Emergency and Humanitarian Action (EHA),

Weekly Activity Report Weeks 42, 43 I. General Situation and 44 a. Political, Social and Security 13th – 2nd November ƒ The security situation in Acholi and Lango sub‐region remains stable. There is October 2008 ongoing population movements from IDP camps to villages of origin ƒ In Karamoja sub‐region, the security situation is volatile with inter‐clan cattle rustling reported. Disarmament of armed Karamojongs by government forces is ongoing. There are also reports of clashes between government and armed Karamojong militias.

b. Main Events of Interest/Concern for Health ƒ Influx of refugees from Democratic Republic of Congo (DRC) to Uganda ƒ Ongoing response to epidemic outbreaks of Hepatitis E in Kitgum ƒ Epidemic outbreak of cholera at Butabika National Mental Referral Hospital

II. Analysis and Health Consequences (Health Problems and Needs of Affected Population)

Malaria: In the number of cases of malaria registered in 2008 has been persistently higher than that for 2007 for the same epi‐week. Increase in number of health facilities reporting, lack of/poor coverage of malaria prevention activities (ITNs, IRS) and frequent stock out of anti‐malarial drugs may partially explain the increase. See figure I for details

Highlights

• Ongoing response to epidemic outbreak of Hepatitis E in Kitgum and cholera in Butabika National Mental hospital

• Responding to influx of refugees from DRC to Uganda

• On‐going Emergency Health and Nutrition Response in Karamoja Dysentery: Over the last four weeks the number of cases of dysentery recorded in all sub‐ (CERF) regions. Cholera: 7 cases of cholera has been reported in Butabika National Mental Referral

Hospital in epi‐week 43 Polio: Threat of wild polio virus in districts bordering Sudan. Two suspected case of acute flaccid paralysis was reported, one from Lira and another from , samples taken to UVRI for confirmation Measles: One case of measles was reported in in epi‐week 43, samples have been taken to UVRI for confirmation Acknowledgement Meningitis: One clinical case of measles reported in epi‐week 43 in Kitgum district Hepatitis E: The number of weekly registered cases of Hepatitis E in Kitgum district in epi‐ Production of this weekly week 42 and 43 was 96 and 94 respectively. To date the cumulative number of cases activity report has registered in all districts is 8,879 with 139 deaths (CFR 1.5%). See table I for details. Sub possible by contribution counties that registered most cases were Mucwinin, Padibe E/W, Agoro, Layamo and from the followings Potika. Sub‐counties reporting increasing number of cases include Kitgum Town Council, Kitgum Matidi and Nam. In Pader district four new case of HEV was reported. See table I for details of HEV

Table I: New Hepatitis E Cases by District in Week 43 District New New Cumulative Cases Cumulative deaths (Case cases deaths Fatality Rate CFR) Kitgum 94 1 8,807 130 (1.47%) Gulu & 0 0 15 (8 confirmed) 2 (13.3%) Amuru

Pader 4 0 54 (8 confirmed) 7(12%) Lango 0 0 3 0 Total 98 1 8,879 139 (1.5%)

III. Actions a. WHO Response

Epidemic Response (Sida) ƒ In response to the current stock out of anti‐malarial drugs in lower health units in Lango, WHO is supporting the office of the DHO to transport drugs from National Medical Stores to the DHOs store in Lira; in Pader district

WHO has supported the office of the DHO to transport drugs from the DHOs store to lower health units. WHO is also advocating for distribution of ITNs and conducting of IRS in Lira district. ƒ In Kitgum district, support was provided to train health workers on surveillance, active case search and screening children under 5 years for immunization. This is in response to the current threat of epidemic outbreak of wild polio virus in Southern Sudan ƒ Provided ongoing technical and financial support to district health teams to coordinate, supervise, monitor and evaluate the hepatitis E epidemic response in Acholi sub‐region ƒ Provided additional health workers for case management, social mobilization and hygiene education in Kitgum district ƒ In response to epidemic outbreak of cholera in Butabika hospital, WHO and MoH conducted a rapid assessment in the hospital. As a result of this assessment, a cholera treatment centre was established in the hospital ƒ Ongoing support to active data collection, analysis and dissemination

ƒ Convened meeting to review mental health interventions in the conflict affected region of Northern Uganda

Flood Risk and Vulnerability Reduction Project in Teso and Mount Elgon Regions (Italian Grant) ƒ Printed VHTs record books for distribution to the trained VHTs ƒ Conducted refresher training of 85 VHTs from district ƒ Printed and distributed weekly surveillance booklets to Bukedea and Kumi districts.

Emergency Health and Nutrition Response in Karamoja (CERF) ƒ Draft concept note on nutrition surveillance strategy developed and circulated ƒ HMIS & IDSR forms printed and distributed to all health units ƒ 13 Village phones procured and delivered to all districts of Karamoja and airtime provided to all HSDs for IDSR ƒ All 10 HSDs were provided with computers to support HMIS/IDSR and nutrition surveillance ƒ Seventy six (76) health workers were trained as trainers for VHTs ƒ Ongoing rehabilitation of 5 health units in the region ƒ Sensitized district and sub‐county leaders in Karamoja region on VHTs

Others ƒ In response to the current influx of refugees from DRC into Western Uganda, one National Professional Officer has deployed to the region to conduct assess the health situation of the refugees. Findings from the assessments will guide further response to the refugees ƒ Participated in a two days CERF training workshop in Nairobi from 28th – 29th October 2008

b. Cluster Partner’s Response ƒ Medical Team International and Medair, is providing mobile clinics to areas with no access to health care in Pader district ƒ ICRC is providing medicines and supplies to facilities in Awere sub‐county Pader district ƒ UNICEF, GOAL and Medair are supporting child days activities ƒ NUMAT is supporting various HIV/AIDS activities

IV. Comments and Conclusions ƒ IDSR reporting in all districts except was above 80%. WHO is supporting the office of the DHO Moroto to provide support supervision to the non reporting health units ƒ The epidemic outbreak of Hepatitis E in Kitgum district still persists. Over the last three weeks the number of new cases registered on weekly bases has stabilized at about 95 cases. Decline in the intensity of response like lack of consistency and poor coverage of water chlorination. Decline in intensity of social mobilization and poor access to safe drinking water. V. Plan for Coming Week ƒ Participate in Hepatitis E review workshop in Kitgum district ƒ Continue supporting the hepatitis E epidemic response in Acholi sub‐region ƒ Complete training of VHTs in Teso and Mount Elgon sub‐regions ƒ Commence training of VHTs in Karamoja ƒ Continue to support response to the influx of refugees from DRC ƒ Conduct re‐fresher training of surveillance focal point persons on e‐HMIS ƒ Continue providing technical and financial support the office of the DHO in strengthening HMIS/IDSR

For further information, please contact:

Dr. Joaquim Saweka, WHO Representative Uganda: Tel. +256 41 335500, Mobile +256 752 728 257, Email: [email protected]