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Epidemiological Week No. 44 (28 Oct-3 Nov 2006) 9 Nov 06/ Vol

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Epidemiological Week No. 44 (28 Oct-3 Nov 2006) 9 Nov 06/ Vol Epidemiological Week No. 44 (28 Oct-3 Nov 2006) 9 Nov 06/ Vol. 50/ DEWS 2006-44 Reporting Units...............................................................2 Total number of consultations ........................................2 DEWS Data, Epidemiological Week N0 44 2006............3 DEWS Data, Monthly Summary (Epidemiological Weeks N0 41-44) ........................................................................4 Acute Watery Diarrhoea .................................................5 Bloody Diarrhoea............................................................6 Acute Jaundice Syndrome..............................................6 Malaria ............................................................................7 Measles ..........................................................................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 ......................................................................................11 Number of reported cases and deaths per District, NWFP ...........................................................................12 Muzaffarabad Picture by Dr. Hammam Elsakka In the past month (Epidemiological In week 44, there was three deaths from weeks 41-44 inclusive), 120,870 health acute respiratory infection. events under surveillance were reported including 61 deaths Six suspected cases of meningitis reported this week, five cases from This week, there were 291 reporting Muzaffarabad district and one case units contributing to the report. from Bagh district In week 44, Total 85,742 consultations This week, there were Seven hundred were reported, with 10 deaths and ninety-four Malaria cases reported this week. 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 published by the World Health Organization (WHO), Health Emergency Operation Centre, House #6, Street #20, F-7/2, 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 9 Nov 2006 / Vol. 50/ DEWS 2006 -44 Reporting Units The number of sites able to report increased by 49 this week and the reporting timelines of the DEWS systems has also increased at the current Epidemiological week compared with week 43. See Table 1 for summary statistics. Table1. Reported heath facilities by district, Earthquake Affected Areas, Pakistan, 28 Oct - 3 Nov 2006. Reporting Health Facilities Area Population 7 – 13 Oct 14 – 20 Oct 21-27 Oct 28 Oct-3Nov Week 41 Week 42 Week 43 Week 44 Muzaffarabad 894,364 100 100 66 80 Bagh 452,532 31 36 35 43 Poonch 633,712 72 67 52 68 Mansehra / Balakot 1,154,804 70 69 64 66 Battagram / Shangla 592,256 38 37 25 34 Total 3,727,668 311(96%) 309(95%) 242(74%) 291(89%) Total number of consultations In week 44, there were an increase in the number of reporting sites, and the number of consultations also increased to 85,742. The highest number of consultations by district was in Mansehra, with 24,202 and the lowest was in Battagram, at 6,048. The decline in the number of consultations in week 43 was related to Eid-ul-Fitr leave. A similar drop can be seen in week 2, which corresponded with Eid-ul-Fitr last year. No. Unit Reporting Units and Consultations No. Consult. 200000 300 Reporting Unit Consultation 250 150000 200 100000 150 100 50000 50 0 0 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W52 W1 W2 W3 W4 W5 W6 W7 W8 W9 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19 W20 W21 W22 W23 W24 W25 W26 W27 W28 W29 W30 W31 W32 W33 W34 W35 W36 W37 W38 W39 W40 W41 W42 W43 W44 Week Figure 1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, 15 October 2005 – 3 Nov 2006. 