HEALTH SURVEILLANCE

INTRODUCTION:-

In the everyday life of hustle and bustle, it is almost a lacking hour to keep a watch on health. As
being noted by many great leaders and personalities around us "health is life". We must keep an
eye to look for it. As it is a need of the hour to keep our health maintained and to keep a keen
watch over it. Thus emphasizing its "SURVEILLANCE".

The surveillance means supervision or close watch e especially on suspected person.

Epidemiologically e surveillance means close vigilance on occurrence and distribution of
diseases and health related problems, - population dynamics, community behavior and
environmental processes resulting in increased risk of ill health in the community. It involves
identification of missed and suspected cases and contacts, their confirmation by laboratory
investigations; identifying source of infection and channel of transmission. This information will
help in planning and implementation of prevention and control programmers for Evarious
diseases in the community. Thus monitoring of the disease prevalence, its related risk factors and
intervention of control programmers for the same are the important activities of surveillance.

DEFINITION:-

Surveillance is a systematic process of collection, transmission, analysis and feedback of public

health data for decision making.

The surveillance means supervision or close watch especially on suspected person.

Epidemiologically surveillance means close vigilance on occurrence and distribution of diseases,
health related problems, population of dynamics, community behavior as well as environmental
processes resulting in increased risk of ill health in the community
 CASUAL
INFERENCE

DISSEMINATION COLLATION
UTILIZATION

ANALYSIS AND
INTERPRETATION

FIG: FLOW OF SURVEILLANCE

IMPORTANCE:

 It serves as an early warning system for impending public health emergencies.

 It document the impact of an intervention, or track progress towards specified goals
 Monitor and clarify the epidemiology of health problems, to allow priorities to be set and
to inform public health policy and strategies.

PURPOSE OF SURVEILLANCE:

 To follow trends in the health status of a population overtime

 To detect and respond to epidemics
 To establish health care and public health priorities
 To evaluate the effectiveness of programs and services
 To facilitate the prevention and control of disease
 To identify persons with disease to provide treatment and quarantine
 To exclude person not having disease
  Assisting in planning and implementation health programs
 Monitoring the quality of health care
 Stimulate research.

TYPES OF HEALTH SURVEILLANCE:-

1. INDIVIDUAL OR FAMILY SURVEILLANCE

2. COMMUNITY OR LOCAL POPULATION SURVEILLANCE
3. NATIONAL SURVEILLANCE
4. INTERNATIONAL SURVEILLANCE
5. ACTIVE SURVEILLANCE
6. PASSIVE SURVEILANCE
7. SENTINEL SURVEILLANCE

1. Individual or family Surveillance

It includes surveillance of an infected person in a family as long as the individual is the

source of infection to others e.g. typhoid case and carriers.

2. Community or Local population Surveillance

It include surveillance of the whole community for early detection and prevention and
control of a disease e.g. Malaria.

3. National Surveillance

It includes surveillance at the National level e.g. surveillance of small pox after its
eradication.

4. International Surveillance

It includes surveillance of some of the diseases which are listed by WHO e.g. Malaria,
Influenza, Filaria; Polio etc. and are to be reported to WHO which then provides information to
the countries in the world to take timely actions.
5. Active surveillance

An active surveillance system provides stimulus to health care workers in the form of
individual feedback or other incentives. Often reporting frequency by individual health workers
is monitored; health workers who consistently fail to report or complete the forms incorrectly are
provided specific feedback to improve their performance. There may also be incentives provided
for complete reporting.

Active surveillance requires substantially more time and resources and is therefore less
commonly used in emergencies. But it is often more complete than passive surveillance. It is
often used if an outbreak has begun or is suspected to keep close track of the number of cases.
Community health workers may be asked to do active case finding in the community in order to
detect those patients who may not come to health facilities for treatment.

6.Passive surveillance

Passive surveillance often gathers disease data from all potential reporting health care workers.
Health authorities do not stimulate reporting by reminding health care workers to report disease
nor providing feedback to individual health workers.

Passive surveillance is the most common type of surveillance in humanitarian emergencies. Most
surveillance for communicable diseases is passive. The surveillance coordinator may provide
training to health workers in how to complete the surveillance forms, and may even send
someone to periodically collect forms from health facilities. But little attention is given to
individual health workers who report the information.

The data requested of each health worker is minimal. Nonetheless, passive surveillance is often
incomplete because there are few incentives for health workers to report.

