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) Mortality and Morbidity Weekly Bulletin (MMWB Mortality and Morbidity Weekly Bulletin (MMWB) Cox’s Bazar o Volume N 1: 15 October 2017 Photo Credit: WHO Bangladesh, Dr. Syed Mahfuzul Huq WHBangladesh This document is built on the Early Warning and Response System (EWARS), daily data received through MOHWF and WHO from the service providers in settlements of the Unregistered Myanmar Nationals (UMNs) and from health facilities in Cox’s Bazar. As such, it can only be considered a snapshot of conditions in those reporting facilities. The presented information may hardly be viewed as representative of the overall health situation in Cox’s Bazar; nonetheless we believe that it gives all actors in the field a stepping stone for building a true picture of morbidity and mortality in the UMNs. We thank all partners contributing to the EWARS. The EWARS itself and the resulting reports can only be a work in progress. We welcome all comments, feedback and further inputs that can help to improve the system and our joint understanding of the prevailing epidemiological situation, and ultimately - to avert spread of diseases. Contact Information Dr. Edwin Salvador, Deputy WHO Representative / Incident Manager, [email protected] Dr. Hammam El Sakka, Team Leader, Health Emergency Programms, [email protected] WHO Bangladesh: http://www.searo.who.int/bangladesh MMWB Morbidity and Mortality Weekly Bulletin, Cox’s Bazar, Bangladesh 15 October 2017 / Vol. 1 1. Early Warning and Response System (EWARS) The main goal of the Early Warning and Response System (EWARS) in Cox’s Bazar District is the early detection of and timely response to public health threats. The main attributes of the system are sensitivity and timeliness. Sensitivity defines the capacity of the system to detect all occurring public health alerts. Since any signal can be the starting point of an outbreak or a public health crisis, EWARS must have the capacity to detect all of them. At the level of reporting, sensitivity refers to the proportion of cases of a given disease detected by the surveillance system. At the level of data analysis and decision-making, sensitivity refers to the ability to detect outbreaks, including the ability to detect new and emerging pathogens. Timeliness defines the capacity of the system to detect a public health alert early enough for control measures to have the greatest possible impact on morbidity and mortality. EWARS is designed to reduce delays in reporting and to detect public health emergencies even when affecting individual or limited disease clusters. Data received through surveillance must be analysed correctly, synthesized clearly, and disseminated effectively. Other attributes to be taken into consideration during the EWARS development and implementation are acceptability, usefulness, simplicity, representation, and sustainability. The success of effective EWARS functions in a national surveillance system depends on strong commitment of both national authorities and health partners working in the field. 1.1 EWARS data collection form All new cases and deaths are reported through a standardized data collection form, which has been developed for the ongoing emergency in Cox’s Bazar. The data collection form includes the following information: identification number, date of reporting, GPS coordinates, district, upazila, union, name of the camps or health facility, total population, population under 5. In addition, name of responsible person filling the form has to be included together with the contact information. The reporting form in English is attached as Annex 1. 1.2 Health events under surveillance and case definitions The EWARS reporting form contains the list of priority diseases and syndromes compiled based on the epidemiological profiles of both Bangladesh and Myanmar; standardized case definitions were developed and distributed to health partners along with the reporting forms. 2 MMWB Morbidity and Mortality Weekly Bulletin, Cox’s Bazar, Bangladesh 15 October 2017 / Vol. 1 The list of priority diseases/syndromes includes: acute watery diarrhoea (AWD), bloody diarrhoea (BD), acute respiratory infections (ARI), suspected measles/rubella (SMR), acute flaccid paralysis (AFP), suspected meningitis (MEN), acute jaundice syndrome (AJS), suspected haemorrhagic fever (HF), neonatal Diseases (NNT), adult tetanus (AT), suspected malaria (SM), confirmed malaria (CM), unexplained fever (UXF), severe malnutrition (SMN), skin diseases (SKN), eye infections (EIF), injuries (INJ) and other consultations (OTH). To facilitate data management, software has been developed by WHO and installed in the Control Room of the Civil Surgeon Office in Cox’s Bazar. WHO Surveillance and Immunization Medical officers (SIMOs) and MoHFW staff have been trained on standardized data collection tools. From daily collected and processed data, trained data managers are able to generate reports down to the upazila level. On a daily basis the data is shared with the MoHFW at central level. A global Information System (GIS) unit established in the Control Room is actively mapping disease patterns in all settlements in Cox’s Bazar. 