Stay safe during the monsoon season with our essential tips for avoiding hazards like floods, waterborne diseases, and accidents. Meri Sehat has you covered.

Monsoon And Your Safety

<h5>Disclaimer!</h5>

The Pakistan Medical Association has asked the government to ensure the supply of properly chlorinated water to the general public following the increasing number of deaths in May this year. 

The cause of death was Naegleria fowleri (also known as the brain-eating amoeba) which is commonly found in freshwater lakes and rivers. People can be infected whilst swimming or using contaminated/non-chlorinated tap water and can die within 7 days of the exposure despite timely treatment. 

The water supply of the Karachi Water &amp; Sewerage Board is believed to be faulty, which means a greater risk of infections like gastroenteritis, <a href="https://merisehat.pk/disease/hepatitis-a&amp;e">hepatitis A and E</a>, <a href="https://merisehat.pk/disease/typhoid-fever">typhoid</a>, <a href="https://merisehat.pk/disease/cholera">cholera</a>, and primary amoebic meningoencephalitis. 

As a preventive measure, water tanks at hospitals, homes, schools, and offices should be cleaned yearly and people should also put chlorine (1 tablet in 1,000 gallons of water) in underground water tanks<a href="#accordion">[9]</a>. 
The increasing global warming has proven that each new spell of monsoon will be more disastrous than the last. 
&nbsp;

Overview

The monsoon season in Pakistan has always been one of reprieve. For children and adults alike, the sound of rain and the smell of wet earth is a welcome break from the scorching heat of the summer.&nbsp;

However, every year there&rsquo;s this fear of disease outbreaks as frequent landslides and floods turn various regions into breeding grounds for many pathogens. The problem is further compounded by the poor hygiene standards of camps for displaced people. It&rsquo;s crucial, therefore, to identify the diseases that may follow such natural disasters. 
&nbsp;

Of the 33 million people affected by floods in Pakistan, children and women suffered the most as infectious and water-borne diseases gripped the country last year[1]. With an apparent lack of access to clean drinking water, food, shelter, food, toilets, and medicines, malnourishment and poor health made the population particularly vulnerable<a href="#accordion">[2]</a>.

Here are the common monsoon diseases and their symptoms you should look out for: 
&nbsp;

<ol>
	<li>
	<h5>&nbsp;<a href="https://merisehat.pk/disease/malaria">Malaria</a></h5>
	</li>
</ol>

According to the World Health Organization (WHO), more than 3.4 million cases were reported in Pakistan in 2022[7]. It usually spreads through female Anopheles mosquitoes breeding in waterlogged areas and presents with high fever, chills, body pain, weakness, sweating, and severe anemia. 

Note: Malaria is considered a notification priority disease in Pakistan, and any presenting cases should be notified to the concerned health authorities. 
&nbsp;

<ol start="2">
	<li>
	<h5>&nbsp;<a href="https://merisehat.pk/disease/dengue">Dengue</a></h5>
	</li>
</ol>

According to the National Institute of Health-Islamabad, 25,932 confirmed dengue cases and 62 deaths were reported nationally during the first three quarters of 2022. The number surged during the flooding in mid-June through Aedes aegypti mosquitoes, associated with polluted and stagnant water<a href="#accordion">[8]</a>.

A low platelet count accompanied by headache, fever, swollen lymph nodes, and rashes is characteristic of this viral infection. Poor management or no treatment can cause death.

Note: Dengue is considered a notification priority disease in Pakistan, and any presenting cases should be notified to the concerned health authorities.

&nbsp;

<ol start="3">
	<li>
	<h5>&nbsp;<a href="https://merisehat.pk/disease/chikungunya">Chikungunya</a></h5>
	</li>
</ol>

Similar to the dengue infection, symptoms of chikungunya include high fever, chills, acute joint pain, and fatigue. It is caused by the Aedes mosquito, which also transmits the dengue and Zika viruses to humans. 

The mosquitoes hatch in stagnant water found in plants, water pipes, and utensils and bite both during the day and at night. Again, early diagnosis is crucial for proper treatment and quick recovery.

