WHO - Health Action in Crisis (HAC) programme carried out the following activities during the last two weeks of March;

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1 WHO - Health Action in Crisis (HAC) programme carried out the following activities during the last two weeks of March; Health systems strengthening Community based disease surveillance Kitgum: WHO continues to support Community based Disease Surveillance (CBDS) training:18 CBDS focal persons have been trained in Omiya Anyima sub-county from 16 2 May 27, bringing the number of sub-counties with CBDS to 4. The total of CBDS in Kitgum district is now 242. Pader: WHO & IMC supported CBDS training for 2 VHTs in Pader Town Council. Village Health Teams In Kitgum: WHO and the DHT shared with health cluster partners the proceedings of the VHT Harmonisation meetings held in Entebbe (February 27) and Gulu (April 27). The meeting agreed to discuss the harmonization of all community health volunteers training and activities under the VHT Concept. WHO supported the DHT and partners to review the harmonization of all community health volunteers training and activities under the VHT Concept. The meeting resolved to form a VHT/ CORPS Core team that will thrash out the way forward Pader: WHO continues to advocate for & liaise with partners in operationalising the VHT concept; IMC trained 148 VHTs in Pajule sub country, while Medair has made final preparation to enable the VHTs in Lapono to begin dispensing coartem. In the coming week the VHTs are expected to be provided with community coartem. Drugs availability: Kitgum: A meeting with WHO was convened at the recommendation of the weekly DHT meeting to discuss Co- Artem use and availability in the district. Notable was the need to include the 5 newly opened units in the supply list for Co-Artem. Pader: WHO continued to support the Ag. District Drugs Inspector to conduct monitoring stock-outs of tracer drugs in the health facilities including community Co-Artem. The stock level of community coartem at district level is good but there is a lag in ordering the health facility Co-Artem. Gulu: WHO supported the district to carry out a Co-Artem availability assessment which revealed the following: At the time of the assessment 9 of the health facilities had facility based Co-Artem in stock but 8 out of 23 facilities had no community Co-Artem in stock. The health facilities serve a total of 261 villages with 363 community based medicine distributors (VHTs). 9 of the medicine distributors had stocks of community Co-Artem. The full report is available on request. Lira: Who carried out an assessment of health facility Co-artem availability with heads of health facilities-no stock outs were reported. 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. Assessment: WHO visited Lwala Hospital ( a sleeping sickness treatment centre) in Kaberamaido to discuss strategies to control Sleeping sickness particularly, how to strengthen Dokolo HC IV as a new treatment centre. In Kitgum, WHO joined DHT members and partners in an assessment of Gwencoo HC II where the population has already moved back to Koc parish (Amida Sub-county, and Loborom HC II where the population is yet to move to Layamo Sub-county. The report was presented to the weekly DHT meeting and the DDMC of 23/4/27. In Lira, Gulu, Kitgum, Pader, Karamoja & Kampala, WHO, health cluster members and OCHA worked together to assess Critical Health Needs to feed into the Mid Year Review and Needs Assessment Framework. WHO, MSF-CH and UNFPA together are preparing a tool to use in a joint assessment of Gulu regional hospital for advocacy purposes. The team shall be joined by AVSI, the district health office &UNICEF. WHO Lira carried out assessments of Apoi HCII (Apac), Aboke HCIV (Oyam), Ongica HCIII & Okwang HCIII (Lira) to assess their renovation needs and prioritise accordingly so that areas with the greatest need are targeted for renovation work first. Gap filling Reproductive health: Mattresses were taken to both Acokara & Okwongo health centre maternity units. Apoi HCII Incomplete staff quarters need renovation 1

