Health Action in Crisis, : Weekly Epidemiological Report – Week 23, 2nd - 8th June 2008

1. Completeness of Reporting All district except Kitgum had over 80% completeness in reporting with 7 out of 14 districts registered 100% completeness. Absenteeism of staff and weak management of the district health system were the main reasons for poor reporting by the district. WHO is supporting the office of the DHO to strengthen support supervision to non reporting health units.

2. Disease Trends

2.1 Malaria Diseases Malaria continues to be the leading cause of morbidity in the region. The number of cases of Malaria in Lango sub-region has reduced by 18% in epi-week 23 as compared to epi-week 22. This number is still much higher than the number recorded in the same epi-week in 2007. 48.6% (6617) of the cases of malaria reported in Lango sub-region originated from Lira district. A technical team from MoH and WHO- visited Lira district to investigate possible outbreak of malaria epidemic in the district, to verify the available response in place and to determine the requirements for responding to the outbreak. This team also investigated the outbreak of a strange disease in Lira district. To date the cumulative number of cases of the “strange disease” is 31 with 1 death (CFR 3.2%). Findings from the team are that cases of the strange disease was originating from two parishes in Apala and Aloi sub-county, because of the scare of the “strange disease” the community initially shunned the use of health centres causing patients to seek treatment late with a complicated picture of malaria, malaria cases are not being treated according to the new treatment policy, poor staffing at the health units has affected disease management, the home management of malaria strategy is non functional and that IRS had not been conducted in the district. The team recommended that additional anti-malarial drugs be dispatched to Lira District and Akura HC II, HBMF strategy be urgently instituted in Lira District through the training of CMDs and supplying them with Coartem so that fever cases are treated promptly within the first 24 hours of onset, train staff in Lira Districts on the new malaria treatment policy. In , the weekly number of cases of malaria has continued to decrease beginning from epi-week 20. This could be attributed to the recently concluded IRS with DDT which was completed in Oyam in epi-week 16. See figure I and II for details.

Figure I:Weekly incidence of malaria in Lango sub-region in WEEKLY MALARIA TRENDS BY DISTRICT IN LANGO SUB-REGION: 1st January - 8th June 2008 2007 and 2008 8500 8000 Lira Apac Oyam Dokolo Amolatar 18000 120% 7500 7000 16000 100% 6500 14000 6000

12000 80% 5500 10000 5000 60% 4500 8000 4000 # of cases #

6000 40% 3500 % of HU reporting HU % of 4000 3000 20% 2000 2500

Number of reported malaria cases malaria reported of Number 2000 0 0% 1500 1 2 3 4 5 6 7 8 9 1011121314151617181920212223 1000 Epi-week 500

Cases 2007 Cases 2008 % HU reporting 2007 % HU reporting 2008 0 1234567891011121314151617181920212223 Epidemiological week

2.2 Diarrhoea disease The number of cases of dysentery in Lango and Acholi sub-region has remained relatively stable. In Karamoja sub-region the number of cases of dysentery in 2008 is 39% higher than the number recorded in 2007 for the same epi-week. This could be attributed to the fact that in 2007 only 64% of health facilities submitted in their weekly epi-report as compared to 93% in 2008. See figure III and IV below for details.

Figure III; Weekly diarrhea incidence Lango sub- Figure IV; Dysentery cases in Karam oja region for the region year 2007 and 2008

140 100% 350 120% 90% 120 300 100% 80% 250 100 70% 80% 200 80 60% 60% 50% 150 60 40% 40% Incidences 100

40 30% 20% HU reporting % of Reported cases 50 20% reporting HU % of 20 0 0% 10% 1 2 3 4 5 6 7 8 9 1011121314151617181920212223 0 0% Epi-week 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 epi-week Incidence 2007 Incidence 2008

Lango 2007 Lango 2008 Lango region 2007 Lango 2008 % HU reporting 2007 % HU reporting 2008

For further information, please contact: Page 1 Dr J.B Tapko, WHO Representative Uganda (a.i.); Tel. +256 41 335500, Mobile +256752728257, Email: [email protected]

2.3 Cholera is on high alert following reports of cholera outbreak in areas of Pajok and Lobone in Southern Sudan. The two areas border Kitgum district.

2.4 Acute Flaccid Paralysis (AFP),

Three suspected cases of AFP were reported in Oyam district in epi-week 23. Sample sent for investigation at UVRI. Results from the previous samples have not yet been received.

Hepatitis E The number of cases of Hepatitis E continuing to rise in Kitgum district, as of 9th June 2008, a cumulative number of 2681 cases of Hepatitis E were registered with 51 deaths (CFR 1.9%). 426 new cases were registered in epi-week 23 as compared to 264 cases in epi-week 22. To date 12 sub counties in Kitgum district namely Agoro, Paloga, Mucwini, Padibe East/West, Orom, Layamo, Kitgum town council, Kitgum matidi, Akwang, Palabek gem and Madi Opei reported cases of Hepatitis E. The weekly number of cases registered continues to rise in Agoro, Padibe, Paloga and Mucwini sub-county, while in Madi Opei the weekly number of cases of Hepatitis E continues to reduce. See figure V and VI for details.

Figure V : epi-curve of Hepatitis E cases in Kitgum district 2 5th Figure IV; Disagrigation of cases of Hepatitis E by sub-county October to 4th May 2008

450 Lokung

400 Akwang 350

300 Orom 250

200 Mucw ini 150 Sub-counties 100 Paloga 50 0 Madi Opei 4748495051521234567891011121314151617181920212223 0 200 400 600 800 1000 1200 Ep i- w eek # of cas es # of cases Cumlative # of cases New cases in the w eek

WHO and partners has continued to provide financial support, technical support and supported the deployment of staff. As of 9th June 2008, additional 8 clinical officers and 2 comprehensive nurses were deployed in the district to support the response. In 9 suspected cases of Hepatitis E was reported in 5 sub-counties. Results of confirmatory test from the suspects are still being awaited. WHO is supporting the district in surveillance, case management, community mobilization and coordination of response.

3. Conclusion The performance of Kitgum district in terms of IDSR reporting has deteriorated. Outbreak of Hepatitis E in Kitgum district still continues unabated especially in Agoro, Paloga and Padibe sub-counties which are recording increasing number of cases on weekly basis. WHO is supporting the DHO to conduct IDSR support supervision to all non reporting health units. Stock out of essential anti-malarial drugs, poor health seeking behaviour of the population and poor management of patients with malaria at health facilities are responsible for the outbreak of the “strange disease” in Lira district. MoH, WHO and partners should implement recommendation of the team.

4. Acknowledgements Production of this weekly update has been made possible by contributions from the following partners:

For further information, please contact: Page 2 Dr J.B Tapko, WHO Representative Uganda (a.i.); Tel. +256 41 335500, Mobile +256752728257, Email: [email protected]