Emergency and Humanitarian Action (EHA),

Weekly Activity Report I. General Situation a. Political, Social and Security; • Acholi and Lango sub-region; the region is calm. Week 24, • Karamoja sub-region: ¾ The security situation is calm with few incidents of cattle raids. 8th – 14 June ¾ Disarmament of armed Karamojong by government of Uganda is still continuing. 2009 b. Main Events of Interest/Concern for Health; • Third round of mass Polio immunization and measles campaign is completed and the coverage achieved in Uganda was above 100% for both Polio and Measels.

II. Analysis and Health Consequences (Health Problems and Needs of Affected Population) Malaria: Lango; Over the last five weeks, the weekly incidence of malaria reported from Lira district increased from 5,423 cases per week in epi week 20 to 7,550 cases per week in epi week 24, representing a 40% increase. See figure I for details.

Highlights

• Lira and district continues to report high

number of cases of Malaria. Acholi, continues to report high number of cases of malaria in 2009 as compared to the average number of cases of malaria reported between 2005 and 2008. See figure II below for details. See figure II below

Figure II;

Malaria trends in Gulu district 2009

8000 6000 4000 2000 Graphs 0 Weekly incidence 1 3 5 7 9 111315171921232527293133353739414345474951 Epi weeks

Gulu Malaria 2009 AV malaria 2005-8

Karamoja, The number of cases of malaria reported in karamoja region in 2009 is comparable to that of 2008 for the same epi-week. Acknowledgement Dysentery: Production of this weekly activity report has been made possible by Acholi sub-region; The number of cases of dysentery registered in all districts in Acholi contribution from the followings sub-region in 2009 is slightly less than that of 2008. See figure III for below for details.

Lango sub-region; Dysentery incidence in Lango sub-region in 2009 remain low as compared to the previous year. See figure IV below.

Karamoja; The incidence of dysentery in Karamoja sub-region in epi-week 24 of 2009 is comparable to that of 2008.

Hepatitis E: A total of 31 new cases of Hepatitis E were registered in Epi week 24, 2009 as compared to 25 cases registered in epi week 23. No death was recorded in the week. The cumulative number of cases of Hepatitis E reported to date is 10,364 with 168 deaths (CFR 1.62%). See table I and figure V below for details.

District New cases New deaths Cumulative cases Cumulative deaths

Kitgum 27 0 10,147 160 (1.57%)

Gulu & Amuru 0 0 40 (9 positive) 0 (0)

Pader 4 0 174 8 (4.6%)

Lango 0 0 3 0

Total 31 0 10,364 168(1.62%)

AFP; • One suspected case reported from . • Immunization coverage for polio for selected districts in Lango sub-region were as follows; Lira 123%, Apac 115%, Oyam 134%, Dokolo 131%, and Amolatar 149%

HAT and Meningitis; No new case reported in the week Measles; • Three suspected cases of measles were reported in the week two suspected cases were from Apac and one from • Immunization coverage for measles for selected districts in Lango sub-regions were as follows Lira 108%, Apac 94%, Oyam 132%, Dokolo 118% and Amolatar 124%.

III. Actions (WHO response, Sida grant)

Epidemic Response

Disease surveillance; WHO continues to support surveillance activity in all district of Acholi, Lango and Karamoja sub-region. Malaria; In response to the high number of cases of malaria being reported from Lira and Gulu district, • Anti malarial drugs were distributed to all HU in Gulu district • EPR committees have been reactivated in both Gulu and Lira district • Rapid Response Team in Lira district are investigating the upserge with support from WHO. • MoH has been notified of the upsurge • Community sensitization on malaria is ongoing using VHTs and radios in Gulu district • Challenges to the response; o Frequent stock out of 1st line anti-malarial drugs especially in Lira district o Lack of human resources in health units

Diarrheal disease; Community mobilization on latrine construction and improve hygiene is ongoing in all district. Measles; Samples from the suspects have been sent to UVRI for confirmation.

HINI; • Draft preparedness and response plan have been developed • Active surveillance continues • Handed over 40,400 doses of Tamiflue and 25 sets of personal protection kits to MoH • Investigated 5 suspected case of HINI since the beginning of the pandemic and all were found negative

Hepatitis E; • Ongoing activities; o District Task force meeting ongoing in Pader and o Community sensitization through radio programs, o Cases management, and o Support to water chlorination ongoing however, the coverage and consistence of this activity is poor as.

Not that the intensity and coverage of the above activity is poor due to lack of fund

HAT; WHO continues to support Dokolo district to respond to HAT there was a review meeting to evaluate the progress made thus far.

Mini UDHS in Acholi and Karamoja sub-region; • Data collection ongoing in all districts in Acholi and Karamoja sub-region • Major challenge is that the number of eligible responders per house hold is more than what was anticipated in the protocol. As a result data collection process may take longer than two months as proposed in the protocol.

Other activities conducted by WHO; • Ongoing rehabilitation works in Lorengechora, Lolachat and Panyagara in Karamoja sub-region

IV Response from others partners; • NUMAT is continuing to support ART clinics and laboratories at HC III and IV. • Visions in Action: providing HCT outreaches in selected areas in both Amuru and Gulu districts. • Health Alert: follow-up of babies born to HIV+ mothers, anti-HIV/AIDS stigma campaigns in schools and adolescent positive HIV/AIDS prevention campaign. • UNICEF: routine immunization in sub counties, support to CHDs and support to PMTCT programmes at HC III and above. A training of health workers from PMTCT sites have been carried out last week. • ARC: supporting local CBO HIDO to run TOT peer educators activities in HIV/AIDS, condom distribution and conducting HCT outreaches.

IV. Comments and Conclusions WHO is continuing to support Gulu and Lira district to respond to the current upsurge of Malaria in the districts. The major challenge to the response is inconsistent supply of 1st line anti-malaria drugs by National Medical Stores and resistance of Lira district officials to IRS V. Plan for Coming Week • Support MOH to respond to Influenza A H1N1 pandemic • Support hepatitis E epidemic response in Kitgum and • Support MoH and the districts of Lira and Gulu to respond to upsurge in the number of cases of malaria being reported. • Provide technical and financial support to the DHOs in strengthening HMIS/IDSR • Provide technical and financial support to MoH and UBoS in planning and 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]