This figure is an example of data gathered by passive surveillance from the hospitals run by one
organization:
7.Sentinel surveillance

Instead of attempting to gather surveillance data from all health care workers, a sentinel
surveillance system selects, either randomly or intentionally, a small group of health workers
from whom to gather data. These health workers then receive greater attention from health
authorities than would be possible with universal surveillance.

Sentinel surveillance also requires more time and resources, but can often produce more detailed
data on cases of illness because the health care workers have agreed to participate and may
receive incentives. It may be the best type of surveillance if more intensive investigation of each
case is necessary to collect the necessary data. For example, sentinel influenza surveillance in the
United States collects nasopharyngeal swabs from each patient at selected sites to identify the
type of influenza virus. Collection of such data from all health workers would not be possible.

SURVEILLANCE PROCESS

Surveillance is a systematic process. The main steps involved are:-

1. Collection of relevant information about the disease under surveillance

2. Compilation and analysis of data

3. Reporting of data and providing feedback

1.COLLECTION OF RELEVANT INFORMATION ABOUT THE DISEASES UNDER
SURVEILLANCE

Effectiveness of surveillance system depends upon identification of cases, collection of relevant

information about disease, their recording and reporting. There are number of methods for
collection of relevant information about the diseases under surveillance. It may be easier to find
some diseases and may be difficult to identify some others. Because of this difficulty no single
method can be adopted for surveillance of all diseases. The various methods of surveillance are
as under:

a. Routine reporting of cases and deaths recorded at health centers, dispensaries and
hospitals

All these institutions are required to maintain record of cases reported in their outpatient
departments and clinics. Daily recording of cases in OPD of Health Centers includes month,
name, age, sex, address, diagnosis, date of onset and remarks. From this record daily, weekly,
monthly and yearly reports of diseases occurred and reported at the centre are prepared. This
kind of routine reporting can help in making assessment of frequency and distribution of diseases
by age, sex, area and time. Such reports are sent to the district and state health authorities. The
practice of recording of cases under the routine reporting system is called as passive surveillance.

b. Active surveillance

It means actively looking for those particular types of cases who have not been recorded under
the routine system. Active surveillance is done by health workers and community people e.g.
surveillance of Malaria or Tuberculosis cases.

c. Epidemiological investigations

Epidemiological investigations are usually done when there is occurrence of more than usual
number of cases in a particular place during particular time period: when there is sudden
outbreak of any disease and when a communicable disease which has never occurred before but
it has occurred now. This will help inpicking up cases and the associated causative factors. Thus
epidemiological investigations provide important supplementary information which is not
obtained by other surveillance methods.
d. Sentinel centres

Sentinel centres are those hospitals, health centres, laboratories, special disease hospital etc.
which are identified for collecting information for selected diseases. The information is
collected, compiled and forwarded to higher authority for immediate action and for making
future plans and policies. Sentinel survey can provide reliable information about selected
diseases indicating the trend of disease prevalence in a particular area. Such information can call
for immediate actions to control the disease and also timely remedial actions in future to prevent
the occurrence of disease.

e. Special sample survey

Special sample survey of disease is an active and efficient method of surveillance. There are
different methods of sample surveys but the survey by cluster sampling technique is
recommended by the WHO. The target population, the sample size vary from disease to disease
e.g. the target population for poliomyelitis is 5-9 years, for diarrhoea 0-4 years, preceding the
date of survey.

2. COMPILATION AND ANALYSIS OF DATA

Once the surveillance data is collected for a reporting period by whatever method, it needs to be
compiled and analyzed to assess the frequency and distribution by person, place and time. The
reporting period can be a week, a month and a year. This information can be presented in tables,
spot maps, charts and graphs. This kind of presentation helps in determining the pattern of
occurrence of disease and whether there is decrease or increase in the number of cases.

3. REPORTING OF DATA AND PROVIDING FEEDBACK

Once the data is analysed, a report is to be prepared in the format prescribed by the authority.
The report is sent regularly for each reporting period. The report should be complete. If there is
nil information, it should be reported. If some information is missed or received late, it should be
included in the next reporting period. If further investigations are done during the period and if
any section is taken or going to be taken, it needs to be reported. Feedback should be given to all
the members of health team as to how the data are used which are collected by them and reported
through regular meetings and as and when desired by anyone.
STEPS IN CARRYING OUT SURVEILLANCE

1)Reporting - Some one has to record the data.

