Driving without looking at the traffic? Is like making public health decisions in the absence of data
Surveillance: A role of the public health system The systematic process of collection, transmission, analysis and feedback of public health data for decision making Surveillance
Information collected by the surveillance system
How many get them?
Who get the disease?
Where they get them?
When they get them?
Why they get them?
What needs to be done as response?
A dynamic vision of surveillance All levels use information to make decisions Surveillance The private sector can treat patients but only the public sector can coordinate surveillance Collect and transmit data Analyze data Feedback information Make decisions
Syndromes under surveillance
Acute flaccid paralysis
Unusual syndrome causing
Fever less than 7 days with:
Rash and cough or coryza or conjunctivitis (suspected measles)
Altered sensorium (suspected Japanese encephalitis or malaria)
Convulsions (suspected Japanese encephalitis )
Bleeding from skin, mucus membrane, vomiting blood or passing fresh blood or black motion (suspected Dengue)
With none of the above (suspected malaria)
Fever > 7 days
More than 2 similar case in the village (1000 Population)/ Camp site
Short duration (Cough < 2 weeks)
Suspected acute respiratory tract infection
Longer duration (Cough of > 2 weeks)
Any new case of watery diarrhea
Passage of 3 or more loose / watery stools in 24 hours
With or without dehydration
Total duration of illness < 14 days
Dysentery : Presence of visible blood in stool
More than 10 houses with diarrhea in a village or urban ward or a single case of severe dehydration or death in a patient > than 5 years with diarrhea
A new patient with an acute illness (<4 weeks) and following symptoms:
Jaundice, dark urine
Anorexia, malaise, fatigue
Pain in abdomen (right upper quadrant)
More than two cases of jaundice in different houses irrespective of age in a village or 1000 population
Acute flaccid paralysis
A case of acute flaccid paralysis is defined as any child:
Aged <15 years
Has acute onset of flaccid paralysis for which no obvious cause is found
Single case of AFP
Anticipated health problems and interventions Phases Anticipated health problems Possible Interventions Days 1-3 Injury/drowning and deaths Safe disposal of dead bodies Injury management Needs assessment for health Days 3-5 Diarrhoeal diseases Acute respiratory infections Psychosocial problems
5-10 days Above plus: Dehydration, Pneumonia, conjunctivitis, and skin infections Above plus; Antibiotics for pneumonia ; IV Fluids Drugs for skin infections and conjunctivitis >10 days Above plus: Vector-borne diseases (malaria, DF), Typhoid fever, Measles, and Malnutrition Ongoing surveillance Health education, measures for vector control, antimalarial Supplementary feeding program Rebuilding health infrastructure
Measured as number of deaths per 10000 population per day
Crude mortality rate (CMR) is for entire population and under 5 mortality rate (U5MR) is for children under 5 years of age
CMR = No. of deaths X 10000 Population X Period
Benchmark Mortality Rates in Emergencies
Crude Mortality Rate CMR (deaths/10,000/day)
Morbidity is the number of NEW cases of a GIVEN DISEASE among the population over a certain period of TIME
Measured per 10000 population per day
AR and CFR
Attack rate (outbreaks): The cumulative incidence of cases (persons meeting case definition since onset of outbreak) in a group observed over a period during an outbreak.
Case-fatality ratio (CFR): the percentage of persons diagnosed as having a specified disease who die as a result of that disease within a given period, usually expressed as a percentage (cases per 100).
The first onset of Measles occurred in Madhepura on the 2 nd of September 2008.
The total population affected is estimated to be 10,000 .
The Measles outbreak had a cumulative admission total of 145 males child and 155 female child.
The daily admission rate is approx 35 patients.
This outbreak claimed 6 lives
Calculate AR and CFR. What do they tell you?
Attack Rate = number of cases x 100 population at risk Attack Rate = (145+155) = .030 ; 10,000 .03 x 100 = 3.0% There was a 3.0% attack rate. Based on the population, what does this attack rate indicate? (The attack rate is very high.This is a crisis situation. Response activities should be re-evaluated.)
Case Fatality Ratio (CFR)= number of deaths x 100 number of cases = 6 = .02 (145+155) = .02 x 100 = 2.0% There was a 2.0% CFR. Based on the standards for Measles treatment, what does this CFR indicate? (This exceeds the standard of 1%. Serious action needs to be taken to improve health seeking behaviour and response activities).
Mortality in Refugee and Displaced Populations
Major causes of death in the emergency phase
Acute respiratory infections
50% - 90% of deaths in some refugee settings due to these 3 diseases
PROLONGED STRESS- NOT/ ENOUGH FOOD- ZERO HYGIENE- OVERCROWDED POPULATION DISEASE DETERMINANTS IN CAMPS
Catch-up Health and Nutrition Round :
Manpower support for Micro planning, Orientation and Monitoring
IEC ( Session site banners, banners, posters, handouts etc)
Intervention Age group Routine immunization Pregnant women and children as per EPI schedule Catch-up immunization (Measles Vaccination) 6 months to 14 years Catch–up Vitamin A doses 9 months to 5 years IFA supplementation 6months to 5 years De-worming tablets 2 years to 5 years Low osmolarity ORS All children affected with diarrhea; 6 months to 5 years Zinc Along with ORS
Prevent or detect the outbreak
- Timely, high quality mass campaigns in emergencies
- Routine childhood vaccination
Appropriate treatment of illness
- Vitamin A
Infants <6m 50,000 IU – repeat next day
Infants 6-11m 100,000 IU – repeat next day
Children 1y+ 200,000 IU – repeat next day
- Antibiotics for bacterial secondary infections
- Treat dehydration
Preventing Measles Illness and Death in Emergencies
Measles and Vitamin A Campaign
To prevent outbreaks in flood affected areas
Congregated populations displaced by flood, living in relief camps.
