Integrated Disease Surveillance and

Response (IDSR) Training

Third Edition

Module 3
Analyze and Interpret data

1
 Outline of presentation
• Purpose of the module
• Learning Objectives
• Importance of data analysis
• Collection and Organization of Data for analysis
• Calculation of basic summary statistics
• Analysis by Time, Place, and Person
• Use of thresholds for public health action
• Drawing conclusions from findings
• Summary
• Instructions to exercises
 Purpose of Module

• Provide participants with skills in data collection,

analysis and interpretation
• Provide guidance in the use of data for decision
making in the form of public health actions
 Learning Objectives - 1

• Collect and organize data for analysis.

• Summarize data
• Use tables, graphs to analyse trends.
• Use maps to analyse place and distribution of
populations at risk
• Draw conclusions about analysis results.
• Make recommendations based on the conclusions.
 Importance of analysing data
• Analysis of surveillance data allows for:
 Observing trends over time and alerting health staff about
emerging and re-emerging events or unusual patterns
 Identifying geographic areas of higher risk
 Characterizing person variables such as age, occupation
that place a person at higher risk for the disease or event
 Monitoring and evaluation of Public Health interventions

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How data analysis informs our decisions

• How does the observed situation compare to previous

observation time periods this year or the previous year?
• Are the disease trends stable, increasing or decreasing?
• Is the reported surveillance information representative enough
of the reporting site’s catchment area?
• How timely were the data received from the reporting sites?
 Minimum Data Analysis

• Calculate completeness and timeliness of reporting.

• Calculate total cases by district (or other level) for the week
(or by month).
• Prepare cumulative totals of cases, deaths and case fatality
rates since the beginning of the reporting period.
• Use geographic variables (such as hospitals, residence,
reporting site, etc.) to analyse the distribution of cases by
place.
• Analyse disease trends for at least the diseases of highest
priority in your district
 Review data quality from health facility
• The surveillance focal person /in-charge should:
 Verify whether the form (hard copy or electronic file) is filled
out accurately.
 Ensure that the form is filled completely (e.g. no blanks).
 Check to be sure there are no discrepancies on the form.
o Immediately verify from the reporting site ( by phone, e-
mail or text message) and correct any discrepancies
identified.
• Merge the data and store them in a database.
General Principles of Data Analysis

-analysis by time

-analysis by place

-analysis by person

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9
Analyze Routine Data by Time, Place and Person

Time Place Person

Determine time- Determine where Describe who is at
based changes in cases are occurring greatest risk for the
disease and the disease and potential
period of time from risk factors
exposure to onset of
symptoms
 Summarizing & presenting data

 Mean/Average
 Tables
 Graphs
 Mean/Average
1. The mean (Average) is the value that is closest to other
values in a distribution.
2. Steps for calculating mean:
(a) Sum up all of the values.
(b) Divide the sum by the number of observations (n).
Days 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Frequency 3 6 7 7 8 8 8 8 9 9 9 9 9 10 10 11 13 16 17 Sum=177

(c) Sum = 177; n = 19

(d) Mean = 177 / 19 = 9.3
 Analysis by Time

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13
 Analysis by Time-1
• Objectives are to detect:
 Changes (sudden or long-term) in disease or unusual event
occurrence
 how many cases occurred
 the period of time from exposure to onset of symptoms
• Display Tools used:
 Table , line graph or histogram
• Method:
 Compare number of cases reported for the current period with
the number reported in a previous period (days, weeks, months,
quarters), same period in previous years

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Example of line graph: Weekly trend of reported Cerebrospinal
Meningitis cases, Gondwana county, weeks 1-9, 2017

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 How to make a graph

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 Creating a Line Graph

• Make x-axis longer than y-axis (best ratio 5:3).

• X-axis: Match x-axis scale to intervals used during data collection
• Y-axis:
 Always start y-axis with 0
 Identify largest value, round up for max. Y value
 Select reasonable interval size for y-axis
• Plot data.
• Add axis labels and title — What, where, when.
• Add comments, footnotes.

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 Creating a Line Graph:
Step 1: Draw X-axis and Y-axis Lines

500,000 Chart Title

400,000

300,000 Y-axis
200,000 X-axis
100,000

0
1111111111111111111111111111111111111111222222222
9999999999999999999999999999999999999999000000000
6666666666777777777788888888889999999999000000000
0123456789012345678901234567890123456789012345678
CPI-WHE-WHO/AFRO
 Creating a Line Graph:
Step 2: Complete and label X-axis and Y-axis

a. Base X-axis intervals on data

500,000 Chart Title– 2008
Data for Years 1960
400,000 (remember to label X-axis)
300,000