2) Data accumulation- someone has to be responsible for collecting the data from all the
reporters and putting it all together.

3) Data analyses.

4) Judgment and action

OCCURRENCE OF HEALTH RELATED EVENT

CASE CONFIRMATION

REPORTING

REPORTING TO RESPONSIBLE PUBLIC HEALTH

AGENCY

CONTROL AND FEEDBACK TO

PREVENTION ACTIVITIES STAKEHOLDERS
FOUR BASIC COMPONENTS OF SURVEILLANCE WHICH COMPONENTS ARE:-

a) Collection b) Analysis c) Dissemination and d) Response

USES OF HEALTH SURVEILLANCE

 Estimate magnitude of problem

 Determine geographic distribution of illness

 Portray of natural history of disease

 Detect epidemics

 Monitor changes in infectious agents

 Facilitate planning

 Evaluate programs, central measures.

METHODS FOR SURVEILLANCE

 Notification of diseases

 Laboratory specimen

 Vital records

 Registries

 Surveys

 Administrative data system

 Environmental monitoring.
 HEALTH INFORMATICS

INTRODUCTION

Informatics is the discipline of People, Information and Technology and refers to enabling users to
interact efficiently and effectively with appropriate technologies in order to improve the
availability of quality information for planning, decision-making and policy formulation at all
levels of an organization.

 Health Informatics is a specific domain of Informatics which may be described as the

appropriate use of information technology in the management of health-related data,
information and knowledge in order to improve individual outcomes of care and the health
status of the population. Thus, Health Informatics is a critical enabler for health system
improvements and health sector modernization and transformation.

DEFINITION:

• To define this information of health or the term "HEALTH INFORMATICS". IT

can be stated as “a mechanism for the collection, processing, analysis, and
transmission of information required for organizing and operating health services
and also for research & training".

Health informatics, It is an umbrella team referring to the application of the methodologies and
techniques of information science computing networking and communications to support health
and health related disciplines such as medicine, nursing pharmacy and dentistry……..WHO
GOALS AND OBJECTIVES OF HEALTH INFORMATION SYSTEM

 To provide reliable, relevant, up-to-date, adequate, timely and reasonably complete

information for health managers at all levels (i.e. centre, intermediate and local)
 To share technical and scientific information by all health personnel participating in the
health services of the country.
 To provide at periodic intervals the data that will show the general performance of the
health services.
 To assist planners in studying their current functioning and trends in demand and work
load.
 To provide solutions for problems related to data, information, and knowledge processing
 To study general principles of processing data, information and knowledge medicine and
health care,
 To provide structures for pooling communicating and applying clinical evidence,,

DIFFERENCE BETWEEN DATA AND INFORMATION

Data consist of discrete observations of events that carry little meaning when considered alone.
Data as collected from operating health care systems are inadequate for planning. Data need to
be transformed into information by reducing, summarizing, adjusting them for variations, such as
age, sex composition of population so that comparisons over time and place are possible.

REQUIREMENTS TO BE SATISFIED BY HEALTH INFORMATION SYSTEM

A W.H.O. Expert Committee identified the following requirements to be satisfied by the health
information systems

1. The system should be population based.

2. The system should avoid the unnecessary agglomeration of data.

3. The system should be problem-oriented.

4. The system should employ functional and operational terms (e.g. episodes of illness, treatment
regimens, laboratory tests)
5. The system should express information briefly and imaginatively (e.g. tables, charts,
percentages)

6. The system should make provision for the feed- back of data.

COMPONENTS OF A HEALTH INFORMATION SYSTEM

A comprehensive health information system requires information and indicators on the following
subjects:

1. Demography and vital events.

2. Environmental health statistics.

3. Health status: mortality, morbidity, disability and quality of life.

4. Health resources: facilities, beds, manpower.

5. Utilization and non-utilization of health services: attendance, admissions, waiting lists.

6. Indices of outcome of medical care.

7. Financial statistics (cost, expenditure) related to the particular objective.

ELEMENTS OF HEALTH INFORMATICS

ACQUISITIO
N

DISPLAY STORAGE

MANIPULA COMMUNIC
TION ATION

USES OF HEALTH INFORMATION

The important uses to which health information may be applied are:-

1. To measure the health status of the people and to quantify their health problems and medical
and health care needs.

2. For local, national and international comparisons of health status.

3. For planning, administration and effective management of health services and programmes.

4. For assessing the attitudes and degree of satisfaction of the beneficiaries with the health
system.

5. For research into particular problems of health and disease.

WHO ARE INVOLVE IN HEALTH IMPORMATICS ?