Target Age Group
Measles immunization: Children from 6 months through 14 years age.
Vitamin A: Children from 9 months to 5 years age
Microplan: Essential Background Information: Infrastructure and Manpower
Safety boxes = AD syringes + syringes for dilution
Vit A- 10 % reserve
CALCULATING COLD CHAIN NEEDS:
Vaccine carriers: at least 2 per team
1 for vaccine 1 for extra icepacks
Cold boxes: 1 for each storage depot
Icepacks: = vaccine carriers X 4 + large cold boxes X 50
Fuel for generator (icepacks need to be frozen 3-5 days before campaign)
Calculating Transport Needs
Transport for supplies
Transport for teams, supervisors, coordinators, monitors
Fuel for vehicles & Hiring cost of vehicles
ASHA for Floods
ASHA workers need to be mobilized
Minimal package for Newborn, child and maternal health care: Training of ASHAs, PNC visit for maternal and newborn care, Breast feeding training for early initiation and exclusive Breastfeeding, ORS and Zinc for the management of Diarrhoea
ASHAs to be equipped with counseling materials, ASHA kits
The ASHA worker will be responsible for
Ensuring chlorination of hand pumps,
Testing water quality,
PNC visits for mother and newborns and
HOME VISIT FOR PNC BY ASHA WORKER COUNSELLING FOR BREASTFEEDING
ENSURING POST NATAL CARE FOR MOTHER AND CHILD IN EMERGENCY ASHA THE REFERRAL LINK FROM VILLAGES TO DISTRICT HOSPITAL NSU
REFERRAL LINKAGE: ASHA WORKER PROVIDING POST NATAL CARE AND REFERRAL IN VILLAGES
To reduce the threat of epidemics regarding acute watery diarrhea & malaria/dengue following steps are to be taken
a. Sustained & continuous provision of safe drinking water through
Water purification plants.
Provision of Aqua Pure tablets for household.
Provision of chlorinated water through tankers.
b. Provision of L-ORS & Zinc.
c. Provision of soap for hand washing before meals and after defecation.
d. Health Education and awareness campaign through Banners, leaflets & electronic media.
e. Fogging in all already covered as well as un-covered areas.
f. Continuous indoor residual spray
g. Continuous and sustained supply of Anti-diarrhoea & Anti malarial drugs.
h. Early diagnosis through rapid diagnostic kits.
i. Quick epidemic response through regional & district epidemic response team.
Government of Bihar Flood Response 2007 Daily IDSP Morbidity Reporting for the Facility / PHC / Mobile Clinic/Camp Name of PHC / GH / Municipal Health post: Team leader of the Mobile team: Date of reporting Syndrome Cases Reported Total (To put the total no. against each syndrome at the end of the day) Under 5 years 5 years and over No. of cases No. of deaths No. of cases No. of deaths 1. Fever 2. Fever with rash 3. Acute Diarrheal Diseases (including cholera) 4. Acute Jaundice 5. Acute Respiratory Infections 6. Others Total Total patients seen at the facility / Mobile Clinic: : Reporting Person (MO / I / C / Heath Officer) : Instructions: a) Each Mobile team to report consolidated figures for all sites visited at PHC level on a daily basis. b) The PHC to send compiled report of PHC and all other activities to District Data Cell and State Data Cell daily.
Government of Bihar Flood Response 2007 COMPILATION of Daily IDSP Morbidity Reporting for the PHC Area Name of PHC (District) Population under PHC Date of reporting PHC Mobile Clinics Other Fixed Sites under PHC TOTAL Syndrome No. of clinics / sites Fever Under 5 years 5 years and over Fever with Rash Under 5 years 5 years and over Acute Diarrheal Diseases (Including Cholera) Under 5 years 5 years and over Acute Jaundice Under 5 years 5 years and over Acute Respiratory Infections Under 5 years 5 years and over Others Under 5 years 5 years and over Total CASES Under 5 years 5 years and over TOTAL DEATHS Under 5 years 5 years and over Other Remarks / Comments: Reporting Person (MO / I / C / Health Officer) : Instructions: a) Each Mobile team to report consolidated figures for all sites visited at PHC level on a daily basis. b) The PHC to send compiled report of PHC and all other activities to District Data Cell and State Data Cell daily.
DISTRICT HEALTH SOCIETY Daily Immunization Report Date- S No- Name of Block OPV Vit A Measles Pregent woman TT Any Adverse Reported No of team .
DISTRICT HEALTH SOCIETY Mobile Team Activity Chart: - Date: Name of PHC Reg. No. of Ambulance No. of Health Camp Visited by Mobile Team No. of Patients (Treated by Mobile Team) Medicines (Distributed by Mobile Team) Others Services provided by Mobile Team (if any) Name & No. of Contact Person of concerned PHC (Where Mobile team is deployed) Name Quantity
Following Components :–
Logistics – Inventory of resources (existing + required), prepositioning