PESHAWAR: The Khyber Pakhtunkhwa government’s complacency coupled with the major hospitals’ lackadaisical attitude has turned dengue into a major epidemic in the provincial capital.

A World Health Organisation (WHO) report into investigation of dengue outbreak in Peshawar and available with Dawn shows that first dengue case was admitted at Khyber Teaching Hospital (KTH) with positive NS1 test on June 14, 2017.

“It followed a sharp rise in dengue cases within next one month, particularly, after torrential rains in Peshawar,” the report notes, adding that by August 16, the number of suspected cases who approached hospitals exceeded 4,000.

The report offers insight into a lack of coordination and preparedness on part of the capital city’s major hospitals and other stakeholders as they failed to contain dengue from turning into an epidemic more than two months after the first case was reported.

Highlights lack of patients’ details, case management guidelines at hospitals, and lab-related issues

The WHO report highlights sloppy response on part of the hospitals in getting detailed information and lack of case management guidelines and laboratory related issues.

“Age and sex wise information with geographical distribution was available only about the admitted patients,” it says, adding that the data on the patients’ occupation, workplace and history of travel wasn’t available.

It also goes to the extent of saying that the data about the suspected cases has not been well recorded (dealt in on OPD basis with no follow-up or sera kept for testing of other arboviral infections).

Besides this, data from private sector clinics, health centres, private physicians and hospitals (except few) was also not available, while algorithm or case management guidelines weren’t available in both public and private hospitals. Also, the education of patients and attendants at the discharge for prevention and follow-up schedule was not in place.

The report notes that all cases are being screened at the KTH laboratory using both NS1 and IgM/IgG rapid test, as the clinical data of cases particularly the date of symptom onset is not provided.

“This is resulting in unnecessary testing and increasing the laboratory burden as well as the screening cost,” it says, adding that no standard lab investigation form is being used for referral to the lab, while no confirmatory Eliza or PCR testing facility is available there.

It also reveals that the nets to catch the mosquito larva were unavailable and the WHO team had to prepare them locally to train technicians and insect collectors in larval source investigation surveys.

The report notes that it was most practical for entomological investigations is to map the cases in order to identify the most affected localities for survey as well as vector control. “Unfortunately, and in spite of tremendous input, we could not be able to get complete patients addresses especially from the KTH, which received most of the cases,” it says.

A health department report into the investigation of suspected dengue cases shared with Dawn says the union councils of Tehkal Payan, Tehkal Bala, Pishtakhra and Sufid Dheri were among the most affected areas.

“On July 19, six cases were reported in Mohallah Charanda and Daudzai in Tehkal Payan and were verified,” it said, adding on July 20, nine more cases were identified. The report paints a frightening picture of rapid spread of the outbreak.

“The magnitude and intensity of the spread can be gauged from the fact during the epidemiological week 17th-23 July, 51 cases had an onset of symptoms, followed by 77, 132 and 181 cases respectively during next three weeks,” it said.

Tehkal Payan contributed major chunk of positive cases and a total of 312 cases amounting to 57 per cent of total positive cases were reported from here.

Tehkal Bala reported 79, Pishtakhara 75 and Sufid Dheri 25. In addition to this, 14 other localities of the city reported cases in single digit.

On the other hand, KP political leadership also failed to take leadership in fighting the outbreak.

KP senior minister for health Shahram Khan Tarkai also took more than two months to realise the imminent threat posed by the outbreak and chaired a meeting on Sunday.

However, five people were dead and around 700 people tested positive for virus by then.

The health minister of Punjab along with a team of doctors was camped in Tehkal, epicenter of outbreak and treating patients.

Sources said the health minister despite having brokered a truce with the chief minister following a month long cold war was still not on speaking terms with the province’s chief executive.

Published in Dawn, August 22nd, 2017