May 13, 2013 DISEASES EARLY WARNING SYSTEM WER-19 (7th Yr)

DEWS WEEKLY EPIDEMIOLOGICAL REPORT EPREPORT SUMMARY:  This report includes surveillance data from 4th May to 10th May 2013.  Out of 349 functional Sentinel sites (SS), all 349 (100%) have sent their reports in Week-19 of 2013.  Out of total 345,178 consultations (145,256 Male, 199,922 Female) recorded in week-19 of 2013, 108,054 (51,869 Male, 56,185 Female) consultations were reported due to DEWS target diseases.  Main causes of consultations this week are Acute Respiratory Infections/ARI (19.8%) and Acute Diarrheal Diseases/ADD (10.6%) from total clients in a continuing trend from the week before.  51 (25 Male, 26 Female) deaths caused due to Pneumonia, Diarrheal diseases and Meningitis/Severely ill children, so 32 deaths (16 Male, 16 Female) caused by Pneumonia, 8 deaths (2 Male, 6 Female) caused by diarrheal diseases and 11 deaths (7 Male, 4 Female) were caused by Meningitis/severely ill children.  In this reporting week, Suspected Measles Outbreak reported from of , Suspected Cholera Outbreak reported from Shoraba district of , Suspected Measles Outbreak reported from Wants waygal district of , Suspected scabies Outbreak reported from Asadabad district of and Suspected Measles Outbreak reported from Keshendeh district of province.

REPORTS RECEIVED FROM REPORTING SITES: As of May 10, 2013, 349 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of . In this reporting week, 349 sentinel sites have sent their reports on new cases of DEWS target diseases, recorded during the reporting week. Out of all events recorded in DEWS sentinel sites, 15 target diseases (priority diseases) are included in DEWS weekly epidemiological reports. Table-1: Status of Reports Received from DEWS Regions during Epidemiological week-19, 2013

Central Central East Central West North North East West South East South East Total No. of Expected Reports from 56 31 57 43 37 46 43 36 349 Sentinel Sites No. of Reports Received in this 56 31 57 43 37 46 43 36 349 week

DEWS Sentinel Sites: Figure-1(Map) shows the distribution of DEWS Table-2 DEWS Epidemiological Regions and types of Sentinel Sites in Week-19, 2013

sentinel sites, already

established in the relevant Type of

regions/provinces by May SS

alEast Centr al West North North East West South East South East Total 10, 2013 by type of health Centr facilities. Data on 15 DEWS CHC/BHC 28 18 42 32 23 36 33 28 240 target diseases are being DH 12 9 10 7 9 5 7 4 63 collected from these sentinel PH/RH/SH 14 4 5 4 4 5 3 4 43 sites (SS).The symbols on Poly Clinic 2 0 0 0 1 0 0 0 3 the map show the number of Total 56 31 57 43 37 46 43 36 349 sentinel sites in each CHC=Comprehensive Health Center, DH=District hospital, PH=provincial hospital, RH= region/province, and do not Regional hospital, SH= specialized hospital indicating the GPS of the SS locations. DEWS Data in Epidemiological Week-19 of 2013: Ut of total 345,178 clients recorded in week-19 Fig-2: Percentages of DEWS Target Diseases by of 2013, 16.8% (57838) of consultations were 20 Gender in W19-13 O reported due to cough and cold and 3% (10248) of 15 consultations was reported due to pneumonia. In the same reporting period, 10.6% or 36,446 events were reported 10

due to diarrheal illnesses (7.7% due to Acute Watery 5 Percentage Diarrhea, 2.1% due to Bloody Diarrhea and 0.8% due to 0 ARI Men/S Measl Malari TyphF acute watery diarrhea with dehydration). In comparison ARI Pn AwD BD AwDw AVHep C&C IC e a ev with previous week (W18 of 2013) the percentage of ARI Male 18.5 3.6 9.1 2.5 1 0.1 0.1 0 0.4 0.6 disease has decreased by 1.7% to 19.8%, whereas the Female 15.5 2.5 6.6 1.8 0.7 0 0 0 0.4 0.5 percentage of Acute Diarrheal disease has increased by 0.4% to 10.6%. These variations could be occurred due to Total 16.8 3 7.7 2.1 0.8 0 0 0 0.4 0.5 changes in temperature /weather during the reporting week.Figure-2 above shows the percentages of DEWS target diseases by gender in week-19 of 2013.

