Integrated Disease Surveillance Project (IDSP) was launched by Hon’ble Union Minister of Health & Family Welfare in November 2004 for a period upto March 2010. The project was restructured and extended up to March 2012. The project continues in the 12th Plan with domestic budget as Integrated Disease Surveillance Programme under NHM for all States with Budgetary allocation of 640 Cr.
A Central Surveillance Unit (CSU) at Delhi, State Surveillance Units (SSU) at all State/UT head quarters and District Surveillance Units (DSU) at all Districts in the country have been established.
Objectives:
To strengthen/maintain decentralized laboratory based IT enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs)
Programme Components:
Integration and decentralization of surveillance activities through establishment of surveillance units at Centre, State and District level.
Human Resource Development – Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team and other Medical and Paramedical staff on principles of disease surveillance.
Use of Information Communication Technology for collection, collation, compilation, analysis and dissemination of data.
Strengthening of public health laboratories.
A decentralized system of disease surveillance for timely and effective public health action with a focus on functional integration of surveillance components of various vertical programmes.
National Leprosy Eradication Programme (NLEP)Kavya .
Chronic infectious disease caused by Mycobacterium leprae.
It usually affects the skin and peripheral nerves
Long incubation period generally 5-7 years.
Classified as paucibacillary or multibacillary
permanent disability
Timely diagnosis and treatment of cases
A decentralized system of disease surveillance for timely and effective public health action with a focus on functional integration of surveillance components of various vertical programmes.
National Leprosy Eradication Programme (NLEP)Kavya .
Chronic infectious disease caused by Mycobacterium leprae.
It usually affects the skin and peripheral nerves
Long incubation period generally 5-7 years.
Classified as paucibacillary or multibacillary
permanent disability
Timely diagnosis and treatment of cases
National Vector Borne Disease Control Programme (NVBDCP)Vivek Varat
The National Vector Borne Disease Control Programme (NVBDCP) is an umbrella programme for prevention and control of malaria and other vector borne diseases. Under the programme, it is ensured that the disadvantaged and marginalised sections benefit from the delivery of services so that the desired National Health Policy and Rural Health Mission goals are achieved. The Directorate of NVBDCP under the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, is the nodal agency responsible for planning, coordination, implementation, monitoring and evaluation of NVBDCP programme at all levels.
New Organogram of Nepalese Health System (Please check the updated slides on ...Prabesh Ghimire
This slide has been updated to accommodate the recent changes. Please check the following link for the updated presentation:
https://www.slideshare.net/PrabeshGhimire/organogram-organization-structure-of-nepalese-health-system-updated-nov-2021
National Vector Borne Disease Control Programme (NVBDCP)Vivek Varat
The National Vector Borne Disease Control Programme (NVBDCP) is an umbrella programme for prevention and control of malaria and other vector borne diseases. Under the programme, it is ensured that the disadvantaged and marginalised sections benefit from the delivery of services so that the desired National Health Policy and Rural Health Mission goals are achieved. The Directorate of NVBDCP under the Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India, is the nodal agency responsible for planning, coordination, implementation, monitoring and evaluation of NVBDCP programme at all levels.
New Organogram of Nepalese Health System (Please check the updated slides on ...Prabesh Ghimire
This slide has been updated to accommodate the recent changes. Please check the following link for the updated presentation:
https://www.slideshare.net/PrabeshGhimire/organogram-organization-structure-of-nepalese-health-system-updated-nov-2021
The Wisconsin Historical Society maintains the Wisconsin History and Architecture Inventory (AHI), consisting of approximately 120,000 properties surveyed by architectural historians or preservation consultants. The inventory has been assembled over a period of more than 25 years from a wide variety of sources. In many cases, the information is dated and properties may be altered or no longer exist. The majority of properties included in this inventory are privately owned and not open to the public. After 25 years of data collection, there are numerous difficulties with inaccurate addresses. Nearly 10,000 properties have errors, which makes it difficult to map out using a geocoder and have to be entered manually and validated with primary and secondary online sources. I will share how Historic Preservationist are using GIS and what online resources I use to validate and find historic sites from the past.
