Surveillance data collection in IDSP Integrated Disease Surveillance Programme (IDSP) district...

Surveillance data collection in IDSP

Integrated Disease Surveillance Programme (IDSP) district surveillance

officers (DSO) course

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Outline of this session

1. Principles of surveillance data collection

2. Diseases under surveillance3. Practical organization of data

collection

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Surveys versus surveillance

• Survey Data collection at one point in time Prevalence data

• Surveillance Ongoing, routine data collection Incidence data

Concepts

4Concepts

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

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Example of a line listing for reporting individual cases of

measlesID Date of

onsetLocation Age Sex Vaccine

status

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

12 Female No

9 16 Jan 06

Village B

4 Male Yes

Concepts

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Reporting of aggregated cases of diseases in (place) during

(time)Disease Under 5 years of age 5 years of age and older

Male 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

Concepts

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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

List

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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

Collection

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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 positive laboratory identification

Medical officer and Laboratory staff

More specificity

Collection

10Collection

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

11Collection

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

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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

Collection

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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 memberCollection

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Core sources of information for “S” forms

• Health workers visit diary (40 houses / day) Require regular maintenance and entries May include information from other co-workers/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 statesCollection

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

to be ultimately merged)

Collection

The new malaria form takes into account IDSP classification of fever cases for

better coordination

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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

Collection

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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

Collection

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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 individuallyDetection of rising trends of disease

Collection

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

S register

S form

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Poor data entry on form “S”:

Some cells are not filledMale Female Total

Fever < 7 days < 5 yr > 5 yr < 5 yr

> 5 yr < 5 yr > 5 yr

1 Only fever  2      6    

2 With rash          

3 With bleeding          

4 With daze/ Semi-consciousness/ Unconsciousness

Fever > 7 days            ------- NIL -------

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Male Female TotalFever < 7 days < 5 yr > 5 yr < 5

yr> 5 yr < 5 yr > 5

yr1 Only fever  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/ Semi-consciousness/ unconsciousness

  NIL   NIL   NIL   NIL   NIL   NIL

Fever > 7 days  2   NIL   NIL  6 2  6

Data entry on form “S” as recommended

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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 linkCollection

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Summary: The flow of the “S” form

House visitsregister

Register inoutpatient clinic

in sub-centre

Other registersand records

Sector primaryhealth centre

Block primaryhealth centre

District surveillanceunit

Form “S”completion

Form “S”transmission

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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” registerCollection

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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

Collection

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

“P” register

“P” form

Collection

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“S”, “P” and “L1” forms converge at the block level

Revised "MF 11"form from

sub-centres

"S" form fromsub centres

"P" form fromprimaryhealthcentre

"P" form fromcommunity health centre

'L1' formfrom community

health centre

District surveillanceunit

Collection

• Block primary health centre (BPHC)

• Community health centre (CHC)

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Information from other reporting sources

Quacks and traditional practitioners “S” forms

Clinics and practitioners “P” forms

HospitalsConsolidated “P” forms

Small labs“L1” form

Big labs

“L2” form

Collection

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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

Collection

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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

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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