Epidemiological Week No. 30 (19 -25 July 08) Aug 9/ Vol. 140/ DEWS 2008-30 Muzaffarabad: Ghel Jabri Picture by Dr. Mazhar Iqbal Reporting Units ....................................................................... 2 Total number of consultations................................................. 2 DEWS Data, Epidemiological Week No. 30, 2008 .................. 3 DEWS Data, (Epidemiological Weeks No.27 – 30, 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 30, a total of 73,183 All the earthquake affected districts consultations were reported from 247 show an increase in the number of reporting units consultations for Acute Diarrhoea over the past few weeks ARI remains the leading cause of Two alerts were received and consultation this week (18% of total investigated accordingly consultations) There was no outbreak reported from any District. Acute Diarrhoea was reported in 12% of all consultations, same percentage 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 4 Aug 2008 / Vol. 139/ DEWS 2008-29 Reporting Units During week 30, 2008, total 247 (74%) weekly reports were received from the DEWS reporting sites on due time. Compared to last week, the DEWS reporting have increased by 10% (64% and 74% respectively). The total number of reporting sites in the Earthquake affected districts remains 335 as of week 30, 2008. 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, 28 June - 25 July 2008. Reporting Health Facilities 28June-4July 5-11 July 08 12-18 July 08 19-25 July 08 Area Population 08 Week-27 Week-28 Week-29 Week-30 Bagh 452,532 36 28 24 29 Battagram 592,256 24 39 37 37 Mansehra 1,154,804 64 64 64 65 Muzaffarabad 770,000 70 54 36 45 Neelum 184,000 12 12 6 11 Poonch 633,712 60 58 46 60 Total 3,727,668 275 (82%) 255 (76%) 213(64%) 247(74%) Total number of consultations During week 30, total 73,183 patient consultations were reported, an increase of 8% compared to last week. Similar to the prior weeks, the district Muzaffarabad reports the highest proportion (27%) 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 affected 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 30, 2008. Overall there seems to be a decline in consultations starting from week 49 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. Figure1. Weekly trend of reporting units and total number of consultations, Earthquake Affected Areas, Pakistan, Week 1, 2007 – week 30 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 W04 W07 W10 W13 W16 W19 W22 W25 W28 W31 W34 W37 W40 W43 W46 W49 W52 W03 W06 W09 W12 W15 W18 W21 W24 W27 W30 Ep i- w e e k W01/07 2 WMMR Weekly Morbidity and Mortality Report Pakistan 4 Aug 2008 / Vol. 139/ DEWS 2008-29 DEWS Data, Epidemiological Week No. 30, 2008 During the Epidemiological week 30 (19th -25th July 2008), a total of 73,183 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, 40%, the majority, are adults 15-45 years of age, and 20% are adults above 45 years age. Of the total consultations reported for week 30, 52% were from female patients. The proportion for Upper Respiratory Tract Infection was 14%, Acute Diarrhoea 12%, Unexplained Fever 8%, Lower Respiratory Tract Infection 4% and Scabies 5% in all age groups and both sexes. Out of the total 73,183 reported consultation in all ages and both sexes, 55% (40,494) 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, 19-25 July 2008, Earthquake Affected Areas, Pakistan Distribution of consultations by age Distribution of consultations by diseases 45 40% URTI AD 14% 13% 40 LRTI 35 4% UF 30 9% 25 19% 21% 20% 20 consultations SCB Percentage of all 15 5% 10 5 0 OTH <5 5-14 15-44 ≥45 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 54% respectively). In males, the proportion for Acute Diarrhoea, URTI and UF were higher than for females. The proportion of consultations for LRTI and Scabies are the same in both males and females. (Figure 3) Figure 3.Distribution of reported consultations by disease/health event and age groups, 19 to 25 July 2008, Earthquake Affected Areas, Pakistan Distribution of consultations (Male) Distribution of consultations (Female) URTI AD URTI AD 13% 12% 15% 13% LRTI LRTI UF 4% 4% UF 8% 9% SCB SCB 5% 5% OTH OTH 54% 58% 3 WMMR Weekly Morbidity and Mortality Report Pakistan 4 Aug 2008 / Vol. 139/ DEWS 2008-29 Disease Distribution by Age: Acute Upper Respiratory Tract Infections (URTI) is the highest reported disease in all age groups during week 30. In children less than five years of age Acute Diarrhoea (AD) comprised 20% of the consultations followed by Upper Respiratory Tract Infection 19% of the consultations, Unexplained Fever 11%, 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 16% of the consultations followed by Acute Diarrhoea 14%, Unexplained Fever (UF) 10%, Scabies 6%, Lower Respiratory Tract Infection 4% 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. 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, 19 – 25 July 2008, Earthquake Affected Areas, Pakistan, SCB SCB AD MAL AD 5% 4% 9% <1% 20% LRTI 3% SCB AD MAL MAL URTI 5% 10% OTH SCB AD <1% <1% 12% LRTI 40% 6% 14% MAL LRTI 4% <1% UF 5% 7% URTI LRTI OTH 12% 4% 64% UF URTI 19% 11% URTI OTH 16% UF 60% < 5yrs (n=13,913) OTH ≥15 - ≤44yrs (n=29,493) 8% 47% UF 10% 5 - <15yrs (n=15,256) ≥ 45yrs (n=14,521) *OTH includes all other reportable conditions, plus all other consultations for conditions not under surveillance DEWS Data, (Epidemiological Weeks No.27 – 30, 2008): During the period 28th June to 25th July, 2008 (Epidemiological weeks 27 to 30, 2008 both inclusive), a total of 288,368 were reported in the Earthquake affected areas. The proportion of the five common diseases under surveillance was, 45% (130,073) of the total consultations reported during this period. This proportion remains almost consistent for the last four weeks. During this period 14% (40,865) of consultations were due to Upper Respiratory Tract Infection (URTI), 8% (24,495) Unexplained Fever (UF), 13% (36,404) Acute Diarrhoea (AD), 4% (11,187) Lower Respiratory Tract Infection (LRTI), and 5% (14,079) due to Scabies (SCB). Acute Jaundice Syndrome was reported in 84 consultations and Bloody Diarrhoea was reported in 1,286 consultations during this period. A total of 57 deaths were reported during the last four weeks period.