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Mortality and Morbidity Weekly Bulletin (MMWB) Cox’s Bazar, Bangladesh: Volume No. 5 - 12 November 2017


1. Population under Surveillance and Reporting Units

During epidemiological week 45 (5-11 November 2017), there was a 3% increase in the population1 under surveillance compared to the previous epidemiological week (806,100 and 830,312 respectively). A total of 375 daily EWARS forms were received on time during epidemiological week 45.
Kutupalong makeshift camp population increased by 2% (437,633 vs 431,000) due to the ongoing relocation of FDMNs from other settlements, while the remaining camp populations remained more or less stable.

EWARS reports were received from the partner agencies active in the field and also from different departments (admission, emergency, surgery, paediatrics, gynaecology and internal medicine) of Cox’s Bazar Sadar hospital, and Teknaf and Ukhia Health Complexes (population of 100,400). The population of these settlements fluctuates daily due to movements between camps and new arrivals.

For the reasons stated above, it was difficult to estimate the actual catchment population covered by the medical mobile teams working in camps and settlement areas. During the epidemiological week 45, the number of daily reports per camp/settlement in Cox’s Bazar increased by 19% compared with the previous week (from 314 to 375 reports). Table 1 below shows the population per camp and the daily number of EWARS reporting forms submitted for each one.

The total number of consultations reported through EWARS increased by 18% compared to the previous week (71,756 vs 85,077). The weekly trend of reporting units participating in the EWARS and the number of consultations is shown in figure 1.

2. Proportion of Primary Causes of Cases and Deaths

During the period 25 August-11 November 2017, a total of 332,973 consultations were reported through EWARS. Of these, 51% (169,233/ 332,973) were events under surveillance. Fevers of unexplained origin accounted for 29%, (49,494), followed by acute respiratory infections (ARIs) 27% (46,077), acute watery diarrhoea (21%, 36,096), skin diseases (9%, 15,181), injuries (3%, 4,321), eye infections (2%, 3,486) and malaria (2%, 4,091). The remaining 7% were due to other causes including bloody diarrhoea and malnutrition.

For the under-5 age group, a total of 66,380 events under surveillance were reported through EWARS, constituting 39% of the events under surveillance. A total of 32% (21,498) of these cases were attributed to ARIs, while 27% (17,841) were due to fevers of unexplained origin and 23% (15,206) were due to acute watery diarrhoea (AWD).

For the over-5 age group, a total number of 102,853 events under surveillance were reported through EWARS, constituting 61% of the events under surveillance. A total of 31% (31,653) of these cases were attributed to fevers of unexplained origin, while 24% (24,579) were due to ARIs and 20% (20,890) were due to AWD. The proportion of primary causes of reported cases for both age groups is shown in figure 2.

During the same period, there were 199 reported deaths. Of this number, 28% (56) were due to ARIs, followed by INJ (10%, 19), NDs (8%, 16), AWD (5%, 10), cardiovascular disease (6%, 11), severe malnutrition (4%, 7), and UNK (12%, 25). The remaining 27% (55) were due to other causes.

There were 78 reported deaths in the under-5 age group, representing 39% of total deaths. Of these, 35% (27) were ARI-related, followed by NDs (21%, 16), AWD (8%, 6), SMN (9%, 7) and INJ (5%, 4). The remaining 22% (18) were due to other causes.

There were 121 reported deaths in the over-5 age group, representing 61% of total deaths. Of these, 24% (29) were ARI-related, followed by INJ (12%, 15), cardiovascular disease (11%, 9), AWD (3%, 4) and UNK (15%, 18). The remaining 35% (46) were due to other causes including meningitis, jaundice, TB and malaria. The weekly distribution of reported deaths is shown in figure 3.

ARI, UNFEV and AWD continues to contribute significantly to the overall consultations in all reporting camps and settlements. The attack rates per 1000 population of the 3 diseases showed slight increases compared to the last week. The weekly attack rates of ARI, UNFEV and AWD are shown in figure 4.