Epidemiological Week No. 20 (10 -16 May 08) May 30/ Vol. 130/ DEWS 2008-20 Rawalakot: Contamination of water sources may cause a threat for water born diseases. Pictured credit: Dr. Nadeem Gondal Reporting Units ....................................................................... 2 Total number of consultations................................................. 2 DEWS Data, Epidemiological Week No. 20, 2008 .................. 3 DEWS Data, (Epidemiological Weeks No.17 – 20, 2008):...... 4 Acute Diarrhoea and suspected Cholera: ............................... 5 Acute Respiratory Tract Infections: ......................................... 7 Upper and Lower Respiratory Tract Infection:......................... 8 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 Total 74,731 consultations were Compared to other districts Neelum reported from 281 reporting units in reporting a higher proportion of Acute Week 20 and Bloody Diarrhoea cases ARI remains the leading cause of District Battagram showing a drop in consultation this week and the weekly the proportion of suspected Malaria trend is on decline compared to previous weeks District Neelum reported increase in The trend of Diarrhoeal Diseases the proportion of Bloody Diarrhoea as increasing gradually compared to last week Acute Diarrhoea reported in 8% of all Two alerts (Meningitis; AFP) reported consultations an increase by 1% as from District Mansehra. compared to 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 Shehzad, 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 6th June 2008 / Vol. 130/ DEWS 2008-20 Reporting Units During week 20, 2008, total 281 (84%) weekly reports were received from the DEWS reporting sites on the due time. Compared to last week the DEWS reporting have decreased by 2% this week (86% and 84% respectively). The total number of reporting sites in the Earthquake affected districts remains 335 as of week 20, 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, 19 April - 16 May 2008. Reporting Health Facilities Area Population 19-25 Apr 08 26Apr-2May 08 3-9 May 08 10-16 May 08 Week-17 Week-18 Week-19 Week-20 Bagh 452,532 36 33 35 35 Battagram 592,256 36 37 37 36 Mansehra 1,154,804 64 61 64 59 Muzaffarabad 770,000 68 66 70 70 Neelum 184,000 17 15 18 17 Poonch 633,712 60 66 63 64 Total 3,727,668 281(84%) 278(83%) 287(86%) 281(84%) Total number of consultations During week 20, Total 74,731 patient consultations were reported, an increase by 2% compared to last week. Similar to the prior weeks, the district Muzaffarabad reports the highest proportion (33%) 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 20, 2008. Figure1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, Week 1, 2007 – week 20 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 W01/07 W06 W11 W16 W21 W26 W31 W36 W41 W46 W51 W04 W09 W14 W19 Ep i- w e e k 2 WMMR Weekly Morbidity and Mortality Report Pakistan 6th June 2008 / Vol. 130/ DEWS 2008-20 DEWS Data, Epidemiological Week No. 20, 2008 During the Epidemiological week 20 (10 – 16 May, 2008), total 74,731 consultations were reported through DEWS. The distribution of consultations by age groups indicates that 20% of the consultations are in children less than 5 years of age, 21% are children 5-14 years of age, 40%, the majority, are adults 15-45 years of age, and 19% are adults above 45 years age,. Of the total consultations reported for week 20, 53% were from female patients. The proportion for Upper Respiratory Tract Infection was 18%, Unexplained Fever 9%, Acute Diarrhea 8%, Lower Respiratory Tract Infection 5% and Scabies 5% in all age groups and both sexes. Out of the total 74,731 reported consultation, in all ages and both sexes, 54% (39,743) 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, 10 to 16 May 2008, Earthquake Affected Areas, Pakistan Distribution of consultations by age Distribution of consultations by 45 reported diseases AD 8% 40 LRTI URTI 40% 5% MA L 35 19% <1% 30 25 UF 20 20% 21% 9% 15 19% consultations Percentage of all 10 SCB 5 5% 0 OTH <5 5-14 15-44 ≥45 54% Age-group *OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance Comparison of consultation by gender shows that in female patients, health events other than the common communicable diseases are reported higher than males (55% and 51% respectively). In males the proportion for Acute Diarrhoea and URTI is higher than for females. The proportion of LRTI, Scabies and Un-Explained fever is same for both male and female (Figure 3) Figure 3.Distribution of reported consultations by disease/health event and age groups, 10 to 16 April 2008, Earthquake Affected Areas, Pakistan Distribution of consultations (Male) Distribution of consultations (Female) AD URTI AD LRTI LRTI URTI 8% 19% 9% 5% 5% 17% MA L MA L <1% <1% UF UF 9% 9% SCB SCB 5% 5% OTH OTH 51% 55% 3 WMMR Weekly Morbidity and Mortality Report Pakistan 6th June 2008 / Vol. 130/ DEWS 2008-20 Disease Distribution by Age: Acute Upper Respiratory Tract Infections (URTI) is the highest reported disease in all age groups during week 20. In children less than five years of age Upper Respiratory Tract Infection was reported in 25% of the consultations, followed by Acute Diarrhoea (AD) 15%, Unexplained Fever 10%, Lower Respiratory Tract Infection (LRTI) 6%, Scabies 5% and other health problems 38%. .In children 5 to 15 years of age Upper Respiratory Tract Infection was reported in 21% of the consultations followed by Unexplained Fever (UF) 10%, Acute Diarrhoea 9%, Scabies 6%, Lower Respiratory Tract Infection 6% and other health problems 46%. In both the adult age groups (15-45 years and above 45 years) the proportion of the other health problems is higher than reported for children (62% and 59% respectively), followed by URTI 15% in both adult 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, 10 – 16 May 2008, Earthquake Affected Areas, Pakistan, SCB AD SCB AD MAL 5% 15% MAL LRTI 4% 6% <1% <1% 4% LRTI 6% URTI SCB AD MAL OTH SCB AD MAL 15% 5% 6% M<1%LRTI 38% 6% 9% <1% LRTI 6% 6% UF URTI URTI OTH 8% URTI 15% 25% 59% UF 21% 10% OTH UF OTH 59% < 5yrs (n=14,715) 46% ≥15 - ≤44yrs (n=30,094) 10% UF 10% 5 - <15yrs (n=15,584) ≥ 45yrs (n=14,338) *OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance DEWS Data, (Epidemiological Weeks No.17 – 20, 2008): During the period 19 April to 16 May, 2008 (Epidemiological weeks 17 to 20, 2008 both inclusive), a total 287,609 consultations were reported in the Earthquake affected areas. The proportion of the five common diseases under surveillance was, 45% (130,351) of the total consultations reported during this period. This proportion remains almost consistent for the last four weeks. During this period 19% (54,653) of consultations were due to Upper Respiratory Tract Infection (URTI), 9% (24,391) Unexplained Fever (UF), 8% (21,400) Acute Diarrhoea (AD), 5% (13,591) Lower Respiratory Tract Infection (LRTI), and 5% (13,612) due to Scabies (SCB). Suspected Malaria reported for 1469 consultation Bloody Diarrhoea in 1157 consultations and Acute Jaundice Syndrome was reported in 69 consultations during this period.