Percentage of ARI by weeks and by Age Groups: In the epidemiological week-19, a total of 68,086 events of ARI were reported. 24.1 % of total clients less than 5 years of age were cough & cold patients and 13.5% among the age group 5 years and over. The percentage of C&C (<5 years) Table-3: Percentages of ARI Diseases during 11 recent weeks by age groups and by weeks Disease Age Week- Week- Week- Week- Week- Week- Week- Week- Week- Week- Week- 09-13 10-13 11-13 12-13 13-13 14-13 15-13 16-13 17-13 18-13 19-13 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) ARI- C&C <5 Yr. 31.6 32.3 30.9 29.5 28.6 28.7 27.4 26.6 25.8 25.5 24.1 5+ 19.1 18.2 17.4 16.8 16.3 15.4 15.6 15.0 14.8 14.7 13.5 ARI- <5 Yr. 11.7 11.1 10.0 9.6 9.3 8.6 8.3 7.7 7.7 7.0 6.6 Pneumonia >=5Yr. 2.3 2.2 2.0 1.9 1.9 1.8 1.7 1.6 1.6 1.6 1.3 consultations in week-9,in comparison with the percentage of C&C in week-19 of 2013, decreased by 7.5%, whereas in case of 5 years and above decreased by 5.6% to 13.5% in this reporting week. The trend of ARI diseases in last 11 weeks can be read in table-3.The percentages of consultations on Pneumonia cases of age group less than 5 years decreased by 5.1% in last 11 weeks, whereas the percentage of age group 5 years and over decreased by 1% to 1.3%. In the reporting week-19 of 2013, the highest percentage of Cough & Cold has been recorded in Kapisa, Daykundi and Bamyan provinces with 26.3%, 24.1% and 23.9%, whereas the lowest percentages of C&C were reported from Laghhman, Farah and Nimroz provinces with 6.7%, 7.7% and 8.7% respectively. The highest percentages of Pneumonia cases reported from Samangan, Saripul and Balkh provinces with 5.8%, 5.6% and 5.5% respectively, whereas the lowest percentage of Pneumonia cases was recorded in Zabul, Nimroz and Urozgan provinces with 0.3%, 0.4% and 0.7% respectively. (Fig-3)

40 Fig-3: Percentages of ARI from Total Clients in week-19 of 2013

30

20

10 Percentage 0 TAK NI KA UR PA WA BA BD FAR GH NA NU SA JO KU GH KH HIL ZAB KAB KAP LOG PAR DAY HER LAGKNR BAL FYB SAR BDS HA BGL PIA PKA M N O N R M G AH O N R M W N A O R Pneumonia 0.4 0.9 1.9 0.3 0.7 4.7 2.6 3.1 3.7 1.9 2.1 3.9 2.4 1.4 0.9 1 2.2 1.6 2 3 3.7 5.8 5.5 5.4 2.7 5.6 3 4.7 5.2 2.2 1.3 1.4 1.1 1.7 Cough&Cold 8.7 11 13 10 14 16 26 20 21 21 19 24 24 9.8 18 7.7 13 20 6.7 20 22 19 21 14 19 14 17 16 14 15 15 23 13 22

Fig-4: Percentages of ARI from Total Clients Among Male/Female Population in W19 of 30 P 2013 e Male Female Total r 25 c e 20 n t a 15 g e 10

