Public health surveilliance 1

PUBLIC HEALTH SURVEI

LLANCE

06/27/23
 Session objectives
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At the end of the session learners will be able to:

 Define surveillance, IDSR, ….

 Identify different sources of data for surveillance

 Criteria for identifying disease for surveillance

 Have a look at on different types of surveillance

 Describe purpose of surveillance

 Describe the possible limitation of surveillance

 The difference between surveillance and survey

Public health surveilliance 06/27/23

 Definition
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 Surveillance , French word, is a continuous

systematic collection, analysis, interpretation and
dissemination of health-related data.
 The aim to prioritize problems and PIE public
health practice
 So that it provides “Information for Action”

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 Information for Action
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Public Health Action

Surveillance
Priority setting
Collection Planning, implementing,
Analysis and evaluating disease
Interpretation  investigation
Dissemination  control
 prevention

Although surveillance is meant to guide a larger action it also prov

ides the basis for identifying individuals who need treatment an
d preventive services.
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 Why surveillance? (USES)
Overall goal
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 To facilitate the prevention and control of the

diseases under surveillance
Specifically,
Estimating Magnitude of the Problem

Determining geographic distribution of illness

Early Recognition of Epidemics

Identifying changes: in health practices

Evaluating public health programs

Generate hypotheses

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Criteria for identifying disease for surveillance

 Frequency
 Cost Morbidity rates
 Incidence
 Preventability  Prevalence

 Communicability Mortality rates

 Public Interest  Severity

 Case fatality ratio
 Hospitalization rate
 Disability rate
 Years of potential life lost
 Quality adjusted life years lost

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 Function of an effective surveillance system
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 Detection and notification of health event

 Collection and consolidation of pertinent data

 Investigation and confirmation( epidemiological.

Clinical, and/or laboratory ) of cases or outbreaks

 Routine analysis and creation of reports

 Feedback of information for those provide the data

 Feed-forward ( the forwarding of data to more central

level
 Reporting data to next administrative level

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 Sources of Surveillance Data
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 Mortality reports  Special surveys (e.g.,

 Morbidity reports
 Epidemic reports
 Reports of laboratory
utilization (including
laboratory test results)
 Reports of individual
case investigations
 Reports of epidemic
investigations
Public health surveilliance
hospital admissions,
disease registers, and
serologic surveys)
 Information on animal
reservoirs and vectors
 Demographic data
 Environmental data
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 Types of Surveillance
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 Passive surveillance
 health care providers send reports based on a

known set of rules and regulations.

 Provider-initiated

Adv. Is relatively cheap covers a wider area &

problem
 Disadv.: unreliable, incomplete, inaccurate, not

available on time, lacks representativeness

(institution based) , no feed back
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 Types of Surveillance…
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 Active surveillance
 public health officials contact providers to solicit
reports of events or diseases
 Health Department-initiated)
 limited to specific ds (epidemic, after exposure)
 Adv.: complete and accurate, timely, required data gathered
 Disadv.: Expensive, need skilled man power, for short period
of time with specific disease, and requires good organization

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 Types of Surveillance…
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 Sentinel surveillance
 uses a pre-arranged sample of reporting sources
to report all cases of one or more conditions
 alternative to population-based surveillance
 relatively inexpensive, use for other purpose
 Lesser quality and timelines, not representative
 E.g. Tb samples, Influenza sentinels

Public health surveilliance 06/27/23

 Types of Surveillance/ Sentinel …
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 M onitor trends in a chosen population grou

ps and chosen sites in a regular and consist
ent way.
 Uses

 To detect changes

 To develop intervention strategies

 To promote further investigations

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 Steps in Planning surveillance
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• Establish objectives
• Develop case definitions
• Determine data source or data collection mechanisms
• Develop data collection instruments
• Field test methods
• Develop and test analytic approach
• Develop dissemination mechanism
• Ensure use of analysisPublic
andhealth
interpretation
surveilliance 06/27/23
 Features of good surveillance S
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ystem
 Uses a combination of passive and active
mechanisms
 Collects the minimum data in a simplest possible
way
 Timely reporting
 Incorporate strong laboratory services for accurate
diagnosis
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 Reporting and notification

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Reporting formats must be clear and easy to use.

Any report must be clear and answer questions like

what, where, when, to whom, for what and why.
Types of reports
 Oral: - passing information verbally and the sender
must check that the message is correctly understood
by the receiver.
 Radio or telephone-for special cases like emergency
situations.
 Written - in normal circumstances.

