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View Full Version : Pakistan Floods, World Health Organization Situation Update Reports, Statement, Information (as for October 12 2010)


Giuseppe Michieli
August 16th, 2010, 11:35 AM
WHO, Floods in Pakistan - Health Cluster bulletin No 11 - 15 August 2010 (edited)


[Source: World Health Organization, <cite cite="http://www.who.int/hac/crises/pak/sitreps/15august2010/en/index.html">WHO | Floods in Pakistan - Health Cluster bulletin No 11 - 15 August 2010 (http://www.who.int/hac/crises/pak/sitreps/15august2010/en/index.html)</cite>. 8/16/10, edited.]

Floods in Pakistan - Health Cluster bulletin No 11 - 15 August 2010


Highlights


In Khyber Pakhtunkhwa, acute diarrhoea (AD) accounted for 3 807 (17%) of the total patient visits in all age groups and is the leading cause of morbidity in the flood affected districts. Acute respiratory tract infections (both upper and lower) were recorded in 3 255 (15%) patient visits. Skin infections were reported in 4 122 (19%) of the patients.
In Punjab, skin diseases were reported in 6% of total patient visits and were the leading cause of morbidity among affected communities while acute diarrhoea accounted for 6% of patient consultations.
In Baluchistan, the leading causes of morbidity are diarrhoea, and scabies. In Sindh, Acute Respiratory Infection (ARI) was the leading cause of consultations followed by skin infection and acute diarrhoea. Suspected cases treated for malaria are rising as more areas with stagnant waters emerge.
Rumors of confirmed cholera cases are pouring in. In accordance with Article 9 and 10 of International Health Regulations (2005), WHO has requested the Ministry of Health for a verification of the news item reported in the international media regarding the cholera case from Mingora town of Swat district; and WHO has requested for a notification if any risk assessment has been carried out using the decision instrument and the result, as stipulated in the Annex-2 of IHR (2005).
Medical Emergency Relief International (Merlin) and Malteser International are conducting health interventions in response to reported cases of diarrhoea in Mingora town in Swat District.
International support has started to build-up through the deployment of medical teams and donations of essential medicines. Indonesia has deployed 5 medical doctors and 10 paramedics in Nowshera. On 15 August, Sri Lanka will send 7 medical doctors, 6 nurses and 2 pharmacists to Sukkur and Jordan will deploy 25 medical doctors and pharmacists in Multan. Hungary, USA and Italy are also sending medical teams to support the humanitarian work in flood affected areas.
The National Health Emergency Preparedness and Response Network (NHEPRN) of the Federal Ministry of Health is leading the health interventions in all affected districts. All health activities are coordinated with provincial/district departments, WHO (Health Cluster lead), UN agencies, national and international agencies.


Situation overview and current scope of disaster

Based on the latest data from the National Disaster Management Authority (NDMA), the affected population is over 14 million. The number of deaths has reached 1 392 while the number of injuries has reached 1 985.


Health situation/ alerts and outbreak


The leading causes of morbidity in flood affected communities are: skin diseases, acute watery diarrhoea, and acute respiratory infections.
Rumors of confirmed cholera cases are pouring in. In accordance with Article 9 and 10 of International Health Regulations (2005), WHO has requested the Ministry of Health for a verification of the news item reported in the international media regarding the cholera case from Mingora town of Swat district; and WHO has requested for a notification if any risk assessment has been carried out using the decision instrument and the result, as stipulated in the Annex-2 of IHR (2005).
As response to cases of diarrhoea in Mingora, Medical Emergency Relief International (Merlin) and Malteser International are conducting health interventions in affected areas.
Fifty-six (56) out of 62 flood affected districts from the provinces of KPK, Punjab, Sindh and Baluchistan shared daily disease surveillance data for 11 August. One new alert (false) of suspected hemorrhagic fever was reported from CH Nawagai, district Buner in Khyber Pakhtunkhwa.
Cholera is endemic in Pakistan and in the current emergency situation it is anticipated that cholera cases will occur sporadically amongst the susceptible population in the affected areas. Therefore the threat of cholera in the flood affected communities remains high. In order to avoid excess mortality, it is important that all acute watery diarrhoea cases with severe dehydration have easy and rapid access to standardized treatment.


Sindh situation


Sindh’s situation is getting critical. By 14 August, 300 000 people have evacuated using the road and railway. Based on reports from the ground, water is entering Shahdadkot Qamber and likely to also flood Larkana. In Karachi, 4 areas (Toll Plaza, Kimari Town, Bin Qasim and Gaddab Town) have been dedicated by city administration to host the affectees.
The Government is planning to establish big camps in 3 locations: Hyderabad, Jamshoro and Karachi. Furthermore, 35% of the Sindh is under water. Upper Sindh districts which where hosting the affectees from Sukkur, Khairpur, Dadu, Ghotki and Shikarpur do not have the capacity to host any more affectees.
Kashmore and Jacobabad are totally under water while Ghotki, Sukkur, Larkana and Qamabar Shahdadkot, Dadu, Nausehro Feroz and many others are partially flooded. In Southern Sindh only a few districts have dry land and some capacity to host the affectees.
The Sindh affected population has reached 2.25 million and figures and is expected to reach 3 million easily in the coming days. According to PDMA 4 Army and 2 Navy helicopters are evacuating people and thousands are still stuck in flooded districts. Around 900 000 people are on the move in the last few days. There are 200 boats currently evacuating the population.


Khyber Pakhtunkhwa (KPK)


From Khyber Pakhtunkhwa, 122 health teams and static health facilities from 8 flood affected districts shared daily reports. A total of 21 813 patient consultations were reported. Acute diarrhoea (AD) accounted for 3 807 (17%) of the total patient visits in all age groups and is the leading cause of morbidity in the flood affected districts of Khyber Pakhtunkhwa. Acute respiratory tract infections (both upper and lower) were recorded in 3 255 (15%) patient visits. Skin infections were reported in 4 122 (19%) of the patients.
The trend of diarrhoeal disease shows an increasing number of patients expected in the period 7 – 15 days after contamination of water sources. A high number of diarrhoea cases in the districts of Charsadda, Swat, Peshawar and Nowshera are being reported. WASH interventions underway but further expansion is needed in these districts as more areas become accessible. If the clean drinking water supply is not supplied and environmental hazards are not addressed in time, it is expected that waterborne disease outbreaks will occur more frequently in the affected community.


Punjab province


In Punjab province, 28 flood affected districts shared the daily disease report. From these districts, 535 health facilities including 368 mobile teams and 167 static facilities are providing health services to the affected communities in Punjab. On 11 August, a total of 143 983 patient consultations were reported. Skin diseases were reported in 6% of total patient visits as the leading cause of morbidity. Acute diarrhoea accounted for 6% of patient consultations and a high number of diarrhoea cases were reported from Muzafargarh.


Baluchistan Province


In Baluchistan, 4 flood affected districts shared daily disease reports on 11August. A total of 2 238 patient visits were reported with 514 (23%) cases of diarrhea, 285 (13%) upper respiratory tract infections and 409 (18%) cases of scabies. Since 29 July, a total of 10 629 patient visits were reported from 20 health facilities in flood affected areas. Diarrhea was recorded in 2 386 (22%) patients, malaria in 2 187 (21%) patients and scabies in 2 070 (19%) patients.
Between 29 July and 11 August, 61 snake bites have been reported from district Naseerabad and Jaffarabad.
A high proportion of acute diarrhoea also has been reported in districts Jaffarabad and Naseerabad. The diarrhea cases visiting the health facilities/mobile teams are presenting with mild symptoms of diarrhea. Health hygiene education sessions are being conducted involving lady health workers (LHW) and water purification tablets have been distributed in the affected community.


Sindh Province


In Sindh, daily disease surveillance reports were received from 342 health facilities (99 mobile teams and 243 fixed facilities) in 16 flood affected districts. A total of 21 493 patient visits were reported from the fixed facilities and mobile medical camps were established in the districts.
In Sindh, ARI was the leading cause of consultation and accounted for 17% of total visits followed by skin infection (17%) and acute diarrhoea (14%). A high numbers of diarrhoea cases are also being reported from districts Kashmor, Sukkur, Ghotki, Khairpur and Dadu. Health education in these districts is being conducted by LHWs. Strong WASH interventions are highly required in these districts.
Results of initial rapid assessments in flood areas show that out of 1 167 health facilities, 189 facilities have been damaged or destroyed in 4 flood affected provinces. Table below shows the damaged or destroyed facilities by district.


Health cluster response

Care International is supporting 4 basic health units (BHUs) in Upper Swat (Bahrain, Tirat, Miadem & Chail). It is also providing primary healthcare services through 2 mobile clinics in Upper Swat which cover the union councils of Bahrain, Bishigram, Tirat and Miadem. Since the onset of floods, Care International’s mobile teams have attended to 5 026 consultations.

One mobile clinic of the Church World Service is providing essential medicine and consultations for patients with a special focus on women and children in Tehsil Balakot, Mansehra. On 12 August, 1 401 consultations were made and patients were given free essential medicine by the mobile health unit.

International Medical Corps teams have provided health services to 613 people and psychosocial services to 32 people in Charsadda, Nowshera and Peshawar. Psychosocial services were provided to people with psychosomatic, psychological distress, anxiety, phobic anxiety, and depression. IMC’s medical officers and lady health volunteers are also conducting regular health education sessions and provide preventive information through health messages to individuals and families for behavior change. In addition, IMC distributed 120 hygiene kits at the Government Higher Secondary School City -1 in KPK.

Medical Emergency Relief International (MERLIN) is continuing its provision of health services to flood affected communities in Swat, Buner and Nowshera districts. On 12 August, a total of 5 034 consultations were conducted. Merlin is providing primary health care services to flood affected communities in 3 districts through 26 static clinics located in Swat (11), in Buner (9), and in Jalozai (7) and 14 mobile teams located in Swat (6), Buner (3), and Nowshera (5). Merlin mobile teams were increased from 6 to 9 in Swat but these additional 3 teams could not be airlifted to target areas in Upper Swat due to bad weather conditions. Five of Merlin's mobile teams are now operating in Upper Swat.

International support has started to build-up through the deployment of medical teams and donations of essential medicines. Indonesia has deployed 5 medical doctors and 10 paramedics in Nowshera. On 15 August, will send 7 medical doctors, 6 nurses, 2 pharmacists to Sukkur and Jordan will deploy 25 medical doctors and pharmacists in Multan. Hungary, USA and Italy are also sending medical teams to support the humanitarian work in flood affected areas.

Mercy Corps will run a static clinic at Thrik-E-Islamic - Pakistan Islamic Centre near the town cemetery surrounded by schools occupied by IDP; and a mobile clinic team will serve other schools or camps nearby in Charsadda. In addition, a static clinic will be functional Pabbi Government High School which is occupied by 200 IDP families; and a mobile clinic team will serve other schools or camps nearby.

Hygiene kits will be distributed in affected areas with partners PATTAN and Pakistan Islamic Medical Association (PIMA). Mercy Corps is also looking into the expansion of its health services to Punjab.

The National Health Emergency Preparedness and Response Network (NHEPRN) of the Federal Ministry of Health is leading the health interventions in all affected districts. All health activities are coordinated with provincial/district departments, WHO (Health Cluster lead), UN agencies, national and international agencies.

UNICEF is providing oral rehydration salts (ORS) and Zinc to the Lady Health Workers for community based management of diarrhoea among under-five children by LHWs in the flood affected areas of Khyber Paktoonkhwa, Punjab, Sindh, Baluchistan, AJK and Gilgit Baltistan. A total of 4.2 million sachets of ORS and 2.1 million doses of zinc are being sent through the Provincial Units of National Programme on Family Planning and Primary Health Care to the Lady Health Workers.

As of 15 August, WHO has distributed 1521 cholera kits, 179 emergency health kits, 3 surgical kits, 700 anti-snake vials which will cover the needs of 1.8 million people in one month in flood affected areas in Balochistan, Gilgit-Biltistan, KPK, Punjab, Sindh.

In Nowshera, 12 water tankers are supplying 1.6 million liters of chlorinated water daily to 100 000 people. In addition, 14 out of 15 tube wells of Tehsil Municipal Authority (TMA) and 57 out of 60 Public Health Engineering Department (PHED) tube wells were made functional and are currently supplying 14 million liters of water in flood affected areas of Nowshera. WHO provided 180 kilograms of chlorine disinfection to TMAs and PHEDs. In Charsadda, 25 water tankers and trucks are providing water to affected communities daily. Around 270 000 liters of chlorinated water per day are being distributed to affected communities.

So far, 1 500 health promotion sessions were conducted by WHO and the National Program (DoH) in hosting schools.In Swat, 37 out of 53 water quality tests from tube wells, boreholes and hand pumps were found unfit for drinking. In response, water disinfection through regular chlorination is being carried out by MSF-B. In addition, 130 residual chlorine tests were conducted. In the camps, no residual chlorine was found in drinking water sources.


For further information contact


Dr Hendrikus Raaijmakers, Emergency Preparedness and Humanitarian Action Coordinator: e-mail: raaijmakersh@pak.emro.who.int
Alfred Dube, Health Cluster Coordinator: e-mail: dubeal@pak.emro.who.int
Syed Haider Ali, Communications Officer: mobile: 0092 3004005944, e-mail:alisy@pak.emro.who.int, focus_ali@yahoo.com
Christina Banluta, Communications and Advocacy Officer: mobile: 0092 3085559639, e-mail: christinabanluta@gmail.com, banlutac@pak.emro.who.int

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Giuseppe Michieli
August 18th, 2010, 11:41 AM
WHO, Floods in Pakistan - Health Cluster bulletin No 12 - 16 August 2010 (edited)


[Source: World Health Organization, <cite cite="http://www.who.int/hac/crises/pak/sitreps/16august2010/en/index.html">WHO | Floods in Pakistan - Health Cluster bulletin No 12 - 16 August 2010 (http://www.who.int/hac/crises/pak/sitreps/16august2010/en/index.html)</cite>. Edited.]

Floods in Pakistan - Health Cluster bulletin No 12 - 16 August 2010

Highlights


An acute diarrhoea patient is being treated in a health facility in Muzzafargarh in the province of Punjab.
WHO/Syed Haider Ali - An acute diarrhoea patient is being treated in a health facility in Muzzafargarh in the province of Punjab.
There is an urgent need to restore health facilities damaged or destroyed by the floods. The results of initial rapid assessments in four flood-affected provinces show that out of 1167 health facilities assessed, more than 200 are damaged, including several hospitals.
The Pakistan Initial Floods Emergency Response Plan 2010 launched on 9 August and requesting more than 56 million for health interventions remains poorly funded.
The Health Cluster response strategy includes communicable disease control, provision of essential medicines, environmental health measures and support of medical teams for life-saving services.
The Cluster function has been rolled out in Khyber Pakhtunkhwa, Punjab and Sindh provinces. According to the WASH Cluster, less than 8% of the 15 million affected people have access to safe water supplies.
In flood-affected communities, the leading causes of illness are skin infections, acute watery diarrhoea and acute respiratory infections. Between the onset of the floods and 12 August, medical consultations in fixed and outreach medical centres reported 143 870 cases of skin infections, 115 922 cases of acute diarrhoea and 113 981 cases of respiratory tract infections.
Essential drugs and medicines were distributed to Ministry of Health (MoH) and Health Cluster partners to cover the health needs of 1.8 million people. They include 179 emergency health kits, 152 cholera kits, 700 vials of anti-snake venom and 1.8 million water purification tablets.


Situation overview and current scope of disaster


According to the National Disaster Management Authority (NDMA), the number of people affected by heavy rains and floods has reached over 14 million population. So far, 1463 deaths and 2024 injuries have been reported. Around 900 000 houses were damaged by the disaster.
On 15 August, United Nations Secretary-General Ban Ki-Moon visited affected areas in Punjab to highlight the United Nations’ support to this crisis.
In Sindh and Baluchistan, floodwaters continue to rise.


Health impact


In Sukkur, a WHO/UNICEF joint team conducted a field assessment in 2 relief camps in Pano Aqil on 13 August. At the Government Secondary School, there were 606 internally displaced people (IDPs), including 193 women and only 1 toilet is available for women. A similar situation was observed in the Government Girls Secondary School where five toilets are available for 304 individuals.
Insufficient sanitation facilities, unsafe drinking water and compromised personal hygiene are some of the major challenges faced by the Health Cluster.
Keeping in view the increasing trends of suspected malaria cases – accounting for 4 to 35% of all consultations (35% in Kambar) vector control activities and mosquito nets are required.
At Sukkur’s City Hospital, the main referral hospital of the District, inpatient wards are overloaded with IDPs, most of whom are suffering from diarrheal diseases. The hospital is also running out of medical staff as many are working in the camps. So far, there is no surveillance records for IDPs. Based on the records of the hospital, there are more than 1000 outpatient consultations per day.


Health situation/alerts and outbreak


As of 15 August, 96 mobile and 250 static health posts are providing services in 16 districts of Sindh.
The Executive Director’s Office for Health in Swat has directed all Department of Health (DoH) staff to establish oral rehydration therapy (ORT) corners in their health facilities. WHO requested organizations working in Swat District to establish similar areas in all their assigned health facilities and mobile medical camps.
In Charsadda in Khyber Pakhtunkhwa Districts, 13 static teams were set up and 19 mobile teams deployed to provide health services to affected communities.
The leading causes of illness are skin diseases, acute watery diarrhoea and acute respiratory infections. Between the onset of the floods and 12 August, medical consultations recorded 113 045 cases of skin diseases, 86 671 cases of acute watery diarrhoea, and 83 050 cases of respiratory tract infection.
In Khyber Pakhtunkhwa (KPK), 124 health teams and static health facilities from 9 flood-affected districts share daily reports. On 12 August, 14 482 patient consultations were reported. Acute diarrhoea was the leading cause of illness and accounted for 2519 (17%) of these, while acute respiratory tract infections (both upper and lower) accounted for 1898 (13%) visits and skin infections for 3021 (21%).
In Punjab, 32 flood-affected districts share daily disease reports. In the affected districts, 532 health facilities, including 365 mobile teams and 167 static facilities, reported 264 894 patient visits on 12 August. Skin diseases were the leading cause of illness, accounting for 11% of and the visits, while acute diarrhoea accounted for 8% of patient visits.
In Baluchistan, 40 health facilities in 4 flood-affected districts share daily reports. Between 29 July and 12 August, 14 404 patient visits were reported with diarrhoea accounting for 3523 (24%) cases; malaria for 3380 (23%) cases and scabies for 2377 (16%).
In Sindh, acute respiratory infection was the leading cause of consultations followed by skin infection and acute diarrhoea. The number of suspected cases of malaria is rising in this province as more areas with stagnant waters are appearing. Daily disease surveillance reports were received from 344 health facilities (96 mobile teams and 248 fixed facilities) in 15 flood-affected districts in Sindh.


Health Cluster Response


Care International is supporting 4 basic health units in Upper Swat (Bahrain, Tirat, Miadem & Chail) with 2 mobile clinics in Upper Swat (Bahrain Union Council, Bishigram UC, Tirat UC, Miadem UC). Since the onset of floods, 5424 patients have been treated, of which 1682 were women and 2495 children. Care International provided hygiene kits to 500 families in Nowshera & 250 families in Charsadda.
CORDAID’s community and household assessment and registration of flood-affected districts continues despite the logistics limitations.
International Medical Corps medical teams are providing medical treatment to in Charssada, Nowshera and Peshwar Districts. The teams’ psychologist and counsellors conducted group session on counselling, psychosocial support and phobia management. They identified 16 persons suffering from depression, aggression, psychological distress and anxiety.
Johanniter International provided 270 consultations through mobile clinic in Charssada district in KPK on 15 August.
Malteser International is working in Swat District and is providing health services through basic health units in Islampur and Meragai and the civil dispensary in Chetewar. In 2 weeks, 3674 persons have received health services. Malteser also organized 4 medical camps in 2 remote UCs as well as in Islampur UC transitional camps and Mingora Town Tahirabad quarter. So far, 1451 patients receivec care and 330 children were vaccinated (EPI protocol + influenza) by the EDO Health Office Vaccination Team. Malteser also distributed 2000 jerry-cans, 500 kg of soap, and hundreds of thousands of aqua-tabs, donated by WHO, UNICEF and Oxfam. DEWS Reports has been regularly submitted to EDO Health and WHO for further analysis.
Medical Emergency Relief International (MERLIN) continues to provide of health services in Swat, Buner and Nowshera Districts through 24 static clinics (11in Swat, 7 in Buner, and 6 in Jalozai) and 16 mobile teams (8 in Swat, 3 in Buner and 5 in Nowshera). Merlin has 7 mobile teams operational in Upper Swat at the moment. On 15 August 3689 consultations were conducted through static health facilities and mobile health units.
Médecins du Monde-France (MDM-F) has agreed to support Kohat District by establishing a diarrhoea treatment centre (DTC) in Liaqat Memorial Hospital (LMH). The DTC will have an initial capacity of up to 20 beds for severe dehydration cases that need IV fluids. Coordination with EDO-Health and Deputy of Medical Superintendent (DMS) of LMH has been made accordingly. Besides supporting Swabi, Buner and Kohat Districts, MDM-F is supporting civil dispensaries in Misri Banda (Misri Banda UC) and Mian Essa (Mughalki UC) in Nowshera District as well as Agra Payan civil dispensary and Gul Abad basic health unit in Charsada District.
The Pakistan Red Crescent Society (PRCS) is providing health care through 20 mobile health units in Nowsehra District and one in Peshawar. On 16 August, consultations were 780 of which 375 were female and 405 male. Skin infection was the leading cause of illness.
Pakistan Peoples Primary Initiatives (PPHI) mobile teams have given 55 024 outpatient consultations between 29 July and 12 August and provided free treatment and medicines to 3462 people in Nowshera, Charsadda, Peshawar, Swabi and Mardan Districts. PAIMAN has offered 25 water tankers to Department of Health and Public Health Engineering Department (PHED) for the provision of safe drinking water. They will also deliver hygiene kits in Dadu, Khair Pur & Sukkur Districts.
Save the Children has reach the basic health unit in Chuprial which was totally damaged by the floods. The team made it to the area by foot and stayed there with the medical officer who is a local resident of Chuprial. Two mobile medical teams are already functional under the recommendations of EDO (H) for providing primary healthcare services. Meanwhile, 5 medical teams are still working in static health facilities in Qamber basic health unit, Rangmohalla civil dispensary, Barikot civil hospital, Talang basic health unit and Dewlai rural health centre. Save the Children has provided 2 ambulances to DoH. SC is providing health services in DI Khn through 5 mobile health units. The mobile units were deployed based on the recommendations of EDO-Health.
SC-UK, MSF Holland and GOAL have started mobile health services in Sukkur District.
UNICEF is working with the Federal MoH and WHO on diarrhoea prevention and awareness and care messages and is assisting the Provincial DoH in sending these messages through the lady health workers, the Inter-religious Council network as well as radio, television and print media. UNICEF is assisting the Provincial EPI directorates to carry out measles immunization and vitamin A supplementation to flood-displaced children. In Sukkur, UNICEF has provided 600 000 ORS to the lady health workers through the National Programme.
WHO distributed essential drugs and medicines to the MoH and Health Cluster partners to cover the health needs of 1.8 million people. These include 179 emergency health kits, 152 cholera kits, 700 vials of anti-snake venom and 1.8 million water purification tablets. WHO as the cluster lead has rolled out the cluster at central and field levels and emergency hubs in Peshawar, Multan and Sukkur.


Health Cluster Bulletin in PDF [pdf 541kb]

For more information contact


Dr Hendrikus Raaijmakers, Emergency Preparedness and Humanitarian Action Coordinator: e-mail: raaijmakersh@pak.emro.who.int
Alfred Dube, Health Cluster Coordinator: e-mail: dubeal@pak.emro.who.int
Syed Haider Ali, Communications Officer: mobile: 0092 3004005944, e-mail:alisy@pak.emro.who.int, focus_ali@yahoo.com
Christina Banluta, Communications and Advocacy Officer: mobile: 0092 3085559639, e-mail: christinabanluta@gmail.com, banlutac@pak.emro.who.int

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Giuseppe Michieli
August 23rd, 2010, 11:03 AM
Pakistan Health Cluster - Floods in Pakistan - Bulletin No 13 - 21 August 2010 (edited)


[Source: World Health Organization, Full PDF Document (LINK (http://www.whopak.org/idps/documents/bulletins/Pakistan%20Health%20Cluster%20Bulletin%2013%202101 10.pdf)). Edited.]

Pakistan Health Cluster - Floods in Pakistan - Bulletin No 13 - 21 August 2010


Highlights


Number of reporting disease cases is increasing. Until 18 August, 204 040 of acute diarrhoea, 263 356 cases of skin diseases and 204 647 of acute respiratory have been reported in flood-affected provinces. More than 1.5 million patient consultations have been conducted in flood-affected provinces since 29 July.
Daily number of reported acute diarrhoea cases, monitored since 31 July is rising, particularly in Charsadda, Nowshera and Peshawar.
From 16-18 August, 6 new suspected acute diarrhoea alerts reported from Khyber Pakhtunkhwa (KPK).
WHO establishing diarrhoeal treatment centres in flood-affected districts with government and partner support.
Health Cluster to have access to UNHAS flights for delivery of medical items.
Health Cluster coordination active in 5 hubs - Islamabad, Peshawar, Multan, Sukkur, Quetta.
WHO delivers large shipment of medicines to Sukkur coordination hub on 20 August.
In first 3 days of emergency vaccination campaign launched in Peshawar and Charsadda on 16 August, 104 640 children under 5 years were vaccinated against polio. All aged over 6 months (92 269 children) also vaccinated against measles and received vitamin A capsules.
As of 21 August, 39% of the US$56.2 million requested to support the health response has been funded.


Situation overview and current scale of disaster


According to the National Disaster Management Authority (NDMA), more than 20 million people have been affected by the floods. Almost 1500 people have been reported killed and more than 2000 injured, while around 1 million are left homeless.
In the heavily-affected Sindh province city of Sukkur, flood waters have forced more than 4 million people from their homes. Many displaced are living beside roads with little food and unclean water supply.
More rains are expected, according to the Pakistan Meteorological Department.


Health impact


In Khyber Pakhtunkhaw (KPK), an assessment conducted by the Kohistan district executive health officer reported that 11 health facilities (1 rural health centre and 10 basic health units) were damaged in the villages of Jog, Dubair Balla, Mani Khel Bela, Muj Gali, Ranolia, Kuz Paro, Thoti, Jashoi, Goshali, Peach Beal and Sheryal. Additional health facilities were unaffected and continue to function.
Currently, 24 health facilities are functional in Kohistan District and 17 more will be functional when damaged paths, bridges and roads are restored. 6 medical camps have been established to cover gaps where no health facilities currently exist – they are located in the rural health centres of Dassu and Pattan, the basic health units in Jijal and Jog and the civil dispensaries of Kafar Banda and Kandia Bridge.
Since 29 July, more than 1.5 million people have been treated for a variety of conditions in the 4 flood-affected provinces by health authorities, nongovernmental organizations, United Nations agencies and other bodies.


Main illnesses reported between 29 July and 18 August based on patient visits in reporting health facilities in KPK, Sindh, Punjab and Baluchistan

[Illness - Number of cases]


Acute diarrhoea 204 040
Skin diseases (including scabies) 263 356
Acute respiratory infections 204 647


Khyber Pakhtunkhwa


The daily number of reported acute diarrhoea cases, monitored since daily reporting on priority communicable diseases began, is rising, particularly in Charsadda, Nowshera and Peshawar. Strong water and sanitation interventions, such as providing clean drinking water supply and addressing environmental hazards, are urgently needed to prevent outbreaks of waterborne diseases in these communities.
On 18 August, 120 health facilities (82 mobile and 38 fixed) in 9 flood-affected districts of KPK reported 15,552 patient consultations, with acute respiratory infections accounting for 17% of cases (2653), skin infections 16% (2521) and acute diarrhoea 15% (2329).
From 31 July-18 August, KPK health facilities have reported 318,032 patient visits.


Punjab


On 18 August, 1093 health facilities (507 mobile and 586 fixed) in 24 Punjab flood-affected districts reported 314,071 patient consultations, with skin disease accounting for 23% of cases and acute diarrhoea for 14%. High numbers of diarrhoea cases were reported in Muzaffargarh, Mianwali and Jhelum. 102 snake bites were also reported.
From 3-18 August, Punjab health facilities have reported 958,951 patient visits.


Baluchistan


On 18 August, 23 health facilities reported 2921 patient consultations, with diarrhoea accounting for 23% of cases (672), suspected malaria 18% (519), scabies 17% (506) and upper respiratory tract infections 14% (412).
From 29 July to 18 Aug, Baluchistan health facilities have reported conducting 26,006 patient visits, with diarrhoea accounting for 23% of cases (6063), suspected malaria 21% (5493) and scabies 16% (4232).


Sindh


On 18 August, 410 health facilities (95 mobile teams and 315 fixed facilities) in 15 flood-affected districts in Sindh reported 34,042 patient visits. Skin infections were the leading cause of consultation, accounting for 19% of visits, followed by acute diarrhoea 15% and acute respiratory infections 16%. High numbers of diarrhoea cases are being reported from districts Kashmore and Shikarpur and Dadu. Strong WASH interventions are highly required in these districts. 5 snake bites also reported from Sindh province.
From 6-18 August, Sindh health facilities have reported 292,973 patient consultations.

The complete daily disease surveillance reports can be downloaded from www.whopak.org


Government response:


The Ministry of Health has set up a taskforce to plan and coordinate guide life saving critical interventions in wake of growing concerns of communicable diseases in affected areas. At its first meeting on 20 August, a plan was formulated to strengthen the existing government disease surveillance system in all affected districts, and the first teams were dispatched on 21 August.
On 20 August, the Ministry of Health launched its Health Volunteer Programme to increase the number of medical and paramedical staff available to work in affected areas. The programme aims to deploy 4-member teams for 15 days to the 50 most affected communities. Depending on needs, the number of teams deployed to the districts will range from 2 to 6. Each team will have a doctor, nurse, public health professional and paramedic.


Khyber Pakhtunkhwa


As of 21 August, Pakistani health authorities had vaccinated tens of thousands of children against polio and measles in Charsadda, Peshawar and Swat districts. Polio doses were given to 66,733 children aged under 5 years in Charsadda (target population 72,071); 71,527 in Peshawar (target 72,629); and 9805 in Swat (target 10,606). Measles vaccinations have been provided to all 61,854 children aged 6 months to 5 years requiring immunization in Charsadda; 64,989 of the targeted 65,162 population in Peshawar; and 8734 of the targeted 8900 population in Swat. This Special Vaccination Campaign was conducted by the National Expanded Programme of Immunization in coordination with the National Health Emergency Preparedness and Response Network.
Since 11 August, the Pakistan Institute of Medical Sciences has on a daily basis deployed 5 medical teams to Nowshera district. These teams have been both expanding capacities at the 50-bed Cantonment Board Hospital in Nowshera city, and providing outreach services for flood-affected communities living outside Nowshera city.
In KPK's Lower Dir district, 5 mobile teams of the Executive Directors’ Office-Health (EDO-H) are providing health services to flood affected communities.
In KPK's DI Khan district, health authorities have deployed 21 mobile teams, while in Tank district another 4 mobile medical teams have been mobilized by district authorities.


Punjab and Sindh provinces


A MoH mission is currently in Sindh to review the situation in Sukkur, Khairpur, Ghottki and other affected areas aiming to establish field hospitals in the most affected areas and to ensure other essential health services can be provided. The team had also visited flood-affected districts in southern Punjab.
The MoH and WHO chaired Health Cluster meetings in Sukkur and Multan, bringing together local and international health providers to identify gaps and identify response.
On 21 August, the Federal General Post-Graduate Medical Centre, based in Karachi, sent a 9-member medical team (doctors and nurses) to Kashmore Hospital in Sindh province to strengthen the health facility's capacity.
The MoH's Malaria Control Programme distributed a combined 200,000 primaquin anti-malarial tablets to the 4 flood-affected provinces. A further 40,000 insecticide-treated bed nets to KPK, Baluchistan and Sindh provinces.
On 21 August, two field hospitals provided by the Turkish Government arrived in Sukkur. Health authorities ordered their dispatching to Khairpur, Sindh province, and to Sibbi in Baluchistan province. Each hospital will be manned by 21 Turkish doctors.


Health Cluster response


The American Refugee Committee (ARC) International is supporting 7 health facilities in Swat (the civil hospital in Barikot, the civil dispensaries in Ghalagay and Telligram and the basic health units in Barasamai, Bishband, KozaSamai and Taghma). On 18 August, 381 consultations were recorded in all 7 facilities, with acute diarrhea accounting for 18.4%, acute respiratory infections 20% and skin infections 20 %. ARC mobile camps in Shah Dehry, Takhta Band and Angora Dehry villages (all in Swat) provided 351, 135 and 164 consultations respectively. In Baluchitan, ARC started working in Sibi District, supporting the rural health centre in Talli and the basic health units in Sultan Kot, Bakhtiarabad, Chandia and Gishkori. On 18 August, the Talli facility conducted 189 consultations, Sultan Kot 122, Bakhtiarabad 148 and Gishkori 136.
Helping Hands is supporting 2 basic health units in the Buner district villages of Batara and Pandhir.
Médecins Du Monde-France is supporting 1 facility in Buner district.
Save the Children Alliance is operating 5 mobile medical teams in DI Khan district.
CARE International is supporting 4 basic health units (BHU) in Upper Swat in Bahrain, Tirat, Miadem and Chail villages, while 2 mobile clinics operating in Upper Swat. Since the onset of floods, 12 199 patients have been treated through the mobile teams and BHUs. CARE has also providing Primary Health Care services. On 18 August, 4 CARE mobile teams started providing health services via mobile clinics in district Charsada and Nowshera districts.
ICRC is providing clean drinking water tankers for flood-affected populations in DI Khan and Tank districts. In addition, ICRC has established a diarrhoea treatment centre at Civil Hospital Paroa for suspected acute watery diarrhoea cases. It has also provided 3 vehicles to EDO Health for emergency response.
Medical Emergency Relief International (Merlin) is operating 27 static health facilities and 17 mobile medical teams in KPK. These are in Swat district (11 fixed and 9 mobile), Buner (10 fixed and 3 mobile) and Nowshera district (6 fixed in Jalozai camp and 5 in all district). On 19 August, Merlin conducted 204 health promotion sessions for 2623 beneficiaries (1561 Swat, 502 Buner, 560 Nowshera). It also distributed 100 hygiene kits in the Swat capital of Mingora, water purification tablets and high energy biscuits in Nowshera, and water purification tablets, micronutrient powder and multi-micronutrient tablets in Buner. Merlin will establish three Diarrheal Treatment Centres in Nowshera, Swat and Buner. Staff are being recruited for these centres and medicines and supplies have been dispatched.
Muslim Aid is operating in KPK province (Nowshera and Charsadda districts), Punjab (Mianwali), Sindh (Shikarpur and Sukkur) and a team is being formed for Baluchistan (Sibbi). In Charsadda, Muslim Aid is providing facilities to flood affectees of UCs Mirza Dher, Tarnab and Agra through mobile medical camps as well as in BHU Agra providing OPD. In Nowshera, Muslim Aid will commence the renovation of BHUs Aman Kot, Pirsabaq and Mohib Banda. On 18 August, it has also started working in 5 camps (3 in Sukkur and 2 in Shikarpur) for promotion of hygiene practices and child health and nutrition.
Pakistan Pediatrics’ Association has provided a field ambulance service in the form of a mobile team to EDO Health for flood response in Nowshera district. PPA is also operating 1 mobile medical teams in DI Khan district.
UNFPA has been responding to emergency reproductive health/maternal newborn needs by deploying 7 equipped and staffed mobile units and supporting 13 existing government health facilities in 10 districts of KPK, Sindh, and Punjab provinces. UNFPA has provided emergency reproductive health medicines and 2400 women’s hygiene kits, 1200 newborn kits and 1531 clean delivery kits to 10 flood-affected districts of KPK, Punjab and Sindh provinces. UNFPA attended 2096 patients, performing 113 deliveries, 306 antenatal consultations, 74 postnatal consultations, 12 postabortion care services, 21 consultations for syndromic case management of sexually transmitted infections, and 288 cases of gastroenteritis. On 18 August, UNFPA distributed 61 women’s hygiene kits for their 1 month menstrual hygiene supplies, 55 newborn kits to the new mothers, and 42 clean delivery packets to visibly pregnant women.
UNICEF is providing oral rehydration salts (ORS) and zinc to lady health workers (LHWs) for community-based management of diarrhoea of children aged under five in KPK, Punjab, Sindh and Baluchistan provinces, as well as Azad Jammu Kashmir and Gilgit Baltistan. 4.2 million sachets of ORS and 2.1 million doses of zinc are being sent through the provincial units of the National Programme on Family Planning and Primary Health Care to the LHWs. UNICEF worked with the Federal Ministry of Health and the World Health Organization (WHO)to produce diarrhoea prevention and care messages relevant to the floods and is assisting the Provincial Department of Health to disseminate these messages via LHWs, network of the Inter-religious Council, radio, television and print media.
WHO is monitoring the AWD situation in multiple locations. It responded to alerts in Rural Health Centre Paroa in DI Khan district and the Swat district towns of Saidu Sharif, Tahir Abad and Gula Abad.

To respond to the increasing number of diarrhoea cases, WHO will establish diarrhoea treatment centres (DTC) in each of the 84 flood-affected districts in coming days. These centres will be established in conjunction with provincial and federal health authorities.

WHO sent a large supply of medical supplies to the humanitarian coordination hub in Sukkur, Sindh Province, on 20 August to bolster existing stocks. The materials sent include 15 emergency kits (capable of treating 90,000 people for 1 month), 20 diarrhoeal disease kits (2000 severe diarrhoea cases for 1 month or 10,000 moderate cases) and 6 interagency emergency health kits (180,000 people for 1 month). WHO conducted a health education campaign in at a temporary camp housing 100 families at Govt Girls College Pabbi in Nowshera where an AWD alert was received and responded to. The campaign was supported by UNICEF, implementing partners and lady health workers from the KPK Provincial Department of Health.

WHO surveillance officers are receiving information for the Disease Early Warning System (DEWS) from 70 out of the 84 affected districts.

Provincial hubs and clusters are now established and are meeting regularly. Intra-cluster coordination with WASH and Logistics Clusters.

On 20 August, WHO trained 17 LHWs in KPK's Charsadda district on health and hygiene promotion so they could train affected people in measures such as safe hand-washing, preparing clean drinking water, and use of oral rehydration salts.


For further information contact


Alfred Dube, Health Cluster Coordinator: email: dubeal@pak.emro.who.int;
Syed Haider Ali, Communications Officer: mobile: 0092 3004005944, email:alisy@pak.emro.who.int; focus_ali@yahoo.com;
Paul Garwood, Communications Officer: Mobile: +92-(0)-301-855-1459, email: garwoodp@who.int;
Dr Jehanzeb Khan Aurakzai, National coordinator, National Health Emergency Preparedness and Response Network, Ministry of Health, Govt. of Pakistan: email: draurakzai@gmail.com

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------

Giuseppe Michieli
August 23rd, 2010, 11:30 AM
Communicable Disease situation update flood affected districts, Pakistan 18 August, 2010 (WHO, edited)


[Source: World Health Organization, Full PDF Document (LINK (http://www.whopak.org/idps/documents/diseases_Sitrep%5CDisease%20situation%20flood%20af fected%20districts%20Pakistan%20update%2018-8-2010.pdf)). Edited.]

Communicable Disease situation update flood affected districts, Pakistan 18 August, 2010


Fifty-three (53) out of 73 flood affected districts in all the four provinces shared daily diseases surveillance data for 18 August, 2010. Three alerts of suspected Acute Watery Diarrhoea reported from districts Swat Peshawar and Kashmor and were responded. Health and Hygiene sessions were conducted with the help of lady health workers.


Alerts Responded and follow-ups:



Swat:

Two suspected cases of acute diarrhoea were reported from Saidu group of teaching hospital, Swat. WHO surveillance team investigated the alert; Patients were from urban area of Saidu Shari and Tahirabad, Buner. Stool samples were taken and sent to NIH for laboratory confirmation Diarrhoea prevention activities have been reinforced in the area.

Peshawar:

An alert for suspected acute watery Diarrhoea was reported from Khyber Teaching hospital, Peshawar. Stool sample was taken and sent to NIH for laboratory confirmation. Health education session was given to the family members and aqua tabs were also provided.

Kashmor, Sindh:

An alert for increasing number of acute water diarrhoea cases and one death reported from the Taluka Head Qauarter hospital Kashmor on 16 August. The DEWS team visited the hospital on 17 August checked hospital record and that from 10 to 16 August total 3077 were attended and 1714 of the patient came with diarrhoea. On 17 August total 511 patients visited the hospital out of which 230 were having diarrhoea of which 80 with severe dehydration. There are 26 camps in the city and 15617 people are residing in these camps and majority of the patients at the hospital are coming from these camps and mostly childrn. The team also visited the IDP camps conducted field investigation. Four deaths of children less than 5 year age due to diarrhoea reported in the camps. Sanitation and environmental hygiene in these camps is extremely poor and immediate attention needed. Water samples from different camps tested for bacteriological contamination and found highly contaminated. The WHO and UNFPA, MNCH officers are also involved in the response activities and Medical teams are organized for mobile clinic in the camps. Taluka Health Officer has activated Lady Health Workers for health education and hygiene promotion in the camps.

Khyber Pakhtunkhwa (KPK) Province:

From Khyber Pakhtunkhwa 120 health teams and static health facilities from 9 floods affected districts shared daily reports. Total 15,552 patient consultations were reported high as compared to previous day. Acute Diarrhoea (AD) accounted for 2,329 (15%) of the total patient visits in all age groups and is the second leading cause of morbidity in the flood affected districts in Khyber Pakhtunkhwa. Acute Respiratory tract infections (both upper and lower) recorded in 2,653 (17%) patient visits. Skin infections reported in 2,521 (16%) of the patients. Table 1 reflects the daily number of cases reported from the flood affected districts in Khyber Pakhtunkhwa. Since 31 July to 18 August 2010 total 318,032 patient visit have been reported by health facilities mobile teams in the flood affected areas.



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

[Diseases - 10‐Aug - 11‐Aug - 12‐Aug - 13‐Aug - 14‐Aug - 15‐Aug - 16‐Aug - 17‐Aug - 18‐Aug - Total (31Jul‐18Aug)]


AD - 3649 - 4056 - 2958 - 3296 - 2521 - 2439 - 2934 - 2869 - 2329 - 51822
AJS - 3 - 2 - 3 - 13 - 0 - 3 - 2 - 5 - 13 - 83
BD - 293 - 126 - 98 - 42 - 39 - 23 - 55 - 76 - 63 - 1578
S. Measles - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 2 - 2
S. Meningitis - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0
S. Mal - 250 - 119 - 102 - 150 - 39 - 97 - 151 - 144 - 137 - 2059
LRTI - 335 - 305 - 109 - 148 - 124 - 332 - 316 - 244 - 178 - 4133
URTI - 2802 - 3173 - 2245 - 2466 - 2186 - 2183 - 3260 - 2756 - 2475 - 43067
Skin Inf. - 3008 - 4277 - 3090 - 2873 - 2134 - 2148 - 3059 - 2497 - 2521 - 55780
UF - 586 - 470 - 280 - 305 - 248 - 176 - 224 - 217 - 336 - 8418
Injuries - 158 - 216 - 125 - 143 - 124 - 109 - 37 - 134 - 75 - 2385
Others - 7919 - 10284 - 7673 - 9999 - 6139 - 4790 - 8739 - 7943 - 7423 - 148705
Total - 19003 - 23028 - 16683 - 19435 - 13554 - 12300 - 18777 - 16885 - 15552 - 318032


Acute Diarrhoea:

Since beginning of the daily reporting on the priority communicable diseases from the health facilities (mobile teams and fixed facilities) the daily trend of diarrhoea is being monitored in the flood affected districts of Khyber Pakhtunkhwa. The daily trend of acute diarrhoea in the flood affected districts reflects that the proportion of patients with acute diarrhoea is high however some decline has been noted in the last three days. Higher proportion of diarrhoea cases are seen in Charsadda, Swat and Peshawar as compared to the other districts. Vigorous WASH interventions are extremely needed in these districts to prevent waterborne disease outbreaks. Figure 2 reflects the daily trend of acute diarrhoea in the flood affected districts in Khyber Pakhtunkhwa during the last 19 days.


