Weekly Morbidity and Mortality Report (WMMR) IDP hosting and crisis affected districts, Khyber Pakhtunkhwa, Pakistan Week # 23 (5 11 June, 2010)

Transcription

1 Weekly Morbidity and Mortality Report (WMMR) IDP hosting and crisis affected districts, Khyber Pakhtunkhwa, Pakistan Week # (5 11 June, 21) Returning children of Bajaur agency in Jalozai IDP camp are being vaccinated Highlights: Eight alerts for suspected measles were received and responded during the Epidemiological week, 21 Five hundred twenty one (521) health facilities in the DEWS network reported 14,39 patient consultations Acute Diarrhea accounted for 17,1 (1) of the total patient visits in all the age groups In children less than 5 years age Diarrhea was recorded in 2 visits while in patients above 5 years age diarrhea recorded in 8% patient visits Acute Respiratory Tract Infections (ARI) accounted for 3,973 (2) of the total patient visits and continues to be the leading cause of morbidity. In children less than 5 years age, ARI accounted 1,717 (3) of the consultations in the age group Sixty five DEWS sites reported 1,96 Ante Natal visits in week, 21 The WMMR is published by the World Health Organization (WHO), Emergency Humanitarian Action (EHA) unit, Park Road, Chak Shahzad, Islamabad, Pakistan. For More Information, please contact: Dr. Hendrikus Raaijmakers, Chief of Operations, EHA WHO, Pakistan; RAAIJMAKERSH@pak.emro.who.int Dr. Roohullah Jan, Director Health Services, Department of Health, Khyber Pakhtunkhwa, Pakistan Dr. Musa Rahim Khan, Senior Public Health Officer (DEWS Coordinator), EHA WHO, Pakistan; khanm@pak.emro.who.int WHO Webpage:

2 1. Alerts and outbreaks investigation and response: During the epidemiological week, 21, eight alerts for suspected Measles were received and responded from five districts (Swat, D.I Khan, Buner, Nowshera and Lower Dir). All the alerts were investigated. Blood samples from nine patients were collected for laboratory confirmation. The results for all the measles samples are still awaited. Measles has been a problem in most of the crisis affected and the hosting districts. Mop up vaccination conducted in some areas and plans are under way to conduct full round of Measles vaccination in the affected districts in addition to strengthening routine EPI. Suspected Measles: Two suspected Measles cases reported from Union Councils Jambel and Charbagh in district Swat. The suspected cases are a male and a female child five years of age. Both the children are vaccinated and no more cases and clustering was found. Blood samples, sent to NIH for confirmation and results are awaited. A female child above five year age from Mohalla Chiragh Roshan from district D.I Khan was reported as a suspected Measles case. No more cases were found in the locality. Blood sample of the patient was sent to NIH for laboratory confirmation and result is awaited. Civil Hospital Chamla, district Buner reported a male child above five year age with high grade fever, rash on face, runny nose and conjunctivitis. The child is not vaccinated. Blood sample was sent to NIH for laboratory confirmation. No other suspected cases found on field investigation. Two alerts for suspected Measles were reported from district Nowshera. On field investigation two female children found as suspected cases of Measles in Mohalla Dagai. Another alert was received from Behram Kalay. One out of three patients was not vaccinated for Measles. Blood samples of all the suspected cases sent to NIH for laboratory confirmation. Results are awaited. Two alerts for suspected Measles were reported from Lower Dir. DHQ hospital Taimer Girah, reported a male child less than five years of age as suspected case of Measles. Another suspected case was reported from BHU Nasafa. Both the children were not vaccinated. No other cases identified in the localities. Blood samples sent to NIH for laboratory confirmation and results awaited. 2. DEWS reporting units and consultations: In week, 21, Five hundred and twenty one (521) health facilities shared their weekly DEWS reports in due time. A total of 14,39 patient consultations were reported through the DEWS network in the 11 districts affected by the crisis and hosting IDPs in Khyber Pakhtunkhwa, Pakistan. Out of the total reported consultations, 82,567 (59%) patient visits were for females and 57,742 (41%) consultations were for male patients. In children less than 5 years age, 33,962 (24%) patient visits were reported. During the week, 68,865 (49%) consultations were reported for the priority communicable diseases under surveillance. Sixty five DEWS reporting sites also reported 1,96 visits for Ante Natal Care. There is no AFP case reported from any district.

