March 17, 2014 DISEASE EARLY WARNING SYSTEM WER-10 (8th Yr) WEEKLY EPIDEMIOLOGICAL REPORT

Summary:

 The surveillance data collected for this week report is from 8 -14 March 2014.  Out of 378 functional Sentinel sites (SS), 378 (100%) have submitted reports for Week-10 of 2014.  Out of a total of 305,464 consultations (132,113 male, 173,351 female) recorded in Week-10 of 2014, 32.2 % or 98,380 (47,536 male, 50,844 female) consultations were reported due to DEWS target diseases.  Main causes of consultations this week were Acute Respiratory Infections (ARI) (28.9%) and Acute Diarrheal Diseases (ADD) (6.1%) from total clients in a continuing trend from the week before.  69 (44 male, 25 female) deaths resulted from Pneumonia, Diarrheal Diseases and Meningitis/Severely Ill Children, which includes 64 deaths (40 male, 24 female) caused by Pneumonia, no deaths caused by Diarrheal Diseases and 5 deaths (4 male, 1 female) caused by Meningitis/Severely Ill Children.  In this reporting week, a Suspected Measles Outbreak reported from Paktya and Paktika provinces, a Rumor of Mumps Outbreak and a Suspected Measles Outbreak reported from .

Reports Received From Reporting Sites:

As of March 14, 2014, 378 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of . In this reporting week, 378 sentinel sites have sent their reports on new cases of DEWS target diseases recorded during the reporting week. Out of all events recorded in DEWS sentinel sites, 15 target diseases (priority diseases) are included in DEWS weekly epidemiological reports.

Table-1: Status of Reports Received from DEWS Regions during Epidemiological Week-10, 2014

Region

Central Central East Central West North North East West South East South East Total No. of Expected Reports from 55 33 58 50 39 51 49 43 378 Sentinel Sites No. of Reports Received in this 55 33 58 50 39 51 49 43 378 week

Figure-1 DEWS Sentinel Sites: Table-2: DEWS Epidemiological Regions and Figure-1(Map) shows the Sentinel Sites by type in Week- 10, 2014 distribution of DEWS sentinel

sites already established in the

relevant regions/provinces by

Type of SS

March 14, 2014. Table-2 shows

East Central West North North East West South East South East Total the SS distribution by type of Central health facility. Data on 15 DEWS CHC/BHC 28 20 43 39 25 41 39 35 270 target diseases are being collected DH 12 9 10 7 9 5 7 4 63 from these sentinel sites (SS). The symbols on the map show the PH/RH/SH 13 4 5 4 4 5 3 4 42 number of sentinel sites in each Poly Clinic 2 0 0 0 1 0 0 0 3 region/province, and do not Total 55 33 58 50 39 51 49 43 378 indicate the GPS of the SS CHC=Comprehensive Health Center, DH=District Hospital, PH=Provincial locations. Hospital, RH= Regional Hospital, SH= Specialized Hospital

DEWS Data in Epidemiological Week-10 of 2014: Out of a total of 305,464 clients recorded in week-10 Fig-2: Percentages of DEWS Target Diseases by of 2014, 23.6% (72,230) of consultations were Gender in W10-14 30 reported due to Cough and Cold and 5.3% (16,245) of consultations was reported due to Pneumonia. In the 25 same reporting period, 6.1% or 18,499 vents were 20 reported due to diarrheal illnesses (4.2% due to Acute 15

