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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
43 SS in 4 Provinces
37SS in 4 Provinces
41 SS in 5 Provinces
41 SS in 4 Provinces
34SS in 4 Provinces
55 SS 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
<5 Years 5 Years & over
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
<5 Years 5 Years & over
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