reality on the ground i.e. IPD return process. 2. Kaabong district continues to report high number of cases of Hepatitis E. This coupled with poor access to both safe water and sanitation in the region implies that control of the epidemic will prove a big challenge. There is need to concentrate efforts early in the region to avoid the repeat of Kitgum scenario where the epidemic has been on for close to two years. 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 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]