Transcript IDSP Module 5

Surveillance data collection
in IDSP
Integrated Disease Surveillance Programme (IDSP)
district surveillance officers (DSO) course
Outline of this session
1. Principles of surveillance data collection
2. Diseases under surveillance
3. Practical organization of data collection
2
Surveys versus surveillance
• Survey
 Data collection at one point in time
 Prevalence data
• Surveillance
 Ongoing, routine data collection
 Incidence data
3
Concepts
Reporting methods
• Individual cases
 Each and every case is reported
 “Line listing” similar to an OPD register
• Aggregated cases
 Number of cases with selected characteristics
 Usual methods in place in the contact of the
Integrated Disease Surveillance Programme (IDSP)
 Requires aggregation of the individual cases
4
Concepts
Example of a line listing for reporting
individual cases of measles
ID
Date of
onset
Location
Age
Sex
1
12 Jan 06
Village A
2 Male
Yes
2
13 Jan 06
Village B
3 Female
Yes
3
14 Jan 06
Village B
1 Female
No
4
14 Jan 06
Village B
5 Male
Yes
5
14 Jan 06
Village B
3 Male
No
6
14 Jan 06
Village B
2 Female
Yes
7
15 Jan 06
Village A
1 Male
Yes
8
16 Jan 06
Village C
9
16 Jan 06
Village B
12 Female
4 Male
5
Vaccine
status
No
Yes
Concepts
Reporting of aggregated cases of
diseases in (place) during (time)
Disease
Under 5 years of age
Male
5 years of age and older
Female
Male
Female
Diarrhea
2
1
4
3
Bloody
diarrhea
0
0
1
0
Pneumonia
3
2
1
2
Fever
4
3
12
10
Fever / rash
1
0
0
0
Total
encounters
10
6
18
15
6
Concepts
Conditions under regular surveillance in
integrated disease surveillance
programme (IDSP)
Type of diseases
Condition under surveillance
Vector borne
•Malaria
Water borne
•Diarrhea (Cholera), Typhoid
Respiratory
•Tuberculosis
Vaccine preventable
•Measles
Under eradication
•Polio
Other conditions
•Road traffic accidents
International commitment
•Plague
Unusual syndromes
•Meningo-encephalitis, respiratory
distress, hemorrhagic fever
7
List
Rationale for the use of case definitions
• Uniformity in case reporting at district, state
and national level
• Use of the same criteria by reporting units to
report cases
• Compatibility with the case definitions used
in WHO recommended surveillance standards
 Allow international information exchanges
8
Collection
Types of case definitions in use
Case definition Criteria
Users
Syndromic
(suspect)
“S” forms
Clinical pattern
Paramedical personnel and
members of community
Presumptive
(Probable)
“P” forms
Typical history and
clinical examination
Medical officers of primary
and community health
centres
Confirmed
“L1/L2” forms
Clinical diagnosis by a Medical officer and
medical officer and
Laboratory staff
positive laboratory
identification
9
Collection
What is an epidemiologically linked case?
1. One or few probable cases are confirmed by the
laboratory
2. Other probable cases that most likely belong to
the same cluster are considered “epidemiologically
linked” if they had:


Exposure to the same source
Contact with a confirmed case
3. These “epidemiologically linked” cases are
reported on a separate section of the “P” form
10
Collection
Example of “epidemiologically
linked” cases
• Outbreak of 123 severe diarrhea cases with
dehydration among adults
• 7/12 rectal swabs confirmed the diagnosis of
cholera
• The non confirmed, probably cases become
“epidemiologically linked” cases and should
be reported as such in the separate section
of the “P” form
11
Collection
Summary of the data collection forms
used for the various levels of case
definition
• Form “S” (Suspect cases)
 Health workers (Sub centres)
• Form “P” (Probable cases)
 Doctors (Primary health centres, Community
health centres, Hospitals)
• Form “L” (Laboratory confirmed cases)
 Laboratories
12
Collection
Persons collecting information on
syndromic reports (“S” forms)
• Health worker, Male
• Health worker, Female
• Auxiliary nurse, midwife/ Public health nurse/ Lady
health visitors
• Accredited Social health Activities (ASHA)
• Anganwadi Worker
• Link worker
• Village Health Guide/Community Health Volunteer
• Panchayat/ Community member
13
Collection
Core sources of information
for “S” forms
• Health workers visit diary (40 houses / day)
 Require regular maintenance and entries
 May include information from other coworkers/functionaries
• Sub centre out patient department register
 Usually records identifiers and drugs dispensed
• Not syndromes
 Age often inadequate, unclear or absent
 No summary
 Does not usually include diary entries
• Similar other diary and register with other workers
• Malaria slide register in some states
14
Collection
Revised malaria form (MF) 11
(Revised to fit IDSP format, to be
ultimately merged)
The new malaria form takes into account
IDSP classification of fever cases for
better coordination
