public health surveillance
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  • 1. 1 03/08/2012
  • 2. 2 A Term paper presentation to fulfill the partial requirement of BPH THIRD SEMESTER [TPP 5.1 BASIC EPIDEMIOLOGY-II] Prepared by  SAgun PAudel Presented with:  Rajesh kumar Yadav  Purnima Timilsina  Kalpana Gurung LA GRANDEE International college, Pokhara 03/08/2012
  • 3. Public health Surveillance3 Public health surveillance is the On-going, systematic collection, analysis, and interpretation of health-related data and dissemination for use in the planning, implementation, and evaluation of public health practice on a specific disease or other health-related event. Such surveillance can:  serve as an early warning system for impending public health emergencies;  document the impact of an intervention, or track progress towards specified goals; and  monitor and clarify the epidemiology of health problems, to allow priorities to be set and to inform public health 03/08/2012 policy and strategies
  • 4. 4 Better surveillance data lead to a more rational establishment of priorities. More timely and accurate data facilitate earlier epidemic detection and control. With better surveillance data, the impact of intervention activities and other public health programs can be evaluated more accurately. 03/08/2012
  • 5. Uses of Public Health Surveillance5 Public Health Surveillance has many uses;  Monitoring trends in health events.  Guiding decision making and action to reduce morbidity and mortality  Detecting cases for intervention, evaluate control and prevention measures.  Guiding planning, implementation and evaluation of public health programs, providing a basis for epidemiological research. 03/08/2012
  • 6. 6  Estimate magnitude of the problem.  Portray the natural history of a disease.  Determine distribution and spread of illness.  Detecting potential outbreaks and threats to public health.  Monitor changes in infectious agents.  Directing public health interventions  Generate hypotheses, stimulate research. 03/08/2012
  • 7. Flowchart of Surveillance Data7 03/08/2012
  • 8. Objective:8 General Objectives:  To Study the Public health surveillance system at national & international level. Specific Objectives:  To study the Public health surveillance frame work, guidelines and strategies.  To study the public health surveillance of Nepal.  To study the Joint National/International Review of Acute Flaccid Paralysis (AFP) Surveillance – Nepal. 03/08/2012
  • 9. METHODOLOGY9 Secondary data 03/08/2012
  • 10. Finding and discussion10 Disease surveillance being a critical component of the health system in generating essential information for optimal health care delivery and a cost-effective health strategy, WHO has been making continuous efforts very actively in developing and strengthening disease surveillance during the last three decades. At present, surveillance activities in the Region are through several vertical surveillance systems resulting in duplication of efforts and resources. 03/08/2012
  • 11. 11 Many of them do not adequately address surveillance issues, namely, objective assessment of estimation of disease burden, identification of risk groups, spread of the disease, detection of early warning signals, anticipation and prediction of outbreaks, understanding drug resistance, etc. The current global trend is to move towards integrated disease surveillance activities that maintain essential resources, planning, monitoring and evaluation so as to monitor the quality of prevention and control activities and assess their impact on various diseases. 03/08/2012
  • 12. Proposed SEAR Strategy for Integrated Disease Surveillance12 The Global Meeting on Communicable Diseases Surveillance, including Epidemic-prone and/or Vaccine Preventable Diseases, held at Cairo, Egypt, in January 2001, recommended integrated multi-disease surveillance as a means of achieving efficiency and effectiveness in surveillance. 03/08/2012
  • 13. 13 an integrated approach to surveillance will require a functional change in the existing surveillance system. The integrated surveillance will sum up all surveillance activities, which will merge into a national integrated disease surveillance programme. It will envisage all surveillance activities in a country as a common public service which carries out many functions using similar structures, processes and personnel. 03/08/2012
  • 14. 14 The guiding principles in integration will be primarily to enhance effectiveness and cost efficiency and to meet the objectives of disease prevention and control through improvement of core and support functions of surveillance. Capacity building, laboratory strengthening and quality assurance should be pro-actively supported and promoted. General guiding principles like simplicity, usefulness, flexibility, accessibility to the data etc. should also be attended too. 03/08/2012
  • 15. 15 The strategy envisions that by the year 2010 all the Member States in the. SEA Region will establish a functional, effective coordinated integrated disease surveillance system that will satisfy all disease surveillance partners and ensure continuous, accurate, timely and complete information for disease prevention, control, elimination and eradication. 03/08/2012
  • 16. The strategy framework broadly16 covers: (a) Developing a and private sectors consensus, (h) Capacity building, (b) Phasing, (i) Community (c) Establishing a strong participation, coordination mechanism, (j) Use of new electronic (d) Evaluating existing tools, and surveillance systems, (k) A syndromic approach. (e) Advocacy, (f) Resource generation, (g) Involvement of NGOs 03/08/2012
  • 17. The major operational thrust areas are:17 (1) To include under integrated surveillance 16 epidemic-prone communicable diseases, three communicable diseases under eradication/elimination, three communicable diseases of major public health importance, four non-communicable diseases and eight risk factors for Non-communicable diseases in phases during the next decade with immediate emphasis on epidemic prone diseases; and priority communicable diseases.; 03/08/2012