Punjab province:

Twenty-four flood affected districts in Punjab shared the daily disease report. On 18th August, 2010 total 314,071 patient consultations were reported. Skin diseases were reported in 23% of total patient visits as leading cause of morbidity. Acute diarrhoea accounted for 14% of patient consultations and higher number of cases of diarrhoea reported from Muzaffargarh, Mianwali, Jhelum. Total 289 dog bites and 102 snake bite were also reported from the flood affected districts. Table 2, presenting the daily number of consultations by disease in the flood affected districts of Punjab.


Table 2: Distribution of daily consultations by disease flood affected districts Punjab

[Diseases - 10‐Aug - 11‐Aug - 12‐Aug - 13‐Aug - 16‐Aug - 17‐Aug - 18‐Aug - Total (3‐18Aug)]


ARI - 5538 - 6352 - 21833 - 8617 - 10 - 92 - 48921 - 105350
AD - 6167 - 9040 - 20404 - 9254 - 23 - 150 - 44359 - 99056
Skin Inf. - 7139 - 9146 - 29720 - 13371 - 14207 - 71296 - 151703
Injuries - 545 - 963 - 4619 - 899 - 0 - 12 - 7223 - 17637
UF - 2502 - 9826 - 30035 - 6221 - 2 - 68 - 21861 - 83240
ENT Cases - 992 - 2202 - 2718 - 4688 - 0 - 0 - 13556 - 25373
Dog Bite - 53 - 61 - 110 - 96 - 10 - 6 - 289 - 691
Snake Bite - 18 - 61 - 57 - 47 - 2 - 0 - 102 - 332
Others - 11711 - 106332 - 155380 - 40399 - 6443 - 897 - 106464 - 475569
Total - 34665 - 143983 - 264876 - 83592 - 6504 - 1432 - 314071 - 958951


Table 3, presenting the number of patient visits by diseases from the flood affected districts in Punjab province on 18 August 2010.

[District - ARI - Injuries - Skin Inf. - UF - ENT - Dog Bite - Snake Bite - AD - Others - Total]


Attock ‐ - ‐ - ‐ - ‐ - ‐ - 12 - 8 - ‐ - ‐ - 20
Bhakkar - 1,304 - ‐ - 1,356 - ‐ - 5 - ‐ - ‐ - ‐ - 2,851 - 5,516
B.Nagar - ‐ - ‐ - 13 - 29 - ‐ - 1 - ‐ - 811 - 118 - 972
Chiniot - 1,348 - 1 - 1,512 - 365 - ‐ - 3 - ‐ - 201 - 525 - 3,955
Faisalabad - ‐ - ‐ - ‐ - ‐ - ‐ - 1 - ‐ - ‐ - ‐ - 1
Hafizabad - ‐ - 93 - 268 - 196 - ‐ - ‐ - ‐ - 183 - ‐ - 740
Jhelum - 300 - ‐ - 2,116 - 393 - ‐ - 44 - 6 - 1,040 - 7,285 - 11,184
Jhang - ‐ - ‐ - 5,863 - 1,935 - ‐ - ‐ - 13 - 2,216 - 5,972 - 15,999
Khanewal 879 - 131 - ‐ - ‐ - ‐ - ‐ - ‐ - ‐ - ‐ - 1,010
Khushab - 2,203 - 8 - 2,422 - 22 - 19 - ‐ - ‐ - 1,680 - ‐ - 6,354
Lahore - 565 - ‐ - 5 - 68 - ‐ - ‐ - ‐ - 2,222 - ‐ - 2,860
Layyah - 8,915 - 1,715 - 11,866 - 2,372 - 2,773 - 45 - 31 - 2,480 - 18,430 - 48,627
Multan - 1,814 - 363 - 2,292 - ‐ - ‐ - 6 - 1 - ‐ - 8,902 - 13,378
Mianwali - 7,526 - 1,786 - 13,434 - 188 - 203 - 2 - ‐ - 4,695 - 13,832 - 41,666
Muzafargarh - 20,806 - 2,795 - 24,529 - 9,731 - 9,071 - 66 - 26 - 25,590 - 39,173 - 131,787
Nankana Sb. - ‐ - ‐ - ‐ - ‐ - ‐ - 6 - 2 - 720 - ‐ - 728
Narowal - ‐ - ‐ - ‐ - ‐ - ‐ - 55 - 2 - ‐ - ‐ - 57
Rawalpindi - 574 - 28 - 139 - 104 - ‐ - 10 - 2 - 283 - 312 - 1,452
R.Yar Khan - 1,364 - 31 - 2,357 - 5,712 - 864 - 17 - 3 - ‐ - 6,126 - 16,474
Rajanpur - 871 - 272 - 2,375 - 612 - 621 - 8 - ‐ - 1,528 - ‐ - 6,287
Sahiwal - ‐ - ‐ - ‐ - ‐ - ‐ - ‐ - ‐ - 289 - 801 - 1,090
Sargoda - 427 - ‐ - 740 - 56 - ‐ - ‐ - 3 - 179 - 1,909 - 3,314
T.T.Singh - ‐ - ‐ - ‐ - 74 - ‐ - ‐ - ‐ - 20 - 1 - 95
Vehari - 25 - ‐ - 9 - 4 - ‐ - 13 - 5 - 222 - 227 - 505
TOTAL - 48921 - 7223 - 71296 - 21861 - 13556 - 289 - 102 - 44359 - 106464 - 314,071


Baluchistan Province:

On August 18, 2010 a total 2921 patient visit reported with 672 (23%) cases of diarrhea, 412 (14%) Upper Respiratory Tract Infection, Scabies reported 506 (17%), while suspected malaria reported 519 (18%) of cases. Since 29th July to 18th Aug, 2010 total 26,006 patient visits were reported from the 23 health facilities in the flood affected districts, Baluchistan. The overall diarrhea recorded in 6063 (23%) patients, suspected Malaria 5493 (21%), while Scabies 4232 (16%) of patient visits were reported. Table 3 presenting the daily number of patients by disease in the four flood affected districts of Baluchistan.


Table 4: Distribution of daily consultations by disease flood affected districts Baluchistan

[Diseases - 10 - 11 - 12 - 13 - 14 - 15 - 16 - 17 - 18 - Total (29Jul‐18Aug)]


AD - 572 - 514 - 1321 - 604 - 87 - 139 - 357 - 497 - 672 - 6063
AJS - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 2 - 2
BD - 112 - 72 - 55 - 78 - 30 - 57 - 81 - 180 - 176 - 1138
S. MAL - 462 - 554 - 1193 - 585 - 99 - 134 - 303 - 473 - 519 - 5493
URTI - 350 - 285 - 733 - 278 - 73 - 85 - 205 - 366 - 412 - 3684
LRTI - 22 - 22 - 20 - 9 - 0 - 6 - 16 - 4 - 12 - 151
UF - 22 - 6 - 7 - 18 - 0 - 6 - 12 - 21 - 28 - 380
Scabies - 494 - 409 - 307 - 477 - 72 - 88 - 252 - 460 - 506 - 4232
Sun Stroke - 0 - 0 - 0 - 0 - 0 - 0 - 32 - 0 - 2 - 44
Snake Bite - 1 - 20 - 27 - 14 - 3 - 6 - 13 - 11 - 2 - 137
E.N.T - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 325
Eye Inf. - 91 - 31 - 43 - 66 - 52 - 64 - 103 - 127 - 124 - 916
Dog Bite - 0 - 0 - 0 - 0 - 0 - 0 - 0 - 4 - 0 - 23
Others - 234 - 325 - 239 - 316 - 55 - 129 - 504 - 860 - 466 - 3418
Total - 2360 - 2238 - 3945 - 2445 - 471 - 714 - 1878 - 3003 - 2921 - 26006


From 29 July to 13 August, 137 snake bites have been reported from the flood affected district in Baluchistan mainly from district Naseerabad and Jaffarabad. High proportion of acute diarrhea also has been reported in districts Jaffarabad, Naseerabad and Sibi. 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 days, the proportion of acute diarrhea has increased on 18 July in flood affected areas in the reporting districts. Figure 4 reflecting the daily trend of acute diarrhea in the flood affected districts of Baluchistan.


Sindh Province:

Daily disease surveillance reports received from 410 health facilities (95 mobile teams and 315 fixed facilities) in fifteen flood affected districts in Sindh. Total 30,442 patient visits were reported from the fixed facilities and mobile Medical camps established in the districts. Skin infections were the leading cause of consultation accounted for 19% of total visits followed by acute diarrhoea 17%, while ARI reported 15%. High numbers of diarrhoea cases are being reported from districts Kashmore, Shikarpur and Dadu. Strong WASH interventions are highly required in these districts. Five (5) snake bites also reported from Sindh province on 18 August.


Table: 5. Distribution of daily consultations by disease flood affected districts, Sindh

[Disease - 10‐Aug - 11‐Aug - 12‐Aug - 13‐Aug - 14‐Aug - 15‐Aug - 16‐Aug - 17‐Aug - 18‐Aug - Total (6‐18 Aug)]


AD - 2904 - 3090 - 3505 - 3374 - 4285 - 4343 - 4634 - 5670 - 5802 - 47103
BD - 507 - 709 - 461 - 774 - 715 - 748 - 903 - 995 - 1113 - 8553
ARI - 3479 - 3693 - 3303 - 3837 - 3766 - 3660 - 4918 - 5671 - 4957 - 48262
Malaria - 2055 - 2355 - 1976 - 2782 - 2459 - 2326 - 3431 - 4129 - 3463 - 31654
Skin Inf. - 3061 - 3722 - 3753 - 4281 - 4415 - 3887 - 5681 - 6332 - 6430 - 51641
Snake bite - 49 - 20 - 18 - 13 - 15 - 9 - 6 - 21 - 5 - 200
Others - 4892 - 7904 - 7144 - 7947 - 9641 - 9071 - 10869 - 12186 - 12272 - 105560
Total - 16947 - 21493 - 20160 - 23008 - 25296 - 24044 - 30442 - 35004 - 34042 - 292973

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Giuseppe Michieli
August 24th, 2010, 11:11 AM
Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 1 Monday 23 August 2010 (WHO, edited)


[Source: World Health Organization, Complete PDF Document (LINK (http://www.who.int/hac/crises/pak/pakistan_epi_23august2010.pdf)). Extracts, edited.]

Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 1 Monday 23 August 2010

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan and World Health Organization (WHO), Pakistan . For Correspondence: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: wr@pak.emro.who.int. or eic.nih@gmail.com


Highlights


Epidemiological week no 33 (14-20 August 2010)

Fifty-six out of the seventy-three flood affected districts in four provinces are now reporting surveillance data to the DEWS;
597 fixed health centers and 361 mobile medical outreach centers have reported to the Disease Early Warning System (DEWS) during the last reporting period (Week no-33: 16-20 August 2010);
1,253,495 patients’ consultations were reported during the last epidemiological week (week no-33) which shows an increase by 25% over the preceding week;
The number of populations currently under surveillance by the Disease Early Warning System (DEWS) in the flood affected districts is close to 8.5 million;
Acute diarrhea, acute respiratory infections, skin diseases and suspected malaria remain the major causes of seeking health care in the flood affected districts
Acute watery diarrhoea has been reported from a number of foci in KPK, Sindh and Punjab provinces.



Epidemic prone diseases under surveillance in the flood affected areas


Acute flaccid paralysis
Cholera/Acute Watery Diarrhoea
Bloody Diarrhoea
Dengue
Malaria
Measles
Viral Hepatitis/ Acute Jaundice Syndrome
Acute Respiratory Infections
Viral haemorrhagic fever


Cumulative number of selected health events reported from the flood affected districts (29 Jul-20 Aug)

[Disease - Number - % of total consultations]


Acute Diarrhoea (AD) - 314,814 - 13%
ARI - 317,450 - 13%
Skin Diseases - 421,198 - 18%
Suspected malaria - 53,707 - 2%


Major health events reported during the week (14-20 Aug)

[Disease - Number - % of total consultations]


Acute Diarrhoea (AD) - 180,872 - 14%
ARI - 183,562 - 15%
Skin Diseases - 244,365 - 19%
Suspected malaria - 27,439 - 2%


Surveillance sites

[Province - Fixed centers - Mobile outreach]


Balochistan - 10 - 11
KPK - 43 - 50
Punjab - 228 - 185
Sindh - 316 - 115
Total - 597 - 361


Selected health events: KPK Province, Week-33 (14-20 Aug):

[Health events - Case counts - (%)]


Acute diarrhea (AD) - 15,502 - (16%)
Acute respiratory tract infection (ARTI) - 17,101 - (18%)
Skin infections (SI) - 15,305 - (16%)
Unexplained fever (UF) - 1308 - (1%)
Suspected malaria (S. Mal) - 846 - (1%)
Injuries (Inj) - 439 - (<1%)


Selected health events: Punjab Province, Week-33 (14-20 Aug):

[Health events - Case counts - (%)]


Acute diarrhea (AD) - 125,646 - (13%)
Acute respiratory tract infection (ARI) - 135,369 - (14%)
Skin infections (SI) - 197,862 - (21%)
Unexplained fever (UF) - 81,774 - (9%)
Injuries (Inj) - 18,845 - (2%)
Others (OTH) - 348,601 - (37%)


Selected health events: Sindh Province, Week 33 (14-20 Aug)

[Health events - Case counts - (%)]


Acute diarrhea (AD) - 37,014 - (17%)
Suspected malaria (S. Mal) - 23,811 - (11%)
Acute respiratory tract infection (ARI) - 33,072 - (15%)
Skin infections (SI) - 41,746 - (19%)
Bloody diarrhoea (BD) - 6,488 - (3%)
Others (OTH) - 75,206 - (35%)


Selected health events: Balochistan Province, Week 33 (14-20 Aug)

[Health events - Case counts - (%)]


Acute diarrhea (AD) - 2904 - (19%)
Suspected malaria (S. Mal) - 2594 - (17%)
Acute respiratory tract infection (ARI) - 2074 - (13%)
Skin infections (SI) - 2184 - (14%)
Bloody diarrhoea (BD) - 944 - (6%)
Others (OTH) - 4172 - (27%)


Patient consultations

Since the beginning of flood, approximately 2,394,492 patients consultations have been reported to the DEWS from the four flood affected provinces in Pakistan. Starting from 213 patients’ consultations reported on 29 July , the number of patients seeking health care from both the fixed and mobile outreach centers are increasing– a sign of increasing health facility utilization by the flood affected communities. During the last week rs (Figure-1), a total of 101,925 patients consultations were reported from 597 fixed and 361 mobile health centers.

This represents an increase by over 25% compared to the preceding day.


Leading causes of morbidity

The major causes for seeking health care by the affected communities in almost all the flood affected provinces are from the commonly prevalent infectious diseases like diarrhoeal diseases, acute respiratory infections, skin diseases and suspected malaria. While in the province of Balochistan and Sindh, the risk of increasing case load from malaria are unfolding (Figure-7), the provinces of Punjab, KPK and Sindh are showing increasing trend of skin diseases, diarrhoeal disease and acute respiratory infections. The number of diarrhoeal diseases reported from the flood affected provinces are on the rise (Figure-7) and a perceptible increasing trend has been observed in each of the affected areas compared to the same corresponding reporting period in the past. As seen in the figure-8, the diarrhoeal diseases, reported from the IDP crisis and hosting districts of KPK province after the flood, as a percentage of total patients consultations, clearly exceeds the number reported during the same corresponding period in 2009

Alert/Alarm thresholds

A total of thirty-eight (38) alerts were raised during the last reporting period (Week no 33: 14-20 August 2010). Out of these, 37 alerts were flagged for suspected acute watery diarrhea and the remaining alert was for Bloody Diarrhoea. The maximum number of alerts for AWD was raised from KPK (31) followed by Sindh (3), Punjab (2) and Balochistan (1) province. The alert for Bloody Diarrhoea was raised from the KPK province. No alert was raised for any other epidemic prone disease during the last reporting period. Following the field investigation, samples were collected from the suspected cases and sent to the National Institute of Health (NIH) for laboratory confirmation. As part of the field investigations, the community at risk has been educated on safe hygiene and behavioural practices as well.

All alerts are monitored and assessed closely in accordance with the alert thresholds set for each of the epidemic prone diseases currently under surveillance for disease early warning system (DEWS).


Epidemic Watch

As the emergency health interventions scale up in the flood affected areas, the surveillance system has been geared up to early detect any potential outbreak. Since the beginning of the flood, the epidemic prone diseases are being closely monitored. The progression of these epidemic prone diseases are under close vigilance through daily analysis of surveillance data as well as, whenever possible, through comparison with past historical trend.

Any alerts for an outbreak, whenever flagged, are rapidly investigated and biological samples collected for laboratory diagnosis and verification.

So far, 66 outbreak alerts have been flagged since the beginning of the flood out of which 61 (92%) were from Acute Watery Diarrhoea. 3 alerts were raised for Measles and 1 alert, each, was raised for malaria and dengue fever. Majority of the alerts (Over 70% ) were raised from the province of Khyber Pakhtunkhwa (KPK).

All these outbreak alerts were verified through field investigation and clinical specimens were collected and sent to the National Reference Laboratory for confirmation. The rapid analysis of surveillance data, almost on a daily basis, field investigation for verification of any unusual health event that represent a threat to public health and use of epidemic intelligence data are the central basis of this early warning system for any potential outbreak in the flood affected areas of Pakistan


Outbreak Alert and Verification

[Diseases - Number - Number investigated]


AWD - 61 - 61
Dengue Fever - 1 - 1
Malaria - 1 - 1
Measles - 3 - 3
Total - 66 - 66


The objective of this weekly epidemiological bulletin is to provide a snap shot on the health events occurring amongst the affected communities displaced by the current flood in Pakistan. It is built upon the daily surveillance data received from over 490 fixed and 554 mobile outreach centers which are currently operational in the 73 flood affected districts of four provinces (Balochistan, KPK, Punjab and Sindh). While every attempt is made to show and analyse the weekly trend of the epidemic prone diseases amongst the flood‐hit communities, the information presented in the bulletin needs to be interpreted in the context that precise information on the reference populations is not always available, The bulletin doesn’t provide any health information on areas not currently accessible or covered by the emergency health response operations of MoH, Pakistan and WHO.

For further information and feed-back


Epidemic Investigation Cell, National Institute of Health, Chak Shahzad, Islamabd, Paksitan. : eic.nih@gmail.com
World Health Organization, Pakistan : wr@emro.who.int

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Giuseppe Michieli
August 25th, 2010, 12:30 PM
Pakistan Health Cluster - Floods in Pakistan - Bulletin No 14 - 25 August 2010 (WHO, edited)


[Source: World Health Organization, Full PDF Document (LINK (http://www.whopak.org/idps/documents/bulletins/Pakistan%20Health%20Cluster%20Bulletin%2014%202508 10.pdf)). Edited.]

Pakistan Health Cluster - Floods in Pakistan - Bulletin No 14 - 25 August 2010


Highlights


Government of Pakistan announces on 24 August measures to strengthen coordination and activities, including disease surveillance, to respond to health impacts of flood emergency.
Increasing numbers of cases of diarrhoeal disease, acute respiratory infections, skin diseases and malaria are being reported, with growing concerns about the overall situation in Sindh and Punjab provinces.
At least 380 health facilities damaged or destroyed by flooding.
21 diarrhoeal disease centres operating, through USAID/OFDA funding, in affected districts of KPK, Punjab and Sindh provinces, with more being set up.
Health Cluster coordination active in 5 hubs - Islamabad, Peshawar, Multan, Sukkur, Quetta.
39% of the US$56.2 million requested to support the health response has been funded, according to OCHA as of 23 August.
On 23 August, 101,925 patient were treated in flood affected districts. Of these consultations, 25,476 cases of skin infections (24% of total), 16,469 cases of acute respiratory infections (16%), 14,008 cases of acute diarrhoea (14%) and 4966 cases of suspected malaria (5%) were reported.


Situation overview and current scale of disaster


According to OCHA, 17.2 million people have been affected by the floods, with Pakistan officials stating number of affected could be upwards of 20 million. 1539 people have been reported killed and more than 2000 injured, while around 1 million are left homeless. Some 160,000 square kilometers of land has been affected.
The situation in Sindh has continued to deteriorate, with evacuations reported from Thatta and Shahdadkot districts in recent days as the second wave of flooding moves into province's south. Provision of clean drinking water and related WASH support in Sindh and Punjab are of increasingly critical importance.


Health impact


At least 380 hospitals and clinics have been totally destroyed or partially damaged in each of the provinces, according to WHO.
During the last 24 hours, a total of 101,925 patients’ consultations were reported from the flood-affected districts. Of these consultations, 25,476 cases of skin infections (24%), 16,469 cases of acute respiratory infections (16%), 14,008 cases of acute diarrhoea (14%) and 4,966 cases of suspected malaria (5%) were reported.
Between 29 July to 21 August, a total of 2,394,492 patients’ consultations were reported from the affected districts. Of these consultations, 314,814 cases of acute diarrhoea (13% of total consultations), 317,450 cases of Acute Respiratory Infection (13% of total consultations), 421,198 cases of skin infections (18% of total consultations) and 53,707 cases of suspected malaria (2% of total consultations) were reported from the flood-affected districts.
The number of cases of suspected malaria is rising in Baluchistan and Sindh provinces compared to KPK and Punjab. During the last 24 hours, the number of cases reported from suspected malaria comprised 17% of patients’ consultations in Baluchistan province and 11% in Sindh.
WHO on 24 August has launched a new weekly disease surveillance document, the full reports can be downloaded from (LINK (http://www.whopak.org/idps/diseases_situation.asp#ds))


Government response


The Government of Pakistan announced on 24 August the creation of a new national steering committee to intensify and streamline the overall health response to the impacts of the flood crisis. The committee be headed by the Federal Secretary of Health and will include all provincial health secretaries plus the representatives of WHO, UNICEF and UNFPA.
The aim of the committee is to ensure better coordination between districts, provinces and the Federal level in terms of improving access to information. Focal points will be appointed at district and provincial level with the responsibility to actively gather and share information so to improve coordination, identify gaps, and reduce duplication of health activities.
There was also a decision to intensify disease early warning and surveillance systems flood-affected areas, ensuring that an "active" system of surveillance is in place, rather than a "passive" one. This will involve making health facilities responsible for actively reporting disease surveillance data to district, provincial and Federal levels.
A further measure taken at the 24 August meeting was the decision to better coordinate and monitor medical resources (supplies and staff) so they are best used in the emergency response. For Health Cluster partners, this would mean providing greater clarity as to where their services are needed.
Since its 20 August launch, the Ministry of Health's National Health Volunteer Programme has seen 840 volunteer doctors, nurses, public health professionals and paramedics register with the scheme. Volunteers will form 4-member teams and work for 15 days in the communities most affected by the floods.
The Ministry of Health-led taskforce on communicable diseases has issued new guidelines on responding to cholera and acute watery diarrhoea cases. These guidelines were revised with the support of WHO. The new guidance, issued in response to the growing disease concerns in flood-affected provinces, have been sent to district and provincial health officials and will be disseminated widely.
Hundreds of thousands of children have be immunized against a range of diseases during vaccination campaigns conducted in the 4 provinces between 4-20 August. The campaign was coordinated by MoH's National Health Emergency Preparedness and Response Centre and implemented by the national Expanded Programme of Immunization.
Children were vaccinated against polio, measles, tuberculosis, diphtheria, tetanus, pertussis (whooping cough), hepatitis B, and Haemophilus influenza type b (often known as Hib) which causes some severe forms of pneumonia and meningitis, and given Vitamin A supplements. Pregnant women were also vaccinated against tetanus and neonatal tetanus.


Health Cluster response


UNFPA provides emergency reproductive health/maternal newborn responds through deploying 23 fully equipped and staffed mobile service units and supporting 13 existing govt. health facilities in 14 districts of KPK, Sindh and Punjab provinces. UNFPA has provided emergency reproductive health medicines to cover 510,000 people for one month, women’s hygiene kits for 3300 families,1800 newborn kits, Interagency clean delivery packets were distributed among pregnant women to in flood affected districts of KPK, Punjab and Sindh provinces. During 21-22 August, UNFPA staff consulted around 4700 patients, including 187 deliveries, 980 antenatal consultations, 132 postnatal consultations, 18 post-abortion care, 30 consultations for syndromic case management of sexually transmitted infections and 500 cases of gastroenteritis. In the same period, UNFPA distributed women’s hygiene kits to cater for 240 families for one month and 187 newborn kits were distributed to newly delivering mothers.
Helping Hands for Relief and Development (HHRD) is operating more than 150 health facilities in Punjab, KPK and Sindh provinces, and, on 23 August its medical staff treated more than 33,000 people for a range of conditions, including diarrhoea, skin infections, respiratory infections and malaria.
World Health Organization is planning to establish 69 diarrhoea treatment centres in 47 priority affected districts in the 4 provinces after receiving funding support from USAID. 21 have already been established, 17 are in the process of being set up and the remainder are under discussion. The centres will be run by implementing partners and health authorities. 11 of 15 centres being established in KPK are operational; 9 of the 11 planned for Punjab have been established; 4 of the 16 planned for Sindh are being established, 4 of the 8 for Punjab are being set up.


Khyber Pakhtunkhwa


Medical Emergency Relief International (MERLIN): Merlin is scaling up operations and mobilizing 682 medical, health and logistics support staff. Merlin has also distributed 50,000 Aqua-Tabs, 90,000 water purification sachets (enough to purify 1 million litres of water) and 10,000 hygiene kits, throughout 3 of KPK's worst-affected areas. Primary health care services are being provided alongside waterborne disease control, blanket distribution of oral rehydration salts. Since 5 August 2010, Merlin has conducted around 90,000 consultations (average 6000 per day). In Nowshera, Merlin is providing health and nutrition services through 5 mobile team in 6 Nowshera union councils and 6 static clinics in Jalozai that provide 24-hour coverage. On 23 August, 1570 consultations were conducted, and 235 water purification tablets, 245 Multi Micronutrients Tablets, 230 high energy biscuits and 700 plumpy nuts were distributed. 23 health promotion sessions were conducted for 410 people. A diarrhoea treatment centre started functioning 21 August and has treated 104 patients to date. Merlin is covering an approximate catchment population of 153,034 in Nowshera.
In Swat, Merlin is providing health services through 9 mobile teams (8 in Upper Swat, 1 in Lower Swat) and 11 fixed health facilities. On 23 August, 3300 consultations were conducted, as were 116 health promotion sessions for 1455 people. A diarrhoea treatment centre is being established at tehsil headquarters Matta. Merlin is covering an approximate catchment population of 590,036 in Swat. A mobile camp was conducted in response to a suspected AWD case in Battai Bunn area,. Hygiene kits and aqua tabs were distributed. In addition, 110 Hygiene Kits were also distributed in Mingora and Bahrain.
In Buner, Merlin is providing comprehensive PHC, reproductive healthcare and disease early warning systems in Buner district through 10 fixed health facilities and 3 mobile teams. On 23 August, 60 health promotion sessions were conducted for 627 people. Merlin is covering an approximate catchment population of 337,808. A diarrhoea treatment centre is being established at tehsil headquarters Pachakalay.
The Pakistan Red Crescent Society continues operations at 7 basic health units in Kohistan and Shangla disitricts of KPK province. On 22 August, the basic health units in the Shangla towns of Damorai and Olandar conducted multiple around 180 consultations.
CARE has treated more than 14,000 patients during the emergency in Upper Swat via 2 mobile teams and 4 basic health units. It has also conducted 7 mobile clinics in Charsada district, providing almost 1200 patients with primary health care, including approximately 300 women & 300 children on 22-23 August. On 23 August in Upper Swat, CARE health facilities treated 1272 patients. In Nowshera, CARE conducted 10 mobile clinics in Nowshera district, treating over 1300 patients, including 370 women and 470 children on 22-23 August.
Doctors Worldwide has rehabilitated and reequipped the Pir Sabaq basic health unit and is working out of the facility since 9 August, with permission from health authorities in Peshawar. Local and international volunteers are staffing the facility. Doctors Worldwide is also establishing a 6-patient inpatient facility at the same centre, and intends to replicate its activities at 4 more basic health units (Ganderi, Misri Banda, Shaidu, Jehangira).
International Medical Corps has deployed 14 medical teams to flood-affected areas of Charsadda, Peshawar and Nowshera. On 22 August, IMC medical teams provided medical treatment to 1300 patients, including 164 cases of acute diarrhoea, 214 cases of acute respiratory infection, and 147 cases of scabies.
Relief International has established 2 medical camps, one at the border of union council Bahrain in Upper Swat, and one in bordering Lower Dir district's Khan union council. On 24 August, its teams conducted 206 patient consultations in Swat and 47 in Lower Dir. There was a reported increase of diarrhoeal cases among the consultations and acute upper respiratory infections, while cases of scabies are also being reported. In recent days, Relief International conducted 3 infant and young child feeding education sessions for 91 pregnant women and lactating mothers, while 7 education sessions were conducted on water-borne diseases. RI workers distributed 400 water purification tablets and demonstrated their use, registered 15 pregnant women antenatal check up, distributed Energy-5 Biscuits for under five children, and Multi micronutrient tablets and sachets to children and women.
IHH-Turkey has been sent a medical team to support health activities in Nowshera, with a second team expected to arrive 25 August. IHH-Turkey plans to support Shelter and WASH cluster activities as well.
UNICEF is providing 4.2 million sachets of oral rehydration salts and 2.1 million Zinc doses to lady health workers for community-based management of diarrhoea in children aged under 5 in flood-affected areas of Khyber Paktoonkhwa, Punjab, Sindh, Baluchistan, AJK and Gilgit Baltistan.
UNICEF and WHO are assisting the Provincial Expanded Programme of Immunization efforts to immunize children against measles and provide vitamin A supplementation. The campaigns are targeting schools, camps and floodaffected areas in Peshawar, Charsadda, Nowshera.
A UNICEF-supported measles campaign started in Swat on 19 Aug. 381 teams have been deployed throughout Swat, Charsadda and Peshawar to conduct the campaign in these 3 districts. These teams have vaccinated 205,520 children aged under 5 against polio, 185,140 children (6-59 months) received measles vaccine and 184,801 children (6-59 months) received Vit A supplementation. 6 UNICEF mobile medical teams have been operating in Charsadda, Nowshera and Swat, providing consultations for 1,626 patients, including 722 children and 571 women. 77 women received antenatal, postnatal care and 32 high risk pregnant women and 2 seriously ill children were provided with referrals through these teams. The teams distributed 270 hygiene kits and 921 soap bars, plus delivered health and hygiene messages to 297 people.
UNICEF supported 5 district health authority medical teams in D.I. Khan that have treated more than 1000 people, including over 500 women and 200 children. These teams have resumed providing services through health facilities. UNICEF supported specialized paediatric services at D.I. Khan districts headquarters hospital, treating 459 children.
A mobile team in D.I. Khan has treated 466 patients, including 296 children and 147 women.
Mother Child Days, supported by UNICEF, have been conducted in 6 Swat union councils. Health teams served 1261 households (11,848 people), providing oral rehydration salts, aqua tab strips, jerry cans, and water purification tablets. Pregnant women received antenatal care and were vaccinated against tetanus. Children were vaccinated against measles, received de-worming and were given multi-micronutrient sachets. Medical teams provided health, hygiene and breastfeeding-related messages. UNICEF distributed 10,000 sachets of ORS and other medical materials to support mobile medical services in Kohistan.
International Catholic Migration Mission operates a health facility Charsadda district's Prang union council, where on 23 August its health staff conducted 96 consultations, numerous of which were for diarrhoeal diseases, respiratory tract infections and scabies.
Malteser International has treated, up until 21 August, 5236 patients at fixed health facilities within the Swat district union councils of Islampur, Chetewar and Meragai, as well as through 7 medical camps. The average number of patients being treated at the 3 fixed health facilities is 65 per day. Each Malteser mobile team has its own ambulancetype referral capacity.
Malteser has supported vaccination efforts and is providing intensive hygiene awareness campaigns in the area with suspected acute watery diarrhoea, including in Barikot, Margazal and Ahunbaba in Islampur, and Mingora Town. During the previous week, several hundred families were registered by Malteser, and printed hygiene materials, aquatabs, soap and ORS sachets were distributed.
Malteser will be procuring, using CERF funds acquired by WHO, additional health supplies and equipment for operating 2 diarrhoea treatment centres in northern Swat with a combined 100 patient capacity. With its own funds and funds from the German government, Malteser will purchase 1000 hygiene/household family kits for Swat, and a further 600 for Kohistan. Malteser International, which is operating in Swat and Kohistan districts of KPK, notes its major challenges are access to people in affected areas, and ensuring access to health facilities.
American Rescue Committee International is working through 7 health facilities in Swat district. On 23 August, ARC staff treated 604 patients, with diarrhoea representing 17.7% of cases, respiratory tract infections 22.6%, and scabies 6.9%. 104 women received antenatal care consultations, and 24 received postnatal care consultations. 41 health education sessions were conducted, 18 sessions for psychosocial counseling and 19 delivery kits were distributed. Mobile health camps have been established in Swat, with more than 600 patients treated in 3 villages of Shah Dehry, Takhta Band Angora Dehry.
Church World Service is operating mobile teams in remote areas of 3 KPK districts - Swat, Manshera and Kohistan - where they provide essential medicines and consultations for patients with a focus on women and children. As of 24 August, the teams had conducted 2446 consultations, while a lady health worker had examined 44 antenatal and 6 postnatal clients. 398 children were examined by the teams. The mobile teams use their own ambulance to transfer patients needing urgent referral to secondary or tertiary level health care facilities.
Church World Service is planning to further expand mobile health units in Kohistan and Shangla Districts.


Punjab province


CARE International is providing primary health care services in southern Punjab province via a mobile clinic in Muzzafargarh, which has treated 213 patients including 30 women and 107 children.
WHO, from the Multan Health Cluster hub, is preparing to sent a consignment of medical supplies to DG Khan and Rajanpur on 24 August, by air asap.
A WHO team visited 2 formal IDP camps near Multan, noting that safe drinking water was available and sanitation conditions were satisfactory. Medicines are available in sufficient quantities. An adequate patient referral system exists from the camps to Nishter Hospital.


Sindh province


CARE International is providing services in Sindh province via 10 mobile clinics. The teams have provided primary health care services to 2105 patients via 10 mobile clinics Sukkur and Shikarpur districts, including 774 women and 845 children. CARE has also provided PHC services to 403 patients via 03 Mobile clinics including 94 women & 183 children in district Sukkur & Shikarpur of Sind province.
WHO is expected to open a new diarrhoea treatment centre on 25 August in Kankhot, near Sukkar, which will be operated by the Health and Nutrition Development Society (HANDS) and district health authorities. Another centre is operating in Khairpur town, near Sukkar, at and by the Gambat Institute of Medical Sciences.
WHO, from the Health Cluster bug in Sukkar, is planning to airlift medicines, including for the treatment of diarrhoeal diseases, to communities inaccessible by road due to flooding.


Baluchistan province


Medical services are being provided to displaced people in 6 districts of Baluchistan, with support being provided by health authorities, Muslim Hands, WHO and community organizations.
Relief International established on 23 August a static emergency PHC services centre in union council Dhadar of Kachi district, Baluchistan, where there are 23,000 displaced people living. The team working at the centre comprises 2 medical officers, 2 lady health volunteers, 2 health educators and 2 dispensers. On its first day, the team conducted 147 consultations, 5 antenatal checkups, 2 health education sessions on diarrhoeal disease prevention and nutritional anthropometry of 14 children.
Johanniter International will commence providing health services in Bolan and the district health facility in Naseerabad. Johanniter will provide medical services at the basic health units in Mitri, Hajio Seher, Chandar, Killi Shahbaz, Masoo and the Chalgri rural health centre.
WHO has provided medicines to the Baluchistan health department, which has distributed the materials 10 health facilities serving flood affected people, including items for treating diarrhoeal diseases.
American Refugee Committee International is working at the rural health centres in Talli and Lehri, and the basic health units at Sultan Kot, Bakhtiarabad, Chandia and Gishkori. More than 930 patients were treated at the different facilities on 23 August.


Inter-cluster coordination


WASH-HEALTH:

WHO is working with UNICEF, as WASH cluster lead, which is coordinating the WASH cluster response to reach safe drinking water, hygiene and sanitation supplies to flood-affected communities. In Multan, WHO briefed at the WASH Cluster meeting on 24 August, presenting current disease patterns, and statistics on the damage to health facilities. WHO also briefed on malaria prevention strategies undertaken by the Punjab Health Department. WHO is leading the sub-cluster on health and hygiene within the WASH Cluster in Multan. A WHO environmental health consultant presented the matrix of an action plan for flood-affected areas.

LOGISTICS-HEALTH:

Logistics cluster receiving 3 helicopters to be based in Multan and they are awaiting partners, including Health Cluster, to provide distribution plan to deliver supplies to areas not accessible by road. The Health Cluster is in constant coordination with the Logistics Cluster to capitalise on opportunities to delivery medical supplies offered by air support.



For further information contact: health_cluster_bulletin@pak.emro.who.int
Please submit your organization's activities by 5pm daily using the above email address.
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Giuseppe Michieli
August 30th, 2010, 11:00 AM
Floods in Pakistan - Bulletin No 15 - 29 August 2010 (WHO, Pakistan Health Cluster, 8/30/10, edited)


[Source: World Health Organization, full PDF Document (LINK (http://www.whopak.org/idps/documents/bulletins/Pakistan%20Health%20Cluster%20Bulletin%2015%202908 10_final.pdf)). Edited.]

Pakistan Health Cluster

Floods in Pakistan - Bulletin No 15 - 29 August 2010


Highlights


Australia, Bangladesh, China, Indonesia, Iran, Japan, Jordan, occupied Palestinian territories, Saudi Arabia, Spain, Sri Lanka, Turkey and UAE have sent medical teams to support medical relief efforts in affected areas.
43% of the US$56.2 million requested to support the health response has been funded, according to OCHA as of 26 August.
Increasing numbers of suspected malaria cases being recorded in Sindh and Baluchistan provinces.
On 24 August, 110,062 patients were recorded as having been treated in flood affected districts. Of these consultations, 21,400 cases of skin diseases (19% of total), 16,557 cases of acute respiratory infections (15%), 18,562 cases of acute diarrhoea (17%) and 7399 cases of suspected malaria (7%) were reported.
Health Cluster coordination active in 5 hubs - Islamabad, Peshawar, Multan, Sukkur, Quetta.


Situation overview and current scale of disaster


According to OCHA, 17.2 million people have been affected by the floods, with Pakistan officials stating number of affected could be upwards of 20 million. 1600 people have been reported killed and more than 2366 injured, while 1.2 million homes have been destroyed, as of 27 August. Floodwaters in Punjab are reportedly receding. Monsoon activity is expected to be subdued during next 3-4 days. Further OCHA information, go to: (LINK (http://tinyurl.com/32n9rjj))


Health impact


Health needs remain great as relief efforts strive to cope with the scale of the challenges. Large numbers of people continue being treated for diarrhoeal disease cases, skin diseases, acute respiratory and increasingly, malaria.
402 of more than 1000 health facilities in flood-affected districts have been damaged or destroyed by the flooding.
Latest epidemiological data released by WHO, as of 27 August, shows that on 26 August, 133,684 patients were recorded as having been treated in flood affected districts. Of these consultations, 28,815 cases of skin diseases (22% of total), 22,902 cases of acute respiratory infections (17%), 19,178 cases of acute diarrhoea (14%) and 7973 cases of suspected malaria (6%) were reported.
In all, 3.7 million people are reported to have been treated from 29 July to, and including, 23 August. Of these, there were 500,635 cases of acute diarrhoea (13% of total consultations), 517,929 cases of acute respiratory infection (14% of total consultations), 693,114 cases of skin infections (19% of total consultations) and 94,186 cases of suspected malaria (3% of total consultations) were reported from flood-affected districts.
The number of cases of suspected malaria is rising in Baluchistan and Sindh provinces compared to KPK and Punjab. During the last 24 hours, the number of cases reported from suspected malaria comprised 27% of patients’ consultations in both Baluchistan and Sindh provinces.
WHO's weekly disease surveillance document id as: (LINK (http://www.whopak.org/idps/diseases_situation.asp#ds))


Government response


On 28 August, the Government of Pakistan's National Steering Committee on Health Emergency Preparedness and Response (HEPR) met in Islamabad with all provincial health secretaries and representatives from WHO, UNICEF and UNFPA, formulating plans to receive more rapid and complete health surveillance data from district and provincial levels.
The Ministry of Health is working with partners on plan to provide incentives to have lady health workers return to duties, as at least 20,000 have been affected by the flooding, many of whom are not working.
Foreign medical teams have been arriving in Pakistan to support health relief efforts, and their activities are being coordinated by the HEPR.


Foreign medical teams supporting Pakistan flood relief effort (not complete)

[Country - Arrived - Capacities - Where operating]


China - 26-Aug - 38 member hospital multi-disciplinary team, including mobile field hospital, medical equipment, doctors, nurses, surgeons, cardiologists. - Thattar district, Sindh province.
Australia - Approx 26-Aug - 72-member army medical corps multidisciplinary team including mobile field hospital - Kotaddu district, Punjab province
Saudi Arabia - 25-Aug - 2100-bed field hospitals with 70 staff each. - Rajanpour, Punjab province and Thatta, Sindh province.
Saudi Arabia - 25-Aug - Medical team with 18 specialists, medicines - District Headquarters hospital, Nowshera district, KPK province.
Indonesia - 26-Aug - 6-member team supporting Pakistan Institute of Medical Sciences. - Charsadda district, KPK
Spain - 26-Aug - 8-member medical team, provided 13 tons of medicines to the Ministry of Health - Sukkur district, Sindh province.
Physicians Across Continents - 26-Aug - Multidisciplinary team that has provided planeload of equipment, water filtration plants. - Nowshera and Charsadda.
Jordan - 16-Aug - Medical team - Multan


Health Cluster response

(Inputs received before 4PM Thursday 28 August through health_cluster_bulletin@pak.emro.who.int)


UNFPA is delivering health care in Sindh, Punjab and KPK provinces is through 23 mobile service units for outreach services and 14 government health facilities for emergency reproductive health care services. UNFPA is also providing primary health care services including 8605 consultations for gastroenteritis, 5556 scabies, 5273 for acute respiratory tract infections, 5686 consultations for fever and 9971 other minor out-patient services for psychosomatic and general medical services.
World Health Organization providing medicines and related supplies to all Health Cluster partners, delivering items that can treat more than 3.4 million people for one month. More than 20 international staff, including public health specialists, epidemiologists and logisticians, been deployed from throughout the WHO network to different locations in Pakistan to support the flood response. WHO is supporting the establishment of diarrhoea treatment centres in affected districts. As of 28 August, more than 60 had been established or where in the process of being set up to provide diarrhoea treatment services for people affected by the flooding.


