Transcript Disease Early Warning System

Islamic Republic of Afghanistan
South Asia Emerging Infectious Disease and
Pandemic Influenza Workshop
Habibullah Ahmadzai MD, EMBA-HM
Head of International Relation Department
Ministry of Public Health, Afghanistan
 Population = 25 Million
 650,000 km2
 34 provinces
 GDP ~ 300 dollars/
capita/year
 Civil War since 1978
 1-2 million people died
>3 million refugees
 80% rural
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Life expectancy at birth: 47 years for men and 45 years for
women
Under-five child mortality rate: 257 deaths per 1,000 live
births per year (2002)
Maternal mortality ratio estimated at 1600 per 100,000 live
births per year, one of the highest in the world
400
300
Afghanistan
200
South Asia
100
0
1960
1990 2002
2006
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Health system infrastructure:
◦ Inequitable distribution of health services
◦ Insufficient numbers of health workers
◦ Many clinics and hospitals damaged by war,
earthquakes and neglect
Limited capacity in the Ministry of Public Health
Little coordination of NGO activities
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Established the “Basic Package of Health Services”
Signed contracts with NGOs on a very large scale – 85% of
Afghans live in areas served by NGOs
Provinces have been assigned to donors
Competitively recruited Afghans to work in the MoPH at
market wages
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Training of community midwives
Established “Essential Package of Hospital Services” as
complaiment to BPHS
Invested heavily in monitoring and evaluation
Disease Early Warning System
(DEWS)
Background of Establishment of (DEWS)
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DEWS established mid December 2006
Prior to DEWS establishment below surveillances
were present
Passive surveillance systems working was
◦ ARI
◦ AWD
◦ Notifiable diseases e.g. CCHF and Cholera.
2. Functional surveillance systems was
◦ AFP, Measles and NNT(WHO)
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To reduce morbidity and mortality by early detection and
response to outbreaks
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To establish a disease early warning system for the early
detection, investigation and control of outbreaks
throughout the country
Record
infectious Chart &
assess
disease
infectious
cases
disease
Daily:
data
Respond to
Weekly:
Alerts
Respond to
Alerts
Investigate
suspected
outbreak
Take
action
to
control
All in full coordination of other stakeholders and
partners
Process of Establishment
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First eight provinces
And at the end of year 2009 all provinces were covered
with at least 3-6 sentinel sites in each Province
Currently DEWS has 177 sentinel sites in 34 provinces
covering, 48 District Hospitals, 83 Comprehensive
Health Centers/ Basic Health Centers and 3 poly clinics
Important to Note
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Number of staff involved with DEWS 132
Number of focal points for DEWS 220
Flow of DEWS Information
Routine weekly reports
Special ALERT reports whenever they happen
CHCs
BHCs
CHWs
Hosp
CDC, EPI,
Malaria etc
HMIS
DEWS
PHD –
HMIS
CDC,
DEWS
Lab
Other
partners
Kabul
◦ Establishment of DEWS in the country
◦ Development of manuals and guidelines
◦ Supply and equipment
◦ Trained staff
◦ Detection and response to outbreaks
◦ Support lab
Outbreaks in Afghanistan, 2007, DEWS data
Chicken
Malaria
pox
CCHF
Brucellosis
ARI 1%
1%
1%
1%
7%
Viral Hepatitis
9%
Pertussis
43%
Measles
17%
Suspected AI
20%
One outbreak was investigated every 2.7 days
Outbreaks in Afghanistan 2008, DEWS data
Bl. Diarrhea
TyphoidCCHF
Malaria
3% 3%1%
Hepatitis
3%
3%
Chickenpox
4%
Pertussis
28%
Diarrhea
6%
ARI
7%
Avian Flu
9%
Other
11%
Measles
22%
One outbreak is investigated every 1.6 days
Outbreaks of Disease 2009, Afghanistan, DEWS data
sus Malaria
2%
Sus Avian Influenza
2%
CCHF
2%
Sus Acute Hepatitis
4%
Sus Typhoid Fever
0%
ARI
5%
Sus, Pertussis
11%
Sus Measles
42%
Others
13%
Diarrhea
19%
Diseases Under Surveillance
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ARI- Cough and cold
ARI- Pneumonia
Acute Diarrhea/AWD
Bloody Diarrhea
Suspected Meningitis
Suspected Acute Viral Hepatitis
Suspected Measles
Diseases Under Surveillance (2)
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Suspected Pertussis
Probable Diphtheria
Tetanus/ Neonatal Tetanus
Acute Flaccid Paralysis
Suspected Malaria
Suspected Typhoid Fever
Suspected Hemorrhagic Fever
Pregnancy-related deaths
Challenges
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Development of the capacity of the staff (Training)
Communication means, especially in remote areas
Patient transportation (ambulance)
Lab capacity for diagnosis of different disease
Office equipment
Access to medical literatures
Internal security
Thank You