Submission ID 131667
| Issue/Objective | Pakistan's 2022 floods displaced over 394,000 people and left 9.6 million children needing humanitarian assistance, while water, sanitation, roads, bridges, and health infrastructure were severely disrupted. In such climate-driven crises, outbreaks are expected; the real public health failure is delayed action on early warning signals. This study quantified excess acute diarrhoea incidence during the floods and examined how Pakistan's Integrated Disease Surveillance and Response system detected and where the response pathway failed to act on early disease signals. |
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| Methodology/Approach | We conducted a national interrupted time-series analysis using weekly acute diarrhea cases reported through Pakistan's IDSR system from Weeks 22-40, 2022. Weeks 22-26 were used as the pre-flood baseline, while Weeks 35-39 represented peak flood exposure. Weekly incidence was calculated using population denominators. A segmented negative binomial regression model estimated excess incidence during peak flood exposure while accounting for seasonal variation. |
| Results | Mean weekly acute diarrhea cases increased from 41,665 before the floods to 91,037 during peak flooding, with a maximum of 125,842 cases in Week 37. This represented a greater than twofold increase. The rise closely aligned with flood intensity, displacement, and disruption of water and sanitation systems. IDSR enabled near real-time detection of disease amplification, demonstrating strong surveillance performance under extreme crisis conditions. |
| Discussion/Conclusion | The central lesson is clear: detection alone is not enough. Despite timely surveillance signals, response was constrained by damaged infrastructure, lack of climate-linked triggers, and weak data-to-response pathways. Closing this detection-action gap requires embedding climate indicators into surveillance and institutionalizing predefined response triggers that mandate immediate WASH, clinical, and public health action. Without this shift, surveillance systems will continue to measure crises rather than mitigate them, particularly for displaced communities and children in climate-affected settings. |
| Presenters and Affiliations | Runa Khan Harvard TH Chan School of Public Health Muhammad Asif Khan UK Health Security Agency Sartaj Muhammad UK Health Security Agency Nadia Nisar National Institute of Health Nudrat Nudrat Health |
