Emergency and Humanitarian Action (EHA),

Weekly Activity Report I. General Situation a. Political, Social and Security; The security situation in Acholi, Lango and Karamoja sub-region is calm. Week 3, b. Main Events of Interest/Concern for Health Implementation of the 3rd round of IRS in on-going in Kitgum and Pader district 12th to 18th January Preparation to conduct mass Polio vaccination campaign is ongoing in Kitgum, 2009 and Pader district. This campaign is scheduled for 31st January to 1st

February 2009.

The number of cases of Hepatitis E reported in is on the increase Home Based Management of Fever using Coartem to begin in 5 sub-counties in Epidemic outbreak of Meningococcal meningitis in the districts of Hoima, Masindi, Arua, Moyo and Adjumani. II. Analysis and Health Consequences (Health Problems and Needs of Affected Population) Malaria: Acholi, Lango and Karamoja sub-regions; The trend of malaria cases in all sub-regions in the last three weeks is similar to that of 2008 for the same epi-week. Limited stock of Coartem in health facilities in Amolatar, Dokolo, Lira and is hampers effective management of malaria cases in Lango sub-region

Figure I

Highlights

Outbreak of Meningitis

3rd round of IRS is being conducted in Kitgum and Pader district

Dysentery: Acholi, Lango and Karamoja; The number of cases of dysentery reported in all sub-regions except Acholi in 2009 is comparable to that of 2008. In Acholi sub-region the number of

cases reported in 2009 is much less than that of 2008 for the same epi-week. See figure II for details.

Acknowledgement Figure II

Production of this weekly activity report has possible by contribution from the followings

Hepatitis E: 34 new cases were registered in epi-week 3 of 2009 down from 38 cases registered in epi-week 2. The cumulative number of cases registered now is 9,407 with 152 deaths (CFR 1.62%). Kitgum district the epi-centre of the epidemic registered 28 new cases with no death. Pader district the second most affected district registered 6 cases up from 1 case registered in epi-week 2. See table I and figure III below for details.

Table I District New cases New deaths Cumulative Cumulative cases deaths

Kitgum 28 0 9,285 143 (1.54%)

Gulu & Amuru 0 0 17 (9 positive) 2 (13.3%)

Pader 6 0 102 7 (7.3%)

Lango 0 0 3 0

Total 34 0 9,407 152 (1.62%)

Meningitis; There is an epidemic outbreak of meningitis in the district of Hoima, Masindi,

Arua, Moyo and Adjumani. A cumulative total of 336 cases have been registered with 43 deaths (CFR 13%). See table II below for details

Table II District Date 1st Date last Cumulative Cumulative CFR Number of sub-counties case seen case seen # of cases deaths affected

Hoima Late 26. 01.09 49 13 27% 1 December

Arua 31.12.09 28, 213 19 9% 2 (with sporadic cases 01.2009 reported in 9 other sub- counties) Masindi 4.01.09 02. 02.09 27 8 32% 2 Adjumani 30.12.09 26. 01.09 31 3 10% 1 Moyo 07.01.09 29.01.09 18 0 0% 1 (2 parishes in the sub- county)

Moroto 04.02.09 1 0 0 The case is being investigated

Total 336 43 13%

Measles; Seven suspected cases were reported, 2 in Pader, 2 in Amolatar and 3 in Cholera and AFP; No case reported in the week III. Actions a. WHO Response

Epidemic Response (Sida) . Disease surveillance; o Continue to provide technical and financial support to disease surveillance in all districts in the region. . Malaria; o Support to DHO Kitgum and Pader with the ongoing 3rd round IRS activities . Meningitis; WHO supported the districts of Arua, Hoima, Masindi, Adjumani and Moyo with oily Chloramphenical for case management. Mass vaccination was conducted in 1 sub-county in Hoima, 3 parishes in Masindi, 2 sub-counties in Arua. Community mobilization and sensitization is ongoing in all the affected district. . Measles; Samples from the suspects have been taken to UVRI for confirmation . Hepatitis E; WHO continues to support weekly task force meeting in Kitgum and Pader district, cases management, community mobilization, community sensitization and disease surveillance. . Polio campaign; Provide technical, financial and logistical to DHO Kitgum, Gulu and Pader during the ongoing Polio campaign Others activities; . Data collection for updating of services availability mapping in Gulu and is complete. The data is being analyzed. Emergency Health and Nutrition Response in Karamoja (CERF) . Ongoing rehabilitation works in Lorengechora, Lolachat and Panyagara . Supported outreach activities to the returnees in Lomoratoit resettlement site Influx of refugees from DRC . WHO continues to support strengthening of EPR and IDSR, in all refugee hosting districts of western Uganda. . At national level WHO continue to support coordination of response to refugee influx b. Cluster Partner’s Response . Distribution of 230,000 ITNs provided by UNICEF is ongoing in Lango sub-region . NUMAT is supporting the districts to conduct inventory of medicines especially ARVs and HIV test kits. . DED is constructing more new offices in Oyam district for the DHO of the district. The construction is being funded under Northern Uganda Reconstruction Program. . CUAMM continues to support Oyam in implementing comprehensive maternal and child health services (staff development, EmoC, ambulance systems for referrals, immunizations, radio talk shows, support supervision). . CUAMM has organized and funded training of health workers on HMIS in Oyam district. The training will be jointly conducted by NUMAT, Oyam DHT and WHO. . MSF is providing health services and outreach program in some selected sub counties in Lamwo HSD in Kitgum district . AVSI is providing PMTCT services in selected health units in Kitgum district . ACF continues to run CTC and SFCS in Lira and Oyam. . MSFH, ASB and CESVI supporting Hepatitis E control activities in Pader District . Others partners include Concern, TPO Uganda, UNFPA, MSU, MTI, Medair, CPAR, World Vision, ZOA, GOAL and URCS Other partners response to refugees influx from DRC . Partners responding to the refugee crisis include; GTZ, UNHCR, AAH, URCS, AIRD, MSF-F, SCiU, Hope After Rape and CESVI IV. Comments and Conclusions . Preparation for the mass Polio vaccination campaign in the districts of Gulu, Kitgum and Pader which is bordering Sudan is progressing well. National and international NGOs are offering financial, logistical and technical support to the districts. . Response to the epidemic outbreak of Meningitis has been adequate in four out of the 6 affected districts. Better response is specifically documented in districts that had Meningitis epidemics in the last three years. Poor response to epidemics as evidenced by high CFR in Hoima and Masindi are due to lack of institutional memory for meningitis outbreak response. This finding outlines the importance of epidemic preparedness especially for districts that have had no epidemics in the last 2-3 years. V. Plan for Coming Week . Support hepatitis E epidemic response in Kitgum and Pader district . Support response to the influx of refugees from DRC . Providing technical and financial support in the above regions to the office of the DHOs in strengthening HMIS/IDSR . Continue to support 3rd round of IRS in Kitgum and Pader district . Support Polio vaccination campaign in Kitgum, Gulu and Pader district For further information, please contact:

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