 Clinical personnel
 Nonclinical personnel
 Heath care administration.
 Health education
 IT professionals,
 Insurance compeny
 policy maker

SOURCES OF HEALTH INFORMATION

1.Census

The census is an important source of health information. It is taken in most of the countries of
the world at regular intervals, usually of 10 years. A census is defined by the United Nations as
the total process of collecting, compiling and publishing demographic, economic and social data
pertaining at a specified time or times to all persons in the country or delimited territory.

2.Registration of Vital Events

Registration of vital events (e.g. births and deaths) keeps a continuous check on demographic
changes. If registration of vital events is complete and accurate, it can serve as a reliable source
of health information. Much importance is therefore given to registration in certain countries.
The United Nations defines a vital events registration system as including legal registration,
statistical recording and reporting of the occurrence of, and the collection, compilation,
presentation, analysis and distribution of statistics pertaining to vital events, i.e., live births,
deaths, fetal deaths, marriages, divorces, adoptions, legal limitations, recognitions, annulments
and legal separations.

3.Sample Registration System (SRS)

SRS was initiated in mid-1960's to provide reliable estimates of births and death rates at the
national and state levels. The SRS is a dual record system, consisting of continuous enumeration
of births and deaths by an enumerator and an independent survey every 6 months by an
investigator- supervisor. This system is more reliable for information on birth and death rates,
age specific fertility and mortality rates, infant and adult mortality etc.

4. Notification of Diseases

The primary purpose of notification is to effect prevention and control of the disease.
Notification is also a valuable source of morbidity data i.e. the incidence and distribution of
certain specified diseases which are modifiable. Lists of modifiable diseases vary from country
to country and also within the same country between the states and between urban and rural
areas. At the international level the diseases like cholera, plague, yellow fever, relapsing fever,
polio, influenza, malaria, and rabies are modifiable to W.H.O.

5. Hospital Records

In India where registration of vital events is defective and notification of infectious diseases is
extremely inadequate, hospital data constitute a basic and primary source of information about
diseases prevalent in the community.

6. Disease Registers

A register requires that a permanent record be established, that the cases be followed up, and the
basic statistical tabulations be prepared both on frequency and on survival. Morbidity registers
exist only for certain diseases such as stroke, myocardial infarction, cancer, blindness, and
congenital defects. Tuberculosis and leprosy are also registered in many countries where they are
common. These registers are of valuable information as to the duration of illness, case fatality
and survival. These registers provide follow-up of patients and provide a continuous account at
the frequency of disease in the community. The useful information can be obtained from
registers on the natural course.

7. Record Linkage

The term record linkage is used to describe the process of bringing together records relating to
one individual (or to one family), the records originating in different times or places. The term
medical record linkage implies the assembly and maintenance for each individual in a
population, of a file of the more important records relating to his health. The events commonly
recorded are birth, marriage, death, hospital admission and discharge. Other useful data might
also be included such as sickness absence from work, prophylactic procedures, use of social
services etc. the main problem with the record linkage is the volume of data that can accumulate.
Therefore in practice record linkage has been applied only on a limited scale e.g. twin studies,
measurement of morbidity, chronic disease epidemiology and family and genetic studies.

8. Epidemiological Surveillance

In many countries where particular diseases are endemic special control eradication programmes
have been instituted. For example National Disease Control Programmes against malaria,
tuberculosis, leprosy etc. the surveillance programmes are set up to report on the occurrence of
new cases and on efforts to control the diseases e.g. immunization is performed. These
programmes have yielded considerable morbidity and mortality data for the specific diseases.

9. Other Health Service Records

These are hospital Out Patient Department, primary health centers and sub centers, polyclinics,
private practitioners, mother and child health centers, school health records, diabetic and
hypertensive clinics etc. For e.g. records in Maternal and Child Health centers provide
information about birth weight, height, arm circumference, immunization, disease specific
mortality and morbidity.

10. Environmental Health Data

Health statistics provide data on various aspects of air, water and noise pollution; harmful food
additives; industrial toxicants; inadequate waste disposal and other aspects of combination of
population explosion with increased production and consumption of material goods.
Environmental data is helpful in the identification and quantification of factors causative of
disease.