200,000

100,000

0
1111111111111111111111111111111111111111222222222
9999999999999999999999999999999999999999000000000
6666666666777777777788888888889999999999000000000
0123456789012345678901234567890123456789012345678
CPI-WHE-WHO/AFRO
 Creating a Line Graph:
Step 2: Complete and label X-axis and Y-axis

500,000 Chart Title

a. Base X-axis intervals on data
400,000 Data for Years 1960 – 2008
(remember to label X-axis)
300,000 b. Base Y-axis height on largest observed value
481,530 cases in 1963
200,000 Start a 0
(remember to label Y-axis)
100,000

0
1111111111111111111111111111111111111111222222222
9999999999999999999999999999999999999999000000000
6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8Year
88888889999999999000000000
0123456789012345678901234567890123456789012345678

CPI-WHE-WHO/AFRO
 Creating a Line Graph:
Step 2: Complete and label X-axis and Y-axis

Number of
Cases
500,000 a. Base X-axis intervals on data
Chart Title
Data for Years 1960 – 2008
400,000 (remember to label X-axis)
b. Base Y-axis height on largest observed value
300,000 481 530 cases in 1963
Start a 0
200,000 (remember to label Y-axis)

100,000 <Done>
0
1111111111111111111111111111111111111111222222222
9999999999999999999999999999999999999999000000000
6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8Year
88888889999999999000000000
0123456789012345678901234567890123456789012345678

CPI-WHE-WHO/AFRO
 Creating a Line Graph:
Step 3: Plot the data

Number
of Cases
500,000 Chart Title
400,000

300,000

200,000

100,000

0
1111111111111111111111111111111111111111222222222
9999999999999999999999999999999999999999000000000
6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8Year
88888889999999999000000000
0123456789012345678901234567890123456789012345678
 Creating a Line Graph;
Step 3: Plot the data

Number
of Cases
500,000 Chart Title
400,000

300,000

200,000

100,000

0
1111111111111111111111111111111111111111222222222
9999999999999999999999999999999999999999000000000
6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8Year
88888889999999999000000000
0123456789012345678901234567890123456789012345678
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 Creating a Line Graph:
Step 4: Add Title

Number
of Cases Title should describe:
500,000 1. What
Chart Titlethe data represent
400,000
(e.g., disease),
2. Where,
300,000
3. When
200,000

100,000

0
1111111111111111111111111111111111111111222222222
9999999999999999999999999999999999999999000000000
6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8Year
88888889999999999000000000
0123456789012345678901234567890123456789012345678
 Creating a Line Graph:
Step 4: Add Title

Number
of Cases Number of Reported Cases of Measles
500,000 by Year,
Chart TitleCountry A, 1960–2008
400,000

300,000

200,000

100,000

0
1111111111111111111111111111111111111111222222222
9999999999999999999999999999999999999999000000000
6 6 6 6 6 6 6 6 6 6 7 7 7 7 7 7 7 7 7 7 8 8 8Year
88888889999999999000000000
0123456789012345678901234567890123456789012345678
CPI-WHE-WHO/AFRO
 Creating a Line Graph:
Step 5: Add Comments, Footnotes, Source
Number of Reported Cases of Measles by Year,
Country A, 1960–2008
Chart Title
Start of vaccination
500,000 Vaccine licensed

400,000

300,000
Number
of Cases
200,000

100,000

0
1111111111111111111111111111111111111111222222222
9999999999999999999999999999999999999999000000000
666666666677777777778Year
8888888889999999999000000000
0123456789012345678901234567890123456789012345678
Source: e.g. WHO Annual Report, 2006

CPI-WHE-WHO/AFRO
 Bar Charts

 Can be vertical or horizontal.

 Use for variables with discrete, non-linear categories
(qualitative), such as districts.
 Bars have same width.
 Bars have space (“gaps”) between them, since categories
are not continuous.
 4 types – simple, grouped, stacked, 100%.
 Best type depends on desired emphasis.

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 Example I: Bar chart
Reported diseases for weekly IDSR Reports, Country A, January-August 2015

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 Example II: Bar chart

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 Analysis by Place
• Objectives are to:
 Determine where cases are occurring
 Identify high risk area (s)
 Locations of populations at risk
• Tools used:
 Spot map of the district or area affected
 table or a bar chart
• Method:
 Plot cases on a map
 look for clusters
 relationships between location of cases and the health event
being investigated

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 Creating maps

• Use manual methods or Geographic Information Software

(GIS) to create a map.
• On map of the area where cases occurred, mark the
following:
 factors related to the transmission risk for the disease
or condition under investigation e.g.:
o Roads
o water sources
o location of specific communities etc.

