Surveillance data collection in IDSP Integrated Disease Surveillance

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Surveillance data collection in IDSP Integrated Disease Surveillance Programme (IDSP) district surveillance officers (DSO)

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

Outline of this session 1. Principles of surveillance data collection 2. Diseases under surveillance 3. Practical organization of data collection 2 2

Surveys versus surveillance • Survey § Data collection at one point in time §

Surveys versus surveillance • Survey § Data collection at one point in time § Prevalence data • Surveillance § Ongoing, routine data collection § Incidence data 3 Concepts 3

Reporting methods • Individual cases § Each and every case is reported § “Line

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 4

Example of a line listing for reporting individual cases of measles ID Date of

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 5

Reporting of aggregated cases of diseases in (place) during (time) Disease Under 5 years

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 6

Conditions under regular surveillance in integrated disease surveillance programme (IDSP) Type of diseases Condition

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 7

Rationale for the use of case definitions • Uniformity in case reporting at district,

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 8

Types of case definitions in use Users Syndromic (suspect) “S” forms Clinical pattern Paramedical

Types of case definitions in use 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 “L 1/L 2” forms Clinical diagnosis by a Medical officer and medical officer and Laboratory staff positive laboratory identification 9 More specificity Case definition Criteria Collection 9

What is an epidemiologically linked case? 1. One or few probable cases are confirmed

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 10

Example of “epidemiologically linked” cases • Outbreak of 123 severe diarrhea cases with dehydration

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 11

Summary of the data collection forms used for the various levels of case definition

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 12

Persons collecting information on syndromic reports (“S” forms) • Health worker, Male • Health

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 13

Core sources of information for “S” forms • Health workers visit diary (40 houses

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 14

Revised malaria form (MF) 11 (Revised to fit IDSP format, to be ultimately merged)

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 15

Completion and transmission of form “S” • Completion § Health worker (Female) usually completes

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 16

Problems associated with completion and transmission of form “S” • While compiling records for

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 17

Check list for “S” form completion ü Filled in time (Friday-Saturday) ü Filled using

Check list for “S” form completion ü Filled in time (Friday-Saturday) ü Filled using figures from registers only ü Tally mark by health worker ü Entries in the “S” form can traced back to individual cases in the registers ü Each cell filled in individually ü Detection of rising trends of disease 18 Collection 18

Applying the checklist: Making sure all numbers in the “S” form come from individual

Applying the checklist: Making sure all numbers in the “S” form come from individual cases in the “S” register S form 19 19

Poor data entry on form “S”: Some cells are not filled Male Fever <

Poor data entry on form “S”: Some cells are not filled Male Fever < 7 days < 5 yr 1 Only fever Female > 5 yr 2 < 5 yr Total > 5 yr < 5 yr > 5 yr 6 2 With rash 3 With bleeding ---- 4 With daze/ Semiconsciousness/ Unconsciousness Fever > 7 days - --- - 20 I N - L - -- 20

Data entry on form “S” as recommended Male Fever < 7 days 1 Only

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 6 2 6 2 With rash NIL NIL 3 With bleeding NIL NIL NIL 2 NIL 6 2 6 4 With daze/ Semiconsciousness/ unconsciousness Fever > 7 days 21 21

First level of consolidation: The sector primary health centre (PHC) • Sector PHC §

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 22

Summary: The flow of the “S” form Form “S” transmission Form “S” completion 23

Summary: The flow of the “S” form Form “S” transmission Form “S” completion 23 23

Sources of data for “P” form • Primary health centre outpatient register § 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 24

Completion of the “P” form in primary health centres (PHCs) • Focal person: §

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 25

Applying the checklist: Making sure all numbers in the “P” form come from individual

Applying the checklist: Making sure all numbers in the “P” form come from individual cases in the “P” register “P” form 26 Collection 26

“S”, “P” and “L 1” forms converge at the block level • Block primary

“S”, “P” and “L 1” forms converge at the block level • Block primary health centre (BPHC) • Community health centre (CHC) 27 Collection 27

Information from other reporting sources Big labs “L 2” form Small labs “L 1”

Information from other reporting sources Big labs “L 2” form Small labs “L 1” form Hospitals Consolidated “P” forms Clinics and practitioners “P” forms Quacks and traditional practitioners “S” 28 forms Collection 28

Reporting units • All government entities should be part of the reporting network •

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 29

Take home messages 1. IDSP is mostly based upon aggregated reporting 2. Know the

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 “L 1/2” forms 30 30

Additional reading • Section 2 and 3 of IDSP operations manual • Module 5

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 31