5

0 SR CER CWR WR ER NR NER SER

Percentages of Diarrheal Diseases by weeks and by Age Groups: The table-4 below shows the percentages of diarrheal diseases (Acute watery Diarrhea, Bloody Diarrhea and Acute watery Table-4: Percentages of Diarrheal Diseases from Total Clients during 11 recent weeks by age groups. Disease Age Week- Week- Week- Week- Week- Week- Week- Week- Week- Week- Week- 09-13 10-13 11-13 12-13 13-13 14-13 15-13 16-13 17-13 18-13 19-13 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Acute Watery <5 Years 6.4 7.3 7.4 8.1 9.2 9.9 11.5 12.9 13.8 14.2 15.3 Diarrhea >= 5 Years 2.1 2.1 2.3 2.6 2.8 2.9 3.5 3.6 4 3.9 4.2 Bloody Diarrhea <5 Years 2.0 2.2 2.3 2.3 2.5 2.5 2.7 2.9 3.3 3.4 3.2 >=5 Years 1.1 1.1 1.2 1.2 1.3 1.3 1.3 1.5 1.6 1.7 1.6 Acute W. Diarrhea <5 Years 0.5 0.6 0.7 0.8 0.8 0.9 1.2 1.3 1.1 1.5 1.7 with Dehydration ≥5 Years 0.2 0.2 0.2 0.2 0.3 0.2 0.3 0.4 0.4 0.5 0.4 diarrhea with dehydration) from week-9 to week-19of 2013, from total clients. Acute watery diarrhea among children less than five years of age has been increased from 6.4% in week-9 to 15.3% in the reporting week, whereas acute watery diarrhea among age group 5 years and above has been increased by 2.1% to 4.2%.(Please refer to Table-4, above).Bloody diarrhea, in age group less than 5 years increased by 1.2% in last 11 weeks, while in case of age group 5 years and above has been increased by 0.5%. Acute watery diarrhea with dehydration in age group less than 5 years show an increase by 1.2% in last 11 weeks, while in case of five years and above has increased by 0.2% to 0.4% in last 11 weeks.

25 Fig-4: Percentages of Diarrheal Diseases from Total Clients in week-19 of 2013

20 AWD BD AWDwD 15

10 Percentage 5

0

HIL

PIA

FYB

BAL

BGL

SAR

ZAB

BDS

LAG

HER

KAP PKA

PAR

KAB

LOG

DAY

KNR

PAN

NIM

KAN

BDG

KHO

KUN

GHA NUR

URO

JOW

NAN

GHO

SAM

BAM

WAR FARAH Provinces TAKHAR

Percentages of suspected Meningitis/SIC, Malaria and Typhoid Fever by Region: In the epidemiologic week-19 of 2013, a total of 137 suspected cases of Fig-6: Percentages of Meningitis,Malaria & typhoid Fever from Total Clients in W19-13 Meningitis/Sever Ill Child were reported from all regions and the highest percentage was recorded in South, Central East and North East regions. In the same reporting week, from all regions 1339 consultations were reported by Sentinel Sites to be malaria and the highest percentages of Malaria cases were reported from East and South and South East regions with SR CER CWR WR ER NR NER SER 1.7%, 0.3% and 0.2%. Out of the total clients, 1800 cases or 0.5% in national Men/SIC 0 0.1 0 0 0 0 0.1 0 level were reported to be suspected Malaria 0.3 0 0 0.1 1.7 0.1 0.1 0.2 Typhoid Fever and the highest Typhoid Fev 1 0.2 0.4 0.3 0.6 0.3 0.4 0.5 percentages of Typhoid Fever were reported from South, East and South East regions with 1%, 0.6% and 0.5% respectively.

Vaccine Preventable Diseases: In DEWS target diseases (priority Table-5: Suspected Cases of Vaccine Preventable Diseases in W-19 diseases) seven vaccine preventable of 2013 by Region diseases are included, so that their Regions occurrences are changing by seasonal Men/SIC AVH Meas Pert Diphth Tetanus AFP variations. Among these diseases SR 12 21 11 1 0 3 2 Meningitis/severely ill child is being CER 54 46 2 3 0 1 3 reported mostly from North region; in CWR 9 6 5 0 1 0 0 this week out of total 137 cases in WR 15 6 1 0 0 0 1 country level, 54 cases have been ER 1 18 17 2 0 2 2 reported from Central East region, 22 NR 22 2 13 0 0 0 0 cases from North and 19 cases were NER 19 22 1 0 0 0 0 reported from North East regions. In general the highest number of SER 5 27 1 0 0 0 0 cases of Acute viral hepatitis been Total 137 148 51 6 1 6 8 reported from East and South East regions, so that in the reporting week out of total 148 cases, 46 cases reported from Central East region,27 cases were reported from South East and 22 cases were reported from North East regions. From total 51 Measles cases reported in the reporting week 17 cases were recorded in East and 13 cases were reported from North regions. Percentages of ARI & Diarrheal Diseases by Epidemiological Weeks (from W25 of 2012 to W19 of 2013) mong the DEWS target diseases, Acute Respiratory Infections (ARI) and Acute Diarrheal Diseases (ADD) as leading causes of morbidity and mortality, having the highest frequency of consultations. The following Line- A Chart shows the trend of ADD and ARI from week-25 of 2012 to week-19 of 2013. In week-25 of 2012, the ARI and ADD curves crossed each other, so that ARI started decreasing and ADD changed its course to increase. By the end of Summer season in 2012, these curves crossed one another again in week-36 and from that time to week-06 of 2013, the percentage of ARI were increasing, while the percentages of ADD were decreasing and both of these groups of diseases reached their Extreme points (maximum and minimum values) respectively, In this regard we can say that week-6 of current year was a turning point for both of these groups of diseases, namely ARI percentages will decrease, while ADD percentages will increase till end of summer season. Comparing this week data with previous week-18 of 2013, ARI decreased by 1.7% to 19.8%, while ADD increased by 0.4% to 10.6% (Please refer to Fig-7).

