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WMMR Pakistan Epidemiological Week No. 40 (30 Sept - 6 Oct 2006) 11 Oct 06/ Vol. 46/ DEWS 2006-40 Reporting Units...............................................................2 Total number of consultations ........................................2 DEWS Data, Epidemiological Week N0 40 2006............3 DEWS Data, Monthly Summary (Epidemiological Weeks N0 37-40) ........................................................................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 ......................................................................................10 Number of reported cases and deaths per District, NWFP ...........................................................................11 Muzaffarabad: Picture by Shahzad Alam Khan In the past month (Epidemiological In this week 40, There were two deaths weeks 37-40 inclusive), 159,831 health from acute respiratory infection events under surveillance were reported reported from Mansehra district including 77 deaths Fourteen suspected cases of measles This week, there were 309 reporting reported this week, Six cases from units contributing to the report Mansehra and Five cases reported from Battagram district In this week 40, Total 96,166 Malaria cases increased by 6% over the consultations were reported, with 21 number in week 39 deaths 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 11 Oct 2006 / Vol. 46/ DEWS 2006 -40 Reporting Units The number of sites able to report increased by 4 this week and the reporting timeliness of the DEWS system has increased by 1% compared with week 39. See Table 1 for summary statistics. Table1. Reported heath facilities by district, Earthquake Affected Areas, Pakistan, 9 Sept - 6 Oct 2006. Reporting Health Facilities 23 – 29 30 Sept – Area Population 9 – 15 Sept 16 – 22 Sept Sept 6 Oct Week 37 Week 38 Week 39 Week 40 Muzaffarabad 894,364 97 107 102 105 Bagh 452,532 33 35 35 34 Poonch 633,712 51 56 59 66 Mansehra / Balakot 1,154,804 67 69 69 65 Battagram / Shangla 592,256 40 40 40 39 Total 3,727,668 288 (89%) 307 (94%) 305 (94%) 309 (95%) Total number of consultations In week 40, there was an increase in the number of reporting sites, and a corresponding increase in consultations, to 96,166. The highest number of consultations by district was in Muzaffarabad, with 32,808, and the lowest was in Battagram, at 7,757. The average number of consultations per facility now stands at 318, increased from 306 in week 39. The maximum number of consultations in a facility was 5,563, in Muzaffarabad, and the minimum was 15, also in Muzaffarabad. No. Unit Reporting Units and Consultations No. Consult. 200000 300 Reporting Unit Consultation 250 150000 200 150 100000 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 Week Figure 1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, 15 October 2005 – 6 Oct 2006. 2 WMMR Weekly Morbidity and Mortality Report Pakistan 11 Oct 2006 / Vol. 46/ DEWS 2006 -40 DEWS Data, Epidemiological Week No. 40, 2006 Between 30 Sept to 6 Oct 2006, 96,166 consultations were reported through DEWS. Overall, 20% (19,564) were due to Acute Respiratory Infections (ARI), 9% (8,228) due to Acute Watery Diarrhoea (AWD), 7% (6,423) due to Fever of Unknown Origin (FUO), and 5% (4,746) due to Injuries (INJ). ARI accounted for 28% and 18% 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 40. AWD ARI AWD ARI 9% AWD 7% 20% 14% ARI 18% 28% FUO FUO 6% 7% INJ FUO 5% INJ OTH* 9% 5% OTH* 42% OTH* INJ 62% 57% 4% < 