Professional Documents
Culture Documents
(IDSR) Training
Third Edition
INTRODUCTION MODULE
1
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Outline of presentation
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Purpose of the introductory module
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Content of the Introduction Module
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Learning Objectives
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Sub-module A: Introduction to IDSR
Training Course
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Purpose and learning objectives of IDSR training course
Participants will :
• Gain appropriate knowledge and skills for using data
to detect and respond to priority diseases, conditions
and events and thereby reduce the burden of illness,
death and disability in communities
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Specific Objectives (1)
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Specific Objectives (2)
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Specific Objectives (3)
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What is new in 3rd edition of IDSR Training Modules?
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Organization of the training course
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Training materials
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Monitoring and evaluation method
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Brief description of training modules- 1
• Introduction Module:
Introduces the IDSR course structure, other modules and
IDSR Linkages
• Module 1: Identify and record cases of priority diseases,
conditions or events
Presents standard case definitions, procedures for planning
and the role of Laboratory in surveillance and response
• Module 2: Report priority diseases, conditions and events
Describes how to report timely priority diseases, conditions
and events
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Brief description of training modules -2
• Module 3: Analyse and interpret data
Describes the analysis of data by time, place and person. It
also provides guidance on how to interpret the analysed data
• Module 4: Investigate and confirm suspected outbreaks and
other public health events
Describes the steps in outbreak investigation
• Module 5: Prepare to respond to outbreaks and other public
health events
Provides guidance in establishing public health emergency
response structure
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Title of the Presentation
Brief description of training modules -3
• Module 6: Respond to outbreaks and other public health events
Provides guidance on how to respond to public health
emergencies using the response structures
• Module 7: Risk Communication
Describes how to conduct risk communication before, during
and after the outbreak as well as community engagement
• Module 8: Monitor, supervise, evaluate and provide feedback to
improve surveillance and response
Describes how to routinely monitor, supervise and evaluate
the performance of the surveillance system as well as
dissemination of information.
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Brief description of training modules -4
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Sub-Module B: Overview of IDSR
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What is Public Health Surveillance?
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Public Health Surveillance Approaches - 1
Passive surveillance:
• A system by which, a health institution receives routine
reports submitted from health facilities:
Such as hospitals, clinics, public health units, or
community or other sources
• There is no active search for cases
• It includes surveillance of diseases/events using routine
Indicator-based surveillance, Health management and
information system (HMIS)
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Public Health Surveillance Approaches -2
Active Surveillance:
• An ongoing search for cases in the community or health
facilities
• Involves regular contact with reporting sources by:
Telephone calls to health care workers at a facility or
laboratory
Physically moving to the reporting sites
Conducting records review of data
Examples: 1. Active search for measles and polio cases
2. Finding additional cases during outbreaks
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Public Health Surveillance Approaches -3
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Title of the Presentation
Types of Public Health Surveillance
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Indicator based surveillance (IBS) and
the common types used
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Common types of IBS -1
Facility-based surveillance:
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Common types of IBS -2
Laboratory-based surveillance:
• Surveillance conducted at laboratories for detecting
events or trends that may not be seen as a problem at
other locations or that originates from laboratory
testing mainly done routinely
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Common types of IBS -3
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Common types of IBS -4
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Common types of IBS -5
• Syndromic surveillance:
• An active or passive system that uses Standard Case
Definitions based entirely on clinical features
without any laboratory diagnosis
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Common types of IBS -6
Sentinel surveillance:
• A given number of designated health facilities or reporting sites
for early warning and reporting of priority events;
such as pandemic, epidemic events or other public health
events
• They are usually representative of an area or are in an area of
likely risk for a disease or condition of concern
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Common types of IBS -7
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Event-Based Surveillance
Verses Indicator-based surveillance
• Unlike indicator-based surveillance, event-based
surveillance is:
Not based on the routine monitoring of indicators and
automated thresholds for action
But Based on the screening of all available information
to detect any event happening in the community such
as:
o Unusual disease
o Deaths in humans or animals,
o Unusual clustering of cases, events/conditions
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IBS and EBS as back bone to IDSR Strategy
EBS IBS
• Both are components of Early Warning and Response (EWAR) and Epidemic
Intelligence incorporated in the IDSR strategy
• Both are complimentary with each having a different role to play and purpose
• Pick up alerts to detect small • Monitoring disease trends overtime
outbreaks early • Useful for signalling start of regular
seasonal outbreaks of endemic
diseases using alert and epidemic
thresholds
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Levels of Applications and Reporting of EBS and IBS in the context of IDSR