Khyber Pakhtunkhwa


American Refugee Committee (ARC) International treated 859 children, women and men on 24-25 August at 7 health facilities it supports in Swat district. On 24 August, a medical camp was established in Dardyal town, Swat, where 1590 patients received consultations mainly for acute respiratory infection, diarrhoea, scabies and eye infections.
CARE International operates 2 mobile teams and 4 basic health units in Upper Swat, treating on 25-27 August 568 patients (including more than 100 women on 26-27 August). CARE conducted 7 mobile clinics Charsadda district on the same days, providing primary health care services to 963 patients including 313 women and 278 children, and 12 mobile clinics in Nowshera district, treating 1829 patients including 515 women and 901 children.
Church World Service (CWS) operates 3 mobile health units in Mansehra, Kohistan and Swat districts, delivering consultations to 3189 patients on 26 August. A lady health visitor examined 62 antenatal and 6 postnatal clients and gave them essential medicine. The medical team examined 531 children aged under 5 years. CWS is planning to further expand mobile health units in Kohistan and Shangla districts to provide more free consultations, free essential medicine and maternal and child health services. CWS ambulances transfer patients needing urgent referral to secondary or tertiary level health care facilities.
International Catholic Migration Commission mobile teams on 27 August treated 66 flood affected people staying at the Prang Primary School in Utmanzai Union council in KPK's Charsadda district.
International Medical Corps (IMC) medical teams are delivering emergency health services in Nowshera and Charsadda districts. IMC and WHO are working together to operate a diarrhoea treatment centre at the Nowshera district headquarters hospital. IMC medical teams treated more than 6353 patients from 25-28 August, with acute diarrhoea, acute respiratory infections and scabies being the main conditions. Health education and hygiene promotion sessions were given to 4200 people. The team from the Dagai basic health unit at Nowshera moved to the Khair Abad rural health centre and started functioning 28 August. A female psychologist has joined the 6-member psychosocial support team, which operates in Peshawar, Nowshera and Charsadda. The team has provided services to 461 people on 25-28 August, including for depression, anxiety and distress.
MERCY Malaysia is collaborating with the Pakistan Islamic Medical Association to operate static clinic for floodaffected people in KPK and a mobile medical team is providing health services in Charsadda district. MERCY Malaysia will help establish a static clinic at Pabbi Government High School which is occupied by 200 families; and a mobile team to support displaced people living nearby. MERCY is delivering hygiene kits and conducting hygiene promotion activities in KPK.
Medical Emergency Relief International (MERLIN) is operational in Swat, Buner, and Nowshera districts, covering an approximate catchment population of 1 million people, and is starting interventions in Charsadda. Merlin currently provides health services through 27 static clinics (11 Swat, 10 Buner, 6 Jalozai) and 17 mobile teams (9 Swat, 3 Buner, 5 Nowshera), while 1 diarrhoea treatment centre is functional at the Satellite Hospital in Nowshera's Pabbi town, and 1 in Matta town, Swat. 2 centres are also being established at Pacha Kaly in Buner district and Charsadda district. Merlin is conducting an average of 4955 daily consultations and has conducted around 121,000 consultations from 5-27 August. Services include primary health care, referrals to tertiary level facilities, distribution of hygiene kits, water purification tablets, maternal and newborn health.
The Pakistan Red Crescent Society and the German Red Cross are conducting joint activities Nowshera district, providing treatment for water-borne diseases, acute respiratory infections and a wide range of other conditions. Routine healthcare is also being delivered, including for hypertension and the delivery of babies. From 31 July-24 August, 8763 people have been treated (4897 males, 3866 females). On 26 August, PCRS teams treated around 400 people in Mana Khel town and Pirpayi station.
Relief International medical staff has treated 518 people at the Madyan medical camp in Swat district for a range of conditions from 25-27 August, with the main health conditions being acute diarrhoea and respiratory infections. Relief International conducted health education sessions on diarrhoeal disease prevention and child immunization, while pregnant and lactating women have received education on the importance of breast feeding and complementary feeding. Hundreds of water purification tablets were distributed among the community. In Lower Dir, Relief International is using a mobile unit to better reach affected communities, with 480 patients being treated. Main health conditions were acute diarrhoea, respiratory infections and scabies. A health education session was conducted on diarrhoeal disease control and prevention.
Sawera Development is running a medical camp in D.I. Khan and conducting disease early warning and surveillance. Sawera is providing medicines, consultations, checkups and health education sessions to raise awareness on communicable diseases and measures to protect public health.
UNICEF is supporting routine expanded programme of immunization activities in Peshawar, Charsadda, Nowshera and D.I. Khan districts, completing a campaign on 28 August that vaccinated 285,154 children aged under 5 against polio, 253,511 children (6-59 months) against measles and providing 257,561 children with Vitamin A supplements.
5 UNICEF-supported mobile medical teams are operating in Charsadda, Nowshera and Swat districts, providing primary health care services, distributing health-related materials including hygiene kits and delivering health and hygiene messages. UNICEF is supporting specialized paediatric services at the D.I. Khan district headquarters hospital.


Punjab province


CARE International mobile clinics operating in Muzzafargarh district of southern Punjab province on 25-27 August, delivering primary health care services to 1402 patients, including 351 women and 688 children.
Cordaid has scaled up its health response, operating 5 mobile medical teams in Shangla, and 2 more teams are scheduled to start in Kohat shortly. Cordaid may conduct medical camps in Kohistan. Cordaid Team A is working in Shangla's most affected areas with mobile and fixed health services in Barkana, Kuzana, Karora, Damorai, Olandar and Shapur. Mule carriages are moving medicines on mountain roads, along with Cordaid vehicles and public transport. The Cordaid-supported basic health unit in Kuzana is delivering healthcare. A lady health volunteer is travelling from Kuzana to Shapur delivering health services to females. Cordaid is also coordinating the Shangla district WASH Cluster working group.
Integrated Health Services (IHS Pakistan) is operating mobile medical teams in Muzzafargarh and DG Khan districts since 12 August.
MERCY Malaysia conducted joint assessment with Pakistan Islamic Medical Association to Punjab for the opportunity to expand health services in Southern Punjab.
Medical Emergency Relief International (MERLIN) is starting interventions in Muzzafargarh in Punjab province, including through the establishment of a diarrhoea treatment centre at the Muzzafargarh district headquarters hospital.
UNICEF is delivering medical and nutritional supplies to 7 Punjab districts of Mianawali, Bhakkar, DG Khan, M. Garh, Layyah, Rajan Pur, RY Khan, Khushab, Multan. Health education sessions are being conducted in displaced people's camps in RY Khan and UNICEF-supported medical officers, lady health volunteers and vaccinators are providing health care services in all Punjab displaced people's camps.
UNHCR is providing health support to Afghan refugees in Pakistan affected by the flooding. In Mianwali, Punjab province, where 18,000 people are located, UNHCR and implementing partners are providing health services to Afghan refugees and locals through makeshift tent health points. Bed nets have also been provided.


Sindh province


CARE International provided primary health care services via 9 mobile clinics to 1282 patients in Sukkur and Shikarpur districts, including 524 women and 446 children, on 25-27 August.
Helping Hand for Relief and Development (HHRD) is supporting 184 medical camps in flood-affected areas and provided medicines to treat 43,000 people. launched a hygiene promotion project in Sukkur district, Sindh province, and will conduct health and hygiene awareness sessions and distribute hygiene kits to 500 families (35 00 people). Clean drinking water will also be provided.
Mercy Corps is operating 2 mobile health teams in Sindh province's Sukkur, Rohri and Pannu Aqil districts, delivering primary health care and maternal, newborn and child health services. The mobile teams contain ambulances, medicines, and health and hygiene kits. Mercy Corps health teams deliver health and hygiene sessions and provide clean delivery kits to pregnant women. Mercy Corps is also supporting water and sanitation activities. Mercy Corps is planning to replicate the same services in Jacobabad, Shikarpur and Jaffarabad.
The UNFPA humanitarian team conducted a joint reproductive health assessment mission with national and the Sindh provincial maternal newborn and child health department in the districts of Sukkur, Shikarpur and Khairpur.
UNICEF is supporting childhood vaccination campaigns in camps providing shelter for flood-affected people, with continuing vaccinations planned for areas where people have moved to, including Karachi. More than 2000 patients have been treated at UNICEF-supported medical facilities in Sindh, while messages on safe motherhood, breastfeeding, clean drinking water, hand washing and immunization are being provided.
World Health Organization conducted disease early warning system training for 36 district health management staff, polio team members and Health Cluster partners on 28 August in 9 flood-affected districts of Sindh to strengthen disease surveillance activities.


Baluchistan province


The American Rescue Committee International is supporting the rural health centre in Talli town, Sibi district, where 214 people were treated (158 men and 80 women) on 25-26 August. At the ARC-supported basic health unit in Chandia, 95 patients were treated on 25 August (58 women and 37 men) mainly for diarrhoea, bloody diarrhoea, upper acute respiratory infections, lower acute respiratory infections, scabies and injuries.
Relief International is working in Dhadar town of Kachi district, conducting 515 consultations between 25-27 August. Main conditions reported include acute respiratory infections and acute watery diarrhoea. Health education sessions have been conducted for mothers and male members of the community, as well as for use of oral rehydration solution. Water purification tablets have been distributed.
UNICEF-supported health services are operating in Barkhan, Kohlu, Sibi, Naseerabad, Jaffarabad and Harnai districts of Baluchistan, treating 9400 patients on 24-25 August, including for diarrhoea (21% of cases), clinical malaria (23%) and scabies /skin diseases (135). UNICEF is conducting polio, measles, turberculosis and tetanus in Baluchistana's 6 most affected districts (Barkhan, Kohlu, Sibi, Naseerabad, Jaffarabad and Kachhi) and a relief camp at Eastern bypass Quetta. UNICEF is supporting malaria control activities being conducted by health authorities in Sibi, Naseerabad and Jaffarabad districts.
World Health Organization is planning to send a 20-bed inflatable hospital to the severely flood-affected Sindh province town of Thul.


Azad Jammu and Kashmir (AJK)


UNICEF is delivering zinc tablets and oral rehydration solution to health authorities and planning measles vaccinations campaigns for flood-affected people.


Gilgit Baltistan


UNICEF is providing emergency medical supplies, zinc tablets and oral rehydration solution to health authorities and is planning measles vaccinations in Ganche, Skardu, Ghizer and Gilgit districts.


Coordination


REPRODUCTIVE HEALTH:

The first reproductive health task force meeting of Health Cluster partners was held 24 August to ensure implementation of Minimum Initial Service Package protocols through the Health cluster response.

WASH-HEALTH:

WHO is working with UNICEF, as WASH cluster lead, which is coordinating the WASH cluster response to reach safe drinking water, hygiene and sanitation supplies to flood-affected communities. UNICEF and WHO launched an appeal on 25 August for more support for water and sanitation activities. (LINK (http://tinyurl.com/3y466zg))

LOGISTICS-HEALTH:

WHO/Health Cluster working closely with the Logistics Cluster to plan deliveries of medicines to flood-affected communities.



Gaps/challenges


Cordaid International reports that Sharpur town, in KPK's Shangla district, has no operational health facility, and the nearby Karora Rural Hospital is badly damaged and non- operational. Critical shortages of medicines reported in Sharpur and Damorai markets. Increased hygiene promotion needed in Sharpur and Towa towns, Shangla district in KPK.
According to UNFPA, more female health care providers (especially gynecologists) in flood-affected districts are needed due lack of access to reproductive health services and limited funds.
Overall funding of the health sector's emergency response projects had reached 43% of the US$56.2 million requested as of 28 August, according to OCHA.

For further information contact: health_cluster_bulletin@pak.emro.who.int
Please submit your organization's activities by 5pm daily using the above email address.
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Giuseppe Michieli
August 30th, 2010, 11:15 AM
Diarrhoeal treatment capacity increasing in Pakistan, but sustained support needed (WHO/EMRO, edited)


[Source: World Health Organization, Regional Office for Eastern Mediterranean (EMRO), full PDF Document (LINK (http://www.whopak.org/idps/documents/pr/Press%20Release-%20Pakistan-%20floods.pdf)). Edited.]

Press Release 10
30 August 2010

Diarrhoeal treatment capacity increasing in Pakistan, but sustained support needed

30 August, 2010 ¦ ISLAMABAD


The World Health Organization is establishing diarrhoeal treatment centres throughout flood-ravaged Pakistan, a key intervention by the humanitarian health sector as it strives to protect people against epidemic-prone acute water-borne diseases, reduce excess deaths and restore routine health care services.

According to new data issued 29 August, 500,635 people are recorded to have been treated have been treated for the various forms of diarrhoeal disease, ranging from acute watery diarrhoea, bloody diarrhoea (shigella) and milder variations including. This number represents 13% of the 3.7 million people recorded to have been treated between 29 July and 26 August. On 26 August alone, 19,178 cases of acute diarrhoea were reported.

Dr Hussein Gezairy, WHO Regional Director for the Eastern Mediterranean has warned against the increased risk of diarrhoeal diseases in the floods-striken areas, pointing that this increase is due to there being no, or a lack of, access to safe water for flood- affected people, as well as poor sanitation and compromised hygiene and living conditions that millions displaced by the floods are forced to live in.

“More than 60 diarrhoeal treatment centres (DTCs) are operational or are in the process of being established in 46 of the most affected districts. USAID and the Office of US Foreign Disaster Assistance is funding the establishment of these centres, which are being operated by nongovernmental organization partners and Pakistani health authorities”. He added "The terrible scale of this disaster has shocked the entire world, and the increasing trend of diarrhoeal diseases remains a grave concern to the humanitarian community ," says Dr Guido Sabatinelli, WHO's representative to Pakistan. "The current situation remains a major threat to public health. If the current poor environmental and hygiene situation in affected areas does not improve, coupled with limited availability of safe drinking water and the need for better access to health services, the risk is we may see more potentially fatal diarrhoeal and other acute waterborne diseases cases in coming days."

Diarrhoeal diseases are not the only public health risks facing Pakistan's flood-affected people.

Acute respiratory infections, hepatitis A and E, malaria and skin infections are among multiple health threats that have already sickened hundreds of thousands of people.

The combination of challenges preventing many people reaching healthcare is worrisome, requiring health providers to intensify efforts both to deliver health services directly to those who need it and find alternative means, such as by air, to reach communities isolated by floodwaters.

"More than 400 hospitals and clinics have been damaged by this disaster, destroying in the blink of an eye services that have been built up over 60 years. And the worst is not over yet," Dr Sabatinelli says. "The waters could remain for weeks, and the damage caused will remain even longer. The humanitarian community has a monumental task to protect the health of so many vulnerable people. And this will require sustained international support."

WHO and Health Cluster partners have sought US$56.2 million to conduct life-saving health programmes in the Pakistan Initial Floods Emergency Response Plan 2010 launched 9 August.

So far, just 43% has been covered by pledges or commitments for the plan, which covers relief efforts for the first 90 days of the emergency. WHO has delivered to healthcare providers supplies capable of treating 2.6 million people since the crisis started to treat a range of illnesses, including diarrhoea.

"More funding is urgently needed to deliver health services to extremely vulnerable communities now, and sustained support will be needed in the months ahead as well as Pakistan tries to rebuild its health system for the future," Dr Sabatinelli says.


For more information, go to (LINK (http://www.whopak.org/idps/documents/diseases_Sitrep/Weekly-Epidemiological%20Bulletin-1-23082010.pdf))

Contacts:


Paul Garwood, Communications Officer, Pakistan mobile: +92-(0)-301-855-1459, Swiss mobile: +41-79-47-55546, Swiss office: +41-22-791-3462, garwoodp@who.int
Gul Afridi, Media & Advocacy Officer, Mob: +92-300-501-0640, Off: +92-51-8432486, afridi.gul@gmail.com, afridig@pak.emro.who.int
Syed Haider Ali, Communications Officer, Mob: +92-300-4005944, focus_ali@yahoo.com, ALISY@pak.emro.who.int

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Giuseppe Michieli
September 1st, 2010, 05:37 AM
Daily Epidemiological Update - Flood Response in Pakistan - 1 September 2010 (WHO, edited)


[Source: World Health Organization, full PDF Document (LINK (http://www.who.int/hac/crises/pak/sitreps/pakistan_epi_1sept2010.pdf)). Edited.]

Daily Epidemiological Update - Flood Response in Pakistan - 1 September 2010

This daily epidemiological update is published jointly by the Federal Ministry of Health, Government of Pakistan and World Health Organization (WHO), Pakistan. For correspondence: Tel: +92-051-9255184-5; fax: +92-051-9255083; E-mail: wr@pak.emro.who.int; eic.nih@gmail.com


Highlights

Date received on 30 August 2010


47 out of the 73 flood affected districts in four provinces have reported over the last 24 hours compared to 37 districts reported on 29 August 2010.
932 fixed health centers and 526 mobile medical outreach centers have reported to the Disease Early Warning System (DEWS) over the last 24 hours;
264,329 patients’ consultations were reported over the last 24 hours compared to 157,058 patients’ consultations reported on 29 August 2010
Acute diarrhoea, acute respiratory infections, skin diseases and malaria remain the leading causes of seeking health care in the flood affected districts;
In Balochistan and Sindh province, higher number of suspected malaria cases were reported compared to either KPK or Punjab provinces;
Sporadic cases of acute watery diarrhoea, laboratory confirmed as Vibrio Cholera 01 Ogawa, have been reported from multiple foci in KPK, Sindh and Punjab province.


Alerts received over last 24 hours

[Province - District/Place - Disease - No of alerts]


KPK - DI. Khan/Village Chaudwan; Mahra; UC Nai - AWD - 3
Sindh - No Alert
Balochistan - No Alert
Punjab - No Alert
AJK - No Alert


Cumulative number of selected health events reported from the flood affected districts (29 Jul-30 Aug)

[Disease - Number - % of total consultations]


Acute Diarrhoea - 559,021 - 13%
ARI - 627,303 - 15%
Skin Diseases - 823,281 - 19%
Suspected malaria - 112,406 - 3%
Total consultation - 4,251,900


Major health events reported during the epi-week -34 (21-27 Aug)

[Disease - Number - % of total consultations]


Acute Diarrhoea - 198,793 - 14%
ARI - 215,619 - 15%
Skin Diseases - 295,193 - 21%
Suspected malaria - 45,459 - 3%
Total consultations - 1,413,980


Major health events reported during last 24 hours (30 August 2010)

[Disease - Number - % of total consultations[


Acute Diarrhoea - 18,623 - 7%
ARI - 73,867 - 28%
Skin Diseases - 87,087 - 33%
Suspected malaria - 6,664 - 3%
Total consultations - 264,329


Selected health events: KPK Province, 30 Aug 2010: Case counts and proportional %

[Health events - Case counts (%)]


Acute diarrhea (AD) - 1,662 (10%)
Bloody diarrhoea - 52 (0.32%)
Acute respiratory tract infection (ARTI) - 2,031 (13%)
Skin infections (SI) - 1,451 (9%)
Unexplained fever (UF) - 132 (1%)
Suspected malaria (S. Mal) - 135(1%)
Total Consultation 16,062


Selected health events: Punjab Province, 30Aug 2010: Case counts and proportional %

[Health events - Case counts (%)]


Acute diarrhea (AD) - 9,058 (5%)
Acute respiratory tract infection (ARI) - 56,115 (28%)
Skin infections (SI) - 76,853 (38%)
Ear Infection (Ear Inf.) - 8,170 (4%)
Unexplained fever (UF) - 13,310 (7%)
Others (OTH) - 33,642 (17%)
Total Consultation - 199,864


Selected health events: Sindh Province, 30 Aug 2010: Case counts and proportional %

[Health events - Case counts (%)]


Acute diarrhea (AD) - 7,055 (16%)
Suspected malaria (S. MAL) - 5,378 (12%)
Acute respiratory tract infection (ARI) - 7,463 (17%)
Skin infections (SI) - 8,138 (19%)
Bloody diarrhoea (BD) - 1,143 (3%)
Others (OTH) - 11,597 (27%)
Total Consultation - 43,594


Selected health events: Balochistan Province, 30 Aug 2010: Case counts and proportional %

[Health events - Case counts (%)]


Acute diarrhea (AD) - 848 (18%)
Suspected malaria (S. MAL) - 1,151 (24%)
Acute respiratory tract infection (ARI) - 419 (9%)
Unexplained fever (UF) - 218 (5%)
Bloody diarrhoea (BD) - 216 (4%)
Others (OTH) - 1,163 (24%)
Total Consultation - 4,809

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Giuseppe Michieli
September 7th, 2010, 10:54 AM
Pakistan Health Cluster - Floods in Pakistan - Bulletin No 16 - Focus on Sindh (WHO, edited)


[Source: World Health Organization, full PDF Document (LINK (http://www.whopak.org/idps/documents/bulletins/Pakistan%20Health%20Cluster%20Bulletin%2016%200309 10.pdf)). Edited.]

Pakistan Health Cluster - Floods in Pakistan - Bulletin No 16 - Focus on Sindh

3 September 2010


Highlights


Poor hygiene and sanitation conditions represent major risk factor for large numbers of flood-affected people living in informal and organised settlements in Sindh province.
Roll-out of diarrhoea treatment centres continuing and efforts need to be intensified.
Almost 4.6 million people received medical treatment in flood-affected areas from 29 July-31 August, with main health conditions reported being acute diarrhoea, acute respiratory infections, skin diseases, and suspected malaria.
Health partners treating people with stress.
Sixth Health Cluster response and coordination hub established in Hyderabad on 31 August, following Islamabad, Sukkur, Multan, Peshawar and Quetta.
47% of the US$56.2 million requested to support the health response has been funded, according to OCHA as of 1 September.


Situation overview and current scale of disaster


According to OCHA, over 18 million people have been affected by the floods.
Waters are receding in parts of northern Sindh, Punjab and Khyber Pakhtunkhwa (KPK), while severe flooding continues in southern districts including Dadu, Larkana, Qambar Shahdadkot and Thatta.
In Thatta, the full extent of the disaster is undetermined but 823,000 people in 436 villages are estimated to have been affected. Further OCHA information, go to: (LINK (http://tinyurl.com/26f3z28))


Health impact


Health needs remain great as relief efforts strive to cope with the scale of the challenges. Large numbers of people continue being treated for diarrhoeal disease cases, skin diseases, acute respiratory and increasingly, malaria.
OCHA Sukkur office reports that due to poor health and hygiene situations in camp settings, authorities want people to leave temporary settlements to move to more organized camps, but waiting for enough shelter to accommodate them.
At least 452 of the 2957 health facilities in 33 flood-affected districts have been damaged or destroyed.
Latest epidemiological data released by WHO, as of 3 September, shows that on 1 September, 135,719 patients were recorded as having been treated in flood-affected districts. Of these consultations, 18,539 cases of skin diseases (14% of total), 24,738 cases of acute respiratory infections (18%), 18,202 cases of acute diarrhoea (13%) and 6549 cases of suspected malaria (5%) were reported.
In all, almost 4.6 million people are reported to have been treated from 29 July to, and including, 1 September. Of these, there were 610,606 cases of acute diarrhoea (13% of total consultations), 671,476 cases of acute respiratory infection (15% of total consultations), 861,986 cases of skin disease (19% of total consultations) and 126,683 cases of suspected malaria (3% of total consultations) were reported from flood-affected districts.
The number of cases of suspected malaria is rising faster in Baluchistan and Sindh provinces. During the last 24 hours, the number of cases reported from suspected malaria comprised 20% of patients’ consultations in Baluchistan province and 12% in Sindh provinces.

WHO's weekly disease surveillance document id as: (LINK (http://www.whopak.org/idps/diseases_situation.asp#ds))


Government response


The Federal Ministry of Heath has positioned medical teams in Kashmore and Khairpur districts of northern Sindh province, Sibi district of Baluchistan, and Nowshera district of KPK.
Federal mobile teams are active in multiple districts treating patients including in:

Punjab province: D.G. Khan district (17 days treated 3598 patients), Rahim Yar Khan (17 days treated 3241 districts); Jhang district (17 days treated 6795 patients); Rajanpour district's Kot Mithan area (16 days treated 4108 patients) and Jampur (16 days treated 4490 patients); Muzaffargarh district's Yadgar Chowk (7 days treated 3408 patients.)
Sindh province: a 10-member mobile medical team operating in Khairpur (in 4 days treated 835 patients) and Kashmore (3 days treated 345 patients) districts; a 10-member team is operating in Khandkot and a 7-member team deployed to Sanghar.
Baluchistan province: 10-memebr mobile team operating in Sibi district.
KPK: 5 10-member teams deployed to Charsadda and Alizai, 6 8-member teams deployed to Nowshera district. 8 medical teams of 4-8 volunteer health workers deployed 3 September to Nowshera and Charsadda.

District health authorities throughout Sindh are serving affected communities, including:

Hyderabad: 5 mobile medical teams and 29 fixed medical stations are serving 58 relief camps for 33,414 people.
Thatta: 23 mobile medical teams and 84 fixed medical stations are serving 823,000 people in 436 villages.
Jamshoro: 9 mobile medical teams and 66 fixed medical stations are serving 94 relief camps. The University Hospital laboratory is also supporting the camps. An estimated 178,000 people in 130 villages have been affected.
Badin: 4 mobile medical teams and 36 fixed medical stations are serving 9724 persons who have moved to Badin from other districts.
Tando Mohamad Khan: 2 mobile medical teams and 8 fixed medical stations are serving 44 camps for 7185 people.
Shaheed Benazirabad (Nawab Shah): 5 mobile medical teams and 2 fixed medical stations are serving 54 camps for 8550 people. Peoples Medical College is also serving affected people.
Matiari: mobile medical teams and 37 fixed medical stations are serving 30 camps for 5137 people. A total of 23,456 persons from 31 villages have been affected.
Sukkur: Health care team from the National Institute of Child Health has established in-patient services with emphasis on pediatric patients at the Railway Hospital, Sukkur district.

The Pakistan Army Medical Corps is providing large-scale support across the country. A detailed breakdown in table form is found below in Annex 1.
Medical teams from multiple countries are also supporting relief efforts, in coordination with Pakistani authorities, and a table indicating some of the support obtained to date is found below in Annex 2.


Health Cluster response

(Inputs received before 4PM Thursday 28 August through health_cluster_bulletin@pak.emro.who.int)


UNFPA is delivering health care in Sindh, Punjab and KPK provinces through 23 mobile units for outreach services and 14 government health facilities for emergency reproductive health care services. Up until 1 September, UNFPA has provided 59,664 patients with reproductive and primary health care services. So far 1222 deliveries have been conducted, 7395 antenatal and 1636 post-natal consultations, delivered 250 post-abortion care services, 92 referrals for cesarean section, 548 syndromic case management of sexually transmitted infections and 638 family planning consultations.
World Health Organization is providing medicines and related supplies to all Health Cluster partners. Until 1 September, it had delivered items that can treat more than 3.6 million people for one month. WHO is supporting the establishment of diarrhea treatment centres in affected districts. 33 diarrhoea treatment centres have been established and are operational in flood-affected districts within the four provinces. More than 20 are in the process of being established. Through support from IOM and the Office of US Foreign Disaster Assistance, WHO is receiving 7 inflatable boats that can be used to deliver mobile health care to isolated communities. The boats are for the hubs in Sukkur, Hyderabad and Multan.


Sindh province


CARE International provided primary health care services via 9 mobile clinics to 1477 patients in Sukkur and Shikarpur districts, including 722 women and 420 children, on 28-31 August.
Helping Hand for Relief and Development (HHRD) launched a hygiene promotion project in Sukkur district, will conduct health and hygiene awareness sessions, and distribute hygiene kits to 500 families (35 00 people). Clean drinking water will also be provided.
Mercy Corps is operating 2 mobile health teams in Sindh province's Sukkur, Rohri and Pannu Aqil districts, delivering primary health care and maternal, newborn and child health services. The mobile teams contain ambulances, medicines, and health and hygiene kits. Mercy Corps health teams deliver health and hygiene sessions and provide clean delivery kits to pregnant women. Mercy Corps is also supporting water and sanitation activities. Mercy Corps is planning to replicate the same services in Jacobabad, Shikarpur and Jaffarabad.
Save the Children is working in Jacobobad and Shikarpur, supporting 30 fixed health and 12 mobile teams, providing water and sanitation items in Thul, purification sachets, buckets, and can establish a diarrhoeal treatment centre in Thul. Save the Children is also willing to handle Thul district level health coordination, feeding into the overall northern Sindh Health Cluster coordination network.
UNICEF is supporting childhood vaccination campaigns in camps providing shelter for flood-affected people, with continuing vaccinations planned for areas where people have moved to, including Karachi. More then 164,500 vaccinations were conducted in flood-affected districts of Sindh. The Expanded Programme of Immunization vaccinated 46,880 children against measles, 51,599 against polio and 41,401 children received Vitamin A supplements. More than 10,000 patients have been treated at UNICEF-supported medical facilities in Sindh, while messages on safe motherhood, breastfeeding, clean drinking water, hand washing and immunization are being provided.
UNICEF/WASH Cluster is focussing on how to have highest impact for health, which is hygiene and sanitation.
WASH and government clean water capacity is covering 10-15% of needs in Sindh, and no extra capacity. On 31 August, a new strategy was launched agreeing to revise Sphere standards to 3.5 litres per day per person (standard 15 litres) and 1 toilet for 100 people (standard 1 per 20 people), but we are still reaching only 20%. Need to scale up digging of defecation trenches, but it depends on the public covering waste. Vector control needs to be scaled up.
World Vision: Sending medical teams to Shakarpur district and Khaipur district's Subaiduru area (6000 households) here it is delivering primary health care services. World Vision will also set up a diarrhoeal treatment centre in Subaiduru and Gombut areas.
The World Health Organization has established a new hub in Hyderabad to coordinated health response activities in southern Sindh province.
WHO Conducted Diseases Early Warning System (DEWS) training of trainers in Sukkur and Hyderabad to health care workers and district government officers during 25- 31 August. Health Cluster partners participated in these trainings.
WHO is also planning to send a 20-bed inflatable hospital to the severely flood-affected Sindh province town of Thul.


Punjab province


CARE International mobile clinics operating in Muzaffargarh district of southern Punjab province on 28-31 August delivered primary health care services to 1712 patients, including 581 women and 739 children.
Cordaid has scaled up its health response, operating 5 mobile medical teams in Shangla, and 2 more teams are scheduled to start in Kohat shortly. Cordaid Team A is working in Shangla's most affected areas with mobile and fixed health services in Barkana, Kuzana, Karora, Damorai, Olandar and Shapur. The Cordaidsupported basic health unit in Kuzana is delivering healthcare. A lady health volunteer is travelling from Kuzana to Shapur delivering health services to females.
NAGE-Pakistan is providing health services through a static and mobile medical camp at Chakar Dari union council, Pattal number 4 of Tehsil Kot Adu, in Muzaffargarh distrct. The mobile camp treated 700 patients (334 female and 100 male and 266 children under five) during 27-28 August. Skin infections, diarrhea and acute respiratory tract infections were the main causes of morbidity.
Helping Hand for Relief and Development (HHRD) has conducted 13,992 consultations through 53 mobile camps in Layyah, Mianwali, Muzaffargarh and DG Khan.
Islamic Relief Pakistan plans to operate 3 more mobile health clinics for Muzaffargarh by 4 September.
MERCY Malaysia conducted joint assessment with Pakistan Islamic Medical Association to Punjab for theopportunity to expand health services in southern Punjab.
Medical Emergency Relief International (MERLIN) is establishing a diarrhoea treatment centre at the Muzaffargarh district headquarters hospital, and its teams are already delivering health services there. The centre's first consultations are expected to occur this week.
UNICEF is delivering medical and nutritional supplies to 7 Punjab districts of Mianawali, Bhakkar, DG Khan, M. Garh, Layyah, Rajan Pur, RY Khan, Khushab and Multan. Health education sessions are being conducted in displaced people's camps in RY Khan. UNICEF-supported medical officers, lady health volunteers and vaccinators are providing health care services in all Punjab displaced people's camps. Some 9287 children were vaccinated for measles and 6300 children were given Vitamin A supplements.
The World Health Organization conducted Diseases Early Warning System (DEWS) training of trainers in Multan for health care workers and district government officers during 25- 31 August. Health Cluster partners participated in these trainings.


Khyber Pakhtunkhwa


American Refugee Committee (ARC) International treated 3490 children, women and men on 30-31 August at 7 health facilities it supports in Swat district. Common fever was the leading cause of morbidity (34%) followed by respiratory tracct infection.
CARE International operates 2 mobile teams and 4 basic health units in Upper Swat and treated on 30-31 August 654 patients (including 269 women and 385 children). CARE conducted 7 mobile clinics Charsadda district on the same days, providing primary health care services to 846 patients including 309 women and 268 children, and 12 mobile clinics in Nowshera district, treating 1293 patients including 334 women and 595 children. Altogether 58 health and hygiene sessions were conducted in KPK benefiting 1125 persons.
Church World Service (CWS) operates 3 mobile health units in Mansehra, Kohistan and Swat districts, delivering consultations to 4618 patients on 31 August. Lady health visitors examined 124 antenatal and 12 postnatal clients and provided essential medicine. The medical team examined 747 children aged under 5 years.
International Catholic Migration Commission mobile teams on 27 August treated 66 flood-affected people staying at the Prang Primary School in Utmanzai Union council in KPK's Charsadda district.
International Medical Corps (IMC) medical teams are delivering emergency health services in Nowshera and Charsadda districts. IMC and WHO are working together to operate a diarrhoea treatment centre at the Nowshera district headquarters hospital. IMC medical teams treated more than 1066 patients from 28-31 August, with acute diarrhoea, acute respiratory infections and scabies being the main conditions. Its psychosocial support team conducted 49 sessions in the Peshawar, Nowsehra and Charssada districts and identified 12 cases of complex stress related issues for further care and referral other than common cases of depression, anxiety and distress.
Helping Hand for Relief and Development (HHRD) has conducted 37,298 consultations through 199 mobile camps in Charsadda, Dir, Swat, Nowshera and Buner.
Doctors Worldwide has completed basic refurbishment of Pir Sabaq basic health unit in Nowshera district. Clinical activities ongoing and on average more than 200 patients a day are given medical treatment, including short stay observations and treatment, plus transfer of critically ill patients. The organization is also supporting the Ganderi basic health unit in Nowshera, where approximately 600 patients were treated during 29-31 August.
MERCY Malaysia is collaborating with the Pakistan Islamic Medical Association to operate static clinics for floodaffected people in KPK. A mobile medical team is providing health services in Charsadda district. MERCY Malaysia will help establish a static clinic at Pabbi Government High School, which is occupied by 200 displaced families; and a mobile team is supporting displaced people living nearby. MERCY is delivering hygiene kits and conducting hygiene promotion activities in KPK.
Medical Emergency Relief International (MERLIN) is operational in Swat, Buner, and Nowshera districts, covering an approximate catchment population of 1 million people, and is starting interventions in Charsadda. Merlin currently provides health services through 27 static clinics (11 Swat, 10 Buner, 6 Jalozai) and 17 mobile teams (9 Swat, 3 Buner, 5 Nowshera), while 1 diarrhoea treatment centre is functional at the Satellite Hospital in Nowshera's Pabbi town, and 1 in Matta town, Swat. 2 centres are also being established at Pacha Kaly in Buner district and Charsadda district. Merlin is conducting an average of 6042 daily consultations and has conducted around 121,396 consultations from 5-31 August. Services include primary health care, referrals to tertiary level facilities, distribution of hygiene kits, water purification tablets, maternal and newborn health.
The Pakistan Red Crescent Society and the German Red Cross are conducting joint activities in Nowshera district, providing treatment for water-borne diseases, acute respiratory infections and a wide range of other conditions. Routinehealthcare is also being delivered, including for hypertension and the delivery of babies. The organization provided health support to more than 1000 people from 25-28 August. From 31 July-28 August, 9899 people were treated (5281 males, 4158 females).
Islamic Relief Pakistan established two mobile health clinics last week for the flood-affected communities in four union councils of Nowshera and Charsada districts. As of 31 August, 2410 consultations have been conducted. Skin problems, acute respiratory infections and eye diseases are the top three health concerns.
Relief International medical staff have treated 615 people at the Madyan medical camp in Swat district from 28-31 August, with the main health conditions being acute diarrhoea and respiratory infections. It distributed water purification tablets among the community. In Lower Dir, Relief International is using a mobile unit to reach affected communities, treating 535 patients. A health education session was conducted on diarrhoeal disease control and prevention.
UNICEF is supporting routine expanded programme of immunization activities in Peshawar, Charsadda, Nowshera and D.I. Khan districts, completing a campaign on 30 August that vaccinated 15,029 children aged under 5 against polio, 21,089 children (6-59 months) against measles and providing 449 children with Vitamin A supplements. So far 285,154 under five children have been vaccinated for polio, 253,511 (6-59 months) for measles and 257,561 children were given vitamen A supplements.
UNICEF-supported mobile medical teams are operating in Charsadda, Nowshera, Swat, D.I. Khan and Kohistan districts, providing primary health care services to 29,767 persons. The organization is distributing health-related materials including hygiene kits and delivering health and hygiene messages. UNICEF is supporting specialized pediatric services are provided at D.I. Khan district headquarters hospital benefiting 699 children and 474 children through mobile services in the district. The first round of mother and child days have been completed in 6 union councils of Swat benefiting 12,818 people.


Baluchistan province


American Rescue Committee International is supporting the rural health centre in Talli town, Sibi district, where 221people were treated (93 men and 128 women) on 28-30 August. At the ARC-supported basic health unit in Chandia, 89 patients were treated on 30 August (56 women and 33 men) mainly for diarrhoea, bloody diarrhoea, upper acute respiratory infections, lower acute respiratory infections, scabies and injuries.
Relief International is working in Dhadar town of Kachi district, conducting 535 consultations between 28-31 August. Main conditions reported include acute respiratory infections and acute watery diarrhoea. Health education sessions have been conducted for mothers and male members of the community, as well as for use of oral rehydration solution. Water purification tablets have been distributed.
UNICEF-supported health services are operating in Barkhan, Kohlu, Sibi, Naseerabad, Jaffarabad and Harnai districts of Baluchistan, treating 9400 patients on 24-25 August, including for diarrhoea (21% of cases), clinical malaria (23%) and scabies/skin diseases (135). UNICEF is conducting polio, measles, tuberculosis and tetanus vaccination campaigns in Baluchistan's 6 most affected districts (Barkhan, Kohlu, Sibi, Naseerabad, Jaffarabad and Kachhi) and a relief camp at Eastern Bypass in Quetta. UNICEF is supporting malaria control activities that are being conducted by health authorities in Sibi, Naseerabad and Jaffarabad districts. 500,000 Aquatabs were sent to Naseerabad, Jaffarabad, Sibi, Kohlu and Barkhan districts, which were sufficient to treat 2.5 million litres of drinking water. 4000 extended family hygiene kits, jerry cans and buckets (500 each) were distributed in five districts (Barkhan, Kohlu, Sibi, Naseerabad and Jaffarabad) benefiting 28,000 people.


Azad Jammu and Kashmir (AJK)


UNICEF provided 1 IEHK, 5430 packs (100 each) of dispersible zinc tablets and 1086 cartons of oral rehydration solution were sent to the Department of Health.


Gilgit Baltistan


UNICEF provided 1 Inter Agency Emergency Health Kit, 3714 packs of zinc tablets and 3714 cartons of oral rehydration solution dispatched to Department of Health.


Coordination


GOVERNMENT COORDINATION: On 4 September, Federal, provincial and district authorities, along with WHO, UNICEF and UNFPA representatives, will meet to plan on malaria control, diarrhoeal treatment and reproductive health interventions. Needs of provinces in these 3 areas will be identified with a view to understanding resources needs to fill gaps.
NEW HYDERABAD HUB: An additional coordination hub has been established in Hyderabad to provide relief to an estimated 500,000 severely affected population in southern Sindh. The Health Cluster has established an office inside the OCHA coordination hub in the Revenue Building, Hyderabad. The first Health Cluster Coordination meeting chaired by the coordinator for the Hyderabad Hub was held on 1 September and the email address for health partners to share information with the cluster is whohyderabad@gmail.com
WASH-HEALTH: WHO is working with and WASH Cluster lead UNICEF to reach safe drinking water, hygiene and sanitation supplies to flood-affected communities. The first joint Health and WASH cluster meeting was held in Islamabad on 31 August. A Sukkur-level coordination meeting was held 31 August during which revised strategy for provision of drinking water was announced. Limited capacities and access to water has resulted in the Sphere standard of 15 litres of safe drinking water per person reducing to 3.5 litres. MSF Netherlands is providing safe drinking water that WHO can distribute in a tanker to Sukkur city's Railway Hospital, which has limited water supplies.
DIARRHOEAL DISEASE: An emergency meeting of the Sukker Health Cluster was held 1 September to plan for response to acute watery diarrhoea cases and map gaps. Key action points included.

Identify focal points for different groups of interventions to control acute watery diarrhoea.
Appoint focal points to provide situation analysis with gaps and strategy for immediate gap filling.

UNICEF and IOM working together to support social mobilization, with backing of cluster partners, to do grass roots health education and messaging with social mobilization officers. Production of materials.


Gaps/challenges


There is an unequal distribution of health partners in southern Sindh districts, exacerbating healthcare delivery gaps.
Throughout affected districts, particularly in Sindh and Punjab provinces, poor standards of hygiene and sanitation continue to pose major health risks.
In northern Sindh, district authorities reported on 28 August reported that diarrhoea treatment centres of Kashmore, Khairpur, Shikarpur, Kambar/Shahdad Kot, Larkana, Jacobabad, Ghotki and Nowsheroferoz are requiring either medical staff or additional medicines.

For further information contact: health_cluster_bulletin@pak.emro.who.int
Please submit your organization's activities by 5pm daily using the above email address.


Annex 1

Pakistan military medical support to flood-affected communities (3 Sept)

[Province - Mobile teams - Field hospitals - Districts operating]


Sindh - 30 - ... - Ghotki, Larkana, Shahdadkot, Danglalcha, Jacobobad, Kashmore, Khandhkot, Sukkur, Shikarpur, Khairpur, Nowshero Feroz, Nawab Shah, Jamshoro, Kotri Barrage, Thatta, Dadu, T.M. Khan, Matiari, Hyderabad, Latifabad.
Punjab - 15 - ... - Rajanpour, Kot Addu, Lyia, Muzaffargarh, Tonsa Sharif, Alipur, Multan (Sultan Colony), D.G. Khan, Bahawalpur, Chathra Sharif, Icha Bunglaw, Jammaldin Wali, Rahwari.
KPK - ... - 5 - Nowshera, D.I. Khan, Kalan, Charsadda, Jalozai.
Baluchistan - 3 - ... - Khandkot, Bakhpiarabad, Jhalnagsi.
Total - 48 - 5 - 43


Annex 2

Foreign medical teams supporting Pakistan flood relief effort (not complete)

[Country - Arrived - Capacities - Where operating]


China - 26-Aug - 55 member hospital multi-disciplinary team, including mobile field hospital, medical equipment, doctors, nurses, surgeons, cardiologists. - Thattar district, Sindh province.
Australia - Approx 26-Aug - 72-member army medical corps multidisciplinary team with mobile field hospital - Kotaddu district, Punjab province
Saudi Arabia - 25-Aug - 2 100-bed field hospitals with 70 staff each. - Rajanpour, Punjab province and Thatta, Sindh province.
Saudi Arabia - 25-Aug - Medical team with 18 specialists, medicines - District Headquarters hospital, Nowshera, KPK province.
Indonesia - 26-Aug - 6-member team supporting Pakistan Institute of Medical Sciences. - Charsadda district, KPK
Spain - 26-Aug - 8-member medical team, provided 13 tons of medicines to the Ministry of Health - Sukkur district, Sindh province.
Physicians Across Continents - 26-Aug - Multidisciplinary team that has provided planeload of equipment, water filtration plants. - Nowshera and Charsadda.
Jordan - 16-Aug - Medical team - Multan

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Treyfish
September 7th, 2010, 06:56 PM
WHO steps in to prevent outbreak of malaria in camps
ISLAMABAD: The World Health Organisation (WHO) will provide ambulances, vans and bed nets to the internally displaced people to protect them from outbreak of malaria in the makeshift camps, WHO Regional Director Dr Hussain A Gezairy said on Tuesday.

Talking to reporters, he said his organisation had already provided essential medicines, including malaria and diarrhoea kits, to the medical teams working in the flood-affected areas.

Earlier, Gezairy called on Federal Health Minister Makhdoom Shahabuddin, along with two other WHO officials, Dr Guido Sabatinelli and Dr Farah Shadoul, and discussed health issues concerning the flood affectees.

The minister welcomed the WHO regional director and thanked him for talking interest in undertaking visits to various flood-affected areas in Pakistan. staff report:tiphat:http://www.dailytimes.com.pk/default.asp?page=2010%5C09%5C08%5Cstory_8-9-2010_pg7_22

Giuseppe Michieli
September 8th, 2010, 10:43 AM
WHO's regional director inspects flood-affected southern Pakistan, visits diarrhoea treatment centre (9/08/10, edited)


[Source: World Health Organization, full PDF Document (LINK (http://www.who.int/hac/crises/pak/releases/pakistan_press_release_5september2010.pdf)). Edited.]

WHO's regional director inspects flood-affected southern Pakistan, visits diarrhoea treatment centre


5 September, 2010 ¦ MULTAN -- The World Health Organization's top official for the Eastern Mediterranean region visited areas in southern Punjab today affected by Pakistan's devastating floods, meeting with senior health officials and assessing one of the health facilities dedicated to treating diarrhoeal disease cases.

Dr. Hussein Gezairy praised the work of Punjab's provincial health authorities in their response to this unprecedented crisis, which has left millions of people vulnerable to water-borne diseases and destroyed and damaged hospitals and clinics.

Accompanying Dr Gezairy were Chief Minister of Punjab, Mr. Mian Mohammed Shahbaz Sharif, Federal Secretary of Health, Mr Khushnnod Lashari, and Dr. Jehanzeb Aurakzai, the coordinator of Pakistan's Health Emergency Preparedness and Response Network.

Dr Gezairy was flown by helicopter to survey the impact of the flooding in the Punjab districts of Muzaffargarh, Rahim Yar Khan, Dera Dhin Panah, Rajanpur and Layyah.

Later, Dr Gezairy helped open the WHO-supported 25-bed diarrhoea treatment centre, run by Save the Children, in Multan city's Fatima Hospital. More than 10 medical staff operate the centre around the clock. The centre is one of several operating in southern Punjab, along with the 47-bed facility run by UK NGO, the Medical Emergency Relief International (MERLIN).

