QUARTERLY REVIEW, 10 – 13 SEPT 2018

INTERIOR SINDH

DISTRICT: Sanghar SBA Division

 District Profile- Sanghar
# Talukas 6
# Union councils 55
# MT UCs & <5 target 415729
# SMT UCs & <5 target 11317
# UCs in Kaccha areas & <5 target 0
Total Population (census’17) 2057057
<5 Population (April’18) 427046
<15 Population (2018) 925675
# Health Facilities 103
# EPI Centers 65
# TSCs (kit stations) 70
# Vaccinators 114
# LHWs 1110
# UCs without LHWs No
# UCs without vaccinator No
Confirmed WPV1 Cases
PARTNER STAFF

AC Consultant DSO PEO DHCSO

Year 2011 2012 2013 2014 2015 2017 2018 1 1 1 2 0

NSTOP UCPOs UCCSO SMs TTSPs
#WPV1 1 0 0 2 0 0 0
1 8 0 0 19
 Basic EPI Information, District Sanghar, 2018
Total No. of Ucs 55
Total No. of EPI centers 65
Total No. of UCs without EPI Centers (Old + New) 4
No. of UCs covered with New EPI Centers (Recent Updates)* 3
Total Health Facilities 103
Total No. Of Health Facilities without EPI Centers 33
No. of Health facilities covered with New EPI Centers (Recent Updates)* 5
No. of active sites 24
No. of zero reporting sites 75
Total No. of LHWs 1110
Total No. of LHWs involved in SIAs 1024
Total No. of Vaccinators 114
No. of vaccinators involved in SIAs 0
Rationalization of vaccinators (2/UC) Yes or No Yes
VPDs 2012 - 2019
Year 2012 2013 2014 2015 2016 2017 2018 2019
#Measles suspected - - - - 56 130 349 01
#Measles confirmed - - - - 45 110 21 00
#Reported measles outbreaks - - - - 2 5 14 00
#Pertussis - - - - - 0 0 0
#NNT - - - - - 4 1 1
 Surveillance
(District & Divisional Surveillance Officer)
 Spot Map Confirmed Polio Cases 2013-2019

2014

DESERT
V

V UC Kanhar and UC Setharpir in 2014

 Active & Zero Reporting Sites, 2016-18

Type of site 2016 2017 2018 2019

Active site 20 20 24 27

Zero Reporting site 35 35 51 53

Total 55 55 75 80
Most recent rationalization was done in: December / 2018
Next rationalization plan: December 2019
 Environmental Surveillance, 2015 – 18
Year 2015 2016 2017 2018

June

June

June
Sept

Sept

Sept
May

May

May
Mar

Mar

Mar

Mar
Nov

Nov

Nov
Aug

Aug

Aug
July

July

July
Dec
Dec

Dec
Site
Feb

Feb

Feb

Feb
Apr

Apr

Apr

Apr
Oct

Oct

Oct
Jan

Jan

Jan

Jan
Dhak
Para

LEGEND

WPV1 (Grab)

WPV1 (BMSF)

Negative (Grab)

Positive (BMSF)

Under Process
Zero Reporting Sites Spot Map

DESERT

Govt. 73

Pvt. 7
Active Sites Spot Map

DESERT

Govt. 20

Pvt. 4
Spot Map AFP Cases, 2018

AFP Cases
 Spot Map AFP Cases, 2019

AFP Cases
Cross notified
 SPOT MAP SILENT UCs 2018

DESERT

2011
1. Tando Adam-2
 Silent UCs – Last 3 Years

• No Silent UC since last three years

 Point in time comparison of AFP Surveillance Indicators,
2017(Jan-Aug) Vs 2018 (Jan – Aug)

