HEALTH ACTION IN CRISES, UGANDA Bi-Monthly Update 01-19 June 2007 WHO- Health Action in Crisis (HAC) programme carried out the following activities during the first two weeks of June 2007: Health systems strengthening Village Health Teams • Kitgum: The VHT/ CORPS Core team meeting was held to discuss the involvement of partners in the training and support of the Village Health Team program. It was agreed that a mapping of community health volunteers trained by the different partners would be carried out, followed by sub-county sensitization, selection of VHT members and training of VHT members. • Pader: The community Co-Artem program is ongoing in 7 of the 18 sub counties. Additional sub counties are expected to be enrolled in the coming weeks depending on the availuability of the registration books or other acceptable record books. CBDS Roll out in Kitgum: CBDS training was conducted in 2 sub-counties of Padibe East and Padibe West from 11 - 15 June 2007. A total of 146 Community surveillance focal persons [86 from Padibe East and 60 from Padibe West] were trained. The total number of CBDS trained in Kitgum district now stands at 556. Roll out CBDS will continue in Lokung sub-county next week, targeting 108 community surveillance focal persons. Below is the summary table of trained CBDS in Kitgum. Sub-county Camp Total Population No. House holds No. of Villages No. of CBDS Trained Akwang Akwang 17,619 4,017 21 42 Omia-Anyima Omiya-Anyima 17,610 3,764 54 108 Paloga Paloga 6,944 1,722 27 54 Madi-Opei Madi Opei 11,135 2,691 25 50 Palabek Kal Palabek Kal 21,575 10,399 31 62 Palabek Gem Palabek Gem 11,731 5,654 29 58 Madi-Kiloch 18 36 Padibe West 17,630 4,042 Padibe West 30 60 Padibe East Padibe East 17,376 4,164 43 86 Total 556 VHTs receive registers, medicine, medicine boxes, gum boots & t-shirts. They hold monthly meetings with Health facilities where they restock. Co-Artem doses: yellow; 4months-3years, blue-3-7yrs, brown-8-12yrs, green-above 12. Assessments: • Assessments on the functionality of laboratories in Gulu/Amuru, Kitgum & Pader were carried out by WHO. Report of the assessment will be a basis for planning and advocacy at both district and national level. • Health sector assessments were carried out in the Northern Uganda districts and the Karamoja region using the IASC Needs Analysis Framework. The assessment reports were shared widely. • WHO Lira together with UNICEF and Lira district health/engineering staff jointly assessed LMC HC II which was damaged by a storm. UNICEF, through Lightforce International has undertaken to rehabilitate (re-roofing, putting ceiling, painting, basic furniture and drugs) LMC HC II. • Assessment monitoring formats and VHT reporting forms-these were developed and shared with the cluster for comments and shall be used for assessments and monthly VHT reporting respectively. Gap filling • WHO supported a 5 day SGBV workshop in Lira and Apac districts and monitoring of Tuberculosis activities in Lira & Apac. • Together with the cluster and OCHA, WHO updated transition indicators and shared a new reporting format for the Health, nutrition & HIV /AIDS cluster. • WHO Pader organized training for the District EPR task force. A total of 22 members including the LC V chairman, RDC, all heads of department attended the 1 day training. The task force agreed to meet quarterly to review the epidemic response activities in the district. • WHO participated in the human resources for health meetings in Lira and Mbale covering conflict affected districts in Northern & North-Eastern Uganda. The meetings discussed health workers settling in allowance, pay roll verification and human resource gaps. The meeting concluded that in post health workers receive a lump sum of 30% salary increment for six month and that all gaps existing in human resources to be advertised. A mechanism was agreed on to implement the above activities. Disease Surveillance and Epidemic Preparedness & response: 1. Diarrhoeal diseases: Cholera: z Kitgum: No case of cholera has been reported during the week ending 17 June 2007. However, the district remains in a state of high alert, with social mobilization and public health promotion activities ongoing. 