MINISTRY OF HEALTH THE WEEKLY EPIDEMIOLOGICAL BULLETIN WEEK 32: 3rd –9th Aug 2020

Dear Reader, Current public health threats We are pleased to share our 32nd weekly epidemiological bulletin COVID-19 as 0f 9th Aug 2020 for the year 2020.  1,297 Cumulative cases of COVID-19 confirmed This epidemiological bulletin serves to inform all stakeholders at cases in the country among Ugandan nationals district, national, and global levels on disease trends, public health  299,036 specimens collected and tested surveillance and interventions undertaken in detecting, preventing  1137 cumulative total recoveries and responding to public health events in the country on a weekly  145 cases on admission basis.  16349 Cumulative contacts listed  1,294 contacts under follow-up This issue, we showcase the following updates among others  9 deaths among confirmed cases  updates on COVID-19  Suspected rabies (Animal bites_dog bites) Fig 1a: Distribution of COVID-19 Local Transmission  Rift Valley Fever in Mbarara  National trends of suspected epidemic prone diseases  National, regional and district weekly surveillance reporting  District success story in weekly reporting  Public health events in border countries For comments please contact: Dr. Allan Muruta, Commissioner, De- partment of Integrated Epidemiology, Surveillance and Public Health Emergencies - MoH; P.O BOX 7272 , Tel: 080010066 (toll free); Email: [email protected] or [email protected]

Fig 1b: Epidemic curve of COVID-19 as of 9th Aug 2020 (n=1297)

19 Surveillance data Surveillance 19

- Source: COVID Source:

Page 1 Health Workers who contract COVID 19 During the response as 9th Aug 2020 (n=41)

 The criteria for determining Front Line Health Work- Fig 3: Distribution of Health workers by workplace ers includes all staff involved in the provision of care to a COVID-19 patient or working in a health care facil- ity caring for COVID-19 patients

 These may include; Clinicians, Physicians other Allied Health Professionals and auxiliary health workers such as cleaning and laundry personnel, x-ray physicians among others

Fig 2 : Distribution of Health workers by workplace

Malaria  47698 Malaria cases reported  21 deaths reported country wide

Fig 5 : Distribution of Malaria outbreak status, week 32

Suspected Rabies (Animal Bites)  There is a gradual increase in number of animal bites

 Mbarara (13)reported the highest number of animal bites followed by Ntugamo (12) and Masindi (12)

Fig 4: Distribution of Animal bites, week 32 (n=167) Rift Valley Fever Outbreak in Mbarara  On 11th Aug 2020, MoH conformed a RVF Outbreak

 A 46 year old man from Presented with Un explained hemorrhagic symptoms such as bloody urine, nose bleeding, vomiting and high grade fever

 These symptoms started on 1st Aug 2020 and was admit- ted in Mbarara Regional Referral Hospital on 2nd Aug 20

Actions taken

 Contact listing and follow up of people including health workers that handled the patient

 Case management is still on going at Mbarara RRH

 Mentorship of the hospital ward staff

 The MoH submitted the IHR Notification to WHO

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Priority Diseases Acute Flaccid Paralysis (AFP) Surveillance The data presented in table 1 consists of suspected cases. The data shows high numbers of water borne diseases such as;  17 AFP cases were reported during week 32 typhoid, Malaria, and cholera, dysentery in different parts of  The 17 cases were reported from; Bugiri (1), Bugweri (1), the country. Iganga (1), Kalangala (1), Kamwenge (2), Kwania (2), Luuka (1), Mbarara (1), Mityana (1), Nakapiripirit (1), Tab 1: Suspected Cases of epidemic prone Diseases, wk 32 Ngora (1), Ntoroko (1), Obongi (1) and Yumbe (2). Conditions Cases Deaths CFR(%)  The Non-polio AFP rate is 1.04/100,000 children 0 - 14 AFP 17 0 0.0 years compared with 1.97/100,000 children 0 -14 years in AEFIs 7 0 0.0 2019 Animal bites 172 0 0.0  The adequate samples collection rate is 94.20% com- Bacterial Meningitis 7 0 0.0 pared with 89.20% in 2019 Cholera 17 0 0.0 Dysentery 55 0 0.0  NPENT rate is 14.50% compared with NPENT rate of 14.48% in 2019 Guinea Worm 0 0 0.0

Malaria 46,916 22 0.04  Ninety two (96) districts have detected and investigated

Hepatitis B 0 at least one AFP case (fig 6) 0 0.0 Measles 36 0 0.0 Fig 6: Total AFP cases by District, week 32 NNT 9 0 0.0 Plague 0 0 0.0 Other Suspected 2 VHFs 0 0.0 SARI 128 0 0.0 Typhoid fever 900 0 0.0 Yellow fever 0

0 0.0 Data source: DHIS2 Anthrax 2 0 0.0 Leprosy 0 0 0.0 RR T.B 2 0 0.0

Severe Acute Respiratory Infection (SARI), Viral Haemorrhagic Fevers (VHF), Neonatal Tetanus (NNT), lab EPI Datasource: Tuberculosis (T.B), Acute Flaccid Paralysis (AFP), Adverse Events Following Immunisation

Measles (Confirmed cases)  Cumulatively, Seventy-nine (79) districts have detected and investigated at least one suspected measles case.

