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Communicable Disease situation update flood affected districts, Pakistan

8 August, 2010

Fifty (50) out of 62 flood affected districts in all the four provinces shared daily diseases
surveillance data for 8 August, 2010. An alert of acute watery diarrhoea (AWD) was reported
Mardan Medical Complex on 8 August and was responded. The AWD in two villages from
where alerts were received previously are being monitored and situation is stable now.

Alert Responded:

• Nowshera: On 9 August an alert for suspected Acute Watery Diarrhoea (AWD) reported
from Mardan Medical Complex. The patients belong to Village Kandharo, Risalpur district
Nowshera in Khyber Pakhtunkhwa. Alert was immediately responded by DEWS team, and
active surveillance was carried out in the village and no other cases with signs and symptoms
of AWD were found in the locality. Stool samples from suspected cases were collected and
sent to NIH for lab confirmation. Health and hygiene messages were communicated to
community and aqua tabs distributed and community educated on its use. Follow up visits to
the area will be done to monitor the situation in the locality.
• Swat: Follow-up of AWD alert on 8 August: A joint team conducted active Surveillance in
village Gulabad (Barikot) for AWD. 40 Households were visited during the surveillance and
179 community members were screened. Total 51 community members complained having
diarrhoea and one case of bloody Diarrhoea was identified during the Surveillance. The water
source is common for the village which is a single water pump near by the water way passing
near the village. ORS Sachets (among the patients suffering from Acute Diarrhea), Aqua
Tabs and IEC Material were distributed among the community remembers. Health
Awareness sessions conducted on the importance of clean drinking water, Personal and
Environmental Hygiene and prevention of water born diseases in context to the present
situation of the area.
• Peshawar: Follow-up of AWD alert on 6 August: The AWD situation in Chandan Ghari is
being monitored by the team deployed there by EDO-Health, 19 cases of Acute Diarrhea
were reported from the area without dehydration and the situation is stable. Health and
hygiene promotion activities by LHWs are in progress and the health team will continue
visiting the area.
• Kashmor Sindh: High numbers of diarrhoea case are reported from Kashmor in Sindh.
WHO Surveillance officer visited the IDP camps and conducted investigation on 9 August
2010. According to doctor at the medical camp around 50% of the patients at the facility are
coming with complaints of diarrhoea. So far no suspected case of AWD has been seen in the
camp the medical team reports. The hygienic condition in the camps is poor, people taking
water from the town water supply system and due to its poor infrastructure it might have got
contaminated. Health Education sessions in the camps organized involving the LHWs on
proper hand washing, the use of safe drinking water and use of freshly prepared food. WASH
interventions are highly required in the camps in Kashmor.
Khyber Pakhtunkhwa Province:
From Khyber Pakhtunkhwa 67 health teams and static health facilities from 7 floods affected
districts shared daily reports. Total 12,352 patient consultations were reported less as compared
to previous day. The reason for this decline in the patient visit is continuous rain in the affected
districts. Acute Diarrhoea (AD) accounted for 1833 (15%) of the total patient visits in all age
groups. Skin infections reported in 2015 (16%) of the patients as the leading cause of morbidity.
Acute Respiratory tract infections (ARI) recorded as the third most common cause of seeking
care which accounted for 1712 (14%) of the total patient visits. Table 1 reflects the daily number
of cases reported from the flood affected districts in Khyber Pakhtunkhwa.

Table 1: Distribution of daily patient visits by the priority diseases, in the flood affected districts Khyber Pakhtunkhwa

Diseases/Conditions 31‐Jul  2‐Aug  3‐Aug  4‐Aug  5‐Aug  6‐Aug  7‐Aug  8‐Aug  Total 

Acute Diarrhoea 337  2221  2277  897  4671  3900  4263  1833  20399 

Acute Jaundice Syndrome ‐  9  ‐  1  5  1  15  ‐  31 

Bloody Diarrhoea 59  49  70  54  113  119  90  95  649 

Injuries ‐  ‐  ‐  71  111  477  298  38  995 

Lower Respiratory Tract


Infections 34  179  109  221  403  248  210  200  1604 

Suspected Malaria ‐  28  75  222  54  162  85  46  672 

Others 1056  7956  8660  3157  14122  12552  12767  6211  66481 

Skin Infections 150  2647  4270  710  7325  4723  5083  2015  26923 

Unexplained Fever 125  945  1122  167  1842  179  420  402  5202 

Upper Respiratory Tract


Infections 276  901  1528  944  3548  3146  3827  1512  15682 

Total 2037  14935  18111  6444  32194  25507  27058  12352  138638 

Figure 1: distribution of patient visits by disease as percent of total patient consultations reported on 8August 2010
in flood affected districts Khyber Pakhtunkhwa.

