DEWS for IPHC November 2008

Disease Early Warning System : 

Disease Early Warning System Dr. Jawad Mofleh AI Coordinator/DEWS and Surveillance Director Afghan Public Health Institute 19 November 2008

Outline: 

Outline Background Objectives Methodology Result and achievements Conclusion

Background: 

Background Afghanistan is a poor country limited infrastructures for health service delivery one of the worst maternal and child health indicators Disease profile dominated by communicable disease. Of 22,571,203 consultations between March 2007 and end June 2008, ARI cases were 6,880,051(30.5%), Diarrheal Disease were 2,595,290(11.5%) ,Urinary tract infections are 1,250,167(5.5%), Malaria cases are 343,647(1.5%) and TB cases are reported to be 169,563 cases which is 0.8%. [1] Regular source of data collection in the country is HMIS, collects data 04 times a year.

Background: 

Background Before establishing DEWS we had Passive surveillance systems for ARI-seasonal AWD- Seasonal Also Notifiable diseases e.g. CCHF and Cholera. Functional surveillance systems was AFP, Measles and NNT

Objective of DEWS: 

Objective of DEWS To reduce morbidity and mortality by early detection, investigation, response and control of outbreaks and other public health states and conditions, throughout the country and ultimately contribute to the economic stability and development.

Methodology: 

Methodology Disease Early Warning System was established in the country mid December 2006 in the eight major provinces of the country. The first officers recruited and deployed to the field after extensive short term training. The first eight sites were the provincial hospitals in Badakhshan, Balkh, Bamyan, Herat, Kabul, Kandahar , Khost and Nangarhar (See map.) The DEWS was worked in these provinces in the first 06 months of 2007 and than extended to other provinces. At the end of first six months DEWS had 58 sentinel sites in 08 provinces.

Result/Achievements-1: 

Result/Achievements-1 Afghan Public Health Institute has established 129 sentinel reporting sites in 34 provinces of the country covering 93 rural districts and 34 cities. In total 8,995 weekly reports were due and 8,866 reports received on time and on time reporting rate is calculated to be 98.5%.

Slide 8: 

Badakhshan Hirat Kandahar Balkh Bamyan Ningarhar Kabul Paktya Badghis Jawzjan Takhar Zabul Laghman Parwan Logar Khost DEWS progress in first 09 months of 2007

Result/Achievements-2 : 

Result/Achievements-2 Since 15 December 2006, 3418 specimens for different disease collected and 613 were positive for different disease. (Rotavirus in not included), positivity rate around 17%. 133 suspected outbreaks investigated in 2007 and 231 outbreaks investigated till Nov 2008. 1 outbreak per 1.8 days .

Slide 11: 

One outbreak was investigated every 2.7 days Suspected outbreaks # Pertussis 59 Suspected AI 26 Measles 23 Viral Hepatitis 12 ARI 9 Brucellosis 1 CCHF 1 Chicken pox 1 Malaria 1 N=133

Slide 12: 

Suspected outbreaks # Pertussis 52 Avian Flu 0 ARI 14 Measles 37 Diarrhea 86 Meningitis 0 Hepatitis 4 Malaria 4 Typhoid 4 CCHF 4 Bl. Diarrhea 1 Chickenpox 6 Other 19 N=231

Result/Achievements-3: 

Result/Achievements-3 Also rotavirus surveillance established in three provinces of the country and 522 specimens collected, 294 were positive for rotavirus, positivity rate 57%. Below disease and causative agents detected/confirmed for the first time inside the country, Hepatitis E, C. Diphtheria, Influenza B virus, B. Pertussis, yersina pestis(causative agent for plague- Bubonic form), rotavirus.

Result/Achievements-4: 

Result/Achievements-4 DEWS have responded to 27 suspected outbreaks of Avian Influenza in human, worth to mention that 12 outbreaks reported in bird population in 2007 and 1in 2008 by Ministry of Agriculture. 85,000 people are monitored for Sever Acute Respiratory Infection and no evidence of H5N1 in human detected by virology lab of Central Public Health Lab and NAMRU-3 Lab in Cairo.

Slide 15: 

AI cases in poultry 2007 The Difference 2006-07 2006 this time of year- 09 infected provinces 2007- 05 infected provinces 2008- only one province-khost AI cases in poultry 2006

Slide 17: 

Cholera cases 30/sept to mid October 2008 Samangan provinces Afghanistan

Conclusion: 

Conclusion A full functional Disease Early Warning System established in the country. 364 outbreaks detected and responded. Every 1.85 days one suspected outbreak investigated. Necessary response mechanism established at the provincial and regional levels. DEWS is providing sensitive surveillance in a timely manner. Investigations bring quick action to mitigate outbreaks and prevent morbidity and mortality. DEWS is also participating in coordination of public health inputs in the field, dissemination of public health information, and investigating and confirming complex outbreaks of emerging diseases.

Questions: 

Questions