Watery Diarrhea, 1.6% due to Bloody Diarrhea and Percentage 10 0.3% due to Acute Watery Diarrhea with 5 Dehydration). In comparison with the previous week 0 ARI Men/SI ARI Pn AwD BD AwDw AVHep Measle Malaria (W9 of 2014) the percentage of ARI disease has C&C C remained the same, and the percentage of Acute Male 26 6.3 4.8 1.8 0.4 0.1 0.1 0 0.2 Diarrheal Disease has increased by 0.6% to 6.1%. Female 21.9 4.6 3.7 1.4 0.3 0 0 0 0.1 These variations could be due to changes in Total 23.6 5.3 4.2 1.6 0.3 0.1 0 0 0.1 temperature /weather during the reporting week. Figure-2 (right) shows the percentages of DEWS target diseases by gender in week-10 of 2014. Percentage of ARI by Weeks and by Age Groups: In the epidemiological week-10 a total of 88,475 events of ARI were reported. 33.8 % of total clients less than 5 years of age were Cough & Cold patients and 18.8% were among the age group 5 years and over. The percentage of C&C (<5 years) consultations in week-1, in comparison with the percentage of C&C in week-10 of 2014, decreased by 3.4%, whereas in case of 5 years and above decreased by 5.1% to 18.8% in this reporting week. The trend of ARI diseases in last 10 weeks can be read in Table-3. The percentages of consultations on Pneumonia cases of age group less than 5 years increased by 1.9% in last 10 weeks, whereas the percentage of age group 5 years and over decreased by 0.4% to 2.6% .

Table-3: Percentages of ARI Diseases during 10 recent weeks by age groups and by weeks Disease Age Week- Week- Week- Week- Week- Week- Week- Week- Week- Week- 1-14 2-14 3-14 4-14 5-14 6-14 7-14 8-14 9-14 10-14 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) ARI- C&C <5 37.2 36.4 36.6 36.6 34.3 33.6 33.9 33.6 33.4 33.8 Years ≥5 23.9 22.1 23.1 22.1 22.6 27.1 20.5 19.7 19.1 18.8 Years ARI- <5 12.9 13.4 13.8 14.2 14.5 13.3 12.1 12.6 11.4 11 Pneumonia Years ≥5 3 2.9 3.1 3.1 3.3 3.2 2.8 2.5 2.4 2.6 Years

In the reporting week-10 of 2014, the highest percentages of Cough & Cold were recorded in Logar, Khost and Kapisa provinces with 49.1%, 46.3% and 37.4%, whereas the lowest percentages of C&C were reported from Farah, Laghman and Zabul provinces with 12.2%, 12.7% and 16.2% respectively. The highest percentages of Pneumonia cases were reported from Logar, Bamyan and Baghlan provinces with 13.9%, 12.5% and 11.9% respectively, whereas the lowest percentages of Pneumonia cases were recorded in Urozgan, Zabul and Kandahar provinces with 1.3%, 1.6% and 1.7% respectively. (Fig-3)

70 Fig-3: Percentages of ARI from Total Clients in Week-10 of 2014 60 50 40

30

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Percentage 10

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BAM WAR Province Pneumonia Cough&Cold

Percentages of Diarrheal Diseases by Weeks and by Age Groups: Figure-4 below shows the percentages of diarrheal diseases (Acute Watery Diarrhea, Bloody Diarrhea and Acute Watery Diarrhea with Dehydration)

15 Fig-4: Percentages of Diarrheal Diseases from Total Clients in week-10 of 2014

10

5 Percentage Percentage

0

HIL

PIA

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BAM WAR Provinces AWD BD AWDwD

From week-1 to week-10 of 2014 from total clients, Acute Watery Diarrhea among children less than five years of age has increased from 5.9% in week-1 to 7.5% in the reporting week, whereas Acute Watery Diarrhea among age group 5 years and above has been increased by 0.6% to 2.6 % (Table-4). Bloody Diarrhea in age group less than 5 years increased by 0.3% in last 10 weeks, while in case of age group 5 years and above has been increased by 0.2%. Acute Watery Diarrhea with Dehydration in age group less than 5 years show an increase by 0.2% in last 10 weeks, while in case of five years and above AWDwD increased by 0.1% to 0.2% in last 10 weeks.

Table-4: Percentages of Diarrheal Diseases from Total Clients during 10 recent weeks by age groups

Week- Week- Week- Week- Week- Week- Week- Week- Week- Week- Disease Age 1-14 2-14 3-14 4-14 5-14 6-14 7-14 8-14 9-14 10-14 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Acute Watery <5 Years 5.9 5.5 6 5.8 5.2 5.7 6.1 6.7 6.9 7.5 Diarrhea ≥5 Years 2 1.9 2 2 2.1 1.9 2.1 2.2 2.3 2.6 <5 Years 1.8 1.9 1.9 1.6 1.7 1.8 1.9 2 2 2.1 Bloody Diarrhea ≥5 Years 1.1 1 1.1 1 1.1 1.1 1.1 1.1 1.2 1.3 Acute Watery <5 Years 0.4 0.4 0.4 0.3 0.4 0.4 0.5 0.5 0.6 0.6 Diarrhea with ≥5 Years 0.1 0.2 0.1 0.1 0.1 0.1 0.2 0.2 0.3 0.2 Dehydration