3 Table 1: Weekly number of reporting units by districts and total consultations from health facilities in the IDP camps and outside camps in IDP hosting and crisis affected districts of Khyber Pakhtunkhwa from week 2 to, 21 Week 2 Week 21 Week 22 Week Consultations Consultations Consultations Consultations District Rep. Rep. Rep. Rep. Outside Units Camp Units Camp Outside Units Camp Outside Outside Units Camp Camp Camp Camp Camp Buner Charsadda D. I. Khan Kohat Lower Dir Mardan Nowshera Peshawar Swabi Swat Tank Total There are 13 fixed health facilities operating in the IDP camps. During the week a total of 8,443 patient consultations reported from the IDP camps (Table 2). Table 2: Weekly total consultations in the IDP camps by district, from week 2 to, 21 District IDP camp Consultations Week 2 Week 21 Week 22 Week Wala Kandawa Lower Dir Sadbar Kallay Khungi Nowshera Benazir Complex Jalozai 1, 2, 3, 4, 5, 6, CO, IMC Total Consultations by age and by diseases: During the week, Upper Respiratory Tract Infection () recorded in 2% of the total patient visits as the most common cause of morbidity in all the age groups reported during the week. Acute Diarrhea recorded as the second most common reason of consultations and recorded in 1 of all the patient visits. Un Explained Fever 6%, Scabies, Lower Respiratory Tract Infection, suspected Malaria and Bloody Diarrhea 1% reported as the common priority communicable diseases in the target districts. Highest number of consultations (26% of all reported visits) recorded for females between to 45 years age. Figure 1 and 2 presenting the overall distribution of consultations by age groups, by gender and by diseases.

4 Figure 1: Percentage of consultations by age groups, by gender and by diseases. Percentage Distribution of consultations by age and gender 13% 11% 1 11% 11% 26% Male Female 7% 9% 6% distribution of consultations by diseases 2% 13% 1% <5 5 to < <45 45 Age group 51% Figure 2: Distribution of consultations by age group and by diseases week, 21 Figure 2: Distribution (Percentage) of consultations by diseases in each age group: 4% 29% 31% <5 years 2 1% 3% 7% 7% 44% 5 to < years 2 1 3% 3% <45 years 14% 6% 1% 45 years 16% 7% 1% 64% 58% During the epidemiological week, 21, patients less than five years of age accounted for 24% of the total consultations and five to fifteen years age group accounted for % of consultations. In the adults age group between fifteen to forty five years age 37% and in adults above 45 years age 16% of the total consultations were recorded in this week. Upper respiratory tract infections () remained the leading cause of consultation in all age groups. Acute diarrhea () recorded as the second common cause of morbidity in all the age groups however it was more reported in children (in children less than five year 2 and 5 to years age groups 1). Scabies was seen more in the five to fifteen years of age group (figure 2).

