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Disease Early Warning System and Response in Pakistan

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Weekly Bulletin Epidemiological Disease early warning system and response in Pakistan Volume 3, Issue 3, Wednesday 25 January, 2012 Highlights Priority diseases under surveillance in DEWS Epidemiological week no. 3 (15 to 21 January, 2012) Acute (Upper) Respiratory Infection • In week 3, 2012, total 75 districts including 1 agency provided surveillance data to the DEWS (URTI) on weekly basis from around 1,554 health facilities. Data from mobile teams is reported through Pneumonia sponsoring BHU or RHC. Suspected Diphtheria Suspected Pertussis Acute Watery Diarrhoea • A total of 500,490 consultations were reported through DEWS of which 25% were acute Bloody diarrhoea respiratory infections (ARI); 5% were Skin disease; 6% were acute diarrhoea; and 4% were sus‐ Other Acute Diarrhoea pected malaria. Suspected Enteric/Typhoid Fever Suspected Malaria Suspected Meningitis • A total of 141 alerts with 8 outbreaks were reported: Altogether 69 alerts for Measles; 20 Suspected Dengue fever for Leishmaniasis; 17 for Neonatal tetanus; 10 for Pertussis; 9 for AWD; 4 for Acute Jaundice Suspected Viral Hemorrhagic Fever Syndrome; 2 each for Bloody diarrhoea and DHF; while 8 for others communicable diseases. Pyrexia of Unknown Origin Suspected Measles Suspected Acute Viral Hepatitis • In week 3, 2012, two new type‐1 polio cases, one each from Balochistan (Quetta district) Chronic Viral Hepatitis and Sindh (Mirpur Khas district). As of 23rd January, the total number of polio cases in 2012 is Neonatal Tetanus three; from two infected districts. Acute Flaccid Paralysis Scabies Cutaneous Leishmaniasis Others Figure‐1: Weekly trend of Acute diarrhoea, Bloody diarrhoea, ARI and Suspected malaria in Pakistan, Week‐1, 2011 to week‐3, 2012. 50 AD BD ARI S. Malaria 45 40 35 30 Percentage 25 20 15 10 5 0 1 3 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk wk Table 1: Most common communicable diseases syndromes reported in 2011, by province Disease Wk-48 Wk-49 Wk-50 Wk-51 Wk-52 Wk-1 Wk-2 Wk-3 Acute respiratory infection 242,844 (27%) 192,900 (27%) 241,869 (28%) 240,042 (29%) 215,219 (30%) 90,563 (27%) 107,692 (27%) 126,941 (25%) Skin diseases 77,057 (9%) 58,406 (8%) 69,079 (8%) 68,422 (8%) 55,185 (8%) 19,737 (6%) 19,582 (5%) 24,370 (5%) Acute diarrhoea 65,718 (7%) 52,625 (7%) 61,478 (7%) 57,942 (7%) 49,544 (7%) 21,574 (6%) 23,844 (6%) 26,878 (5%) Bloody diarrhoea 4,912 (0.54%) 4,556 (0.64%) 4,856 (0.57%) 4,332 (0.52%) 4,257 (0.59%) 1,492 (0.44%) 2,204 (0.55%) 2,104 (0.42%) Suspected malaria 63,826 (7%) 47,753 (7%) 52,040 (6%) 50,480 (6%) 39,991 (6%) 13,887 (4%) 15,050 (4%) 19,482 (4%) Total consultation 904,948 709,4184 856,582 835,260 717,926 340,073 403,874 500,490 • The above graph shows the weekly trend of ARI; Acute diarrhoea; Bloody diarrhoea and Suspected malaria as percentage of cases out of total consultations reported to DEWS on weekly basis. • The above table provides the total consultations and proportional morbidity of five disease syndrome. Proportional mor‐ bidity of ARI is highest in KP while acute diarrhoea is highest in Sindh and Balochistan. • Proportional morbidity of suspected malaria were very high for the year at 9% in Balochistan and 6% in Sindh (Please see provincial trends graphs). This weekly Epidemiological Bulletin is published jointly by the National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: [email protected]; WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083; E-mail: [email protected]. 