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GIS as tool for cultural heritage managementyllferizi
Digital tools for Disaster Management: Lecture & Workshop
- The usage of GIS, crowd mapping, social media and similar, in processing data
- Data management and protection
Planning and specification of Intensive Care UnitsAchi Kushnir PMP
This presentation has been designed to give the reader an overview in relation to the different aspects that are to be considered when planning and designing a new intensive care unit within a hospital
Now a days new apps and applications came into existence which are routinely using by public..in this context use of these software tools and android applications can be exploited to help the farming community for real time solutions without any gap in transfer of IPM information.This ppt useful to know the areas and forms of usage of computers in IPM.
The key objective of the programme is to strengthen/maintain decentralized laboratory based IT enabled disease surveillance system for epidemic prone diseases to monitor disease trends and to detect and respond to outbreaks in early rising phase through trained Rapid Response Team (RRTs).
Universal Health Coverage Action Framework for the Western Pacific RegionAlbert Domingo
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Chapter 19 Public Health InformaticsBrian Dixon PhDSaurabh .docxzebadiahsummers
Chapter 19: Public Health Informatics
Brian Dixon PhD
Saurabh Rahurkar DrPH
Learning Objectives
After reviewing the presentation, viewers should be able to:
Define public health informatics (PHI)
Explain the importance of informatics to the practice of public
health and the role of informatics within a public health agency
Define and distinguish the various forms of public health surveillance systems used in practice
List several common data sources used in the field of public health for surveillance
Public health: “the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals.”
Public health informatics: “systematic application of information and computer science and technology to public health practice, research and learning”
Whereas physicians and care delivery organizations focus on the health of individuals, public health focuses on the health of populations and communities.
Definitions
Definitions
Public health surveillance: ongoing systematic collection, analysis, and interpretation of health-related data essential to planning, implementation and evaluation of public health practice, closely integrated with the timely dissemination of these data for prevention and control
Syndromic surveillance: surveillance using health-related data that precede diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response
Introduction
The overarching goal of public health has been to monitor a variety of medical diseases and conditions rapidly and accurately so as to intervene as early as possible to detect, prevent, and mitigate the spread of epidemics, the effects of natural disasters, and bioterrorism
To address these challenges, public health organizations conduct a range of activities across three, broad core functions – assessment, policy development and assurance.
Assessment – Public health agencies spend most of their time and resources on investigations of potential threats to the public’s health. Activities include testing and monitoring of water quality, laboratory examination of diseases carried by mosquitoes, tracking food-borne illnesses, testing for environmental hazards (e.g. soil lead levels), monitoring for potential bioterrorism threats, and tracing the contacts for individuals exposed to diseases as well as hazardous chemicals.
Public Health 3 Core Functions
Policy Development – Public health agencies also create policies and regulations to protect the health of populations. For example, children may be required to have certain immunizations before they can attend school to prevent disease outbreaks that would harm children and disrupt family life. Agencies use the evidence they gather from their investigations as well as the scientific literature to advocate for p.
Universal health coverage (UHC) is a vision where all people and communities have access to quality health services where and when they need them, without suffering financial hardship. It includes the full spectrum of services needed throughout life—from health promotion to prevention, treatment, rehabilitation, and palliative care—and is best based on a strong primary health care system.
The Union Health and Family Welfare Minister J P Nadda on 15 May 2015 launched kayakalp Award Scheme.
The scheme is intended to encourage and incentivize Public Health Facilities (PHFs) in the country to demonstrate high levels of cleanliness, hygiene and infection control practices.
The objectives of the award scheme is to promote cleanliness, hygiene and infection control practices in public health care facilities, to incentivize and recognize such public healthcare facilities that show exemplary performance in adhering to standard protocols of cleanliness and infection control, to inculcate a culture of ongoing assessment and peer review of performance related to hygiene, cleanliness and sanitation, to create and share sustainable practices related to improved cleanliness in public health facilities linked to positive health outcomes.
To understand:
The principles of detecting and controlling an
outbreak.
What is needed for outbreak investigation
Steps in disease outbreak investigations.
Women's empowerment has become a significant topic of discussion in development and economics. It can also point to approaches regarding other trivialized genders in a particular political or social context. Women's economic empowerment refers to the ability for women to enjoy their rights to control and benefit from resources, assets, income and their own time, as well as the ability to manage risk and improve their economic status and well being. While often interchangeably used, the more comprehensive concept of gender empowerment refers to people of any gender, stressing the distinction between biological sex and gender as a role. It thereby also refers to other marginalized genders in a particular political or social context.
