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HEALTH CLUSTER PAKISTAN Crisis in Khyber Pakhtunkhwa

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HEALTH CLUSTER PAKISTAN Crisis in Khyber Pakhtunkhwa HEALTH CLUSTER PAKISTAN Crisis in Khyber Pakhtunkhwa Issue No 5 12 April ‐ 5 May 2010 Highlights • As of 6th May, 2010, 341,768 people (approximately 48,824 families) from Orakzai and Kurram Agency, of Khyber Pakhtunkhwa have become IDPs and are living in host communities. Of the total IDPs, 111,482 people (approx. 15,926 families) are living in Hungu, 27,013 people (approx. 3,859 families) in Peshawar and 203,273 people (approx. 29,039 families) in Kohat.. • There are another 1,513,713 IDP’s (approx207,358 families) residing in host communities of Mardan, Peshawar, Swabi, Charsadda, Nowshera, Kohat, Hangu, Tank, DI-Khan, Abbotabad, Haripur, Mansehra and Battagram districts of Khyber Pakhtunkhwa. Besides the IDPs living in host communities, 124,169 IDPs (approx 24,626 families) are living in camps. Jalozai is the largest camp with a population of 111,798 people (22,532 families). (Multiple Sources: CAR reports, SSG, PDMA PaRRSA, NADRA, Social Welfare Department) • Health Directorate, FATA, WHO and UNICEF have conducted assessment of Health facilities in Mohmand agency in preparation for the expected return of IDPs from Jalozai camp. • 517 DEWS health facilities reported a total of 317,084 consultations carried out from 17th April, 2010 to 30th April, 2010. 184,374 (58 %) of the total consultations were reported for female patients while 132,710 (42%) consultations were carried out for male patients. Children aged under 5 years represented 78,742 (25%) of all consultations. 72 health facilities reported 2,675 visits for antenatal care. • For the period 17 April to 30 April, Twenty four alerts – one alert for acute flaccid paralysis (AFP), fifteen alerts of suspected measles, and two alerts of Acute Watery Diarrhoea (AWD), were received from Tank, D.I Khan, Lower Dir, Mardan, Nowshera, Peshawar, Swabi and Swat. All reported alerts were responded to accordingly. According to data from reporting health facilities, acute upper respiratory tract infection, with 71,092 patient consultations, remain the leading cause of morbidity; followed by acute diarrhoea. • UNICEF conducted Measles campaign in 2 union council of district Nowshera. Out of the total target population of 23,737 children, aged between 9 months to 13 years, 23500 children (99%), were successfully vaccinated. In 2010, 777,837 children of same age group were successfully vaccinated. 2650 children, aged less than 5 years, were provided polio vaccines by 8 teams in Bajour agency, while 928 children of returning IDPs were provided polio vaccine by 4 teams at Eka Ghund (Mohmand Agency). • From 13 April to 5 May, 2010, WHO moved life saving medicines, including emergency, cholera and maternal health essential drugs alongside 53 mini emergency Kits and 1 Inter Emergency Health Kit to Swat, Buner, Kohat and Abbotabad districts. These medicines are sufficient for the population of 319 000 for two months. • Cluster members are prioritizing reproductive health care services in Lower Dir, Swat, DI Khan and Tank districts. During the last week of March, UNFPA supported 9 health facilities (District Head Quarters Hospital Tank, Rural Health centre Gomal Bazar, Parroha, Paharrpur, Basic Health Unit Dabarrha, Mufti Mehmood Memorial hospital, Tehsil Headquarters Hospital Matta and Samarbagh) in these districts. From 1st April, 2010 to 12th April, 2010, a total of 4,921 patients consulted for health services in these districts. This includes 397 antenatal consultations, 127 postnatal consultations, 124 deliveries, 17 post abortion care cases, 6 referrals for C-section, 21 syndromic case management of sexually transmitted infections, 193 family planning consultations, 326 ARI, 968 gastroenteritis, 765 fever, 151 scabies and 1,773 consultations for other minor general outpatient services. During the above mentioned period, 123 newborn and 370 hygiene kits were distributed for improving menstrual and personal hygiene of the concerned women. Distribution of these kits would provide psycho-social support to the affected women at reproductive age group to overcome/transform socio-cultural taboos in women accessing reproductive health care. HEALTH ASSESSMENT Mohmand Agency Health Assessment Health Directorate, Federally Administrated Tribal Areas (FATA), WHO and UNICEF conducted assessment of health facilities in Mohmand agency to find gaps in service delivery in the areas of essential medicine, primary health care services, human resources, etc. Out of the targeted 27 health facilities, only 22 health facilities were assessed in the agency. On 19th April, 2010, Training of medical staff from the Health Directorate, Federally Administrated Tribal Areas on the assessment tools was conducted in WHO