01 Special Bulletin: DEWS, Pakistan, Week no. 3 (15 to 21 January, 2012) Previous week's (2/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Alert for Bloody diarrhoea, 3 cases were reported from BHU Manakarai. Stool sample was taken and sent to Khyber NIH. Water samples were tested and found to be contaminated. LHWs were involved in active case finding 2 9‐Jan BD Pakhtunk‐ Haripur Village Manakarai 0 3 1 1 more cases were found. Aqua tabs were distributed in the community for disinfection of household water. hwa Health and hygiene sessions were conducted. EDO health was informed of the cases Village Cheejpur, UC Alert for probable Pertussis, 14 suspected cases were found in village, vaccination is not regular, health 12‐Jan Pertussis Sindh Dadu Chorr Qambar, Taluka 4 1 8 1 education imparted, 1 Throat sample taken, EDOH, THO and EPI focal person informed. K.N.Shah Village Long Khoso, UC Alert for probable Pertussis, 7 suspected cases were found in village, Vaccination status is very poor, health 12‐Jan Pertussis Sindh Dadu 2 0 3 2 Gozo, Taluka K.N Shah education imparted, 1 Throat sample taken, EDOH, THO and EPI focal person informed. Village Sangrano, UC Alert for probable Pertussis, 7 suspected cases were found in village, health education imparted, area was 12‐Jan Pertussis Sindh Sanghar Chotiyaryoon, Taluka 0 4 0 3 partially vaccinated, Erythromycin and Cough syrup provided to cases and contacts and EDOH informed. Sanghar Alert for Typhoid from Islamabad for Haripur district. A case of AJS and with Widal positive from village Kot Najibullah. During active surveillance 13 more suspected cases were identified. Medicines were provided to Khyber the CD. 14 LHWs were involved in active case finding and response. 6 water samples were taken and 4 of 12‐Jan Typhoid Pakhtunk‐ Haripur Village Kot Najibullah 0 8 1 6 them were contaminated. 10,000 aqua tabs were distributed in 2 days between 287 houses. Filters and soaps hwa were also distributed. Health and hygiene sessions were also conducted involving LHWs. EDO health was informed of the outbreak. Public Health Engineering has also been informed and intervention is planned for current week Current week's (3/2012) Outbreaks: Date Disease Province District Area <5M >5M <5F >5F Action Taken Alert for suspected cases of Dengue hemorrhagic fever reported from Lahore. The cases were investigated and blood sample was taken and sent to lab testing and found positive. The cases were kept in isolation ward Mayo Hospital ‐ Ravi of Teaching hospital. LLINS applied around the bed to prevent spread of infection. There is no Travel History 16‐Jan DHF Punjab Lahore 0 15 0 1 Town of patient. WHO SO along with, CDCO,DDHO, and entomologist visit the area, Vector Surveillance was carried out. Mechanical Eradication of larva was done successfully. Health education session was given to the com‐ munity, the area would be visited again for follow up. Alert for Typhoid, 10 cases of enteric fever have been reported from Khalabut Township. Blood sample of 2 Khyber patients were taken and found positive for typhidot. Previous alerts have indicated contaminated water and 17‐Jan Typhoid Pakhtunk‐ Haripur Khalabut Township 1 6 0 3 leaked distribution system are the sources of the outbreaks health and hygiene sessions have been conducted hwa for the LHWs which will be replicated in the community. TMA Khalabut was involved and Cleaning and Chlorination of tanks was undertaken. EDO Health was informed of the cases. Alert for probable Pertussis, 5 suspected cases including 1 death investigated at DHQH. Communication was Jamboo UC Zeedi Tehsil made with DDHO, during active surveillance 20 more cases were found, provided symptomatic treatment 17‐Jan Pertussis Balochistan Khuzdar 12 3 8 2 Khuzdar with health education. 