It is not necessary (although desirable) to know everything about the natural history of a disease to initiate preventive measures. Often times, removal or elimination of a single known essential cause may be sufficient to prevent a disease. The objective of preventive medicine is to intercept or oppose the "cause" and thereby the disease process. The epidemiological concept permits the inclusion of treatment as one of the modes of intervention.
RTS,S/AS01 (RTS,S) is a malaria vaccine that has been developed through a partnership between GlaxoSmithKline Biologicals (GSK) and the PATH Malaria Vaccine Initiative (MVI), with support from the Bill & Melinda Gates Foundation and from a network of African research centers that performed the studies.
Influenza vaccines or flu shots protect against influenza. A new version of the vaccine is developed twice a year as the influenza virus rapidly changes. Their effectiveness varies from year to year, most provide modest to high protection against influenza.
Social Security scheme for Women and Old age PeopleVivek Varat
Social security may also refer to the action programs of government intended to promote the welfare of the population through assistance measures guaranteeing access to The loss of support suffered by a widow or child as the result of the death of the breadwinner (survivor’s benefit);
Responsibility for the maintenance of children (family benefit);
The treatment of any morbid condition (including pregnancy), whatever its cause (medical care);
A suspension of earnings due to pregnancy and confinement and their consequences (maternity benefit);
A suspension of earnings due to an inability to obtain suitable employment for protected persons who are capable of, and available for, work (unemployment benefits);
A suspension of earnings due to an incapacity for work resulting from a morbid condition (sickness leave benefit);
A permanent or persistent inability to engage in any gainful activity (disability benefits);
The costs and losses involved in medical care, sickness leave, invalidity and death of the breadwinner due to an occupational accident or disease (employment injuries).
People who cannot reach a guaranteed social minimum for other reasons may be eligible for social assistance (or welfare, in American English).
Modern authors often consider the ILO approach too narrow. In their view, social security is not limited to the provision of cash transfers, but also aims at security of work, health, and social participation; and new social risks (single parenthood, the reconciliation of work and family life) should be included in the list as well.
National Program for Prevention and Control of Cancer, Diabetes, CVD and Stro...Vivek Varat
Government of India initiated a National Programme for Prevention and Control of Cancers, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) during 2010-11 after integrating the National Cancer Control Programme (NCCP) with (NPDCS).
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
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The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
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1. Integrated Disease Surveillance
Project (IDSP): Current Status
1
12/25/2016
Mentor
Prof.(Dr.) E. Venkata Rao
Community Medicine
Presenter
Dr. Vivek Varat Pattanaik
PG
Community Medicine
2. Outline
Introduction
Management structure of the
Integrated Disease Surveillance Project
Reporting units, participants
and their roles
Private sector participation in
disease surveillance
Case definitions of diseases and syndromes
under surveillance
Working with the laboratory
Outbreak investigation, response and control
Analysis and interpretation of data
Feedback
Monitoring, supervision and
quality control
Inter-sectoral coordination and social mobilization
Human resources development in the integrated
disease surveillance project
2
12/25/2016
3. History
1997-98: National Surveillance Program for Communicable Diseases
(NSPCD) initiated
March, 2003: Central Surveillance Unit (CSU)
Nov, 2004: Integrated Disease Surveillance Project (IDSP)
2007-08: Making of IDSP as part of National Rural Health Mission (NRHM)
12/25/2016
3
4. Public health Surveillance
Surveillance is defined as the ongoing systematic collection, collation,
analysis and interpretation of data and dissemination of information to
those who need to know in order that action be taken.
4
12/25/2016
5. Public health Surveillance
Surveillance is defined as the ongoing systematic collection, collation,
analysis and interpretation of data (disease / health event) and
dissemination of information to those who need to know in order that
action be taken.
5
12/25/2016
6. Why do we need to do surveillance?
Recognize cases or cluster of cases to trigger intervention to prevent transmission or reduce
morbidity and mortality.
Identify high risk groups or geographical areas to target interventions and guide analytic studies.
Develop hypotheses that lead to analytic studies about risk factors for disease causation,
propagation or progression.
Assess the public health impact of health events and measure trends.
Demonstrate the need for public health intervention programme and resources during public
health planning.
Monitor effectiveness of prevention and control measures and prevent outbreaks.