2 2 HEALTH ACTION IN CRISES, UGANDA IEC production: WHO produced 25 Acholi VHT job aids with integrated health messages for VHTs to use in the community as well as posters and brochures for cholera prevention & control. Disease Surveillance and Epidemic Preparedness & response: Number of cases Weekly Incidence of diarrheal diseases in Acholi sub-region Jan-May Epidemiological week Cholera Dysentery Completeness of reporting 1. Diarrhoeal diseases: The disease burden due to diarrhoeal diseases as summarized in the graph above mainly falls with Kitgum, whose reporting of particularly dysentery remains high. Almost all the cases of cholera indicated were reported in Kitgum district. Cholera: In Kitgum, the last case was reported on 16 March. The cumulative number of cases from week is 1714 with 31 deaths, giving a CFR of 1.8%. The cumulative number of cases reported in Pader since Epi week 4, 26 is 143 with 15 deaths; no new cases have been reported since 1 February. Plans to intensify surveillance and health promotion programs should be made and implemented as the risk of a new outbreak of cholera is quite high due to onset of rains. Zero cases of cholera have been reported in the rest of Northern Uganda. Dysentery has persisted in the community due to poor sanitation and hygiene practices in camps. In Gulu/Amuru: A total of 222 suspected cases of dysentery were reported during week 19 in the two districts representing an increase of over 1. Kitgum district reported 77 cases, a 53% reduction from two weeks ago. WHO has plans to carry out investigations. 2. Schistosomiasis: Kitgum: Twenty seven cases of schistosomiasis were reported in epi week 19. All the 27 cases were registered in the 2 hospitals, authenticating the diagnosis. The source of the infection is thought to be a stream that runs through Kitgum town. This is an indication that a large number of the population still performs their domestic activities e.g. bathing, washing in the stream. This information and the trend of schistosomiasis will be presented to the WASH cluster meeting such that health promotion/ education activities are put in place. Amuru district also continues to report cases of Gulu District Weekly Malaria Incidence, July 26-13th May 27 schistosomiasis. 3. Malaria: 6, 1 Gulu/Amuru: 5,5 9 A marked increase of malaria 5, incidence has been noted this 8 4,5 week in Gulu and Amuru, 4, although generally, there has been a steady decline of 3,5 6 malaria cases since April this 3, 5 year. The cause of this decline 2,5 4 will be established with 2, empirical evidence following a 3 1,5 detailed data analysis at the 2 end of this month. However, 1, we suspect community 5 1 Coartem and increased Number of Cases Epidemiological Week Malaria Completeness of reports number of ITNs to be responsible. The sudden rise number of cases in Gulu (see the graph) from 2797 last week to 4956 this week is partly due to 1 completeness of reporting. Although the incidence appears high this week, it is actually low when compared to previous weeks with 1 completeness. This confirms the Completeness of Reporting

3 MALARIA CASES HEALTH ACTION IN CRISES, UGANDA declining incidence of malaria this year. Amuru continues to have 1 completeness of reporting and weekly malaria incidence is continuing to take a declining trend In Kitgum the trend of malaria morbidity experienced a sharp decline during week 12 and has since stabilised (around 2,5 cases per week) probably as a result of improved completeness of reporting. In Lango sub-region the incidence 1 WEEKLY MALARIA INCIDENCE IN LANGO SUB-REGION: JAN - 13th MAY 27 of malaria is on the general 1 increase, due to the onset of rains 9 9 and improved completeness of 8 8 reporting. 4. African Human 7 Trypanasomiasis: 6 6 Gulu/Amuru: No new cases reported. A total of 25 cases 5 5 have been investigated in Lacor 4 4 Hospital since 23 and all were found free of 3 3 trypanosomes. The process of EPIDEMIOLOGICAL WEEK MALARIA CASES COMPLETENESS OF REPORTING investigating trypanosomiasis and the sensitivity of the test are yet to be verified and validated. Lango region: No new cases were reported in Lango subregion, however, Lwala hospital trypanosomiasis treatment centre in Kaberamaido has received 6 patients in the last 3 weeks from Dokolo alone. In Dokolo district health unit-based weekly surveillance is unable to report the cases due to the fact that the patients go directly to Lwala. There is need to support Dokolo to sensitise the community and conduct active case search especially in the most affected sub-county of Kangai. 5. Measles In the Lango region 4 cases of suspected measles were reported by Bata HC III in Dokolo district during the last month. Blood samples were taken to UVRI for confirmation and the first 2 cases showed Rubella. None of the children had completed vaccination.. WHO supported the district in transporting vaccines from Lira to Dokolo district s vaccine stock outs was noted at some facilities. In Gulu one suspected case was reported from Lalogi HC IV and a blood specimen was sent to UVRI for confirmation. 6. Guinea worm: On the 2 &14 May 27suspected guinea worm cases in Moroto Municipality and Iriir sub-county respectively were reported to the Uganda Guinea Worm Eradication Program (UGWEP) Secretariat by the Surveillance Focal Person (SFP), of Moroto district. Teams from UGWEP, WHO and Moroto District Health Office investigated the suspected cases on 16 th and 17 th May 27, with support from WHO. Investigation included mapping of cases, interviews with health personnel from the facilities in the area and the patients, review of records, collection of samples for laboratory examination. The cases were unlikely to be guinea worm. Recommendations made include; continued surveillance, non monetary incentives for members of the community involved in surveillance and roll out of Village Health Teams in the Karamoja sub-region. 7. Chicken Pox: Ten cases were reported this week. Six cases were reported from the community in Pabwo in Gulu District by AID Africa on the 17 th May 27. The District Surveillance Focal Point has visited the area and confirmed the report. The six wre cumulative cases number since 2 nd of April 27. He allayed anxiety in the community and encouraged them to report to the nearest health facility for help. Pader district reported 17 cases of chicken pox in week 19 and 13 in week Polio: WHO Lira joined the national EPI team from Ministry of Health in reviewing the child days as well as polio cases in the district, particularly at Fredie s rehabilitation centre in Lira and found only 7 post polio paralysis cases out of the 23 cases of various deformities. Weekly Epidemiological (HMIS) reporting: WHO continues to support Acholi and Lango sub-region in management of Health Management Information Systems (HMIS) by providing technical and logistic assistance to the District Surveillance Focal Points, Health Sub-district level and all health facilities. See the graph below which shows malaria morbidity plotted against weekly surveillance for Acholi & Lango sub-regions. 2 1 COMPLETENESS OF REPORTING 3

