Emergency and Humanitarian Action (EHA),

Weekly Activity Report ¾ General Situation Political, Social and Security; a. Disarmament of armed Karamojong by UPDF continues. Cattle raids by armed Karamojongs reported. Acholi and Lango sub-region is calm ¾ Main Events of Interest/Concern for Health; Week 31, a. WFP conducted Nutrition and Health assessment in Acholi sub-regions in …. Preliminary findings from the assesment revealed that GAM for 26th July – 2nd August was above the emergency level and U5MR was 1.9/10,000/day. b. Joint mission from WHO office lead by WHO Country Representative 2009 Dr. Joaquim Saweka visit Amuru, , Kitgum, Pader and from 2nd – 6th August 2009. c. Preparation for the 4 days mass polio campaign in the 12 high risk district of Uganda is ongoing. This campaign is scheduled to begin on the 15th August 2009 ¾ Analysis and Health Consequences (Health Problems and Needs of Affected Population) Malaria: Lango; The number of cases of malaria reported in Lango sub region in 2009 is comparable to that of 2008 in all districts in except Apac. See figure I below for for details

Highlights

• There is need for WHO to continue providing technical support to the district during the return and early recovery Acholi, For 13 consecutive weeks now the number of cases of malaria reported in Gulu phase district in 2009 is much higher than that of 2008. See figure II below for details.

• The nutrition situation and mortality in Amuru district is alarming according to the report of the nutrition and health assessment conducted by WFP in Acholi sub-region.

Karamoja sub-region: For the last seven weeks, the number of cases of malaria reported in district in 2009 has been significantly (>50%) higher than that of 2008. See figure III below for details.

Acknowledgement

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

Epidemic outbreak of Cholera in ; • Cumulative number of cases since the begging of the outbreak is 93 with 7deaths (CFR 7.5%). 6 of the 7 death occurred at HU. • 3 cases discharged from the ward today. No patient on admission in CTC currently • Response; ƒ Rapid response team has been reactivated ƒ CTC opened at Busia HC II ƒ Community mobilization using radios and VHTs ongoing ƒ Major challenge to the response is resistance of the community to behavior change.

Dysentery: Acholi and Lango sub-region; Dysentery incidence in Lango and Acholi sub-region in 2009 remains low as compared to 2008. See figure IV below for Lango sub-region for details.

Karamoja sub-region; continues to register high number of cases of dysentery in 2009 as compared to 2009. See figure V below for details.

Hepatitis E; 22 new cases of Hepatitis E were registered in in epi-week 31 down from 32 cases registered in epi-week 30 representing an increase of 31.2% decline in the number of cases. See table I and figure VI below for details.

District New cases New deaths Cumulative cases Cumulative deaths

Kitgum 22 0 10,359 165 (1.59%)

Gulu & Amuru 1 0 43 (9 positive) 0 (0)

Pader 4 0 219 8 (3.7%)

Lango 0 0 3 0

Total 27 0 10,624 173(1.63%)

Four suspected cases of Hepatitis E were reported from in epi-week 31. This number is up from three suspected cases reported in epi-week 30.

One suspected cases of hepatitis E was reported in in epi-week 31, same number as that of epi-week 30. Note that previous sample sent to UVRI has not been analyzed due to lack of reagents.

Measles and Meningitis; No suspected case reported in the week AFP; One suspected case reported in Kitgum district HINI: No suspected case reported in the week. ¾ Actions (WHO response, Sida grant)

Epidemic Response

Disease surveillance; WHO continues to support districts financially and technically in disease surveillance. Weekly epidemiological reports depicting disease trends have been shared with all the districts and partners.

Malaria; • NMS supplied anti-malarial drugs to health facilities in Gulu and Lira district. The drug stock is anticipated to last one month. • Community mobilization using radios, community mobilization and sensitization using VHTs is ongoing • Amuru district is expected to receive anti-malarial drugs from NMS next week.

Diarrheal disease; Stool samples sent to UVRI from Kotido district showed no growth because of poor sample collections. WHO is supporting the district to send another stool sample.

HINI; • Screening for Influenza A (H1N1) is ongoing at Entebbe international airport and Busia border. • Gaps o Inadequate funding for the response o Supplies (gloves, mask and other protective gears) low

Hepatitis E; Response includes; case management, community dialogues, health education and enforcing the bylaws and public health act.

AFP; Preparations for implementation of the 4 days Polio campaign in 12 high risk is progressing well. This activity is scheduled to begin on the 14th August. Stool sample from the suspected case in Kitgum district has been sent to UVRI for confirmation.

Mini UDHS in Acholi and Karamoja sub-region; • Data collection ongoing in all districts in Acholi and Karamoja sub-region • Data capture ongoing

WCO mission to Acholi and Lango sub-region; Joint mission from WHO Kampala office lead by WHO Country Representative Dr. Joaquim Saweka visit Amuru, Gulu, Kitgum, Pader and Lira district from 2nd – 6th August 2009. The objective of the mission was to; ¾ Discuss and create common understanding with district officials (CAO, LC IV chairman, RDCs and DHOs) on WHOs plan for the region given the current return and recovery period ¾ Better understanding of the current challenges facing return and recovery process (draught, starvation, epidemics, frequent drug stock out, HR challenges and other health systems challenges) ¾ Better understanding of the expectations of other humanitarian and development partners on the role of WHO in return and recovery The team met district leaders (Resident District Commissioners, Local Council V chairman, Chief Administrative Officers and District Health teams), Village Health Teams and return population. The team also visited health facilities, IDP camps and return villages. Major findings were; ¾ District officials Recognized the vital role of WHO in responding to the humanitarian situation in the region. They still feel that the role of WHO as a technical agent in essential especially during the recovery period. ¾ DHTs There is need to continue providing technical support to the DHT in planning, disease surveillance, epidemic preparedness and response and control of neglected tropical diseases ¾ Health units 9 Stock out of essential medicines 9 Poor staffing at health units ¾ VHTs 9 All district have trained VHTs however, the number of trained VHTs varies from district to districts. For instance Lira district has trained more than 2,500 VHT. Gulu district has less than 1,000 trained VHTs 9 The VHTs lack drugs for home management of fever 9 There is inadequate supervision of VHTs by health units ¾ Return sites 9 Majority of the population have moved away from IDP to village of origin 9 Access to health care, safe water and sanitation is poor at return sites 9 Prevalence of NTD especially Onchocerciasis is high along Pager river\ 9 VHT coverage in return sites is poor

Reports from Nutrition and Health assessment in Acholi sub-region by WFP;

The assessment was conducted in July 2009 in the districts of Amuru, Kitgum, Gulu and Pader. GAM Mortality U5 CMR (per 10,000/day) (per 10,000/day) Amuru 11.3 1.9 0.8 Kitgum 7.4 0.58 0.55 Gulu 5.1 1.1 0.87 Pader 4.7 1.14 0.85

• GAM and Under 5 mortality in Amuru district is close to emergency level • Common causes of morbidity was malaria, cough and diarrheal disease • Immunization coverage for region has declined from 98% in 2006 to below Comments and Conclusions • There is need for WHO to continue maintaining its presence in Acholi and Lango • The mortality rates and nutrition status of under 5 in Amuru district calls for immediate action be humanitarian partners. 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 district 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]