Since the flood crisis started in late July, more than 3 million people have received medical consultations in Punjab, including 361,718 for acute diarrhoea, 618,165 for skin diseases, 444,193 for acute respiratory infections and 374 suspected malaria cases. At least 242 health facilities were damaged or destroyed in the province.

In response, WHO has distributed medicines to partners to cover the potential health needs of 703,000 people in Punjab, including 57 emergency health kits, 63 diarrhoea disease kits and 150 vials of anti-snake venom.


For more information:

WHO Pakistan, Gul Afridi, Media & Advocacy Officer: Mob: +92-300-501-0640, Off: +92-51-8432486, afridig@pak.emro.who.int

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Giuseppe Michieli
September 8th, 2010, 10:46 AM
This thread contains some of the reports about health situation in Pakistan compiled by WHO headquarters and regional office.

Giuseppe Michieli
September 8th, 2010, 11:51 AM
Pakistan: Health Clinics on the Move to Save Lives Across the Country (Relief Web, via WHO website, edited)


[Source: ReliefWeb, via WHO Website, <cite cite="http://www.reliefweb.int/rw/rwb.nsf/db900sid/MMAO-893BV8?OpenDocument&RSS20&RSS20=FS">ReliefWeb » Document » Pakistan: Health Clinics on the Move to Save Lives Across the Country (http://www.reliefweb.int/rw/rwb.nsf/db900sid/MMAO-893BV8?OpenDocument&RSS20&RSS20=FS)</cite>. Edited.]

Pakistan: Health Clinics on the Move to Save Lives Across the Country

Source: United Nations Office for the Coordination of Humanitarian Affairs (OCHA) (http://ochaonline.un.org/)
Date: 06 Sep 2010
(New York / Geneva / Islamabad: 06 September 2010):


The World Health Organization (WHO), Pakistani health authorities, and partners, are currently operating almost 1,200 mobile health teams in flood-affected areas of the country.

"During this crisis, these mobile clinics are very effective. For many people, these are the only places where they can receive health care", said Dr. Guido Sabatinelli, WHO's Representative to Pakistan.

Dr. Hussein Gezairy, WHO's Regional Director of its Eastern Mediterranean office, said: "When these clinics enter affected areas, they provide basic emergency health care services, which include medical consultations, vaccinations, maternal and child care, management of non-communicable diseases, and health education. The whole mobile mechanism is a key component of the overall emergency health response strategy, and the delivery of outreach medical services".

So far, more than two million people have received medical care through this system. The most frequent health conditions observed are acute respiratory infections, skin and eye diseases, and diarrhoeal diseases.

More than 1,200 health volunteers, recruited through a drive called by the Government of Pakistan, have been enrolled in a programme of mobile health teams in affected districts in support of residual health services.

Non-governmental organizations (NGOs) and Pakistani health authorities are key partners in this endeavour in flood-affected provinces. These include the International Medical Corps, Medical Emergency Relief International (MERLIN), Médecins du Monde – France (MDM-F), Centre of Excellence for Rural Development, Sahara, Friend Foundation, Muslim Aid Pakistan, National Rural Support Program, Swat Participatory Council, Islamic Relief, Family Planning Association of Pakistan, the Tahliq Foundation, the Initiative for Development and Empowerment Axis (IDEA), and the Health and Nutrition Development Society (HANDS).

Pakistani Federal and Provincial authorities, along with the country's military medical corps, have mobilized hundreds of medical teams to support flood health relief efforts.Merlin was among the first NGOs to respond with mobile clinics in the country's most severely flood-affected areas including the remote north-western Swat Valley in the Khyber Pakhtunkhwa Province (KPK). This NGO has been providing essential health care and supporting the Pakistan health system for five years, when the Emergency Response Team arrived to assist in the earthquake relief effort.

"Merlin has mobilized health teams, logistics experts and medical staff for an immediate and effective response to the devastating floods of July 2010", said Jacqueline Koch, Communications Officer of the NGO, "In many cases our teams walk for six hours, carrying up to 20 kg of medical supplies on their back, to reach those in need". Merlin teams are currently working in Buner, Charsadda, Nowshera, and Swat in KPK, and Muzaffargarh in Punjab.

For further information, please call: OCHA Islamabad: Maurizio Giuliano,+92 300 8502397 giuliano@un.org; Stacey Winston, +92 300 8502690, winston@un.org; OCHA New York: Nicholas Reader, +1 212 963 4961, mobile +1 646 752 3117, reader@un.org; OCHA Geneva: Elisabeth Byrs, +41 22 917 2653, mobile +41 79 473 4570, byrs@un.org

For specific information on health, please contact: WHO Islamabad: Gul Afridi, +92 300 5010640, afridig@pak.emro.who.int - OCHA press releases are available at http://ochaonline.un.org or www.reliefweb.int
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Giuseppe Michieli
September 14th, 2010, 12:30 PM
Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 4 Monday 13 September 2010 (edited)


[Source: World Health Organization, full PDF Document (LINK (http://www.whopak.org/idps/documents/wmmrs/wmmr_idp_w36_2010.pdf)). Extracts, edited.]

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan and World Health Organization (WHO), Pakistan . For Correspondence: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: wr@pak.emro.who.int. or eic.nih@gmail.com

Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 4 Monday 13 September 2010


Highlights


Epidemiological week no 36 (4 - 10 September 2010)

48 out of the 79 flood affected districts (61%) in four provinces are now reporting surveillance data to the Disease Early Warning System (DEWS)
903 fixed health centers and 417 mobile medical outreach centers reported to DEWS
533,169 patient consultations were reported, a decrease from the previous reporting period
Acute diarrhea, acute respiratory infections, skin diseases and suspected malaria were the major causes of seeking health care in the flood affected districts
Laboratory confirmed cases of Vibrio Cholera 01 have been reported sporadically from a number of foci in KPK, Sindh and Punjab provinces.



Epidemic prone diseases under surveillance in the flood affected areas


Acute flaccid paralysis
Acute Respiratory Infections
Bloody Diarrhoea
Cholera/Acute Watery Diarrhoea
Dengue
Malaria
Measles
Viral Hepatitis/ Acute Jaundice Syndrome


Major health events reported during the week-36 (4-10 September)

[Disease - Number - % of total consultations]


Acute Diarrhoea - 65,913 - 12%
ARI - 92,087 - 17%
Skin Diseases - 86,930 - 16%
Suspected malaria - 40,415 - 8%
Total consultations - 533,169


Cumulative number of selected health events reported from the flood affected districts (29 Jul-10 Sept)

[Disease under surveillance - Number of consultations - Percentage of total consultations]


Acute Diarrhoea - 708,891 - 13%
ARI - 802,670 - 15%
Skin Diseases - 986,843 - 18%
Suspected malaria - 182,762 - 3%
Total consultations - 5,335,581


Surveillance sites

[Province - Fixed centers - Mobile outreach]


Balochistan - 36 - 12
KPK - 87 - 72
Punjab - 312 - 176
Sindh - 468 - 157
Total - 903 - 417


Selected health events: KPK Province, Week-36 (4 to 10 Sept):

[Health events - Case counts (%)]


Acute diarrhea (AD) - 7,417 (10%)
Acute respiratory tract infection (ARI) - 10,234 (13%)
Skin infections (SI) - 7,287 (9%)
Unexplained fever (UF) - 712 (1%)
Suspected malaria (S. Mal) - 809 (1%)
Bloody diarrhoea - 145 (0.18%)
Total consultation 77,965


Selected health events: Punjab Province, Week-36 (4 to 10 Sept):

[Health events - Case counts (%)]


Acute diarrhea (AD) - 13,748 (9%)
Acute respiratory tract infection (ARI) - 30,696 (20%)
Skin infections (SI) - 30,193 (19%)
Unexplained fever (UF) - 20,283 (13%)
Injuries (Inj) - 3,766 (2%)
Ear Infections (Ear Inf) - 9,712 (6%)
Total consultation - 155,716


Selected health events: Sindh Province, Week-36 (4 to 10 Sept):

[Health events - Case counts (%)]


Acute diarrhea (AD) - 40,996 (15%)
Suspected malaria (S. Mal) - 34,579 (13%)
Acute respiratory tract infection (ARI) - 48,237 (18%)
Skin infections (SI) - 46,098 (17%)
Bloody diarrhoea (BD) - 8,065 (3%)
Total consultation - 274,362


Selected health events: Balochistan Province, Week-36 (4 to 10 Sept):

[Health events - Case counts (%)]


Acute diarrhea (AD) - 3,752 (15%)
Suspected malaria (S. Mal) - 4,978 (20%)
Acute respiratory tract infection (ARI) - 2,920 (12%)
Skin infections (SI) - 3,352 (13%)
Bloody diarrhoea (BD) - 1,009 (4%)
Total consultation - 25,126


Patient consultations

Since July 29, approximately 5,335,581 patient consultations have been reported to the DEWS from the four flood affected provinces in Pakistan. This may partially be attributed to the increase in reporting sites as well as increase in health facility utilization.

Reports were received from 903 fixed and 417 mobile health centers. However, this is a decrease compared to the preceding week (possibly due to Eid holidays).


Leading causes of morbidity

The major causes for seeking health care by the affected communities in almost all of the flood affected provinces were diarrhoeal diseases, acute respiratory infections, skin diseases and suspected malaria.

Increasing cases of suspected malaria were reported in Balochistan and Sindh, while unexplained fever has increased in Punjab (Figure-2).

The number of cases of diarrhoeal diseases continue to rise in KPK (Figure-7 and 8 ) and is proportionally higher compared to the corresponding reporting period from 2009.


Alert/Alarm thresholds

A total of seven alerts were raised during this last reporting period. Out of these, six alerts were flagged for suspected acute watery diarrhea (3 from Sindh, 2 from KPK, 1 from Punjab) and one alert was for measles (Sindh). In the Sindh province, alerts were reported from Kashmore, Jacobabad and Umerkot districts. In the KPK province, one alert for AWD was reported from DI Khan and Nowshera districts, respectively. One alert for suspected measles was reported from Kashmore district in Sindh province.

Laboratory samples were collected from all sites, as necessary, and sent to National Institute of Health (NIH) for laboratory confirmation.

Relevant public health actions were initiated in the field to arrest a potential outbreak.


Outbreak Alerts reported during the current reporting week

[Event - Place - District - Province - Action taken]


AWD - RHC Parora - DI Khan - KPK - Lab. Test negative
AWD - Pabbi, Jalozai camp, and Kurwai village - Nowshera - KPK - Sample collected and test under process
AWD - THQ Alipur - Muzaffarabad - Punjab - Lab. test Negative
AWD - Khahi Village - Kashmore - Sindh - Sample collected and test under process
AWD - UC Thull - Jacoabad - Sindh - Sample collected and test under process
AWD - Gamoori Palli Village - Umerkot - Sindh - Sample collected and test under process
Measles - Khahi Village - Kashmore - Sindh - Sample collected and test under process


Epidemic Watch

Laboratory confirmed cases of both Vibrio Cholera 01 Ogawa and Inaba have been reported sporadically from 16 of the 79 flood affected districts in the country. Cases were localized and reported from multiple foci within these districts. Fiftyseven confirmed cases have been identified (50 tested positive for Vibrio Cholera 01 Ogawa, 1 for 01 Inaba, and six for non 01). Stool samples were tested at the NIH. The districts reporting laboratory confirmed cases of Vibrio Cholera include 10 districts in KPK province, 4 districts in Sindh, 1 district in Punjab and 1 district in AJK province (Please see the map)

Until now, no major cholera outbreak has been reported from any of the districts reporting Vibrio Cholera cases. The transmission of Vibrio Cholera remains localized, and the geographic spread seems to be limited. There are higher number of cases in some foci, however, these reporting sites also have stronger surveillance system in place. Health education, personal hygiene promotion and risk communication campaigns have been scaled up in the affected communities using both formal and nonformal means. Other control measures such as chlorination, soap and ORS distribution at the household levels are ongoing.

The surveillance for Vibrio Cholera cases have been geared up in these areas to detect any evolving outbreak.

Since the beginning of the flood, all other epidemic prone diseases are being closely monitored. The progression of these epidemic prone diseases are under close surveillance through daily data analysis of surveillance data and, where possible, through comparison with past trends.

Apart from Vibrio Cholera , no other epidemic diseases have either been reported or been laboratory confirmed so far. All alerts reported during the last epidemiological week were investigated and samples (wherever necessary) were collected and tested. The result of most of these laboratory samples is negative signifying no presence of any epidemic disease in the flood affected areas.


The objective of this weekly epidemiological bulletin is to provide a snap shot on the health events occurring amongst the affected communities displaced by the current flood in Pakistan. It is built upon the daily surveillance data received from over 490 fixed and 554 mobile outreach centers which are currently operational in the 73 flood affected districts of four provinces (Balochistan, KPK, Punjab and Sindh). While every attempt is made to show and analyse the weekly trend of the epidemic prone diseases amongst the flood‐hit communities, the information presented in the bulletin needs to be interpreted in the context that precise information on the reference populations is not always available, The bulletin doesn’t provide any health information on areas not currently accessible or covered by the emergency health response operations of MoH, Pakistan and WHO.

For further information and feed-back
Epidemic Investigation Cell, National Institute of Health, Chak Shahzad, Islamabd, Paksitan. : eic.nih@gmail.com
World Health Organization, Pakistan : wr@pak.emro.who.int

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Giuseppe Michieli
September 17th, 2010, 10:39 AM
Pakistan Health Cluster - Floods in Pakistan - Bulletin No 17- Focus on Coordination (WHO, 9/17/10, edited)


[Source: World Health Organization, full PDF Document (LINK (http://www.whopak.org/idps/documents/bulletins/Pakistan_Health_Cluster_Bulletin_No_17_1220910.pdf )). Edited.]

Pakistan Health Cluster - Floods in Pakistan - Bulletin No 17- Focus on Coordination

14 September 2010


H i g h l i g h t s


Coordination among Health Cluster partners is paramount to ensure an efficient and timely response. This week has witnessed a number of initiatives to fine‐tune coordination between and within organizations.
Health Cluster partners have recently established a Reproductive Health Task Force to address the needs of around 500,000 pregnant women in the affected areas.
Cluster partners are scaling up their response and increasing health services and surveillance coverage.
According to Merlin, the number of malaria cases is expected to rise to 2 million over the next four months.


Situation overview and current scale of disaster

As the water in the northern areas of Pakistan recedes, people are moving back to their places of origin. However, the southern lowland areas of Sindh province are increasingly affected by the rising floodwaters. Manchar lake is in a dangerous state of overflow, and Jhangara town has been flooded.

The number of people believed to be affected has now almost reached 21 million. A total of 1752 people have lost their lives; the overall scale of the disaster continues to grow. Assessments in the four provinces in early September show that 436 of the 2957 health facilities were either severely damaged or destroyed.


Health impact


Out of 5.3 million consultations conducted up to 10 September, 708 891 (13%) were for acute diarrhoea, 802 670 (15%) were for acute respiratory infections (ARI), 986 843 (18%) were for skin disease and 182 762 (3%) were for suspected malaria.
The number of suspected malaria cases is rising in Baluchistan and Sindh provinces compared to Khyber Pukhtoonkhwa (KPK) and Punjab. A total of 40 415 cases of suspected malaria were reported from 4 to 10 September.
The Health Cluster plans to establish 81 diarrhoea treatment centres (DTCs) in the 41 most affected districts. More than 40 centres have already been opened.
There are around 500,000 pregnant women among the affected population. This means that many deliveries each month will be in an unsafe environment, without access to skilled birth attendants.
A total of 165 Static Health Units and almost 1200 Mobile Health Units are operating in the four flood‐affected provinces.
Acute respiratory tract infections (ARI) are the leading cause of morbidity. The number of cases of suspected malaria is rising faster in Baluchistan and Sindh provinces: over the last 24 hours, the number of cases reported accounted for 17% of consultations in Baluchistan province and 13% in Sindh province.
Paediatric malnutrition is increasingly a concern: 30 to 50% of children arriving at health facilities show symptoms of acute malnutrition. This has brought to light the pre‐existence of widespread child malnutrition in some rural areas.
HIV/AIDS is also a significant problem. Pakistan has a concentrated epidemic among injecting drug users, with a prevalence over 20% that reaches 50% in Sargodha.
According to OCHA, 50% of the $56.2 million requested by the Health Cluster has been received as of 5 September.

WHO's weekly disease surveillance document is at: (LINK (http://www.whopak.org/idps/diseases_situation.asp#ds))


Government Response

A Polio Surveillance Officer identified urgent health needs in the area of Tehsil Bareeja, District Jhal Magsi. In response, the Federal Ministry of Health dispatched a mobile team of physicians and paramedics from Karachi. The team is working in a remote are of Baluchistan where large numbers of internally displaced people (IDPs) from Sindh are sheltering. Most of these IDPs ‐ accessible only by boat ‐ were found to have major health issues. The team has seen over 1400 patients in the past five days. Between 25 and 30 of these are being taken by ambulance to Sibi/Quetta each day. Keeping medical supply lines open is a challenge; the cooperation of the EDO has been most helpful. The Ministry of Health has assumed operational control of the Railway Hospital in Sukkur, where its team of medical and nursing staff from the National Institute of Child Health is admitting pediatric patients. Health services are being conducted in collaboration with Aga Khan University Hospital, WHO and MSF. Plans to open a comprehensive DTC in the hospital are well advanced.


Health Cluster Response

Church World Service ‐ CWS

CWS‐P/A mobile health units are operating in the districts of Mansehra, Kohistan and Swat. CWS conducted 6733 consultations. Lady health visitors (LHVs) examined 142 ante‐ and 21 postnatal patients. The CWS team examined 1111 children under five years of age. CWS‐P/A teams also conducted 145 health education sessions on common health issues such as personal hygiene, skin infections, safe drinking water, sanitation, and locally endemic diseases. These sessions reached a total of 1885 community members (870 males and 1015 females).


Citizens' Commission for Human Development (CCHD)

CCHD has eight mobile camps in the district of Muzaffargarh. CCHD has provided medical care and treatment for 5500 people, and given medicines and mineral water to 5500 children suffering from diarrhoea. It also provide five safe delivery kits to pregnant women, food items to 150 families, and 20 tents to widows. It formed two village health committees and conducted health and hygiene sessions for 5500 people.


Chinese Mobile Hospital

Since 28 August, the CISAR Chinese mobile hospital based in Thatta Police Headquarter has been treating 600‐800 patients each day. The hospital has a team of 55 staff, including 36 doctors. The numbers of patients have overwhelmed the capacity of the hospital, despite efforts to control the flow of patients since 1 September. Almost half of patients are women (49.2%). Children, some of whom are less than one year old, account for another 31.5%. Skin diseases, with 21% of consultations, are the main cause of consultation, followed by acute respiratory infections (16.4%) and acute diarrhoea (7.3%). Isolated cases of communicable diseases such as dysentery and suspected malaria have been detected. CISAR aims to strengthen joint working mechanisms among relief teams and local doctors. It is welcoming local pediatricians to work with its staff.


IDEA

IDEA is providing medical relief in the form of mobile medical units (MMUs) and static units in Districts Buner and Swat, with funding from CARE International. IDEA has provided 15 latrines in schools, particularly female primary schools, as well as safe drinking water (22 schemes) for schools and communities in Tehsil Matta, Swat. IDEA has four MMUs in Nowshehra district with a male and female medical officer, LHV, a nurse and a helper providing services in UCs Nowshera‐Kalan, Kabul River, Nawi Kali, Kheshgi Bala and Kheshgi Payan, Nowshera. A water purification plant will be installed in the coming week, with as second one the week thereafter. IDA is distributing 200000 water purification sachets in Nowshehra and another 100 000 in Swat, packaged with education sessions.


ICDI PESHAWAR

Last week ICDI Peshawar organized one medical camp for women and children in UC Agra district Charsadda. A total of 179 patients were treated, included 35 pregnant and 57 lactating women, and 39 children under five years old. Most of the pregnant and lactating mothers were anaemic. Nine children under five were suffering from diarrhoea and ten women and girls had conjunctivitis. One 24‐year‐old pregnant mother was suffering from tuberculosis. ICDI has also distributed 100 aid packages (2 kg rice, 2kg oil, 2 kg sugar, one packet of vermicelli, 20 kg flour) to pregnant and lactating women in District Charsadda.


INTERNATIONAL MEDICAL CORPS (IMC)

IMC medical teams provided medical treatment to 1283 patients, including 155 cases of acute diarrhoea, 268 cases of ARI and 58 cases of scabies. The teams also conducted health education/hygiene promotion sessions for 904 people. Six members of IMC's psychosocial support team (one in District Peshawar, two in District Nowshehra and three in Charsadda) are serving the flood‐affected population. Psychosocial support sessions were conducted with 91 persons. The team identified seven cases of depression, five cases of stomach upsets, 17 cases of anxiety, two cases of insomnia, one case of anorexia and three cases of post‐traumatic stress disorder.


INTERNATIONAL ORGANIZATION FOR MIGRATION (IOM)

In southern Punjab, IOM has established two fixed health centres with mobile outreach capacity in rural health centres (RHCs) in Districts of Muzaffargarh and Rajanpur. IOM also established a fixed clinic with mobile outreach capacity at RHC Kot Mitthan. Since 6 September, IOM clinics have provided services for more than 550 patients in two centres. IOM is recruiting female medical officers to strengthen its teams. IOM doctors have mainly given treatment for diarrhoeal and skin diseases. IOM conducted a health field assessment for Thatha District in Southern Sindh in early September. It visited district health authorities and health facilities. Approximately 89 50,000 patients had been assessed by EDO health teams, which treated around 10 000 cases of diarrhoea. Skin infections and snake bites were also reported. IOM requested EDO health to provide any available information on the patient caseload, including disaggregated data for acute watery diarrhoea (including suspect cholera), dysentery, malaria, TB and other diseases.

In addition to supporting district health authorities, IOM will support the health response in southern Sindh through the establishment of fixed clinics with outreach capacity in RHC Jharrack and RHC Gharo. These clinics will become operational this week.


ISLAMIC RELIEF PAKISTAN

Islamic Relief's three mobile health clinics each in districts Nowshera, Charsaddah and Muzaffargarh are up and running. During the last three weeks a total of 7056 consultations have taken place for patients of different age groups. Children make up 60% of all consultations. Four doctors from Islamic Relief Canada are also working in the mobile health clinic in Muzaffargarh. Skin and acute respiratory infections and eye diseases are the top three causes of consultation. Islamic Relief is setting up two more mobile health clinics in Muzaffargarh.


JAPAN DISASTER RELIEF MEDICAL TEAM

A team from the government of Japan arrived on 4 September. Its resources consist of a 23‐strong medical team including four doctors, seven nurses and two pharmacists, and three tons of equipment and supplies. The team is operating in the Punjab province in the Multan area, in collaboration with a rural health establishment. So far the team treated 1511 patients including 690 females and 809 children. Major diseases include digestive disorders (31%), respiratory infections (14%), skin infections (13%) and fever (9%).


KHYBER AID

Khyber Aid is working in Civil Dispensary Amankot District Swat and running two mobile medical camps, one in Tehsil Babuzai and the other in Tehsil Behran District Swat, KPK. Khyber Aid staff have treated 1500 patients since 10 August. Most consultations were for diarrhoea, urinary tract infections, scabies and other skin diseases. Khyber Aid's medical team includes a doctor, LHV, dispenser, ambulance and medicines.


MERCY Malaysia

MERCY Malaysia is currently operating one static and one mobile clinic each in Charsada and Pabbi, Nowshera, in partnership with PIMA. MERCY Malaysia has conducted hygiene education sessions and distributed hygiene kits to 200 families in Pabbi Government High School. It is planning similar sessions in other locations. It also conducted an assessment in South Punjab to plan for an expansion of health services to the affected areas in that region. On 4 September, in partnership with PATTAN, MERCY Malaysia conducted hygiene education sessions and distributed 199 hygiene kits in Swat Valley to displaced families from Lower Dir and Malakand.


MERLIN

To address the expected surge of plasmodium falciparum outbreaks (projected to reach 2 million in the next four months), Merlin is expanding and integrating its malaria programme into existing health programmes in the emergency flood response, Merlin's medical and health teams are treating approximately 6500 patients a day through 17 mobile health units (by car, by foot or both), 28 static health facilities, and six DTUs. The top three disease priorities are acute watery diarrhoea (AWD), malnutrition and malaria. Nine of 17 mobile health units are operating in Upper Swat Valley, trekking to villages that remain inaccessible with backpacks filled medicines. One 24/7 DTC has been fully functional at DHQ Muzafargarh since 3 September 2010. To date, 1718 consultations have taken place (male 876, female 842). Over 75 000 sachets of oral rehydration salts and 28 000 hygiene kits have been distributed. As of 14 September Merlin will expand its existing programmes considerably: an office will be established in Multan and three new mobile health teams and five static clinics will be made operational in Muzaffargah district. Ten new static clinics are to be set up in Upper Swat, and five new mobile teams and five new static clinics will be launched in Charsadda District.


MDM France

Medecins du Monde (France) is providing primary health care (PHC), nutrition, immunization services, and ante‐ and postnatal care in Swabi, Buner and Kohat. MdM medical teams are also providing primary health care services in district Nowshera and Charsadda. Two DTC shave been established in Liaqat Memorial Hospital and Divisional Headquarter Hospital Kohat.


MSS

MSS is participing in the Health Cluster’s recently‐established Reproductive Health Task Force. MSS health teams are providing services in KPK, Punjab, and Sindh. Services include counselling for trauma, PHC, treatment for gastrointestinal and waterborne infections, first aid for acute injuries, treatment for acute respiratory infections, contraceptives, ante‐ and postnatal care, clean delivery kits, referrals to MSS centres for post‐abortion care, provision of clean drinking water, dry food rations and other support. MSS has conducted 28 camps and has treated 5683 men, women and children. In the affected provinces, MSS teams first branched into Khyber Pakhtunkhwa (KPK), where they conducted 1‐2 medical camps in the initial days. MSS recently received a donation of medical supplies from Direct Relief International to help assist with relief efforts. The flooding has devastated MSS facilities and the communities in which they work. MSS is in the process of identifying more resources to help deal with the crisis.


PAIMAN – USAID

PAIMAN‐USAID delivered 40 314 jerry cans and 4654 water tanks to DCO offices for distribution to affected families and communities. It also donated 569 water tanks to Thatta district at the request of Secretary Health, Sindh. It contracted 19 district‐based NGOs to organize emergency mobile health camps and hold health promotion sessions. A total of three mobile health camps and five health education sessions were held: 701 persons received health care and 468 people (225 men, 295 women and 148 children) participated in health education sessions.


SAVE THE CHILDREN

SC is operating three mobile teams and three ambulances in Multan and Muzaffargarh. SC has established and is working in two DTCs (Children’s Hospital Complex Multan and Fatima Jinnah Hospital Multan). SC’s hygiene consultants are in the field promoting positive hygiene behaviours and practices. Since the start of the Punjab’s programme on 6 August, a total of 1316 beneficiaries have been reached. SC has 21 mobile teams in Sindh and has established three DTCs there. Operations in this Province began on 12 August. Since then and until 9 September SC has treated 2165 patients. In KPK, SC’s emergency relief programme is working in D I Khan, Swat and Shangla. SC has five static and two mobile teams in Khan, along with four ambulances. Between 29 July and 9 September, the teams treated 19 150 patients. SC has seven static and two mobile health units (CIDA ) in Swat and another three mobile units (CIDA FR) in Shangla. It also has four ambulances, three under CIDA FR and one under WHO BPRM. Hiring for CIDA is complete.


UNFPA

UNFPA has served a total of 1.1 million people in Sindh, KPK and Punjab provinces through 23 mobile service units for outreach services, and 16 governamental health facilities for emergency reproductive health care services. As of 5 September, UNFPA has distributed inter agency clean delivery kits for 80 000 pregnant women. UNFPA has also handed over interagency reproductive health (RH) kits containing various medical instruments, equipment, drugs and supplies to Punjab's Provincial Department of Health Punjab. The kits contain enough supplies to cover the needs of 1.2 million people in five districts of Punjab in the next three months. UNFPA is conducting a RH task force meeting on 8 September 2010 to ensure better implementation of sexual and reproductive health services to the flood‐affected population. The recruitment of female health care providers (especially gynecologists) in flood‐affected districts remains a challenge. Other challenges include the road blocks that impede the transport of RH supplies to some flood affected districts, and the limited funds available to scale up UNFPA services.


UNICEF

In KPK, UNICEF supported medical teams providing services through six static health facilities. The teams include a female doctor, LHV, community health worker and community mobilizers. A total of 4235 patients, including 751 ante‐ and postnatal women and 113 children, have been treated for various ailments at these facilities. Health and hygiene messages have been communicated to 2,988 beneficiaries. High‐energy biscuits were distributed to 7411 people (5989 children, 649 pregnant and 773 lactating women) in Charsadda, Nowshera, Peshawar, lower Dir and Swat. A total of 889 children and 4952 women in Charsadda, Nowshera, lower Dir, Peshawar and Shangla were given micronutrient sachets and tablets In Balochistan UNICEF provided 50 Community Midwifery Kits (CMWs) and 10 000 Clean Delivery Kits (CDKs) for distribution in flood‐affected districts. A total of 1,829 children in four districts (Sibi, Jaffarabad Naseerabad & Jhal Magsi) were given high‐protein therapeutic feeding. Another 1,599 PLWs were given highenergy biscuits and micronutrient supplements, and 1313 children were treated with amoxicillin. In Sindh almost 108 000 patients in IDP camps have been treated. The target population of these camps is 24,188 which is increasing due to the situation in Thatta. In Punjab UNICEF supplied safe delivery kits to districts for distribution to end users. UNICEF also donated 1050 cartons of high‐energy biscuits. The biscuits will benefit 21 000 pregnant or lactating women and children aged between six months and three years.


SWWS

From 6 August to 9 September, SWWS treated a total of 9039 patients (4711 male and 4328 female) in KPK, of whom 5010 were children under the age of 18. Scabies and acute respiratory problems were the most frequent diseases reported.


WHO

WHO has provided essential medicines for 4 million people., including supplies to treat 187 500 cases of diarrhoea. It has distributed a total of 375 diarrhoeal disease kits (21 in Balochistan, 2 in Gilgit Bilistan, 154 in KPK, 67 in Punjab, 130 in Sindh and 1 in AJK). It is continuing to set up DTCs across the affected areas, with an initial target of 81 DTCs.

Two cases of confirmed paediatric cholera were found in a IDP camp in Sukkur. WHO disinfected the taps that were being used to gather water for multiple purposes in the camp. WASH cluster partners including WHO conducted a training session for local partners.

WHO is planning to scale up its intervention in the southern most affected areas of Pakistan. More international staff are being deployed to the most affected areas. Epidemiologists from the Centers for Disease Control (Atlanta) and the International Center for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) have also been deployed to support efforts to control potential disease outbreaks. WHO is working with partners to plan refurbishing of first‐level health facilities in the affected areas.


Coordination

The scope of this disaster is unprecedented. The response requires the unprecedented involvement and close coordination of a significant number of players addressing a number of issues that are often cross cutting, including health. This week has seen a number of initiatives to strengthen coordination at all levels:


GOVERNMENT COORDINATION

On 4 September, federal, provincial and district authorities, along with WHO, UNICEF and UNFPA representatives, met to discuss and plan malaria control and diarrhoeal disease treatment and reproductive health interventions. The needs of provinces in these three areas were identified with a view to understanding the resources needed to fill gaps. A follow‐up meeting will be held on 13 September to measure progress.


INTER‐CLUSTER COORDINATION:

The Inter‐Cluster Survival Plan Realizing the importance of environmental factors, in particular water and sanitation, in controlling disease outbreaks and related mortalities, as well as the aggravating impact of malnutrition, the WASH, Health, Nutrition and Food clusters recognized that more systematic coordination and cooperation between them was needed. A concept note was developed to improve coordination across clusters and ensure a more effective, timely and coordinated strategic response in all the flood affected area.

The overall objective of the survival strategy is to reduce excess mortality. Water quality, sanitation and hygiene are critical factors for diarrhoea and ARI. The provision of safe drinking water, together with adequate sanitation and hygiene, are critical to the success of diarrhoea and IRA prevention and control efforts.

The principles governing the design and implementation of the joint survival strategy are: integrated outbreak response, continuum of care, focus on life saving, synergy between all players and real‐time monitoring and evaluation:


HEALTH CLUSTER COORDINATION

The Health Cluster is preparing a revised Pakistan Initial Flood Response Plan (PIFERP) strategy that is awaiting review and approval by OCHA and other stakeholders. the plan is expected to be finalized and released this coming Friday. Members of the Health, Food, Nutrition and WASH clusters have developed a joint Inter‐Cluster Survival Strategy to ensure a more integrated, effective and timely survival response in priority flood‐affected districts. The strategy outlines cross‐cutting essential life‐saving activities that need to be implemented over coming months and identifies principles for coordination and joint planning.

The overall strategy is to achieve its objective through the following interventions:


Monitoring health threats, risks and outbreaks ‐ including CDC hazards ‐ through surveillance and integration with existing routine health information systems/early warning surveillance and outbreak response systems;
Ensuring access to quality health care services in the flood affected areas, assessing damage to health infrastructure and emerging needs of the health systems;
Ensuring coordinated humanitarian relief activities in the health sector.

This will be achieved through the implementation, strengthening and/or scaling up of activities such as epidemiological surveillance and disease control, establishment of new mobile clinics and DTCs, malaria prevention, emergency vaccination campaigns, water quality monitoring, regular assessments of health needs and health services; and monitoring the implementation of the humanitarian health response.


THE TECHNICAL WORKING GROUP ON HIV AND HUMANITARIAN CONCERNS UNDER THE JOINT UN TEAM ON HIV AND AIDS

Although HIV is under the Health Cluster for the emergency response, the Joint UN Team on HIV and AIDS has convened a working group on HIV and humanitarian concerns. The group includes UNAIDS, UNICEF, WHO, UNFPA, UNDP, UNHCR and IOM. For the emergency flood response UNICEF, UNAIDS and WHO are supporting 1200 people living with HIV and their families in flood‐affected areas with conditional cash transfers as well as food and non‐food items to cover clinical consultation and transport costs. In Punjab, four Family Health Days have taken place where women attending health services are assessed for risks for HIV and receive HEB and micronutrients. Voluntary confidential counseling and testing is offered to women who answer positively to two risk questions during registration. Among more than 100 women tested so far, all are negative. UNICEF has integrated HIV messages into the counselling cards used by LHVs during health promotion sessions.


HEALTH CLUSTER’S REPRODUCTIVE HEALTH TASK FORCE

On 1 September, the second RH task force (RHTF) meeting was held under the leadership of the Health Cluster. The meeting was co‐chaired by UNFPA and the National MNCH programme (MoH). Various RH partners from the Health Cluster including UN agencies, NGOs/ INGOs along with government counterparts participated in the meeting.

Alfred Dube, Health Cluster Coordinator, email: dubea@pak.emro.who.int, Telephone: +92‐ 03004005934
Maria Anguera de Sojo, Communications Officer, email: sojom@pak.emro.who.int, Telephone: +92‐ 03018551459
Syed Haider Ali, Communications officer, email: alisy@pak.emro.who.int, Telephone: +92‐ 3004005944

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Giuseppe Michieli
September 21st, 2010, 11:04 AM
WHO EMRO - Emergency Preparedness and Humanitarian Action: Health crisis continues in southern Sindh (WHO, 9/21/10, edited)


[Source World Health Organization, full text: <cite cite="http://www.emro.who.int/eha/pakistan_floods_sindh_story.htm">WHO EMRO - Emergency Preparedness and Humanitarian Action (http://www.emro.who.int/eha/pakistan_floods_sindh_story.htm)</cite>. Edited.]

Current crises in the region - Pakistan floods

Health crisis continues in southern Sindh

By Aphaluck Bhatiasevi
WHO Communications Officer


The perils of Pakistan's floods have followed Barsumri and her four children from their washed away home in Baluchistan province to the crises' current epicentre in southern Sindh, where responding to health and water threats are priorities for healthcare providers.

"My one-year-old son Shenwaz has been very sick with high fever and vomiting," Barsumri, aged in her 50s, says from the informal settlement in Sindh's Jamshoro district where her family first took refuge in mid-August.

"It is difficult living here, we get food but not enough. We want to go back home but we don't know how or when we will do so."

Barumsri is among 8 million people needing direct humanitarian assistance in flood-affected Pakistan. In all, 20 million people have been affected in one way or another by the catastrophe.

In response, the World Health Organization, Pakistani authorities and humanitarian health partners have been delivering care to more than 4 million people, and are seeking US$200 million as part of a 12-month program to deliver health relief and rebuild damaged health services.

As flood waters start receding in some parts of Pakistan, the emergency situation continues in southern Sindh province as roads and homes remain submerged in water, displacing up to 20,000 people daily. Twelve-year-old Shazia and her family are among hundreds of thousands of people who have fled their homes in Sindh province, where many villages are still covered with water. Her parents have taken shelter in a camp in northern Sindh, while she stays 300 kilometres to the south in a temporary shelter at Municipal Model School in Hyderabad district.

The school is part of the provincial government's effort to provide shelter to flood-affected people.

''More people want to come to us, but we have limited capacity," says Mr Mohamad Bhutto, a teacher at the school where 300 people from neighbouring districts of Dadu, Thatta, Jamshoro and Shadad Kot have been staying since mid-August.

"Currently, there are about nine families living in each classroom:" Unlike Shazia, many villagers are camped out by roadsides, with more than 10 camp sites along the highway between Hyderabad and Badin districts alone. Local authorities and nongovernment organizations are doing their best to respond to the increased needs, but more support is required.

The number of health partners in these areas is lower than in others, while there are limited mobile or fixed medical clinics to support settlement camps, says WHO's Dr Muireann Brennen, who also coordinates the Health Cluster Hub in Hyderabad.

''We are seeing more and more malnourished children being admitted to hospitals," says Dr Brennen.

"Many of them also suffer from acute diarrhoea, and this is very concerning."

WHO is supporting health facilities across Pakistan, including in southern Sindh where diarrhoeal treatment centres have been established in seven hospitals.

WHO has also been providing drugs and equipment for providing both routine and emergency care, including for treating patients with acute respiratory infections and suspected malaria.

Dr Guido Sabatinelli, WHO Representative in Pakistan, recently visited a Jamshoro district hospital and says much has been done to save lives and prevent illness. But he adds that this is just the beginning.

''We need to continue to work together to protect the health of the people displaced by the floods by working closely with sectors dealing with water and sanitation, as well as nutrition, to make sure that people have access to basic hygiene, sanitation, food and water,'' says Dr Sabatinelli.

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Giuseppe Michieli
September 23rd, 2010, 05:19 AM
Floods in Pakistan - Bulletin No 18 - Focus on Malaria (WHO, edited)


[Source: World Health Organization, full PDF Document (LINK (http://www.whopak.org/idps/documents/bulletins/Pakistan_Health_Cluster_Bulletin_No_18_2010.pdf)). Edited.]

Pakistan Health Cluster

Floods in Pakistan - Bulletin No 18 - Focus on Malaria

20 September 2010


HIGHLIGHTS

The Ministry of Health (MoH) and Health Cluster partners are preparing for a significant rise in the number of cases of malaria. The disease is being increasingly reported in all flood‐affected districts; up to 2.2 million cases are expected over the next six months.

In Sindh, the situation in Hyderabad is exacerbated by an acute shortage of humanitarian staff on the ground. The Executive Director of Health in the town of Dadu has asked the UN and partners for help dealing with the worsening situation, especially in the area around lake Manchar.

The Pakistan Flood Emergency Response Plan (PFERP) was launched in New York on 17 September.

The plan ‐ a revision of the initial response plan (PIFERP) ‐ proposes a comprehensive set of relief and early recovery activities.

The Disease Early Warning and Surveillance (DEWS) system is functioning well: so far, the MoH and partners have managed to avert a second wave of deaths from disease.

In Punjab province, Multan hub reports that between 65 and 90% of internally displaced people (IDPs) are returning home.

Senior officials from WHO, UNICEF and WFP will visit affected areas from 22 to 25 September.


Situation overview and current scale of disaster

In Khyber Pukhtoonkhwa (KPK) and Punjab, the situation continues to stabilize. People are gradually returning to their homes and villages. The Health Cluster coordinator in Multan reports that between 65% and 90% of IDPs in the area have returned. Nevertheless, the severe damage to infrastructure, agriculture and homes cannot be overstated. The Health Cluster will need to begin implementing early recovery programmes to address the needs of these returnees. In addition, outbreaks of malaria in southern Punjab, an area with low rates of endemic malaria, are giving rise to some concern.

In northern Sindh more than half of the IDPs are returning home. Although the situation is stabilizing in some areas, it remains critical in the south. The city of Dadu is cut off, and the Hub Coordinator in Hyderabad reports an acute shortage of humanitarian partners on the ground. Moreover, sanitary conditions in some IDP camps are reported to be rudimentary, with overcrowding and open defecation within the camp area. Stagnant rain water is used to wash utensils and clothes. There is no safe drinking water and food is cooked and eaten by IDPs in unhygienic conditions.

Security issues due to the murder of MQM party convener Dr Imran Farooq in London on 16 September have hampered humanitarian operations in Sindh (in both Sukkur and Hyredabad), and in Karachi. Humanitarian activities as well as general services were completely halted on 17 September, and international staff were assigned to residence. The situation improved on 18 September; activities on the ground are now resuming.


Health impact

Acute diarrhoea, acute respiratory infections, skin diseases and suspected malaria remain the leading causes for seeking health care in the flood‐affected areas.


Basic statistics update


Out of 5.3 million consultations conducted up to 17 September, 708 891 (13%) were for acute diarrhoea, 802 670 (15%) were for acute respiratory infections (ARI), 986 843 (18%) were for skin disease and 182 762 (3%) were for suspected malaria.
The number of suspected malaria cases is rising in Baluchistan and Sindh provinces compared to KPK and Punjab. A total of 40 415 cases of suspected malaria were reported from 4 to 10 September.
There are around 500 000 pregnant women among the affected population. This means that many deliveries each month will be in an unsafe environment, without access to skilled birth attendants.
Acute respiratory tract infections (ARI) are the leading cause of morbidity. However, the number of cases of suspected malaria is rising fast: over the last 24 hours, the reported number of malaria cases accounted for 17% of consultations in Baluchistan province and 13% in Sindh province.


New concerns and latest needs; upcoming and recent concerns


A total of 389 snake bites were reported in Sindh from 31 July to 14 September.
4 alerts of AWD and one alert of meningitis were reported and responded to from 11 to 17 September.
Paediatric malnutrition is increasingly a concern: 30 to 50% of children arriving at health facilities show symptoms of acute malnutrition. Before the floods, paediatric malnutrition was not foreign to Pakistan: according to the last National Nutrition Survey, the global acute malnutrition rate was 13%. A total of 10% of children had moderate acute malnutrition (MAM), and 5% had severe acute malnutrition (SAM).
Around 500 000 women are pregnant among the affected population. This means that around 83 000 deliveries will take place per month, many of which will be in an unsafe environment without access to skilled birth attendants.


Malaria Situation Focus

Malaria is endemic in 36 of the 77 flood‐affected districts. The floods have favoured vector breeding, resulting in high densities of disease‐transmitting mosquitoes. This, together with the high exposure of the population (IDPs) has greatly increased the transmission potential of the disease.


Punjab province


Six districts located in the low‐endemic province of Punjab that have reported sporadic cases in the past have shown a decline in Slide Positivity Rate (SPR‐current 20%) compared with the highest rate in the first week of September. The number and percentage of vivax cases is disproportionately high in Southern Punjab. The total number of reported cases from the highly endemic district of Mozaffargarh since 1 September is 1420. The data from five other districts are not available.


Sindh and Balochistan provinces


In Sindh, except for the central districts of Karachi city, all districts are highly endemic for malaria. The situation is deteriorating in the districts affected by floods. The situation is expected to reach epidemic levels in coastal (Thatta, and Badin) and southern districts (Dadu, T.Muhammad Khan etc).
In Balochistan, there have been confirmed malaria outbreaks in north‐eastern districts (Zhob, Loralai, Musakhail) that have received heavy rainfall this year. The falciparum proportion has reached 95%, and the overall SPR is 50%, which is the highest in the country.
The situation in districts Sibi, Naseerabad and Mastung (Balochistan) is not encouraging. Mastung has shown a rise in falciparum cases in recent days, due to the influx of IDPs from Sindh. Information from other districts is lacking due to the non‐functioning surveillance system.
Balochistan has the highest burden of malaria in the country. This poses challenges for the malaria control programme when trying to cope with emerging needs.