6
12/25/2016
7. Objectives of the Integrated Disease
Surveillance Project.
To establish a decentralized district based system of surveillance for communicable
and non-communicable diseases so that timely and effective public health actions
can be initiated in response to health changes in the urban and rural areas.
To integrate existing surveillance activities to avoid duplication and facilitate
sharing of information across all disease control programmes and other stake
holders so that valid data is available for health decision making in the district,
state and national levels
7
12/25/2016
8. Classification of surveillance in IDSP
Syndromic
Diagnosis made on the basis clinical pattern by paramedical personnel and
members of community
Presumptive
Diagnosis is made on typical history and clinical examination by medical officers
Confirmed
Clinical diagnosis by medical officer and or positive laboratory identification
8
12/25/2016
9. Conditions under regular surveillance
Type of disease Disease
Vector borne diseases •Malaria
Water borne diseases •Diarrhea (Cholera)
•Typhoid
Respiratory diseases •Tuberculosis
Vaccine preventable diseases •Measles
Disease under eradication •Polio
Other conditions •Road traffic accidents
International commitment •Plague
Unusual syndromes •Meningo-encephalitis
•Respiratory distress
•Hemorrhagic fever
12/25/2016 9
10. Other conditions under surveillance
Type of surveillance Categories Conditions
Sentinel surveillance •STDs •HIV/HBV/HCV
•Other
conditions
•Water quality
•Outdoor air quality
Regular surveys •Non
communicable
disease risk
factors
•Anthropometry
•Physical activity
•Blood pressure
•Tobacco, blood pressure
•Nutrition
•Blindness
Additional state priorities •Up to five diseases
12/25/2016 10
11. Reporting units for disease surveillance
Public sector
(Exhaustive)
Private
(Sentinel)
Rural •Community health centres
•District hospitals
•Practitioners
•Hospitals
Urban •Urban hospitals
•ESI
•Railways
•Medical colleges
•Nursing homes
•Hospitals
•Medical colleges
•Laboratories
12/25/2016
11
12. Phases of implementation for the
Integrated Disease Surveillance Project
Phase I (2004-05)
Madhya Pradesh, Andhra, Himachal, Karnataka, Kerala, Maharashtra,
Mizoram, Tamil Nadu & Uttaranchal
Phase II (2005-06)
Chattisgarh, Goa, Gujarat, Haryana, Orissa, Rajasthan, West Bengal,
Manipur, Meghalaya, Tripura, Chandigarh, Pondicherry, Nagaland,
Delhi
Ph III (2006-07)
UP, Bihar, J&K, Punjab, Jharkhand, Arunachal, Assam, Sikkim, A&N
Island, D&N Haveli, Daman & Diu, Lakshadweep
12/25/2016
12
14. National surveillance committee
Central surveillance unit
State surveillance committee
State surveillance unit
District surveillance committee
District surveillance unit
Organizational structure
12/25/2016
14
15. District surveillance committee
15
Chairperson
CMO
Representative
Water Board
Superintendent Of
Police
IMA
Representative
NGO
Representative
Medical College
Representative
District
Surveillance
Officer (Member
Secretary)
District Panchayat
Chairperson
District Training
Officer(IDSP)
Representative
Pollution Board
District Data
Manager (IDSP)
Chief District PH
Laboratory
District Program
Manager Polio,
Malaria, TB, HIV -
AIDS
12/25/2016
16. Functions of the district surveillance unit
Centralize and analyze data from all reporting units
Constitute rapid response teams and their deputation
Implement and monitor all project activities
Coordinate with laboratories, medical colleges, non
governmental organizations and private sector
Send regular feedback to the reporting units
Organize training and communication activities
Organize district surveillance committee meetings
12/25/2016
16
17. Functions of state surveillance unit
Collate and analyze data received from districts
Coordinate activities of rapid response teams
Monitor and review the activities of district surveillance units
Coordinate with state public health laboratories, medical
colleges and other state level institutions
Feedback trend analysis to district surveillance units
Organize and coordinate training activities
Organize meetings of the state surveillance committee
12/25/2016
17
18. Functions of central surveillance unit
Execute the approved annual plan of action
Monitor progress of implementation
Obtain reports and statements of expenditure
Seek reimbursement from the World Bank
Report to the national surveillance committee
Procure goods and services at central level
Analyze data and send feedback to states
Coordinate with NICD, ICMR and others
Organize non communicable diseases surveys
Conduct periodic review meetings with state surveillance officers
Organize independent evaluation studies
Produce guidelines, manuals and modules
12/25/2016
18
19. Information flow of the weekly surveillance system
Sub-centres
P.H.C.s
C.H.C.s
Dist. hosp.