5 4. Morbidity pattern of the seven most common communicable diseases in the IDP hosting and the crisis affected districts of Khyber Pakhtunkhwa, during week of 21: Upper Respiratory Tract Infection () remained the leading cause of consultations (2%) in all the districts in the IDP camps as well as outside the camps and in all the age groups. Acute Diarrhea () was reported in 1 of the total consultations with a highest number of cases reported in districts Swat, Buner, Nowshera, Peshawar, D.I. Khan, Mardan and Lower Dir (figure 3). Lower Respiratory Tract Infection () is reported in of the total consultations during the week. Districts Swat and D. I. Khan reported more cases of as compared to the other districts. Scabies () reported in of the consultation with high numbers in districts Swat, Nowshera and Peshawar, while Un explained fever in 6% of the consultation with highest number of cases was reported from districts Swat, Peshawar and D. I. Khan. Suspected Malaria reported in 3,22 () cases with high numbers in District Buner. Bloody Diarrhea reported in 1,793 of the total patient consultations from all DEWS implemented districts in Khyber Pakhtunkhwa (figure 3). Figure 3: Pattern of the seven most common communicable diseases reported in the 11 IDP hosting and crisis affected districts, in Khyber Pakhtunkhwa as number of consultations during week, 21 Number of cases SWAT Nowshera Peshawar BUNER D.I.KHAN Charsadda Mardan Lower Dir Kohat Swabi TANK 5. Morbidity pattern of the seven most common communicable diseases by number of consultations in the IDP camps of Khyber Pakhtunkhwa during week 22, 21 Figure 4: Pattern of seven most common communicable diseases in the IDP camps Khyber Pakhtunkhwa, week, 21 Number of cases Jalozai 1 Jalozai 2 Jalozai 3 Jalozai 4 Jalozai 5 Jalozai 6 Jalozai IMC Jalozai CO WK WV WK CAMP B.Complex Khungi SadbarKally

6 During week, 21, all the health facilities in the IDP camps reported as the leading cause of morbidity except health post Walakandawa camp, where acute diarrhea is the leading cause of morbidity. While acute diarrhea and Scabies reported as the second and third common causes of consultations in majority of the IDP camps (fig. 4). The acute diarrhea cases are mostly mild and present without severe or moderate dehydration. Health and WASH teams are motivating the people in IDP camps to use chlorinated water to prevent diarrhea in the camp. The teams in the Jalozai IDP camps are also vigilantly monitoring the diarrhea situation and WASH interventions are further reinforced focusing on the sectors in the camp from where more cases are reported. 6. Weekly Trends of the five most common communicable diseases in the IDP hosting and crisis affected districts Khyber Pakhtunkhwa (NWFP): The morbidity trend of the common priority diseases is represented as number of cases of each disease per 1, consultations reported during each week. The weekly trend of Acute Diarrhea is remained almost stable with slight fluctuation during the recent weeks after a consistent increasing trend till week 16, 21. However in week, 21 has slightly decreased as compared to the previous week. Acute Lower Respiratory Tract Infections, Acute Upper Respiratory tract Infection, Unexplained Fever and Scabies depicting a stable picture (fig. 5). Figure 5: Weekly morbidity pattern of five most common reported communicable diseases by number of cases per 1 consultations in IDP hosting and crisis affected districts of Khyber Pakhtunkhwa (NWFP) from week 29 to week 21: Number of cases per 1 consultations The weekly trend of Acute Diarrhea showing the usual seasonal pattern in the area. The cases are mostly of mild nature and scattered. No unusual clustering of acute diarrhea cases from any location or patients with severe dehydration were reported yet. As compared to the same period last year the overall diarrhea is slightly higher this year. Figure 6 presenting the comparison of weekly trends of Acute Diarrhea during year 29 and 21. The DEWS teams in the districts is vigilantly following the acute diarrhea situation and responding as appropriate. Figure 6: Comparison of Acute Diarrhea weekly trends 29 and 21 IDP crisis Khyber Pakhtunkhwa. 13 Weekly pattern of acute diarrhea, IDP crisis and hosting districts (29-21) Percentage Epi-w eek