KP Province


The situation in KPK is stable, with normal transmission patterns.


Government Response


On 16 September 2010, the Federal Secretary for Health and the Coordinator of the National Health Emergency Preparedness and Response Network (NHEPRN) briefed members of the Standing Committee on Health on the health response to the floods. The Committee requested the Ministry of Health to continue health care services in the flood‐affected areas as well as continue its efforts to contain disease outbreaks and thus avoid epidemics.
The third meeting of the National Steering Committee on Health Emergencies, chaired by Mr Kushnood Lashari, Federal Secretary of Health, was held at NHEPRN Centre on 16 September 2010. The Committee, established by the Prime Minister of Pakistan, comprises of all Provincial Secretaries, Heads of UN Agencies, the President, CPSP, PMDC and PMA. All Provincial Secretaries present weekly reports (including needs) on a common reporting format developed by NHEPRN.
The committee expressed its satisfaction over improved coordination at various levels, resulting in a better use of resources and the avoidance of duplication. A subcommittee of the MoH, WHO and UNICEF was formed to work out the distribution of long‐lasting insecticidal nets (LLINs) being donated by various countries.
MoH has asked the national Disaster Management Authority (NDMA) to provide water filtration plants to the provinces through UNICEF and the Water, Sanitation and Hygiene (WASH) Cluster.
To facilitate information‐sharing, NHEPRN launched its official website on 15 September on a trial basis.
NHEPRN is organizing the deployment of foreign field hospitals and medical teams in the provinces, depending on the affected population and damaged health facilities. Seven field hospitals donated by the Italian Government are being deployed at Charsaddah, Nowshera, Bhakhar, Layyiah, Mianwali, Giligit and Balochistan.


Health Cluster Response

CARE

Update from 8 to 14 September:


KPK:

A total of 807 patients have been treated via four BHUs in Upper Swat (KPK) including 285 women and 368 children. CARE has conducted 15 Mobile clinics (via three mobile teams) in the district of Charsadda, treating 2556 patients including 761 women and 1042 children. CARE also held 36 health and hygiene sessions for 742 people.
CARE operated four mobile clinics (via four mobile teams) in the district of Nowshera (KPK) and treated 1580 patients including 481 women and 692 children. It also held 23 health and hygiene sessions for 796 persons.

Punjab:

Primary health care (PHC) services were provided via 10 mobile clinics in Rajanpur (South Punjab). A total of 2866 patients including 979 women and 1388 children were treated.

Sindh:

CARE provided PHC services to 837 patients including 258 women and 422 children via mobile medical camps in districts Sukkur, Kasmore and Shikarpur.



CHURCH WORLD SERVICE – CWS P/A


KPK

Three mobile health units (MHUs) are operating in districts of Mansehra, Kohistan District and Swat, especially in remote areas where these MHUs are providing essential medicines and consultations for patients, with a special focus on women and children. A total of 7855 consultations were made. Lady health visitors (LHVs) examined 156 ante‐ and 32 postnatal clients, who were registered and given medicines. A total of 1252 children under five years of age were examined.
CWS‐P/A teams conducted 208 health education sessions on common health issues including personal hygiene, HIV/AIDS, skin infections, safe drinking water, sanitation and locally endemic diseases.



CITIZENS' COMMISSION FOR HUMAN DEVELOPMENT (CCHD)


CCHD has begun work ensuring that health and sanitations needs are met, plus other daily necessities.
CCHD is 1) providing direct services (medical camps, food items, clothing etc), 2) coordinating among local organizations and the government, and 3) facilitating the availability of doctors and other medical staff to local organizations. CCHD has also treated 5500 patients. It operates eight medical camps, each staffed by a doctor and paramedical staff. A total of 1500 children suffering from diarrhoea have been provided with mineral water and oral rehydration salts (ORS). Over 150 families have been given food items. CCHD collaborates with other organizations in providing services. Twenty tents have been provided to widows, and over 800 new dresses and other items of clothing have been donated to children, women and men for Eid. CCHD is monitoring cases of epidemics, and common diseases and infections.


IDEA


KPK

Wooden frames for 35 latrines have been completed, of which 15 have been installed successfully. Work is in progress on another 20 latrines being installed in Khema Basti Nawa Kili of District Nowshera. Five water tanks have also been installed. Stickers and banners with hygiene messages have been pasted on latrines.
In mobile medical camps, 5760 water purification sachets have been distributed, which benefited 480 families (30 sachets per family) of District Nowshera. Another 7689 sachets were distributed in Upper Swat. IDEA conducted 20 mobile medical camps in the target Union Councils of District Nowshera. Total consultations reported in the week are 6455, out of which 1855 are male, 2945 are female and 1665 are children. IDEA also held 301 health and hygiene sessions for 3570 people (1530 female, 1389 male and 651 children).
A water purification plant was installed in District, Nowshera, UC kheshkai payan, with funding from CARE International.
IDEA received 13 small water purifier plants from GEO TV Network and Rotary Club Peshawar. It has installed the plants in selected UCs.



INTERNATIONAL MEDICAL CORPS (IMC)


KPK

As of 17 September, the organization has conducted 39 946 health consultations in 14 static units in three districts (Peshawar, Charsadda, Nowshera). In addition, IMC has opened diarrhoea treatment centres at DHQ Nowshera and Mardan Medical Complex. All IMC's psychosocial support members will be attending psychosocial support training for three days: there will be no health statistics kept for these three days.



ISLAMIC RELIEF PAKISTAN


KPK

Islamic Relief Pakistan is running two static health camps with outreach capacity at two civil dispensaries in Union Councils Nissata and Zandu Banda in districts Charsadda and Nowshera respectively. A total of 6663 consultations have been undertaken since 25 August. During this period 46 cases of suspected malaria have been seen and treated. Skin problems and acute respiratory infection are the two main health concerns, followed by eye infections and acute diarrhoea cases. Islamic Relief has also distributed 4003 hygiene kits to the most affected population in the area.

Punjab

In Muzaffargarh Islamic Relief has one mobile health clinic working since 5 September in four Union Councils. A total of 1934 consultations have been undertaken so far. A total of 253 cases of suspected malaria have been treated in these four UCs. Islamic Relief has also distributed 1479 hygiene kits to the most affected population in the area.



HELPING HAND FOR RELIEF AND DEVELOPMENT‐HHRD


Since the floods began in Pakistan, HHRD provided free consultations and medicines to flood affectees by organizing medical camps
Till 19 September, HHRD held 396 medical camps in 13 districts including Charsada, Nowshehra, Dir, swat, Buner( KPK) Mianwali, Muzafargarh, Layyah, D.G. Khan (Punjab) Nawabshah, Sukkur, Karachi, Larkana ( Sindh).
So far, more than 71,500 patients were treated and 6 safe deliveries have been conducted in medical camps
Major diseases observed: Diarrhoea, Scabies, eye and Skin infection, Malaria etc


JAPAN DISASTER RELIEF MEDICAL TEAM


Punajb

The Japan Disaster Relief team has been working in Southern Punjab since 5 September. The Japanese government has extended its assistance and sent a new (second) medical team to replace the first one. A total of 17 medical professionals among 23 team members have been working since 14 September.
Since 5 September, the team has treated 2248 patients including 1178 females and 1131 children.
Major diseases (up to 14 September) are: digestive (30%), respiratory (13%), skin (14%) and malaria (9%).



MALTESER INTERNATIONAL


KPK

A total of 5442 patients have been treated over the last six weeks through PHC services in three health facilities, with an average number of 60 patients per day and per facility. Malteser also organized ten medical camps, where over 3577 patients were treated by two mobile medical teams (MMTs). Several hundred children have been vaccinated (EPI protocol + Influenza) by the EDO Health Office's vaccination team; these medical camps were organized in UC remote areas, Transitional Camps of Islampur UC, and Tahirabad quarter of Mingora Town. MMTs are also providing intensive hygiene awareness campaigns in areas with suspected acute water diarrhoea (AWD) cases (Barikot, Margazal and Ahunbaba of Islampur UC and Mingora Town). Every week, several hundred families have been enrolled, and hygiene printed materials, Aqua‐Tabs, soap and ORS sachets have been distributed. MSTs/MMTs also distributed 3000 jerry‐cans, 800 kgs of soap and several hundred thousand Aqua‐Tabs donated by WHO, UNICEF and Oxfam.
The main challenges on the ground are 1) the lack of access to the beneficiaries and health facilities in the the Upper Swat Valley and Kohistan district, and 2) the ongoing outbreaks of AWD, measles and the approaching malaria outbreak.



MERLIN


KPK

A total of 6234 consultations were conducted in Merlin health facilities and by Merlin MHUs in KPK on 16 September 2010.
Nowshera: Merlin is providing health and nutrition services through five MHUs in six UCs of Nowshera and through six 24/7 static clinics in Jalozai. In addition one Diarrhoea Treatment Centre (DTC) is functional since 29 August. It has seen 2382 patients; cases have stabilized but have not decreased.
Merlin is covering an approximate catchment population of 280 000 in Nowshera.
Swat: Merlin is providing health services through nine MHUs (eight in Upper Swat and one in Lower Swat) and 12 health facilities (HFs). One DTC was established at THQ Matta and has been functional since 27 August (total patients seen: 922). Merlin is covering an approximate catchment population of 590 036 in Swat.
Buner: Through 10 HFs and three MHUs, Merlin is providing comprehensive PHC including reproductive health and early warning systems in Buner. Two DTCs have been established at DHQ Doggar and have been functional since 2 September. One DTC at THQ Pachakalay is also functional (total number of cases: 415). Merlin is covering an approximate catchment population of 337 808 in Buner.
Charsadda: The DTC At DHQ Charsadda has been functional since 1 September (total number of cases: 1390). Another DTC at CH SHABQADAR has also been functional since 1 September (total number of cases: 625).

Punjab

Muzzafargarh: One 24/7 DTC is fully functional at DHQ Muzafargarh since 3 September 2010; to date, 2200 (1123 male, 1077 female) consultations have been conducted. Merlin is also in the process of conducting assessments and is planning to launch five static clinics and five MHTs (two initially) to provide PHC and nutrition services to flood‐affected people in Muzaffargarh district.



MOBILINK:


Mobilink has donated 244 pre‐fabricated structures to WHO. WHO has already devised a system to prioritize the distribution and erection of these structures. Health cluster partners were asked to submit requests for these structures in case of need.


NETWORK FOR THE ADVANCEMENT OF GENDER EQUALITY (NAGE) PAKISTAN


(Reporting from 30 August to 17 September)
NAGE‐Pakistan is providing medical health services through a static and mobile medical camp in Union Council n°s 3, 4 and 5 of Tehsil Kotadu in district Muzzafar Garh. From 30 August to 17 September, NAGE‐Pakistan medical teams treated 1847 patients, including 578 female (31%), 498 male (27%) and 771 children (42%) under five. Major diseases include fever (34%), diarrhoea (21%), eye infections (14%), skin infections (12%) and respiratory infections (11%).
NAGE‐ Pakistan also formed five "Health Watch Committees", conducted eight health and hygiene sessions , and provided clean drinking water with ORASAL‐F to 250 families in Union Council Pattal n° 4 of Kotadu (Muzzafar Garh).


RELIEF INTERNATIONAL


(Reporting from 8 to 17 September)
KPK

District: Swat: A total of 867 consultations were held from 8 to 17 September. Rising trends in acute watery diarrhoea and URTI were registered in all age groups. Preventive health measures include community awareness sessions on the prevention of diarrhoeal diseases and use of ORS during diarrhoeal episodes. Sixteen health education sessions were conducted, which included hand‐washing demonstrations. An ORT corner is present for the purpose. Moreover, 25 pregnant women were registered for antenatal visits and 11 women received postnatal checkups. An ambulance is present to transport critical patients.
District Dir Lower: A total of 340 consultations were held from 8 to 14 September, and 11 health and hygiene education sessions were conducted, as well as IYCF sessions with 82 PLWs. Thirteen pregnant women were registered for antenatal visits and six women received postnatal checkups. Since the start of September, RI’s mobile health teams in Lower Dir have distributed Unimix and multi‐micronutrient tablets to 4151 pregnant and lactating mothers, and 3443 children have been provided with high‐energy biscuits and multi‐micronutrient sachets.

Baluchistan

District: Kachi: A total of 1160 consultations were held from 8 to 17 September. Acute watery diarrhoea is still a rising trend; mitigating measures include regular health education sessions in the camp (17 sessions conducted, with an ORT corner that is used to help diarrhoeal patients rehydrate effectively). RI is negotiation with UNICEF for supplies of Plump doze for blanket distribution. RI conducted one postnatal and 35 antenatal check ups.



PAIMAN – USAID


Sindh

USAID/PAIMAN supported the establishment of new IDP camps in Khairpur by supplying water tanks and jerry cans. A total of 43 320 jerry cans and 5230 water tanks have been delivered to DCO offices for distribution to affected families and communities. USAID/PAIMAN also donated 2,600 insecticidetreated bednets to EDO‐Health Jaffarabad, Swat and Charsadda.
USAID/PAIMAN NGOs are running accelerated health camps and holding health education sessions for the flood‐affected population. Over 4000 people have received health care. Women have received preand postnatal care, TT vaccinations and general check ups. A total of 24 health and hygiene education sessions have been held, attended by 1736 people (361 men, 989 women and 386 children).
USAID/PAIMAN's relief team attends health cluster meetings in Islamabad as well as at Province and district levels, and shares information on its activities with the Provincial Health Department, DCO, and EDO‐H.



UNAIDS


The population most at risk of HIV/AIDS in the affected areas are injecting drug users (IDUs), transgenders and sex workers. UNAIDS is mainly focusing on five affected districts (Sukker, Hyderabad, Jacobabad, Larkana and Sargodha). The transgender population has become internally displaced in Jacobabad, Sukker, Larkana, and Hyderabad districts. Pakistan has had concentrated HIV epidemics since 2005, with a prevalence of 21% among IDUs, 6‐7 % among transgenders, and 1‐2% among sex workers.
The humanitarian response working group of the joint team on HIV and AIDS met immediately after the floods and identified the following priority actions: 1) continuity of antiretroviral therapy for people living with HIV and ensuring their access to treatment centres; 2) integration of HIV prevention services and messages in reproductive health services; 3) integration of HIV educational materials into general health education materials; 4) assessment of the impact of floods on most‐at‐risk population. A total of 1200 people living with HIV/AIDS were given care and support packages, in collaboration with provincial and national aids control programmes.


SAVE THE CHILDREN


Save the Children has medical teams in six districts (Multan, DG Khan, Rajanpur districts in Punjab, Sukkur, Shikapur, and Jacobabad districts of Sindh).


WHO


WHO has provided essential medicines for 4 million people, including supplies to treat 187 500 cases of diarrhoea. It has distributed a total of 375 diarrhoeal disease kits (21 in Balochistan, 2 in Gilgit Bilistan, 154 in KPK, 67 in Punjab, 130 in Sindh and 1 in AJK). It is continuing to set up DTCs across the affected areas, with an initial target of 81 DTCs.
The International Center for Diarrhoeal Disease Research, Bangladesh (ICDDRB) has also been deployed to support efforts to control potential disease outbreaks.
WHO is working with partners to plan the refurbishing of first‐level care facilities in the affected districts.
The initial target of 81 DTCs should be met (not necessarily operational) by the end of next week.
As of 15 September, 42 DTCs had been established, as reported by partners (NGOs).

A team of experts from the International Centre for Diarrheal Disease Research, Bangladesh (ICDDRB), will train 15 master trainers next week on managing a DTC, including case management, reporting, and infection control. The master trainers will then train DTC staff in their respective hubs.
The ICDDRB team has conducted field visits in all four hubs to evaluate currently operational DTCs and address issues identified on the ground. They have given special attention to case management shortcomings.
Next step for the DTCs will be to implement a solid routine of monitoring and evaluation.

WHO is planning to scale up its intervention in the southernmost affected areas of Pakistan. More international staff are being deployed to the most affected areas. WHO is working with partners to plan the refurbishing of first‐level care facilities in the affected districts.
To address the increasing rates of malnutrition in the flood areas and limit morbidity and mortality due to malnutrition among children under five, WHO, MoH and partners are screening each child brought to a DTC using mid‐upper arm circumference (MUAC) standardized tape. Children with severe acute malnutrition will either be treated in the DTC or will be referred to the nearest stabilization centre.
UNICEF has pledged to provide supplies for such treatments, in particular therapeutic milks (F‐75 and F‐ 100). WHO will also train MoH staff and NGO partners on the facility‐based management of severe acute malnutrition.


Malaria Response

MERLIN


Merlin has been working in malaria control in Pakistan since 2007, in close collaboration with federal and provincial malaria control programmes. The programme covers around 6 million people living in several locations in FATA, KPK and Baluchistan.
Baluchistan Province:

As a sub‐recipient of Global Fund malaria R‐7 grant, the programme (covering Sibi, Harnai, Noshki and Naseerabad districts) addresses the timely diagnosis and effective treatment of malaria through 27 malaria microscopy and 21 rapid diagnostic test (RDT) centres established or strengthened by Merlin.
These centres are functioning within public sector primary and secondary level health care facilities. A total of 287 health care providers trained by Merlin provide case management services to the target population. Merlin has established another 10 RDT centres in Sibi and Naseerabad, where access to public sector facilities was interrupted by the floods. It aims to expands its operations to five more districts (Zhob, Qila SaifUllah, Loralai, Turbat and Gawadar), with the support of the Federal Directorate of Malaria Control.

KPK and FATA

Merlin's malaria control programme is well established in Bannu and Kakki Marwat districts and Kurrum, Khyber and Bajaur Agencies, and is working through 54 malaria microscopy and 23 RDT centres. Malaria case management services are provided by 777 health care providers trained by Merlin on national case management guidelines.
Merlin is providing PHC services in Nowshera, Charsadda, Swat and Buner and other districts. Malaria case management services according to the national guidelines are provided through these centres. Beside malaria cases management, Merlin will expand its vector control (IRS) and outbreak response interventions to all parts of SWAT and Buner this week. All logistical arrangements have been finalized.
Merlin will also upgrade an additional 30 public health facilities for malaria microscopy and treatment in SWAT and Buner districts. The expansion foresees the establishment of 30 case management and outbreak response centres in Charsadda and Nowshera districts.

Expansion Plans to Punjab and Sindh

Expansion of malaria case management and outbreak response services are currently being made for Muzafargarh in Punjab and four uncovered districts in Sindh province.



NAGE‐ PAKISTAN


NAGE is working in the Punjab districts of Muzzafar Garrh and Layyah. The targeted locations (Union Councils n°s 3, 4 and 5 of Tehsil Kotadu of district Muzzafar Garrh) are situated near Tonsa Bairaage (about 100 km from Multan) and are among the most affected UCs in the district. NAGE‐Pakistan medical teams are reporting increasing rates of malaria. NAGE is forming "Health Watching Committees" at village level to promote preventive measures against malaria, and is arranging awareness‐raising seminars and corner meetings in flood‐affected communities. Through seminars, NAGE is encouraging the population to use mosquito nets while sleeping, burn smoky fires at night, and fill stagnant any water ponds near dwellings with mud. It is also raising funds for 15 000 mosquito nets for targeted communities.


RELIEF INTERNATIONAL


Reporting period: 8‐17 September 2010
KPK

No suspected case of malaria has been reported in DEWS, one of main reasons being the RI clinic's highaltitude location and the cold weather. The medical team remains vigilant, and has Para Check strips to diagnose Falciparum Malaria if suspected cases are reported.

Baluchistan

The weather is warm and humid in Kachi, Balochistan, and four or five suspected malaria cases are being reported each day. The medical team has the facility to diagnose all suspected cases for Falciparum malaria, but no case has been confirmed until now. Other cases are referred to the laboratory in DHQ hospital Kachi. RI's two female health educators inform the community about preventive measures for malaria, and refer all suspected cases with positive symptoms.



SAVE THE CHILDREN


Save the Children has medical response in six districts ‐ Multan, DG Khan, Rajanpur districts in Punjab; and in Sukkur, Shikapur, Jacobabad districts of Sindh. It is currently seeing a rise in fever cases in its mobile clinics. It plans to procure and distribute LLINs to 36 000 families in coordination with Health Cluster partners and the MoH, and provide diagnosis and treatment using rapid diagnostic tests, and Artemisinin‐based combination therapy (ACT) according to national guidelines.


USAID/PAIMAN


USAID/PAIMAN plan to provide 8000 LLINs and 2000 Rapid Malaria Diagnostic Kits (RDKs) to the floodaffected population in nine districts. Each kit contains 40 tests. So far 2600 LLINs have been delivered to EDO‐Health.


WHO


WHO is working with MoH and partners to address potential malaria outbreaks in the most affected areas:

Punjab province

The first round of indoor residual spraying and thermal fogging has almost been completed in all the six districts, showing its effectiveness in reduction of vector densities and resulting decline in overall incidence.
A total of 50 000 RDTs to detect both vivax and falciparum received from WHO Kabul have been shifted to Punjab province earlier this month. The kits are being used at FLCFs.
Currently, there are sufficient quantities of antimalarial drugs to treat confirmed cases, except for Primaquine tablets, which will be out of stock in the next few days. A consignment of 30 000 Primaquine tablets requested by the Director of Malaria Control, Islamabad were shifted from KPK to the WHO Hub in Multan on 18 September to fill the gap.
The overall situation in Punjab is well under control.

Sindh and Balochistan provinces

The surveillance system is generating daily reports.
A total of 20 000 RDTs have been shifted to Hyderabad and Sukkur to strengthen early diagnosis and effective treatment.
Four districts of Sindh (Khairpur, Dadu, Thatta and Tharparkar) are the target districts of the Global Fund in the R‐7 grant, but the floods have diluted the effectiveness of the interventions due to the rising trend of the disease and the interrupted supply of RDTs, ACT and LLINs in these districts.
A total of 75000 LLINs out of 14 5000 being procured by WHO will be distributed to Sindh province in September as soon as the consignment arrives.
A total of 15 000 RDTs have been distributed to Balochistan.
Sindh and Balochistan are waiting for the arrival of WHO logistic support materialized through the outbreak prevention plan accepted by donors amounting to US$4.2 million.

Situation in KPK

National and international staff are being recruited to enhance capacities to implement planned antimalaria interventions over the coming year. They are expected to begin arriving on 15 October 2010. Drugs including ACT, Chloroquine, Primaquine and Artemether , together with LLINs and RDTs, are expected to arrive within five weeks. Donations are required to procure spraying equipment, insecticides for IRS and thermal fogging.
A total of 55 000 LLINs were received from Hanoi on 19 September, and are being distributed to WHO hubs.
Another 40 000 LLINs are on their way from Hanoi and will arrive in Pakistan on 20 September.




Coordination

GOVERNMENT COORDINATION

On 4 September, federal, provincial and district authorities, along with WHO, UNICEF and UNFPA representatives, met to discuss and plan malaria control and diarrhoeal disease treatment and reproductive health interventions. The needs of provinces in these three areas were identified with a view to understanding the resources needed to fill gaps. A follow‐up meeting will be held on 13 September to measure progress.


HEALTH CLUSTER COORDINATION

Islamabad

Health cluster meetings are taking place twice a week in Islamabad. The participants are national and international NGOs, MoH and donor representatives, Economic Affairs Division and UN agencies. Pakistan Floods Response Plan: The Pakistan Floods Response Plan (PFERP) was launched in New York on Friday 17 September. This is the largest humanitarian appeal ever, asking the international community for more than $2 billion to assist 14 million people for the next year in flood‐ravaged Pakistan. The Health Cluster is appealing for US$ 200,771,963 to fund 95 projects prepared by six UN agencies, 19 international and 31 national NGOs.

Damage and Needs Assessment (DNA):

The Asian Development Bank, in collaboration with the International Monetary Fund, the World Bank and WHO, carried out a Damage and Needs Assessment (DNA) across all flood‐affected districts. The assessment found out that 558 of the total 97 000 health
facilities in the flood‐affected districts were either destroyed or severely damaged. An overwhelming number of health facilities are partially damaged. The exact data will be released soon. The DNA assessment team has estimated that around US$40 million is required to rebuild and rehabilitate all 558 damaged or destroyed health facilities.

Multan

As of today, seven cluster coordination meetings have been conducted since 12 August. The Health Cluster coordinator (HCC) arrived on 30 August. The weekly cluster coordination meetings in Multan (chaired by the MoH (EDO Multan) and co‐chaired by WHO) are attended by representatives of the MoH, UN Agencies, the Pakistani Army and the NDMA, as well as over 50 international and national NGOs. More NGOs (from Islamabad and Lahore) are contacting the cluster for guidance on establishing activities in non‐ covered areas.

The Who Does What, Where (3W) database is 80% completed; a draft mapping of partners' activities will be available this week.

To improve coordination at the district levels, NGO and representatives have been identified as focal points to support the EDOH. Currently, four districts have focal points, and coordination meetings have started in three districts (Muzaffargah, Ranjanpur and DGK), with RYK district to follow this week. Focal points will be selected to cover all districts. WHO surveillance officers will also help the EDOH to coordinate partners.

The HCC has frequent ad hoc meetings with local goverment authorities (the District Commissioner, the Southern Punjab DG of Health, the Multan Health EDO, the Army medical corps brigadier, and the NDWA provincial representative) and receives daily updates on procurements and epidemiological reports.

Sukkur

At the 12th Health Cluster meeting on 16 September, EDOs from all nine districts of Sukkur hub were requested to participate and share information on the status of functional, damaged, partially damaged and affected health facilities. They were asked to expound on the exact location of diarrhoea cases to help Health Cluster partners identify the root causes of the disease and take remedial action. The meeting focused on the current disease situation, including surveillance, cholera case management, control and prevention strategy for AWD, improving capacity and measures to mitigate the problems of the flood‐affected population. Disease trends and reporting sites of partners were highlighted. Partners were requested to share their activities and data to help WHO map all activities and affected sites and work with WASH to complete the first phase of strengthening hygiene and sanitation.

During the meeting, Dr Nevio Zagaria (WHO/HQ) introduced the new “survival strategy” adopted by the four clusters (Health, WASH, Food and Nutrition). The strategy aims to focus on coherent and synergetic actions between the four clusters in order to enhance the efficiency and effectiveness of the humanitarian response and minimize the damage caused by this unprecedented catastrophe.

An issue of concern was the very low presence of NGOs working in the health sector, a point that was repeatedly mentioned by the EDUs responsible for the different districts.

Hyderabad

The ICDDRB Team has cancel the planned training on the weekend owing to movement restrictions. Dadu’s Executive Director of Health (EDO) has asked the UN and partners for help to deal with the worsening situation in the town, especially the area around lake Manachar EDO Badin has asked for assistance dealing with the influx of IDPs to Golachari area and Badin town.

There is a health cluster meeting on Wednesday the 22rd at 11am to which it is proposed to join nutrition WASH and food.

WHO is working with colleagues in the nutrition, WASH and food cluster to prepare for the visit of the senior officials delegation of Wednesday. There will be an inter cluster meeting at OCHA to discuss the visit. WHO is coordinating with District authorities and NGO partners for the Hyderabad and Jamshoro visits. It is also hoped the Delegation will attend the intra cluster meeting for 30 minutes.

Two new partners (IMC and MDM) come forward for Dadu and Sejawl (Thatta)


INTER‐CLUSTER COORDINATION: The Inter‐Cluster Survival Plan

Four senior officials from WHO, UNICEF, WFT and UNFPA are visiting Pakistan this week to launch the Survival Plan. They plan to visit KP and Sindh.



Alfred Dube, Health Cluster Coordinator, email: dubea@pak.emro.who.int, Telephone: +92‐ 03004005934
Maria Anguera de Sojo, Communications Officer, email: sojom@pak.emro.who.int, Telephone: +92‐ 03018551459
Syed Haider Ali, Communications officer, email: alisy@pak.emro.who.int, Telephone: +92‐ 3004005944

-
------

Giuseppe Michieli
October 1st, 2010, 10:59 AM
Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 6 Monday 27 September 2010 (WHO, 10/01/10, extracts, edited)


[Source: World Health Organization, full PDF Document (LINK (http://www.who.int/hac/crises/pak/pakistan_epi_27september2010.pdf)). Extracts, edited.]

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan . For Correspondence: Tel : +92-051-9255184- 5, Fax : +92-051-9255083, E-mail: wr@pak.emro.who.int. or eic.nih@gmail.com

Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 6 Monday 27 September 2010


Highlights

Epidemiological week no 38 (18 - 24 September 2010)


Between 18-24 September 2010 (epidemiological week no. 38), 40 of the 78 flood affected districts provided surveillance data to the DEWS system. Of these 40 districts, 87% reported 6-7 days of the week.
745 fixed health and 215 mobile medical outreach centers provided surveillance data for this week.
486,376 consultations were reported through DEWS of which 18% were acute respiratory infections (ARI), 13% were acute diarrhoea, 12% were skin disease, and 9% were suspected malaria.
17 alerts were received and responded to this week; 9 alerts were for acute watery diarrhoea (AWD), 3 were for acute flaccid paralysis, 2 for suspected malaria, 1 was for measles and 2 were for meningitis.
No deaths were reporting to DEWS for this reporting week

Note: All presented data are based on the number of patient consultations and include information on priority diseases under surveillance as well as major health events reported through DEWS.


Priority diseases under surveillance in the flood affected areas


Acute Flaccid Paralysis
Acute Jaundice Syndrome
Acute Respiratory Infections
Acute Watery Diarrhoea/Suspected Cholera
Bloody Diarrhoea
Other Diarrhoea
Suspected Hemorrhagic Fever
Suspected Malaria
Suspected Measles
Suspected Meningitis
Unexplained Fever
Others


Table-1: Major health events reported during the week 31 - 38, 2010 (29 July - 24 September 2010)

[Diseases - Week‐31 - Week‐32 - Week‐33 - Week‐34 - Week‐35 - Week‐36 - Week‐37 - Week‐38]


Acute Diarrhea - 25,689 (13%) - 94,288 (11%) - 182,548 (14%) - 199,607 (14%) - 138,644 (13%) - 68,909 (12%) - 57,072 (14%) - 64,925 (13%)
Bloody Diarrhea - 1,449 (1%) - 4,566 (1%) - 7,907 (1%) - 11,024 (1%) - 10,839 (1%) - 9,228 (2%) - 6,705 (2%) - 6,411 (1%)
ARI - 25,335 (13%) - 92,134 (11%) - 185,546 (15%) - 217,071 (15%) - 187,226 (18%) - 96,607 (17%) - 69,969 (1%) - 89,949 (18%)
Suspected Malaria - 3,954 (2%) - 17,348 (2%) - 27,453 (2%) - 45,542 (3%) - 45,652 (4%) - 40,441 (7%) - 32,692 (8%) - 42,759 (9%)
Skin Diseases - 36,383 (19%) - 115,080 (14%) - 246,959 (20%) - 296,441 (21%) - 202,630 (19%) - 92,039 (16%) - 56,844 (14%) - 60,704 (12%)
Others - 101,725 (52%) - 521,872 (62%) - 615,448 (49%) - 654,520 (46%) - 468,791 (44%) - 251,769 (45%) - 191,129 (46%) - 221,553 (46%)
Total (All Events) - 194,552 - 845,353 - 1,265,912 - 1,424,260 - 1,053,827 - 559,006 - 414,437 - 486,376


Table‐2: Average number of reporting districts per week

[Province - Week 33 - Week 34 - Week 35 - Week 36 - Week 37 - Week 38]


Balochistan - 6 - 6 - 6 - 6 - 6 - 6
KPK - 8 - 8 - 8 - 8 - 8 - 6
Punjab - 8 - 8 - 9 - 9 - 9 - 10
Sindh - 18 - 18 - 18 - 18 - 18 - 18
Total - 40 - 40 - 41 - 41 - 41 - 40



Table-3: Followup Alerts reported in week 37, 2010.

[Dates - Event - Place/District - Province - Action taken]


11‐Sep‐10 - AWD - Abdul Rehman Jatoi Village/Sukkur - Sindh - Active surveillance carried out. Laboratory test negative for AWD (V. Cholera)
11‐Sep‐10 - AWD - Razi Goth/Khairpur - Sindh - Active surveillance carried out. Laboratory test Positive for AWD (Ogawa)
14‐Sep‐10 - AWD - THQ Matta/Swat - KPK - Active surveillance carried out. Laboratory test Positive for AWD (Ogawa)
14‐Sep‐10 - AWD - CMC Hospital / Larkana - Sindh - Active surveillance carried out. Laboratory test negative for AWD (V. Cholera)
15‐Sep‐10 - AWD - CH Pachakalay (Sultan Wass Village)/Buner - KPK - Aqua tabs were distributed. Active surveillance done in the surrounding areas. Laboratory test negative for AWD (V. Cholera)
15‐Sep‐10 - AWD - RHC Munda (Mian Kalay)/Lower Dir - KPK - Active surveillance carried out in the locality. Laboratory test Positive for AWD (Ogawa)
15‐Sep‐10 - AWD - RHC Munda (Gardai)/Lower Dir - KPK - Active surveillance carried out in the locality. Laboratory test Positive for AWD (Ogawa)
15‐Sep‐10 - Meningitis - Kokari/Swat - KPK - Laboratory test negative for Meningitis. Active surveillance carried out.
15‐Sep‐10 - AWD - TH Golarchi Thatta - Sindh - One Cholera Kit and one MEHK kit was donated.
15‐Sep‐10 - AWD - Shikarpur City/Shikarpur - Sindh - Active surveillance carried out. Laboratory test negative for AWD (V. Cholera)


Table-4: Alerts and Outbreaks (Week 38, 2010)

[Dates - Event - Place/District - Province - Action taken]


18‐Sep‐10 - AWD - DHQ Mianwali/Mianwali - Punjab -Upon investigation no active cases were seen, no sample was taken
18‐Sep‐10 - AWD - BHU Paikhel/Mianwali - Punjab - Upon investigation no active cases were seen, no sample was taken
19‐Sep‐10 - AWD - Kotmagsi/Naseerabad - Balochistan - Sporadic cases were found, no sample was taken
20‐Sep‐10 - AWD - DHQ Sibi/Sibi - Balochistan - Mild diarrhea cases were found, declared as false alert
20‐Sep‐10 - Meningitis - Dakorak Village/Swat - KPK - Laboratory test negative fo meningitis
21‐Sep‐10 - Meningitis - DHQ Loralai/Lorali - Balochistan - Patient’s father did not agree, no sample taken
21‐Sep‐10 - Measles - RHC Alladand Malakand - KPK - Sample in transportation
22‐Sep‐10 - AWD - Kot Addu/Muzaffarabgarh - Punjab - Sample collected and test under process
23‐Sep‐10 - AWD - Alipur, Bheda Kot/Muzaffargarh - Punjab - Sample collected and test under process
23‐Sep‐10 - AWD - BHU Naakband/Kohat - KPK - Hygiene education sessions were conducted at mosque. 8,000 aqua tabs and 1,000 ORS were distributed
23‐Sep‐10 - AWD - DHQ Timergara/Lower Dir - KPK - Previously 3 positive cases were identified, no new sample was taken
23‐Sep‐10 - Malaria - UC Khazana/Lower Dir - KPK - Malaria control program has been informed and will take care of on site sample collection
23‐Sep‐10 - Malaria - UC Norakhiel/Lower Dir - KPK - Malaria control program has been informed and will take care of on site sample collection
23‐Sep‐10 - AFP - Nishter Hospital/Multan - Punjab - Polio program has been informed and active surveillance is in progress
24‐Sep‐10 - AFP - Nishter Hospital/Muzaffargarh - Punjab - Polio program has been informed and active surveillance is in progress
24‐Sep‐10 - AFP - CHC Hospital/Muzaffarargarh - Punjab - Polio program has been informed and active surveillance is in progress
23‐Sep‐10 - AWD - Alipur, Tibbi Arain/Muzaffargarh - Punjab - Sample collected and test under process


Province KPK


6 out of 17 flood affected districts reported to DEWS from KPK province
55 fixed health centers and 24 mobile medical outreach centers reported to DEWS
101,679 patient consultations were reported during the reporting period of 18-24 September, week 38, 2010
6 alerts were received this week; 3 were for AWD, 2 were for suspected malaria and 1 each for measles and meningitis were reported and responded to this week


Diseases - Number % of total consultations


Acute Diarrhoea - 11,715 12%
ARI - 18,780 18%
Skin Diseases - 8,543 8%
Suspected malaria - 1,515 1%
Others 57,477 57%
Total Health events - 101,679


Province Punjab


10 out of 12 flood affected districts reported data to DEWS from Punjab province
164 fixed health centers and 46 mobile medical outreach centers reported to DEWS
141,915 patient consultations were reported during this reporting period
8 alerts were received and responded this week, 4 were for AWD and 3 were for AFP


Diseases - Number % of total consultations


Acute Diarrhoea - 18,016 13%
ARI - 25,633 18%
Skin Diseases - 14,852 10%
Suspected malaria - 12,041 8%
Others - 51,357 37%
Total Health events - 141,915


Province Sindh


18 out of 22 flood affected districts reported to DEWS from Province Sindh
504 fixed health centers and 139 mobile medical outreach centers reported to DEWS
223,401 patient consultations were reported during the reporting period of 18-24 September, week 38, 2010
No alert was reported for this week from any flood affected districts of province Sindh


Diseases - Number % of total consultations


Acute Diarrhoea - 32,021 14%
ARI - 42,959 19%
Skin Diseases - 37,309 17%
Suspected malaria - 24,817 11%
Others - 58,725 26%
Total Health events - 223,401


Province Balochistan


6 out of 19 flood-affected districts reported to DEWS from province Balochistan
22 fixed health centers and 6 mobile medical outreach centers reported to DEWS
19,381 patient consultations were reported during the reporting period of 18-24 September, week 38, 2010
3 alerts were received and responded, 2 for AWD and 1 for meningitis from province Balochistan


Diseases - Number % of total consultations


Acute Diarrhoea - 3,137 16%
ARI - 2,577 13%
Suspected Malaria - 4,286 23%
Unexplained Fever - 346 2%
Others - 8,120 42%
Total Health events - 19,381


Since July 29, 2010, approximately 6,243,723 patient consultations have been reported to DEWS from the flood affected provinces in Pakistan. DEWS is currently in place in 64 of the 78 flood affected districts (82%) and reporting is received from 50 of these 64 districts (78%).

The major causes for seeking healthcare by the affected communities continue to be diarrhoel diseases, acute respiratory infections, skin diseases and suspected malaria.

In KPK, ARI increased from 13% to 18% while AD continues to decline, however, it remains proportionally higher compared to the corresponding reporting period from 2009.

In Punjab, a higher proportion of suspected malaria was reported this week (1% to 8%), however, it is important to note the corresponding decrease in unexplained fever (17% to 7%). Thus, caution should be used when interpreting these data.

In Sindh, proportional morbidity of major health events remained the same when compared to last week.

In Balochistan, reporting remains irregular due to security issues. Suspected malaria continues to make up the largest proportion of consultations.

Seventeen alerts were raised during this reporting period. Nine alerts were for AWD bringing the total number of alerts for AWD to 126. There are currently 67 confirmed cholera cases through DEWS. The laboratory samples were collected from all sites, as necessary, and sent to National Institute of Health (NIH) for laboratory confirmation. Relevant public health actions were initiated in the field to arrest a potential outbreak.


Focus On….

Malaria

Floods may indirectly lead to an increase in vector‐borne diseases through the expansion in the number and range of vector habitats. Standing water caused by heavy rainfall or overflow of rivers can act as breeding sites for mosquitoes, and therefore enhance the potential for exposure of the disaster‐affected population and emergency workers to infections such as dengue, malaria and West Nile fever. Flooding may initially flush out mosquito breeding, but it comes back when the waters recede. The lag time is usually around 6‐8 weeks before the onset of a malaria epidemic. The risk of outbreaks is greatly increased by complicating factors, such as changes in human behavior (increased exposure to mosquitoes while sleeping outside, a temporary pause in disease control activities, overcrowding), or changes in the habitat which promote mosquito breeding (landslide, deforestation, river damming, and rerouting).(i)

Malnutrition and other concurrent infections can leave displaced populations particularly vulnerable to malaria infection as well.

In 2008, about 15% of Pakistan’s population lived in areas of high malarial transmission (only 4% lived in “malaria‐free zones”) and 4.5 million suspected malaria cases were reported in Pakistan, accounting for 6% of all outpatient visits and 18% of all medical admissions. (ii)

Movement of people from areas of low endemicity to hyperendemic regions can result in high levels of transmission and infection in a population with relatively little previous exposure. Movement in the other direction risks high levels of transmission as well: despite having left hyperendemic areas, persons moving to areas with low endemicity but suitable vector conditions may raise the epidemic risk there. In particular, the Anopheles mosquito vector may be prevalent in areas of stagnant water or flooding, as is seen in Pakistan.

Although the risk of transmission of malaria can increase in the context of an emergency, effective control and the reduction of transmission is possible. Flooding does not necessarily lead to an immediate major increase in mosquito numbers, and there may still be time to implement preventive measures such as indoor residual spraying. Distribution of insecticide‐treated nets, especially long‐lasting nets (LLNs), including how to use these nets are frequently effective options in areas where their use is well‐known. This will also have an effect on other mosquito‐borne diseases. (iii)

Malarial treatments are more complex, however, and generally take the form of antimalarial drugs, though these must have demonstrated efficacy against local strains and rigid compliance to maintain the effectiveness of the treatment and deter evolution of drug‐resistance.

(i) Flooding and communicable diseases fact sheet. Risk assessment and preventive measures. World Health Organization. (LINK (http://www.who.int/hac/techguidance/ems/flood_cds/en/)) Accessed 26 Sept. 2010
(ii) World Health Organization. World Malaria Report 2009. Geneva
(iii) Flooding and communicable diseases fact sheet. Short-term measures. World Health Organization. (LINK (http://www.who.int/hac/techguidance/ems/flood_cds/en/index1.html)) Accessed 26 Sept. 2010


Objective of this weekly epidemiological bulletin is to provide a snap shot on selected health events reported from the communities affected by the current flood in Pakistan. While every attempt is made to present the weekly trend of the epidemic prone diseases, the information presented in the bulletin needs to be interpreted in the context that precise information on the reference populations is not always available, The bulletin doesn’t provide any health information on areas not covered by the emergency health response operations of MoH, Pakistan and WHO. The primary focus of DEWS is the early detection of epidemic prone diseases, to facilitate a rapid public health response. We would like to thank all the numerous national and international partners who have contributed to the Disease Early Warning System.

For further information and feed-back:
Epidemic Investigation Cell, National Institute of Health, Chak Shahzad, Islamabd, Paksitan. : eic.nih@gmail.com
World Health Organization, Pakistan : wr@pak.emro.who.int
-
------

Giuseppe Michieli
October 1st, 2010, 11:24 AM
Floods in Pakistan, 28 september 2010 - Pakistan Health Cluster - No. 19. Focus on Donors (WHO, edited)


[Source: World Health Organization, full PDF Document (LINK (http://www.whopak.org/idps/documents/bulletins/Health%20Cluster%20Bulletin%20No%2019-Final.pdf)). Extracts, edited.]

Floods in Pakistan, 28 september 2010 - Pakistan Health Cluster - No. 19. Focus on Donors

(...)

Situation overview and current scale of disaster

The situation has been stable over the past with no new flooded areas except for Lake Manchar in Southern Sindh.

Nevertheless, large areas, especially in southern Sindh, are still under water and many people remain displaced. Relief operations continue in several districts. In Khyber Pakhtunkhwa (KP) and Punjab, the situation continues to stabilize. The health coordinator in Multan reports that almost all internally displaced people (IDPs) in the area have returned home.

Stagnant water, lack of sanitation and poor access to health are the main causes of concern.

According to Pakistan's disaster management authorities, the number of people affected by the floods stands at 20.25 million in 78 districts across the country, with over 1.9 million houses damaged or destroyed. According to provincial governments, 514 health facilities so far have been affected (280 partially damaged (PD) and 234 fully damaged (FD).

Partially damaged - Fully damaged


Baluchistan 117 - 35
Punjab 14 - 40
KP 123 - 46
Sindh 26 - 113

There are currently three distinct target population groups, each of which requires a different approach: 1) IDPs 2) IPDs returning home where services are available; 3) IDPs returning home where services are not available. Humanitarian agencies are concerned that the widespread dispersal of these returnees may create difficulties in providing the necessary services. It should be noted that some IDPs had better access to health care in the settlements than before the floods, when only around 33% of the rural population had access to health care within 5 km. Health care access is, therefore, likely to decrease upon return to the original areas.