1.3 Population under surveillance and reporting units The population under surveillance is the entire population of Unregistered Myanmar Nationals (UMNs) living presently in different locations such as public places, established or informal camps, and within host community in Cox’s Bazar. To calculate disease incidences, the denominator is calculated based on IOM estimated population data as of 10 October 20171. New cases and deaths of health events under surveillance are reported daily using the EWRAS standardized data collection tool form District Sadar hospital Cox’s Bazar, health complexes in Ukhia and Teknaf, and humanitarian health partners providing health services to UMNs through static or mobile units as shown in table 1. Table1: Estimated Population and Health Service Providers by upazila, Cox’s Bazar, Bangladesh, 2017. Ukhia Teknaf Camp/Settlement Provider Population Camp/Settlement Provider Population Hakimpara BDRCS 52,204 Ali Akbar Prara IOM 6,500 Jamtoli/ /Thangkhali IHA, MSF 27,459 Leda Make Shift IOM 26,015 Kutupalong UNHCR, 33,900 Rangikhali IOM 7,500 Registered Camp MSF, IOM Kutupalong, Balukhali IOM, MSF 300,460 Shamlapur Settlement IOM 35,756 Expansion Nayapara Registered Baggoha/Potibonia MSF 20,792 UNHCR 34,230 Camp Ukhia Health IOM, 39,559 Roikhong / Unchiprang MSF 28,494 Complex MOHFW Teknaf Health Complex MOHWF 71,607 TOTAL 474,374 TOTAL 210,102 IHA=Indonesia Humanitarian Alliance, BDRCS: Bangladesh Red Crescent Society, MOHWF: Ministry of Health and Family Welfare. 1 https://reliefweb.int/report/bangladesh/bangladesh-situation-update-rohingya-refugee-crisis-cox-s-bazar-10-oct-2017; 3 MMWB Morbidity and Mortality Weekly Bulletin, Cox’s Bazar, Bangladesh 15 October 2017 / Vol. 1 2. Proportion of primary causes for cases and deaths During the period of 25 August-10 October 2017, a total of 38,209 consultations under surveillance were reported through the EWARS system of which 32% (12,165) were due to ARI, 10% (3,876) due to AWD, 7% (2,585) due to SKN, 6% (2,272) due to unexplained fever (UNFEV), 4% (1,460) INJ, 2% BD, the rest 40% from other disease including severe malnutrition, eye infection, suspected measles/rubella, jaundice, and malaria. During the same period, there were 71 reported deaths, 41% due to ARI, 8% injury, 7% AWD, 7% neonatal tetanus, 4% cardio vascular disease, 3% suspected malaria, 3% meningitis like disease, and 7% unknown causes. The rest of the deaths were due to other causes and reported under the category “Others”. The proportion of primary causes for the reported cases and related deaths is shown in Figure2. Cases (n=38,209) Deaths (n=71) Figure 2: Proportion of primary causes for all reported cases and deaths, Cox’s Bazaar, Bangladesh, 25 August -10 October 2017. (ARI: Acute Respiratory Tract Infection, AWD: Acute Water Diarrhoea, BD: Bloody Diarrohea, CVD: Cardio Vascular Disease, INJ: Injuries, MEN: Meningitis like Disease, MAL: Malaria, NNT: Neonatal Diseases, OTH: Other diseases, SKN: Skin Disease, UNFEV: Fever of unexplained origin and UNK: Unknown Causes). For under-5 year age group, a total number of 14,015 cases of health events were reported through EWARS constituting 37% of the total consultations. 39% (5,461) of these cases were attributed to ARI while 16% (2,190) were due to AWD. There were 29 reported deaths in the children under-5 representing 41% of total deaths reported from Cox’s Bazar. Of these figures, 59% (17 deaths) were ARI- related, 17% (5 deaths) were due to neonatal diseases and 10% (3 deaths) due to AWD. The proportion of primary causes for the reported cases and deaths for the children under-5 year is shown in Figure 3. 4 MMWB Morbidity and Mortality Weekly Bulletin, Cox’s Bazar, Bangladesh 15 October 2017 / Vol. 1 Figure 3: Proportion of primary causes for the reported cases and deaths in the under-5 year age group, Cox;s Bazar, Bangladesh, 25 August -10 October 2017. For the over-5 year age group, a total number of 24,194 cases of health events were reported through EWARS constituting 63% of the total number of consultations. 28% (6,704) of these cases were attributed to ARI and 7% (1,686) to AWD. There were 42 reported deaths in this age group, representing 59% of total deaths reported from Cox’s Bazar. Of these, 29% (12 deaths) were due to ARI, 4% to injury, 10% to AWD and 5% to CVD. The proportion of primary causes for the reported cases and deaths for the children under-5 year is shown in Figure 4. Figure 4: Proportion of primary causes for the reported cases and deaths in the Over 5 year age group, Cox;s Bazar, Bangladesh, 25 August -10 October 2017. 3. Measles cases Between 10 and 25 September 2017, a total of 22 suspected measles cases were reported from Cox’s Bazar district: 55% (12/22) from Ukhia, 41% (9/12) from Teknaf and 4% (1/22) from Ramu upazila. No cases were reported from Bandarban district.
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