Epidemiological Week No. 25 (14 -20 June 08) July 8/ Vol. 135/ DEWS 2008-25 Bagh: WHO Surveillance officer during investigation of AWD alert in Thub, Bagh. Picture credit: Dr. Majid Bhatti Reporting Units ....................................................................... 2 Total number of consultations................................................. 2 DEWS Data, Epidemiological Week No. 25, 2008 .................. 3 DEWS Data, (Epidemiological Weeks No.22 – 25, 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 ....... 10 Number of reported cases and deaths per District, NWFP ... 11 In week 25, a total of 73,132 All the earthquake affected districts consultations were reported from 278 reported higher proportion of reporting units consultations for Acute Diarrhoea Seven alerts were received and ARI remains the leading cause of investigated accordingly consultation this week and the weekly trend is on decline None of the alerts was found to be an outbreak Acute Diarrhoea was reported in 11% of all consultations, similar to reports from 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 8 July 2008 / Vol. 135/ DEWS 2008-25 Reporting Units During week 25, 2008, total 278 (83%) weekly reports were received from the DEWS reporting sites on the due time. Compared to last week, the DEWS reporting has increased by 2% this week (81% and 83% respectively). The total number of reporting sites in the Earthquake affected districts remains 335 as of week 25, 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, 24May -20 June 2008. Reporting Health Facilities 31May-6June 14-20 June 24-30 May 08 7-13 June 08 Area Population 08 08 Week-22 Week-23 Week-24 Week-25 Bagh 452,532 36 33 35 36 Battagram 592,256 32 30 33 36 Mansehra 1,154,804 65 62 64 64 Muzaffarabad 770,000 73 70 65 71 Neelum 184,000 19 19 17 15 Poonch 633,712 63 63 57 56 Total 3,727,668 288(86%) 277(83%) 271(81%) 278(83%) Total number of consultations During week 25, a total 73,132 patient consultations were reported, an increase by 7% compared to last week. Similar to the prior weeks, the district Muzaffarabad reports the highest proportion (35%) and Neelum reports the lowest proportion (3%) 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 25, 2008. Overall there seems to be a decline in consultations starting from week 49 onwards compared to the previous weekly pattern. This decline in trend could be a result of several reasons which are being investigated. Figure1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, Week 1, 2007 – week 25 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 W05 W09 W13 W17 W21 W25 W29 W33 W37 W41 W45 W49 W05 W09 W13 W17 W21 W25 W01/07 Epi-week W01/08 2 WMMR Weekly Morbidity and Mortality Report Pakistan 8 July 2008 / Vol. 135/ DEWS 2008-25 DEWS Data, Epidemiological Week No. 25, 2008 During the Epidemiological week 25 (14 – 20 June, 2008), a total of 73,132 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, 41%, the majority, are adults 15-45 years of age, and 20% are adults above 45 years age. Of the total consultations reported for week 25, 53% were from female patients. The proportion for Upper Respiratory Tract Infection was 15%, Unexplained Fever 9%, Acute Diarrhoea 11%, Lower Respiratory Tract Infection 4% and Scabies 5% in all age groups and both sexes. Out of the total 73,132 reported consultation in all ages and both sexes, 55% (40,529) 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, 14 to 20 June 2008, Earthquake Affected Areas, Pakistan Distribution of consultations by age Distribution of consultations by diseases 45 AD BD 40 11% 41% URTI <1% LRTI 35 15% 4% 30 MA L UF <1% 25 9% 20 19% 20% 20% 15 SCB consultations Percentage of 10 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 (58% and 52% respectively). In males, the proportion for Acute Diarrhoea and URTI and Scabies were higher than for females. The proportion of consultations for UF, LRTI and Malaria are the same in both males and females. (Figure 3) Figure 3.Distribution of reported consultations by disease/health event and age groups, 14 to 20 June 2008, Earthquake Affected Areas, Pakistan Distribution of consultations (Male) Distribution of consultations (Female) AD AD BD BD URTI 12% URTI 10% LRTI <1% LRTI <1% 16% 14% 4% 4% MAL MAL UF <1% UF <1% 9% 9% SCB SCB 4% 5% OTH OTH 52% 58% 3 WMMR Weekly Morbidity and Mortality Report Pakistan 8 July 2008 / Vol. 135/ DEWS 2008-25 Disease Distribution by Age: Acute Upper Respiratory Tract Infections (URTI) is the highest reported disease in all age groups during week 25. In children less than five years of age Upper Respiratory Tract Infection was reported in 21% of the consultations, followed by Acute Diarrhoea (AD) 20%, Unexplained Fever 10%, Lower Respiratory Tract Infection (LRTI) 4%, Scabies 4% and other health problems 39%. In children 5 to 15 years of age Upper Respiratory Tract Infection was reported in 18% of the consultations followed by Acute Diarrhoea 12%, Unexplained Fever (UF) 10%, Scabies 6%, Lower Respiratory Tract Infection 5% and other health problems 47%. In both adult age groups, 15-45 years and above 45 years, the proportion of the other health problems is higher than reported for children, followed by URTI. The proportion of the remaining reported communicable diseases in adults is lower than reported in children. Figure 4 presents the comparisons of the reported consultation by age groups. Figure4. Proportion of primary causes for all reported cases by age groups, 14 – 20 June 2008, Earthquake Affected Areas, Pakistan, SCB AD SCB AD MAL 4% 20% MAL LRTI 4% 7% <1% <1% 3% LRTI OTH 4% URTI SCB AD MAL SCB AD MAL 39% 12% 4% 7% M<1%LRTI 6% 12% <1% LRTI 5% 5% UF URTI URTI OTH 7% 12% URTI 21% 66% UF 18% 10% OTH UF OTH 59% < 5yrs (n=14,247) 47% ≥15 - ≤44yrs (n=29,730) 11% UF 10% 5 - <15yrs (n=14,313) ≥ 45yrs (n=14,842) *OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance DEWS Data, (Epidemiological Weeks No.22 – 25, 2008): During the period 24 May to 20 June, 2008 (Epidemiological weeks 22 to 25, 2008 ), a total of 286,885 consultations were reported in the Earthquake affected areas. The proportion of the five common diseases under surveillance was, 46% (131,031) of the total consultations reported during this period. This proportion remains almost consistent for the last four weeks. During this period 16% (46,956) of consultations were due to Upper Respiratory Tract Infection (URTI), 9% (26,703) Unexplained Fever (UF), 10% (28,804) Acute Diarrhoea (AD), 4% (12,488) Lower Respiratory Tract Infection (LRTI), and 5% (13,340) due to Scabies (SCB). Acute Jaundice Syndrome was reported in 58 consultations and Bloody Diarrhoea was reported in 1215 consultation during this period. A total of 84 deaths were reported during this period.