&nbsp;

<ol start="4">
	<li>
	<h5>&nbsp;Gastroenteritis</h5>
	</li>
</ol>

Also known as stomach flu, this viral infection presents as a lack of appetite, diarrhea, fever, abdominal pain, nausea and vomiting, and fever. The root cause is when the normal underground water gets mixed with sewage. 
&nbsp;

<ol start="5">
	<li>
	<h5>&nbsp;Dysentery</h5>
	</li>
</ol>

A highly infectious condition, dysentery affects the intestines. It can be identified by bloody mucus, bloody diarrhea, vomiting, painful stomach cramps, and a high temperature. &nbsp; 
&nbsp;

<ol start="6">
	<li>
	<h5>&nbsp;<a href="https://merisehat.pk/disease/diarrhea">Diarrhea</a></h5>
	</li>
</ol>

Did you know diarrhea (i.e., frequent watery stools) condition accounts for 10.8% of under-five deaths in Pakistan, making it a leading cause of mortality in this age group<a href="#accordion">[6]</a>? 

It is actually easy to prevent if you eat properly-cooked meals and drink properly boiled water. However, in places where unhygienic practices are rampant, bloating, abdominal cramps or pain, vomiting, bloody stool, and fever are common complaints in the community. 

Note: Diarrhea outbreaks are considered a notification priority disease in Pakistan, and any presenting cases should be notified to the concerned health authorities. 
&nbsp;

<ol start="7">
	<li>
	<h5>&nbsp;<a href="https://merisehat.pk/disease/cholera">Cholera</a></h5>
	</li>
</ol>

The leading water-borne illness caused by Vibrio cholera results in severe dehydration due to severe watery diarrhea. Other symptoms include low blood pressure, rapid heart rate, loss of skin elasticity, thirst, dry mucous membranes, and muscle cramps. In extreme cases, it can even lead to death. Poor sanitation and hygiene trigger this disease during monsoon. 

Note: Cholera is considered a notification priority disease in Pakistan, and any presenting cases should be notified to the concerned health authorities. 
&nbsp;

<ol start="8">
	<li>
	<h5>&nbsp;Leptospirosis</h5>
	</li>
</ol>

This bacterial infection affects both animals and humans. The bacteria spread through the urine of infected animals, including dogs, cattle, horses, and rodents. Broken skin and exposure to contaminated water, such as floodwaters, increase the risk of transmission.

Red flags include diarrhea, muscle pain, skin rashes, jaundice, high fever, abdominal pain, and vomiting. However, some may be asymptomatic, too. Without treatment, the infection can be fatal, leading to kidney damage, respiratory distress, liver failure, meningitis, and death. 
&nbsp;

<ol start="9">
	<li>
	<h5>&nbsp;<a href="https://merisehat.pk/disease/typhoid-fever">Typhoid</a></h5>
	</li>
</ol>

The frequency of typhoid cases in the country is increasing even though Pakistan was the first country in the world to introduce the WHO-recommended vaccine into its routine immunization program in 2019<a href="#accordion">[5]</a>.

A serious bacterial infection, typhoid is suspected in case of prolonged high fever, sore throat, nausea and vomiting, stomach pain, weakness, constipation, and discomfort. Contaminated standing water and food items provide the necessary conditions for the survival of the Salmonella typhi bacteria, which spread through the fecal-oral route. 

&nbsp;

<ol start="10">
	<li>
	<h5><a href="https://merisehat.pk/disease/hepatitis-a&amp;e">&nbsp;Hepatitis A + E</a></h5>
	</li>
</ol>

Liver inflammation and liver failure are often caused by food and water contamination and poor sanitation. Hepatitis A is described by fever, upset stomach, vomiting, abdominal pain, extreme lethargy, and body pain. Furthermore, it may cause jaundice.

Note: Hepatitis A and E are considered notification priority diseases in Pakistan and any presenting cases should be notified to the concerned health authorities. 
&nbsp;

<ol start="11">
	<li>
	<h5>&nbsp;<a href="https://merisehat.pk/disease/cold-flu">Cold And Flu </a></h5>
	</li>
</ol>

Airborne infections, like the cold and flu, are common during monsoon. The sudden shift in the temperature affects everyone, but more particularly the children and elderly because of their weak or developing immune systems. 

