HEALTH CLUSTER PAKISTAN Crisis in NWFP WEEKLY BULLETIN No
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HEALTH CLUSTER PAKISTAN Crisis in NWFP WEEKLY BULLETIN No 12 9 September 2009 HIGHLIGHTS • The IDP return process continues. Health Cluster partners are moving forward with health interventions in the districts of Swat, Buner, Lower Dir and Upper Dir while continuing to support IDPs who remain in the camps. To date, a total of 235 159 families have returned to their respective districts. (Source: PDMA/PaRRSA.) • The latest data from the National Database Registration Authority (NADRA) show there has been an influx of returnees in Waziristan. A total of 17 375 families, including 8281 in D.I. Khan District and 2756 in Tank District, have registered. Maternal, neonatal and and child health remains a priority among health interventions in NWFP • An assessment of health facilities in D.I. Khan was completed on 28 August. The report is being finalized and will be shared shortly. An assessment of health facilities in Swat district will begin on 13 September. • Between 22 and 28 August, a total of 69 892 consultations were reported from 226 disease surveillance sentinel sites in NWFP. This represents a 7% decrease compared to the number of consultations registered the previous week. • Seventeen DEWS sites reported 546 antenatal visits between 22 and 28 August. Data from UNFPA’s seven maternal, neonatal and child health (MNCH) care service delivery points in Lower Dir, Nowshera, Charsadda and Mardan districts showed an overall 16% increase in patient consultations in government and in-camp health facilities. However, postnatal consultations decreased from 48 to 35, and deliveries dropped from 18 to 10 at MNCH clinics. These variations in caseload are due to people returning to their home districts during Ramadan and to the increasing number of returnees. • Eleven out of 34 water samples taken from IDP-hosting districts of Swabi, Mardan, Peshawar and Nowshera tested positive for faecal coliform contamination. Eighteen out of a second batch of 27 samples tested positive for residual chlorine. The Health Cluster took remedial action, together with WASH partners. ASSESSMENT • In Swat District, 17 out of 75 health facilities are non-functional as a result of the conflict. These include 13 BHUs, 3 CDs and 1 RHC. Five health facilities are completely destroyed and 21 are partially damaged. (Source: EDO Health.) MNCH/RH/FP • Seventeen DEWS sites reported 546 antenatal visits between 22 and 28 August. Data from UNFPA’s seven maternal, neonatal and child health (MNCH) care service delivery points in Lower Dir, Nowshera, Charsadda and Mardan districts showed an overall 16% increase in patient consultations in government and in-camp health facilities. However, postnatal consultations decreased from 48 to 35, and deliveries dropped from 18 to 10 at MNCH clinics. These variations in caseload are due to people returning to their home districts during Ramadan and to the increasing number of returnees. Disease surveillance • Between 22 and 28 August, a total of 69 892 consultations were reported from 226 disease surveillance sentinel sites in NWFP. The number of consultations dropped by 4868, representing a decrease of 7% compared to the number of consultations registered the previous week. As the return programme continues, a decrease in the number of consultations in camps is expected. Consultations included 546 visits for antenatal care, 707 consultations for chronic noncommunicable diseases and 227 consultations for injuries. The table below shows the type of patient, number of consultations and percentages recorded between 22 and 28 August 2009: Type of patient Number of consultations Percentage Female 40 277 58% Male 29 615 42% Children under 5 15 808 23% • The table below shows the leading causes of morbidity among IDPs inside and outside camps. Health facilities in IDP camps reported upper respiratory tract infections as the leading cause of consultations and acute diarrhoea as the second most common cause. Only Benazir Complex IDP camp in Nowshera reported acute diarrhoea as the leading cause of consultation. Disease surveillance Most common conditions Percentage Acute Respiratory Tract Infection (ARI) • Acute Upper Respiratory tract Infection (URTI) 18% • Acute Lower Respiratory Infection (LRTI) 4% Acute Diarrhoea (AD) 9% Unexplained fever (UF) 4% Scabies (SCB) 5% Suspected malaria (MAL) 2% Bloody diarrhoea (BD) 1% • Surveillance officers are monitoring reports from health facilities closely. The necessary medical supplies have been prepositioned. The graph below presents the weekly morbidity pattern of the seven most common communicable diseases reported in IDP-hosting districts in NWFP between 15 and 21 August 2009. 