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WMMR Pakistan Epidemiological Week No. 30 (21 – 27 July) August 1/ Vol. 88/ DEWS 2007-30 Rawalakot: DEWS training Pictured by: Mohammad Ali Reporting Units...............................................................2 Total number of consultations ........................................2 DEWS Data, Epidemiological Week No. 30, 2007.........3 DEWS Data, Monthly Summary (Epidemiological Weeks No. 27-30).......................................................................4 Acute Watery Diarrhoea .................................................5 Acute Jaundice Syndrome..............................................6 Malaria ............................................................................7 Acute Respiratory Infection ............................................8 Other Reportable Diseases and Conditions ...................8 Outbreak Alert and Response ........................................9 Number of reported cases and deaths per District, AJK ......................................................................................10 Number of reported cases and deaths per District, NWFP ...........................................................................11 The number of bloody diarrhoea cases One alert of suspected measles was decreased by 6% from week 29 reported from DHQ hospital Bagh. (W29=601 & W30=568) One suspected case of meningitis Malaria cases increased by 26% from reported from DHQ hospital Bagh. week 29 (W29=706 & W30=893) Five cases of suspected acute watery Acute watery diarrhoea cases increased diarrhoea reported from BHU Mallot, by 3% from week 29 (W29=12,416 & District Bagh. W30=12,770) The Weekly Morbidity and Mortality Report (WMMR) is published by the Ministry of Health of Pakistan (MOH) and the World Health Organization (WHO). The WMMR is built on surveillance data that health service providers and NGOs transmit on a weekly basis from health facilities and hospitals in those areas affected by the earthquake that struck Pakistan on 8 October 2005. The WMMR objectives are to monitor the trend of health conditions over a period of time and provide vital information to all health partners. The WMMR is only a snapshot of the health conditions in those facilities where events are registered and data collected and does not necessarily reflect the situation from other health facilities. The WMMR is a publication that has been developed for emergencies and previously used in other areas such as the Darfur Crisis. The WMMR is produced with the financial support of AAI Australia, Americares, CIDA, Denmark, DFID, ECHO, Ireland, Italy, Japan, Korea, Monaco, Norway, SIDA, Slovak Republic, Switzerland, Turkey, USAID The WMMR is published by the World Health Organization (WHO), Health Emergency Operation Centre, National Park Road, Chak Shehzad, Islamabad, Pakistan. For More Information, please contact: Dorcas Taylor, Epidemiologist, WHO/EHA/Pakistan; [email protected] or Dr. Birjees Mazher Kazi, Chief, Public Health Laboratories Division, NIH MOH; [email protected] or WHO Webpage: http://www.whopak.org/disaster WMMR Weekly Morbidity and Mortality Report Pakistan 1 August 2007 / Vol. 88/ DEWS 2007-30 Reporting Units The number of reporting sites able to report this week was 298; the reporting timeliness of the DEWS system has decreased by 3% compared with the previous week (epidemiological week 29). See Table 1 for summary statistics. Table1. Reported heath facilities by district, Earthquake Affected Areas, Pakistan, 30June to 27July 2007. Reporting Health Facilities 30June- 7-13 July 14-20 July 21-27 July Area Population 6July Week-27 Week-28 Week-29 Week-30 Bagh 452,532 41 40 42 40 Battagram 592,256 29 29 28 28 Mansehra 1,154,804 70 65 71 72 Muzaffarabad 894,364 90 82 86 82 Poonch 633,712 69 68 74 69 Total 3,727,668 299(89%) 284(85%) 301(90%) 291(87%) Total number of consultations In week 30, there was a 3% decrease in the number of reporting sites, but the number of consultations increased from 94,085 to 96,673. The highest number of consultations was from Muzaffarabad, with 33,607, and the lowest from Battagram district, at 5,333. The weekly trend of reporting units participating in the DEWS and the number of consultations is shown in figure 1. No. Unit Reporting Units and Consultations No. Consult. 200000 Reporting Unit Consultation 300 150000 250 200 100000 150 100 50000 50 0 0 W42 W46 W50 W2 W6 W10 W14 W18 W22 W26 W30 W34 W38 W42 W46 W50 W02 W06 W10 W14 W18 W22 W26 W30 Week Figure 1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, 15 October 2005 - 27 July 2007. 