Programme
officers
Pvt. practitioners
D.S.U.
P.H. lab.
Med. col.
Other Hospitals:
ESI, Municipal
Rly., Army etc.
S.S.U.
C.S.U.
Nursing homes
Private hospitals
Private labs.
Corporate
hospitals 12/25/2016
19
22. Reporting unit
Nature
Health facility / individual in private/ public sector
Located in rural or urban area
Function
Collects information of health conditions identified in specified formats
Transmits these in pre-specified timely manner to the next higher level
12/25/2016
22
23. Reporting units for disease surveillance
Public sector
(Exhaustive)
Private
(Sentinel)
Rural •Community health centres
•District hospitals
•Practitioners
•Hospitals
Urban •Urban hospitals
•ESI
•Railways
•Medical colleges
•Nursing homes
•Hospitals
•Medical colleges
•Laboratories
12/25/2016
23
24. Active and passive reporting
Active reporting
Health workers
House visits
Passive reporting
All other reporting units
12/25/2016
24
25. Three levels of case definitions
for three levels of actors
Level Actor of the surveillance system
•Syndromic
(Form “S”)
•Health workers
•Presumptive
(Form “P”, probable)
•Medical officers
•Confirmed •Laboratories
* Except for malaria and tuberculosis
12/25/2016
25
26. Reportable diseases for multi-purpose
health workers and health assistants
Diarrhea
Jaundice
Fever
Cough
Acute flaccid paralysis
Unusual events (Death, hospitalization)
12/25/2016
26
28. Zero reporting
Zero reporting is important to confirm that the condition was looked for and not
found
12/25/2016
28
29. Person responsible for data
compilation and transmission
Levels Person responsible
•Primary health centres •Pharmacists
•Community health centres •Computer / pharmacists
•Sentinel private providers •Medical officers
•District hospitals •Computer / pharmacists
•Medical colleges •Statistical officer
•Laboratories •Medical officer / technician
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30. Time sequence
•Community health centre
reports to district
Tuesday
•Primary health centre
reports to community
health centre
Monday
EventDay of the week
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32. Need for private sector participation
in disease surveillance
Most patients (>70%) go to private sector
Private physicians are the preferred first contact
Private sector is more likely to detect early warning signs of outbreak
Lack of public sector service provider especially in urban areas
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33. Initiating partnership
MOU (memorandum of
understanding) with
IMA/IAP/other professional
bodies
National/State/District level
Training
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34. Criteria for inclusion
Reporting units
Hospitals
Nursing homes
Clinics
Various systems of medicine
Geographical distribution
Involve professional associations
Indian Medical Association
Indian Academy of Pediatrics
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35. Expected numbers of practitioners
to include
Rural areas
15-45/100,000 population
Urban areas
15-30/100,000 population
Increase the number in phases
More private practitioners in rural areas
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38. Types of case definitions in use
Case definition Criteria Who uses it
Syndromic Clinical pattern Paramedical personnel and
members of community
Presumptive Typical history and
clinical examination
Medical officers of primary
and community health
centres
Confirmed Clinical diagnosis by a
medical officer and
positive laboratory
identification
Medical officer and
Laboratory staff
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39. 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
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40. Levels of case definitions
Suspect case
A case that meets the clinical case definition
Probable case
A suspect case that is diagnosed by a medical officer
Confirmed case
A suspect case that is laboratory confirmed
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41. Levels of response to different triggers
Trigger Significance Levels of response
1 Suspected /limited outbreak • Local response by health worker
and medical officer
2 Outbreak • Local and district response by
district surveillance officer and
rapid response team
3 Confirmed outbreak • Local, district and state
4 Wide spread epidemic • State level response
5 Disaster response • Local, district, state and centre
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42. Conditions under regular surveillance
Type of disease Disease
Vector borne diseases •Malaria
Water borne diseases •Diarrhea (Cholera)
•Typhoid
Respiratory diseases •Tuberculosis
Vaccine preventable diseases •Measles
Disease under eradication •Polio
Other conditions •Road traffic accidents
International commitment •Plague
Unusual syndromes •Meningo-encephalitis
•Respiratory distress
•Hemorrhagic fever
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43. Other conditions under surveillance
Type of surveillance Categories Conditions
Sentinel surveillance •STDs •HIV/HBV/HCV
•Other conditions •Water quality
•Outdoor air quality
Regular surveys •Non
communicable
disease risk
factors