7 7. Weekly pattern of Acute Diarrhea and in children <5 year age, in the IDP hosting and crisis affected districts of Khyber Pakhtunkhwa from week 29 to week 21 During the epidemiological week, 21, a total of 33,962 consultations were reported in the children less than five years of age. Out of those, 8,53 (2) consultations were for Acute Diarrhea and 978 (3%) for. The weekly trend of Acute Diarrhea in children less than 5 years age was reflecting a consistently increasing trend from week 5 onwards (accounting for 11% of under 5 patient visit in week 5 to 2 of the visits in week ) while Lower Respiratory Tract Infection is depicting a stable pattern during the last few weeks (Fig 6). Figure 7: Weekly trends of Acute Diarrhea and Lower Respiratory Tract Infections from week 29 to week 21, IDP crisis Khyber Pakhtunkhwa. Number of cases per 1 consultations <5 < Mortality: During week, 21, 4 deaths were reported through the health facilities in the DEWS network, 2 were reported from district Lower Dir and 1 each from districts Kohat and Swat. All reported deaths were due to non communicable diseases (table 3). Table 3: Deaths by age, gender and district week, 21, Khyber Pakhtunkhwa Districts Age group <5 Years 5 years 45 year 45 years Male Female Total Kohat Lower Dir Swat Total Number of reporting/non reporting Health Facilities by type and department (Week, 21): During the Epidemiological week, 21, a total of 521 (84%) health facilities in the DEWS network in the IDP hosting and crisis affected districts of Khyber Pakhtunkhwa shared the weekly reports to the system.

8 Table 4: DEWS reporting by type of facility, IDP hosting and crisis affected districts for week, 21 Department Health Facility Number of DEWS Implemented Health Facilities Reporting Health Facilities Percentage PPHI BHU Dept. Of Health RHC % DHQ % THQ % IDP Camps % Mobile, CD and CH % Total % 1. Maternal health care and <5 year Children, Nutrition surveillance: Sixty five DEWS sites reported 1,96 Ante Natal visits in this week. Pregnancy and child birth related referrals were reported in 1 case. Moderate Acute Malnutrition recorded in 98 children less than 5 year age with highest number of moderate malnutrition in districts Lower Dir and Kohat. The information on Maternal Health Care and <5 children nutrition surveillance by each district during week, 21 is presented in the table 5. Table 5: Weekly maternal health care and nutrition surveillance data, IDP camps and hosting districts, Khyber Pakhtunkhwa No of Pregnant women received Pregnancy and delivery related Moderate Acute Malnutrition in Antenatal Care Referrals children <5 District Inside Outside Inside Outside Inside Outside Total Total Total Camp Camp Camp Camp Camp Camp Buner Charsadda Lower Dir Kohat Mardan Nowshera Peshawar Swabi Swat Tank D. I. Khan Total Environmental Health Activities/Response WHO Environmental Health Engineers monitoring the water quality (biological) in the IDP camps routinely and in the host community from where alert or outbreaks of the waterborne disease are reported. WHO EH unit is monitoring the WATSAN situation in Jalozai IDP camp Nowshera. Construction of WASH facilities in Phase 2 has been completed by IRSP (Oxfam IP). Water quality samples were collected from Phase 3 and 6 Jalozai camp. All the samples were found safe for drinking. WHO EH team completed WASH assessment of RHC Kot Jai, BHU Awan, RHC Toru and BHU Mayar. Water samples were tested for bacteriological contamination and were found safe for use. The findings were shared with WASH partners and Health authorities. WHO EH team is providing technical assistance to WASH partners in IDP camp Walakandawa, district Lower Dir where decommissioning of WASH facilities are in progress. Water quality samples tested from Walakandawa IDP camp were found safe for human consumption with minimum Residual Chlorine detected in 88 % of the samples.

9 During the week, WHO Environmental Health Engineers tested 3 water samples for bacteriological contamination and 16 samples for residual chlorine from IDP camps and host communities. Results are presented in tables 6 and 7. Table 6: Water sample results for the Bacteriological test: Bacteriological test result District Total No. Water sample fit Water sample Water sample for drinking unfit for drinking tested No. % No. % Nowshera 7 7 1% Dir % 1 1 DI Khan 2 2 1% Remarks Mardan 5 5 1% Swat 8 Result Awaited Health education session with affected household in Walakandawa 2 camp. Results shared with WASH working group for remedial response. Table 7: Water samples test results for Residual Chlorine: Residual Chlorine (.2mg.5mg) District Total No. of water sample tested Water samples chlorine detected and within permissible limit Action Taken No. % Nowshera 8 8 1% 5 Kg HTH was provided to SSD for regular chlorination. Dir %