And it tends to spread quickly from one person to the next. Symptoms include throat irritation, running nose, nasal congestion, cough, difficulty swallowing, sneezing, dizziness, fatigue, and sometimes fever.

Note: Influenza is considered a notification priority disease in Pakistan, and any presenting cases should be notified to the concerned health authorities. 
&nbsp;

<ol start="12">
	<li>
	<h5>&nbsp;<a href="https://merisehat.pk/disease/pneumonia">Pneumonia</a></h5>
	</li>
</ol>

Fluid accumulation in one or both lungs due to the swelling of the air sacs is yet another risk of the season, more so for newborns and adults over 65. Some of its symptoms are chills, fever, clammy skin, lack of appetite, intense pain in the chest, sweating, quick and shallow breathing, and malaise. 
&nbsp;

<ol start="13">
	<li>
	<h5>&nbsp;Skin Diseases And Eye Infections</h5>
	</li>
</ol>

People with <a href="https://merisehat.pk/disease/diabetes-type-1-and-2">diabetes </a>or weak immunity usually suffer from skin rashes, allergies, and wound infections from yeast, fungus, or bacteria because of high humidity during monsoons. <a href="https://merisehat.pk/disease/allergic-conjunctivitis">Conjunctivitis </a>or &ldquo;pink eye&rdquo; often occurs after direct contact with polluted water. 
&nbsp;

<ol start="14">
	<li>
	<h5>&nbsp;Foot Infections</h5>
	</li>
</ol>

Wet socks and shoes make for the perfect environment for fungus. Wearing closed-toe or tight shoes, not treating minor nail or skin injuries on feet, and keeping the feet wet for a long time are common causes of fungal infections of the feet. Common symptoms include peeling of the skin (usually between the toes or on the soles), discolored thick toenails, burning of feet, and itching.

Note: Get tested if you or a loved one notice any of the above signs and symptoms! 
&nbsp;

Many patients during the initial aftermath of the 2022 torrential rains were traumatized by the flooding it caused. Nearly 73,000 pregnant women were exposed to the risks of living in flood-hit areas living in makeshift homes or tents and were worried about safe delivery<a href="#accordion">[4]</a>. Access to quality medical treatment was also affected by damage to the health facilities. 

Families from flood areas were also distressed by the fact that they could lose ownership of their plots of land because of a lack of formal or legal documents to prove it. Relocation and homelessness, especially when living away from family and friends, increased psychological challenges in men.

Moreover, 15 cases of wild poliovirus had already been reported in the country last year before the rain affected the nationwide polio vaccination campaigns<a href="#accordion">[3]</a>. Given that Pakistan is one of the two remaining countries in the world where polio is endemic and predictions that floods will worsen in coming years, this can have a greater public health impact. 
&nbsp;

Note: Polio is considered a notification priority disease in Pakistan, and any presenting cases should be notified to the concerned health authorities. 
&nbsp;

understanding general precautions during monsoon

Mosquitos are the main culprits for transmitting most diseases during monsoon, and they&rsquo;ll find pools of stagnant water &ndash; on streets, in the marketplace, in schools or workplaces, at your home &ndash; to lay their eggs in. While it may take several months for flood water to recede, here are some preventive tips for you to keep them at bay: 
&nbsp;

<ul>
	<li>Use mosquito repellents &ndash; electric, sprays, creams, coils, whatever suits or is conveniently available.</li>
	<li>Avoid sitting in the dark.</li>
	<li>Install mosquito screens on windows.</li>
	<li>Wear long-sleeved shirts.&nbsp;</li>
	<li>Place mosquito nets around the bed, especially for babies and infants.</li>
	<li>Keep windows closed to ensure water doesn&rsquo;t enter your place during heavy downpours.</li>
	<li>Dispose of stored water. Or, if necessary, ensure that the water is not stored in open cans or drums. 
	&nbsp;</li>
</ul>

As they say, prevention is better than cure. You can jump all you want in the rain puddles at the park or on the streets but don&rsquo;t forget to take these following precautions while enjoying this season: 
&nbsp;

