Setting up the Integrated Disease Surveillance Programme (IDSP) at district level Integrated Disease...
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Transcript of Setting up the Integrated Disease Surveillance Programme (IDSP) at district level Integrated Disease...
Setting up the Integrated Disease Surveillance Programme
(IDSP) at district level
Integrated Disease Surveillance Programme (IDSP) district surveillance
officers (DSO) course
2
Preliminary questions to the group
• Were you involved in setting up surveillance your district?
• If yes, what difficulties did you face?
• What would you like to learn about setting up surveillance?
3
Outline of the session
1. Warm up session2. Initiating surveillance3. The district surveillance unit4. Initiating passive surveillance
4
Warm up session: A Bhutanese village close to the state of
West Bengal, India• Number of blood slides collected for malaria monitored over time
• Data analyzed for 2001-4
Warm up
5
Number of blood slides tested for malaria in Phuentsholing,
Bhutan, 2001-2004
0
100
200
300
400
500
600
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Weeks
Number of slides tested for malaria
2004
2003
2002
2001
Warm up
6
What happened in 2004?
• Observe the data What do you see?
• Interpret the information What action will you take?
Warm up
7
Fever cases in Phuentsholing, 2004
• What is to be seen? Peak in the number of blood smears requests in 2004
Peak is in excess to what was usually seen in this season
• What to do? The increase in the number of fever cases suggests an outbreak that needs to be investigated
Although not designed for this, this imperfect surveillance system captured an outbreak of Dengue
Warm up
8
What happened in 2003?
• Observe the data What do you see?
• Interpret the information What action will you take?
Warm up
9
Fever cases in Phuentsholing, 2003
• What is to be seen? Smaller peak in the number of blood smears requests at the end of 2003
Peak seem in excess to what was usually seen in this season, but this is less obvious
• What to do? The increase in the number of fever cases suggests an outbreak that needs to be investigated
In fact there was an outbreak of Plasmodium falciparum malaria
Warm up
10
Number of slides tested for malaria in Phuentsholing,
Bhutan, 2001-2004
0
100
200
300
400
500
600
1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51
Weeks
Number of slides tested for malaria
2004
2003
2002
2001
The 2004 Dengue outbreak was detected
A 2003 falciparum outbreak was missed
Warm up
11
Take home message from this example
• All the data is there Only a lively surveillance system that collects, compiles, transmits and analyzes the data can lead to useful public health decisions
• The better the system works, the better it will react If the system is weak, it will only react to large signals (e.g., the 2004 Dengue outbreak)
If the system is strong, it will also react to more subtle signals (e.g., the 2003 Plasmodium falciparum outbreak that had been missed)
• Make surveillance operational and lively in your district!
Warm up
12
The essence of surveillance
• What is the disease? How many get them?
• Time, place and person Who get the disease? Where they get them? When they get them?
• Why they get them?• What needs to be done as public health response?
Info for action
13
A functional vision of surveillance
1. Collect and transmit
data
2. Analyzedata
3. Feedbackinformati
on
4. Make decisions
All levels use information to make decisions
Info for action
14
Questions to address to set up
a surveillance system1. What is the objective of the programme
served by the surveillance system?2. What kind of decisions need to be
made?3. What information will be needed?4. What indicators will be needed?5. What data will be needed?