At National level:
EBS implementation using hotlines and media scanning at PHEOC
Supervises implementation of EBS and IBS at district level
Oversees implementation of EBS and IBS at all levels
District level:
• DHMT ensures EBS implementation using hotlines and media scanning
• Supervises implementation of EBS and IBS at health facility and community levels
Community level:
• CBS Focal persons implement EBS and IBS at community level
• Detects and notify alerts to nearest health facilities
What is IDSR? -1
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Key principles of IDSR
• Integration:
Refers to harmonizing different methods, software, data
collection forms, standards and case definitions in order to
prevent inconsistent information and maximize efforts
among all disease prevention and control programmes and
stakeholders
• Coordination:
Refers to working or acting together effectively for the
rational and efficient use of available but limited resources
such as the Health Management Information System (HMIS)
and various disease programs
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Advantages of IDSR Strategy
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Specific objectives of IDSR-1
1. Strengthen the capacity of countries to conduct
effective surveillance activities
2. Integrate multiple surveillance systems so that tools,
personnel and resources are used more efficiently
3. Improve the triangulation and use of information to
detect changes in trend in order to conduct a rapid
response to suspected and confirmed outbreaks;
monitor the impact of interventions
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Specific objectives of IDSR - 2
4. Improve the flow of surveillance information
between and within levels of the health system and
other health systems
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Specific objectives of IDSR - 3
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International Health Regulations (2005)
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Purpose and Scope of IHR (2005)
Turn to Annex G of the 3rd Edition IDSR TG for the roles of the
following in IDSR:
1. Community health worker
2. Health Facility staff and Point of Entry
3. Surveillance Officer at district level
4. District Health Management Team
5. Political Leaders at district level
6. Regional or Provincial Health Management Team
7. Ministry of health
8. WHO and other partners
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Title of the Presentation
Other IDSR Linkages
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IDSR in the context of One Health-1
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IDSR and Disaster Management (DRM)
• DRM is a systematic process of using administrative and
organizational directives, operational skills and capacities to
implement strategies, policies and improved coping capacities
in order to lessen the adverse impact of hazards and the
possibility of disaster
• IDSR is a tool for DRM:
Provides early warning information, for risk assessment and
risk reduction
Assists in identification of hazards, assessment and
monitoring of disaster risks
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IDSR and Cross-Border Surveillance
• Countries in collaboration with WHO to establish:
Cross-border surveillance and response framework with
neighbouring countries
Procedures for information sharing within the framework of
IDSR
Procedures for notification of detected Outbreaks to
neighbouring cross border areas and districts
Develop and organize simulation exercises with cross border
district teams
Organize regular cross border meetings
• Note: Strong Political Leadership required
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IDSR and Points of Entry (PoE)
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Electronic IDSR (eIDSR)
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What are the priority diseases, conditions
and events for IDSR?
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Practice Exercise 1
• Use information in the Introduction Section of the 3rd Edition
IDSR Technical Guidelines
• Answer Exercise 1 in your participants guide page 27 (see next
slide)
Fill in the blank boxes with the appropriate terms from
the list provided:
o Prepare
o Respond
o Report
o Investigate and Confirm
o Communicate risk and provide feedback
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Practice Exercise 1
Figure 2 below is an incomplete flow diagram of an epidemic cycle.
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Introduction to CBS
Introduction Sub-Module C: Community-
Based Surveillance
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What is Community-Based Surveillance?
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Role of community members in public health
surveillance and response
1. Provide early warning or alerts during the pre-epidemic
period
2. Report alerts and information on unusual public health
events in the community to the nearest health facility.
3. Support in active case detection and response during the
epidemic including contact tracing, community mobilization
& sensitization
4. Providing a forum for feedback to the community on
outbreak or event assessment
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Procedure for CBS Focal person selection
Who is responsible:
• District and chiefdom health team should work with
community leaders to identify members of the
community to be selected as CBS Focal persons
Who is Eligible to be CBS Focal Person:
• Any community member acceptable by the
community can be a CBS focal person
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CBS Focal person selection criteria-1
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CBS Focal person selection criteria-2
6. Be literate enough to record events/data on the register
provided
7. Selected irrespective of Gender
8. Be recognized by all identified groups where ethnic and
religious differences exist
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Roles and Responsibilities of a community
based surveillance focal person-1
1. Use community case definitions to identify, record
priority diseases/conditions/events
2. Report to nearest health facility/sub-district
immediately within 24 hours
3. Support health workers during case/outbreak
investigation and contact tracing
4. Conduct household visits on a regular basis
5. Meet with key informants on a regular basis
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Roles and Responsibilities of a community
based surveillance focal person-2
6. Sensitization of the community on priority diseases,
conditions, and unusual events
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Example of CBS activities
• CBS focal person hears of several cases of acute watery
diarrhoea with vomiting in the community. The CBS focal
person suspects cholera and reports the rumour to the local
health facility and to the district level heath officer by text
messaging.