1 For information, please contact: Dr Melville George, WR Uganda Email: [email protected] Tel. +256 41 335500 Mobile +256752760214 HEALTH ACTION IN CRISES, UGANDA Bi-Monthly Update 01-19 June 2007 z Gulu/Amuru: Follow up of cholera cases that were reported last week in Lacor Hospital was done a day after receiving the report. Two cases (mother and son) were reported in Bobi camp (31 May & 2 June) and the third case was a resident of Orom in Kitgum District who picked up the illness on his way back from Juba and was admitted in Lacor Hospital (2 June). The specimens of the child and the man were positive of vibrio cholerae while that of the woman (index case) was negative. z The response included: VHT mobilization (community surveillance), contact tracing and community dialogue activities were carried out. Following the dialogue environmental sanitation activities were initiated. Drugs, medical supplies, IEC materials and infection control advice were provided to the Health facility. Limited access to safe water and inadequate latrine coverage remain the remains the biggest risk factors for the spread of cholera. Recommendations include; intensive health education, improvement of environmental sanitation, intensification of surveillance, maintenance of minimum stock of essential drugs and supplies and frequent monitoring by the DSFP and DHI Dysentery has persisted in the community due to poor sanitation and hygiene practices in camps. • In Gulu/Amuru: A total of 147 suspected cases of bacillary dysentery were reported this week in both districts. The trend of the infection shows near constant incidence rates of the disease in both districts (see graphs below). Gulu Weekly Dysentery Trend, Oct 06 - 17th June 07 Amuru Weekly Dysentery Trend, Oct 06 - 17th June 07 240 240 210 210 180 180 150 150 120 120 90 Number of Cases of Number 90 Number of Cases of Number 60 60 30 30 0 0 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 Epidemiological Week Epidemiological Week Dysentery continues to pose a huge disease burden in Kitgum, with 64 cases registered in epi-week 23. • Lango sub-region: Though the incidence of weekly dysentery has remained low, there is need to identify the causative organisms by proper laboratory examination to exclude the risk of epidemic shigellosis. 2. Schistosomiasis: Twenty two [22] cases of schistosomiasis have been reported in epi week 23 in Kitgum. Two cases were reported this week in Atiak HC IV in Amuru District. 3. Malaria: • Gulu/Amuru: This week, there was a slight decrease in incidence by 6% and 7% in Gulu and Amuru districts respectively. Despite the increased ITN distribution and availability of both community and health facility based anti-malarial drugs, Weekly Malaria morbidity, Kitgum district sub-region Jan-June 2007 5,000 100% malaria continues to be a leading cause of morbidity and 4,500 90% mortality in the sub-region. Anti- malaria campaign continues to 4,000 80% be high among the district and 3,500 70% partners health activities. • Kitgum: The rising trend in 3,000 60% malaria morbidity is still 2,500 50% unrelenting (see the graph). A total of 2,738 cases of malaria 2,000 40% Number of cases of Number [with 8 deaths] have been 1,500 30% % of Health unitsreporting registered in epi week 23 compared to 2,512 cases the 1,000 20% previous week. This represents a 9% increase in malaria 500 10% morbidity, despite a reciprocal 0 0% 9% reduction in completeness of 1234567891011121314151617181920212223 reporting. Epidemiological week 2 For information, please contact: Dr Melville George, WR Uganda Email: [email protected] Tel. +256 41 335500 Mobile +256752760214 HEALTH ACTION IN CRISES, UGANDA Bi-Monthly Update 01-19 June 2007 Though a rising trend in malaria morbidity would be expected in Northern Uganda due to seasonal variation in malaria transmission, it does not tally well in light of the IRS conducted in Kitgum in April – May, 07. The impact of IRS is usually realized within 3 weeks of completion of the exercise. In the subsequent weeks, attempts will be made to compare the current trends with those of the previous years. [Obviously, the challenge here is the availability and reliability of the HMIS data for the previous years]. Meanwhile, the need for having reliable tools for monitoring malaria morbidity in the face of IRS [and other interventions] is critical. One such tool could be the use RDT for diagnostic purposes. • Pader: Malaria morbidity trend is still undulating as a result of variation in completeness of reporting. • Lango sub-region: Incidence of malaria in the Lango sub-region is on the general increase, due to the onset of rains and improved completeness of reporting. 4. African Human Trypanasomiasis: No cases have been reported in Acholi sub-region. No HAT was reported during the week. Distribution of HAT cases by district and sub-county: 2000-2007 300 However, note that the 284 majority of HAT cases from Dokolo district go 250 directly to Lwala treatment centre in 200 Kaberamaido district and are reflected in its weekly report. WHO Lira sub- 150 office has set surveillance No. of cases 116 for HAT for Lango and Teso regions and the data 100 74 76 is up dated and shared on 69 monthly basis.