Percentages of suspected Meningitis/SIC, Malaria and Typhoid Fever by Region:

In the epidemiologic week-10 of Fig-5: Percentages of Meningitis,Malaria & Typhoid Fever from Total 2014, a total of 153 suspected Clients in W10-14 cases of Meningitis/Severely Ill 1 Child were reported from all regions and the highest 0.8 percentage was recorded in North, Central East and North 0.6

East regions. In the same Percentage reporting week, from all regions, 0.4 458 Malaria consultations were reported by Sentinel Sites and the highest percentages of Malaria 0.2 cases were reported from East region with 0.5% respectively. 0 SR CER CWR WR ER NR NER SER Out of the total clients, 1097 cases or 0.4% at the national Men/SIC 0 0 0 0.1 0 0.1 0.1 0 level were reported to be Malaria 0.2 0 0 0 0.5 0.2 0 0.1 suspected Typhoid Fever and the Typhoid Fev 0.6 0.1 0.4 0.2 0.7 0.2 0.2 0.5 highest percentages of Typhoid Fever cases were reported from East, South and South East regions with 0.7%. 0.6% and 0.5% respectively.

Vaccine Preventable Diseases: Among DEWS target diseases (priority diseases) seven vaccine preventable diseases are included, and their occurrences are changing by seasonal variations. Among these diseases Meningitis/Severely Ill Child is being reported mostly from the North region. In this week out of total 153 cases in country level, 51 cases have been reported from North region, 29 cases from the Central East region and 22 cases from the North East region.

In general the highest number of cases of Acute Viral Hepatitis has been reported from the East and South East regions, so in the reporting week out of total 138 cases, 44 cases reported from Central East region, 30 cases were reported from South East and 21 cases were reported East regions. From a total of 116 Measles cases reported in the reporting week, 43 cases were recorded in South and 40 cases were reported from the North regions. Table-5 (below) shows the distribution of vaccine preventable diseases across all reporting regions. Table-5: Suspected Cases of Vaccine Preventable Diseases in W- 10 of 2014 by Region Meningitis/ Acute Viral Acute Flaccid Total Regions Severely Ill Measles Pertussis Diphtheria Tetanus Hepatitis Paralysis Children 17 15 43 0 0 0 1 76 SR 29 44 4 0 0 0 0 77 CER 3 3 5 2 0 1 2 16 CWR 21 17 3 0 0 0 1 42 WR 2 21 19 0 0 0 1 43 ER 51 4 40 0 0 0 2 97 NR 22 4 2 0 0 0 1 29 NER 8 30 0 0 0 0 1 39 SER 153 138 116 2 0 1 9 419 Total

Percentages of ARI & Diarrheal Diseases by Epidemiological Weeks (trend from W24 of 2013 to W10 of 2014): Among the DEWS target diseases, Acute Respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) are the leading causes of morbidity and mortality, having the highest frequency of consultations. The following line-chart shows the trend of ADD and ARI from week-24 of 2013 to week-10 of 2014. In week-24 of 2013, the ARI and ADD curves crossed each other, as ARI started decreasing and ADD changed its course to increase. By the end of the summer season in 2013, these curves crossed one another again in week-35 and from that time to week-10 of 2014; the percentages of ARI were increasing, while the percentages of ADD were decreasing, it is expected that these courses will continue till end of winter season. Comparing this week data with previous week the percentage of ARI remained the same with 28.9%, while the percentage of ADD increased by 0.6% to 6.1% (Fig-7).

