Epidemiological Week No. 23 (31 May -6 June 08) June 23/ Vol. 133/ DEWS 2008-23 Muzaffarabad: WHO team assessing the health situation in Khun Bandi affected by landslide Picture credit: Dr. Mazhar Iqbal Reporting Units ....................................................................... 2 Total number of consultations................................................. 2 DEWS Data, Epidemiological Week No. 23, 2008 .................. 3 DEWS Data, (Epidemiological Weeks No.20 – 23, 2008):...... 4 Acute Diarrhoea and suspected Cholera: ............................... 5 Acute Respiratory Tract Infections: ......................................... 7 Upper and Lower Respiratory Tract Infection:......................... 7 Other Conditions under Surveillance: ..................................... 8 Outbreak Alert and Response................................................. 8 Number of reported cases and deaths per District, AJK ......... 9 Number of reported cases and deaths per District, NWFP ... 10 In week 23, total 71,601 consultations Districts Battagram and Neelum were reported from 277 reporting reported higher proportion of units consultations for Acute Diarrhoea compared to other districts ARI remains the leading cause of Two alerts were received and consultation this week and the weekly investigated accordingly trend is on decline None of the alerts was found to be an Acute Diarrhoea reported in 10% of all outbreak consultations almost same as was reported last 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 produced with the financial support of AAI Australia, Americares, CIDA, Denmark, DFID, ECHO, Ireland, Italy, Japan, Korea, Monaco, Norway, SIDA, Slovak Republic, Switzerland, Turkey, USAID The WMMR is published by the World Health Organization (WHO), Health Emergency Operation Centre, National Park Road, Chak Shahzad, Islamabad, Pakistan. For More Information, please contact: Dr. Rayana Bouhaka, Manager Operations, 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 23 June 2008 / Vol. 133/ DEWS 2008-23 Reporting Units During week 23, 2008, total 277 (83%) weekly reports were received from the DEWS reporting sites on the due time. Compared to last week the DEWS reporting have decreased by 3% this week (86% and 83% respectively). The total number of reporting sites in the Earthquake affected districts remains 335 as of week 23, 2008. Table 1, summarizes reporting by each earthquake affected district for the last 4 weeks. Table1. Heath Facilities by district, reported from Earthquake Affected Areas, Pakistan, 31May -6 June 2008. Reporting Health Facilities 31May-6June 10-16 May 08 17-23 May 08 24-30 May 08 Area Population 08 Week-20 Week-21 Week-22 Week-23 Bagh 452,532 35 36 36 33 Battagram 592,256 36 38 32 30 Mansehra 1,154,804 59 65 65 62 Muzaffarabad 770,000 70 76 73 70 Neelum 184,000 17 18 19 19 Poonch 633,712 64 61 63 63 Total 3,727,668 281(84%) 294(88%) 288(86%) 277(83%) Total number of consultations During week 23, Total 71,601 patient consultations were reported, a decrease by 3% compared to last week. Similar to the prior weeks, the district Muzaffarabad reports the highest proportion (35%) and Neelum reports the lowest proportion (5%) of the total consultation reported from all the Earthquake affected districts. Neelum is the smallest district with the least number of DEWS reporting sites among all the districts in the earthquake area. Figure 1 depicts the pattern of weekly reporting units participating in the DEWS and the total number of weekly consultations reported from week 1, 2007 to week 23, 2008 Figure1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, Week 1, 2007 – week 23 2008. # of Units Weekly pattern of reporting consultations # of Cns. 350 120000 Reporting Unit Consultations 300 100000 250 80000 200 60000 150 40000 100 50 20000 0 0 W03 W05 W07 W09 W11 W13 W15 W17 W19 W21 W23 W25 W27 W29 W31 W33 W35 W37 W39 W41 W43 W45 W47 W49 W51 W03 W05 W07 W09 W11 W13 W15 W17 W19 W21 W23 W01/07 Ep i- w e e k W01/08 2 WMMR Weekly Morbidity and Mortality Report Pakistan 23 June 2008 / Vol. 133/ DEWS 2008-23 DEWS Data, Epidemiological Week No. 23, 2008 During the Epidemiological week 23 (31 May – 6 June, 2008), total 71,601 consultations were reported through DEWS. The distribution of consultations by age groups indicate