15
Collection
Completion and transmission of form “S”
• Completion
 Health worker (Female) usually completes the form on the
basis of registers
• Ideally the new IDSP “S” register
• Or other registers (OPD, house visits)
• Transmission
 Health worker (Male) usually takes the form to health
supervisor/ inspector at the PHC on MONDAY
 In some places:
• The form reaches the block PHC directly
• The form is communicated to the district by phone
16
Collection
Problems associated with completion and
transmission of form “S”
• While compiling records for “S” forms the core
registers may not be consulted (although it should)
• The report may cover a period modified to suit
convenience of meeting date
• Incomplete information usually gets dropped
17
Collection
Check list for “S” form completion
 Filled in time (Friday-Saturday)
 Filled using figures from registers only
 Tally mark by health worker
 Entries in the “S” form can traced back to
individual cases in the registers
 Each cell filled in individually
 Detection of rising trends of disease
18
Collection
Applying the checklist: Making sure all
numbers in the “S” form come from
individual cases in the “S” register
S register
S form
19
Poor data entry on form “S”:
Some cells are not filled
Male
Fever < 7 days
1 Only fever
< 5 yr
Female
> 5 yr
2
< 5 yr
Total
> 5 yr
< 5 yr
6
2 With rash
3 With bleeding
4 With daze/ Semiconsciousness/
Unconsciousness
Fever > 7 days
20
> 5 yr
Data entry on form “S”
as recommended
Male
Fever < 7 days
1 Only fever
< 5 yr
Female
> 5 yr
< 5 yr
Total
> 5 yr
< 5 yr
> 5 yr
2
NIL
NIL
6
2
6
2 With rash
NIL
NIL
NIL
NIL
NIL
NIL
3 With bleeding
NIL
NIL
NIL
NIL
NIL
NIL
4 With daze/ Semiconsciousness/
unconsciousness
NIL
NIL
NIL
NIL
NIL
NIL
2
NIL
NIL
6
2
6
Fever > 7 days
21
First level of consolidation:
The sector primary health centre (PHC)
• Sector PHC
 Approximate population: 20-30,000
 Sometimes more
• Target date for receipt of forms is MONDAY
 5-6 “S” forms expected
• Transmission to the block PHC or community health
centre (CHC) on Tuesday
 “S” forms forwarded
 PHC “P” form added
 Responsibility: Pharmacist (Usually)
• Often a weak link
22
Collection
Summary: The flow of the “S” form
District surveillance
unit
Block primary
health centre
Form “S”
transmission
Sector primary
health centre
Form “S”
completion
House visits
register
Register in
outpatient clinic
in sub-centre
23
Other registers
and records
Sources of data for “P” form
• Primary health centre outpatient register
 Records name of the patient
 Social status (e.g., Below poverty line)
• Primary health centre pharmacist
 Register with name, outpatient number etc.
• At some places there is a medical officers
individualized register as well
• New IDSP “P” register
24
Collection
Completion of the “P” form in primary
health centres (PHCs)
• Focal person:
 Pharmacist
 Public health nurse
• Various combinations in practice to fill “P” form
 Pharmacist register does not have diagnosis
 OPD registers do not have any disease/treatment info
 Doctors register generally incomplete and do not cover all
patients
• Checklists similar to the one used for the “S” Form
can be used to assure data quality at this level
25
Collection
Applying the checklist: Making sure all
numbers in the “P” form come from
individual cases in the “P” register
“P” register
“P” form
26
Collection
“S”, “P” and “L1” forms
converge at the block level
District surveillance
unit
• Block primary health
centre (BPHC)
• Community health
centre (CHC)
'L1' form
from community
health centre
"P" form from
community health centre
"P" form from
primary
health
centre
Revised "MF 11"
form from
sub-centres
"S" form from
sub centres
27
Collection
Information from other reporting sources
Big
labs
“L2” form
Small labs
“L1” form
Hospitals
Consolidated “P” forms
Clinics and practitioners
“P” forms
Quacks and traditional practitioners
“S” 28
forms
Collection
Reporting units
• All government entities should be part of the
reporting network
• All local health institutions should be made part of
the network in phases
• Gradually the data should be disaggregated by
reporting unit to pinpoint the source and demarcate
local trend line for particular diseases
• Ultimately we need to report incidences in relation
with the denominator
 CDC: Count, divide compare
 Compare rates rather than numbers
29
Collection
Take home messages
1. IDSP is mostly based upon aggregated
reporting
2. Know the diseases under surveillance
3. Understand the data flow of each of the
case definition levels
•
•
•
“S” forms
“P” forms
“L1/2” forms
30
Additional reading
• Section 2 and 3 of IDSP operations manual
• Module 5 of training manual
• Format and guidelines for reporting of
information on disease surveillance
(electronic manual)
• IDSP manual
31