35.0 Fig.-7: Trend of ARI/ADD as Propotion of Total Clients From Week-25 of 2012 to Week- 19 of 2013 ARI 30.0 32.632.3 32.4 32.4 31.2 31.6 ADD 30.5 29.3 29.4 29.1 28.3 28.7 28.4 25.0 27.4 26.1 26.1 25.1 24.9 24.3 18.9 23.423.0 20.0 22.022.5 22.2 17.717.3 17.6 21.8 21.5 16.816.8 16.5 16.8 20.920.5 15.715.7 15.7 19.920.0 19.8 14.7 19.0 14.4 17.9 15.0 13.317.1 16.4 12.012.0 15.2 15.3 10.9 14.6 14.3 14.5 10.210.3 10.3 10.210.6 14.013.6 13.7 14.0 13.9 13.6 9.8 Percentages 12.6 8.8 9.0 10.0 8.1 7.8 8.3 7.3 6.9 6.8 7.2 6.4 6.1 6.2 5.4 5.5 5.8 5.2 4.9 4.7 4.6 4.7 4.7 4.7 4.8 5.2 5.0

0.0

W2 W3 W4 W5 W6 W7 W8 W9

W1

W26 W39 W52 W25 W27 W28 W29 W30 W31 W32 W33 W34 W35 W36 W37 W38 W40 W41 W42 W43 W44 W45 W46 W47 W48 W49 W50 W51 W10 W11 W12 W13 W14 W15 W16 W17 W18 W19

Weeks of the Year

ARI Dis & ADD from Week-21 to Week-38 of 2008

18 16.8 ARI 16.4 16.4 16.316.1 Dis 16 15.3 16.716.9 16.6 16.5 ADD 16.2 14.4 13.9 14.9 13.713.613.3 14 14.8 1312.8 14.2 12.2 14 12.1 13.5 11.3 11.2 12 10.9 11.2 10.7 10.810.9 10.7 11.8 10.7 10 10.6

8 Percentages

6

4

2

0

Reporting Weeks

Mortality:

Among DEWS target diseases Pneumonia, Diarrheal diseases and Meningitis/ Severely Ill Children (SIC) are main causes of mortality which make in general more than 95% of total deaths of surveillance target diseases. Usually deaths due to diarrheal diseases increases during summer season, while the number of deaths due to Pneumonia increases during cold period/Winter Season. In this week out of 51 (25 Male, 26 Female) deaths reported from all regions, 32 deaths (16 Male, 16 Female) caused by Pneumonia, 8 deaths (2 Male, 6 Female) caused by diarrheal diseases and 11 deaths (7 Male, 4 Female) were caused by Meningitis/severely ill children. (Table-6)

Table-6: Deaths by Main Causes of Mortality and by Region in W19 of 2013

Main

Causes of

East

East East

West West West

Total

South South North North

Deaths North

Region Region Region Region Region Region Region Region Central Central

Central Central G.