% Investigated

% EV isolation
within 7 days

within 48 hrs
% Non Polio

% Adequacy
Compatible

% Detected
Confirmed

% 60-d FU
Reported
Expected

AFP Rate
Pending
Taluka

2018
2017

2018

2017

2018

2017

2018

2017

2018

2017

2018

2017

2018

2017

2018

2017

2017

2018

2017

2018

2017

2018
Sanghar 12 12 12 10 0 0 0 0 0 2 8 7 66 100 100 100 66 100 100 100 10 4

Tando Adam 9 9 4 06 0 0 0 0 0 2 5 6 66 84 100 100 66 89 100 100 2 0

Sinjhoro 8 8 5 11 0 0 0 0 0 1 5 12 100 82 100 100 85 75 100 100 4 2

Shahdadpur 12 12 9 07 0 0 0 0 0 1 7 6 100 86 100 100 83 83 100 100 4 0

Jam Nawaz
Ali
4 4 3 2 0 0 0 0 0 1 8 5 100 100 100 100 100 100 100 100 2 2

Khipro 9 9 8 12 0 0 0 0 0 1 10 12 100 100 100 100 100 100 100 100 0 0

Total 54 54 41 47 0 0 0 0 0 8 6.5 7.8 88 91 100 100 88 91 100 100 22 18

 Point in time comparison of AFP Surveillance Indicators,
2017 (Jan – Aug) Vs 2018 (Jan – Aug)
14
60 54 12 12
12
50 47 10
41 10
40 8 8 7.8
8 7 7
6.5
6 6
30 6 5 5 5
Expected 2017
20 12 4
2017 reported 2018
12 10 11 12 12
9 8 97 98 2018 reported 2
10 46 5 432
0
0

120 120
100 100 100 100
100 100
100 100 100 100
100 100
84 86 8891 89 85 88
82 83
80 80
66 66
60 60 % Detected within 7 days
% Adequacy 2017 2017
40 40
% Adequacy 2018 % Detected within 7 days
20 20 2018
100 89 75 83 100 100 91
0 0
 AFP Surveillance 2017
Case Notification and Health Seeking Behavior Analysis
AFP Cases Notification -
HSB Data by Contacts Health Seeking Behavior - Sites
# of AFP Case Reported
Network

Armed Forces

Informal HCP
/ Institution

Community
Active Site

SIA Team/
Contact &

Reporting
Reported

Reported

Reported
from 2nd

from 3rd

Network
from 1st

Onward

Outside
Contact

Contact

Private
Public

Other
Zero

Site
Taluka

# % # % # % # % # % # % # % # % # % # % # % # %

Sanghar 20 10 50 7 35 3 15 7 35 10 50 3 15 17 85 0 0 2 10 1 5 1 5 0 0

Tando Adam 9 6 66 1 11 2 22 8 88 0 0 1 11 8 88 0 0 1 11 0 0 0 0 0 0

Sinjhoro 6 3 50 3 50 0 0 5 83 0 0 1 16 5 83 0 0 1 16 0 0 0 0 0 0

Shahdadpur 15 5 33 7 46 2 13 13 86 0 0 2 13 13 86 0 0 2 13 0 0 0 0 0 0
Jam Nawaz
Ali 5 4 80 0 0 1 20 1 20 0 0 4 80 1 20 0 0 2 40 0 0 2 0 0 0

Khipro 11 2 18 8 72 1 9 9 81 0 0 2 18 8 72 0 0 3 27 0 0 0 0 0 0

Total 66 30 45 26 39 9 13 43 65 10 15 13 19 52 78 0 0 11 16 1 15 3 4 0 0
 AFP Surveillance 2018
Case Notification and Health Seeking Behavior Analysis
AFP Cases Notification -
HSB Data by Contacts Health Seeking Behavior - Sites
# of AFP Case Reported
Network

Reporting Site

Armed Forces

Informal HCP
/ Institution

Community
Active Site

SIA Team/
Contact &
Reported

Reported

Reported
from 2nd

from 3rd

Network
from 1st

Onward

Outside
Contact

Contact

Private
Public

Other
Zero
Taluka

# % # % # % # % # % # % # % # % # % # % # % # %

Sanghar 10 6 60 2 20 2 20 5 50 1 10 4 40 6 66 0 0 2 33 0 0 2 40 0 0
10 10
Tando Adam 05 2 40 2 40 1 20 5 0 0 0 0 5 0 0 1 20 0 0 0 0 0 0
0 0
Sinjhoro 11 5 45 3 27 2 18 10 90 0 0 1 9 10 90 0 0 1 09 0 0 0 0 0 0

Shahdadpur 07 3 43 2 28 2 28 4 57 0 0 3 42 4 57 0 0 0 0 0 0 0 0 0 0
Jam Nawaz
Ali
2 0 0 0 0 1 50 1 50 0 0 1 50 1 50 0 0 0 0 0 0 1 50 0 0