11. Health and Manpower Statistics

This information relates to the number of physicians (by age, sex, specialty and place of work),
dentists, nurses, medical technicians etc. there records are maintained by The State
Medical/Dental/Nursing Councils and the Directorates of Medical Education. The census also
provides information about occupation. The Institute Of Applied Manpower Research attempts
estimates of manpower, taking into account different sources of data, mortality and out turn of
qualified persons from different institutions. The Planning Commission also gives estimates of
active doctors for different states.

12. Population Surveys

The term health surveys is used for surveys relating to any aspect of health- morbidity, mortality,
nutritional status etc. when the mean variable to be studied is disease suffered by the people, the
survey is referred as morbidity survey.

CLASSIFICATION OF HEALTH SURVEY

1. Health examination survey

2. The Health Interview
3. Health record survey
4. Questionnaires

13. Other Routine Statistics Related To Health

Demographic: In addition to routine census data, statistics on other demographic phenomena as

population density, movement and education level.

Economic: consumption of consumer goods like tobacco, dietary fats, sales of drugs,
employment and non-employment data.

Social security schemes: medical insurance schemes make it possible to study the occurrence of
illnesses in the insured population.

14. Non-Quantifiable Information

Health planners require this information e.g. information on health policies, health legislation,
public attitudes, programme costs, procedures and technology. There should be proper storage,
processing and dissemination of information.
SUMMARY:

In my topic discuss about definition, importance, Purpose, Types of Health Survillance,

surveillance process, steps of health surveillance health informatics, Definition goals and
objectives of health information system, difference between data and information, components of
a health information system, elements of health informatics, uses of health information, who
involves health impormatic, component of health informatics, sources of health information,
sources of health informatics.

CONCLUTION:

Health surveillance is the ongoing systematic collection, analysis, and interpretation of health
related data essential to planning implementation and evaluation of public health .

"It is health that is real wealth and not pieces of gold and silver."- Mahatma
Gandhi

Health informatics focuses on information technology to positively impact the patient and
institutions relationship through effective collection safeguarding and understanding of health
data,

Nursing, as with healthcare in general, informatics is being used to address the challenges of the
day, significantly impacting the way nurses function in patient care.

The Healthcare Information and Management Systems Society reported that as the result of
electronic charting, nurses are able to obtain information quickly and efficiently, using the
information to improve the daily workflow. Storing the information electronically is more easily
available to all members of the care team, including the physician and other care providers, as
well as staff teams at other healthcare organizations that the patient may visit.
 JOURNAL:

Evaluation of syndromic surveillance for the early detection of outbreaks

among military personnel in a tropical country

 May 2008
 Journal of Public Health 30(4):375-83

DOI:10.1093/pubmed/fdn026

 Source
 PubMed

AUTHOR- Henry Jefferson Et Al

ABSTRACT

Background to evaluate a new military syndromic surveillance system (25E BAG)

set up in French Guiana.

Methods: The evaluation was made using the current framework published by the
Centers for Disease Control and Prevention, Atlanta, USA. Two groups of system
stakeholders, for data input and data analysis, were interviewed using semi-
structured questionnaires to assess timeliness, data quality acceptability,
usefulness, stability, portability and flocbility of the system. Validity was assessed
by comparing the syndromic system with the routine traditional weekly
surveillance system.

Results: Qualitative data showed a degree of poor acceptability among people who
have to enter data. Timeliness analysis showed excellent case processing time,
hindered by delays in case reporting. Analysis of stability indicated a high level of
technical problems, System flexibility was found to be high. Quantitative data
analysis of validity indicated better agreement between syndromic and traditional
surveillance when reporting on dengue fever cases as opposed to other diseases

Conclusions: The sophisticated technical design of 2SE FAG has resulted in a

system which is able to carry out its role as an early warning system Efforts must
be concentrated on increasing its acceptance and use by people who have to enter
data and decreasing the occurrence of the frequency of technical problems.

Keywords: early warning, evaluation, real-time surveillance, syndromic

surveillance
BIBLIOGRAPHY:-

1. P. Basheer.Shebeer and Khan Yassen S. “A Concise Text book of Advance

Nursing Practice”.2nd edition.Mahalaxmipuram,Bengaluru: Emmess Medical
Publishers;2019.Page No186-189
2. Soni Samta.“Textbook of Advance Nursing Practice”.2nd edition. NewDelhi:
Jaypee Brothers Medical Publishers(P) ltd; page No236-238