<ul>
	<li>Carry an umbrella and raincoat at all times so you don&rsquo;t get caught unexpectedly in a shower.</li>
	<li>Stay hydrated. Boil water before use to prevent water-borne diseases.</li>
	<li>Do not walk/play in or near submerged areas. There can be sharp objects lurking in the muddy water besides bacteria and viruses that can injure you. </li>
	<li>Cover any open cuts or bruises when stepping out.</li>
	<li>Make sure your livestock is not assembled on wet ground or where houseflies are in abundance. </li>
	<li>Get your pets and livestock vaccinated before monsoon.</li>
	<li>Say no to eating street food. Eating nutritious food helps boost immunity and keep most viral or bacterial infections at bay.</li>
	<li>Also, avoid eating raw foods during monsoon. Wash vegetables and fruits before consumption. </li>
	<li>Take a warm bath to normalize body temperature.</li>
	<li>Practice good hygiene during the monsoon, like gargling regularly and washing your hands thoroughly before and after meals and after using the toilet.</li>
	<li>Avoid crowded places like shopping malls since contagious diseases can spread through contact. 
	&nbsp;</li>
</ul>

<h5>Important!</h5>

<ul>
	<li>Keep checking weather reports for flash flood warnings and other updates. Follow the safety guidelines issued by authorities.</li>
	<li>Report any sign of disease to concerned officials. </li>
	<li>As a general precaution, finish any pending home repair and maintenance work before the onset of the monsoon. Ideally, municipal authorities should also complete sanitation or repair work on streets in their area before the season begins. This is so to avoid electric burns or electrocution during the rainy season. 
	&nbsp;</li>
</ul>

Make sure you are prepared for the worst. Here&rsquo;s a checklist:

<ul>
	<li>Mosquito-repellents and mosquito nets</li>
	<li>Bandage and cotton swabs</li>
	<li>Topical anti-bacterial ointments, antiseptic liquids</li>
	<li>Medicines (Note: Check the expiry date when stocking all essential medicines)</li>
	<li>OTC medicines, including paracetamol, ibuprofen, and anti-allergies</li>
	<li>Thermometer</li>
	<li>Drinking water bottles</li>
	<li>Oral solutions (e.g., ORS)</li>
	<li>Spare masks</li>
	<li>Sanitizers </li>
	<li>Dry food items with long shelf-lives</li>
	<li>Set of dry clothes </li>
	<li>Emergency lights, candles, matchsticks </li>
	<li>Extra batteries</li>
	<li>Chargers and power banks to support your electronic devices</li>
</ul>

Moreover, documents like CNIC, domicile, property documents, and medical records are necessary to get desired services. Keep these in a well-sealed plastic bag to protect them from flood water. Also, keep cash aside for emergency purposes.

&nbsp;

<h5>Emergency Contacts</h5>

<ul>
	<li>Edhi Ambulance: 115</li>
	<li>CHHIPA: 1020 </li>
	<li>Aman Foundation Ambulance: 1021</li>
	<li>Rescue: 1122</li>
	<li>K-Electric: 118</li>
	<li>LESCO: 118</li>
	<li>SDMA (AJK): 05822-921536</li>
	<li>GBDMA: 05811-920208</li>
	<li>PDMA (Punjab): 1129</li>
	<li>PDMA (KP): 1700</li>
	<li>PDMA (Baluchistan): 081-9241133</li>
	<li>PDMA (Sindh): 1736 
	&nbsp;</li>
</ul>

Conclusion

Every season has its challenges. Preparing well in advance helps ensure that all goes well during those months. Stay indoors unless it&rsquo;s essential to go out. 

&nbsp;

[1] Lewis O. Millions displaced in Pakistan after 2022 Monsoon season. Direct Relief. October 20, 2022. Accessed June 7, 2023.

[2] Syed Raza Hassan AS. Children, women prone to diseases in Pakistan’s stagnant flood water. Reuters. September 16, 2022. Accessed June 7, 2023.

[3] Major health risks unfolding amid floods in Pakistan. World Health Organization. Accessed June 7, 2023.

[4] Ahmed M. Concern grows over spread of waterborne diseases in Pakistan as floods recede. PBS. August 31, 2022. Accessed June 7, 2023.

[5] Butt MH, Saleem A, Javed SO, et al. Rising XDR-typhoid fever cases in Pakistan: Are we heading back to the pre-antibiotic era? Frontiers in public health. January 17, 2022.