Health impact

Acute diarrhoea, acute respiratory infections (ARI), skin infections and suspected malaria remain the leading causes for seeking health care in the flood‐affected areas.


Basic statistics update (reporting period 18‐24 September)


Since 29 July, 6 243 723 patient consultations have been reported to the Disease Early Warning System (DEWS). DEWS is in place in 64 of the 78 flood affected districts (82%) and reports are received from 50 of these 64 districts (78%)
In KP, ARI has increased from 13% to 18% while acute diarrhoea continues to decline. Diarrhoea remains proportionally higher than t the same period of the last year. In Punjab, a higher proportion of suspected malaria was reported this week (1% to 8%), but decrease in unexplained fever has been noted (17% to 7%). Epidemiologists in WHO recommend caution in interpreting the increase in rates of malaria.
One out of five stool samples collected for testing by WHO in Sukkur turned out to be positive for cholera.

For a more detailed Epidemiologic report kindly go to (LINK (http://www.whopak.org/))


Upcoming issues

Health concerns are evolving as winter approaches. Diarrhoea is less reported in the north, as expected with the change of weather, but remains high in the southern areas of Pakistan. ARI on the other hand is expected to rise in KP and northern Punjab with the cold and the inadequate shelter.

Malaria still remains a potential threat. Areas where vivax was endemic are now reporting falciporum, which is more dangerous. The season for falciporum is approaching; epidemiologists anticipate outbreaks in the coming weeks.

Malnutrition is increasingly a concern. Food insecurity will continue to be very high in the coming months, mainly as a result of disruption of canalization and loss of seeds. Increasing numbers of children are expected to develop acute malnutrition combined with infectious diseases (which can be life‐threatening in malnourished children).


Government Response


The fourth meeting of the National Steering Committee on Health Emergencies was held on 23 September 2010 at the National Health Emergency Preparedness and Response Center (NHEPR), Islamabad, under the chairmanship of Secretary, Federal Ministry of Health, Mr Khushnood Lashari. Representatives of all Provinces participated.
The provinces were asked to provide consolidated requirements for the early recovery phase.
Four teams from the MoH's National Health Volunteer Programme (NHEPRN), comprising male and female doctors, nurses and dispensers, provided medical care to flood victims in Charsadda and Nowshera. Additional medical teams will be deployed to Razzakabad Camp, Karachi and Swat in early October.
NHEPRN is coordinating the deployment of foreign medical teams and field hospitals in all provinces. A team from Spain (which arrived on Tuesday) will be assigned to Jhal Magsi, Baluchistan. At the request of KP's health department, the field hospital donated by Italy will be deployed at Swat and Dasu, Kohistan instead of Charsadda and Nowshera.
NHEPRN will shortly install three water purification units at Civil Hospital Akora Khattak, EDO Office and Mian ESSA camp at Nowshera district.
A handover ceremony for 250 000 long‐lasting insecticide‐treated bed nets donated by WHO and UNICEF is planned for 1 October.


Donor Response

The Health Cluster would be unable to carry out its life‐saving work in the flood‐affected areas of Pakistan without the generous support of its donors. The section below highlights the work and contributions of some of these donors. (Note: there is not enough space in the bulletin to acknowledge all contributions from all donors. Therefore, please note that the list below is not exhaustive: it includes text received directly from some donors as well as a brief summary of some of the Health Cluster's main donors).


Cash contributions

AUSAID is planning to donate Aus$ 2 million for the flood response. (See also under in‐kind contributions.)

CANADA: Pakistan is one of Canada's 20 countries of focus. Canada has donated over US$4 million for health sector flood response activities.

CENTRAL EMERGENCY RESPONSE FUND (CERF) has allocated over US$4 million for the health response.

EISAI CO. LTD. (Japan) has contributed US$ 100,000.

EUROPEAN COMMISSION HUMANITARIAN AID DEPARTMENT (ECHO) has allocated €70 million to address the impact of the floods, of which over US$12 million is for health. ECHO's rationale is to support partners who were already working in the conflict‐affected areas and are therefore able to integrate the flood response into the more general support to the conflict ‐affected population. ECHO also supports partners' efforts to cover evolving health needs in the flood‐struck areas . As the situation evolves, health and WASH activities must be expanded to encompass newly accessible areas as well as those where the flood waters have not fully receded. Moreover, early recovery needs are huge in the areas of return, where the population is confronted with a lack of basic health, water and sanitation services and systems.

ECHO is supporting PHC services, including the management of acute malnutrition, and WASH activities. It aims to maintain its current levels of support to health operations while at the same time being prepared for emerging health threats including malaria, malnutrition and acute respiratory infections.

ECHO's health and WASH partners include Acted, Alliance 2015, DCA, German Red Cross, Hope 87, IRC, Merlin, Oxfam, Save the Children, Solidarite, and WHO.

FINLAND has donated almost US$800 000 for the health response.

GERMANY has donated almost US$2 million for the health response.

ITALY has donated over US$600 000, in addition to its in‐kind donations (see next section).

JAPAN has donated almost US$1.5 million for the health response in addition to its in‐kind donations (see next section).

MONACO has donated just under US$130 000 for the health response.

NEW ZEALAND has donated over US$400 000 for the health response.

NORWAY has donated over US$3 million for the health response.

PACKARD FOUNDATION has allocated US$887 778 for flood relief, of which US$700 000 has been awarded to the National Rural Support Programme (NRSP), the Health and Nutrition Development Society (HANDS), and the Society of Obstetricians and Gynecologists of Pakistan (SOGP). NRSP 's activities include the provision of food, shelter, clothing, livestock care, and medical services. SOGP is providing medical outreach services, including maternal health care, through teams of doctors, midwives and dispensers/vaccinators. HANDS has over 1200 staff and 10 000 volunteers working to meet immediate relief needs in different districts. The Punjab Rural Support Programme, Shirkat Gah and the Indus Resource Centre received the balance of the funds allocated by the Packard Foundation.

UNITED KINGDOM DEPARTMENT FOR INTERNATIONAL DEVELOPMENT (DFID) has committed £134 million for flood relief in Pakistan, of which £64 million (including £22.5 million for health and/or water and sanitation projects) has already been allocated. The money will be used to provide safe drinking water, hygiene kits and latrines; monitor the quality of drinking water; and support hygiene awareness campaigns, sewage clearance and waste removal. It will also be used to scale up the geographic coverage of the country's disease early warning system (DEWS) and strengthen immediate and essential primary health care services, including obstetric care and the treatment of communicable diseases in children under five. DFID has also deployed experts to support its office in Pakistan on a full‐time basis. (For more information on DFID's support to the flood response, see under in‐kind donations.)

UNITED STATES AGENCY FOR INTERNATIONAL DEVELOPMENT (USAID) has provided support for several types of flood response and recovery programs in health: approximately $21.5 million to UN agencies for expansion of the Disease Early Warning System, establishment of diarrhea treatment centers, measles and polio vaccination activities, malaria control, and emergency reproductive health activities. USAID has also strategically provided bilateral support to both international and local health agencies: not including support for WASH and nutrition, to date, USAID has provided nearly $13.6 to support direct primary and secondary clinical care via emergency and mobile medical teams, emergency medical transport services, logistics support and medical supplies, community health education, including support for the Lady Health Worker program, and health facility rehabilitation.


In‐kind contributions

AUSAID The Australian Medical Treatment Facility (AMTF) is running a static tented health facility in the KAPCO compound in Kot Addu (Punjab). The facility ‐ staffed by the Australian Defence Force and civilian medical teams ‐ treated 1900 patients over the past week. Main causes of consultation are malaria (24%), skin infections (12.5%), diarrhoea (10%) and acute respiratory infections (5%). AMTF is providing statistics on weight for age and arm circumference to the Nutrition Cluster: 55% of girls under five and 39% of boys (weight for age) are below the third percentile in AMTF's cohort.

AUSTRIA has donated water purification supplies and one inter‐agency Emergency Health Kit (IEHK).

CHINA has donated a field hospital, which has been established in Thatta, Sindh. The hospital has treated over 18 000 patients to date.

DENMARK: the Danish Emergency Management Agency has donated a light field hospital, which is operating in the area of Radhan, Sindh province. Denmark has donated water purification supplies and deployed technical experts.

FRANCE has donated water purification equipment and emergency medical supplies including a cholera kit.

GERMANY has donated water purification equipment and deployed technical experts. It has also donated medical supplies.

ITALY has contributed to the health cluster through WHO and donated medical kits and materials (91 IEHKs and eight diarrhoeal disease kits) to flood affected areas. 7 Italian light field hospitals are being dispatched to different flood affected localities of Pakistan. Water purification supplies and equipment have also been donated.

JAPAN has donated 1650 tents, 67 de‐watering pumps, 20 water tanks, 25 water purifiers and 1 million water purification tablets. Following consultations with Pakistan's Ministry of Health, provincial authorities and the UN, Japan's International Cooperation Agency (JICA) dispatched a 46‐strong medical team to Muzaffargarh District (Punjab) from 5 to 23 September. The team established a medical facility at Rural Health Centre Sinawan and examined a total of 3501 patients during their stay. A midwife in the team played an important role in instructing nursing mothers on correct lactation skills.

MOBILINK PAKISTAN has donated 237 prefabricated structures (each measuring 12m2) to the Health Cluster. The structures are intended to replace damaged or destroyed health facilities in camps and other areas. They can also be used as medical warehouses if needed.

SWEDEN has donated water purification supplies and sent relief teams.

UNITED KINGDOM DEPARTMENT FOR INTERNATIONAL DEVELOPMENT (DFID) has donated water purification tablets and other relief supplies. DFID has also brought forward a £10 million programme to provide bridges as part of the early recovery effort. Ten pre‐fabricated road bridges from the UK are scheduled to arrive in Karachi in mid September for installation in KP, with more to follow in due course.


Health Cluster Response


CARE - (Reporting period: 11 to 17 September)

KP

CARE treated 772 patients (including 277 women and 356 children) via four basic health units (BHUs) in upper Swat. In Charsadda, 15 mobile clinics managed by three mobile teams treated 2416 patients (including 725 women and 977 children). CARE also conducted 41 health and hygiene sessions that were attended by 738 people. In Nowshera, another 12 mobile clinics managed by four teams treated 1833 patients including 588 women and 788 children. A total of 1158 people attended 44 health and hygiene sessions conducted by CARE in Nowshera.

PUNJAB

CARE treated 1203 patients (including 436 women and 706 children) via 12 mobile clinics in Rajanpur.

SINDH

CARE provided primary health care (PHC) services to 897 patients (including 298 women and 423 children) via 17 mobile medical camps in districts Sukkur, Kashmor and Shikarpur.





CENTRE OF EXCELLENCE FOR RURAL DEVELOPMENT (CERD)

KP

In Nowshera, CERD is proving PHC services including mother and child health (MCH) and nutritional services (initially through mobile clinics and now through the MCH centre) in UC Pashtun Gharee. In Dir Lower, CERD is helping the Executive District Officer for Health (EDO‐H) to provide medical and nutrition services in UC Baduwaan.





CHURCH WORLD SERVICE (CWS P/A)

KP

CWS P/A mobile and fixed health units are operating in Mansehra, Kohistan, Swabi and Swat districts. CWS carried out 10 402 consultations and examined 1527 children under five. Lady health visitors (LHVs) registered and gave medicines to 240 ante‐ and 67 postnatal women. CWS P/A also held 293 education sessions attended by 2936 people (1661 women and 1275 men). It is planning to expand operations to include Shangla district. Main needs and challenges reported by CWS P/A include damaged health infrastructures, a lack of human resources, and shortages of medicines and medical equipment.





HELPING HAND FOR RELIEF AND DEVELOPMENT (HHRD) - (Reporting period: 29 July to 23 September)

To date, more than 75 000 patients have been treated in HHRD's free medical camps in KP (Charsadda, Nowshera, Dir. Swat, Buner), Punjab (Mianwali, Muzaffargarh, Layyah, D.G. Khan) and Sindh (Nawabshah, Sukkur, Karachi and Larkana). Major diseases observed include diarrhoea, scabies, eye and skin infections, and malaria.




INTERNATIONAL MEDICAL CORPS (IMC) -(Reporting period: 18 to 24 September)

KP

IMC treated a total of 822 patients in districts Peshawar, Charsadda and Nowshera, and provided psychosocial support to 254 people.

PUNJAB

IMC has signed a memorandum of understanding with Punjab's Health Department covering the provision of emergency health care services. Most field staff have now been recruited, and four teams have been deployed to rural health centre (RHC) Rohillan Wala, and basic health units (BHUs) Aluday Wali, Umerpur Janobi and Mahra. More teams are being deployed in various government health facilities in Rajanpur, Multan, Rahimyarkhan, Muzaffargarh and Layyah districts. diarrhoea Treatment Centres (DTCs) are being established in RHCs Jampur (Rajanpur), Rohila wala (Muzaffargarh), and Lalisan Crore (Layyah).

SINDH

IMC is recruiting staff and deploying medical teams to THQ Rato Dhero, RHCs Nodhero, Banguldhero, Gerello, BHU Areeja in Larkana District and BHUs Jehangir Tahim, Nim and Nabi Shah Wagan in Shikarpur district. DTCs are being established in RHCs Dhokri (Larkana), Khanpur (Shikarpur) and Qambar Shahdatkot.





INTERNATIONAL ORGANIZATION FOR MIGRATION (IOM) - (Reporting period: 20 to 24 September)

PUNJAB

IOM treated 1262 patients in Muzaffargarh and Rajanpur districts. It also organized seven outreach medical camps in Ameer Abad, Basti Bandu Sandela and BHU Umer Kot that reached more than 1000 internally displaced people (IDPs).

SINDH

IOM treated 772 patients in district Thatta.





MALTESER INTERNATIONAL

A total of 5442 patients have been treated over the last six weeks through PHC services in three health facilities, with an average number of 60 patients per day and per facility. Malteser also organized ten medical camps, where over 3577 patients were treated by two mobile medical teams (MMTs). Several hundred children have been vaccinated (EPI protocol + Influenza) by the EDO Health Office's vaccination team; these medical camps were organized in UC remote areas, Transitional Camps of Islampur UC, and Tahirabad quarter of Mingora Town. MMTs are also providing intensive hygiene awareness campaigns in areas with suspected acute water diarrhoea (AWD) cases (Barikot, Margazal and Ahunbaba of Islampur UC and Mingora Town). Every week, several hundred families have been enrolled, and hygiene printed materials, Aqua‐Tabs, soap and ORS sachets have been distributed. MSTs/MMTs also distributed 3000 jerrycans, 800 kgs of soap and several hundred thousand Aqua‐Tabs donated by WHO, UNICEF and Oxfam.
The main challenges on the ground are 1) the lack of access to the beneficiaries and health facilities in the Upper Swat Valley and Kohistan district, and 2) the ongoing outbreaks of AWD, measles and the approaching malaria outbreak.




MERLIN -(Reporting period: 22‐23 September)

Merlin is scaling up operations and mobilizing its entire staff to meet the needs of a growing humanitarian emergency. Since 5 August 2010, Merlin has conducted a total of 227 545 consultations.
KP

Merlin is working through health facilities, mobile health units and DTCs to provide health and nutrition services and health promotion sessions in Nowshera, Swat, Buner and Charsadda (approximate catchment populations: 153 000, 590 000, 338 000 and 172 000 respectively).
In Nowshera, where Merlin is providing health and nutrition services through six mobile health units (MHUs) in six Union Councils (UCs) and six 24/7 static clinics in Jalozai, it held a total of 3827 consultations on 22 and 23 September, and distributed multi‐micronutrients tablets, micro‐nutrient sachets, and Amunuts. It also conducted 55 health promotion sessions for 423 beneficiaries, and held another 266 consultations in a DTC.
In Swat, where Merlin is providing health services through nine MHUs and 11 health facilities, it conducted 5249 consultations on 22 and 23 September, and carried out 337 health promotion sessions. It conducted another 144 consultations at the DTC in THQ Matta. Merlin teams also delivered seventeen babies and referred four patients.
In Buner, where Merlin is providing PHC services (including reproductive health) through 10 health facilities and three MHUs, it conducted 2592 consultations and carried out 52 health promotion sessions. It held twenty consultations at the DTC in THQ Pachakalay. It also delivered 21 babies and referred four patients.
In Charsadda, Merlin conducted 135 consultations at the newly‐established DTC in DHQ Charsadda and another 307 consultations at the DTC in CH Shabqadar.

PUNJAB

Merlin carried out 153 consultations at the new DCT in DHQ Muzaffargarh. Merlin will begin providing PHC and nutrition services through five static and mobile health facilities, and will expand services to another two health facilities in the coming weeks.





MOTHER HELPAGE

Mother Helpage is taking care of critically injured patients and vulnerable groups. It has set up maternal and child health medical camps and communication centres, and is offering trauma counseling. It has set up medical camps in Makri and Pateeka villages (Azad Jammu & Kashmir) and plans to set up other camps in Neelum and Shonther valley, Punjab,Sindh and KPK. It is also constructing chair lift air bridges at several locations.




MUSLIM AID UK

KP

In Charsadda (BHU Gulab Abad, UC Agra), Muslim Aid treated 207 women, 299 children and 81 men, distributed 320 hygiene kits and 17 800 sachets of aqua tabs, and conducted 18 hygiene and public awareness sessions. The BHU has been rehabilitated, cleaned and painted, and a new well has been dug.
Muslim Aid also assessed water, sanitation and hygiene needs in 25 villages (10 in UC Mirza Dher, 12 in Tarnab and three in Hisar Dheri). In Nowshera (Mohib Banda, Banda Mala Khan and Aman Kot), Muslim Aid distributed 6600 aqua tabs and conducted 16 hygiene sessions. The rehabilitation of BHUs Aman Kot, Banda Mula Khan and Mohib Banda continues.

PUNJAB

In Jampur (District Rajan Pur) a Muslim Aid medical team has treated 161 women, 183 children and 172 men. It will begin offering medical services in UC Kotal Mughaln next week. Muslim Aid has conducted 20 hygiene awareness sessions in 10 villages, and has distributed 50 000 aqua tabs and 2400 sachets.

SINDH

In Shikarpur, Muslim Aid treated 75 women, 155 children and 31 men, and referred three people to hospital level. It also conducted 21 hygiene and general health awareness sessions and distributed 200 mosquito nets. In Qambar Shehdad Kot, it distributed 320 mosquito nets, conducted eight awareness sessions, and treated 616 women, 517 children and 289 men. In Thatta, it treated 282 women, 75 children and 69 men. Diseases included bloody diarrhoea, suspected malaria, acute respiratory infections (ARI) and skin infections. It also distributed 1000 aqua tabs and treated 1 252 000 liters of water through its water purification plant. In Sukkur, where health activities were slower than usual due to illness among the medical team, Muslim Aid treated 20 women, 58 children and nine men for malaria, ARI and skin infections. It also conducted 15 hygiene/healthy living sessions.





NATIONAL RURAL SUPPORT PROGRAMME (NRSP)

NRSP is running medical camps in KP (districts Charsadda and Nowshera), Punjab (districts DG Khan, Rajanpur, Mianwali and Bhakkar) and Sindh (districts Thatta and Benazirabad). It is also rehabilitating health facilities in Punjab (Rajanpur and DG Khan).




NCHD

KP

NCHD is running medical camps in several districts in KP. It has treated a total of 163 694 patients to date.





SUPPORT WITH WORKING SOLUTION (SWWS)

KP

SWWS is providing medical care at BHU Sherigle, Dir Upper, where it has so far treated 9867 people, of whom 57% have been children. It has also organized three medical camps at District Charsadda, with philanthropists and volunteer doctors who provided medical care to 450 patients at Katukhail Nowshera.





UNFPA - (Reporting period: 1 August to 23 September)

KP

UNFPA has established 12 service delivery points, including a mobile unit, in Nowshera, D.I. Khan, Tank, Swat and Lower Dir. It has provided women’s hygiene kits to 1791 families, distributed 1103 newborn kits to new mothers, and prepositioned enough reproductive health (RH) kits in Peshawar warehouse to cater for 600 000 people for three months. It has provided RH and PHC services for 36 513 patients, delivered 2137 babies, conducted 4678 ante‐ and 1266 postnatal consultations, provided post‐abortion care for 195 women, referred 149 patients for Caesarean section, treated 415 sexually transmitted infections, and held 1185 family planning consultations. UNFPA's PHC services included 5692 consultations for gastroenteritis, 1543 for scabies, 3369 for acute respiratory tract infections, 3652 for fever and 11 838 for minor ailments.

PUNJAB

UNFPA has established 11 service delivery points, including three mobile units, in Muzaffargarh, Rajanpur, Layyah, D.G. Khan and Rahim Yar Khan. It has provided RH and PHC services for 14 622 patients, delivered 310 babies, held 2707 ante‐ and 499 postnatal consultations, provided post‐abortion care for 63 women, referred 29 patients for Caesarean section, treated 186 sexually transmitted infections, and held 179 family planning consultations. Moreover, it has donated women's hygiene kits to 1500 families and distributed 600 newborn kits to new mothers. UNFPA has also prepositioned enough RH kits in Multan warehouse to cater for 1.2 million people for three months. UNFPA's PHC services included 2235 consultations for gastroenteritis, 942 for scabies, 1537 for acute respiratory tract infections, 1970 for fever and 2858 for minor ailments.

SINDH

UNFPA has established 31 service delivery points, including 23 mobile units, in Jaccabad, Thatha, Shikarpur, Sukkur, Larrkana, Khairpur, Qamber Shahdadpur, Kashmor and Ghotki. It has donated women’s hygiene kits to 724 families, distributed 1400 newborn kits to new mothers, and pre‐positioned enough RH kits in Sukkur and Hyderabad warehouses to cater for 1.1 million people for three months. It has provided RH and PHC services for 67 147 patients, delivered 370 babies, conducted 8288 ante‐ and 1392 postnatal consultations, provided post‐abortion care for 301 women, referred 41 patients for Caesarean section, treated 377 sexually transmitted infections, and held 609 family planning consultations. UNFPA's PHC services included 13 775 consultations for gastroenteritis, 12 189 for scabies, 9379 for acute respiratory tract infections, 12 637 for fever and 6331 for minor ailments.

NEEDS AND CHALLENGES

The main challenges faced by UNFPA include a lack of funds and skilled human resources to re‐establish basic and comprehensive RH services in areas affected by the floods. Limited information management resources are also hampering the Health Cluster's efforts to gain a comprehensive overview of needs on the grounds and the activities being implemented.





UNICEF

BALUCHISTAN

Acute diarrhoea (12%), acute respiratory tract infections (12%) and suspected malaria (23%) remain the leading causes of seeking health care in flood‐affected districts, with higher numbers of suspected cases of malaria in Nasreeabad and Jaffarabad as compared to other districts.
UNICEF's main activities in Baluchistan include vaccination campaigns against polio, measles, BCG and TT, Mother and Child Days, the distribution of emergency food rations and supplements, as well as hygiene and other kits, and health and hygiene awareness sessions.

KP

UNICEF, in collaboration with the MoH, WHO and other partners, is conducting mass vaccination campaigns against polio and measles in 15 districts, and continuing routine immunization activities in schools and camps in flood‐affected areas. In phase 1 so far, the following numbers of children have been vaccinated: measles: 335 460; polio: 384,397; Pentalent vaccine: 13 669; BCG: 3,410; TT: 9,474 women. UNICEF is also providing specialized obstetrics, gynaecology and paediatric care through mobile units, and supporting medical teams at six static health facilities, as well as specialized paediatric services at DHQ D.I. Khan.
UNICEF's Mother and Child Days (being conducted in 11 Union Councils of Swat) include vaccinations, de‐worming, blanket distribution of MM sachets and aqua tabs, and distribution of non‐food items including clean delivery kits, jerry cans, buckets, newborn and hygiene kits. UNICEF has also distributed high‐energy biscuits, fortified blended food, micronutrient sachets and tablets, and Plumpy' Doz.

PUNJAB

Routine immunization of children is continuing in schools and camps in flood‐affected areas.

SINDH

UNICEF is conducting routine vaccination activities in schools, camps and flood‐affected areas, and providing antenatal, natal, neonatal and postnatal health services through mobile and static mother, neonatal and child health services.
UNICEF is also conducting routine vaccination activities in flood‐affected areas of Azad Kashmir and Gilgit Baltistan.





USAID/PAIMAN

USAID/PAIMAN field staff attended local level health cluster coordination meetings and participated in mass vaccination campaigns in all provinces.
BALUCHISTAN

USAID/PAIMAN has donated 1140 jerry cans and 566 water tanks to Sibi and Jaffarabad. Its local NGO partners conducted eight mobile health camps and three health and hygiene promotion sessions, using materials donated by UNICEF.

KP

USAID/PAIMAN donated 21 744 jerry cans and 1578 water tanks to Swat, Charsadda and DI Khan. It also organized 10 mobile health camps, conducted 10 health and hygiene promotions sessions, and donated 2000 insecticide‐treated bed nets to Swat and Charsadda.

PUNJAB

USAID/PAIMAN donated 16 293 jerry cans and 1524 water tanks to MSD Multan (handover ceremony attended by the Minister of Health) and DCO DG Khan. It also organized eight mobile health camps and conducted six health and hygiene promotion sessions.

SINDH

USAID/PAIMAN donated 36 504 jerry cans and 3361 water tanks to Sukkur (handover ceremony attended by the Minister of Health) and Khairpur. USAID/PAIMAN organized a specialized medical camp in the Government Atta Hussain Degree College Rohri; 512 patients were treated. It also supported 27 mobile health camps and 15 health and hygiene promotion sessions.





WHO

WHO is finalizing the "Who Does What, Where" (3W) table mapping all partners' activities. The updated matrix, revised to make it more user‐friendly, has been sent to all health partners for review and completion. WHO will use the data submitted by partners to create detailed maps showing Health Cluster partners' presence on the ground. WHO is also working to anticipate the health needs of displaced people in areas of return.
Some DTCs report that they working at less than full capacity. As IDPs return home, there may be a need to relocate some DTCs. Independently of the number of patients in DTCs, as long as the risk factors remain (stagnant, contaminated water, poor hygiene, insufficient latrines), WHO will maintain the DTCs in a state of readiness. There are currently 18 DTCs in KP, 12 in Punjab, seven in Baluchistan, seven in Sindh (including three opening in three days) and two in Gilgit.
WHO staff in Sukkur travelled to Islamabad to attend a "training of trainers" course on the case management of diarrhoeal diseases and on prevention and control strategies. They will begin on‐site training of DTC staff next week (beginning of October).
In Sukkur WHO is distributing malaria rapid diagnostic kits to all health partners, and has asked partners to share the percentage of positive malaria cases. WHO will also provide malaria treatment guidelines to partners.
A joint WHO/UNICEF/MoH immunization campaign polio and measles began on 20 September. The first phase of the campaign will be completed by 2 October.




WORLD VISION (WV)

KP

WV continues to support four static health facilities in Koto, Kandaro, Munjai and Chakdara. During the reporting period 10 261 people were seen at health facilities supported by WV. The DTC at THQ Chakdara admitted and treated 138 cases of acute diarrhoea. WV has assessed health coverage gaps, and is deploying static and mobile teams in consultation with the EDO‐H in Nowshera and Charsadda. The teams have begun services in Amangarh, Nowshera and Umarabad Mujikai‐Charsadda, Majuki (UC MC‐2, UC MC‐4 and UC Meraprang). A total of 3378 individuals have consulted the health teams to date. In Nowshera, one mobile and two static units have conducted 2304 consultations. The teams will shortly expand services to include three more facilities. WV has initiated a detailed assessment of health facilities in Charsadda, Nowshera and Lower Dir.

PUNJAB

WV has provided 10 trucks and drivers for one month to EDO‐H to ensure medical and relief supplies in Multan are able to be distributed to the flood‐affected districts. It is treating patients and conducting health education sessions via mobile clinics in Onttahwala (UC Nusan) and Shaheen Nager (UC Basira). It is continuing to assess unmet needs in Alipur, Jatoi and S. Muzaffargarh.

SINDH

WV has established four mobile teams at Kotdegi and Goth Abdullah Shah Panu Aqil.

NEEDS AND CHALLENGES

WV reports that the shortage of trained health care providers in Punjab is a major constraint.




Health Cluster Coordination

Inter Cluster Coordination:

Members of the Health, Nutrition, WASH and Food clusters have developed a joint strategy to ensure a more integrated, effective and timely emergency response in priority flood affected districts. The strategy aims to address the factors that contribute to the main mortality risks (acute diarrhoea, acute respiratory infections, malaria, measles, malnutrition, and maternal and neo‐natal mortality/morbidity). An integrated approach is essential, with a very strong component of community‐based interventions. Once "hot spots" have been identified, organizations will need to consult each other and come up with ways of working through existing projects and activities (e.g. using polio campaigns to screen for malnutrition). The strategy needs to be operationalized at district or even Union Council (or Tehsil) levels. OCHA has assigned full‐time staff in each district to facilitate coordination and implementation of the survival. Operational plans will be established in a "bottom‐up" approach, not from Islamabad.


Coordination at provincial & hub levels:

Regular Health cluster meetings are being held in Peshawar, Multan, Sukkur and Hyderabad. A coordination system is in place with PDMA, DoH, OCHA, NGOs and other UN agencies.


Revision of Health Cluster Projects under PFERP:

The Health Cluster has completed the revision of its projects in the Pakistan Flood Emergency Response Plan (PFERP).

The revision was undertaken in compliance with NDMA guidelines to make the projects more elaborative and realistic.

The Health Cluster is seeking over US$ 200 million for 95 projects, which cover both relief and early recovery, to be implemented by six UN agencies, 19 international and 28 national NGOs.




Alfred Dube

Health Cluster Coordinator
email: dubea@pak.emro.who.int
Telephone: +92‐ 03004005934

Sadia Iqbal

Donor Relations Focal Point
email: iqbalsa@pak.emro.who.int
Telephone : +92 300 4995937

Maria Anguera de Sojo

Communications Officer
email: sojom@pak.emro.who.int
Telephone: +92‐ 03018551459

Syed Haider Ali

Communications officer
email: alisy@pak.emro.who.int
Telephone: +92‐ 3004005944


-
------

Giuseppe Michieli
October 7th, 2010, 10:50 AM
Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 7 Monday 4 October 2010 (WHO, edited)


[Source: World Health Organization, full PDF Document (LINK (http://www.who.int/hac/crises/pak/sitreps/pakistan_epi_4october2010.pdf)). Extracts, edited.]

Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 7 Monday 4 October 2010

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com


Highlights

Epidemiological week no 39 (25 September - 1 October 2010)


Between 25 September - 1 October 2010 (epidemiological week no. 39), 41 of the 78 flood-affected districts provided surveillance data to the DEWS system. Of these 41 districts, 87% reported 6-7 days of the week.
715 fixed health and 192 mobile medical outreach centers provided surveillance data for this week.
433,890 consultations were reported through DEWS of which 19% were acute respiratory infections (ARI), 13% were acute diarrhoea, 13% were skin disease, and 8% were suspected malaria.
16 alerts were received and responded to this week; 6 alerts were for acute watery diarrhoea (AWD), 4 were for Dengue fever, 4 for Bloody diarrhoea, 1 was for measles and 1 was for unexplained fever.
7 deaths were reported to DEWS for this reporting week

Note: All presented data are based on the number of patient consultations and include information on priority diseases under surveillance as well as major health events reported through DEWS.


Priority diseases under surveillance in the flood affected areas


Acute Flaccid Paralysis
Acute Jaundice Syndrome
Acute Respiratory Infections
Acute Watery Diarrhoea/Suspected Cholera
Bloody Diarrhoea
Other Diarrhoea
Suspected Hemorrhagic Fever
Suspected Malaria
Suspected Measles
Suspected Meningitis
Unexplained Fever
Others


Table-1: Priority diseases reported during the week 31 - 39, 2010 (29 July - 1 October 2010)

[Diseases - Week‐31 - Week‐32 - Week‐33 - Week‐34 - Week‐35 - Week‐36 - Week‐37 - Week‐38 - Week‐39]


Acute Diarrhea - 25,689 (13%) - 94,288 (11%) - 182,548 (14%) - 199,607 (14%) - 138,644(13%) - 68,909 (12%) - 57,072 (14%) - 64,925 (13%) - 54,404 (13%)
Bloody Diarrhea - 1,449 (1%) - 4,566 (1%) - 7,907 (1%) - 11,024 (1%) - 10,839 (1%) - 9,228 (2%) - 6,705 (2%) - 6,411 (1%) - 5,896 (1%)
ARI (URTI & LRTI) - 25,335 (13%) - 92,134 (11%) - 185,546 (15%) - 217,071 (15%) - 187,226(18%) - 96,607 (17%) - 69,969 (1%) - 89,949 (18%) - 81,583 (19%)
Suspected Malaria - 3,954 (2%) - 17,348 (2%) - 27,453 (2%) - 45,542 (3%) - 45,652 (4%) - 40,441 (7%) - 32,692 (8%) - 42,759 (9%) - 36,514 (8%)
Skin Diseases - 36,383 (19%) - 115,080 (14%) - 246,959 (20%) - 296,441 (21%) - 202,630(19%) - 92,039 (16%) - 56,844 (14%) - 60,704 (12%) - 57,020 (13%)
Total consultation - 194,552 - 845,353 - 1,265,912 - 1,424,260 - 1,053,827 - 559,006 - 414,437 - 486,376 - 433,890


Table‐2: Average number of reporting districts per week

[Week 33 Week 34 - Week 35 - Week 36 - Week 37 - Week 38 - Week 39]


Balochistan - 6 - 6 - 6 - 6 - 6 - 6 - 6
KPK - 8 - 8 - 8 - 8 - 8 - 6 - 6
Punjab - 8 - 8 - 9 - 9 - 9 -10 -11
Sindh - 18 - 18 - 18 - 18 - 18 - 18 - 18
Total - 40 - 40 - 41 - 41 - 41 - 40 - 41



64 districts have DEWS in place and 41 districts reported to DEWS this week; 6 in Balochistan, 6 in KPK, 11 in Punjab and 18 in Sindh. Not all districts are reporting regularly.
The average number of districts and health facilities reporting per week are shown in the table 2 and figure 2 above.
87% of reporting districts reported 6‐7 times during the last reporting period, 9% reported between 3‐5 times, 4% reported 1‐2 times.


Table-3: Followup Alerts reported in week 38, 2010.

[Dates - Event - Place/District - Province - Action taken]


20‐Sep‐10 - Meningitis - Dakorak Village/Swat - KPK - Laboratory test negative for Meningitis. Active surveillance in progress.
21‐Sep‐10 - Measles - RHC Alladand Malakand - KPK - Sample in transportation
22‐Sep‐10 - AWD - Kot Addu/Muzaffargarh - Punjab - Active surveillance carried out. Stool test negative. Case management and environmental improvement ongoing
23‐Sep‐10 - AWD - Alipur, Bheda Kot/Muzaffargarh - Punjab - Active surveillance carried out. Stool test negative. Case management and environmental improvement ongoing
23‐Sep‐10 - AWD - Alipur, Tibbi Arain/Muzaffargarh - Punjab - Active surveillance carried out. Stool test negative. Case management and environmental improvement ongoing
23‐Sep‐10 - AWD - BHU Naakband/Kohat - KPK - Hygiene education sessions were conducted at mosque. 8,000 aqua tabs and 1,000 ORS were distributed.
23‐Sep‐10 - AWD - DHQ Timergara, Tangi‐Bajour /Lower Dir - KPK - Previously 3 positive cases were identified so no new sample was taken. Case management and environmental improvement ongoing
23‐Sep‐10 - AWD - DHQ Timergara, Pajigram‐Bajour /Lower Dir - KPK - Previously 3 positive cases were identified so no new sample was taken. Case management and environmental improvement ongoing
23‐Sep‐10 - Malaria - UC Khazana/Lower Dir - KPK - Malaria control program is investigating. Report awaited.
23‐Sep‐10 - Malaria - UC Norakhiel/Lower Dir - KPK - Malaria control program is investigating. Report awaited.
23‐Sep‐10 - AFP - Nishter - Hospital/Multan - Punjab - Polio active surveillance is in progress. Specimen collected and in process.
24‐Sep‐10 - AFP - Nishter Hospital/Muzaffargarh - Punjab - Polio active surveillance is in progress. Specimen collected and in process.
24‐Sep‐10 - AFP - CHC Hospital/Muzaffargarh - Punjab - Polio active surveillance is in progress. Specimen collected and in process.


Table-4: Alerts and Outbreaks (Week 39, 2010)

[Dates - Event Place/District - Province - Action taken]


25‐Sep‐10 - UF - DHQ Timergara/Lower Dir - KPK - Active surveillance and lab investigations are under process.
26‐Sep‐10 - AWD - Wanda Balochan/DI Khan - KPK - Stool sample was collected and lab investigations are under process
27‐Sep‐10 - AWD - Malakhra Ground Camp (Bhit Shah)/Matiari - Sind - Stool sample was negative. Water Samples were collected. TMA Bhit Shah was contacted to provide safe drinking water. Requested to PPHI to provide health education through LHWs.
27‐Sep‐10 - AWD - Shah jo Bagh Relief Camp (Bhit Shah)/Matiari - Sind - Stool sample was negative. Water Samples were collected. TMA Bhit Shah was contacted to provide safe drinking water. Requested to PPHI to provide health education through HWs.
27‐Sep‐10 - DHF - Ayub Teaching Hospital/Abbottabad - KPK - Tragic death of medical doctor confirmed due to CCHF. 14 contacts tested negative for both CCHF and Dengue. 8 samples were reported to be positive for Dengue in private labs.
28‐Sep‐10 - AWD - DHQ Daggar (Kandao Patiy Village)/Buner - KPK - 2 Stool samples were positive for V. Cholera Ogawa. Health Education messages given to the family and aqua tabs/Water Purification Sachets also provided. Importance of use of ORS and hand washing explained to the patient and attendants.
28‐Sep‐10 - AWD - DHQ D.I.Khan (Lakhra Village)/DI Khan - KPK - Stool sample was negative. Hygiene promotion sessions were conducted, line listing was maintained and active surveillance was done.
28‐Sep‐10 - AWD - RHC Munda (Kambat ‐ Samar Bagh)/Lower Dir - KPK - Stool sample was positive for V. Cholera Ogawa. Water samples were collected, antiseptic soaps, HTH chlorine powder, aqua tabs were provided.
28‐Sep‐10 - DHF - SGTH (Kotlai, Kokrai, Chakesar)/Swat - KPK - Suspected cases were found, blood samples were taken. 2 out of 3 were positive for Dengue.
28‐Sep‐10 - DHF - KTH (Lower Dir)/Peshawar - KPK - Patient is isolated, blood sample collected. Patient is positive for Dengue.
28‐Sep‐10 - BD - DHQ Muzaffargarh (Wasendey Wali)/Muzaffargarh - Punjab - Stool sample was negative. Active surveillance was done.
28‐Sep‐10 - BD - DHQ Muzaffargarh (Basti Korewali)/Muzaffargarh - Punjab - Stool sample was negative. Active surveillance was done.
29‐Sep‐10 - DHF - KTH (Polytechnic Colony‐Haripur)/Peshawar - KPK - Sample was collected and found negative for Dengue. Active surveillance is under process.
29‐Sep‐10 - BD - DHQ Muzaffargarh (Basti Karimabad)/Muzaffargarh - Punjab - Stool sample was negative. Active surveillance was done.
29‐Sep‐10 - BD - DHQ Muzaffargarh (Zakrya Colony)/Muzaffargarh - Punjab - Stool sample was negative. Active surveillance was done.
30‐Sep‐10 - Measles - BHU Dhandla/Bhakkar - Punjab - Blood sample was collected and active surveillance is under process


Table-5: List of confirmed Polio Cases from flood affected districts

[S. NO. - Province - Districts - SEX - AGE (m) - Date onset of Paralysis - WPV Type]


1 - KPK - Peshawar - F - 12 - 06/08/2010 - NSL1
2 - KPK - Hangu - F - 05 - 07/08/2010 - NSL1
3 - KPK - Hangu - M - 13 - 27/08/2010 - NSL1
4 - Sindh - Sanghar - F - 144 - 21/08/2010 - NSL1
5 - Sindh - Ghotki - M - 36 - 18/08/2010 - NSL1
6 - Punjab - Muzaffargarh - F - 37 - 26/08/2010 - NSL1
7 - Sindh - Ghotki - F - 60 - 03/09/2010 - NSL1
8 - Punjab - DG Khan - F - 9 - 10/09/2010 - NSL1
9 - Sindh - Ghotki - M - 6 - 15/09/2010 - NSL1
10 - KPK - Peshawar - M - 29 - 14/09/2010 - NSL1


Province KPK


6 out of 17 flood affected districts reported to DEWS from KPK province
48 fixed health centers and 21 mobile medical outreach centers reported to DEWS
87,204 patient consultations were reported during the reporting period of 25 Sept– 1 October, week 39, 2010
9 alerts were received this week; 4 were for AWD, 4 were for Dengue fever and 1 for unexplained fever reported and responded to this week


[Diseases - Number - % of total consultations]


Acute Diarrhoea - 8,770 10%
ARI - 15,615 17%
Skin Diseases - 5,736 7%
Suspected malaria - 1,278 1%
others - 54,066 62%
Total Consultations - 87,204


Province Punjab


11 out of 12 flood affected districts reported data to DEWS from Punjab province
176 fixed health centers and 45 mobile medical outreach centers reported to DEWS
133,494 patient consultations were reported during this reporting period
5 alerts were received and responded this week, 4 were for BD and 1 was for suspected Measles


[Diseases - Number - % of total consultations]


Acute Diarrhoea - 17,407 13%
ARI - 24,365 18%
Skin Diseases - 19,023 14%
Suspected malaria - 12,546 9%
Others - 42,718 32%
Total consultations - 133,494


Province Sindh


18 out of 22 flood affected districts reported to DEWS from Province Sindh
464 fixed health centers and 120 mobile medical outreach centers reported to DEWS
190,636 patient consultations were reported during the reporting period of 25 Sept - 1 October, week 39, 2010
2 alerts of AWD were reported for this week from flood affected districts of province Sindh


[Diseases - Number - % of total consultations]


Acute Diarrhoea - 24,661 13%
ARI - 38,249 20%
Skin Diseases - 32,261 17%
Suspected malaria - 18,651 10%
Others - 57,190 30%
Total consultations - 190,636


Province Balochistan


6 out of 19 flood-affected districts reported to DEWS from province Balochistan
27 fixed health centers and 6 mobile medical outreach centers reported to DEWS
22,556 patient consultations were reported during the reporting period of 25 Sept - 1 October, week 39, 2010
No alerts were received from flood affected districts of province Balochistan


[Diseases - Number - % of total consultations]


Acute Diarrhoea - 3,566 16%
ARI - 3,354 15%
Suspected Malaria - 4,039 18%
Unexplained Fever - 737 3%
Others - 10,827 48%
Total consultations - 22,556


Since July 29, 2010, approximately 6,745,548 patient consultations have been reported to DEWS from the flood affected provinces in Pakistan. DEWS is currently in place in 64 of the 78 flood affected districts (82%) and reporting is received from 41 of these 64 districts (64%)

The major causes for seeking healthcare by the affected communities continue to be diarrhoel diseases, acute respiratory infections, skin diseases and suspected malaria.

In KPK, ARI decreased from 18% to 15% also AD continues to decline, however, it remains proportionally higher compared to the corresponding reporting period from 2009. (Please see Fig.13)

In Punjab, a higher proportion of suspected malaria was reported this week (8% to 9%), although a peak of malaria

in October reflects seasonal trend of diseases, DEWS officers are collaborating with Malaria Control Program to investigate areas of increased malaria.

In Sindh, proportional morbidity of major health events remained the same when compared to last week.

In Balochistan, reporting remains irregular due to security issues. Suspected malaria continues to make up the largest proportion of consultations. WHO expert team has gone to Balochistan and will conduct outbreak investigation for malaria in collaboration with Malaria Control Program.

Sixteen alerts were raised during this reporting period. Six alerts were for AWD bringing the total number of alerts for AWD to 132. There are currently 57 confirmed cholera cases through DEWS. The laboratory samples were collected from sites, according to case definition and sent to National Institute of Health (NIH) for laboratory confirmation. Relevant public health actions were initiated in the field to arrest potential outbreak.

Please see the Map on next page. In this new form of map, the number in the center of the chart pie is the total number of alerts for the district.


Focus On….

Crimean-Congo Hemorrhagic Fever (CCHF)

Of three cases testing positive for CCHF in the past month, two have died, and an additional seven have become infected by nosocomial transmission at a Rawalpindi hospital. In Pakistan, the incidence of CCHF peaks in June and October but cases occur throughout the year.

