Feedback Integrated Disease Surveillance Programme IDSP district surveillance
Feedback Integrated Disease Surveillance Programme (IDSP) district surveillance officers (DSO) course
Preliminary questions to the group • Were you already involved in feedback of surveillance data? • If yes, what difficulties did you face? • What would you like to learn about feedback of surveillance data? 2 2
Warm up exercise • Diphtheria persists in Delhi • One hospital used at a sentinel centre • Data analyzed from 1954 -1997 3 3
Diphtheria incidence and case fatality, sentinel unit, New Delhi, India, 1954 -97 1800 40% 1600 Cases Case fatality 1400 35% 30% 1000 20% 800 Case fatality 25% 15% 600 10% 400 0% 19 5 8 19 60 19 62 19 64 19 66 19 68 19 70 19 72 19 74 19 76 19 78 19 80 19 82 19 84 19 86 19 88 19 90 19 92 19 94 19 96 0 6 5% 4 200 19 5 Number of cases 1200 4 Year 4
Diphtheria incidence by month, sentinel unit, New Delhi, India, 1997 35 Cases Deaths 30 Number of cases 25 20 15 10 5 0 J F M A M J 5 Month J A S O N D 5
Characteristics of diphtheria cases, sentinel unit, New Delhi, India, 1997 Characteristics Age Cases % Total Death CFR (%) <1 20 14 10 50 1 -4 73 51 22 30 5 -9 38 27 13 34 10+ 12 8 0 0 Male 90 63 27 30 Female 53 37 18 34 Hindu 89 62 25 28 Muslim * 54 38 10 37 Yes 15 10 1 7 No 114 80 43 38 14 10 1 7 143 100 45 31 * Account for 9%, 17% ad 5% of the population 6 in Delhi, UP and Haryana 6 Sex Religion Vaccine ? Total
Questions for the group: Propose messages for feedback • Describe what you see • Recommend action to report in your feedback bulletin 7 7
Key findings messages re: diphtheria in Delhi, India, 1997 • Incidence decreases • Case fatality increased • Seasonality: § August to October • Most cases among unvaccinated, at at age when they should be protected from primary vaccination 8 8
Key recommendations re: diphtheria in Delhi, India, 1997 • Increase vaccine coverage and reach unvaccinated pockets • Store and use anti-toxin early 9 9
Outline of the session 1. Rationale for feedback 2. Content of feedback 3. Feedback mechanisms Group exercise to conclude 10 10
Difficulties with surveillance system with no feedback Lack of motivation • Data disappear in a black hole Unreliability • Mistakes are not corrected Sluggishness • The various levels do not communicate Data falsification • The data is opaque Weak human resources • The actors do not see the system in action 11 11
Rationale for feedback of surveillance data ü Motivation • Everyone sees how their data fit in the bigger picture ü Reliability • Identifies errors ü Reactivity • Places everyone on the same page ü Quality • Increases transparency ü Education • Demonstrates how the system works 12 12
A dynamic vision of surveillance Collect and transmit Make decisions data All levels use information to make decisions Analyze data Feedback information 13 13 Surveillance
Data flow and feedback: Level by level Centre State Data District Feedback Primary / Community health centre Community 14 14
Content of feedback • Information on diseases under surveillance • Information on quality of data collected 15 15
Content of feedback • Information on diseases under surveillance § Summary data tables § Analyzed epidemiological information • Time (Graphs with trends) • Place (Maps) • Persons (Tables) • Information on quality of data collected 16 16
Content of feedback • Information on diseases under surveillance • Information on quality of data collected § § § Regularity of reporting Timeliness of reporting Completeness of reporting Responses initiated by the unit Validity of data 17 17
Feedback methods • • • Newsletters, bulleting Monthly review meetings Outbreak investigation reports Informal feedback Electronic communication 18 18
Newsletter • Regular epidemiological bulletin • Educational tool • Contains § Summary tables and graphs § Commentary on diseases or topic 19 19
Monthly review meetings • • District / block monthly meeting Presentation of data during meetings Generates comments from peers Need to stress positive aspects § Public negative comments may de-motivate 20 20
Outbreak investigation reports • Excellent for feedback and learning • Allow sharing of experiences that may be encountered in other places • Content § Information about the epidemiological characteristics of disease § Lessons learned in the investigation process 21 21
Informal feedback • Oral feedback • Useful for pointing out mistakes • Does not suffice by itself 22 22
Electronic methods • • Through email, websites Fast and efficient May be updated rapidly Allows § Dynamic data presentation § Queries 23 23
Take home messages 1. Feedback closes the surveillance loop 2. Feedback • Epidemiological information • • Time Place Person Information on data quality 3. Use all possible mechanisms of feedback to get the information across 24 24
Exercise • Read the article on the analysis of measles surveillance data in Uttar Pradesh in 1996 § Singh J. et al. Widespread outbreaks of measles in rural Uttar Pradesh, India, 1996: High risk areas and groups. Indian Pediatrics 1999; 36: 249 -255. • Imagine you need to prepare a feedback meeting with health officials in Uttar Pradesh • You need to prepare a presentation 25 25
Group work • Sit down by by groups of 4 or 5 • Extract information from the article to structure your feedback • Use a table format to prepare your presentation 26 26
Empty table shell to organize feedback information Epi data Data quality issues Findings Interpretation Recommendations Time • … Place • … Person • … Surveillance issues • … 27 27
Break in groups Take 15 minutes
Key elements of feedback for measles in Uttar Pradesh, India, 1996 Epi data Data quality issues Findings Interpretation Recommendations Time • Most cases in low transmission months • Measles all year long • Be mobilized all year long Place • Deaths concentrates in 10 districts • Higher incidence? • Better reporting? • Compare reporting practices in the 10 districts with the others Person • 85% cases not vaccinated • Measles persists • Increase coverage because of low vaccine coverage • Efficacy 92% • Vaccine works in UP Surveillance • 1% of • Measles estimated surveillance is cases reported weak 29 • Increase coverage • Improve reporting 29
Presenting your feedback • Present the background • Explain how you collected the data • Display the key results presented in the summary table § Back up data with tables, graphs and maps • Interpret the data • Summarize the recommendations that can be deducted from the data 30 30
Additional reading • Section 4 of IDSP operations manual (Report 2 -7, page 57 -64) • Section 10 of IDSP operations manual • Module 10 of training manual 31 31
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