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 Example of district spot map showing
location of suspected and confirmed measles cases, January 2018

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 Analysis by Person
• Objectives are to:
 Describe reasons for changes in behaviour and disease occurrence
 How it occurred
 Who is at greatest risk for the disease
 Potential risk factors
• Tools used:
 Extract specific data about the population affected and summarize in a
table or a bar chart or a pie chart
• Methods
 characterize cases by age, sex, occupation, immunization status,
educational status, and other known risk factors for the diseases.

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 Tables

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 Steps in developing Tables
Descriptive Title (What, where, when)

Confirmed cholera cases by age group, Country A ,

1 January–30 May 2015

Row totals
Clear, Age group when
concise applicable
labels
Cases Deaths CFR%
0 - 4 years 40 4 10.0
Row
5-14 years 9 1 11.0
Unknown, 15 years and
if needed 1 0 0.0
older
Total 50 5 10.0

Column Cell
Totals Column Footnote, source

WHO-AFRO: IDSR quarterly reports, 2016.

Use Thresholds for Public Health Action

• Alert: An alert threshold tells health staff and the

surveillance team that further investigation is needed

• Action (Epidemic): An Action (epidemic) threshold

triggers a definite response. It marks the specific data
or investigation finding that signals an action beyond
confirming or clarifying the problem

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 Draw conclusions from the
findings and generate reports
• Routinely (weekly, monthly or quarterly)
 prepare graphs, maps, and tables
 meet with health facility staff and relevant
stakeholders
 review analysis results and discuss the findings

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 Summary-1

• Data should be analysed by time, place and person.

• Data can be organized through tables, graphs, charts and maps.
• Purpose of creating these visual displays of data .
 is to verify and analyze the data.
 explore patterns and trends, and to communicate information
to others.
• Use appropriate titles and labels .
 an effective figure should be able to be interpreted without
any additional information.

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 Summary 2

• Tables can illustrate:

 number of people with particular characteristics .
 provide valuable information about relationships between 2
variables.

• Line graphs are useful for showing patterns or trends of a variable,

usually over time.

• Maps are useful for showing the geographic distribution of health

events or conditions.

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 Practice Exercises

Instructions:
• Break into 5 small groups of a minimum of 3 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
Instructions:
• Each group assigned an exercise (exercises 1 to 5 )
 Turn to your participants guide booklet two module 3,
pages 70 to 89
 Each group has 40 min to read, discuss and answer all
questions to the assigned exercise
 Group leaders present answers during plenary
discussions:
o 5 min presentation; 10 min discussion

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 Practice Exercises
Exercise 1
Review a Hospital Register
Makata Hospital serves a population of about 30 000 people
in its catchment area. The health facility provides medical,
surgical, maternal and child health care services. The basic
information of those attending the outpatient department is
summarized in the registers below:
Table below shows Extract from the register of Makata
Hospital, new cases received from 6–10 May 2017

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CPI-WHE-WHO/AFRO
 Practice Exercises
Question 1. Using data from the Makata Hospital Register
show the distribution of patients by disease or syndrome by
completing the following table 3.2. To record frequency,
place a tick (√) or slash (/) in the column for each instance of
a suspected case or syndrome.

Note: Count diarrhoea and severe diarrhoea as “diarrhoea”.

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Answer to Q1: Distribution of patients by frequency and proportion of
disease/syndrome in Makata Hospital, 6–10 May 2017

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 Practice Exercises
Exercise 2
Instructions: Use graph paper or if you have computers, use an excel spreadsheet.
Otherwise, you can use the blank space provided in the module.
Refer to the Makata Hospital Register in Exercise 1 to answer questions below.
Q1. What are the top 5 disease conditions by proportion recorded in the Makata
Hospital?
Q2. Draw a bar chart to display the top 5 disease conditions by number of cases.
Use the next page to create a grid and then draw the bar graph. If available, use
graph paper or a computer. You may refer to the example in Section 3, of the 3rd
Edition IDSR Technical Guidelines.

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 Practice Exercises
Question 3: In the table below, summarize the distribution of malaria patients by
community from Makata Hospital using the data in Answer to Question 1

Question 4. What conclusion can you make from this table about the patients and
communities where they live?

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 Practice Exercises
Refer to Table in slide 40. Locate the columns for “age” and “sex.” Summarize the
distribution of patients by age and sex from the Makata Hospital to complete Table
below

Question 5. Which groups of patients are seen most often?

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Line List from Dumbura District for Lassa fever Outbreak—Oct-November 2017…1

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Line List from Dumbura District for Lassa fever Outbreak—Oct-November 2017 …2

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 Practice Exercises
Question 7. In the table below, analyze the distribution of cases by occupation.
Ensure that you calculate the case fatality rate.

Question 8. Which occupation is most affected?

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 Practice Exercises

Question 9. Use the

Community variable on
the line list to plot the
cases of Lassa Fever on
the map of the district
shown here

Question 10. Which

areas are most at
risk for
transmission?

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 Thank you

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