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DEWS WER 38-2013.Pdf (English) September 23, 2013 DISEASE EARLY WARNING SYSTEM WER-38 (7th Yr) DEWS WEEKLY EPIDEMIOLOGICAL REPORT SUMMARY: This report includes surveillance data from 14 September to 20 September 2013. Out of 360 functional Sentinel sites (SS), 357 (99.1%) have submitted reports for Week-38 of 2013. Out of a total of 325,197consultations (137,642 male, 187,555 female) recorded in Week-38 of 2013, 34 % or 110,441 (53,300 male, 57,141 female) consultations were reported due to DEWS target diseases. Main causes of consultations this week were Acute Respiratory Infections (ARI) (18.1%) and Acute Diarrheal Diseases (ADD) (14.4%) from total clients in a continuing trend from the week before. 37 (18 male, 19 female) deaths resulted from Pneumonia, Diarrheal Diseases and Meningitis/Severely Ill Children, which includes 18 deaths (9 male, 9 female) caused by Pneumonia, 12 deaths (6 male, 6 female) caused by Diarrheal Diseases and 7 deaths (3 male, 4 female) caused by Meningitis/Severely Ill Children. In this reporting week, a Cholera Outbreak reported from Nangarhar province and a Suspected Cholera Outbreak reported from Balkh. REPORTS RECEIVED FROM REPORTING SITES: As of September 20, 2013, 360 sentinel sites were functioning in eight epidemiological regions, in 34 provinces of Afghanistan. In this reporting week, 357 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-38, 2013 Central Central East Central West North North East West South East South East Total No. of Expected Reports from 56 32 57 47 38 49 45 36 360 Sentinel Sites No. of Reports Received in this 55 32 56 47 38 49 45 35 357 week DEWS Sentinel Sites: Figure-1(Map) shows the Table-2: DEWS Epidemiological Regions and distribution of DEWS sentinel Sentinel Sites by type in Week-38, 2013 sites already established in the relevant regions/provinces by Type of SS September 20, 2013. Table-2 East Central West North North East West South East South East Total shows the SS distribution by type Central of health facility. Data on 15 CHC/BHC 28 19 42 36 24 39 35 28 251 DEWS target diseases are being DH 12 9 10 7 9 5 7 4 63 collected from these sentinel sites (SS). The symbols on the map PH/RH/SH 14 4 5 4 4 5 3 4 43 show the number of sentinel sites Poly Clinic 2 0 0 0 1 0 0 0 3 in each region/province, and do Total 56 32 57 47 38 49 45 36 360 not indicate the GPS of the SS CHC=Comprehensive Health Center, DH=District Hospital, PH=Provincial Hospital, locations. RH= Regional Hospital, SH= Specialized Hospital DEWS Data in Epidemiological Week-38 of 2013: Fig-2: Percentages of DEWS Target Diseases by Out of a total of 325,197 clients recorded in week-38 of Gender in W38-13 20 2013, 15.8% (51,468) of consultations were reported 18 due to Cough and Cold and 2.3% (7,589) of consultations was reported due to Pneumonia. In the 16 same reporting period, 14.4% or 46,935 events were 14 reported due to diarrheal illnesses (10.7% due to Acute 12 Percentage Watery Diarrhea, 2.5% due to Bloody Diarrhea and 10 1.2% due to Acute Watery Diarrhea with Dehydration). 8 In comparison with the previous week (W37 of 2013) 6 the percentage of ARI disease has increased by 0.9% to 4 18.1%, and the percentage of Acute Diarrheal Disease 2 0 has decreased by 0.7% to 14.4%. These variations ARI Men/SI Malari TyphFe ARI Pn AwD BD AwDw AVHep Measle could be due to changes in temperature /weather during C&C C a v the reporting week. Figure-2 (right) shows the Male 17.5 2.8 12.5 2.8 1.5 0.1 0.1 0 0.7 0.6 percentages of DEWS target diseases by gender in Female 14.6 2 9.4 2.3 1 0 0.1 0 0.5 0.6 week-38 of 2013. Total 15.8 2.3 10.7 2.5 1.2 0 0.1 0 0.6 0.6 Percentage of ARI by Weeks and by Age Groups: In the epidemiological week-38 a total of 59,057 events of ARI were reported. 