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Pakistan Health Cluster Bulletin No 18- Focus on Malaria 20 September 2010

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Pakistan Health Cluster Bulletin No 18- Focus on Malaria 20 September 2010 Floods in Pakistan Pakistan Health Cluster Bulletin No 18- Focus on Malaria 20 September 2010 Railway Hospital Sukkur- Photograph by Syed Haider Ali (WHO). HIGHLIGHTS The Ministry of Health (MoH) and Health Cluster partners are preparing for a significant rise in the number of cases of malaria. The disease is being increasingly reported in all flood-affected districts; up to 2.2 million cases are expected over the next six months. In Sindh, the situation in Hyderabad is exacerbated by an acute shortage of humanitarian staff on the ground. The Executive Director of Health in the town of Dadu has asked the UN and partners for help dealing with the worsening situation, especially in the area around lake Manchar. The Pakistan Flood Emergency Response Plan (PFERP) was launched in New York on 17 September. The plan - a revision of the initial response plan (PIFERP) - proposes a comprehensive set of relief and early recovery activities. The Disease Early Warning and Surveillance (DEWS) system is functioning well: so far, the MoH and partners have managed to avert a second wave of deaths from disease. In Punjab province, Multan hub reports that between 65 and 90% of internally displaced people (IDPs) are returning home. Senior officials from WHO, UNICEF and WFP will visit affected areas from 22 to 25 September. Situation overview and current scale of disaster In Khyber Pukhtoonkhwa (KPK) and Punjab, the situation continues to stabilize. People are gradually returning to their homes and villages. The Health Cluster coordinator in Multan reports that between 65% and 90% of IDPs in the area have returned. Nevertheless, the severe damage to infrastructure, agriculture and homes cannot be overstated. The Health Cluster will need to begin implementing early recovery programmes to address the needs of these returnees. In addition, outbreaks of malaria in southern Punjab, an area with low rates of endemic malaria, are giving rise to some concern. In northern Sindh more than half of the IDPs are returning home. Although the situation is stabilizing in some areas, it remains critical in the south. The city of Dadu is cut off, and the Hub Coordinator in Hyderabad reports an acute shortage of humanitarian partners on the ground. Moreover, sanitary conditions in some IDP camps are reported to be rudimentary, with overcrowding and open defecation within the camp area. Stagnant rain water is used to wash utensils and clothes. There is no safe drinking water and food is cooked and eaten by IDPs in unhygienic conditions. Security issues due to the murder of MQM party convener Dr Imran Farooq in London on 16 September have hampered humanitarian operations in Sindh (in both Sukkur and Hyredabad), and in Karachi. Humanitarian activities as well as general services were completely halted on 17 September, and international staff were assigned to residence. The situation improved on 18 September; activities on the ground are now resuming. Health impact Acute diarrhoea, acute respiratory infections, skin diseases and suspected malaria remain the leading causes for seeking health care in the flood-affected areas. Basic statistics update • Out of 5.3 million consultations conducted up to 17 September, 708 891 (13%) were for acute diarrhoea, 802 670 (15%) were for acute respiratory infections (ARI), 986 843 (18%) were for skin disease and 182 762 (3%) were for suspected malaria. • The number of suspected malaria cases is rising in Baluchistan and Sindh provinces compared to KPK and Punjab. A total of 40 415 cases of suspected malaria were reported from 4 to 10 September. • There are around 500 000 pregnant women among the affected population. This means that many deliveries each month will be in an unsafe environment, without access to skilled birth attendants. • Acute respiratory tract infections (ARI) are the leading cause of morbidity. However, the number of cases of suspected malaria is rising fast: over the last 24 hours, the reported number of malaria cases accounted for 17% of consultations in Baluchistan province and 13% in Sindh province. New concerns and latest needs; upcoming and recent concerns • A total of 389 snake bites were reported in Sindh from 31 July to 14 September. • 4 alerts of AWD and one alert of meningitis were reported and responded to from 11 to 17 September. • Paediatric malnutrition is increasingly a concern: 30 to 50% of children arriving at health facilities show symptoms of acute malnutrition. Before the floods, paediatric malnutrition was not foreign to Pakistan: according to the last National Nutrition Survey, the global acute malnutrition rate was 13%. A total of 10% of children had moderate acute malnutrition (MAM), and 5% had severe acute malnutrition (SAM). • Around 500 000 women are pregnant among the affected population. This means that around 83 000 deliveries will take place per month, many of which will be in an unsafe environment without access to skilled birth attendants. Malaria Situation