•Anthropometry
•Physical activity
•Blood pressure
•Tobacco, blood pressure
•Nutrition
•Blindness
Additional state priorities •Up to five diseases12/25/2016 43
45. Role of laboratories in disease surveillance
Early diagnosis of diseases under surveillance
Epidemiological investigation
Rapid laboratory confirmation of diagnosis
Implementation of effective control measures
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45
46. Laboratory network for the Integrated
Disease Surveillance Project
Laboratories Description
L1 • Peripheral laboratories and microscopic centres
L2 • District public health laboratory
L3 • Disease based state laboratories
L4 • Regional laboratories and quality control laboratories
L5 • Disease based reference laboratories 12/25/2016
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47. Conditions under regular surveillance
Type of disease Disease
Vector borne diseases •Malaria
Water borne diseases •Diarrhea (Cholera)
•Typhoid
Respiratory diseases •Tuberculosis
Vaccine preventable diseases •Measles
Disease under eradication •Polio
Other conditions •Road traffic injuries
International commitment •Plague
Unusual syndromes •Meningo-encephalitis
•Respiratory distress
•Hemorrhagic fever
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48. Other conditions under surveillance
Type of surveillance Categories Conditions
Sentinel surveillance •STDs •HIV/HBV/HCV
•Other conditions •Water quality
•Outdoor air quality
Regular surveys •Non communicable
disease risk factors
•Anthropometry
•Physical activity
•Blood pressure
•Tobacco, blood pressure
•Nutrition
•Blindness
Additional state priorities •Up to five diseases12/25/2016 48
49. Syndrome Action
•Fever •Blood smear for all patients
•Acute flaccid paralysis •2 stool samples at interval of 24 hours
transported to the medical officer of
the primary health centre in reverse
cold chain
•Fever with rash, altered sensorium or
bleeding
•Refer to the medical officer of the
primary health centre for specific
laboratory action•Fever more than 14 days
•Cough < or > 3 weeks
•Loose watery stools
•Acute jaundice
•Unusual syndromes
Action to be taken by the multi-purpose
worker in the field
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50. Information to be recorded on each specimen/
accompanied with each specimen
Name, age, sex
Address in detail
Reporting unit referring the sample
Syndromic diagnosis
Date of onset of illness
Nature of sample, date of collection, date of receipt and condition
of sample
Investigation requested
Whether convalescent specimen or not
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51. ID no Name and
address of
patient
Age Sex Prov.
Diag.
Lab tests
ordered
Lab
results
Date
sent
to L2
Result
from L2
Date of
result
Sample laboratory register
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52. The L form
Weekly reports from laboratories to the district surveillance officer
Prepared on the basis of the laboratory register
Filled by nodal person in the laboratory
Sent every Saturday of each week
Zero/NIL reporting
Electronic link between
District public health laboratory
District surveillance unit
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54. Definition of an outbreak
Occurrence in a community of cases of an illness clearly in excess of expected
numbers
The occurrence of two or more epidemiologically linked cases of a disease of
outbreak potential constitutes an outbreak
(e.g., Measles, Cholera, Dengue, Japanese encephalitis, or plague)
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55. Sources of information
to detect outbreaks
Rumour register
To be kept in standardized format in each institution
Rumours need to be investigated
Community informants
Private and public sector
Media
Important source of information, not to neglect
Review of routine data
Triggers
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56. Early warning signals for an outbreak
Clustering of cases or deaths
Increases in cases or deaths
Single case of disease of epidemic potential
Acute febrile illness of an unknown etiology
Two or more linked cases of meningitis, measles
Unusual isolate
Shifting in age distribution of cases
High vector density
Natural disasters
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57. Objectives of an outbreak investigation
1. Verify
2. Recognize the magnitude
3. Diagnose the agent
4. Identify the source and
mode of transmission
5. Formulate prevention and
control measures
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58. Outbreak preparedness:
A summary of preparatory action
Formation of rapid response team
Training of the rapid response team
Regular review of the data
Identification of ‘outbreak seasons’
Identification of‘outbreak regions’
Provision of necessary drugs and materials
Identification and strengthening appropriate laboratories
Designation of vehicles for outbreak investigation
Establishment of communication channels in working conditions
(e.g., Telephone)
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59. Basic responses to triggers
There are triggers for each condition under surveillance
Various trigger levels may lead to local or broader response