Khipro 12 7 58 3 25 2 16 10 83 0 0 2 16 10 83 0 0 2 16 0 0 0 0 0 0

Total 47 25 53 12 25 10 21 35 74 1 2 12 25 36 74 0 0 6 12 1 2 3 6 0 0
 HSB SINDH 2017-18, (RANK OF REPORTING PERSON
(BY 1ST ,2ND ,3RD ,4TH ,5TH ETC CONTACT)
35

30
30

26
25
25

20
#of Cases 2017
#of Cases 2018
15
12
10
10 9

1
0 0 0 0
0
1st 2nd 3rd 4th 5th 6th 7th

Contact 1st 2nd 3rd 4th 5th 6th 7th

#of Cases
30 26 09 1 0 0 0
2017
#of Cases
25 12 10 0 0 0 0
2018
 HSB Sindh 2017 (case reporting channels) HSB Sindh 2018 (case reporting channels)

13, 20%
12, 25%
Active Site
Active Site
Zero site Zero site
1, 2%
10, 15% Outside Network Outside Network

43, 65%
35, 73%

HSB Sindh 2017 (Type of site) HSB Sindh 2018 (Type of site)
0, 0%
2%
0% 1, 2%
4% 3, 7%
Public

16% Armed Forces

6, 13%
Public
Private
0, 0%
Armed Forces
0%
IHCP
Private

IHCP SIA Team/Community

SIA Team/Community Other

52, 78% 36, 78%
Other
 AFP CASES DIAGNOSIS 2017 & 2018
(PIE CHART EACH FOR 2018)

2017
GBS

Traumatic Neuritis
2018

Trans Myelitis 20
GBS
34% 26 Traumatic Neuritis

48% Hemiplegia 4
Trans Myelitis
2 Hemiplegia
6 Hypokalemia
Hypokalemia
8 Encephalitis/Meningitis
0% 34 Others
12% 2% Encephalitis/Meni
ngitis
2% 2% Others
 Comparison of “Good AFP”, 2017 (Jan-Aug) &
2018 (Jan – Aug)
40

35 34

30

25
25

20
20 18

15

10

5 4
2 2
0
0
GBS Transverse Myelitis Tramatic Neuritis NP EnteroVirus

2017 Jan - Aug 2018 Jan - Aug

 Active & Zero Reports
(Timeliness & Completeness 2017)
100
90
80
70
60
50
40
30
20
10
0

Timeliness Completeness
 Active & Zero Reports 2018
(Timeliness & Completeness)
100
89 91
90 87 8887 88 87
84 84 85 8585
8183 8081
83
80 80 80 8183
80 7575 77 75
70 65 65
60
60 57
51 5253 53
50 48

40
30
20
10
6551575253485375758183897784758480818783888791858880878065808585818360
0
 Weakness cases reported by SIA teams, 2018

Campaign #Weakness Cases #Linelisted #E-Listed

Jan’18 3 1 2

Feb’18 6 2 4

Mar’18 3 0 3

Apr’18 4 0 4

May’18 6 1 5

Aug’18 1 0 1

Total 23 4 19
 Surveillance Active Visits, 2018
June July Aug

#Planned Visits

#Planned Visits

#Planned Visits
#Implemented

#Implemented

#Implemented
#Uploaded on

#Uploaded on

#Uploaded on
Staff Category

ODK

ODK

ODK
DSO 06 4 4 06 4 4 06 4 4
DSC 25 20 15 25 14 14 20 18 18
PEO 11 11 11 11 1 1 20 12 12
NSTOP 0 1 1 8 8 8 5 5 5
AC 0 0 0 0 0 0 0 0 0
TIP/STC 0 0 0 0 0 0 0 0 0
Total 42 36 31 50 27 27 51 39 39
 AFP Investigation, 2018

Total Cases
Investigated till DSO DSC PEO AC NSTOP
date

48 30(%) 40(%) 30(%) 0(%) 0(%)

AFP Validation, 2018

Total Cases
DSO PEO AC NSTOP
Validated till date
28 30 (%) 30%) 0 (%) 0 (%)
 AFP SL/EV Isolation, 2018 (graph)
Taluka #AFP Expected # AFP Line listed EV Isolation % SL Isolation %
Jam Nawaz Ali 4 2 0 0
Shahdadpur 12 7 1(2) 0
Tandoadam 9 6 0 1
Sanghar 12 11 4(6) 0
KHipro 9 12 0 1
Sinjhoro 8 10 1(2) 1
Total 54 48 18 4
14
12 12 12
12 11
10
10 9 9
8 #AFP Expected
8 7
6 # AFP Line listed
6 EV Isolation %
4 4
4 SL Isolation %

