Surveillance dews Afghanistan_14_jan2013

Islamic Republic of Afghanistan

Ministry of Public Health

2013 Health Results Conference January 13th and 14th 2013 – Kabul

SESSION: 2nd Day, Session 05

Surveillance/DEWS Data Analysis and Results– 2007-2012

Presenter: Dr. Khwaja Mir Islam Saeed

MD (KMU), MSc-HPM (AKU), FELTP (NIH-ISB) Director Surveillance/DEWS, ANPHI, MoPH

Surveillance/DEWS Directorate is a vital department of ANPHI involved in routine reporting of priority diseases and outbreak investigations

It is National Focal Point (NFP) for International Health Regulations (IHR2005)

In Afghanistan, DEWS was first established in mid-December 2006, with technical support of WHO and financial support of USAID

DEWS is a sentinel site based surveillance system for weekly reporting of infectious diseases morbidity and mortality

While daily reporting system for injuries and seasonal diseases are done by through Codan Radio system

Surveillance/ DEWS

Central Office

CER CWR NR WR NER ER SR

30 SS in 4 Provinces

49 SS 5 Provinces


37SS in 4 Provinces



34SS in 4 Provinces


SER

MOPH and

NGOS

International

Agencies

Daily Surveillance for seasonal diseases and injuries from 34 provinces

To describe the pattern of morbidity and

mortality due to priority diseases and

explain burden of outbreaks in

Afghanistan

To provide evidence for MoPH and

partners to take informed decisions

To encourage and improve data use and

culture of action based on information

Study Design: Analysis of Surveillance database

including routine reports, outbreak and lab reports

Sampling: All weekly, daily and outbreaks reports (line

lists) with lab data 2007-2012

Disease Under surveillance: 16 priority diseases

including ARI, Diarrheal Diseases, Meningitis/Severely ill

child, Acute Viral Hepatitis, Vaccine Preventable

diseases, Malaria, Typhoid Fever, Hemorrhagic Fever,

Pregnancy related deaths

Data Management: Paper and computer based using

forms, Ms Word, Excel and Access

Analysis and Dissemination: Descriptive analysis in

term of person, place and time

Years Sentinel Sites

Weekly Reports

Daily Reports

Outbreak Reports

2007 123 3143 298 129

2008 130 6731 298 235

2009 177 7871 298 232

2010 245 10349 298 217

2011 283 13544 248 329

2012 330 15870 248 358

Total 330 57508 1688 1500

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

Jan

Ma

r

Ma

y

Jul

Se

p

No

v

Jan

Ma

r

Ma

y

Jul

Se

p

No

v

Jan

Ma

r

Ma

y

Jul

Se

p

No

v

Jan

Ma

r

Ma

y

Jul

Se

p

No

v

Jan

Ma

r

Ma

y

Jul

Se

p

No

v

Jan

Ma

r

Ma

y

Jul

Se

p

No

v

2007 2008 2009 2010 2011 2012

C&CPneumoniaLinear (C&C)Linear (C&C)

Cyclical trend of ARI ( Cough & Cold and Pneumonia) as percentage of total clients 2007-2012

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

Jan

Ma

r

Ma

y

Jul

Se

p

No

v

Jan

Ma

r

Ma

y

Jul

Se

p

No

v

Jan

Ma

r

Ma

y

Jul

Se

p

No

v

Jan

Ma

r

Ma

y

Jul

Se

p

No

v

Jan

Ma

r

Ma

y

Jul

Se

p

No

v

Jan

Ma

r

Ma

y

Jul

Se

p

No

v

2007 2008 2009 2010 2011 2012

ADD ARI

Cyclical trend of ARI and ADD as percentage of total clients 2007-2012

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

Jan

Mar

May Ju

l

Sep

No

v

Jan

Mar

May Ju

l

Sep

No

v

Jan

Mar

May Ju

l

Sep

No

v

Jan

Mar

May Ju

l

Sep

No

v

Jan

Mar

May Ju

l

Sep

No

v

Jan

Mar

May Ju

l

Sep

No

v

2007 2008 2009 2010 2011 2012

Malaria

Typhoid F.