Similar to Dengue Hemorrhagic Fever (DHF), CCHF presents as a fever of 2‐7 days which does not respond to antibiotics or anti‐malarial treatment and is associated with dropping platelets and hemorrhagic signs with case fatality rate as high as 50%. Two main differences are that CCHF is transmissable from the blood of patients with the disease, and it is successfully treated with high dose Ribavirin, while DHF does not respond to antivirals and it is not transmissable directly from the patient.

CCHF is caused by a Nairovirus and transmitted to humans by the bite of the Hyalomma tick or by direct contact with blood of an infected animal or human. The disease was first described in Crimea in 1944 and identified in 1956 in Congo and thus developed the current name for the disease and its causative virus. Population migration with animals contributes to the higher probability of susceptible animals being bitten by infected ticks, thus increasing the risk of transmission to humans who handle the animals.

CCHF was first reported in Pakistan in 1976 but the number of cases has shown a dramatic rise since 2000 with 50‐60 cases being reported annually. It is endemic in Balochistan, but every province has seen a few cases and unfortunately nosocomial outbreaks have occurred in the past in major hospitals in Karachi, Peshawar, Rawalpindi and Quetta.

Guidelines for CCHF are available on NIH website (LINK (http://hygimia69.blogspot.com/www.nih.org.pk/Guid_Lin.asp)) and WHO website (LINK (http://hygimia69.blogspot.com/whopak.org/pdf/guidelines_for_CCHF.pdf))


The objective of this weekly epidemiological bulletin is to provide a snap shot on selected health events reported from the communities affected by the current flood in Pakistan. While every attempt is made to present the weekly trend of the epidemic prone diseases, the information presented in the bulletin needs to be interpreted in the context that precise information on the reference populations is not always available, The bulletin also includes information collected by DEWS teams established during earlier emergencies, including 2005 earthquake, 2007 floods and 2008 ID crises. The primary focus of DEWS is the early detection of epidemic prone diseases, to facilitate a rapid public health response. We would like to thank all the numerous national and international partners who have contributed to the Disease Early Warning System.

-
------

Giuseppe Michieli
October 12th, 2010, 03:03 AM
Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 8 Monday 10 October 2010 (WHO, edited)


[Source: World Health Organization, full PDF Document (LINK (http://www.who.int/hac/crises/pak/sitreps/pakistan_epi_11oct2010.pdf)). Extracts, edited.]

Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 8 Monday 10 October 2010

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan. For Correspondence: NIH: eic.nih@gmail.com, WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: wr@pak.emro.who.int.


Highlights

Epidemiological week no 40 (2 - 8 October 2010)


Between 2 - 8 October 2010 (epidemiological week no. 40), 48 of the 78 flood-affected districts provided surveillance data to the DEWS system. Of these 48 districts, 90% reported 6-7 days of the week.
655 fixed health and 153 mobile medical outreach centers provided surveillance data for this week.
326,071 consultations were reported through DEWS of which 20% were acute respiratory infections (ARI), 12% were acute diarrhoea, 13% were skin disease, and 8% were suspected malaria.
42 alerts were received and responded to this week: 26 alerts were for acute watery diarrhoea (AWD, Suspected Cholera), 9 were for Viral Hemorrhagic Fever, 4 were for Acute Flaccid Paralysis (AFP, Suspected Poliomyelitis), 2 were for Measles and 1 was for Bloody Diarrhoea.
Ongoing malaria surveillance in collaboration with the Malaria Control Program identified districts with higher than usual malaria transmission rates during peak Falciparum season. Districts Layyah, Rajanpur, DG Khan and Muzaffargarh in Punjab; Jacobabad, Larkana, Thatta and Khairpur in Sindh; Naseerabad, Sibi, Zhob and Jhal Magsi in Balochistan.
Seven of the 10 cases of poliomyelitis confirmed this week were from the flood-affected districts
Note: All presented data are based on the number of patient consultations and include information on priority diseases under surveillance as well as major health events reported through DEWS.


Priority diseases under surveillance in the flood affected areas


Acute Flaccid Paralysis
Acute Jaundice Syndrome
Acute Respiratory Infections
Acute Watery Diarrhoea/Suspected Cholera
Bloody Diarrhoea
Other Diarrhoea
Suspected Hemorrhagic Fever
Suspected Malaria
Suspected Measles
Suspected Meningitis
Unexplained Fever
Others


Table-1: Priority diseases reported during the week 31 - 40, 2010 (29 July - 8 October 2010)

[Diseases - Week‐31 - Week‐32 - Week‐33 - Week‐34 - Week‐35 - Week‐36 - Week‐37 - Week‐38 - Week‐39 - Week‐40]


Acute Diarrhea - 25,689 (13%) - 94,288 (11%) - 182,548 (14%) - 199,607 (14%) - 138,644(13%) - 68,909 (12%) - 57,072 (14%) - 64,925 (13%) - 54,404 (13%) - 37,624 (12%)
Bloody Diarrhea - 1,449 (1%) - 4,566 (1%) - 7,907 (1%) - 11,024 (1%) - 10,839 (1%) - 9,228 (2%) - 6,705 (2%) - 6,411 (1%) - 5,896 (1%) -5,253 (2%)
ARI (URTI & LRTI) - 25,335 (13%) - 92,134 (11%) - 185,546 (15%) - 217,071 (15%) - 187,226(18%) - 96,607 (17%) - 69,969 (17%) - 89,949 (18%) - 81,583 (19%) - 65,216 (20%)
Suspected Malaria - 3,954 (2%) - 17,348 (2%) - 27,453 (2%) - 45,542 (3%) - 45,652 (4%) - 40,441 (7%) - 32,692 (8%) - 42,759 (9%) - 36,514 (8%) - 25,625 (8%)
Skin Diseases - 36,383 (19%) - 115,080 (14%) - 246,959 (20%) - 296,441 (21%) - 202,630(19%) - 92,039 (16%) - 56,844 (14%) - 60,704 (12%) - 57,020 (13%) - 41,664 (13%)
Total consultation - 194,552 - 845,353 - 1,265,912 - 1,424,260 - 1,053,827 - 559,006 - 414,437 - 486,376 - 433,890 - 326,071


Table‐2: Average number of reporting districts per week

[Province - Week 33 - Week 34 - Week 35 - Week 36 - Week 37 - Week 38 - Week 39 - Week 40]


Balochistan - 6 - 6 - 6 - 6 - 6 - 6 - 6 - 5
KPK - 8 - 8 - 8 - 8 - 8 - 6 - 6 - 15
Punjab - 8 - 8 - 9 - 9 - 9 - 10 - 11 - 11
Sindh - 18 - 18 - 18 - 18 - 18 - 18 - 18 - 17
Total - 40 - 40 - 41 - 41 - 41 - 40 - 41 - 48



64 districts have DEWS in place and 48 districts reported to DEWS this week; 5 in Balochistan, 15 in KPK, 11 in Punjab and 17 in Sindh. Not all districts are reporting regularly.
The average number of districts and health facilities reporting per week are shown in the table 2 and figure 2 above.
Almost 90% of reporting districts reported 6‐7 times during the last reporting period, 7% reported between 3‐5 times, 3% reported 1‐2 times.


Table-3: Follow-up alerts reported in week 39, 2010.

[Weeks - Date of alert - Alert - Province - District - Location (detailed) - Age (yr) - Sex - Action taken / Notes]


2010‐39 - 25‐Sep‐10 - UXF - KPK - Lower Dir DHQ Timergara - ** - ** - Team examined 1700 people; no DF, DHF or CCHF identified in area related to this report.
2010‐39 - 26‐Sep‐10 - AWD - KPK - D.I. Khan Wanda Balochan - 22 - F - Stool sample collected and was found negative. Active surveillance was done.
2010‐39 - 27‐Sep‐10 - AWD - Sind - Matiari Malakhra Ground Camp (Bhit Shah), Shah jo Bagh Relief Camp (Bhit Shah) - ** - ** - Stool sample was negative. Public health response in place with TMA, PPHI, LHWs.
2010‐39 - 27‐Sep‐10 - DHF - KPK - Abbottabad Ayub Teaching Hospital - ** - ** - Tragic death of medical doctor confirmed due to CCHF. 14 contacts tested negative for both CCHF and Dengue. DF and DHF detailed below.
2010‐39 - 28‐Sep‐10 - AWD - KPK - Buner DHQ Daggar (Kandao Patiy Village) - 8,8 M, M - 2 Stool samples were positive for V. Cholera Ogawa. Public health response in place.
2010‐39 - 28‐Sep‐10 - AWD - KPK - D.I. Khan DHQ D.I.Khan (Lakhra Village) - 1.5 - M - Stool sample was negative. Public health response in place.
2010‐39 - 28‐Sep‐10 - AWD - KPK - Lower Dir RHC Munda (Kambat ‐ Samar Bagh) - 30 - F - Stool sample was positive for V. Cholera Ogawa. Public health response in place.
2010‐39 - 28‐Sep‐10 - DHF x 3 - KPK - Shangla SGTH (Kotlai, Kokrai, Chakesar) - 65, 75, 35 - M, F, M - Suspected cases were found, blood samples were taken. 2 out of 3 were positive for Dengue.
2010‐39 - 28‐Sep‐10 - DHF x 2 - KPK - L.Dir, Haripur KTH (Lower Dir), (Polytechnic Colony‐Haripur) - 24, 20 - F, M - Lower Dir case positive for DF, Haripur case negative for DF. Active surveillance continuing.
2010‐39 - 28‐Sep‐10 - BD x 4 - Punjab - Muzaffargarh DHQ Muzaffargarh (Wasendey Wali), (Basti Korewali), (Basti Karimabad Tibba), (Zakrya Colony) - 9, 2, 50, 8 - M, M, M, M - Stool samples were negative for pathogens. Active surveillance was done in four villages and no further cases were found.
2010‐39 - 30‐Sep‐10 - Measles - Punjab - Bhakkar BHU Dhandla - 4 - M - Blood sample was found negative. No further cases were found on active surveillance.
2010‐39 - 1‐Oct‐10 - AWD - KPK - Tank DHQ Tank (Kot Azam) - 1 - F - Stool sample negative. Active surveillance was done and no further cases were found.


Table-4: Alerts and Outbreaks (Week 40, 2010)

(...)


Province KPK

[Diseases - Number - % of total consultations]


Acute Diarrhoea - 4,520 8%
ARI - 10,074 17%
Skin Diseases - 2,738 5%
others - 39,853 67%
Total Consultations - 59,482



15 out of 17 flood affected districts reported to DEWS from KPK province
47 fixed health centers and 17 mobile medical outreach centers reported to DEWS
59,482 patient consultations were reported during the reporting period of 2 – 8 October, week 40, 2010
20 alerts were received and investigated this week; 11 were for AWD, 8 were for suspected DHF, and 1 was for suspected Measles.
Regarding Dengue Fever (DF) and Degue Hemorrhagic Fever (DHF), from early September up until 9th October 2010, DEWS teams have identified 137 suspected cases of DF, including 55 cases of suspected DHF, in the districts Haripur, Mansehra and Abbotabad. Of the suspected cases, 97 were male and 40 were female, none were under five years old and five cases were between 5 and 15 years old. During this time, there were nine cinfirmed deaths of cases with fever and hemorrhagic signs but only one was confirmed positive for DF.


Province Punjab

[Diseases - Number - % of total consultations]


Acute Diarrhoea - 13,269 12%
ARI - 21,439 19%
Skin Diseases - 15,876 14%
Suspected malaria - 9,785 9%
Others - 37,966 34%
Total consultations - 111,665



11 out of 12 flood affected districts reported data to DEWS from Punjab province
187 fixed health centers and 36 mobile medical outreach centers reported to DEWS
111,665 patient consultations were reported during this reporting period
18 alerts were received and investigated this week; 12 were for AWD, 1 was for BD, 1 was for suspected Measles, and 4 were for AFP. Ten cases were confirmed positive for Vibrio cholera Ogawa in Muzaffarabad District and treated successfully at the DTC while teams are in the field to assess and improve the water and sanitation situation. Four districts with highest levels of malaria in Punjab are Layyah, Rajanpur, DG Khan and Muzaffargarh.


Province Sindh

[Diseases - Number - % of total consultations]


Acute Diarrhoea - 16,850 12%
ARI - 30,679 23%
Skin Diseases - 23,050 17%
Suspected malaria - 11,918 9%
Others - 36,448 27%
Total consultations - 136,129



17 out of 22 flood affected districts reported to DEWS from Province Sindh
390 fixed health centers and 96 mobile medical outreach centers reported to DEWS
136,129 patient consultations were reported during the reporting period of 2 - 8 October, week 40, 2010
4 alerts were received and investigated this week; 3 were for AWD and one was for VHF. 15 cases of suspected DF were identified by DEWS teams in Hyderabad district; 14 were male and 1 was female; 12 were tested DF positive; none were ubder age five years. Jacobabad, Larkana, Thatta and Khairpur districts are experiencing peak Falciparum malaria season.


Province Balochistan


Acute Diarrhoea - 2,985 16%
ARI - 3,024 16%
Suspected Malaria - 3,171 17%
Unexplained Fever - 1,093 6%
Total consultations 18,795



5 out of 19 flood-affected districts reported to DEWS from province Balochistan
31 fixed health centers and 4 mobile medical outreach centers reported to DEWS
18,795 patient consultations were reported during the reporting period of 2 - 8 October, week 39, 2010
No alerts were received from Balochistan but malaria-endemic districts were reporting unusual seasonal peaks of falciparum malaria in Naseerabad and Sibi while Jhal Magsi had high levels of vivax malaria. Zhob is experiencing a unusually high slide positive rate of 52% with mostly falciparum confirmed cases.


Table-5: List of confirmed Polio Cases from flood affected districts since 19 September 2010

[S. NO. - Province - Districts - SEX - AGE (m) - Date onset of Paralysis - WPV Type]


1 - KPK - Swabi - F - 9 - 19/09/2010 - NSL1
2 - Sindh - Ghotki - F - 42 - 20/09/2010 - NSL1
3 - KPK - Lakki Marwat - M - 12 - 20/09/2010 - NSL1
4 - Sindh - Khairpur - F - 18 - 21/09/2010 - NSL1
5 - KPK - Kohat - F - 18 - 21/09/2010 - NSL1
6 - Punjab - Mianwali - M - 36 - 21/09/2010 - NSL1
7 - Sindh - Sukkur - F - 36 - 26/09/2010 - NSL1


Summary of Health Event in Flood affected districts

Since July 29, 2010, approximately 7,035,683 patient consultations have been reported to DEWS from the flood affected provinces in Pakistan. DEWS is currently in place in 64 (82%) of the 78 flood affected districts and reporting is received from 48 (75%) of these 64 districts.

The major causes for seeking healthcare by the affected communities continue to be diarrheal diseases, acute respiratory infections, skin diseases and suspected malaria.

In KPK, ARI decreased from 19% to 12% also AD continues to decline, however, it remains proportionally higher compared to the corresponding reporting period from 2009. (Please see Fig.13)

In Punjab, a higher proportion of suspected malaria was reported this week (9% to 10%), although a peak of malaria in October reflects seasonal trend of diseases, DEWS officers are collaborating with Malaria Control Program to investigate areas of increased malaria.

In Sindh, proportional morbidity of major health events remained the same when compared to last week.

In Balochistan, reporting remains irregular due to security issues. Suspected malaria continues to make up the largest proportion of consultations. WHO expert team has gone to Balochistan and will conduct outbreak investigation for malaria in collaboration with Malaria Control Program.


Focus on: Malaria

Every year Pakistan records about 4.5 million suspected cases of malaria and has evidence of about 1.6 million confirmed cases. September and October are the months for high transmission of Falciparum Malaria, but out of 47 flood‐affected districts which are endemic for malaria, only nine are experiencing unusually high numbers of confirmed falciparum malaria cases. These districts are Layyah and Rajanpur in Punjab; Jacobabad, Larkana, Thatta, and Khairpur in Sindh; and Naseerabad, Sibi, and Zhob in Balochistan. At the same time, DG Khan, Muzaffargarh and Jhal Magsi are still showing considerable number of vivax malaria cases.

DEWS Teams are collaborating with Malaria Control Dept and other partners to identify the malaria “hot spots” and bring a rapid response with medicines and appropriate vector control strategy. Preparation for malaria season started with distribution of anti‐malarial medicines in each of the emergency health kits deployed in flood‐affected districts. Provincial Malaria Control Programs undertook indoor residual spraying as a vector control strategy in flood ‐affected districts. WHO sent Rapid Diagnostic Tests (RDT) to the provinces to confirm cases of suspected malaria who were distant from microscopy centers.

Supplies of primaquine tablets were distributed to areas with high vivax transmission while additional tabs of ACT‐SP were distributed to provinces with high numbers of falciparum cases. WHO, UNICEF, and UNHCR have distributed bed nets to the hotspots to increase coverage and protection of the population.

The objective of this weekly epidemiological bulletin is to provide a snap shot on selected health events reported from the communities affected by the current flood in Pakistan. While every attempt is made to present the weekly trend of the epidemic prone diseases, the information presented in the bulletin needs to be interpreted in the context that precise information on the reference populations is not always available, The bulletin also includes information collected by DEWS teams established during earlier emergencies, including 2005 earthquake, 2007 floods and 2008 ID crises. The primary focus of DEWS is the early detection of epidemic prone diseases, to facilitate a rapid public health response. We would like to thank all the numerous national and international partners who have contributed to the Disease Early Warning System

(...)
-
------

Giuseppe Michieli
October 15th, 2010, 11:14 AM
Pakistan Health Cluster - No 20. 12 October 2010 (WHO, edited)


[Source World Health Organization, full PDF Document (LINK (http://www.who.int/hac/crises/pak/sitreps/pakistan_health_cluster_12oct2010.pdf)). Extracts, edited.]

Floods in Pakistan - Pakistan Health Cluster - No 20. 12 October 2010

(...)


Situation overview

While substantial areas in Sindh, in particular Dadu and Qamber Shahdkot, are still flooded, access to northern districts of Khyber Pakhtunkhwa (KP) continues to improve; the flood is visible only in the destruction it has left behind. As the weeks go by, the ways in which the flood has affected the different areas of the country are becoming more apparent. Partners are designing and implementing activities that respond to these diverse needs and situations.

According to OCHA, in KP and Punjab most internally displaced people (IDPs) have returned home. In Sindh and Baluchistan, where vast areas remain under water, some people have successfully returned home while others are moving to camps closer to their still inaccessible homes. The number of people affected stands at 20.2 million. Around 2.4 million hectares of agriculture have been damaged, and 1.9 million houses have been damaged or destroyed.


Health impact

Acute diarrhoea, acute respiratory infections (ARI,) skin infections and suspected malaria remain the leading causes for seeking health care in the flood-affected areas.


Basic epidemiological update (reporting period 2-8 October)


48 of the 78 flood-affected districts provided surveillance data to the Disease Early Warning and Surveillance (DEWS) system. Of these 48 districts, 90% reported 6-7 days of the week.
655 fixed health facilities and 153 mobile medical outreach centres provided surveillance data for this week.
326 071 consultations were reported through DEWS, of which 20% were for acute respiratory infections (ARI), 12% were for acute diarrhoea, 13% were for skin disease, and 8% were for suspected malaria.
A total of 42 alerts were received and responded to this week, of which 26 were for acute watery diarrhoea (AWD, suspected Cholera), nine were for viral haemorrhagic fever, four were for acute flaccid paralysis (AFP, suspected poliomyelitis), two were for measles and one was for bloody diarrhoea.


Upcoming issues


In the last two weeks, ten cases of confirmed cholera have been reported in Kot Addu, whith patients coming from a number of villages and camps in the area. Outbreaks of AWD are expected to continue until the end of October.
The increase of anecdotal reports of cases of severe acute malnutrition (SAM) is a concern for all health partners. The clinical management of SAM is the responsibility of the Health Cluster. Health Cluster Partners are planning to open stabilization centres in priority locations, and are working with the Nutrition Cluster, which is focusing on community-based responses.
In the north, severe cases of ARI-like pneumonia are increasing as winter approaches.
Over the last week, Dengue and CCHF have featured prominently in the news in Pakistan. So far, the number of cases remains within the normal range for this time of the year. Dengue is endemic in some areas of Pakistan, Karachi (Sindh) and Haripour (KPK) in particular. CCFH is endemic to Baluchistan. Health authorities in partnership with WHO are studying the potential impact of the flood in the frequency of these fevers. Increased prevention measures will be implemented.
During upcoming Eid ul Azha, when massive displacement and slaughtering of the cattle occurs, the risk of humananimal contact causing the Crimean Congo Hemorrhagic disease will be increased. WHO, MoH and FAO are jointly coordinating preventive measures in preparation for that festivity.
WHO’s epidemiological bulletin will now be published on a weekly rather than daily basis.
In KP, 20 alerts were received and investigated this week, of which 11 were for AWD, eight were for suspected dengue haemorrhagic fever, and one was for suspected measles.
In Punjab, 18 alerts were received and investigated this week, of which 12 were for AWD, one was for BD, one was for suspected measles, and four were for AFP. The four districts with highest levels of malaria in Punjab are Layyah, Rajanpur, DG Khan, and Muzaffargarh.
In Sindh, four alerts were received and investigated this week, of which three were for AWD and one was for VHF. Jacobabad, Larkana, Thatta, and Khairpur districts are experiencing a peak malaria season.
In Baluchistan, no alerts were received, but malaria-endemic districts were reporting higher than usual peaks of falciparum malaria in Naseerabad and Sibi, while Jhal Magsi had high levels of both vivax and falciparum malaria. Zhob is experiencing an unusually high slide positivity rate of 52% with mostly falciparum.
Nine new polio cases have been reported over the past week. Apart from one type-3 case, all of them are type-1. They include three cases from the conflict-affected Federally Administered Tribal Areas (FATA) and two from KP. There are three cases from north Sindh and one case from north Punjab. As of 11 October 2010, Pakistan has reported a total of 78 polio cases including 58 type-1 and 20 type-3 cases. There are four new infected districts including Kohat in KP, neighbouring district Mianwali in Punjab, and two districts in north Sindh (Sukkur and Khairpur). The total number of infected districts/towns/tribal agencies is now 27. There are wild polio virus type-1 isolates from environmental samples from Karachi, Rawalpindi and Peshawar.

For a more detailed Epidemiologic report kindly go to (LINK (http://www.whopak.org/))


Brief Focus on Malaria

Every year Pakistan records about 4.5 million suspected cases of malaria, of which around 1.6 million are confirmed. September and October are the months for high transmission of Falciparum Malaria. To date, however, only nine of the 47 flood-affected districts that are endemic for malaria have experienced unusually high numbers of confirmed falciparum malaria cases. These districts are Layyah and Rajanpur in Punjab; Jacobabad, Larkana, Thatta, and Khairpur in Sindh; and Naseerabad, Sibi, and Zhob in Baluchistan. At the same time, DG Khan, Muzaffarghar and Jhal Magsi are reporting a considerable number of vivax malaria cases.

DEWS teams are collaborating with Pakistan's Malaria Control Department and other partners to identify malaria “hot spots” and respond rapidly with medicines and vector control measures. Preparations for the malaria season started with the inclusion of anti-malarial medicines in each of the emergency health kits distributed in flood-affected districts.

Provincial malaria control programmes have carried out indoor residual spraying in flood-affected districts. WHO sent rapid diagnostic tests (RDTs) to the provinces, and donated supplies of primaquine tablets to areas with high vivax transmission and additional tabs of ACT-SP to areas with high numbers of falciparum cases. WHO, UNICEF, and UNHCR have distributed bednets to the hotspots to increase coverage and protection of the population.


Government Response

The Prime Minister was fully apprised of the health situation in the flood-affected areas at a special briefing session.

The Federal Secretary for Health presented a detailed overview of current health initiatives and future plans and interventions.

The Federal Secretary for Health chaired the 5th National Steering Committee on Health Emergencies in Islamabad on 7 October 2010. Different provinces gave a district-by-district update on damages to health facilities. The representative from Sindh Province provided an estimate of the cost of rehabilitating the health facilities.

A three-phase mass immunization campaign has been launched in the 77 most affected districts. The first phase, which has been completed, covered 35 districts. The other districts will be covered in the remaining phases. The Ministry of Health (MoH) conducted two trainings-of-trainers courses in psychosocial support, in collaboration with Kings College London and the British Council in Islamabad. A total of 55 psychiatrists from the most affected districts were trained; their names have been provided to provincial governments, who will enlist their help in developing and implementing strategies for providing psychosocial support to those affected by the floods. The MoH held a special meeting with UN agencies to discuss recent alerts for Crimean-Congo haemorrhagic fever and dengue fever. The National Institute of Health will organize a meeting with all stakeholders in this regard. Seven field hospitals donated by the Republic of Italy have been deployed: three in Punjab (Muzzaffargarh (2) and Layyah), two in KP (Dasu and Madyan) one in Gilgit-Baltistan (Ganchee) and one in Baluchistan (Dera Allah yar).


Health Cluster Response



ARC INTERNATIONAL

BALUCHISTAN

ARC is working in five health facilities in Sibi (Rural Health Centre (RHC) Talli, BHUs Sultan Kot, Bakhtiarabad, Chandia and Gishkori). A total of 2776 patients were treated over the last week. ARC is also running four diarrhoea treatment centres (DTCs) in Sibi DHQ, Dahdar DHQ, Bolan Medical Complex Quetta and Eastern Bypass DTC, as well as a medical camp. A total of 1392 patients were treated at the DTCs. ARC is also providing health education and psychosocial support.

KP

ARC is working in seven health facilities in Swat (Civil Hospital Barikot, Civil Dispensary (CD) Ghalagay, Telligram, Basic Health Units (BHUs) Taghma, BaraSamai, Koza Samai, Bishband). Last week a total of 3160 patients (2080 women and 1080 men) were treated. ARC conducted 43 health education sessions, delivered seven babies, referred four patients, and provided psychosocial counseling to 13 patients. RC is donating long-lasting insecticide-treated bednets (LLINs) to pregnant women and children under five.





AUSAID/AUSTRALIAN DEFENCE FORCE

The joint AusAID/Australian Defense Force static health clinic at Kot Addu continues to see over 250 outpatients daily. Malaria continues to present in over 25% of cases. Malarial rapid detection tests allow the clinic to differentiate Vivax, Falciparum and mixed infections. The positivity rates of rapid diagnostic tests are over 50% daily, and Falciparum cases total 15-25 daily (10%). The clinic has wormed 1445 patients (85%) presenting this week; regrettably, the new DEWS system does not capture numbers wormed. Several cases of AWD were reported last week, although numbers have fallen to one or less daily (down from five per day four weeks ago). Clinic staff report they are seeing a return to more chronic issues and general health care, apart from the obvious ongoing burden of high malaria rates. The clinic plans to close in the next ten days (19 October).




CARE INTERNATIONAL PAKISTAN

(Reporting period: 24 September to 1 October 2010)
KP

CARE provided health care through mobile and static facilities to 11 194 people (3523 women, 4269 children and 3402 men), and held 201 health and hygiene sessions for 5424 people. In Upper Swat, where CARE is working through its implementing partner IDEA, 899 patients (216 women, 116 men and 517 children) received health care through BHUs. In other parts of District Swat, 1509 patients (including 424 women and 797 children) received health care through seven mobile clinics. CARE also held 20 health and hygiene awareness raising sessions for 1420 people. In District Charsadda, where CARE is working through its implementing partner, CRDO, 2933 patients (including 994 women and 1095) were treated through 18 mobile clinics. A total 45 health and hygiene sessions were conducted for 735 people.

PUNJAB

In South Punjab, CARE, in collaboration with AWAZ and CARITAS, provided health care through mobile health clinics to 2073 people in District Rajanpur (including 695 women and 941 children).

SINDH

CARE provided health care services to 2374 people in Sindh Province and another 216 people in District Kandhkot. In District Sukkur, a total of 170 patients received health care through five mobile health camps. In Shikarpur District, 788 patients (including 291 women and 364 children) received health care through seven health camps. CARE’s activities were supported in these three districts by HANDS, a local implementing partner. In Shahdadkot, 1 542 patients were treated at 11 mobile health clinics conducted by CARE and its partner Takhleeq Foundation.





CHURCH WORLD SERVICE (CWS P/A)

KP

CWS/PA mobile health units in Districts Balakot, Kohistan, Swat and Swabi have treated and provided free medicines to 14 856 patients to date, 82% of whom are women and children. Common complaints include upper respiratory tract infections, watery diarrhoea, skin infections and chronic diseases such as tuberculosis and diabetes. CWS teams have conducted 458 health and hygiene education sessions for 4225 people. CWS/PA is planning to launch additional mobile health units in Kohistan and Shangla Districts.





HELPING HAND FOR RELIEF AND DEVELOPMENT (HHRD)

HHRD has conducted 400 medical camps so far and treated 72 492 patients all over Pakistan.
KP

HHRD has established two medical centres in District Nowshera that provide free 24/7 consultations and medicines. Services include ante- and postnatal care, safe delivery services and immunization for children and pregnant women. HRRD is conducting health education sessions and providing outpatient services in BHU batara and Pandair, District Bunair. It has also established a field hospital in Agra Union Council (UC), District Charsadda.

PUNJAB

HHRD is running an maternal and child health centre in Utrakalan , District Mianwali that provides ante- and postnatal care, safe delivery services and referral services for complicated cases. The centre has ultrasound facilities. HHRD's mobile medical and surgical unit is providing ambulatory medical services in southern Punjab. Lastly, HHRD has established two field hospitals (one in Jampur, District Rajanpur and another in Kotaddu, District Muzaffargarh).

SINDH

HHRD's medical camp in Larkana provides safe delivery services and general outpatient care. HHRD is establishing three field hospitals in districts Jaccobabad, Kashmor and Shikarpur.





IDEA/CARE INTERNATIONAL

KP

IDEA/CARE International is working in Districts Nowshera and Swat. It has installed five water tanks and 15 latrines in Khema Basti (another 20 are under construction), and has distributed 5760 water purification sachets to 480 families in District Nowshera and 7689 families in Upper Swat (30 sachets per family). In District Peshawar, IDEA/Care International conducted 20 mobile medical camps in various Union Councils (UCs) of District Nowshera, treating a total of 6455 people (2945 female, 1855 male, 1665 children), and held 301 health and hygiene sessions for 3570 people (1530 women, 1389 men and 651 children). It has installed a water purification plant (funded by CARE International) in UC Kheshkai payan, and another 13 small water purification plants (donated by GEO TV Network and the Peshawar Rotary Club) in various UCs.





INTERNATIONAL MEDICAL CORPS (IMC)

(Reporting period: 1 to 8 October)
KP

IMC treated a total of 9888 patients in Districts Peshawar, Charsadda and Nowshera. Its psychosocial team treated 700 individuals.

PUNJAB

IMC teams are working in nine health facilities in four districts (Layyah, Muzaffargarh, Multan and Rajanpur). A total of 2411 patients were treated during the reporting period, mostly for ARI, skin infections, diarrhoea & malaria.

SINDH

IMC has deployed ten medical teams in four districts (Larkana, Shikarpur, Thatta and Kambar) and is recruiting additional staff. A total of 1965 people received medical care during the reporting period, mostly for ARI, malaria, skin diseases and gastroenteritis. New DTCs will be opened next week.





INTERNATIONAL ORGANIZATION FOR MIGRATION (IOM)

PUNJAB

Following health needs assessments in Muzaffargarh and Rajanpur, IOM has deployed health care workers in both districts and has donated vehicles and ambulances for mobile outreach and health referrals. To date IOM has provided health care to more than 5000 patients, 2000 of whom were treated through mobile outreach services.

SINDH

Following health needs assessments in Thatta, IOM has deployed ten health care workers to IOM fixed clinics at RHCs Gharo and Chohar Jamali. To date almost 2000 patients have received medical care through these clinics.





ISLAMIC HELP PAKISTAN

PUNJAB

Islamic Help is working in District Muzaffargarh (RHC in Daira Din Pannah and mobile health clinic in Kot Addu) and in Jampur, District Rajan (mobile health clinic). To date it has treated a total of 16 773 patients.

SINDH

Islamic Help is running a DTC in Civil Hospital Sukkur, where it has treated 7014 patients to date. It has helped restore the hospital, with support from army lady doctors.




NEEDS AND CHALLENGES

Islamic Help reports that damaged medical equipment, poor hospital hygiene and a shortage of ambulances are hampering the delivery of health care services. Damaged roads mean it is difficult to access RHUs and BHUs; however many of these health centres are not operational anyway, as government staff (doctors, cleaners) are reporting for duty only intermittently. These problems are compounded by the lack of female doctors. IDPs living in rural areas do not have access to health facilities.

According to Islamic Help, the Health Cluster should focus more closely on District Thatta, particularly Jati tehsil and rural areas in Sujawal Tehsil, where IDPs are returning home and settling close to their villages, despite the fact the waters have not yet receded.



KHYBER AID

Khyber Aid has conducted various medical and hygiene mobile camps at UCs Madain, Takhtaband, Kokarai and Jambil, with a total catchment population of around 48 000. Khyber Aid's medical team is composed of a doctor, a dispenser, two health promoters, a lady health visitor and a driver.

MARIE STOPES SOCIETY (MSS)

MSS is an active member of the Health Cluster's Reproductive Health Task. MSS teams have mobilized organizational and personal resources to respond to the crisis.
KP

Many patients visiting the MSS camps are complaining of severe flu and cold symptoms. The shortage of blankets, jackets and beds means that patients are at the mercy of the changing weather. The MSS teams have requested medication to treat flu and colds; these medications are in very short supply. The medical teams have also referred patients to secondary/tertiary levels and have dealt with two abortion cases.

PUNJAB

In Lower Punjab (Layyah, Muzzafargarh, Rajanpur), MSS camps have faced difficulties due to a shortage of medicines, ambulatory services and health staff. In spite of this, the camps have provided quality services, particularly family planning services. MSS teams have provided medicines, treated cases of sexually transmitted infections and infertility, and given psychological counseling. MSS is striving to accommodate all patients, in spite of staffing shortages.

SINDH

MSS staff has treated a number of respiratory infections, and have distributed health kits to patients. Most consultations are for respiratory problems and skin diseases. MSS medical staff offer one-to-one consultation for female patients, and provide female health workers to assist them. MSS teams' efforts to promote contraceptives have met with resistance, since the men in the area are against contraceptives and forbid women in their households to use them. Health is not a priority for IDPs, whose first needs are basic necessities such as food and water.





MEDECINS DU MONDE FRANCE (MDM-FRANCE)

KP

MDM-France is providing primary health care (PHC) and immunization services in two health facilities (one in district Charsadda and one in district Nowshera). MdM is planning to cease operations by the end of October and make minor repairs to these facilities. It has already closed the DTCs in LMH and DHQ Kohat. A total of 2100 diarrhoea patients have been treated, of whom 300 were severely dehydrated. The district health structure is now able to cope with the normal situation. MdM is providing PHC, ante- and postnatal care, immunization and nutrition services in Kohat, Buner and Swabi.





MERLIN

KP

Merlin is working in Districts Nowshera, Charsadda, Buner and Swat through 33 static clinics , 23 mobile teams and five DTCs. Merlin is providing integrated primary and secondary health care, including referral services, CMAM interventions, family planning and outpatient services, treatment of diarrhoea (mild, moderate and severe dehydration), and malaria diagnosis, management and prevention. Some facilities in Swat and in Buner are hard to access due to the difficult terrain, and security in Shabqader remains a concern.

PUNJAB

Merlin is working in District Muzaffargarh through two static clinics, two mobile teams and a DTC. Services include integrated primary and secondary healthcare, including referral services, CMAM interventions, family planning and outpatient services, and treatment of diarrhoea (mild, moderate and severe dehydration). Constraints include the need for a NOC for expatriate staff, and a shortage of qualified medical personnel.





SAVE THE CHILDREN

Save the Children’s health initiatives focus primarily on maternal, newborn and child health. Its activities range from operating mobile health camps at varying localities to revitalizing damaged health facilities, while at the same time providing support through ambulances for emergency referrals to secondary/tertiary health facilities. Save the Children supports 1300 Lady Health Workers (LHWs) in Sindh and Punjab, who are given a one-time cash incentive of Rs. 5000 as well as kits, medicines, supplies and information materials worth Rs. 15000. The LHW network will be used to distribute newborn, health and hygiene and clean delivery kits, LLINs, and information material. Save the Children also supports DEWS and HMIS in district health departments.
PUNJAB

Save the Children’s mobile teams in Multan, Muzaffargarh, Rajanpur and Dera Ghazi Khan have been working round the clock since August, and have provided free medicines and medical consultations to 30 696 people. A total of 1525 patients, mostly women and young children, have been treated at two DTCs in Multan. Skin diseases are on the rise while diarrhoea, albeit still a problem, is no longer a major concern. Save the Children is also conducting health and hygiene sessions alongside individual counseling sessions, and has broadened its activities by starting nutrition-related interventions and providing tangible support to static health facilities.

SINDH

Save the Children's mobile teams are working in Sukkur, Jacobabad and Shikarpur. On average, each team conducts over 80 consultations per day. Save the Children is also running DTCs at DHQ Shikarpur and Taluka Hospital Thul. As the weather cools down and stagnant water continues to be a problem, cases of malaria appear to be on the rise. Similarly, ARI and skin diseases are increasing, while diarrhoea is less of a concern. Save the Children’s teams have begun to incorporate nutrition in their health programme, focusing mainly on treating malnutrition. In Sukkur and Shikarpur, Save the Children has screened 3936 children under five, as well as pregnant women and lactating mothers. Strong emphasis is placed on health education sessions. As far as perceived needs in the province are concerned, the introduction of EPI services and rehabilitation of static health facilities are two pressing requirements, as expressed by the district health departments. With regard to the latter, Save the Children is in the process of acquiring health facilities for support in the future.

KP

Save the Children is working in Swat, Shangla, Lower Dir and Dera Ismail Khan Districts through mobile teams and static facilities. Around 59 000 medical consultations have been held to date. As Save the Children was working in KP before the floods, its emergency response there has been easier to implement than in Punjab and Sindh, since it had already established outpatient and mother and child health services, together with an efficient referral system. However, it remains difficult to access certain areas, and the need to introduce EPI still exists. Additionally, cases of pneumonia are on the rise with the fast-approaching winter season.





USAID/PAIMAN

BALUCHISTAN

USAID/PAIMAN is working in Sibi, Jaffarabad. Over the past five weeks 6416 people have been treated through 30 health camps, and 1014 people have attended health and hygiene sessions. The health camps have attracted many IDPs, many of whom have received medical treatment for the first time ever (including one mother who is pregnant with her 16th child). USAID/PAIMAN donated 766 water tanks, 8500 jerry cans and 1800 ITNs.

KP

USAID/PAIMAN is working in Swat, Charsadda and DI Khan. A total of 10 073 people (mainly IDPs) received medical care through 46 health camps conducted in remote, hilly areas. A total of 4188 people attended health and hygiene sessions.
USAID/PAIMAN donated 2395 water tanks, 24 274 jerry cans and 2600 ITNs.

PUNJAB

USAID/PAIMAN is working in DG Khan, where 11 238 people have been treated via 29 health camps, and 2362 people have attended health and hygiene sessions. The team has also transported people needing referral to the nearest health facilities. USAID/PAIMAN has donated 1574 water tanks, 16 227 jerry cans and 1300 ITNs.

SINDH

USAID/PAIMAN is working in Dadu, Sukkur and Khairpur. Over the past five weeks, a total of 13 249 people have been treated via 70 health camps, and 5279 people have attended health and hygiene sessions. USAID/PAIMAN's NGO implementing partners are working in remote areas to provide emergency health care. USAID/PAIMAN has donated 3403 water tanks, 39 702 jerry cans and 3300 insecticide-treated bedbets. Field assessments conducted by USAID/PAIMAN in Sukkur and Khairpur found that while the district administration has been able to accommodate almost all internally displaced people (IDPs) in camps and tents, some camps are unstaffed, meaning that the IDPs have no-one to turn to for relief assistance or in the event of an emergency. The authorities in Khairpur have requested warm clothes and blankets to see the IDPs through the hard winter ahead.





WORLD VISION (WV)

KP

WV is supporting nine static health facilities and nine mobile teams in Amankot, Muhib Banda and Taru Jabba in Nowshera and Majuki UC MC–2, UC MC–4 and UC Meraprang in Charsadda, and Koto, Kandaro, Munjai in Lower Dir. During the reporting period, 3299 people were seen at health facilities supported by WV. The DTC at THQ Chakdara treated 266 cases of acute diarrhoea, and 777 men and 1242 women participated in community health education sessions. A total of 17 508 individuals have consulted the health teams to date. Four Women and Infant Friendly Spaces (WAIFS) are being established in Nowshera and Charsadda.

PUNJAB

WV is providing health, nutrition and psychosocial support services in BHUs at UCs Kharak, Nohanwala, Kotaddu, Bet Mir Hazzar, Jatoi, Jaggatpur, Belay Wala and Beit mulla wala. Two OTPs are functional at static and five at mobile health posts. Two WAIFs have been opened and another three are being established, linked to health facilities. A total of 250 women and infants have participated in WAIF activities.
WHO is currently supporting the MoH Essential Medicines and NGO partners including NAGE Pakistan, IR, CCHD, Merlin, AMTF, ADRA, Al-Shifa, Save the Children, World Vision, IOM, Muslim Aid and EMED. Furthermore trainings on LSS (Inventory Management Software) / Drug Demand Quantification Methods for DOH & Implementing Partners has been conducted in Multan. for the EDO H technical staff as well as WHO essential medicines supported partners. The training on Inventory Management (Logistic Support System) which helps in managing the drugs inventory and also help in reporting like consumptions was given as well as Drug Demand Quantification Methods (Which helps in preparing the internal and external medicines requests)

SINDH

WV has established three static and four mobile teams, together with two WAIFs to provide, health nutrition and psychosocial support services at Nooraja, Khairpur, Kot Diji, UC Saddar Ji, Bhatyoon, Saddar G Bhatti and UC Layari (catchment population: 165 263). A total of 2470 individuals sought treatment during the reporting period, and 993 women and 904 men attended health education sessions.





UNHCR

Union Aid for Afghan Refugees (UAAR) an IP of UNHCR, is providing emergency health services to the Afghan refugees population affected by the floods in the KP districts of Peshawar, Nowshera & Charsaddha through its health facilities and mobile health teams. Around 6,479 patients have been treated so far.
All refugee camps in the affected districts of KP and Punjab, participated in the ongoing immunization campaigns organized by the department of health. UAAR assisted immunization campaign in three districts of KP where 2,928 refugee children received immunization against measles and 3,269 for polio.




WHO

WHO is organizing social mobilization training courses which will take place in Multan hub on 13 October as part of the early recovery strategy.
There are 62 DTCs currently set up and operated by partners. A focal point in each hub is monitoring the DTCs. Clusters of cases arriving at DTCs from the same area are promptly investigated.
To date, WHO has distributed medicines, including 236 000 diarrhoea treatments, for a total population coverage of 5.2 million.
In collaboration with Sindh University of Jamshoro, WHO conducted a brief health education training course for 100 university students (volunteers) who will be working with IDPs in Sehwas and Shahbaz Colony camps of Jamshoro.
Key health messages in Sindhi were made available. This type of training is an easy way to ensure that simple hygiene messages are conveyed that have the potential to reduce morbidity and mortality.
WHO, the MoH, Ministry of Agriculture and FAO are meeting on 11 October 2010 to discuss the new outbreaks of fever and design a preventive campaign for the forthcoming EID day, on which one million animals are expected to be slaughtered.
Rapid water and sanitation assessments at DHQ hospital Nowshera, Civil Hospital Akora Khattak and the Children's hospital Peshawar showed these hospitals were facing serious water and sanitation problems. WHO rehabilitated the water supply system in DHQ Hospital Nowshera (repairing the main water source and the distribution network and cleaning the water storage facilities serving a catchment population of 3.4 million).
In Peshawar hub, WHO is helping WASH and Health partners build their capacity to undertake critical water quality improvement measures, prevent and control waterborne diseases, investigate and respond to disease alerts, comply with WASH SPHERE standards and undertake emergency water disinfection techniques. A total of 216 persons from TMA, PHED and DoH have been trained on emergency environmental health issues.
Four new DTCs are being established in the Sukkur Hub, one in Nowsheroferoz at THQ Moro, Second at RHC Khan Pur district Shikar Pur, third at THQ Dokri in Larkana and fourth at THQ Shahdad Kot in district Kambar.
In Hyderabad, six stabilization centres have been planned in response to acute malnutrition cases reported in that area. A meeting with main stakeholders, including WFP and the health authorities, was held to discuss an integrated multisectoral strategy for the area.



