Epidemiological Trends and Burden of Acute Watery Diarrhea during 2022 in Khyber Pakhtunkhwa, Pakistan

Abstract

Background: In developing countries like Pakistan, diarrheal disease remains a major cause of morbidity and mortality. Despite improved diagnosis and treatment, key risk factors persist.

Objective: This study assessed the trends and burden of acute watery diarrhea (AWD) in Khyber Pakhtunkhwa (KP) in 2022 to guide targeted interventions.

Methods: Retrospective one year data on AWD was extracted from the District Health Information System 2 (DHIS2) event visualizer, from primary and secondary health facilities across 26 districts of KP. Only stool culture confirmed bacterial cases were included. Standardized case report forms captured demographic, clinical, risk factor, laboratory, and outcome data. Severe cases were referred for stool culture. Data was cleaned, analyzed, and presented using tables, graphs, and maps using Epi Info 7.2.1.

Results: A total of 322 cases were recorded, with 56% males. The mean age was 19.5 years, with the 15-30 years group most affected. Passage of three or more watery stools in 24 hours was the most common symptom (74%). Cases began on 5 May 2022 and peaked on 3 June with 41 cases reported in a single day. Most cases were from Malakand, followed by Swat and Nowshera. Spring water was the main drinking source (81%), while only 10% reported using water treatment methods.

Conclusion: The findings suggest a substantial AWD burden, likely underestimated. Key risk factors include younger age, overcrowding, shared sanitation, untreated water, and seasonal variation. Strengthening prevention through safe water, improved sanitation, health education, and integrated disease surveillance is essential for early detection and control.