Tables in the operation manual propose standardized actions to take following
various triggers
Investigations are needed in addition to standardized actions
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60. Levels of response to different triggers
Trigger Significance Levels of response
1 Suspected /limited outbreak • Local response by health worker
and medical officer
2 Outbreak • Local and district response by
district surveillance officer and
rapid response team
3 Confirmed outbreak • Local, district and state
4 Wide spread epidemic • State level response
5 Disaster response • Local, district, state and centre
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61. Importance of timely action: The first
information report (Form C)
Filled by the reporting unit
Submitted to the District Surveillance Officer as soon as the suspected outbreak is
verified
Sent by the fastest route of information available
Telephone
Fax
E-mail
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62. The rapid response team
Composition
Epidemiologist, clinician and microbiologist
Gathered on ad hoc basis when needed
Role
Confirm and investigate outbreaks
Responsibility
Assist in the investigation and response
Primary responsibility rests with local health staff
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63. Incidence of acute hepatitis
by source of water supply, Bhimtal block,
Uttaranchal, India, July 2005
Mehragaon
main
village
Dov
Water supply
Spring
Reservoir
Pipeline
Attack rate
< 5%
5-9%
10% +
Mehragaon
Hydle colony
Chauriagaon
Mehragaon
Suspected
spring
Place
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64. Specific outbreak control measures
Waterborne outbreaks
Access to safe drinking water
Sanitary disposal of human waste
Frequent hand washing with soap
Adopting safe practices in food handling
Vector borne outbreaks
Vector control
Personal protective measures
Vaccine preventable outbreaks
Supplies vaccines, syringes and injection equipment
Human resources to administer vaccine
Ring immunization when applicable
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66. Selected outcomes of data analysis
Identification of outbreaks / potential outbreaks
Identification of appropriate and timely control measures
Prediction of changes in disease trends over time
Identification of problems in health systems
Improvement of the surveillance system through:
Identification of regional differences
Identification of differences between the private and the public sectors
Identification of high-risk population groups
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67. Types of data
Syndromic case data
Presumptive case data
Confirmed case data
Sentinel case data
Regular surveillance data
Urban data
Rural data
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68. Basic surveillance data analysis
1. Count, divide and compare
Direct comparisons between number of cases are not possible in the absence of the
calculation of the incidence rate
2. Descriptive epidemiology
A. Time
B. Place
C. Person
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69. Reported varicella and typhoid cases, Darjeeling
district, West Bengal, India, 2000-4
Figure 3: Reported varicella and typhoid cases, Darjeeling
district, WB, India, 2000-2004
1
10
100
1000
10000
100000
2000 2001 2002 2003 2004
Years
Numberofcases(Log)
Typhoid
Varicella
Incidence by year
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72. Malaria in Kurseong block, Darjeeling
District, West Bengal, India, 2000-2004
0
5
10
15
20
25
30
35
40
45
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
January
February
March
April
May
June
July
August
September
October
November
December
2000 2001 2002 2003 2004
Months
Incidenceofmalariaper10,000
Incidence of malaria
Incidence of Pf malaria
Example of monthly and yearly analysis
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73. Review of analysis results by the technical
committee
Meeting on a fixed day of every week
Review of a minimum of:
4 reports weekly
7 reports monthly
Review by disease wise
Search for missing values
Check the validity
Interpret
Prepare summary reports and share
Take action
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80. Supervision and monitoring
Good supervision helps health staff to perform their best
Monitoring is also a vital component of any surveillance programme
Monitor all surveillance activities using standard performance indicators
District surveillance office monitor indicators of reporting on a regular basis
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81. Creative monitoring solutions,
Haryana, 2007
District register keeping track of
reports
Reporting units that are not
timely are flagged with a
highlighter
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82. WEEKS 1 2 3 4 5 6 7 8 9 10
Baripada(DHH)
B.Pahad CHC
B.posi
BahaldaCHC
BarasahiCHC
Betnati CHC
Bijatala PHC
Dukura CHC
G.mahisani PHC
JamdaPHC
Jashipur CHC
K.tandiUHPHC
KaptipadaCHC
Karanjia,SDH
KC PurPHC
Khunta PHC
KosthaCHC
KulianaPHC
ManadaCHC
RangamatiaPHC
Raruan PHC
RG PHC
RR Pur, SDH
SC Pur PHC
ShirsaCHC
Sukruli PHC