Focus Malaria is endemic in 36 of the 77 flood-affected districts. The floods have favoured vector breeding, resulting in high densities of disease-transmitting mosquitoes. This, together with the high exposure of the population (IDPs) has greatly increased the transmission potential of the disease. Punjab province • Six districts located in the low-endemic province of Punjab that have reported sporadic cases in the past have shown a decline in Slide Positivity Rate (SPR-current 20%) compared with the highest rate in the first week of September. The number and percentage of vivax cases is disproportionately high in Southern Punjab. The total number of reported cases from the highly endemic district of Mozaffargarh since 1 September is 1420. The data from five other districts are not available. Sindh and Balochistan provinces • In Sindh, except for the central districts of Karachi city, all districts are highly endemic for malaria. The situation is deteriorating in the districts affected by floods. The situation is expected to reach epidemic levels in coastal (Thatta, and Badin) and southern districts (Dadu, T.Muhammad Khan etc). • In Balochistan, there have been confirmed malaria outbreaks in north-eastern districts (Zhob, Loralai, Musakhail) that have received heavy rainfall this year. The falciparum proportion has reached 95%, and the overall SPR is 50%, which is the highest in the country. • The situation in districts Sibi, Naseerabad and Mastung (Balochistan) is not encouraging. Mastung has shown a rise in falciparum cases in recent days, due to the influx of IDPs from Sindh. Information from other districts is lacking due to the non-functioning surveillance system. • Balochistan has the highest burden of malaria in the country. This poses challenges for the malaria control programme when trying to cope with emerging needs. KP Province • The situation in KPK is stable, with normal transmission patterns. Government Response • On 16 September 2010, the Federal Secretary for Health and the Coordinator of the National Health Emergency Preparedness and Response Network (NHEPRN) briefed members of the Standing Committee on Health on the health response to the floods. The Committee requested the Ministry of Health to continue health care services in the flood-affected areas as well as continue its efforts to contain disease outbreaks and thus avoid epidemics. • The third meeting of the National Steering Committee on Health Emergencies, chaired by Mr Kushnood Lashari, Federal Secretary of Health, was held at NHEPRN Centre on 16 September 2010. The Committee, established by the Prime Minister of Pakistan, comprises of all Provincial Secretaries, Heads of UN Agencies, the President, CPSP, PMDC and PMA. All Provincial Secretaries present weekly reports (including needs) on a common reporting format developed by NHEPRN. • The committee expressed its satisfaction over improved coordination at various levels, resulting in a better use of resources and the avoidance of duplication. A subcommittee of the MoH, WHO and UNICEF was formed to work out the distribution of long-lasting insecticidal nets (LLINs) being donated by various countries. • MoH has asked the national Disaster Management Authority (NDMA) to provide water filtration plants to the provinces through UNICEF and the Water, Sanitation and Hygiene (WASH) Cluster. • To facilitate information-sharing, NHEPRN launched its official website on 15 September on a trial basis. • NHEPRN is organizing the deployment of foreign field hospitals and medical teams in the provinces, depending on the affected population and damaged health facilities. Seven field hospitals donated by the Italian Government are being deployed at Charsaddah, Nowshera, Bhakhar, Layyiah, Mianwali, Giligit and Balochistan. Health Cluster Response CARE Update from 8 to 14 September: KPK A total of 807 patients have been treated via four BHUs in Upper Swat (KPK) including 285 women and 368 children. CARE has conducted 15 Mobile clinics (via three mobile teams) in the district of Charsadda, treating 2556 patients including 761 women and 1042 children. CARE also held 36 health and hygiene sessions for 742 people. CARE operated four mobile clinics (via four mobile teams) in the district of Nowshera (KPK) and treated 1580 patients including 481 women and 692 children. It also held 23 health and hygiene sessions for 796 persons. Punjab Primary health care (PHC) services were provided via 10 mobile clinics in Rajanpur (South Punjab). A total of 2866 patients including 979 women and 1388 children were treated. Sindh CARE provided PHC services to 837 patients including 258 women and 422 children via mobile medical camps in districts Sukkur, Kasmore and Shikarpur. CHURCH WORLD SERVICE – CWS P/A KPK Three mobile health units (MHUs) are operating in districts of Mansehra, Kohistan District and Swat, especially in remote areas where these MHUs are providing essential medicines and consultations for patients, with a special focus on women and children. A total of 7855 consultations were made. Lady health visitors (LHVs) examined 156 ante- and 32 postnatal clients, who were registered and given medicines.
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