UF URTI
AD
3% 12%
15% AJS
<1%
SkInf
BD
16%
1%

INJ
<1%

LRTI
2%
MAL
<1%

OTH
50%
Acute Diarrhoea:
The daily reporting on the priority communicable diseases from the health facilities (both by
mobile teams and fixed facilities) has been started. The daily trend of acute diarrhoea in the flood
affected districts reflects that the proportion of patients with acute diarrhoea is gradually
increasing. Higher proportion diarrhoea cases are seen in Swat, Peshawar, Charsadda, Mardan
and Nowshera as compared to the other districts. Vigorous WASH interventions are extremely
important in these districts to avoid waterborne disease outbreaks. Figure 2 reflects the daily
trend of acute diarrhoea in the flood affected districts in Khyber Pakhtunkhwa during the last 6
days.

Figure 2: Daily trend of acute diarrhoea flood affected districts Khyber Pakhtunkhwa (KPK).
18
17% 16%
15% 15% 15%
16
15% 14%
14
13%
12

10

0
7/31/10 8/1/10 8/2/10 8/3/10 8/4/10 8/5/10 8/6/10 8/7/10 8/8/10

Punjab province:
Twenty-five flood affected districts in Punjab shared the daily disease report. In the flood
affected districts 1003 mobile teams and 917 static facilities providing health services to the
affected communities in Punjab. On 8 August, 2010 total 109,822 patient consultations were
reported. Skin diseases were reported in 19% of total patient visits as leading cause of morbidity.
Acute diarrhoea accounted for 9% of patient consultations and higher number of cases of
diarrhoea reported from Mianwali, Muzafargarh, Sargodha and Khushab. Total 66 dog bites and
39 snake bite were also reported from the flood affected districts. Total 687,176 ORS sachets and
61,630 Aqua tabs distributed in the affected communities and other preventive measures are also
being taken by the health department in the affected districts. Table 2 presenting the
consultations by disease and by district in the flood affected districts of Punjab.
Table 2: Distribution of patient visits by district and by disease flood affected districts in Punjab 8-8-2010
Dog  Snake 
District  RTI  Injiris  Skin  POU  Eye Ear  AWD  Others  Total 
Bite  Bite 
Attock  0  10  14  5  0  0  2  56  12  99 
Bhakkar  1084  0  771  0  0  0  0  456  1644  3955 
B.Nagar  0  0  13  5  0  0  0  14  56  88 
Chiniot  0  0  0  0  0  0  0  42  0  42 
D.G.Khan  0  0  0  0  0  0  0  42  0  42 
Faisalabad  0  0  0  5  0  0  0  0  0  5 
Gujrat  0  0  3  0  0  0  0  4  0  7 
Hafizabad  0  33  191  77  0  23  1  68  0  393 
Jhelum  0  0  292  89  0  2  3  174  1067  1627 
Jhang  0  0  839  1006  0  0  5  363  1588  3801 
Khanewal  92  20  221  97  0  0  0  47  217  694 
Khushab  1222  0  1468  0  0  0  0  997  3408  7095 
Lahore  244  0  80  43  0  3  0  118  15  503 
Layyah  2549  606  3646  988  1217  6  17  493  11489  21011 
M.B.Din  29  0  35  0  0  0  0  38  25  127 
Multan  0  0  0  0  0  0  0  137  0  137 
Mianwali  3866  1751  7920  0  0  0  0  3379  6922  23838 
Muzafargarh  1144  110  1670  9191  0  21  4  1643  10297  24080 
Nankana Sb.  0  0  0  0  0  10  2  58  0  70 
Rawalpindi  25  4  32  0  0  0  0  0  0  61 
R.Yar Khan  0  0  0  1203  0  0  3  67  3050  4323 
Rajanpur  0  0  0  0  0  1  2  0  2597  2600 
Sialkot  0  18  199  16  0  0  0  216  297  746 
Sahiwal  0  0  0  0  0  0  0  32  0  32 
Sargoda  3732  824  3416  0  0  0  0  1215  5259  14446 
TOTAL  13987  3376  20810  12725  1217  66  39  9659  47943  109822 

Figure 3: Distribution of patient’s visits by disease as percentage of all patient consultations in the flood affected
districts of Punjab, 8 August, 2010