T.mundaCHC
TatoPHC
Tiring PHC
Udala, SDH
Colour-coded monitoring of reporting,
Mayurbhanj district, Orissa, India, 2004
Legend
Timely, complete
Timely, incomplete
Complete, not timely
Incomplete and late
No reports
The colour coding stimulates
reporting units that
are not performing Monitoring
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83. Central agencies responsible
for quality control
Central surveillance office
National Institute of Communicable Diseases (NICD)
Indian Council of Medical Research (ICMR)
Quality 12/25/2016
83
84. Other agencies identified by the Ministry of
Health and Family Welfare for external
evaluation
World Bank
World Health Organization
United States Centers for Diseases Control and prevention (CDC)
INDIACLEN
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84
86. Coordination
The process of linking the activities of various departments of
an organization
The process by which managers achieve integrated patterns
of group and individual effort
i.e., Develop unity of action in common purposes
The integration, synchronization or orderly patterning of
group efforts by an organization towards the accomplishment
of common goals or objectives
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87. Stakeholders
Medical officer of primary health centres
Sentinel private practitioners
Community representatives
District
All members of the district surveillance unit
State
All members of the state surveillance unit
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87
88. Aim of the social mobilization campaign
Create awareness among:
Partners
Private practitioners
Non governmental organizations
Community
Establish an institutional mechanism to involve community and their leaders
Rotating membership in:
District surveillance committee
Block surveillance committee
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89. Strategizing communication
Adapt message and format to the audiences
Consider all media
Electronic media
Press
Hoardings
Handbills
Posters
Inter-personal communication through health providers
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90. Being close from the community
People volunteer in areas where health workers enjoy a good
relationship with their communities
Individual initiatives taken by enthusiastic health staff make a
difference
Key contacts
Village elders’
Ladies
Pradhan (Village head)
Panchayat members
Chowkidar (Village guard)
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91. Engaging medical colleges
Responsibility of the state surveillance unit
Memoranda of understanding
Selection of a coordinating medical college by the Director of Medical Education
Facilitation by the health secretary
Possibility for medical colleges to work in urban surveillance
Contacts at the central level will facilitate these synergies
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92. Institutional Integrated Disease Surveillance
Project sub-committee
within medical colleges
Principal / superintendent
Report to Integrated Disease Surveillance Project
Community medicine
Medicine
Pediatrics
Chest and tuberculosis
Microbiology
Cardiology
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93. Additional potential roles of
medical colleges
Reference laboratories
Quality assurance and evaluation
Training
Outbreak investigations
In collaboration with the district surveillance officer / medical officer
Non communicable disease risk factor surveillance
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95. Principles for human resources development in
the Integrated Disease Surveillance Project
No additional staff to be employed
Existing personnel will be provided training
Training will be provided locally
Public private partnership
Quality assurance process in the training of the trainers process
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96. Categories of trainees
I. State and district surveillance teams
II. Medical officers
III. Clinical medical officers
IV. Sub-block staff
V. State and district level laboratory staff
VI. Laboratory staff at sub district level
VII. Data entry operators
VIII. Statisticians at district and state level
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97. Induction training courses
1. State and district teams (The trainers)
2. Medical officers
PHC / CHC / Urban Health services / Medical colleges
1. Medical officers
• Private sector
2. Peripheral workers
3. Microbiologists and technicians - State and district
4. Laboratory technicians at sub district level
5. Data entry operators - State/ district/ sub district
6. Data managers - District and State
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98. Location and duration of the training
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Target audience Site Duration
1. Trainers Region / state 6 days
2. Medical officers District headquarters 3 days
3. Other officers District headquarters 1 day
4. Health workers Community health centre 2 days
5. Microbiologists Region / state 6 days
6. Lab assistants District headquarters 3 days
7. Data operators District headquarters 2 days
8. Data managers Region / state 3 days