Health Action in Crisis, Uganda: Weekly Epidemiological Report – Week 24, 9th - 15th June 2008 1. Completeness of Reporting All district had over 80% completeness of reporting with 6 out of 14 districts registering 100% completeness. In Kitgum district only 57.7% of health facilities reported on time. Staff absenteeism and weak management of the district health system are the main reasons for continuing poor performance by the district. WHO is supporting the office of the DHO to strengthen support supervision and to provide on job training of health staff in non reporting units. 2. Disease Trends 2.1 Malaria Diseases Malaria continues to be the leading cause of morbidity in the region. In Lango sub-region the weekly incidence of malaria in 2008 is 32% higher than that for 2007. Lira district accounted for 51.8% (7,796) of cases of malaria reported in the sub-region originated. The most affected sub-counties in Lira district are Apala and Aloi. Lira district with support from WHO-field office in Lira has deployed 4 additional health workers to the sub-county, provided RDT to aid diagnosis, provided additional drugs for fist line treatment of malaria, conducted community meeting with VHTs, distributed 570 ITNs to most affected people and constituted task force in 5 sub-counties for control of malaria. In Oyam district, malaria incidence has decreased from 1836 in epi-week 20 to 1,312 in week 24. In Apac district, the weekly incidence of malaria over the last three weeks drop from 4300 in epi week 22 to 3,400 in epi week 24. Both these decrease is due to the recently concluded IRS with DDT in Oyam district in epi-week 16 and Apac district in epi-week 21. WEEKLY MALARIA TRENDS BY DISTRICT IN LANGO SUB-REGION: 1st January - 15th June 2008 Figure I: Malaria incidernce in Lango sub-region in 2007 and 8500 8000 2008 Lira Apac Oyam Dokolo Amolatar 7500 7000 18000 120% 6500 16000 100% 6000 14000 5500 12000 80% 5000 10000 60% 4500 8000 4000 # of cases # of 6000 40% 4000 3500 20% % ofreporting HU 2000 3000 0 0% 2500 1 5 9 13 17 21 Number of r eport2000 edmal ar i a cases 1500 epi-week 1000 500 # of cases Lango 07 # of cases Lango 08 0 % of HU reporting Lango 07 % of HU reporting Lango 08 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Epidemiological week 2.2 Diarrhoea disease The number of cases of dysentery in Lango and Acholi sub-region has remained relatively stable. In Karamoja sub-region the number of cases of dysentery in 2008 is 49% higher than the number recorded in 2007 for the same epi-week. This could be attributed to the fact that in 2007 only 64% of health facilities submitted in their weekly epi-report as compared to 91% in 2008. See figure III and IV below for details. Figure III; Weekly diarrhea incidence Lango sub- Figure IV; Dysentery cases in Karamoja region for the region year 2007 and 2008 140 100% 350 120% 90% 300 120 100% 80% 250 100 70% 80% 200 80 60% 60% 50% 150 60 40% 40% Incidences 100 30% 20% 40 HU % reporting of Reported cases 50 20% reporting % HU of 20 0 0% 10% 1 2 3 4 5 6 7 8 9 6 3 10 11 12 13 14 15 1 17 18 19 20 21 22 2 24 0 0% 1 2 3 4 5 6 7 8 9 Epi-week 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 epi-week Incidence 2007 Incidence 2008 Lango 2007 Lango 2008 Lango region 2007 Lango 2008 % HU reporting 2007 % HU reporting 2008 2.3 Cholera No cholera cases reported in the week. For further information, please contact: Page 1 Dr J.B Tapko, WHO Representative Uganda (a.i.); Tel. +256 41 335500, Mobile +256752728257, Email: [email protected] 2.4 Meningitis One case of meningitis was reported from Oyam district. CSF analysis was not done. Measles Two suspected cases were reported in the week. One was from Oyam district and the second one was from Gulu district. Sample sent for investigation at UVRI. Results from the previous samples have not yet been received. 2.5 Hepatitis E The number of cases of Hepatitis E continuing to rise, as of 16th June 2008, a cumulative total of 3062 cases of Hepatitis E were registered in Kitgum district with 64 deaths (CFR 2.1%). 381 new cases were registered in epi-week 24 down from 426 cases in epi-week 23. To date 12 sub counties in Kitgum district have been affected. The weekly number of cases registered in Madi Opei sub-county continues to drop. 11 cases of Hepatitis E were registered in epi-week 24 as compared to 22 cases in epi-week 21. In Agoro, Padibe and Paloga sub-county the weekly number of cases of Hepatitis E continues to increase, which is an indication of continuing transmission. See figure V and VI for details. Figure V : epi-curve of Hepatitis E cases in Kitgum district 25th Figure VI; Disagrigation of cases of Hepatitis E by sub-county October to 4th May 2008 Lokung 450 400 Akw ang 350 300 Orom 250 Muc w ini 200 Sub-counties 150 Paloga 100 Madi Opei 50 0 200 400 600 800 1000 1200 0 4748495051521 2 3 4 5 6 7 8 9101112131415161718192021222324 # of cases Epi- week Cumlative # of cases New cases in the w eek A joint mission comprising of MoH, MUSPH and WHO visited Kitgum district from 16th to 20 June 2008 to review the status of implementation of Hepatitis E epidemic response interventions, identify factors responsible for persistence of the disease, provide technical assistance in development of strategies to address the gaps and to provide recommendations to bring the epidemic to an end. Main findings are that the hepatitis E epidemic is still ongoing and spreading to new sub-counties. The high transmission is facilitated by the poor personal and domestic hygiene in most of the camps. Appropriate interventions have been instituted but there is lack of consistency in the implementation and suboptimal geographic coverage of the interventions, making the response fragmented. Generally implementation of surveillance and case management is satisfactory but implementation of community/social mobilization, water, sanitation and hygiene promotion interventions is still inadequate. The key issues that need to be urgently addressed to control the epidemic are community mobilization, hygiene promotion and inspection; water purification/chlorination at all water sources and/or households in main camps, satellite camps and return areas, and accelerating provision of latrines using appropriate technology and national standards. These should be implemented consistently and with full geographical coverage for at least 3 months to bring the epidemic to a halt. 3. Conclusion The performance in IDSR reporting in all districts is above 80%, outbreak of Hepatitis E in Kitgum district still continues unabated especially in Agoro, Paloga and Padibe sub-counties which are recording increasing number of cases on weekly basis. Lira district with support from partners is responding to the suspected outbreak of malaria epidemic in the sub-county of Apala and Aloi. 4. Acknowledgements Production of this weekly update has been made possible by contributions from the following partners: For further information, please contact: Page 2 Dr J.B Tapko, WHO Representative Uganda (a.i.); Tel. +256 41 335500, Mobile +256752728257, Email: [email protected] .