SURVEILLANCE

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How the surveillance is important and how it is simple while controling of epidamic.....

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Principles of Disease Surveillance:

Principles of Disease Surveillance

Surveillance :

Surveillance Surveillance is the ongoing systematic collection, collation, analysis and interpretation of data; and the dissemination of information to those who need to know in order that action may be taken

Rationale for Disease Surveillance:

Rationale for Disease Surveillance Public health importance of disease ? Can public health action be taken ? Are relevant data easily available ? Is it worth the effort (money, human resources)?

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Is the disease a priority ? What are the objectives of surveillance ? (e.g. to monitor cases and deaths from dengue fever so as to evaluate control measures) What data will be required to generate the indicators and what sources of data exist? What disease indicators will be used ? (e.g. the number of new cases of TB per 100,000 pop + the number of deaths in TB cases) PRIORITY OBJECTIVES MINIMUM DATA AND DATA SOURCES TARGET POPULATION What is the population in which we wish to detect cases ? (e.g. all? high risk groups ..) INDICATORS

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Objectives of surveillance Epidemic (Outbreak) detection Monitoring trends in endemic disease Evaluating an intervention Monitor progress towards a control objective Monitor programme performance Epidemic (Outbreak) prediction Estimate future disease impact

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Dysentery Polio Malaria AIDS Tuberculosis To detect outbreaks of dysentery by monitoring the incidence of cases of acute bloody diarrhoea To monitor progress towards polio eradication by monitoring the incidence of poliomyelitis where wild poliovirus is isolated in children under 14 years To monitor the incidence of laboratory confirmed malaria including the incidence of disease due to P. falciparum and associated antiparasitic resistance. To measure the incidence of AIDS cases so that future trends may be predicted and health services planned To monitor the ability of the TB programme to detect cases, ensure treatment completion and cure Examples of Surveillance Objectives

Cases of acute bloody diarrhoea in a rural district by month, January 1994- April 1995:

Cases of acute bloody diarrhoea in a rural district by month, January 1994- April 1995 1994 Objective: To detect outbreaks of dysentery by monitoring the incidence of cases of acute bloody diarrhoea 1995

To monitor progress towards polio eradication by monitoring the incidence of poliomyelitis where wild poliovirus is isolated in children under 14 years :

To monitor progress towards polio eradication by monitoring the incidence of poliomyelitis where wild poliovirus is isolated in children under 14 years Cases of poliomyelitis where wild poliovirus was isolated in children in a rural district, 1980-1996 Objective:

To monitor the incidence of laboratory confirmed malaria and proportion due to P. falciparum:

To monitor the incidence of laboratory confirmed malaria and proportion due to P. falciparum Cases of malaria in a region, 1992-1996 Objective:

To measure the incidence of AIDS to predict future trends and facilitate health service planning :

To measure the incidence of AIDS to predict future trends and facilitate health service planning Cases of AIDS in a city district, 1990-2004 Objective:

To monitor the ability of a TB programme to ensure treatment completion and cure :

To monitor the ability of a TB programme to ensure treatment completion and cure Treatment completion and cure in TB cases, 1994-1997 Objective:

Disease Indicators:

Disease Indicators The measures that you use to monitor a disease e.g. Number No of cases of malaria reported No of cases of P. falciparum malaria reported Rate Number of cases of ARI in children under 5 years per 100,000 population Ratio Proportion of children with ARI who die

Disease Indicators:

Disease Indicators They may be indicators of Disease incidence Cases of TB per 100,000 population Effectiveness of treatment Case fatality in measles

Surveillance: General principle :

Surveillance: General principle Health Care System Public Health Authority Data Information Decision Action Feedback Reporting Evaluation Analysis & Interpretation

Source of Data:

Source of Data Vital events registration Notifiable diseases (Hospitals / physician-based) Hospital discharges Sentinel surveillance Community surveillance Periodic surveys Health insurance schemes

Data source and data collection mechanism:

Data source and data collection mechanism Data source notifiable disease s vital statistic s survey laboratory member of the public, media other information sources, e.g. sanitarian data, mete re ological data, immunisation, nutrition Data collection passive vs active

Surveillance Methods:

Surveillance Methods Facility based routine surveillance Community based surveillance Sentinel surveillance

Surveillance:

Surveillance Active Sentinel Serial health surveys Database linkage Passive Notification Legislation Laboratory Hospital records Vital events Health insurance schemes

Surveillance: Data:

Surveillance: Data Health Care System Public Health Authority Information Decision Action HEALTH EVENT Disease Syndrome (e.g., AFP, jaundice, VHF) Public health issue (e.g., CRS) Environment (e.g., animal vector, water )

Surveillance: Data:

Surveillance: Data Health Care System Public Health Authority Information Decision Action CASE DEFINITION Clinical/laboratory Levels (suspected, probable, confirmed) Indicators

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Exposed Clinical case Disease Lab confirmation Infected Seek medical attention Report

Surveillance: Reporting :

Surveillance: Reporting Health Care System Public Health Authority Data Information Decision Action Reporting frequency immediate weekly monthly ...