Info for action
15
Questions to address to set up
a surveillance system: Cholera example
1. What is the objective of the programme served by the surveillance system?• Detect cholera outbreak early
2. What kind of decisions need to be made? Investigations and control
3. What information will be needed? Sudden rise in incidence
4. What indicators will be needed? Baseline incidence rates to detect unusual
rates
5. What data will be needed? Number of new cases per week
Info for action
16
Information for action
The surveillance system is thought and operated from the point of view of the decisions
that need to be taken
Info for action
17
Chairperson* District surveillance committee
District Surveillance Officer (Member Secretary)
CMO(Co. Chair)
RepresentativeWater Board
Superintendent Of Police
IMA Representative
NGORepresentative
District PanchayatChairperson
Chief District PHLaboratory
Medical CollegeRepresentative
if any
RepresentativePollution Board
District Training Officer(IDSP)
District Data Manager(IDSP)
District Program ManagerPolio, Malaria, TB, HIV - AIDS
* District collector or district magistrate
District surveillance committee
Superintendent of hospitals
DSU
18
District surveillance officer
AccountantAdministrative
assistant
Data entry operators (2)
Response team•Epidemiologist•Microbiologist•Clinicians
Chief medical and health officer
District surveillance unit
DSU
19
Epidemiologist (Nodal officer)*
District administration
nominee
Support Staff:Entomologist**
Health assistantsLaboratory technician
Clinician(Pediatrician/Physician)
Microbiologist
* Selected from programme officers other than district surveillance officer, based on disease
** Only when vector borne disease is suspected
District epidemic investigating team (DEIT)
DSU
20
Information flow of the weekly
surveillance systemSub-centres
P.H.C.s
C.H.C.s
Dist. hosp.
Programmeofficers
Pvt. practitioners
D.S.U.
P.H. lab.
Med. col.
Other Hospitals: ESI, Municipal Rly., Army etc.
S.S.U.C.S.U.
Nursing homes
Private hospitals
Private labs.
Corporate hospitalsDSU
21
Functions of the district surveillance unit
• Managerial Implement and monitor all project activities Coordinate with laboratories, medical colleges, non governmental organizations and private sector
Organize training and communication activities Organize district surveillance committee meetings
• Data handling Centralize data Analyze data Send regular feedback
• Outbreak response Constitute rapid response teams Investigate
DSU
22
Interactive session: What functions of the district
surveillance unit are in place in your district?
• Review the functions of the surveillance unit at the district level one by one
• All participants in the class take turn to say if this specific function is operational in their district
DSU
23
Interactive session: What functions of the district
surveillance unit are in place in your district?
• Managerial Is the unit implementing / monitoring all project
activities ? Do laboratories, medical colleges, non governmental
organizations and private sector report in your district? Was IDSP training completed as per recommendations? When did your district surveillance committee meet last
time?• Data handling
Does the district centralize data? Does the district analyze data by time, place and person? Do you send regular feedback containing data?
• Outbreak response Do you have a rapid response team? When was the last time the district Investigated an
outbreak?
DSU
24
Key elements of a surveillance system that need to be in
place• Regular and timely collection of data
Case definition, forms, reporting units• Compilation of data
Aggregation of cases• Analysis of data
Calculation of rates, time place and person analysis
Graphs and tables• Interpretation of data
Conclusions• Feedback of information
Recommendations• Action
Starting up!
25
The role of the district within the surveillance system
Compilation Analysis
Feedback
District
State
Reporting units Action
Data are compiled before they are passed on
Starting up!
26
Interactive session:How would you address
obstacles to passive reporting in a district
1. What are the obstacles to data collection?
2. What are the obstacles to data compilation?
3. What are the obstacles to data transmission?
4. What are the obstacles to data analysis?5. What are the obstacles to review by
committee6. What are the obstacles to using
surveillance information to make decisions?
Starting up!
27
Interactive session:How would you address
obstacles to passive reporting in a district
• Break down in 6 groups• Each group select one of the key function of the surveillance system
• Participants list the most important obstacles to this function in their district
• Participants identify solutions to the obstacles identified
Starting up!
28
Example: Data collection
• Obstacles Medical officers do not write the diagnosis in the registers
• Solution Phase in IDSP register with diagnoses
Starting up!
29
Obstacles and possible solutions to initiate passive reporting (Fill with
feedback from the groups)
Activities Locks Keys
Collection •… •…
Compilation •… •…
Transmission •… •…
Analysis •… •..
Review
Action •… •…
Starting up!
30
Take home message
1. Give life to your surveillance system
2. Design surveillance to make decisions
3. Implement the functions of the district surveillance unit
4. Identify and lift obstacles to initiation of passive surveillance
31
Additional reading
• Section 1 of IDSP operations manual
• Module 2 and 4 of training manual• Annexure 4 and 5 IDSP guidelines