  • 18. 18 (2) Capacity building covering epidemiology, laboratory, communication including use of computer and acquiring competence in data handling; (3) Understanding vectors and animal reservoirs; (4) anti-microbial drug resistance; (5) Involvement of the private sector, and (6) Feedback. 03/08/2012
  • 19. 19 03/08/2012
  • 20. 20 The disease surveillance system in Nepal has been integrated with the health management information system (HMIS) which conducts routine surveillance activities. The early warning reporting system (EWARS) is activated at sentinel surveillance centres and provides early notifications about diseases under sentinel surveillance. Rapid response teams (RRT) report daily when there is an outbreak of disease under surveillance. Reporting is carried out through health workers, NGOs/INGOs, media and through adhoc reporting. 03/08/2012
  • 21. 21  Malaria, kala-azar, Japanese encephalitis, lymphatic filariasis, leprosy, HIV/AIDS, STDs, human rabies, snake-bites, ARI, diarroheal diseases, EPI diseases, meningitis, dengue, typhoid fever, viral hepatitis, UTI and influenza are the diseases under the routine surveillance system and case definitions and standards are available. 03/08/2012
  • 22. 22  All the clinically suspected cases are reported to the intermediate level by peripheral level health workers with available information and with supportive laboratory data, if available. Clinical samples are sent to Regional and central laboratories for confirmation. All these cases are reported to HMIS routinely. Anti-microbial resistance surveillance on vibrio, shigella, pneumococci, streptococci pneumonia, heamophilus influnzae and Neissseria gonorrhoeae is institutionalized. 03/08/2012
  • 23. 23 Joint National/International Review of Acute Flaccid Paralysis (AFP) Surveillance – Nepal 03/08/2012
  • 24. Surveillance Structure24 AFP surveillance is well established in Nepal and, although integrated with other disease reporting, it has special status as evidenced by the monitoring of specific performance indicators, zero reporting, and active surveillance. Public health staff appears motivated, conscientious, well trained, and aware about AFP notification and investigation procedures at all levels – even among the FCHVs working at the village level. As discussed earlier, the SMOs are key focal persons for AFP surveillance in the districts/regions. 03/08/2012
  • 25. 25  After PEN was established, guidelines specifically for AFP surveillance were developed in 1998. These were updated in 2003 and again in 2005 to include additional priority VPDs. The guidelines and manuals for AFP and EPI surveillance activities were readily available in the SMO field locations visited. Display of EPI data, including spot maps of AFP cases and surveillance indicators were prominently displayed. Polio eradication and AFP posters were also noticeable at all levels including the 03/08/2012 sub-health posts.
  • 26. The different components of the26 AFP surveillance system are;  Immediate reporting,Case investigation  Active surveillance  Zero reporting  Surveillance of Acute Flaccid Paralysis (AFP) cases: Nepal continues to maintain certification standard AFP surveillance since 2000. There are 15 surveillance medical officers based in ten field offices supported by WHO conducting surveillance and also assisting national counter parts in the field of vaccine preventable diseases.  Active surveillance 03/08/2012
  • 27. Surveillance Quality Indicators, Nepal 2001 – 2006 (as of 31 July 2006).27 1- Number of AFP cases per 100 000 children under 15 years of age. 2006 AFP Rate annualized as of week 30, 2006. 2-Number of discarded AFP cases per 100 000 children under 15 years of age. The 2006 non-polio AFP Rate annualized as of week 30, 2006. 3- Percent with two specimens 24 hours apart and within 14 days of paralysis onset 03/08/2012
  • 28. Nepal Surveillance medical officers28 [SMO] Network 03/08/2012
  • 29. Conclusion29 In conclusion WHO urges all the Member Countries to initiate the process of reviewing their existing surveillance systems and implement an integrated national disease surveillance programme by merging all surveillance systems through consensus among all the partners and stakeholders and mobilizing resources for the same. 03/08/2012
  • 30. 30 The Nepal Ministry of Health, Department of Health Services should be commended for an efficient and well-integrated AFP surveillance, strong EPI coverage, and commitment to polio eradication. All these areas appear to have been strengthened over the last several years due to strong leadership and motivated staff at all levels. However, it is likely that wild poliovirus continues to circulate in high-risk areas of Nepal. 03/08/2012
  • 31. Recommendations31 • The FCHVs should be mobilized to raise awareness and encourage health institutions and private practioners at community levels in border areas to report AFP cases immediately to SMOs and health services. • Unless circumstances change substantially in 2006, no additional AFP surveillance review is required this year. Ongoing monitoring of the sensitivity of the surveillance system should continue and the need for another AFP review in 2007 assessed. 03/08/2012
  • 32. 32 • SMOs should continue to increase awareness on AFP among private practioners, traditional healers and local community health staff and leaders, in order to improve timely notification and investigations. • Nepal should continue to review its Plan of Action for Responding to Polio Outbreaks in order to ensure that it is up to date with the latest WHO and ACPE recommendations. 03/08/2012
  • 33. References:33 • A report of Joint National/International Review of Acute Flaccid Paralysis (AFP) Surveillance – Nepal. • Regional Strategy for Integrated Disease Surveillance Report of an Intercountry Consultation Yangon, Myanmar, 21-24 August 2002 • Polio fact sheet-NEPAL WHO • World Health Organization. 03/08/2012
  • 34. 34 03/08/2012