Skin
POU
19%
12%
Eye Ear
Injiris
1%
3%
Dog Bite
<1%

Snake Bite
RTI <1%
13%
AWD
9%

Others
44%
 
Baluchistan Province:
Four flood affected districts in Baluchistan shared daily disease reports on August 7, 2010. Total
1,175 patient visits were reported at the health facilities in the flood affected areas. Scabies
recorded in 24% of patient visits, Diarrhoea 20% and Clinical Malaria in 19% patients. Table 3
presenting the daily number of patients by disease in the four flood affected districts of
Baluchistan.
Table 3: Distribution of daily consultations by disease flood affected districts Baluchistan
Disease / Health July - August, 2010
Problems 29-Jul 30-Jul 1-Aug 2-Aug 3-Aug 4-Aug 5-Aug 6-Aug 7-Aug 8-Aug Total
Acute Diarrhea 56 52 81 42 113 32 84 77 232 62 831
Bloody Diarrhea 32 11 36 14 57 15 32 26 29 26 278
Clinical Malaria 46 55 130 55 127 25 61 15 226 50 790
URTI 0 23 43 73 119 34 51 59 192 51 645
LRTI 0 0 0 0 11 0 3 70 6 4 94
Unexplained Fever 2 10 42 15 43 10 6 19 55 36 238
Scabies 45 28 72 57 31 36 53 56 283 48 709
Sun Stroke 0 10 0 0 0 0 0 0 0 0 10
Snake Bite 5 1 4 5 1 2 2 1 6 2 29
E.N.T Cases 27 16 27 23 32 30 42 25 54 16 292
Eye Infection 0 22 10 7 27 21 28 25 62 2 204
Others 0 0 0 0 24 0 45 81 30 9 189
Total 213 228 445 291 561 205 362 454 1175 306 4309

From 29 July to 8 August, 37 snake bites have been reported from district Naseerabad and
Jaffarabad. High proportion of acute diarrhoea also has been reported in district Naseerabad. The
cases are coming from different places and no clustering is reported by health care providers.
The diarrhoea cases visiting the health facilities / mobile team are presenting with mild
symptoms signs of diarrhoea. Health hygiene education sessions are being conducted involving
LHWs and water purification tablets have been distributed in the affected community. As
compared to the previous two days, the proportion of Acute Diarrhoea has dropped in the flood
affected areas in the reporting districts. Figure 5 reflecting the daily trend of acute diarrhoea in
the flood affected districts of Baluchistan.

Figure 4: Daily trend of acute diarrhea flood affected districts, Baluchistan.


30
26%
25
23%
18% 19% 21% 20% 20%
20
17%
Percentage

14% 16%
15

10

0
7/29/2010

7/30/2010

7/31/2010

8/1/2010

8/2/2010

8/3/2010

8/4/2010

8/5/2010

8/6/2010

8/7/2010

8/8/2010
Sindh Province:
Daily disease surveillance reports received from 337 health facilities (mobile teams and fixed
facilities) in fourteen flood affected districts in Sindh. Total 9,069 patient visits were reported
from the fixed facilities and mobile Medical camps established in the districts. ARI was the
leading cause of consultation accounted for 22% of total visits followed by skin disease 20% and
acute diarrhoea 17%. High numbers of diarrhoea cases are being reported from districts Tando
Muhammad Khan Khairpur, Dadu, Gotki and Shikarpure. Health education in these districts is
being conducted by LHWs. Strong WASH interventions are highly required in these districts.
Ten (10) snake bites have been reported from Sindh province.

Table: 4. Distribution of patient visits in the flood affected districts by disease Sindh 8-8-2010
Skin 
District  AD  BD  ARI  Malaria  Others  Total 
diseases 
Shikarpur  108  11 187 53 162 204  725
Sukkur  161  19 210 201 50 59  700
Larkana  56  8  40 88 132 635  959
Khairpur  225  15  182  135  174  79  810 
Kashmore  12  56 150 236 78 468  1000
Ghotki  127  54 105 135 0 33  454
N. feroze  65  10 66 50 123 272  586
Dadu  178  56 356 46 167 189  992
Jamshoro  40  18 78 0 29 14  179
Benazeerabad  69  8  43 111 134 101  466
Matairi  0  0  0 0 0 0  0
Hyderbad  0  0  0 0 0 0  0
T. M. Khan  370  55 426 219 768 65  1903
Thatta  0  0  0 0 0 0  0
Total  1519  310 2030 1274 1817 2119  9069

Figure 5: Distribution of patient’s visits by disease as percentage of all patient consultations in the flood affected
districts of Sindh, 8 August, 2010
BD ARI
3% 22%

AWD
17%

Malaria
14%

Others
23% Skin diseases
20%

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