that 19% are children less than 5 years of age, 20% are children 5-14 years of age, 42%, the majority, are adults 15-45 years of age, and 19% are adults above 45 years age. Of the total consultations reported for week 23, 53% were from female patients. The proportion for Upper Respiratory Tract Infection was 16%, Unexplained Fever 10%, Acute Diarrhoea 10%, Lower Respiratory Tract Infection 4% and Scabies 5% in all age groups and both sexes. Out of the total 71,601 reported consultation, in all ages and both sexes, 55% (39,036) accounted for health problems other than the diseases reported above. See (Figure 2). Figure 2.Distribution of reported consultations by disease/health event and age groups, 31 May to 6 June 2008, Earthquake Affected Areas, Pakistan Distribution of consultations by age Distribution of consultations by disease 45 AD 10% LRTI 40 URTI 42% 4% 35 16% 30 25 UF 20 10% consultations 19% 20% Percentage of 15 19% 10 SCB 5 5% 0 <5 5-14 15-44 ≥45 OTH 55% Age-group *OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance Comparison of consultation by sex shows that in female patients, health events other than the five common communicable diseases are reported higher than males (57% and 51% respectively). In males, the proportion for Acute Diarrhoea LRTI and URTI is higher than for females. The proportion of consultations for UF, and Scabies is same both in males and females (Figure 3) Figure 3.Distribution of reported consultations by disease/health event and age groups, 31 May to 6 June 2008, Earthquake Affected Areas, Pakistan Distribution of consultations (Male) Distribution of consultations (Female) AD URTI AD LRTI 9% 11% LRTI 4% URTI 15% 5% 17% UF 10% UF 10% SCB 5% SCB 5% OTH OTH 57% 51% 3 WMMR Weekly Morbidity and Mortality Report Pakistan 23 June 2008 / Vol. 133/ DEWS 2008-23 Disease Distribution by Age: Acute Upper Respiratory Tract Infections (URTI) is the highest reported disease in all age groups during week 23. In children less than five years of age Upper Respiratory Tract Infection was reported in 23% of the consultations, followed by Acute Diarrhoea (AD) 18%, Unexplained Fever 10%, Lower Respiratory Tract Infection (LRTI) 6%, Scabies 4% and other health problems 39%. In children 5 to 15 years of age Upper Respiratory Tract Infection was reported in 19% of the consultations followed by Acute Diarrhoea 11%, Unexplained Fever (UF) 11%, Scabies 6%, Lower Respiratory Tract Infection 5% and other health problems 47%. In both the adult age groups (15-45 years and above 45 years) the proportion of the other health problems (51% and 57%) is higher than reported for children, followed by URTI 17% and 15% in the respective age groups. The proportion of the remaining reported communicable diseases in adults is lower than reported in children but with slight differences between the two adult age groups. Figure 4 presents the comparisons of the reported consultation by age groups. Figure4. Proportion of primary causes for all reported cases by age groups, 31 May – 6 June 2008, Earthquake Affected Areas, Pakistan, SCB AD SCB AD MAL 4% 18% MAL LRTI 4% 6% <1% <1% 3% LRTI 6% URTI SCB AD MAL OTH SCB AD MAL 13% 5% 7% M<1%LRTI 39% 6% 11% <1% LRTI 5% 5% UF URTI URTI OTH 8% URTI 13% 23% 64% UF 19% 10% OTH UF OTH 57% < 5yrs (n=13,904) 47% ≥15 - ≤44yrs (n=29,836) 12% UF 11% 5 - <15yrs (n=14,212) ≥ 45yrs (n=13,649) *OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance DEWS Data, (Epidemiological Weeks No.20 – 23, 2008): During the period 10 May to 6 June, 2008 (Epidemiological weeks 20 to 23, 2008 both inclusive), total 298,935 consultations were reported in the Earthquake affected areas. The proportion of the five common diseases under surveillance was, 46% (138,551) of the total consultations reported during this period. This proportion remains almost consistent for the last four weeks. During this period 17% (52,118) of consultations were due to Upper Respiratory Tract Infection (URTI), 9% (27,824) Unexplained Fever (UF), 9% (27,444) Acute Diarrhoea (AD), 5% (14,257) Lower Respiratory Tract Infection (LRTI), and 5% (13,958) due to Scabies (SCB). Acute Jaundice Syndrome was reported in 70 consultations and Bloody Diarrhoea was reported in 1388 consultation during this period. A total of 69 deaths were reported during this period.