450 URTI LRTI AD SCB MAL UF BD 400 s 350 300 250 consultation of 200 150 Number 100 50 0 Jalozai ‐3 Jalozai ‐4 Jalozai ‐2 Jalozai ‐1KG‐II KG‐I Karapa Jalala B.Complex Palosa • Over the last four weeks, the common causes of morbidity and leading causes of death among children under five living in IDP camps were acute diarrhoea and lower respiratory tract infections. There were 15 808 consultations of children under five, of whom 2402 (15%) had acute diarrhoea and 796 (5%) had lower respiratory tract infection. Alerts and outbreaks • On 5 September, an alert for a suspected H1N1 case was reported from Khyber Teaching Hospital in Peshawar. The 22-year old patient suffered from lower respiratory infection while in Dubai on 26 August and was treated with antibiotics and oseltamivir. The patient was deported from Dubai on 2 September and admitted to the hospital on arrival in Pakistan. Investigations are underway; a nasal swab sample has been sent to NIH for laboratory confirmation. • An increasing number of consultations for scabies have been reported in most IDP camps. Health facilities have been put on alert to intensify hygiene promotion and water and sanitation interventions for the prevention of waterborne and water-related diseases. • Between 22 and 28 August, one alert of suspected smallpox was reported from Lady Reading hospital in Peshawar. While the alert was investigated, the patient underwent treatment. No other suspected cases were found. Water and sanitation • Water and sanitation are regularly monitored and evaluated in all IDP camps. Together with WASH partners, the Health Cluster took remedial action on 11 out of 34 water samples that tested positive for faecal coliform contamination and 18 out of 27 samples that tested positive for residual chlorine. The water samples were taken from IDP-hosting districts of Swabi, Mardan, Peshawar and Nowshera. Actions included: o Disconnecting the handpump source in Mohalla, Sodairwala in Mardan District. o Providing sodium hypochlorite for water chlorination in Kacha Garhi, Peshawar Camp. o Conducting awareness activities in IDP camps on good hygienic practices. Health promotion activities were also conducted in Khat Kallay, Nowshera district. o Chlorinating 11 water sources in Mardan, Peshawar, Swabi and Nowshera. COORDINATION Health Cluster, Peshawar The 55th Provincial Health Cluster meeting was held on 3 September 2009 at the office of the Director General of Health in Peshawar. Main points include: • An assessment of health facilities in D.I. Khan was completed on 28 August. An assessment of health facilities in Swat district will begin on 13 September. • A training course on using health assessment tools will be held for Department of Health staff from 11- 12 September. • Health Cluster partners were asked to verify IDP populations in host areas to allow proper planning of follow-through health activities. • The Director of Health Services asked health partners to avoid duplication of services in urban areas and extend services to remote areas, particularly those in Malakand Division. Who does what, where? The map "Who Does What, Where", updated as of 9 September, is attached. FILLING GAPS Care International continues to operate its mobile medical cllinics in Buner and Mardan. Between 31 August and 6 September, a total of 711 patients were treated in four medical clinics conducted in three Union Councils of Buner (Makhrani, Koga and Elai). In Mardan, a total of 648 patients were treated at mobile medical clinics in three Union Councils (Patbaba, Taker and Tehsil Takbahi). Cordaid is continuing its primary health care services, referral services and health education campaigns through nine BHUs and one CD in Swabi District. Between 31 August and 4 September, Cordaid's health teams conducted 10 medical clinics and treated 967 patients. Community Appraisal and Motivation Programme (CAMP) is supporting the primary health care needs of women and children in Jalozai camp. Four mobile teams are providing primary health care services in all sub- camps of District Peshawar in order to reach out to IDPs in host communities. The mobile health units are equipped with all necessary equipment and medicines to meet the requirements of the IDP population. The CAMP mobile health teams operate around the clock and offer referral services to secondary and tertiary health facilities. Health Net TPO, in collaboration with the Malaria Control Programme, has completed spraying campaigns in Kacha Ghari 1,2 and Jalozai. Currently, it is conducting malaria prevention awareness-raising activities in Palowsai, Kacha Ghari and Jalozai camps. USAID-Paiman donated five ambulances to NWFP’s Department of Health on 5 August. The ambulances will be used in Mardan, Charsadda and Buner. The handover ceremony was attended by the Secretary Health of NFWP, the Mission Director of USAID, Dr Nabeela, Chief