Health Cluster Coordination

Coordination at Provincial & Hub levels:

Health cluster meetings are regularly taking place in Peshawar, Multan, Sukker and Hyderabad to coordinate the health cluster response. A close coordination system is in place with PDMA, DoH, OCHA, NGOs and other UN agencies.

Multan


The 8th cluster coordination meeting has been held.
Over 60 agencies (UN, NGOs, etc) are working in the health sector and registered in the Who is Doing What and Where database.
A health focal coordination cell has been established in five districts.

Peshawar


WHO is working in close collaboration with WASH Cluster partners and local WASH authorities at district and provincial levels, highlighting the health risks associated with contaminated water, poor sanitation and hygiene issues confronting the flood- affected communities. It has guided provincial and district WASH clusters in identifying feasible locations in which to install water filtration plants in Charsadda, Nowshera and Swat. WHO regularly monitors diarrhoea prevalence in the flood-affected districts and investigates and responds to AWD alerts. WHO's environmental health team regularly chlorinates and disinfects drinking water supplies and mobilizes resources for the provision of water collection and storage facilities, hygiene kits, non-food items and health education and awareness-raising materials.

Sukkur


The district coordination cell has been activated in two districts Khair Pur & Larkana, WHO team participated in both meetings and nominated two Surveillance Officers as representatives for the respective districts for future participation.

Hyderabad


The inter-cluster meeting focused on (1) the creation of District Coordination Cells, and (2) McRAM – where 15 000 settlements (including camps and schools) have been or will be mapped with GPS coordinates. An assessment of villages, including the status of health facilities, will be conducted and posted on a web site accessible to all.
Each cluster present (Education, Food, Shelter, WASH, Nutrition, and Health) provided a brief update and identified their gaps, with the objective of identifying action points.
The Nutrition Cluster meeting on 6 October focused on the nutrition survey in flood-affected areas, the Who, What, and Where (3W) matrix partners update, and the Integrated Survival Strategy.


Key Principles for Operationalizing the Survival Strategy

The four clusters (Health, WASH, Nutrition and Food) have agreed on the following key principles governing the design and implementation of the joint survival strategy:


Focus on evidence-based, high-impact interventions to ensure survival: these include water disinfection, mass measles immunization campaigns (associated with polio vaccination, vitamin A distribution and de worming), communication and support for life-saving behavior changes (such as hand-washing with soap, exclusive breastfeeding for the first six months), and appropriate treatment interventions;
Target the most vulnerable: in addition to prioritizing the most affected districts for those activities which will have general coverage (such as the provision of safe water supplies and sanitation facilities, and access to basic health services), specific life-saving interventions should target particularly vulnerable populations such as women, especially pregnant women, neonates, children under five, and to the extent possible, the elderly and disabled;
Ensure an integrated outbreak response to strengthen the complementarity of interventions and ensure a continuum of care: from having a more sensitive DEWS for communicable diseases of epidemic potential, to ensuring that case management at the health care facility level is combined with large-scale preventive measures at community level, including proper early detection and referral of severe cases, provision of treated water, sanitation and shelter, as well as food and nutrition;
Identify and maximize opportunities for synergies between all players, through enhanced coordination and joint planning at provincial/hub and particularly district levels. Strong commitment from all partners is essential to operationalize the strategy; opportunities to engage non-traditional partners from civil society, youth associations and women’s groups, as well as traditional and religious leaders should be sought;
Work in coordination with and support of Government authorities at all levels, using existing systems to implement the response wherever possible, through the reinforcement or the establishment of effective local coordination mechanisms such as the District Coordination Cells;
Ensure real-time monitoring and evaluation of the strategy's implementation, to support district-level planning and adjustments as needed to ensure high coverage of the selected priority interventions in the target areas and to allow progress to be documented.
“Hot spots” communities (with high incidence of acute diarrhea and/or malaria) have been identified in the most flood affected districts. WHO and the health cluster partners used the daily epidemiological data to identify these communities. In addition it was agreed with the WASH cluster partners should prioritize these communities as part as their criteria of intervention. As part of the unified response between Health, WASH and Nutrition clusters these communities will also be targeted for the health and hygiene promotion, health education and awareness raising on water related issues.


For corrections and corrigendum please contact the following:

Alfred Dube, Health Cluster Coordinator, email: dubeal@pak.emro.who.int, Telephone: 0300 400 5934

Mohammad Shafiq, Health Cluster Coordination Officer, email : Shafiqm@pak.emro.who.int, Telephone: 0303 555 2270

Maria Anguera de Sojo, Communications Officer, email: sojom@pak.emro.who.int, Telephone: 0301 855 1459

Syed Haider Ali, Communications Officer, email: alisy@pak.emro.who.int, Telephone: 0300 400 5944

-
------

Giuseppe Michieli
October 20th, 2010, 11:19 AM
Flood Response in Pakistan - Volume 1, Issue 9 Monday 17 October 2010 (10/20/10, edited)


[Source: World Health Organization, full PDF Document: (LINK (http://www.who.int/hac/crises/pak/sitreps/pakistan_epi_17october2010.pdf)). Extracts, edited.]

Weekly Epidemiological Bulletin

Flood Response in Pakistan - Volume 1, Issue 9 Monday 17 October 2010


Priority diseases under surveillance in the flood affected areas


Acute Flaccid Paralysis
Acute Jaundice Syndrome
Acute Respiratory Infections
Acute Watery Diarrhoea/Suspected Cholera
Bloody Diarrhoea
Other Diarrhoea
Suspected Hemorrhagic Fever
Suspected Malaria
Suspected Measles
Suspected Meningitis
Unexplained Fever
Others


Highlights

Epidemiological week no 41 (9 - 15 October 2010)


Between 9 - 15 October 2010 (epidemiological week no. 41), 38 of the 78 flood-affected districts provided surveillance data to the DEWS system. Of these 38 districts, 90% reported 6-7 days of the week.
575 fixed health and 128 mobile medical outreach centers provided surveillance data for this week.
306,799 consultations were reported through DEWS of which 19% were acute respiratory infections (ARI), 10% were acute diarrhoea, 11% were skin disease, and 8% were suspected malaria.
11 alerts were received and responded to this week: 6 alerts were for Dengue hemorrhagic fever (DHF), 3 were for Acute watery diarrhoea, 1 each for Bloody diarrhoea (BD) and suspected Measles (MS).
Malaria outbreak control in collaboration with the Malaria Control Program is being implemented in districts Layyah, Rajanpur, DG Khan and Muzaffargarh in Punjab; Jacobabad, Larkana, Thatta and Khairpur in Sindh; Naseerabad, Sibi, Zhob and Jhal Magsi in Balochistan.
Five of the 10 cases of poliomyelitis confirmed this week were from the flood-affected districts
Note: All presented data are based on the number of patient consultations and include information on priority diseases under surveillance as well as major health events reported through DEWS.


Table-1: Priority diseases reported during the week 31 - 40, 2010 (29 July - 8 October 2010)

[Diseases - Week‐31 - Week‐32 - Week‐33 - Week‐34 - Week‐35 - Week‐36 - Week‐37 - Week‐38 - Week‐39 - Week‐40 - Week‐41]

Acute Diarrhea - 25,689 (13%) - 94,288 (11%) - 182,548 (14%) - 199,607 (14%) - 138,644 (13%) - 68,909 (12%) - 57,072 (14%) - 64,925 (13%) - 54,404 (13%) - 37,624 (12%) - 29,570 (10%)
Bloody Diarrhea - 1,449 (1%) - 4,566 (1%) - 7,907 (1%) - 11,024 (1%) - 10,839 (1%) - 9,228 (2%) - 6,705 (2%) - 6,411 (1%) - 5,896 (1%) - 5,253 (2%) - 4,426 (1%)
ARI (URTI & LRTI) - 25,335 (13%) - 92,134 (11%) - 185,546 (15%) - 217,071 (15%) -187,226 (18%) - 96,607 (17%) - 69,969 (17%) - 89,949 (18%) - 81,583 (19%) - 65,216 (20%) - 56,991 (19%)
Suspected Malaria - 3,954 (2%) - 17,348 (2%) - 27,453 (2%) - 45,542 (3%) - 45,652 (4%) - 40,441 (7%) - 32,692 (8%) - 42,759 (9%) - 36,514 (8%) - 25,625 (8%) - 24,768 (8%)
Skin Diseases - 36,383 (19%) - 115,080 (14%) - 246,959 (20%) - 296,441 (21%) - 202,630 (19%) - 92,039 (16%) - 56,844 (14%) - 60,704 (12%) - 57,020 (13%) - 41,664 (13%) - 33,293 (11%)
Total consultation - 194,552 - 845,353 - 1,265,912 - 1,424,260 - 1,053,827 - 559,006 - 414,437 - 486,376 - 433,890 - 326,071 - 306,799


Table‐2: Average number of reporting districts per week

[Province - Wk 33 - Wk 34 - Wk 35 - Wk 36 - Wk 37 - Wk 38 - Wk 39 - Wk 40 - Wk 41]


Balochistan - 6 - 6 - 6 - 6 - 6 - 6 - 6 - 5 - 6
KPK - 8 - 8 - 8 - 8 - 8 - 6 - 6 - 15 - 5
Punjab - 8 - 8 - 9 - 9 - 9 - 10 - 11 - 11 - 11
Sindh - 18 - 18 - 18 - 18 - 18 - 18 - 18 - 17 - 16
Total - 40 - 40 - 41 - 41 - 41 - 40 - 41 - 48 - 38


Table-3: Leading causes of seeking health care in the flood affected districts as of 15 Oct 2010

[Diseases - Total]


Skin Diseases - 1,243,346 (17%)
Acute Respiratory Infection - 1,177,886 (16%)
Acute Diarrhoea - 963,326 (13%)
Bloody Diarrhoea - 74,033 (1%)
Suspected Malaria - 343,481 (<5%)
Unexplained Fever - 367,488 (5%)
Total Consultations - 7,357,826


Table-4: Follow-up alerts reported in week 40, 2010.

[Weeks - Date of alert - Alert - Province - District - Location (detailed) - Age (yr) - Sex - Action taken / Notes]


2010‐40 - 2‐Oct‐10 - AWD - Punjab - Muzaffargarh - DHQ Muzaffargarh (Sharif Shajra P.O) - 50 - M - Stool sample positive for V. Cholera Ogawa. - Active surveillance ongoing.
2010‐40 - 3‐Oct‐10 - AWD - Punjab - Multan - THQ Shujabad - 12 - F - Stool sample negative for pathogens. Active surveillance revealed no further cases
2010‐40 - 4‐Oct‐10 - Measles - Punjab - Multan - Rasheed Hospital ‐ Private - 4,6 - M,F - Blood sample was negative for measles and rubella.
2010‐40 - 4‐Oct‐10 - AWD - Sind - Jacobabad - DHQ Jacobabad (UC Dashti) - 35 - F - Stool sample negative for pathogens. Active surveillance revealed no further cases
2010‐40 - 4‐Oct‐10 - AWD x 5 - KPK - Mardan - DHQ Mardan (Toot Kaley, Guli Bagh, Kochian, Sikandari, Janday Takhtbhai) - 4m, 6m, 60y, 6m, 45y - M,F,F,F,F - Cases admitted to DTC, stool samples were negative for pathogens. No further cases were found during active surveillance
2010‐40 - 4‐Oct‐10 - Measles - KPK - Swabi - Bacha Khan Medical Complex - 2.5 - F - Blood sample was positive for measles. Further investigation planned
2010‐40 - 4‐Oct‐10 - AWD x 3 - Punjab - Muzaffargarh - Australian Medical Camp (Nigad abad, Chah Langar Wala, Khoo Kukanwala) - 32, 26, 25 - M, M, M - Stool samples were negative for pathogens, active surveillance revealed no further cases
2010‐40 - 5‐Oct‐10 - AWD x 2 - KPK - Lower Dir - RHC Munda (Ganderey‐Mayar, Gambir‐Mayar) - 40, 46 - M, M - Stool sample was positive for V. Cholera Ogawa. Active surveillance carried out, health education was given and IEC material was provided. DTC health staff, hygiene promotors were trained on case management.
2010‐40 - 5‐Oct‐10 - AWD - KPK - D.I. - Khan Madina Colony - 5 - F - Stool sample was positive for V. Cholera Ogawa. Active surveillance ongoing
2010‐40 - 6‐Oct‐10 - AWD - KPK - D.I. Khan - Chah Faqir Wala - 25 - F - Stool sample positive for V. Cholera Ogawa, active surveillance ongoing
2010‐40 - 6‐Oct‐10 - AWD x 14 - Punjab - Muzaffargarh - DTC‐MSF Kot Addu (Chowk Munda, Ward # 8, Kot Addu, Mirpur Bhagal), Village Sinawan, Village Rakhpattan, Pnora, Mouza Chaudry, Manhan, Village Gourmani, Rojewala, Village Kita Lonwala, Pul88, Village Sheikh Umah - 8m to 25 years - 11M, 4F - 10 positive Ogawa patients treated at DTC. Active surveillance ongoing. Response in collaboration with WASH Cluster. Distributed filters and soaps to affected families
2010‐40 - 7‐Oct‐10 - AWD - KPK - Swat - THQ Matta - 40 - M - Stool sample positive for V. Cholera Ogawa, active surveillance is under progress for the two UCs.
2010‐40 - 7‐Oct‐10 - DHF - KPK - Swat - SGTH (Mian Bela) - 60 - M - Blood sample negative, no further cases found during active surveillance
2010‐40 - 7‐Oct‐10 - DHF - KPK - Haripur - Muhalla Syed Abad - 18, 28 - M, F - Blood sample collected and active surveillance is under progress .
2010‐40 - 7‐Oct‐10 - AFP - Punjab - RY Khan - UC Nawazabad - 3 - F - Stool sample collected and sent to NIH, Active surveillance is under process
2010‐40 - 8‐Oct‐10 - DHF - KPK - Swat - SGTH (Topseen Village) - 18 - M - Blood sample negative, active surveillance revealed no further cases
2010‐40 - 8‐Oct‐10 - DHF - KPK - Swat - SGTH (Aspand‐Lower Dir) - 13 - M - Blood sample negative, active surveillance revealed no further cases


Table-5: Alerts and Outbreaks (Week 41, 2010)

[Weeks - Date of alert - Alert - Province - District - Location (detailed) - Age (yr) - Sex - Action taken / Notes]


2010‐41 - 9‐Oct‐10 - DHF - KPK - Mansehra - Khaki - 38 - M - Blood sample collected and active surveillance is under progress .
2010‐41 - 10‐Oct‐10 - DHF - KPK - Mansehra - UC Jallu - 65, 42 - M,F - Blood sample collected and active surveillance is under progress. Health education was provided, Mosquito Nets were provided. MS DHQ Mansehra was informed.
2010‐41 - 10‐Oct‐10 - AWD - Punjab - Muzaffargarh - AMT (KAPCO‐Wapda Office) - 5 - M Stool sample collected and sent to NIH, active surveillance is under process.
2010‐41 - 10‐Oct‐10 - DHF - KPK - Charsadda - Harichand Bangla (IPD‐Malakand) - 18 - F - Blood sample collected and found negative. Active surveillance was done.
2010‐41 - 10‐Oct‐10 - Measles - KPK - Nowshera - IDP Camp Jalozai Phase V - 5 - M - Blood sample collected and active surveillance is under progress .
2010‐41 - 11‐Oct‐10 - DHF - KPK - Swat - Mangarkot Charbagh - 18 - M - Blood sample collected and found negative. Active surveillance was done. Patient was isolated, bed net was provided and health education was given. WHO, Merlin & DoH combined response is planned. EDO Health was informed.
2010‐41 - 12‐Oct‐10 - AWD - KPK - Nowshera - IDP Camp Jalozai Phase III‐Pabbi - 3,5,10 - M,F, M - Stool sample collected and found positive, active surveillance was done.
2010‐41 - 12‐Oct‐10 - DHF - KPK - Swat - Sersenai Village‐Kabal - 55 - F - Blood sample collected and active surveillance is under progress . Patient is isolated, ITNs were given and health education was provided. Medical camp was established and active surveillance was done.
2010‐41 - 12‐Oct‐10 - BD - Punjab - Muzaffargarh - AMT (Basti Ghurki) - 18 - M - Stool sample collected and sent to NIH, active surveillance is under process.
2010‐41 - 13‐Oct‐10 - AWD - Punjab - Muzaffargarh - AMT (Kot Addu) - 25 - F - Stool sample collected and sent to NIH, active surveillance is under process.
2010‐41 - 14‐Oct‐10 - DHF - KPK - Swat - Shahdam Kaley - 13 - M - Blood sample collected and sent to NIH, active surveillance is under process. Patient is isolated, ITNs were given and health education was provided.


Table-6: List of confirmed Polio Cases from flood affected districts, week 41-2010

[S. NO. - Province - Districts - SEX - AGE (m) - Date onset of Paralysis - WPV Type]


1 - Sindh - Ghotki - Female - 72 - 22‐09‐2010 - NSL1
2 - KPK - Lakki Marwat - Female - 20 - 20‐09‐2010 - NSL1
3 - Sindh - Kamber - Female - 16 - 25‐09‐2010 - NSL1
4 - Sindh - Ghotki - Female - 12 - 01‐10‐2010 - NSL1
5 - Sindh - Ghotki - Female - 156 - 26‐09‐2010 - NSL1


Province KPK

[Diseases - Number - % of total consultations]


Acute Diarrhoea - 3,928 6%
ARI - 12,256 17%
Skin Diseases - 3,090 4%
others - 47,575 68%
Total Consultations - 70,046



This week 5 out of 17 flood affected districts reported to DEWS from KPK province
36 fixed health centers and 14 mobile medical outreach centers reported to DEWS
70,046 patient consultations were reported during the reporting period of 9 – 15 October, week 41, 2010
8 alerts were received and investigated this week; 6 were for DHF, 1 was for Measles, and 1 was for AWD.
Regarding Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF), from early September up until 15th October 2010, DEWS teams have identified 188 suspected cases of DF in the districts Haripur, Mansehra and Abbotabad. Of the suspected cases, 131 were male and 57 were female. No case was under age five years. During this time, there were nine confirmed deaths of cases with fever and hemorrhagic signs but only one was confirmed positive for DF.


Province Punjab


11 out of 12 flood affected districts reported data to DEWS from Punjab province
192 fixed health centers and 28 mobile medical outreach centers reported to DEWS
96,624 patient consultations were reported during this reporting period
3 alerts were received and investigated this week; 2 were for AWD, and 1 was for BD. DEWS officers are following up the AWD cases in Kot Addu reported last week.
In Punjab, a higher proportion of suspected malaria was reported this week (10% to 11%), although a peak of malaria in October reflects seasonal trend of diseases, DEWS officers are collaborating with Malaria Control Program to investigate areas of increased malaria.

[Diseases - Number - % of total consultations]


Acute Diarrhoea - 9,915 10%
ARI - 19,132 20%
Skin Diseases - 12,277 13%
Suspected malaria - 8,732 9%
Others - 33,157 34%
Total consultations - 96,624


Province Sindh


16 out of 22 flood affected districts reported to DEWS from Province Sindh
310 fixed health centers and 81 mobile medical outreach centers reported to DEWS
115,903 patient consultations were reported during the reporting period of 9 - 15 October, week 41, 2010
In Sindh, proportional morbidity of major health events remained the same when compared to last week.
No alerts were received this week
A Dengue surveillance and response cell has been established in Hyderabad to address increasing numbers of cases of Dengue Fever.

[Diseases - Number - % of total consultations]


Acute Diarrhoea - 12,157 10%
ARI - 21,346 18%
Skin Diseases - 17,580 15%
Suspected malaria - 11,834 10%
Others - 41,257 36%
Total consultations - 115,903


Province Balochistan


6 out of 19 flood-affected districts reported to DEWS from province Balochistan
37 fixed health centers and 5 mobile medical outreach centers reported to DEWS
24,226 patient consultations were reported during the reporting period of 9 - 15 October, week 41, 2010
Suspected malaria has declined as a proportion of total consultations across the province but certain hot spots are still experiencing outbreak levels of malaria cases. Malaria outbreaks in districts Naseerabad, Sibi, Zhob and Jhal Magsi are being addressed in collaboration with the Malaria Control Program.
No alerts were received from Balochistan

[Diseases - Number - % of total consultations]


Acute Diarrhoea - 3,570 15%
ARI - 4,257 18%
Suspected Malaria - 3,358 14%
Unexplained Fever - 1,173 5%
Total consultations - 24,226


Summary of Health Event in Flood affected districts

Since July 29, 2010, approximately 7,357,826 patient consultations have been reported to DEWS from the flood affected provinces in Pakistan. DEWS is currently in place in 64 (82%) of the 78 flood affected districts and reporting is received from 38 (59%) of these 64 districts.

The major causes for seeking healthcare by the affected communities continue to be diarrheal diseases, acute respiratory infections, skin diseases and suspected malaria.

In KPK, ARI increased from 12% to 14% also AD continues to decline, however, it remains proportionally higher compared to the corresponding reporting period from 2009. (Please see Fig.13)


Focus on: Dengue Fever and Dengue Hemorrhagic Fever

So far about 2,443 cases of suspected Dengue Fever (DF) have been reported in Pakistan with about 1,082 confirmed cases. Karachi in the south and Haripur in the north are the endemic areas. Control of mosquitoes is the only primary prevention strategy.

Four different dengue viruses, spread by the bite of the urban Aedes aegypti mosquito, can cause the headache or flu‐like symptoms with fever called Dengue Fever. When DF cases are infected another year with a different dengue virus, Dengue Hemorrhagic Fever (DHF) is a potentially deadly complication.

DHF often begins with a sudden rise in temperature accompanied by facial flush and other flu‐like symptoms. The fever usually continues for two to seven days and can be as high as 41°C, possibly with convulsions and other complications. In moderate DHF cases, all signs and symptoms abate after the fever subsides. In severe cases, the patient's condition may suddenly deteriorate after a few days of fever; the temperature drops, followed by signs of circulatory failure, and the patient may rapidly go into a critical state of shock, or quickly recover following appropriate medical treatment.

WHO currently estimates about 2/5 of the world’s population is at risk for Dengue Fever (DF) with about 50 million dengue infections worldwide every year and about 500,000 (1%) hospitalized for Dengue Hemorrhagic Fever (DHF). In a recent study of DF in Pakistan from 2003‐2007, there were 15,040 patients with suspected DF during that time with 3,952 (26%) testing positive for dengue IgM antibody, and 209 hospitalized of whom 45 were diagnosed as DHF. In this review, 63% of suspected DF cases were male and 37% were female. The median age declined over the study period from 32 in 2003 to 24 in 2007.

The first confirmed outbreak of DF in Pakistan was in 1994 and found due to DF virus serotype DV‐2. The current annual epidemic trend began in September to December 2005, when a sudden rise in DHF patients was noted at major hospitals in Karachi apparently due to introduction of serotype DV‐3 in the country. During the outbreak of DHF in 2006, both DV‐2 and DV‐3 serotypes were found to be circulating.

All dengue patients must be carefully observed for complications for at least 2 days after recovery from fever because life threatening complications often occur during this phase. Patients and households should be informed that severe abdominal pain, passage of black stools, bleeding into the skin or from the nose or gums, sweating, and cold skin are danger signs. If any of these signs is noticed, the patient should be taken to the hospital. Please use only paracetamol for pain and fever as other medicines may increase the bleeding tendency.

Due to rises in incidence of DF and DHF, WHO‐Geneva has established a unit for prevention and control of Viral Hemorrhagic Fevers. WHOEMRO and Pakistan Country Office are in coordination with them to bring resources to Pakistan to address the issues here such as improving case management of DHF in hospitals and improving vector control in community level.

Khan E, Kisat M, Khan N, Nasir A, Ayub S, Hasan R. Demographic and Clinical Features of Dengue Fever in Pakistan from 2003–2007: A Retrospective Cross‐Sectional Study. PLoS One. 2010; 5(9): e12505. Published online 2010 September 13. doi: 10.1371/journal.pone.0012505. PMCID: PMC2938342
World Health Organization. Dengue and Dengue Hemorrhagic Fever. Fact Sheet No. 117. March 2009. http://www.who.int/mediacentre/factsheets/fs117/en/. Accessed on 17 October 2010.


The objective of this weekly epidemiological bulletin is to provide a snap shot on selected health events reported from the communities affected by the current flood in Pakistan. While every attempt is made to present the weekly trend of the epidemic prone diseases, the information presented in the bulletin needs to be interpreted in the context that precise information on the reference populations is not always available, The bulletin also includes information collected by DEWS teams established during earlier emergencies, including 2005 earthquake, 2007 floods and 2008 ID crises. The primary focus of DEWS is the early detection of epidemic prone diseases, to facilitate a rapid public health response. We would like to thank all the numerous national and international partners who have contributed to the Disease Early Warning System

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan.

For Correspondence: NIH: eic.nih@gmail.com
WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: wr@pak.emro.who.int.

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Giuseppe Michieli
October 27th, 2010, 11:05 AM
Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 10 Monday 25 October 2010 (WHO, edited)


[Source: World Health Organization, full PDF Document (LINK (http://www.who.int/hac/crises/pak/Weekly-EpidemiologicalBulletin-10-27102010.pdf)). Extracts, edited.]

Weekly Epidemiological Bulletin - Flood Response in Pakistan - Volume 1, Issue 10 Monday 25 October 2010


Priority diseases under surveillance in the flood affected areas


Acute Flaccid Paralysis
Acute Jaundice Syndrome
Acute Respiratory Infections
Acute Watery Diarrhoea/Suspected Cholera
Bloody Diarrhoea
Other Diarrhoea
Suspected Hemorrhagic Fever
Suspected Malaria
Suspected Measles
Suspected Meningitis
Unexplained Fever
Others


Highlights

Epidemiological week no 42 (16 - 22 October 2010)


Between 16 - 22 October 2010 (epidemiological week no. 42), 50 out of 64 districts in 4 provinces provided surveillance data to the DEWS system.
509 fixed health and 105 mobile medical outreach centres provided surveillance data for this week.
257,980 consultations were reported through DEWS of which 18% were acute respiratory infections (ARI), 9% were acute diarrhoea, 11% were skin disease, and 11% were suspected malaria.
21 alerts were received and responded to this week: 12 alerts were for Dengue Hemorrhagic Fever (DHF), 7 were for Diphtheria, and 2 for Acute Watery Diarrhoea (AWD) .
Four of the 9 cases of poliomyelitis confirmed this week were from the flood-affected districts
Emergency conditions exist for over 35,000 people in Dadu District of Sindh who are stranded without food or shelter on bits of land surrounded by water. AWD alert was received on 23 October of 50 year old male with diarrhea and serious dehydration in Tent City Kakar at Dadu.

Note:

All presented data are based on the number of patient consultations and include information on priority diseases under surveillance as well as major health events reported through DEWS.


Table-1: Priority diseases reported during the week 31 - 42, 2010 (29 July - 22 October 2010)

[Diseases - Wk‐31 - Wk‐32 - Wk‐33 - Wk‐34 - Wk‐35 - Wk‐36 - Wk‐37 - Wk‐38 - Wk‐39 - Wk‐40 - Wk‐41 - Wk‐42]

Skin Disease - 36,383(19%) - 115,080(14%) - 247,88(20%) - 296,441(21%) - 202,922(19%) - 92,210(16%) - 56,982(14%) - 61,845(12%) - 57,977(13%) - 42,325(13%) - 33,966(11%) - 27,522(11%)
ARI (URI and LRI) - 25,335(13%) - 92,134(11%) - 186,808(15%) - 217,071(15%) - 187,623(18%) - 97,352(17%) - 70,396(17%) - 93,291(19%) - 83,840(19%) - 67,045(20%) - 58,464(19%) - 46,015(18%)
Acute Diarrhoea - 25,689(13%) - 94,286(11%) - 183,118(14%) - 199,916(13%) - 139,391(13%) - 69,900(12%) - 57,421(14%) - 67,156(13%) - 57,954(13%) - 38,925(12%) - 30,637(10%) - 23,335(9%)
Bloody Diarrhoea - 1,449(1%) - 4,566(1%) - 8,019(1%) - 11,024(1%) - 10,847(1%) - 9,274(2%) - 6,766(2%) - 6,493(1%) - 5,907(1%) - 5,262(2%) - 4,435(1%) - 3,237(1%)
Suspected Malaria - 3,954(2%) - 17,348(2%) - 27,503(2%) - 45,542(3%) - 45,717(4%) - 40,483(7%) - 32,795(8%) - 43,121(9%) - 36,531(8%) - 24,825(8%) - 27,956(11%)
Total consultation - 194,551 - 845,353 - 1,270,525 - 1,422,503 - 1,056,106 - 563,426 - 417,643 - 502,282 - 444,948 - 333,690 - 313,429 - 257,980


Table-2: DTCs functioning with WHO and health partners support

[Province - Targeted Districts - Functioning - Handed Over - In Progress - Remarks]


KPK - 16 - 21 - 7 - 0 - 7 handed over to MS Hospital for pediatric pneumonia patients
Punjab - 8 - 12 - 2 - 1 - 2 handed over to MS Hospital, 1 in progress
Balochistan - 7 - 10 - 0 - 3 - 3 were started on 25th October
Sindh - (Sukkur) - 7 - 10 - 0 - 0 - ...
Sindh - (Hyderabad) - 5 - 3 - 0 - 2 - 1 will be started on 26th October
Gilgit Baltistan - 2 - 2 - 0 - 0 - ...
Total - 45 - 58 - 9 - 6 - ...


Table-3: Leading causes of seeking health care in the flood affected districts as of 22 Oct 2010

[Diseases - Total]


Skin Diseases - 1,271,541 (17%)
Acute Respiratory Infection - 1,225,374 (16%)
Acute Diarrhoea - 987,728 (13%)
Bloody Diarrhoea - 77,279 (1%)
Suspected Malaria - 371,494 (5%)
Unexplained Fever - 371,686 (5%)
Total Consultations - 7,622,436


Table-4: Follow-up alerts reported in week 41, 2010.

[Weeks - Date of alert - Alert - Province - District - Location (detailed) - Age (yr) - Sex - Action taken / Notes]


2010‐41 - 9‐Oct‐10 - DHF - KPK - Mansehra - Khaki, UC Julla - 38,65,42 - M,M, F - 2 out of 3 Blood samples were positive for DF, bed nets were provided, health education given, Active surveillance was done
2010‐41 - 10‐Oct‐10 - AWD - Punjab - Muzaffargarh - Australian Medical Team (KAPCO ‐ Wapda Office) - 5 - M - Stool sample was positive for V. Cholera Ogawa. Active surveillance was done.
2010‐41 - 10‐Oct‐10 - DHF - KPK - Charsadda - Harichand Bangla (IPD ‐ Malakand) - 18 - F - Blood sample was negative for DF. Active surveillance was done. Patient was isolated.
2010‐41 - 10‐Oct‐10 - Measles - KPK - Nowshera - Jalozai Phase V - 5 - M - Blood sample was positive for measles, child was guest in camp. Active surveillance was done. No other cases were found in the camp
2010‐41 - 11‐Oct‐10 - DHF - KPK - Swat - Mangarkot Charbagh - 18 - M - Blood sample was negative for DF. Active surveillance was done. Patient was isolated. WHO, Merlin & DoH combined response is planned. EDO Health was informed.
2010‐41 - 12‐Oct‐10 - AWD - KPK - Nowshera - Jalozai Phase III ‐ Pabbi - 3,5,10 - M,F,M - Stool sample collected and found positive for V. Cholera Ogawa, active surveillance was done. Health education session conducted, soaps and aqua tabs were distributed.
2010‐41 - 12‐Oct‐10 - DHF - KPK - Swat - Sersenai Village‐ Kabal - 55 - F - Blood sample was negative for DF. Patient was isolated, ITNs were given and health education was provided. Medical camp was established and active surveillance was done.
2010‐41 - 12‐Oct‐10 - BD - Punjab - Muzaffargarh - Australian Medical Team (Basti Ghurki) - 18 - M - Stool sample collected and found negative, active surveillance was done.
2010‐41 - 13‐10‐10 - AWD - Punjab - Muzaffargarh - Australian Medical Team (Kot Addu) - 25 - F - Alert was reported and investigated by Australian medical team.
2010‐41 - 13‐10‐10 - Malaria - Punjab - Muzaffargarh - Australian Medical Team (KAPCO) - ** - ** - 87 blood samples were tested by Australian Medical Team and 23 were found positive for Falciparum, 31 for Vivax, cases were treated, community was prioritized for bed nets distribution.
2010‐41 - 14‐10‐10 - DHF - KPK - Swat - Shahdam Kaley - 13 - M - Blood sample was negative for DF, active surveillance was done. Patient is isolated, ITNs were given and health education was provided.
2010‐41 - 14‐10‐10 - AWD - KPK - Mardan - Rashakai - 5 - M - Stool sample was positive for V. Cholera Ogawa. Active surveillance was done.


Table-5: Alerts and Outbreaks (Week 42, 2010)

[Weeks - Date of alert - Alert - Province - District - Location (detailed) - Age (yr) - Sex - Action taken / Notes]


2010‐42 - 17‐10‐10 - DHFx3 - Punjab - Rahim Yar Khan - Sheikh Zaid Hospital ‐ Swaitra Basti, Sadiqabad, Allama Iqbal Town, Stadium Road - 25,20, 30 - M,M,F - Blood samples were sent to IPH Lahore and were found positive for DF, active surveillance was done.
2010‐42 - 17‐10‐10 - DHFx2 - Punjab - Rahim Yar Khan - Sheikh Zaid Hospital ‐ Kot Faiz, Ghotki, Mouza Ahsanpur - 12, 22 - M, M - Blood samples were sent to IPH Lahore and were found negative for DF, active surveillance was done.
2010‐42 - 17‐10‐10 - DHF - KPK - Swat - Banr Charbagh - 40 - M - Blood sample was found positive for DF, active surveillance was done.
2010‐42 - 19‐10‐10 - AWD - Sindh - Ghotki - DTC Ghotki ‐ Malook Kolachi - 10,3,10m - F,F,F - Stool samples collected and active surveillance is under progress .
2010‐42 - 20‐10‐10 - AWD - Balochistan - Washuk - DHQ Washuk - ** - ** - About 100 cases of acute diarrhea and 2 deaths confirmed. Investigation revealed that source of water was contaminated Karez (irrigation canal). ORS, intravenous fluids and medicines provided to patients. Household water purification by aqua tabs established. No further cases reported
2010‐42 - 20‐10‐10 - DHF - Punjab - Rahim Yar Khan - Sheikh Zaid Hospital ‐ Khan Bela - 30 - M - Blood sample was found positive for DF at Sheikh Zaid Hospital.
2010‐42 - 20‐10‐10 - DHF - KPK - Swat - SGTH (UC Kuzabakhel) - 40 - F - Blood sample was found negative for DF, active surveillance was done.
2010‐42 - 21‐10‐10 - DHF - Punjab - Rahim Yar Khan - Sheikh Zaid Hospital ‐ Adda Fatehpur Punjabian - 20 - M - Investigations are under process at Sheikh Zaid Hospital.
2010‐42 - 21‐10‐10 - DHF - Sindh - Ghotki - UC Qadir Pur - ** - ** - Blood samples collected and sent to NIH, active surveillance is under process
2010‐42 - 21‐10‐10 - DHF - Sindh - Khairpur Jeelani Mohalla - ** - ** - Blood samples collected and sent to NIH, active surveillance is under process
2010‐42 - 22‐10‐10 - Diph - KPK - Peshawar - KTH (Bajour) - 4 - M - Death of patient with probable diphtheria , residential details are not known.
2010‐42 - 22‐10‐10 - Diph - KPK - Peshawar - Lady Reading Hospital (Charsadda) - 7 - M - Patient with probable diphtheria discharged from Lady Reading Hospital. Lost to followup
2010‐42 - 22‐10‐10 - Diph - KPK - Peshawar - KTH (Karak) - 3,3,7 - F,M,M - 3 cases probable diphtheria, 1 death, investigation and response continuing in Karak
2010‐42 - 22‐10‐10 - Diph - KPK - Peshawar - KTH (Lakki Marwat), LRH, Peshawar - 10,6,2.5 - M,M,M - 2 deaths probable diphtheria, residential details unknown
2010‐42 - 22‐10‐ 10 - Diph - KPK - Peshawar - KTH (South Waziristan) - 3 - M - Probable diphtheria case, discharged from KTH. Residential details unknown
2010‐42 - 22‐10‐10 - Diph - KPK - Peshawar - Lady Reading Hospital (Upper Dir) - 7 - M - Probable diphtheria case, discharged from LRH. Residential details unknown
2010‐42 - 22‐10‐10 - DHF - Punjab - Lahore - Wapda Hospital - 50 - F - Blood sample was found negative for DF, active surveillance was done.


Table-6: List of confirmed Polio Cases from flood affected districts, week 42-2010

[S. NO. - Province - Districts - SEX - AGE (m) - Date onset of Paralysis - WPV Type]


1 - KPK - Nowshera - Female - 54 - 25‐09‐2010 - NSL1
2 - Sindh - Kashmore - Male - 35 - 28‐09‐2010 - NSL1
3 - Sindh - Ghotki - Male - 8 - 29‐09‐2010 - NSL1
4 - Sindh - Sanghar - Female - 96 - 06‐10‐2010 - NSL1


Province KPK

This week 14 out of 24 flood affected districts reported to DEWS from KPK province


47 fixed health centers and 14 mobile medical outreach centers reported to DEWS
51,175 patient consultations were reported during the reporting period of 16 – 22 October, week 42, 2010
8 alerts were received and investigated this week; 6 were for Diphtheria while 2 were for Dengue Hemorrhagic Fever.
Regarding Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF), from early September up until 15th October 2010, DEWS teams have identified 311 suspected cases of DF in the districts Haripur, Mansehra and Abbotabad. Of the suspected cases, 87 were confirmed for DF, 100 were negative for DF and 124 are pending. During this time, there were nine confirmed deaths of suspected DHF. There were five confirmed cases of CCHF including one death.


[Diseases - Number - % of total consultations]


Acute Diarrhoea - 2,330 5%
ARI - 7,772 15%
Skin Diseases - 1,999 4%
Others - 37,885 74%
Total Consultations - 51,175


Province Punjab

11 out of 11 flood affected districts reported data to DEWS from Punjab province


197 fixed health centers and 22 mobile medical outreach centers reported to DEWS
103,588 patient consultations were reported during this reporting period
8 alerts were received and investigated this week; all were for Dengue Fever, 7 alerts were reported from districts Rahim Yar Khan while 1 alert was received from Lahore city.
In Punjab, a higher proportion of suspected malaria was reported again this week (11% to 13%), although a peak of malaria in October reflects seasonal trend of diseases, DEWS officers are collaborating with Malaria Control Program to investigate areas of increased malaria, providing rapid diagnostic test and appropriate medicines.


[Diseases - Number - % of total consultations]


Acute Diarrhoea - 9,447 9%
ARI - 20,339 20%
Skin Diseases - 11,673 11%
Suspected malaria - 13,447 13%
Others - 38,142 37%
Total consultations - 103,588


Province Sindh

17 out of 17 flood affected districts reported to DEWS from Province Sindh


227 fixed health centers and 64 mobile medical outreach centers reported to DEWS
77,547 patient consultations were reported during the reporting period of 16 - 22 October, week 42, 2010
In Sindh, proportional morbidity of major health events remained the same when compared to last week.
3 alerts were received and responded this week; 2 for Dengue Fever and 1 alert was for Acute Watery Diarrhoea
A Dengue surveillance and response cell has been established in Hyderabad to address increasing numbers of cases of Dengue Fever.


[Diseases - Number - % of total consultations]


Acute Diarrhoea - 8,479 11%
ARI - 13,070 17%
Skin Diseases - 11,554 15%
Suspected malaria - 9,888 13%
Others - 25,944 33%
Total consultations - 77,547


Province Balochistan

8 out of 12 flood-affected districts reported to DEWS from province Balochistan


38 fixed health centers and 5 mobile medical outreach centers reported to DEWS
25,670 patient consultations were reported during the reporting period of 16 - 22 October, week 42, 2010
1 alert of Acute Watery Diarrhoea was received and responded this week
Certain hot spots are still experiencing higher than usual levels of malaria cases. Malaria outbreaks in districts Naseerabad, Sibi, Zhob and Jhal Magsi are being addressed in collaboration with the Malaria Control Program.


[Diseases - Number - % of total consultations]


Acute Diarrhoea - 3,079 12%
ARI - 4,834 19%
Suspected Malaria - 3,794 15%
Unexplained Fever - 1,150 4%
Total consultations - 25,670


Summary of Health Event in Flood affected districts

Since July 29, 2010, approximately 7,622,436 patient consultations have been reported to DEWS from the flood affected provinces in Pakistan. DEWS is currently in place in 64 (82%) of the 78 flood affected districts and reporting is received from 50 (78%) of these 64 districts. The major causes for seeking healthcare by the affected communities continue to be diarrheal diseases, acute respiratory infections, skin diseases and suspected malaria.

In KPK, ARI increased from 12% to 14% also AD continues to decline, however, it remains proportionally higher compared to the corresponding reporting period from 2009. (Please see Fig.13)


Focus on: Dengue Fever and Dengue Hemorrhagic Fever

So far about 4,363 cases of suspected Dengue Fever (DF) have been reported in Pakistan with about 2,062 confirmed cases and 15 deaths. As Dengue Fever cases are on the rise in many places across the country, Pakistan joins 40% of the global community who are at risk for Dengue, the most widespread mosquito‐borne infection in human beings.

The only way to prevent Dengue Fever is to prevent mosquito bites. Dengue is not spread by droplets or blood. Dengue mosquitoes bite during the daytime. To protect yourself wear full‐sleeve clothes and long trousers, avoid wearing black color, use repellents, use mosquito coils and electric vapor mats, use bednets for children and elderly who may rest in bed during the day.

To control Dengue in the community, we must reduce the places where mosquitoes live and breed: drain out the water from all unused tanks, barrels, drums, and buckets and cover all stored water containers. Remove garbage piles where water collects in discarded containers.

As 95% of Dengue Fever can be treated at home, when someone falls ill with a fever and headache, pain behind the eyes, or body aches and no other symptoms, the best advice is to


rest at home in bed,
take plenty of fluids like soup, water, milk and juice, and
take paracetamol (Panadol, Calpol, etc) for pain.

All dengue patients must be carefully observed for complications for at least 2 days after recovery from fever because life threatening complications often occur during this phase. Patients and households should be informed that severe abdominal pain, passage of black stools, bleeding into the skin or from the nose or gums, sweating, and cold skin are danger signs. If any of these signs is noticed, the patient should be taken to the hospital. Please use only paracetamol for pain and fever as other medicines may increase the bleeding tendency.

At the hospital, the patient is monitored with frequent blood pressure readings, tests of hematocrit and platelets to determine when to give intravenous fluid and how much to give. Blood or platelets may need to be given if the patient is actively bleeding. The four WHO criteria for diagnosis of Dengue Hemorrhagic Fever, fever with headache or body aches; evidence of bleeding or positive tourniquet test; platelet count less than 100,000; and evidence of leaky capillaries such as >20% rise in hematocrit, have been found to be 62% sensitive and 92% specific for identification of dengue illness requiring intervention.

Srikiatkhachorn A, et al. Dengue Hemorrhagic Fever: The Sensitivity and Specificity of the WHO Definition for Identification of Severe Cases of Dengue in Thailand, 1994–2005. Clinical Infectious Diseases 2010;50:1135–1143


The objective of this weekly epidemiological bulletin is to provide a snap shot on selected health events reported from the communities affected by the current flood in Pakistan. While every attempt is made to present the weekly trend of the epidemic prone diseases, the information presented in the bulletin needs to be interpreted in the context that precise information on the reference populations is not always available, The bulletin also includes information collected by DEWS teams established during earlier emergencies, including 2005 earthquake, 2007 floods and 2008 ID crises. The primary focus of DEWS is the early detection of epidemic prone diseases, to facilitate a rapid public health response. We would like to thank all the numerous national and international partners who have contributed to the Disease Early Warning System.

This weekly Epidemiological Bulletin is published jointly by the Federal Ministry of Health, Government of Pakistan, National Institute of Health, Islamabad and World Health Organization (WHO), Pakistan .

For Correspondence: NIH: eic.nih@gmail.com. WHO: Tel : +92-051-9255184-5, Fax : +92-051-9255083, E-mail: wr@pak.emro.who.int.
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