 34/79 districts reporting measles cases have had at least one positive IgM case

Fig 7. Trends of maternal and perinatal deaths week 1– 32, 2020

Data Data source: DHIS2

Page 3 Table 2: Distribution of maternal deaths (09) and perinatal deaths (225), week 32 Maternal Deaths Perinatal Deaths

Maternal Neonatal Name of Health Fa- Macerated Fresh Still District death- District District District deaths (0-7 cility Still births Birth Deaths days )

Kampala Kawempe NRH 3 Kampala 18 Kampala 22 Kampala 18 Lira Pag Mission HC III 1 Mbarara 7 Mubende 8 Masaka 12 Kotido Kotido HC IV 1 Iganga 6 Mbale 6 Hoima 6

Mayuge Mayuge HC III 1 Mbale 5 Gulu 5 Bushenyi 6 Sheema Kitagata Hosp 1 Kabarole 5 Hoima 4 Kabale 4 Luwero Luwero Hosp 1 Luwero 4 Lira 3 Lira 3 Kabarole Fort Portal RRH 1 Rukungiri 3 Pakwach 3 Nebbi 3 Maracha 0 Nebbi 3 Mayuge 3 Yumbe 2 Kyotera 0 Gulu 3 Luwero 3 Kamuli 2 Buyende 0 Mubende 3 Kisoro 3 Agago 2 Amudat 0 Kasese 2 Mbarara 3 Kisoro 2 Pakwach 0 Kagadi 2 Kabarole 3 Mpigi 2 Abim 0 Ntungamo 2 Kabale 3 Pakwach 1 Yumbe 0 Hoima 2 Iganga 2 Kole 1 Kibuku 0 Kabale 2 Kasese 2 Nakapiripirit 1 Napak 0 Mpigi 2 Nebbi 2 Iganga 1 Kaabong 0 Katakwi 2 Kagadi 2 Rukungiri 1 Bukedea 0 Kazo 2 Busia 2 Kasese 1 Kole 0 Tororo 2 Bushenyi 2 Mbale 1

Fig 8: Completeness and Timeliness of weekly reporting per region, Epi week 32, 2020

 There is a general improvement in completeness of reporting with the highest reporting rates recorded in Karamoja (100), Kigezi (89), Tooro (90), (85), West Nile (90), Lango (89), and Bugisu (89) while Kampala at (32), South central (70)% and North central (75). National average reporting rate declined to 76%

 Timeliness is still a challenge across the country. The regions with the highest reporting rates on time include Kara- moja (74), Kigezi (65), Tooro (56), Busoga (57), West Nile (64) and Lango (45). While those with the least reporting rates include Kampala(18) South Central (48), North Central(53) and Bunyoro (51) (refer to fig 7). National average

Timeliness of reporting is 53% Data source: DHIS2 source: Data

Page 4 Fig 10: Distribution of suspected SARI, 2020 Completeness and Timeliness of reporting by District  There is a great improvement in completeness of re- porting across all Districts (fig 7a)

 Majority of the districts reported late (fig 7b) Fig 9a: Completeness of reporting, week 32, 2020

Public Health Emergencies in neighboring countries Fig 9b: Timeliness of reporting, week 32, 2020

Severe acute Respiratory Infections (SARI) amidst COVID

 SARIs are a significant cause of infectious disease mor- bidity and mortality

 Private health centers are reporting a surge of SARI espe- cially in Kampala

 Differentiating COVID-19 from other SARIs is challeng- ing

 Clinicians should be on the alert during assessments

Source: WHO EPI bulletin week 32 Page 5

Data source: DHIS2 Page 6

Jayne Jayne Tusiime.

Hands on training on MTRAC sending remindersWeekly reporting on by Biostatistician. 3 prison facilities do not exist hough in Iganga District alt- they (Namungalwe, Iganga Busesa) and are registered in DHIS2 system Positive change comes from within staff Continuous reminding of staff has a beneficial effect Need for data quality support supervision Division of Health Information should update the list of active health facilities in Iganga District Districts with ongoing outbreaks should submit their linelists to the PHEOC on a daily basis MOH acknowledges efforts all made by all districts and health facilities in surveillance activities. Regions of; Lango, Kigezi, West Nile, Tooro, Karamoja, Ankole and Bugisu achieved the national targets for the twolast weeks UNEPI reminds and encourages the all districts to carry activeout search for AFP, NNT, EAFI and measles cases in their health facilities and communities. Maternal deaths and perinatal deaths audits should be conducted addressto issues of excessive deaths of moth- ers and newborns especially for Kampala region.

Lesson Learnt

  Challenge for not achieving 100%.    Recommendation        AcknowledgementRecommendations and

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Remember, your feedbackRemember, is important to us.

L) Mwondha Isaac -

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Supplied facilities visited revised with HMIS tools Enrolled missing facilities onto MTRAC Platform We mentored staff on HMIS 033b filling Extracted non reporting scheduled visits facilities including clinics from DHIS2 and Some had old versions of reporting tools Limited knowledge on weekly reporting Some facilities were enrolled not on mTrac

IGANGA TEAM (Surveillance FP), Magala Dickson (Biostatistician) Ms.and Namutamba Sarah (HMIS Focal Person Godfrey Ekuka, Emma Arinaitwe, Job K., Robert Kato, Joyce Nguna, Milton Wetaka, Joshua Kayiwa, Allan Muruta, Carol Kyozira, Godfrey Bwire , David Muwanguzi, Opolot John, Anne Nakinsige, Eldard Mabumba, Benard Lubwama, Leocadia Kwagonza, Harriet Mayinja, Specioza Katusiime, Maureen Nabatanzi, Apolo Ayebale, Freda Aceng, Editorial team  Fig Trends of 11: weekly reporting, in Iganga District   Actions taken    analysis (fig 11). fromFindings bottleneck analysis  For time a Iganga long District was struggling with poor ratesreporting in reporting. weekly Support supervision was yieldingnot results, until the team performed a bottle neck

Improvement in WeeklyReporting Experience from District Iganga