• Members of the public health emergency rapid response
team (PHERRT) travelled to the community to verify and
investigate the possible outbreak, and, based on the
investigation results, implemented control and prevention
measures. The outbreak is quickly contained thanks to the
early warning from the community-based surveillance focal
person
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IDSR community case definitions for use at the
community level
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Sources of information for CBS-1
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Sources of information for CBS-2
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What and how to report in CBS-1
What to report immediately/within 24hours:
• Anyone with onset of an illness meeting any of the IDSR
community case definitions in the catchment area
OR
• Any sudden death, if the catchment area is experiencing an
ongoing public health event of the IDSR priority conditions
OR
• Any unusual public health event e.g. unexplained cluster of
similar severe illnesses within one week, high absenteeism at
school
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What and how to report in CBS-2
How to report:
• Report to the CBS Supervisor or Surveillance officer or
nearest Health facility Manager
• By phone call/test message/hand delivery/using
vehicle/walking to nearest health facility
• Record in community alert forms
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Linkage between Facility-based
surveillance and CBS
• HF/sub-district health team with DHMT support should verify all
reports from CBS Focal person
• If it is confirmed as TRUE;
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Verification and Investigation of CBS Events
Community alert reporting form
Community alert reporting form
2. Telephone number:_____________________Community___________________District_________________
District______________________________________Ward/Subdistrict______________________________
Community:_________________________________________Month__________________ Year__________
Serial Type of illness/ When did this Where did How many How what
Number Condition/Event/Alert happen this happen have been many action was
affected died taken
(DD/MM/YYY) (Community,
District)
Sample pictorial CBS register/note book
Cases/Conditions/Events/Alert to be
Code Image
reported
True if...
presenting with illness presenting with similar signs
• The persons present with and symptoms who live or work
dissimilar signs and symptoms in the same community
• There is no temporal • The ill persons had an
association, and >1 week opportunity for exposure or
separates the patients’ illness close contact with one another
• The persons presenting with • The persons’ illness requires
similar symptoms reside in hospitalization
different communities that are • One or more persons has died
physically well-separated • There is a common source of
exposure
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Steps for investigating and confirming a suspected public
health event reported by CBS Focal Person-1
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Steps for investigating and confirming a suspected public
health event reported by CBS Focal Person-2
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Providing feedback to the community–1
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Providing feedback to the community–2
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Monitoring, supervision and evaluation of CBS
implementation-1
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Monitoring, supervision and evaluation of CBS
implementation-2
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Monitoring, supervision and evaluation of CBS
implementation-3
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CBS Supervision -1
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CBS Supervision-2
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Practice Exercises
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Practice Exercises-1/2
Instructions:
• Break into 3 small groups of a minimum of 5 people
• Each group should select a leader and a rapporteur
The leader moderates the group discussions
Rapporteur documents the agreed answers by
the group
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Practice Exercises-2/2
Instructions:
• Each group assigned one exercise (exercises 2, 3 and 4 )
Turn to your participants guide Introduction Module, pages
40 to 45
Each group has 30 min to read, discuss and answer all
questions to the assigned exercise
Group leaders present answers during plenary discussions:
• 5 min presentation; 5 min discussion
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Exercise 2
Exercise: Reporting a public health event and maintaining community
register at the community level.
In this exercise you will practice how to complete CBS reporting forms.
Instructions
Use the copies of the community case definitions for cholera,
meningitis, viral haemorrhagic fever, avian influenza, malaria and acute
flaccid paralysis, to complete and submit the following:
1. Community alert reporting form
2. Community-Based Surveillance Suspected Diseases and Public
Health Events Monthly Log Sheet
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Exercise 3
Instructions: Read through the case study for Exercise 3 and then answer all the
questions that follow in a group of 4 to 5. Refer to Section 11 of the 3rd Edition IDSR
Technical Guidelines for information to answer the questions.
After answering the questions your Facilitator will ask you to select a group leader to
present the answers during plenary discussions.
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Exercise 3
Questions cholera
1. What outbreaks are you familiar with 6. Since Josephine has not visited a
in your catchment area and from the health clinic, what should the
adjacent area (across the border)? community do?
2. What is cholera? 7. What action do you think that the
community-based surveillance focal
3. How does cholera spread within a person should take?
community?
8. Discuss if a community-based
4. Can cholera spread to or from a surveillance focal person should be part
neighbouring area (a cross the border)? of the investigation and community
5. Using the community case definition feedback team
for cholera, discuss within your group if
Josephine should be suspected of having
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Exercise 4
Participants Instructions
Read through the case study for Exercise 4. Then answer all the questions that
follow in a group of 4 to 5. Refer to Sections 11 of the 3rd Edition IDSR Technical
Guidelines whilst answering the questions. After answering the questions your
Facilitator will let you select a group leader to present the answers during plenary
discussions.
Three brothers from the Dogbera Family residing in Mende community went to
trap wild animals for meat in Gola forest reserve in early December 2017. They
managed to catch one limping monkey and some bats, which they killed, roasted
and ate as they looked for more game to take home and sell. Two days later, the
younger brother fell sick with a high fever, a headache, muscle pain, abdominal
pain, diarrhoea and vomiting of blood. He could hardly walk, so his siblings carried
him but he died on the way home. Soon after, the elder brother also fell ill but
refused to go to hospital fearing arrest by government authorities.
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Exercise 4
Questions 7. Since the Dogbera brothers are known to not
have yet visited the clinic, what should the
1. Have you heard about viral haemorrhagic community do?
fever? If yes, how?
8. What action should the community-based
2. What is viral haemorrhagic fever? surveillance focal point take?
3. Is viral haemorrhagic fever dangerous? If Yes, 9. Discuss if a community-based surveillance
Why? focal person should be part of the investigation
and community feedback team.
4. How is viral haemorrhagic fever spread?
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Summary- Introduction Module-1
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Summary- Introduction Module-2
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Thank you
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