Office, Peshawar. From 21st to 24th April, 2010 medical officers and medical technicians of Mohmand Agency conducted an assessment of public health facilities in Mohmand Agency, with WHO and UNICEF’s technical and financial support. It was determined that all assessed health facilities lacked facilities for nutrition screening, dental services and detection and management of Sexually Transmitted Infections. Only 2 health facilities provide minor surgical procedures and Tuberculosis detection while only 3 health facilities offer Integrated Management of Neonatal and Child hood Illnesses (IMNCI). Essential new born care is provided at 4 assessed health facilities; growth monitoring is carried out at 5 facilities while 6 facilities assessed offer post abortion care and family planning services. The detailed assessment will be shared soon. Pakistan IDPs living in camps and Host communities (Photo 1; An IDP child visiting at health post (run by Health Cluster partner) with her mother in Jalozai Camp – Photo 2; Jalozai camp Nowshera district Photographs by Syed Haider Ali-WHO/EHA) Disease Surveillance The disease early warning system (DEWS) network has been established in the 10 districts hosting IDPs affected by conflict in KPK. Expansion of the DEWS network in all Hangu districts hosting IDPs from Orakzai and Kurram agencies is in process. Districts in the DEWS network coverage in NWFP crises Nature of involvement Number Districts Peshawar Hosting IDPs of Malakand Division and Mardan Bajour Agency 5 Charsadda Swabi Nowshera Buner IDP Return Districts in Malakand 3 Swat Division Lower Dir Hosting IDPs of South Waziristan Agency Tank 2 DI Khan Hosting IDPs of Orakzai Agency 1 Kohat Total 11 Alert and outbreak investigations and response: Between 17 April to 30 April, 2010, Twenty four alerts –one alert for Acute flaccid Paralysis (AFP), fifteen alerts of suspected measles and two alerts of Acute Watery Diarrhea (AWD) were received from seven districts (Tank, D.I Khan, Lower Dir, Mardan, Nowshera, Peshawar, Swabi and Swat) and were responded to accordingly. All the alerts were investigated and 21 samples (19 blood samples and 2 stool samples) were collected for laboratory confirmation. Measles outbreaks in two locations in district Peshawar were identified and mop up vaccination in both the localities was conducted. Both AWD samples were reported negative while laboratory results for all 19 blood samples are still awaited. Result of the stool sample for AFP is awaited. Acute Flaccid Paralysis: An alert for a case of Acute Flaccid Paralysis was reported at DHQ hospital, Swabi. The patient is a less than 5 year old female child, from union council Thana, district Buner. The Polio Eradication Initiative team conducted a detailed investigation and sent stool samples for laboratory confirmation. The results are awaited. Suspected Acute Watery Diarrhea (AWD): Two AWD alerts were reported from Mardan and Swat districts. • One alert for a suspected case of AWD (a female patient above five year age) was reported from BHU Machi, district Mardan. Field investigation was conducted and a tool sample was collected and sent to National Institute of Health (NIH), Islamabad for laboratory confirmation. The laboratory result reported negative. No other suspected cases or clustering was found in the locality. • Another alert of a suspected case of AWD (male patient above five year age) was reported from Kuza Banda district Swat. Field investigation was conducted and a stool sample was sent to NIH for laboratory confirmation of diagnosis. Laboratory results reported negative for AWD pathogen. No other suspected cases or clustering was found in the locality. Suspected Measles: Twenty one measles alerts were reported from Peshawar, Nowshera, Lower Dir, Mardan, Swat, Swabi, D.I Khan and Tank districts. All cases were scattered and no clustering was identified on field investigation. • In Peshawar district, an alert for suspected case of measles was received from Rural Health Center (RHC), Badaber. A joint team conducted field investigation and active surveillance in the region. Clustering of cases was found in two locations - Mohala Badsha Khel (union council Badber Hureezai) and Mohala Bin Khazee (union council Badber Merazai). The team declared measles outbreak in both the localities on clinical basis and a mop up vaccination was carried out at both locations in which a total of 1140 children were vaccinated. Blood samples from 4 patients were sent to National Institute of Health (NIH), Islamabad for Laboratory confirmation of diagnosis and results are awaited. • An alert for a suspected case of Measles was reported from IDP Camp Walekandawa in districts Lower Dir. Blood sample was sent to NIH for laboratory confirmation and result awaited. No more cases were found in the camp. • Six suspected cases of measles were reported
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