Linear (Malaria)

Cyclical trend of malaria and typhoid fever as percentage of total clients 2007-2012

9% 8%

7%

5% 5% 5% 4% 4% 4%

4% 4% 4% 4%

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

Top ten provinces with Pneumonia cases as percentage of total clients, 2012

16% 16% 16%

15% 15%

14%

14% 13% 13% 13%

12% 12% 12%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Top ten provinces with percentage of Diarrheal Diseases from total clients, 2012

2.15%

1.97% 1.95%

1.34%

1.04% 1.03%

0.89% 0.88% 0.81%

0.50% 0.47% 0.46% 0.45%

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

Top ten provinces with percentage of Malaria cases from total clients, 2012

2498

2227

516 440

368 319

261 260 192 178 131

0

500

1000

1500

2000

2500

3000

Top ten provinces with percentage of Acute viral hepatitis cases from total clients, 2012

0

500

1000

1500

2000

2500

3000

3500

Top ten provinces with percentage of Measles cases from total clients, 2012

0% 10% 20% 30% 40% 50% 60% 70%

Kohistan

Azra

Muqur

Qarabagh

Hisa-I- Awali Bihsud

Dara-I-Pech

Fayzabad

Jabalussaraj

Dur Baba

Kharwar

Paghman

Chapa Dara

Top ten districts with percentage of ARI ( cough & cold and Pneumonia) cases from total clients, 2012

0% 10% 20% 30% 40% 50%

Muqur

Dawlatabad

Jabalussaraj

Kohistan

Arghandab

Bala Buluk

Dand Wa Patan

LalPur

Dahana-I- Ghuri

Nawa-I- Barak Zayi

Shahidi Hassas

Dawlat Shah

Top ten districts with percentage of Acute Watery Diarrheal cases from total clients, 2012

0 500 1000 1500 2000 2500 3000

Jalalabad

Kabul

Mazari Sharif

Khost(Matun)

Mihtarlam

Jaji

Khogyani

Kunduz

Lashkar Gah

Shinwar

Saydabad

Maydan Shahr

Top ten districts with number of Measles cases from total clients, 2012

0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0%

Dand Wa Patan

LalPur

Nari

Chawki

Maywand

Dila

Dawlat Shah

Sarobi

Bar Kunar

Qarghayi

Jaji

Narang (Taragn -o-Badil)

Top ten districts with percentage of Malaria cases from total clients, 2012

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

5 Years & over

<5 Years

Weekly trend of ARI (pneumonia) by age groups in 2012

0

5000

10000

15000

20000

25000

30000

35000

<5 Years 5 Years & over

Weekly trend of diarrheal diseases by age groups in 2012

0

50

100

150

200

250

300

350

400


Weekly trend of ARI Measles cases by age groups in 2012

0

200

400

600

800

1000

1200

1400

1600

1800

2000

W1

W3

W5

W7

W9

W11

W13

W15

W17

W19

W2

1

W2

3

W2

5

W2

7

W2

9

W31

W33

W35

W37

W39

W4

1

W4

3

W4

5

W4

7


Weekly trend of Typhoid fever by age groups in 2012

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

Jan

Ap

r

Jul

Oct

Jan

Ap

r

Jul

Oct

Jan

Ap

r

Jul

Oct

Jan

Ap

r

Jul

Oct

Jan

Ap

r

Jul

Oct

Jan

Ap

r

Jul

Oct

2007 2008 2009 2010 2011 2012

Ca

se F

ata

lity

Ra

te(%

)

Case Fatality Rate (CFR) Meningitis/SIC, 2007-2012

0.00

0.05

0.10

0.15

0.20

0.25

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

Jan

Ap

r

Jul

Oct

Jan

Ap

r

Jul

Oct

Jan

Ap

r

Jul

Oct

Jan

Ap

r

Jul

Oct

Jan

Ap

r

Jul

Oct

Jan

Ap

r

Jul

Oct

2007 2008 2009 2010 2011 2012

Dia

rrh

ea

l Dis

ea

ses

CF

R

Pn

eu

mo

nia

CF

R

ADD-CFR Pn-CFR

Cyclical trend of Case Fatality Rate (CFR) Pneumonia and Diarrheal Diseases, 2007-2012

