Epidemiological Week No. 35 (23 - 29 Aug 08) Sept 25/ Vol. 145/ DEWS 2008-35 Rawalakot: Water supply tanks are eroded with grass and weeds in spring. Need a mechanism for cleaning. Reporting Units ....................................................................... 2 Picture credit: Dr. Nadeem Gondal Total number of consultations................................................. 2 DEWS Data, Epidemiological Week No. 35, 2008 .................. 3 DEWS Data, (Epidemiological Weeks No.32 – 35, 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 35, total 67,419 consultations Proportion of consultations for acute reported from 254 reporting units diarrhoea showing a gradual declining trend in all earthquake affected districts ARI remains the leading cause of consultation this week accounting for Three alerts were received and 19% of total consultations investigated accordingly Acute Diarrhoea was reported in 10% There were no outbreak reported from of all consultations, a decrease by 1% any earthquake affected district. compared to the previous 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 25 September 2008 / Vol. 145/ DEWS 2008-35 Reporting Units During week 35, 2008, total 254 (76%) weekly reports were received on due time out of the total 335 DEWS reporting sites in the earthquake districts. Compared to last week, the DEWS reporting have decreased by 3%. The reporting from district Bagh, Muzaffarabad and Neelum has dropped in this week. Table 1, summarizes the reporting by each earthquake affected district for the last 4 weeks. Table1. Heath Facilities by district, reported from Earthquake Affected Areas, Pakistan, 2 – 29 Aug 2008. Reporting Health Facilities Area Population 2-8 Aug 08 9-15 Aug 08 16-22 Aug 08 23-29 Aug 08 Week-32 Week-33 Week-34 Week-35 Bagh 452,532 29 26 27 20 Battagram 592,256 39 33 35 36 Mansehra 1,154,804 65 68 67 70 Muzaffarabad 770,000 66 62 71 65 Neelum 184,000 15 12 13 8 Poonch 633,712 60 51 53 55 Total 3,727,668 274(82%) 252(75%) 266(79%) 254(76%) Total number of consultations During week 35, total 67,419 patient consultations were reported, a decrease by 7% compared to last week. District Mansehra reports the highest proportion (34%) and district Neelum reports lowest proportion (2%) 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 affected area. There is an overall decline in consultations starting from week 49, 2007 onwards compared to the previous weekly pattern. This declining trend could be a result of people going to private clinics for health care which are now functional in the earthquake affected areas. 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 35, 2008. Figure1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, Week 1, 2007 – week 35 2008. # of Units Weekly Pattern of reporting consultations # of Cns. 350 120000 Reporting Unit Consultations 300 100000 250 80000 200 60000 15 0 40000 10 0 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 W25 W27 W29 W31 W33 W35 Ep i- w e e k W01/07 W01/08 2 WMMR Weekly Morbidity and Mortality Report Pakistan 25 September 2008 / Vol. 145/ DEWS 2008-35 DEWS Data, Epidemiological Week No. 35, 2008 During the Epidemiological week 35 (23 to 29 August, 2008), a total of 67,419 consultations were reported through DEWS. The distribution of consultations by age groups indicate that 19% are children less than 5 years of age, 21% 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 35, 53% were female patients. The proportion for Upper Respiratory Tract Infection was 16%, Acute Diarrhoea 10%, Unexplained Fever 9%, Lower Respiratory Tract Infection 4% and Scabies 5% in all age groups and both sexes. Out of the total 67,419 reported consultations in all ages and both sexes, 56% (37,643) 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, 23-29 August 2008, Earthquake Affected Areas, Pakistan Distribution of consultations by age Distribution of consultations by disease 45 AD URTI 10% 40 LRTI 41% 16% 35 4% 30 25 UF 9% 20 21% 20% Percentage 15 19% 10 SCB 5% 5 OTH 0 <5 5-14 15-44 ≥45 56% 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 common communicable diseases are reported higher than males (56% and 54% respectively). In males, the proportion for Acute Diarrhoea and URTI were higher than females. (Figure 3) Figure 3.Distribution of reported consultations by disease/health event and age groups, 23-29 Aug 2008, Earthquake Affected Areas, Pakistan Distribution of consultations (Male) Distribution of consultations (Female) AD AD URTI 9% URTI 11% LRTI LRTI 15% 17% 4% 4% UF UF 9% 9% SCB SCB 5% 5% OTH OTH 54% 58% 3 WMMR Weekly Morbidity and Mortality Report Pakistan 25 September 2008 / Vol. 145/ DEWS 2008-35 Disease Distribution by Age: Acute Upper Respiratory Tract Infections (URTI) is the highest reported disease in all age groups. In children less than five years of age Upper Respiratory Tract Infection comprised of 24% of the total consultations, followed by Acute Diarrhoea (AD) 16% of the consultations, Unexplained Fever 10%, Lower Respiratory Tract Infection (LRTI) 5%, Scabies 5% and other health problems 40%. In children 5 to 15 years of age Upper Respiratory Tract Infection was reported in 19% of the consultations followed by Acute Diarrhoea 12%, Unexplained Fever (UF) 9%, Scabies 6%, Lower Respiratory Tract Infection 4% and other health problems 48%. 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. The proportion of the remaining reported communicable diseases in both adult groups 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, 23-29 Aug 2008, Earthquake Affected Areas, Pakistan. SCB SCB AD AD MAL 5% 4% 7% 16% <1% LRTI 3% SCB AD MAL MAL URTI 6% 8% OTH SCB AD <1% <1% 12% LRTI 40% 6% 12% MAL LRTI 3% <1% UF 5% 7% URTI LRTI OTH 14% 4% UF URTI 66% 24% 10% URTI OTH 19% UF 58% < 5yrs (n=12,699) OTH ≥15 - ≤44yrs (n=27,454) 10% 48% UF 9% 5 - <15yrs (n=13,965) ≥ 45yrs (n=13,343) *OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance DEWS Data, (Epidemiological Weeks No.32 – 35, 2008): During the period 2 to 29 August, 2008 (Epidemiological weeks 32 to 35, 2008 both inclusive), total 280,115 consultations were reported in the Earthquake affected areas. The proportion of the five common diseases under surveillance was, 44% (122,431) of the total consultations reported during this period. This proportion remains almost consistent for the last four weeks. During this period 15% (41,258) of consultations were due to Upper Respiratory Tract Infection (URTI), 11% (31,094) Acute Diarrhoea (AD), 8% (23,578) Unexplained Fever (UF), 4% (10,749) Lower Respiratory Tract Infection (LRTI), and 5% (13,229) due to Scabies (SCB). Acute Jaundice Syndrome was reported in 49 consultations and Bloody Diarrhoea was reported in 1,084 consultations during this period. Total 93 deaths were reported during the last four weeks period.