Fig.-6: Trend of ARI/ADD as Propotion of Total Clients From Week-24 of 2013 to Week-10 of 2014 40.0

35.0 ARI ADD

30.0

25.0

20.0

Percentages 15.0

10.0

5.0

0.0

W3 W1 W2 W4 W5 W6 W7 W8 W9

W32 W44 W24 W25 W26 W27 W28 W29 W30 W31 W33 W34 W35 W36 W37 W38 W39 W40 W41 W42 W43 W45 W46 W47 W48 W49 W50 W51 W52 W53 W10

Weeks of the Year

Mortality: Among DEWS target diseases Pneumonia, Diarrheal Diseases and Meningitis/Severely Ill Children (SIC) are main causes of mortality which generally amount to more than 95% of total deaths of surveillance target diseases. Usually deaths due to diarrheal diseases increase during the summer season, while the number of deaths due to Pneumonia increases during the cold period/Winter Season. In this week out of 69 (44 male, 25 female) deaths reported from all regions, 64 deaths (40 male, 24 female) were caused by Pneumonia, no death were caused by diarrheal diseases and 5 deaths (4 male, 1 female) were caused by Meningitis/Severely Ill Children. (Table-6)

Table-6: Deaths by Main Causes of Mortality and by Region in W10 of 2014

Grand Main Causes

Total Total

East East East West West

of Deaths West

South South

North North

Region Region Region Region Region Region Region Region

Central Central

F F F F F F F F F

M M M M M M M M M Pneumonia 2 2 13 7 3 2 5 2 3 1 8 9 6 1 0 0 40 24 64

Diarrheal 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Diseases Meningitis/S 0 0 1 0 0 0 0 0 0 0 3 1 0 0 0 0 4 1 5 IC Total 2 2 14 7 3 2 5 2 3 1 11 10 6 1 0 0 44 25 69

M: Male F: Female

Report of Outbreaks: Last week, two Suspected Measles Outbreaks and a Suspected CCHF Outbreak reported from Kandahar, province, a Rabies Outbreak reported from , two Suspected Measles Outbreaks reported from Jawzjan province and a Suspected ARI/Avian Influenza Outbreak reported from and in this reporting week, a Suspected Measles Outbreak reported from Paktya and Paktika provinces, a Rumor of Mumps Outbreak and a Suspected Measles Outbreak reported from Nangarhar province.. Table-7 (below) shows the number of outbreaks investigated in 2014 with details of week-9 and week-10 of 2014.

Table-7: Reported outbreaks since first week of 2014 to date Type of outbreak Investigated Rumor Clinic-ally/lab Pertussis 0 0 0 Avian/Swine Flu 1 0 1 ARI 2 0 2 Measles 23 0 23 Diarrhea 0 0 0 Meningitis 0 0 0 Hepatitis 0 0 0 Malaria 0 0 0 Typhoid 0 0 0 CCHF 3 0 3 Bl. Diarrhea 0 0 0 Chickenpox 2 0 2 Other 7 0 6 Total 38 0 37