2
2 1 1
0 0 0
0
Jam Nawaz Ali Shahdadpur Tandoadam Sanghar KHipro Sinjhoro
 EV/SL Isolation for U5 AFP Cases, 2018 (graph)
Taluka #AFP Expected # AFP Linelisted % EV Isolation % SL Isolation
Jam Nawaz Ali 4 2 0 0
Shahdadpur 12 7 2 0
Tandoadam 9 6 0 1
Sanghar 12 11 6 0
KHipro 9 12 0 1
Sinjhoro 8 10 2 1
Total 54 48 18 4
14
12 12 12
12 11
10
10 9 9
8 #AFP Expected
8 7
6 6 # AFP Linelisted
6 % EV Isolation
4
4 % SL Isolation

2 2 2
2
0 0 0
0
Jam Nawaz Ali Shahdadpur Tandoadam Sanghar KHipro Sinjhoro
 AFP SL/EV Isolation, 2018
Sanghar Khipro Tando Adam Shahdadpur Sinjhoro Jam Nawaz Ali

12 12 12
11
10
9 9
8
7
6 6

2 2 2

0 0 0

#AFP Expected #AFP Reported & EV Isolation

Investigated
 Comparative analysis of Measles Cases trend 2016 – 18

Year 2016 2017 2018

Notified 56 130 345
Sample collected 56 130 340
Lab +ve 45 110 21
Lab -ve 11 20 3
 Informal surveillance sensitization sessions, 2018
#Sessions #Sessions Category of
Month #Participants
planned Conducted participants
M.O, WMOs,
Jan 17 12 140 LHW, Vaccinator
UCPOS
M.O, WMOs,
Feb 10 10 200 LHW, Vaccinator
UCPOS
Mar 13 11 230 ==
April 08 08 130 ==
May 14 14 190 ==
June 10 10 218 ==
July 16 14 215 ==
Aug 10 09 200 ==
Total 98 88 1523
 Silent active sites, 2017 – 18
Not Reported
Name of Active site
2017 2018
RHC JHOL YES Yes
RHC Sehrari No YES
BHU Nauabad YES YES
BHU Khahi No YES
BHU jendorind YES YES
BHU Malook Mehar No YES
BHU Berani Yes YES
BHU bhit Bhaiti YES YES
BHU Malook Junego YES YES
Murk Hospital Tandoadam YES YES
KMC Hospital Tandoadam YES YES
Irfan Childern Hospital YES YES
RHC Jam Nawaz Ali YES YES
 Detail analysis and actions on in-adequate AFP cases, 2017

EPID# Age D.O.O D.O.N Notified by Enlist missed contacts

SD/32/17/002 18 17/01/2017 18/01/2017 Shafqt Illahi Dr. Abdul Rehman

Dr. Manzoor Mr. Hassan (Quack)
SD/32/17/006 54 20-2-17 8-3-17
Qureshi Dr. Jameel Ahmed
SD/32/17/010 29 1-3-17 27-3-17 Dr. Talib Saeed Khan (Quack) Balochistan.
SD/32/17/027 2 15-5-17 14-6-17 Dr. Manzoor Dr. Rizwan
SD/32/17/029 30 17-6-17 26-6-17 Dr. Manzoor Mr. Hareesh (Quack)
SD/32/17/040 5 25-7-17 8-8-17 Dr. Qudartullah Dr. Qadir Bux + NICH Karachi
Dr. Mubarak Noohri & Dr. Gul
SD/32/17/050 12/10/2017 14/10/2017 NICH Karachi
38 Hassan Magsi
SD/32/17/056 16 5-11-17 23-11-17 Dr. Ismail Khoso (Quack)
SD/32/17/066 8 27-12-17 16-1-18 Dr. Nadeem Dr. Qadir Unnar & Shahnwaz
SD/32/18/007 72 16-1-18 22-1-18 Dr. Ali Akbar Dr Ashok Kumar Dr Umed Ali
SD/32/18/009 120 2-2-18 17-2-18 Dr. Ali Akbar Dr Rauf Mr Mohsin
SD/32/18/010 120 7-2-18 20-2-18 Dr. Ali Akbar Mr Gul Hassan Dahri
SD/32/18/026 84 24.3.18 24.4.18 Dr. Rajesh Dr. Paman,
 DERC Meetings, 2018
DERC Meeting minutes #Cases
#Pending cases #Cases
Month Conducted recorded referred to
presented discarded
(Yes / No) (Yes / No) PERC
March yes No 21 18 3
September Yes Yes 12 12 0
 District Surveillance Committee Reviews Jan – Aug 2018
DSCR Meeting minutes
Month Conducted recorded Major decisions taken
(Yes / No) (Yes / No)