5yrs (n=22,639) ≥ 5yrs (n=73,527) All Ages (n=96,166) Figure 2. Proportion of primary causes for all reported cases, Earthquake Affected Areas, Pakistan, 30 Sept - 6 Oct 2006. *OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance DEWS Data, Epidemiological Week No. 40, 2006: Consultations by age ARI is the most common reason for consultations among the diseases under surveillance. It is more common in patients under 5 years of age, and the fluctuations in ARI as a percent of all consultations in this age group are greater than in the older patients. After declining in the warmer months, ARI is once again increasing, and increasing more quickly in patients under five. See figure 3. 45.0 40.0 35.0 30.0 25.0 <5 20.0 >=5 15.0 10.0 ARIa percent as of all 5.0 consultations within group consultations age 0.0 42 44 46 48 50 52 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 Week Figure 3: Trend in ARI as a percent of all consultations within age groups, Earthquake Affected Areas, Pakistan 15 Oct 2005 – 6 Oct 2006 3 WMMR Weekly Morbidity and Mortality Report Pakistan 11 Oct 2006 / Vol. 46/ DEWS 2006 -40 DEWS Data, Monthly Summary (Epidemiological Weeks No. 37-40) In the past four weeks, between 9 Sept to 6 October (Epidemiological weeks 37-40 inclusive), 159,831 consultations for health conditions under surveillance were reported, out of a total 374,164 consultations. 20% (75,324) of consultations were due to acute respiratory infection (ARI), 10% (35,949) acute watery diarrhoea (AWD), 6% (23,543) unexplained fever (FUO) and 5% (18,956) Injuries (INJ). Table 2. Comparison of the weekly distribution of reported cases, deaths and monthly Case Fatality Rate (CFR), Earthquake Affected Areas, Pakistan, 9 Sept - 6 Oct 2006. Week WEEK 37 WEEK 38 WEEK 39 WEEK 40 TOTAL CFR% Event C D C D C D C D C D AWD 9507 1 9577 1 8637 1 8228 0 35949 3 0.008 BD 654 1 664 0 516 0 594 0 2428 1 0.041 AFP 1 0 0 0 1 0 1 0 3 0 0.000 MAL 876 0 765 0 760 0 806 0 3207 0 0.000 ARI 18025 1 19085 2 18650 3 19564 2 75324 8 0.011 MES 10 0 1 0 5 0 14 0 30 0 0.000 MEN 7 0 6 0 3 1 3 0 19 1 0.000 JAU 86 0 102 1 80 0 101 0 369 1 0.000 TET 0 0 0 0 1 0 2 0 3 0 0.000 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 5558 0 6034 0 5528 0 6423 0 23543 0 0.000 INJ 4543 0 4964 0 4703 0 4746 0 18956 0 0.000 OTH 50711 9 58858 23 49080 12 55684 19 214333 63 0.029 TOTAL 89978 12 100056 27 87964 17 96166 21 374164 77 RU 287 303 290 309 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, 91,267 consultations were reported in the less than 5 years old group, (24% of the total consultations), of which 26% (24,032) were due to ARI, 15% (13,749) due to AWD, 8% (7,236) due to FUO and 4% (3,750) 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 9 Sept - 6 Oct 2006. Week WEEK 37 WEEK 38 WEEK 39 WEEK 40 TOTAL CFR% Event C D C D C D C D C D AWD 3605 0 3759 1 3226 1 3159 0 13749 2 0.015 BD 201 0 169 0 177 0 208 0 755 0 0.000 AFP 1 0 0 0 1 0 1 0 3 0 0.000 MAL 164 0 115 0 133 0 152 0 564 0 0.000 ARI 5785 1 5977 0 6031 2 6239 2 24032 5 0.021 MES 6 0 1 0 0 0 7 0 14 0 0.000 MEN 3 0 2 0 2 1 0 0 7 1 0.000 JAU 23 0 29 1 16 0 28 0 96 1 0.000 TET 0 0 0 0 0 0 1 0 1 0 0.000 AHF 0 0 0 0 0 0 0 0 0 0 0.000 FUO 1598 0 1910 0 1750 0 1978 0 7236 0 0.000 INJ 891 0 1013 0 1000 0 846 0 3750 0 0.000 OTH 9557 4 11746 9 9737 6 10020 6 41060 25 0.061 TOTAL 21834 5 24721 11 22073 10 22639 8 91267 34 RU 287 303 290 309 4 WMMR Weekly Morbidity and Mortality Report Pakistan 11 Oct 2006 / Vol.
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