Epidemiological week- 9

 Suspected Measles Outbreak: Reported from Nahrerabat village of Daman district, on Feb27 /2014, the team investigated the area on March 01/2014, Vaccination coverage is 25%. During the investigation there were 7 suspected measles cases ,it was clinical confirm outbreak , There were 3 cases of under five years old and 4 cases of over five years old .Based on sex, there were 2 female and 5 male cases with no deaths associated. The team collected lab samples and send them to CPHL, the cases treated. Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases  Suspected Measles Outbreak: Reported from Asheq village of Shahwalikot district, Kandahar province on March01 /2014, the team investigated the area on March 02/2014, Vaccination coverage is poor. During the investigation there were 45 suspected measles cases ,it was clinical confirm outbreak , There were 21 cases of under five years old and 24 cases of over five years old .Based on sex, there were 25 female and 20 male cases with no deaths associated. The team collected lab samples and send them to CPHL, the cases treated. Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases  Suspected CCHF Outbreak: Reported from Sanzaria village of Zheria district of Kandahar province on March 03, 2013. The team investigated the case on the same day .The patient has been admitted at the Merwais regional hospital. During the investigation, there was one suspected CCHF case and field investigation has been performed. The patient had the following sign and symptoms Fever, headache, body pain and gum bleeding; he was two years old boy and who had contact with animals. The team collected lab samples and send them to CPHL .The case was treated and health education session was conducted for his family members and other, the team is investigating for further cases.  Rabies Outbreak: Reported from Ashtorgram Sanglakh, Latifkhil, Lala shah Khil and Molla khil villages of Kohistan-1and Kohistan-2 districts of Kapisa province on March 02, 2013. The team investigated the case on the following day. During the investigation there were 30 suspected Rabies cases, the dog had sign and symptom. And field investigation has been performed jointly by Veterinary health workers and public health professional, there were 2 cases of under five years old and 28 cases of over five years old .Based on sex, there were 14 female and 16 male cases with no deaths associated. Veterinarian’s team collected lab samples from head of the dog and send them to CVDRL and the result was positive .The cases were treated and health education session was conducted for his family members and other, the team is investigating for further cases.  Suspected Measles Outbreak: Reported from Qaraboin Sofla village of , Jawzjan province on March 02 /2014, the team investigated the area on March 03/2014, Vaccination coverage is 10%. During the investigation there were 7 suspected measles cases ,it was clinical confirm outbreak , There were 2 cases of under five years old and 4 cases of over five years old .Based on sex, there was one female and 5 male cases with no deaths associated. The team collected lab samples and send them to CPHL, the cases treated. Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases  Suspected Measles Outbreak: Reported from Yangi Arigh village of Sheberghan city of , Jawzjan province on March 02/2014, the team investigated the area on March 04/2014, Vaccination coverage is 90%. During the investigation there were 7 suspected measles cases ,it was clinical confirm outbreak , There were no case of under five years old and 6 cases of over five years old .Based on sex, there was one female and 6 male cases with no deaths associated. The team collected lab samples and send them to CPHL, the cases treated. Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases  Suspected ARI/Avian influenza Outbreak: Reported from pio villages of Warsag district, Takhar province on March03 /2014, the team investigated the area on March 04 /2014, During the investigation there were 70 suspected ARI cases, it was clinical confirm outbreak, There were 45 cases of under five years old and 15 cases of over five years old .Based on sex, there were 21 female and 49 male cases with no deaths associated. The cases treated. And health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases. Epidemiological week- 10

 Suspected Measles Outbreak: Reported from Fakhari village of Gardasari district of , Paktya province on March 05/2014, the team investigated the area on March 07/2014, Vaccination coverage is 10%. During the investigation there were 7 suspected measles cases ,it was clinical confirm outbreak , There were no case of under five years old and 7 cases of over five years old .Based on sex, there was 2 female and 5 male cases with no deaths associated. The team collected lab samples and send them to CPHL, the cases treated. Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases.  Suspected Measles Outbreak: Reported from Tiemorkhil village of Mata khan district of , on March 10 /2014, the team investigated the area on March 11 /2014, Vaccination coverage is poor. During the investigation there were 6 suspected measles cases ,it was clinical confirm outbreak , There were 5 case of under five years old and one cases of over five years old .Based on sex, there was one female and 5 male cases with no deaths associated. The team collected lab samples and send them to CPHL, the cases treated. Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases.  Rumor of Mumps Outbreak: Reported from Zerani village of Sorkhroad district, Nangarhar province on March 09 /2014, the team investigated the area on March 10 /2014, during the investigation there were no cases of mumps, it was not an outbreak but it was a rumor.  Suspected Measles Outbreak: Reported from Zangoyee and Qalai Ishaq village of Behsood district of , Nangarhar province on March 09 /2014, the team investigated the area on March 08 /2014, Vaccination coverage is 43%. During the investigation there were 13 suspected measles cases ,it was clinical confirm outbreak , There were 9 cases of under five years old and 5 cases of over five years old .Based on sex, there was 8 female and 5 male cases with no deaths associated. The team collected lab samples and send them to CPHL, the cases treated. Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases

Recommendations:

 High number of deaths due to Pneumonia and Meningitis/SIC can be analyzed/discussed at provincial level among stakeholders to find out the gaps results the high morbidity and mortality, especially in Central East and North regions.  High incidence of Pneumonia overall up to 5.3% and 11% in the age group of less than five years should be analyzed and stakeholders should ensure the adequate amount of medicine for the treatment of the cases.  The high number of Meningitis in North, high number of Meningitis and Acute Viral Hepatitis cases in Central East, high number of Measles cases in South and North should be analyzed at peripheral level.  The increase in the outbreaks of Measles in South East and East regions is to be given serious consideration at the provincial level coordinating agencies.  DEWS focal points should coordinate AFP cases with the provincial AFP surveillance focal point.