0.00

0.10

0.20

0.30

0.40

0.50

0.60

0.70

0

20000

40000

60000

80000

100000

120000

140000

2007 2008 2009 2010 2011 2012

Pe

rce

nta

ge

s

Ca

ses

Cases CFR(%)

Trend of watery diarrheal with dehydrations (suspected cholera) and CFR, 2007-2012

0

50

100

150

200

250

2007 2008 2009 2010 2011 2012

Nu

mb

er

of O

utb

rea

ks

Inve

stig

ate

d a

nd

AWD / Sus Cholera Susp CCHF Susp Pertusis Susp Measles

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Pe

rce

nta

ge

s

Surveillance Regions

2012

2011

2010

2009

2008

2007

0

200

400

600

800

1000

1200

1400

Burn Criminal Explosion Natural Traffic

Number of Death due to injuries, 2009-2012

2009 2010 2011 2012

0

10000

20000

30000

40000

50000

60000

Burn Criminal Explosion Natural Traffic

Number and type of injuries 2009-2012

2009

2010

2011

2012

0

10000

20000

30000

40000

50000

60000

70000

Bad

akh

shan

Bad

ghis

Bag

hla

n

Bal

kh

Bam

ian

Dai

kon

dy

Fara

h

Fary

ab

Gh

azn

i

Gh

or

Hilm

and

Hir

at

Jaw

zjan

Kab

ul

Kan

dah

ar

Kap

isa

Kh

ost

Ku

nar

ha

Ku

nd

oz

Lagh

man

Loga

r

Mid

an W

ard

ak

Nee

mro

z

Nin

garh

ar

No

ori

stan

Oro

zgan

Pak

tia

Pak

tika

Pan

jsh

eer

Par

wan

Sam

anga

n

Sar-

e-p

ul

Takh

ar

Zab

ul

Sustainability of Surveillance system White area in some provinces Poor coordination among stakeholders Turn-over of trained staff Less clear role and responsibilities of different

partners Lab limitation for infections and toxicology IHR (2005) implementation as a legal requirement Use of data Dispersion and duplications of surveillance systems Implementation of Influenza surveillance System Security concern

Financial support of current successful/DEWS surveillance system for future years

Expansion of BPHS coverage to white areas Development and strengthening of coordination Clear-cut role and responsibilities for

stakeholders Motivation and maintaining of staff Strengthening Lab support of surveillance

System Supporting IHR-2005 implementations Encouragement and promotion of data use Establishment of Integrating Disease

Surveillance System (IDSR)

Figure-1: Proposed model-1: IDSR information flow

*TB is not notifiable, but suspected cases detected are referred to the health facility (HF)

APHI – Surveillance unit

National Level

IDRS

Provincial HIMS

manager

APHI-Provincial surveillance focal point

HMI S

I DR S

WK L Y

Health facility level (Forms now in use: - IDSR-wkly, Tb, EPI, Polio & HMIS )

I DR S

NOT I F I AB L E

Community level (Teams currently:- DEWS, Tb*, EPI, Malaria, Polio & HMIS )

Provincial Level

CDs monthly (IDSR)

CDs monthly (IDSR)

NOT I F IABLE

Figure 2: Proposed model-II: Information flow

*TB is not notifiable, but suspected cases detected are referred to the health facility

APHI – Surveillance unit

IDRS

APHI-Provincial surveillance focal point

I DR S

WK L Y

I DR S

MN L Y

Health facility level (Forms now in Use: - DEWS-wkly, Tb, EPI, Polio & HMIS )

I DR S

NOT I F I AB L E

Community level (Teams currently:- DEWS, Tb, EPI, Malaria, Polio & HMIS )

NOT I F I ABL E

National Level

Provincial Level

Thanks [email protected]

Phone: 0093(0)202301366, cell: 0093700290955

mailto:[email protected]

mailto:[email protected]

Surveillance dews Afghanistan_14_jan2013

Health & Medicine

Transcript of Surveillance dews Afghanistan_14_jan2013