WZR issue not submit timely, Orientation session in

January Yes YES
Silent UC New DSC Training

Febuar
Yes Yes Measles Outbreak, WZR issue not submit timely .
y

April Yes Yes Silent Union Councils, Reverse Cold Chain

June Yes Yes Measles Outbreak, Low AFP Rate , Silent Ucs.

Low AFP Rate At Taluka Jam Nawaz Ali, WZR

August Yes YES
submission, Ownership of DHMT and THMT.
Routine Immunization of AFP cases 6-23m of age 2016-2018*

SBA N.Firoz Sanghar

100%

90%

80%
4
70% 5
3

60%
7 11
50% 3 3 12 7

40% 3
2
30% 1
20%

10% 1 2 2
1 2
0% 0 0 0 0 0 0 0 0
2016 2017 2018 2016 2017 2018 2016 2017 2018
0 Dose 1-2 Doses 3 Doses
 SIAs doses of AFP cases <60m of age, 2016-2018*

SBA N.Firoz Sanghar

100%

90%

80%

70%

60% 38 37
15 58
32 27 28
50% 59 18

40%

30%

20%
3
6 2
10% 1 3
0 0 4 3
1 0
1 0
1 3 1 2 2
0% 0 0 0 0 0
2016 2017 2018 2016 2017 2018 2016 2017 2018
0 dose 1-2 doses 3 doses 4-6 doses 7+ doses
 Major Challenges & way forward
Component Challenges Way-forward / Support required
1. Lack of interest from the PPHI side, 1. Discussed several time in all level meetings (Support
Coordination IHS ,UCMOs didn’t work properly required from PEOC to raise this matter with the
during the SIAs. Province office of PPHI and IHS)

1. PEOC support required for the posting of THOs

1. Shortage of HR, 03 Taluka Health permanent bases.
officers Post are vacant. 2. PEOC directive to DC/ DHO/ DM PPHI to ensure female
SIAs 2. Male Teams are working staff in male working areas
3. Poor Monitoring from the DHMT level. 3. Involving new MOs with capacity building and motivation
planned

1. No Proper Monitoring from UCMO Sides.
SIAs Routine 2. During visit found Gaps Discuss with
DHMT but no fruitful Results .
Immunization 3. No Evening Meeting at DPCR for
discussion of Issues and way forward.
1. FP DPCR chair daily or alternate day Evening meetings to
give direction to stakeholders (DHO, PPHI and HIS for
corrective actions)
2. DHMT also participate the evening meetings so timely
actions and proper utilization done.

1. DSC with mobility issue.

AFP Surveillance
2. Separate ILR for Taluka Khipro and
shahdadpur .
3. DSV and TSV not collect WZR as per
SOPs , Reports are submitted at PPHI
office then they have submit to DHO
office on Wednesday.
1. DC/ DHO Directive to UCMOs/ other staff for searching
and reporting cases of weakness (AFP?)
2. EOC/ provincial directive to district to realize importance
of ZRs (backbone of surveillance)
3. DHO may support to provide vehicle to DSC.

HRMP IPV of HRMP. 1. Direction from DTF given but no response.

Separate ILR needed at taluka khipro and

Cold Chain
(SIAs, EPI & Surveillance)
Logistic & Admin
shahdadpur for Reverse cold chain.
Many time during EPI center visit found SIA
Vials but district show Zero vials
DHO will provide two separate ILR for ice pack of AFP in taluka
shahdadpur and Khipro.
After campaign stock report submit at DPCR leftover of vaccine.
Randomly check by partner staff.