F F F F F F F F F

M M M M M M M M M Total Pneumonia 3 1 2 3 4 1 1 1 1 1 5 8 0 0 0 1 16 16 32 Diarrheal Diseases 0 1 1 2 0 0 0 0 0 1 1 1 0 1 0 0 2 6 8 Meningitis 0 0 1 2 2 0 1 1 0 0 1 0 1 1 1 0 7 4 11 Total 3 2 4 7 6 1 2 2 1 2 7 9 1 2 1 1 25 26 51

M: Male F: Female

Number of Outbreaks investigated in 2013 with details of W18/W19

Reported outbreaks since first week of 2013 to date Type of outbreak Investigated Rumor Clinic-ally/lab Pertussis 4 4 Avian/Swine Flu ARI 3 1 2 Measles 2 2 Diarrhea 23 1 22 Meningitis 1 1 Hepatitis Malaria 1 1 Typhoid CCHF Bl. Diarrhea 3 3 Chickenpox Other 3 3 Total 20 20 60 2 58

Epidemiological week- 18  Suspected poisoning : reported from Sultan Razia girl high school of Kabul city of on May01 /2012 and the team investigated the area on the same day, and during investigation there were 262 cases of suspected poisoning with following sign and symptoms excessive crying , weakness , dizziness and nervous with no deaths case and lab sample collected and send it to CPHL, the patients treated and health education and hygiene session conducted for students, outbreak is under control.  Suspected viral hepatitis Outbreak: reported from Tishi palak and Malek ata villages of Adraskan district , on April 27/2013, the team investigated the area on April 28/2013 , the population of the affected area is around 1500 ,and it is under coverage of Shirad BHC. During the investigation there were 18 suspected hepatitis cases with following clinical manifestation weakness/weight loss, dark urine, nausea, RUQ pain, Jaundice/Icter, lose of appetites and fever it was clinical confirm outbreak, there were 18 cases of over five year old but no case of under five year old and base on sex 6 female and 12 male cases ,In addition to this there were 4 death cases and one of the death cases were under five and 3 cases of over five which were 2 male and 2 female the team collected lab samples and send them to CPHL and the cases treated . Susceptible individual were vaccinated and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases.  Suspected Measles Outbreak: reported from Kochiai Kariz villages of Shahwali , Kandahar province on April 29/2013, the team investigated the area on April 30/2013 , the population of the affected area is around 420 ,and it is under coverage of Shahwali kot CHC, It has poor vaccination coverage which is around zero %. During the investigation there were 8 suspected measles cases, it was clinical confirm outbreak, there were 5 cases of over five year old and 3 cases were under five year old and base on sex 6 female and 2 male cases , the team collected lab samples and send them to CPHL and the cases treated . Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases.

 Suspected Measles Outbreak: reported from Janikhil village of Khairkot district , on April 30/2013, the team investigated the area on May 01/2013 , the population of the affected area is around 600 ,and it is under coverage of Khairkot BHC, It has poor vaccination coverage . During the investigation there were 6 suspected measles cases, it was clinical confirm outbreak, there were one case of over five year old and 5 cases were under five year old and base on sex 2 female and 4 male cases , the team collected lab samples and send them to CPHL and the cases treated . Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases.

 Suspected Measles Outbreak: reported from Janikhil village of Khairkot district , Paktika province on April 29/2013, the team investigated the area on April 30/2013 , the population of the affected area is around 2600 ,and it is under coverage of Sarobi BHC, It has poor vaccination coverage . During the investigation there were 8 suspected measles cases, it was clinical confirm outbreak, there were 3 cases of over five year old and 5 cases were under five year old and base on sex 3 female and 5 male cases , the team collected lab samples and send them to CPHL and the cases treated . Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases.

Epidemiological week- 19  Suspected Measles Outbreak: reported from Kakaran village of Qalat district , Zabul province on May 05/2013, the team investigated the area on May 05/2013 , the population of the affected area is around 441 ,and it is under coverage of Qalat PH . During the investigation there were 7 suspected measles cases, it was clinical confirm outbreak, there were 2 case of over five year old and 5 cases were under five year old and base on sex 5 female and 2 male cases with no death case , the team collected lab samples and send them to CPHL and the cases treated . Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases.  Suspected Cholera Outbreak: reported from Karagah village of Shoraba district , Kandahar province on May 06/2013, the team investigated the area on May 07/2013 , the population of the affected area is around 1572 ,and it is under coverage of Spin boldak DH . During the investigation there were 55 suspected cholera cases, it was clinical confirm outbreak, there were 41 case of over five year old and 14 cases were under five year old and base on sex 34 female and 21 male cases , the team collected lab samples and send them to CPHL and the cases treated . The wells were chlorinated and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases.