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 Attributes of a good surveillance system
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 simplicity
 flexibility (with changes in case definition or funding, to add ne

w diseases)
 acceptability (often judged by proportion who report, completen

ess of forms)
 sensitivity (ability to detect events it is intended to detect)

 predictive value positive (proportion of reported cases which tr

uly are cases, or of epidemics which are actual epidemics)

 representativeness (extent to which one can generalize or draw

conclusions from surveillance data, such as for

calculating rates)
 timeliness
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• Cost effective
 Limitation of surveillance
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 Under reporting
 Non representativeness
 Bias
 Lack of timeliness
 Inconsistencies of case definitions
 In outbreak – urgency , pressure to conclude ,
limited statistical power

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 Dissemination of surveillance da
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ta
 Disseminate surveillance data to all stakehold
ers (health providers, community and decision
makers)

 Disseminate report locally, nationally or globa

lly; as necessary as well timely & regularly

 Disseminate through appropriate media: new

sletter or bulletin (paper or electronic)
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Integrated disease surveillance & response (IDSR)
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 An approach adopted to strengthen national diseases

surveillance system by coordinating & streamlining
all surveillance activities and ensuring timely action.

 IDSR initiative was launched by the WHO-AFRO

(Africa regional office for WHO) in the second h
alf of the 1990’s.

 Then has been adapted by many African countri

es including Ethiopia.
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 IDSR…
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 Focuses at the Woreda level

 IDSR facilitate collaboration between

surveillance focal points and epidemic
response committees at the Woreda, regional
and national levels….for response

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 Disease Targeted for surveillance
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Diseases to be included in surveillance should (in

Ethiopia): 

 Are top causes of high morbidity and mortality

 Their epidemic potential

 Surveillance required internationally (for example,

plague, yellow fever and cholera);

 Availability of effective intervention programs for

prevention, control, eradication or elimination of the
diseases (for example, EPI ).
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 List of Priority Diseases for Surveillance in
Ethiopia

A.Epidemic-prone diseas B. Diseases targeted for eradicat

es ion
1. Cholera
12.Acute flaccid paralysis (Polio)
2. Diarrhea with blood (Shi
gellosis) 13.Dracunculiasis (Guinea worm)
3. Measles 14.Leprosy
4. Meningitis 15.Neonatal Tetanus
5. Plague C. Other diseases of public healt
6. Viral hemorrhagic fevers h importance
7. Yellow fever 16.Pneumonia in children
8. Typhoid fever 17.Diarrhea in children
9. Relapsing fever 18.New AIDS cases
10.Epidemic typhus 19.Onchocerciasis
11.Malaria 20.Sexually transmitted diseases
21.Tuberculosis
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 Reporting frequency
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1. Immediately
2. Weekly
3. Monthly
4. Quarterly

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 Diseases to be reported immediately on case-
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based reporting format
 AFP/polio
 Cholera

 Dracunculiasis

 NNT

 Plague

 Viral haemorrhagic fever

 Yellow Fever

Any newly emerging infection

If no cases Record zero in the routine report
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 Diseases to be reported Weekly on case-based
reporting format
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 Report weekly if the threshold is crossed/ outbreak:

 Measles
 Meningitis WEEKLY During epidemic season and
when there is an outbreak
 Malaria
 Outbreaks of any sort

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 Diseases to be reported routinely (monthly) on
monthly reporting format:

  malaria Onchocerciasis
Pneumonia < 5  typhoid fever
Diarrhea <5 RF

new AIDS cases  epidemic typhus
STIs  rabies

dysentery ----

 Diseases to be reported quarterly on
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quarterly reporting format:

Tuberculosis
 Leprosy

Public health surveilliance 06/27/23

 Steps of the Integrated Disease Surveillance
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Step 1 - Identify cases

 Identify cases using standard case definitions identify

priority diseases and conditions

Step 2 - Report
 Report all suspected cases or conditions to the next level

 If this is an epidemic prone disease, or a disease targeted

for elimination or eradication, investigate and respond

immediately

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 Cont…
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Step 3 - Analyze and interpret data

 Compile the data, and analyze its trends

 Compare information with previous periods and

summarize the results

Step 4 - Investigate and confirm suspected cases and

epidemics
 Take action to ensure that the case or epidemic is

confirmed (by laboratory )

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 Cont…
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Step 5 - Respond
 Mobilize resources and personnel to implement the

appropriate epidemic or public health response

Step 6 - Provide feedback

 Encourage future cooperation by communicating with

levels that reported epidemics and cases about the

investigation outcome and success of response efforts

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 Cont…
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Step 7 - Evaluate and improve the system

 Assess the effectiveness of the surveillance system, in
terms of timeliness, quality of information,
preparedness, thresholds, case management and overall
performance
 Take action to correct problems and make
improvements
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 Thank !!

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