2 swabs were collected and sent to NIH. 51 children were vaccinated for Measles and Pentavalent by EPI team while only 1 child found with BCG Scar. Alert for 6 cases of Leishmaniasis were reported from Different areas of Jhal Magsi village. Each patient was 18‐Jan Leishmaniasis Balochistan Jhal Magsi Village JhalMagsi 1 2 2 1 investigated separately. Medicines were provided and Health education was given to community. DHO was informed about outbreak and requested for preventive measures. Alert for 7 cases of suspected cutaneous Leishmaniasis were reported from one village. The cases were from same family and had a history of travel to Balochistan for harvesting season 4 months ago. The cases were treated with topical and parental antibiotics but were not cured. 2 samples of scrapings were collected from Rahim Yar Nawazabad, Tehsil 18‐Jan Leishmaniasis Punjab 0 2 1 4 the cases and sent to SZH laboratory. The patient were referred to Leishmaniasis treatment center at RHC Khan Sadiqabad Zahirpir. Patients were provided injection Glucantime at RHC. Patients were also prescribed polyfax cream to cover the lesions. The information shared with CDCO and Entomologist Health Department Rahim Yar Khan for sampling and control of vector and permethrin fogging is scheduled. Alert for 6 suspected cases of Leishmaniasis were investigated at DHQH. Cases were reported from different 19‐Jan Leishmaniasis Balochistan Sibi DHQH Sibi 1 0 1 4 areas. There is no travelling of history. Injection Glucantime was provided and advised to come regularly at DHQ Hospital for treatment. Alert for Bloody diarrhoea, 6 suspected cases were admitted in hospital, during active surveillance samples Nagori Mohalla, UC were not collected because the patients were already on antibiotics, health education imparted, Aqua tabs, 20‐Jan BD Sindh Mirpur Khas 4 0 2 0 Jhudo, Taluka Jhudo Zinc tabs, ORS, Jerry cans, Nerox filters, Hygiene kits and IEC material distributed, informed EDOH and DSM‐ PPHI. Alert for probable Diphtheria was received from LRH Peshawar.
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    Social Status and Political Participation of Christian Minority in Pakistan

    i Social Status and Political Participation of Christian Minority in Pakistan Ph.D. Thesis By: Akhlaq Hussain Shamsi CENTRE FOR SOUTH ASIAN STUDIES University of the Punjab, Quaid-e-Azam Campus, Lahore, Pakistan. 2011 ii Social Status and Political Participation of Christian Minority in Pakistan A thesis submitted in fulfillment of the requirement for the Degree of Doctor of Philosophy South Asian Studies with Specialization in Social Work. By: Akhlaq Hussain Shamsi CENTRE FOR SOUTH ASIAN STUDIES University of the Punjab, Quaid-e-Azam Campus, Lahore, Pakistan. 2011 iii iv DEDICATION This thesis is dedicated to my wife and sons without their support and encouragement it would not have been possible. v ACKNOWLEDGEMENT All praise of Allah Almighty whose mercifulness and greatness could not change. All love and respect for Prophet Muhammad (P.B.U.H) who gave us the knowledge to recognize our creator. I owe my deepest gratitude to Dr. Umbreen Javed, Director South Asian Studies Centre who always encouraged, supported and guided me with affection and respect. She was not just a Director in a traditional sense but a true mentor. She was very accessible, considerate about my problems and understood my limits. My greatest gratitude and debt to my guide and supervisor in this research work, Dr. Zahid Javaed, who encouraged me and gave me so much of his precious time and goodwill during the supervision of this thesis. His guidance, wisdom and best wishes really made this work possible. My sincere thanks to Mr. Abdul Hameed for providing required relevant material as well as support for the completion of this work.