 Suspected Measles Outbreak: reported from Dewaz ,katar ,Gambeer villages of Wants waygal district , Nuristan province on May 03 /2013, the team investigated the area on May 04/2013 ,. During the investigation there were 7 suspected measles cases, it was clinical confirm outbreak, there were 07 cases under five year old but no case of over five year old and base on sex 4 female and 3 male cases with no death case , the team collected lab samples and send them to CPHL and the cases treated . Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases.

 Suspected scabies Outbreak: reported from a Madrassa of Karamar village of Asadabad district, Kunar province on May o6 /2013, the team investigated the area on May 07/2013. During the investigation there were 39 suspected scabies cases, it was clinical confirm outbreak, there were no case

of over five year old but 39 cases were under five year old and base on sex no female but 39 male cases, the team collected lab samples and send them to CPHL and the cases treated and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases.

 Suspected Measles Outbreak: reported from Erghan, Chochola, Shaikhab and Sardara villages of Keshendeh district , on April 30/2013, the team investigated the area on May 04/2013 , the population of the affected area is around 10150 ,and it is under coverage of Zequat sub health center and immunization coverage is zero . During the investigation there were 34 suspected measles cases, it was clinical confirm outbreak, there were 11 cases of over five year old and 23 cases were under five year old and base on sex 16 female and 18 male cases with no death case , the team collected lab samples and send them to CPHL and the cases treated . Vaccination campaign was conducted, Vita A supplements was distributed and health education session conducted in surrounding villages, the active surveillance has been established for investigation of further cases

ANNEX: Mapping of Percentages/Cases of Selected Diseases in Week-19of 2013 by Province µ Malaria Cases in week-19-2013 by province Date: 05/13/2013 Jowzjan Badakhshan Kondoz (Kunduz) Balkh Takhar ظ.ق Time: 09:41:08

Faryab Samangan Baghlan Sar-e Pol

Panjshir Nurestan Badghis 1 cm = 60 km Parvan (Parwan)Kapisa Konar (Kunar) Bamian Laghman Kabol (Kabul) Vardak (Wardag) Nangarhar Herat Ghowr Lowgar Daykondi Legend Paktia Khowst Ghazni Province_34 Oruzgan (Uruzgan) Mal Farah Paktika 0.000000 - 7.000000 Zabol (Zabul) 7.000001 - 19.000000 19.000001 - 40.000000 40.000001 - 66.000000 Helmand Kandahar Nimruz 66.000001 - 225.000000 225.000001 - 503.000000

In this week from all 349 sentinel sites reports have been received 1 cm = 60 km

Acute Viral Hepatitis Cases in week-19-2013 Typhoid Fever Cases in week-19-2013 by province µ by province µ Date: 05/13/2013 Date: 05/13/2013 Jowzjan Badakhshan Jowzjan Badakhshan Kondoz (Kunduz) Kondoz (Kunduz) Balkh Takhar ظ.ق Balkh Takhar Time: 09:51:10 ظ.ق Time: 09:39:01

Faryab Samangan Faryab Samangan Baghlan Baghlan Sar-e Pol Sar-e Pol

Panjshir Nurestan Panjshir Nurestan Badghis Badghis 1 cm = 60 km Parvan (Parwan)Kapisa Konar (Kunar) 1 cm = 60 km Parvan (Parwan)Kapisa Konar (Kunar) Bamian Laghman Bamian Laghman Kabol (Kabul) Kabol (Kabul) Vardak (Wardag) Nangarhar Vardak (Wardag) Nangarhar Herat Ghowr Lowgar Herat Ghowr Lowgar Daykondi Legend Daykondi Legend Paktia Paktia Khowst Khowst Ghazni Province_34 Ghazni Province_34 Oruzgan (Uruzgan) AVH Oruzgan (Uruzgan) TF Farah Paktika 0.000000 - 1.000000 Farah Paktika 2.000000 - 13.000000 Zabol (Zabul) Zabol (Zabul) 1.000001 - 3.000000 13.000001 - 28.000000 3.000001 - 6.000000 28.000001 - 55.000000 6.000001 - 9.000000 55.000001 - 95.000000 Helmand Kandahar Helmand Kandahar Nimruz 9.000001 - 18.000000 Nimruz 95.000001 - 144.000000 18.000001 - 62.000000 144.000001 - 218.000000

In this week from all 349 sentinel sites reports have been received In this week from all 349 sentinel sites reports have been received 1 cm = 60 km 1 cm = 60 km