22.4 % of total clients less than 5 years of age were Cough & Cold patients and 12.8% were among the age group 5 years and over. The percentage of C&C (<5 years) consultations in week-28, in comparison with the percentage of C&C in week-38 of 2013, increased by 5.9%, whereas in case of 5 years and above increased by 3.1% to 12.8% 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 increased by 0.8% in last 11 weeks, whereas the percentage of age group 5 years and over increased by 0.1% to 1.1% . 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- 28-13 29-13 30-13 31-13 32-13 33-13 34-13 35-13 36-13 37-13 38-13 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) ARI- C&C <5 Yr. 16.5 16.6 16.8 16.9 16.6 16.5 18.7 20 21.2 21.1 22.4 5+ 9.7 9.8 9.8 10.1 9.6 9.3 10.9 11.5 12.1 12 12.8 ARI- <5 Yr. 4.2 4.2 4.3 4.1 3.9 3.9 4.2 4.8 4.9 4.9 5 Pneumonia >=5Yr. 1 0.9 0.9 0.8 0.9 0.9 1 1 1.1 1.1 1.1 In the reporting week-38 of 2013, the highest percentages of Cough & Cold were recorded in Khost, Kapisa and Nuristan provinces with 28.9%, 27.2% and 23.8%, whereas the lowest percentages of C&C were reported from Farah, Ghor and Badghis provinces with 6.1%, 8% and 9% respectively. The highest percentages of Pneumonia cases were reported from Saripul, Samangan and Takhar provinces with 6.2%, 3.9% and 3.8 respectively, whereas the lowest percentages of Pneumonia cases were recorded in Zabul, Urozgan and Paktika provinces with 0.2 and 0.5% respectively. (Fig-3) 35 Fig-3: Percentages of ARI from Total Clients in week-38 of 2013 30 25 20 15 Percentage 10 5 0 TAK NI UR WA BA BD FAR GH NA NU SA JO KU GH KH HIL KAN ZAB KAB KAP LOGPANPAR DAY HER LAG KNR BAL FYB SAR BDS HA BGL PIA PKA M O R M G AH O N R M W N A O R Pneumonia 1.1 2.2 1 0.2 0.5 3.4 2.1 3.6 2.1 2.5 2 3.6 1.1 0.7 0.6 0.6 1 1.9 3 3.2 2.5 3.9 3.2 3.7 2.2 6.2 2.6 3.8 3.8 2.8 0.7 0.7 0.5 1 Cough&Cold 16 15 12 9.9 12 14 27 20 14 15 16 15 22 9 14 6.1 8 22 11 19 24 19 16 12 17 15 15 17 16 17 9.8 18 15 29 Percentages of Diarrheal Diseases by Weeks and by Age Groups: 20 Fig-4: Percentages of Diarrheal Diseases from Total Clients in week-38 of 2013 15 10 Percentage 5 0 HIL PIA FYB BAL BGL SAR ZAB BDS LAG HER PKA KAP PAR KAB LOG DAY KNR PAN NIM KAN BDG KHO KUN GHA NUR URO JOW NAN GHO SAM BAM WAR FARAH TAKHAR Provinces AWD BD AWDwD Figure-4 above shows the percentages of diarrheal diseases (Acute Watery Diarrhea, Bloody Diarrhea and Acute Watery Diarrhea with Dehydration) from week-28 to week-38 of 2013 from total clients, Acute Watery Diarrhea among children less than five years of age has decreased from 23.1% in week-28 to 20.6% in the reporting week, whereas Acute Watery Diarrhea among age group 5 years and above has been decreased by 1.4% to 6.1 % (Table-4). Bloody Diarrhea in age group less than 5 years decreased by 0.2% in last 11 weeks, while in case of age group 5 years and above also has been decreased by 0.2%. Acute Watery Diarrhea with Dehydration in age group less than 5 years show an decrease by 1% in last 11 weeks, while in case of five years and above AWDwD decreased by 0.2% to 0.7 in last 11 weeks. Table-4: Percentages of Diarrheal Diseases from Total Clients during 11 recent weeks by age groups. Week Week Week Week Week Week Week Week Week Week- Week- -28- -29- -30- -31- -33- -34- -35- -37- -38- Disease Age 32-13 36-13 13 13 13 13 13 13 13 13 13 (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) (%) Acute Watery <5 Years 23.1 24.6 25.6 25.9 26.2 26.5 24.7 23.5 22.2 21.5 20.6 >= 5 Diarrhea 7.5 7.6 7.4 7.8 8.5 8.5 7.4 6.6 6.9 6.3 6.1 Years <5 Years Bloody 3.8 4.1 3.9 3.9 3.9 4 3.9 3.9 3.8 3.6 3.6 >=5 2.1 2.1 2.1 2.2 2.2 2.3 2.1 2.1 2.1 1.9 1.9 Diarrhea Years Acute Watery <5 Years 3.3 3.3 3.5 3.1 3.3 4 2.7 2.7 2.5 2.5 2.3 Diarrhea with ≥5 Years 0.9 0.9 0.9 0.9 0.9 1 0.8 0.8 0.8 0.8 0.7 Dehydration Percentages of suspected Meningitis/SIC, Malaria and Typhoid Fever by Region: In the epidemiologic week-38 of 2013, a Fig-6: Percentages of Meningitis,Malaria & typhoid Fever from total of 130 suspected cases of Total Clients in W38-13 Meningitis/Severely Ill Child were reported from all regions and the highest percentage was recorded in Central East and South regions.
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