2 WMMR Weekly Morbidity and Mortality Report Pakistan 1 August 2007 / Vol. 88/ DEWS 2007-30 DEWS Data, Epidemiological Week No. 30, 2007 During the last week (21 to 27 July, 2007), 96,673 consultations were reported through DEWS. Acute Respiratory Infections (ARI) accounted for 20% (18,938) of consultations, which was 3 percentage points higher than the rate seen in the same week last year. Acute Watery Diarrhoea (AWD) was 13% (12,770) of consultations, 8% (7,284) were due to Fever of Unknown Origin (FUO) and less than 1% (272) due to Injuries (INJ). The rate of AWD in patients under five years was less than one percentage point higher in week 30 of 2007 compared to the same week last year. In patients aged five and above, AWD was 11% of consultations, which was almost the same rate reported in the same week last year. All other reportable conditions each represented less than 1% of the total consultations in week 30. AWD ARI AWD ARI 11% 18% 13% 20% AWD ARI 21% 26% FUO 7% FUO INJ 8% <1% INJ FUO <1% 8% INJ OTH* OTH* OTH* <1% 61% 58% 43% < 5yrs (n=19,060) ≥ 5yrs (n=77,613) All Ages (n=96,673) Figure 2. Proportion of primary causes for all reported cases, Earthquake Affected Areas, Pakistan, 21 to 27 July 2007. *OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance DEWS Data, Epidemiological Week No. 30, 2007: Consultations by age The rate of AWD in patients five years and older was almost the same in last four weeks in 2007 compared with the same weeks in 2006. However, the rate in patients less than five years is 2 to 4 percent higher in week 27 and 28 but almost same in week 29 and 30 of 2007 compared with the same weeks last year. See figure 3. 25 20 15 10 5 AWD as percentage of all consultation 0 Weeks 27 28 29 30 2006 <5 yrs 2006 >=5 yrs 2007 <5 yrs 2007 >=5 yrs Figure 3: AWD as a percent of all consultations, by age group, Earthquake Affected Areas, Pakistan, 1 -28 July 2006 to 30 June - 27 July 2007 3 WMMR Weekly Morbidity and Mortality Report Pakistan 1 August 2007 / Vol. 88/ DEWS 2007-30 DEWS Data, Monthly Summary (Epidemiological Weeks No. 27-30) During the period, 30 June to 27 July, 2007 (Epidemiological weeks 27 to 30 inclusive), 153,659 consultations relating to health conditions under surveillance were reported, out of the total of 375,554 consultations. 19% (69,753) of consultations were due to acute respiratory infection (ARI), 13% (50,020) acute watery diarrhoea (AWD), 7% (26,624) unexplained fever (FUO) and 1% (1,983) Injuries (INJ). Table 2. Comparison of the weekly distribution of reported cases, deaths and monthly Case Fatality Rate (CFR), Earthquake Affected Areas, Pakistan, 30June – 27 July 2007. Week WEEK 27 WEEK 28 WEEK 29 WEEK 30 TOTAL Event C D C D C D C D C D CFR% AWD 11967 1 12867 1 12416 1 12770 3 50020 6 0.012 BD 618 0 464 0 601 0 568 0 2251 0 0.000 AFP 1 0 0 0 0 0 0 0 1 0 0.000 MAL 699 0 588 0 706 0 893 0 2886 0 0.000 ARI 16377 1 17210 2 17228 3 18938 3 69753 9 0.013 MES 9 0 8 0 9 0 4 0 30 0 0.000 MEN 1 0 1 1 1 0 2 1 5 2 40.000 JAU 26 0 37 0 22 0 21 0 106 0 0.000 TET 0 0 0 0 0 0 0 0 0 0 0.000 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 6572 0 6303 0 6465 0 7284 0 26624 0 0.000 INJ 1152 1 313 1 246 0 272 0 1983 2 0.101 OTH 56520 16 53063 10 56391 10 55921 13 221895 49 0.022 TOTAL 93942 19 90854 15 94085 14 96673 20 375554 68 RU 299 284 301 291 C – Cases, D – Deaths, AWD - Acute Diarrhoea, BD - Bloody Diarrhoea, AFP - Acute Flaccid Paralysis, MAL – Malaria, ARI - Acute Respiratory Infection, MES – Measles, Men - Meningitis, JAU - Acute Jaundice Syndrome, TET - Neonatal Tetanus, AHF Acute Hemorrhagic Fever, FUO –Unexplained fever, INJ – Injuries, OTH – Others, RU – Reporting Units. Please note data from late reporting in previous weeks has been updated. During the same reporting period, 69,692 consultations were reported in children less than 5 years of age, (19% of the total consultations), of which ARI was 26% (18,206), AWD 22% (15,471), FUO 7% (4,765) and INJ was less than 1% (333). Table 3. Total number of reported cases, deaths and monthly Case Fatality Rate (CFR), less than 5 years old, Earthquake Affected Areas, Pakistan 30June – 27July 2007. Week WEEK 27 WEEK 28 WEEK 29 WEEK 30 TOTAL Event C D C D C D C D C D CFR% AWD 4083 1 3840 1 3581 1 3967 2 15471 5 0.032 BD 185 0 128 0 163 0 144 0 620 0 0.000 AFP 1 0 0 0 0 0 0 0 1 0 0.000 MAL 120 0 85 0 96 0 127 0 428 0 0.000 ARI 4783 1 4371 2 4143 3 4909 3 18206 9 0.049 MES 4 0 3 0 5 0 4 0 16 0 0.000 MEN 0 0 0 0 0 0 1 0 1 0 0.000 JAU 3 0 6 0 3 0 4 0 16 0 0.000 TET 0 0 0 0 0 0 0 0 0 0 0.000 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 1071 0 991 0 1097 0 1606 0 4765 0 0.000 INJ 201 0 43 0 39 0 50 0 333 0 0.000 OTH 7191 4 6752 4 7644 2 8248 2 29835 12 0.040 TOTAL 17642 6 16219 7 16771 6 19060 7 69692 26 RU 299 284 301 291 4 WMMR Weekly Morbidity and Mortality Report Pakistan 1 August 2007 / Vol.
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