Surveillance: Reporting :

Surveillance: Reporting Health Care System Public Health Authority Data Information Decision Action Reporting methods Paper Telephone, Fax E-mail, Web reporting

Surveillance: Data flow :

Ministry of Health WHO Peripheral level Intermediate level Central level Regional/International level Surveillance: Data flow Clinical (suspected) + Supportive laboratory data + epidemiological link (probable) Diagnostic Laboratory (confirmed) Regional reference laboratory

Surveillance: Tasks:

Ministry of Health WHO Peripheral level Intermediate level Central level Regional/International level Surveillance: Tasks Detect Treat Report Analyse Investigate Report Respond Feedback Analyse Investigate Confirm Respond Plan and Fund Feedback Analysis and feedback Support Policy and targets Funding

Surveillance: Analysis & Interpretation :

Surveillance: Analysis & Interpretation Health Care System Public Health Authority Data Decision Action Data characteristics Data validation Descriptive analysis Hypothesis generation

Surveillance: Analysis & Interpretation :

Surveillance: Analysis & Interpretation Health Care System Public Health Authority Data Decision Action Various sources of notifications Various levels of quality Continuous data collection subject to change Data characteristics

Surveillance: Analysis & Interpretation :

Surveillance: Analysis & Interpretation Health Care System Public Health Authority Data Decision Action Missing data Bias Duplication Data validation

Surveillance: Analysis & Interpretation :

Surveillance: Analysis & Interpretation Health Care System Public Health Authority Data Decision Action Time Place Persons Descriptive analysis

Surveillance: Analysis & Interpretation :

Surveillance: Analysis & Interpretation Health Care System Public Health Authority Data Decision Action related to time related to place related to persons Hypothesis generation

Surveillance: Action:

Surveillance: Action Health Care System Public Health Authority Data I nformation Decision Control Feedback Policy

Surveillance: Action:

Surveillance: Action Health Care System Public Health Authority Data I nformation Decision Control Rapid response Case management Prevention (e.g. immunization)

Surveillance: Action:

Surveillance: Action Health Care System Public Health Authority Data I nformation Decision Feedback Epidemiological bulletin Reports Website, others

Surveillance: Action:

Surveillance: Action Health Care System Public Health Authority Data I nformation Decision Policy Policy change Prediction, planning Epidemic preparedness

Surveillance: Action:

Surveillance: Action Health Care System Public Health Authority Data I nformation Decision Action Evaluation results of action results of surveillance

Attributes of a Good Surveillance System :

Attributes of a Good Surveillance System Simplicity Flexibility Acceptability Sensitivity Predictive value positive Timeliness Representativeness

System capacity & attributes Simplicity:

System capacity & attributes Simplicity Structure information needed number and type of sources training needs number of information users Functionality data transmission system maintenance data analysis information dissemination Is the system SIMPLE?

System capacity & attributes Flexibility:

System capacity & attributes Flexibility new event to follow-up new data about an event new sources of information Can change be accommodated ?

System capacity & attributes Acceptability:

System capacity & attributes Acceptability participation rate of sources refusal rates completeness of report forms timeliness of reporting Willingness to participate in the system

System capacity & attributes Sensitivity:

System capacity & attributes Sensitivity Proportion of cases reported among actual cases Affected by: % of cases seeking medical care % of these correctly diagnosed % of these reported public/physician awareness

System capacity & attributes Predictive value :

System capacity & attributes Predictive value Proportion of cases reported that actually have the condition Low predictive value wastes resources. More specific case definition can improve the predictive value

System capacity & attributes Timeliness:

System capacity & attributes Timeliness Delay between steps in a surveillance system, for example : From onset of illness to receipt of the report of cases From time of diagnosis to identifying trends of outbreaks

Surveillance: Function:

Surveillance: Function Core function Detection Reporting Investigation & confirmation Analysis & interpretation Action / response Support function Training Supervision Resources Standards / guidelines

Surveillance: Basic Ingredients:

Surveillance: Basic Ingredients A good network of motivated people Efficient communication system Clear case definition and reporting mechanism Basic but sound epidemiology Good feedback and rapid response Laboratory support

Steps in planning a surveillance system:

Steps in planning a surveillance system Establish objectives Develop case definition Determine data source or data collection mechanism Develop data collection instrument Field-test methods Develop and test analytic mechanism Develop dissemination mechanism Assure use of analysis and interpretation Evaluation

Surveillance: Indicators:

Surveillance: Indicators S pecific M easurable A ction oriented R ealistic T imely

Public health importance & priority:

Public health importance & priority major public health burden with feasible intervention epidemic potential international importance

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