ANNEX: Mapping of Density Cases of Selected Diseases in Week-10 of 2013 by Province 8 Density Cases of Pneumonia in Week-10 of 2014

Jowzjan Kondoz (Kunduz) Badakhshan Takhar

Faryab Samangan Baghlan Sar-e Pol PanjshirNurestan Badghis Konar (Kunar) Bamian Parvan (Parwan) Laghman Kabol (Kabul) Vardak (Wardag) Nangarhar Herat Ghowr Lowgar Daykondi Legend Paktia Ghazni Khowst Province_34 Pn Oruzgan (Uruzgan) 52.000000 - 69.000000 Farah Paktika 69.000001 - 118.000000 Zabol (Zabul) 118.000001 - 160.000000 160.000001 - 203.000000

Helmand Kandahar 203.000001 - 272.000000 Nimruz 272.000001 - 331.000000 331.000001 - 563.000000 563.000001 - 773.000000 773.000001 - 1053.000000 1053.000001 - 4037.000000 In this week 378 sentinel sites sent their report

8 Density Cases of Typhoid Fever in Week-10 of 2014

Jowzjan Kondoz (Kunduz) Badakhshan Balkh Takhar

Faryab Samangan Baghlan Sar-e Pol PanjshirNurestan Badghis Konar (Kunar) Bamian Parvan (Parwan) Laghman Kabol (Kabul) Vardak (Wardag) Nangarhar Herat Ghowr Lowgar Legend Daykondi Paktia Province_34 Ghazni Khowst TF Oruzgan (Uruzgan) 1.000000 - 4.000000 Farah Paktika 4.000001 - 7.000000 Zabol (Zabul) 7.000001 - 10.000000 10.000001 - 13.000000 13.000001 - 25.000000 Helmand Kandahar Nimruz 25.000001 - 34.000000 34.000001 - 52.000000 52.000001 - 73.000000 73.000001 - 102.000000 102.000001 - 146.000000 In this week 378 sentinel sites sent their report

8 Density Cases of Malaria in Week-10 of 2014

Jowzjan Kondoz (Kunduz) Badakhshan Balkh Takhar

Faryab Samangan Baghlan Sar-e Pol PanjshirNurestan Badghis Konar (Kunar) Bamian Parvan (Parwan) Laghman Kabol (Kabul) Vardak (Wardag) Nangarhar Herat Ghowr Lowgar Legend Daykondi Paktia Province_34 Ghazni Khowst Mal Oruzgan (Uruzgan) 0.000000 Farah Paktika 0.000001 - 1.000000 Zabol (Zabul) 1.000001 - 2.000000 2.000001 - 7.000000 7.000001 - 11.000000 Helmand Kandahar Nimruz 11.000001 - 18.000000 18.000001 - 26.000000 26.000001 - 44.000000 44.000001 - 89.000000 89.000001 - 160.000000 In this week 378 sentinel sites sent their report

8 Density Cases of Acute Viral Hepatitis in Week-10 of 2014

Jowzjan Kondoz (Kunduz) Badakhshan Balkh Takhar

Faryab Samangan Baghlan Sar-e Pol PanjshirNurestan Badghis Konar (Kunar) Bamian Parvan (Parwan) Laghman Kabol (Kabul) Vardak (Wardag) Nangarhar Herat Ghowr Lowgar Legend Daykondi Paktia Province_34 Ghazni Khowst AVH Oruzgan (Uruzgan) 0.000000 Farah Paktika 0.000001 - 1.000000 Zabol (Zabul) 1.000001 - 2.000000 2.000001 - 3.000000 3.000001 - 4.000000 Helmand Kandahar Nimruz 4.000001 - 5.000000 5.000001 - 9.000000 9.000001 - 13.000000 13.000001 - 18.000000 18.000001 - 43.000000 In this week 378 sentinel sites sent their report