4 Completeness and timeliness of weekly reporting; Gulu: Community reporting has greatly improved due to improved vigilance of the VHTs. Health facility reporting has also improved and has more or less stabilised at between 8-1. Amuru has maintained a 1 average for more than 6 weeks. Kitgum: The new HMIS focal point together with WHO are in the process of organising the HMIS district database. WHO together with the surveillance focal point carried out targeted support supervision visits to health facilities in Kitgum district as part of the plan to improve weekly reporting. See the graph below for information on reporting in the Acholi sub-region. Lango region: Completeness of COMPLETENESS OF WEEKLY IDSR REPORTING IN LANGO SUB-REGION reporting for the 5 1 districts in Lango sub-region has 9 greatly improved in 8 the last 4 weeks. In week 19 completeness of 6 reporting in the all the 5 districts is 5 above 8 with 4 Oyam and Dokolo maintaining 1 3 reporting (see table). 2 Overall completeness of 1 reporting for the sub-region has been maintained above EPI-WEEK 8 between LIRA APAC OYAM DOKOLO AMOLATAR LANGO SUB-REGION weeks 16 and 19. The sustained improvements are due to the current support supervision of the districts on IDSR/HMIS and emphasis on the use of radio calls for IDSR. Efforts are made to maintain reporting levels to above 8 in all the 5 districts. Repair of non-functional radios and installation of radios in health facilities which are lacking will improve on the completeness and timeliness of IDSR/HMIS. Pader district: WHO and the district surveillance focal point carried out support supervision visits to health facilities with a record of poor weekly HMIS reporting, the visits are expected to yield improvement. Population movement: No significant changes in the return patterns in Northern Uganda have been noted, with exception of the fact that areas bordering Karamoja region (Northern Lira (Otuke), Eastern Pader and Eastern Kitgum) remain in constant threat of attack by Karamajong warriors. This might be a deterrent to return in these areas. According to DDMC Lira currently has 53,94 IDPs in 11camps down from 346, 94 in 4camps by Dec. 26 (over 8 return). There are no IDPs in 12 of the 19 sub-counties. In Oyam there is no significant return in the last two or so months and the figures have stagnated at 36, 478 in the same 18 camps compared to 18,199 in Dec.26 in 18 camps. In Apac, there are 2,31 IDPs as opposed to 19, 991 in Dec. 26 in the same 2 camps. Coordination: WHO organized a cluster capacity building workshop in Kampala from 7-9 May 27. Cluster members from the UN, NGOs, government and districts attended the 3 day workshop which covered topics including humanitarian reform, assessing and working with health systems in conflict situations, health communication, epidemic preparedness & response among others. WHO is in the process of mapping health cluster interventions in Northern Uganda districts, starting with the Lango sub-region. Once finalised, the information shall be shared with the health cluster at district and national levels to improve service provision. WHO Karamoja initiated dialogue with partners in Moroto district on inauguration of Health, Nutrition and HIV/AIDS cluster coordination and on cluster coordination mechanisms. In Karamoja, WHO held discussions with the DHOs of Kotido and Nakapiripirit districts and UNICEF on preparedness and budget proposal to prepare for a possible cholera outbreak in these districts. % COMPLETENESS 4

5 WHO coordinated Health & Nutrition meetings in Lira, Pader, Kitgum, Amuru & Gulu districts. The meetings were well attended and very productive action points developed for the week. Issues in Kitgum include; A new DHO, Dr Olwedo Alex Odwong was expected to take office by the end of May 27. Coordination for the Child Health Days had gone on very well at the district level, but not at the lower levels Health Unit Management Committees need to be reactivated to spearhead sub-county to parish level mobilization. Partial report for coverage is; De-worming, 41%; Vit. A supplementation, 53%. No data was available for vaccination coverage. The UN Undersecretary General for Humanitarian Affairs visited Kitgum between 14 &16 May 27 and key issues raised include; continued support to return communities, coordination & protection of vulnerable populations. WHO Pader attended a workshop held by PSI to disseminate the implementation status of their HCT Mobile programme. Acknowledgements The progress achieved so far by WHO/HAC Uganda was made possible by contributions from partners and staff. Of importance to note are the government of Britain (through DFID), Sweden (through Sida), Finland, Norway, EU (through ECHO), who provided funds for the operations. The efforts and support of WHO/HAC teams in headquarters and the African regional office (AFRO) and Uganda WCO led by the WHO representative also deserve a lot of commendation. We are very grateful for their technical and logistic support, as well as that of the MOH, District Health Officers (DHOs) and District Health Teams (DHTs) in the conflict affected districts of Northern Uganda. 5