2 WMMR Weekly Morbidity and Mortality Report Pakistan 9 Nov 2006 / Vol. 50/ DEWS 2006 -44 DEWS Data, Epidemiological Week No. 44, 2006 Between 28 Oct to 3 Nov 2006, 85,742 consultations were reported through DEWS. Overall, 22% (61,077) were due to acute respiratory infections (ARI), 8% (21,659) due to acute watery diarrhoea (AWD), 7% (18,858) due to fever of unknown origin (FUO), and 5% (14,147) due to injuries (INJ). ARI accounted for 31% and 19% of consultations in the less than 5 years old and 5 or more years old respectively. All other reportable conditions each represented less than 1% of the total consultations in week 44. AWD AWD ARI ARI 7% AWD 5% 22% 11% 19% ARI 31% FUO 6% FUO 6% INJ OTH* 5% INJ 44% FUO OTH* OTH* 5% 8% 64% 59% INJ 4% < 5yrs (n=21,328) ≥ 5yrs (n=64,414) All Ages (n=85,742) Figure 2. Proportion of primary causes for all reported cases, Earthquake Affected Areas, Pakistan, 28 Oct-3 Nov 2006. *OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance DEWS Data, Epidemiological Week No. 43, 2006: Consultations by age ARI is the single most common reason for children under five to seek a consultation. With cooling weather, the rate of consultation for ARI has increased in almost all districts, but the pattern of increase differs by district. Mansehra and Poonch have seen a gradual increase from a relatively low rate (in comparison to the other districts), while Battagram and Bagh have seen much more fluctuation in their rates, week to week. See figure 3. 45.0 40.0 35.0 BAGH 30.0 BATTAGRAM 25.0 MA NSERA 20.0 years MUZAFFARABAD 15.0 10.0 POONCH 5.0 ARI as a percent of all all of percent a as ARI 0.0 consultations inconsultations children < 5 2006- 2006- 2006- 2006- 2006- 2006- 2006- 38 39 40 41 42 43 44 Week Figure 3: Trend in ARI in patients under five years old, by district, Earthquake Affected Areas, Pakistan 16 September, – 3 November 2006. 3 WMMR Weekly Morbidity and Mortality Report Pakistan 9 Nov 2006 / Vol. 50/ DEWS 2006 -44 DEWS Data, Monthly Summary (Epidemiological Weeks No. 41-44) In the past four weeks, between 7 Oct to 3 Nov, 2006 (Epidemiological weeks 41-44 inclusive), 120,373 consultations for health conditions under surveillance were reported, out of a total 281,870 consultations. 22% (61,077) of consultations were due to acute respiratory infection (ARI), 8% (21,695) acute watery diarrhoea (AWD), 7% (18,858) unexplained fever (FUO) and 5% (14,147) Injuries (INJ). Table 2. Comparison of the weekly distribution of reported cases, deaths and monthly Case Fatality Rate (CFR), Earthquake Affected Areas, Pakistan, 7Oct – 3 Nov 2006. Week WEEK 41 WEEK 42 WEEK 43 WEEK 44 TOTAL CFR% Event C D C D C D C D C D AWD 7793 0 5198 0 3035 1 5669 0 21695 1 0.005 BD 636 0 367 0 228 0 556 0 1787 0 0.000 AFP 1 0 1 0 1 0 0 0 3 0 0.000 MAL 724 0 733 0 282 0 794 0 2533 0 0.000 ARI 19190 3 16543 1 6511 1 18833 3 61077 8 0.013 MES 2 0 1 0 0 0 2 0 5 0 0.000 MEN 3 1 2 0 3 0 6 0 14 1 0.000 JAU 86 0 58 0 30 0 78 0 252 0 0.000 TET 0 0 0 0 2 0 0 0 2 0 0.000 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 5947 0 5337 0 2251 0 5323 1 18858 1 0.005 INJ 4557 0 3919 0 1754 0 3917 0 14147 0 0.000 OTH 52136 21 44991 11 13806 12 50564 6 161497 50 0.031 TOTAL 91075 25 77150 12 27903 14 85742 10 281870 61 RU 311 309 242 291 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 68,348 consultations were reported in the less than 5 years old group, (24% of the total consultations), of which 30% (20,355) were due to ARI, 13% (8,655) due to AWD, 8% (5,662) due to FUO and 4% (2,920) were reported as injuries (INJ). Table 3. Total number of reported cases, deaths and monthly Case Fatality Rate (CFR), less than 5 years old, Earthquake Affected Areas, Pakistan 7Oct – 3 Nov 2006. Week WEEK 41 WEEK 42 WEEK 43 WEEK 44 TOTAL CFR% Event C D C D C D C D C D AWD 2977 0 2298 0 1072 1 2308 0 8655 1 0.012 BD 237 0 123 0 57 0 196 0 613 0 0.000 AFP 0 0 1 0 0 0 0 0 1 0 0.000 MAL 137 0 156 0 47 0 164 0 504 0 0.000 ARI 5795 3 5716 1 2159 1 6685 3 20355 8 0.039 MES 1 0 0 0 0 0 2 0 3 0 0.000 MEN 1 1 2 0 0 0 0 0 3 1 0.000 JAU 24 0 16 0 7 0 13 0 60 0 0.000 TET 0 0 0 0 2 0 0 0 2 0 0.000 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 1759 0 1596 0 685 0 1622 0 5662 0 0.000 INJ 923 0 819 0 330 0 848 0 2920 0 0.000 OTH 9119 6 8222 6 2739 3 9490 4 29570 19 0.064 TOTAL 20973 10 18949 7 7098 5 21328 7 68348 29 RU 311 309 242 291 4 WMMR Weekly Morbidity and Mortality Report Pakistan 9 Nov 2006 / Vol.
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