Role of Disease Early Warning System in disease control and prevention, Afghanistan -2008

Role of Disease Early Warning System in disease control and prevention

, Afghanistan -2008

Background of DEWS in Afghanistan

Afghanistan is a poor country with limited infrastructures for health service delivery and has one of the worst maternal and child health indicators in the world.

Disease profile in Afghanistan is obviously 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]

The regular source of data collection in the country is HMIS that collects data quarterly and reports 04 times a year. That is in fact too late for most of acute public health emergencies and only can lead MOPH in terms of long term policy making and can not provide data/information for day to day management of MOPH, which can result immediate corrective measures and prevent deaths.

To reduce incidence and prevalence of morbidities and mortalities in the children and women and ultimately reduce economic loss, MoPH has established Early Warning System in 08 regional provinces of country.

Objectives:

To reduce morbidity and mortality by early detection, investigation, response and control of outbreaks and other public health states and conditions, throughout the country.

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 and as of 10 November 2008, DEWS has 129 sentinel sites all over the country.

Result/Achievements

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 8995 weekly reports were due and 8866 reports received on time and on time reporting rate is calculated to be 98.5%.

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.

DEWS has established the rotavirus surveillance 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).

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. 85000 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.

Conclusion

A full functional Disease Early Warning System established in the country. 364 outbreaks detected and responded. Every 1.8 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.

[1] HMIS Report 2007 and first quarter 2008

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