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Innovation in Surveillance of Communicable and Non-Communicable Diseases

Innovation in Surveillance of Communicable and Non-communicable Diseases http://nirmalkandel.com/wp-content/uploads/2014/03/Innovation-in-Surveillance.pdf

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Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
1 |
3rd National Scientific Conference on
Epidemiology
Innovation in Surveillance of
Communicable and Non-Communicable
Diseases
Dr Nirmal Kandel , MBBS, MA (Anthropology), MPH, EMBA
Public Health Specialist
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
2 |
Outlines
 Surveillance, Uses and Components
 Traditional Surveillance Design
 Advances
 Stepwise Approach – NCDs Surveillance
 Universal Health Coverage and Surveillance
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
3 |
What is Surveillance
• Systematic, ongoing…
– Collection
– Analysis
– Interpretation
– Dissemination
• …of health outcome data
Health action
• investigation
• control
• prevention
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
4 |
Why we do surveillance
 Estimation the size of health problem
 Detection of outbreaks
 Characterize disease trends
 Evaluate interventions and preventive programmes
 Provide information for health planning and financing
 Identifying training needs in terms of categories and levels
 Identify and prioritize research needs
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
5 |
Surveillance Support Functions
Standards and guidelines
Trainings
Supervisions
Communication facilities
Resources (including logistics) all type
Monitoring and Evaluation (M & E) and Coordination
Surveillance System Structure
Legislation (laws and regulations); including IHR (2005)
Surveillance strategy
Improve preparedness for surveillance and response
Surveillance implementation and stakeholders
Networking and partnerships
Core Functions of Surveillance
Case detection, registration and Confirmation
Reporting
Data Analysis and interpretation
Epidemic preparedness
Response and control
Feedback and evaluate
Surveillance Quality
Completeness and Timeliness
Usefulness and Simplicity
Acceptability and Flexibility
Sensitivity and Specificity
Positive predictive value
Representativeness
Components of Surveillance System
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist
6 |
Surveillance Design
 Traditional disease notification
 Outbreak investigation
 Cluster investigation
 Active and Passive Surveillance
 Enhanced surveillance
 Sentinel surveillance
 Emerging infectious diseases
– diagnosis-based surveillance
– syndromic surveillance
 Molecular biology and
surveillance
 Event Based Surveillance
 Non – Traditional Surveillance

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Innovation in Surveillance of Communicable and Non-Communicable Diseases

  • 1. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 1 | 3rd National Scientific Conference on Epidemiology Innovation in Surveillance of Communicable and Non-Communicable Diseases Dr Nirmal Kandel , MBBS, MA (Anthropology), MPH, EMBA Public Health Specialist
  • 2. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 2 | Outlines  Surveillance, Uses and Components  Traditional Surveillance Design  Advances  Stepwise Approach – NCDs Surveillance  Universal Health Coverage and Surveillance
  • 3. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 3 | What is Surveillance • Systematic, ongoing… – Collection – Analysis – Interpretation – Dissemination • …of health outcome data Health action • investigation • control • prevention
  • 4. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 4 | Why we do surveillance  Estimation the size of health problem  Detection of outbreaks  Characterize disease trends  Evaluate interventions and preventive programmes  Provide information for health planning and financing  Identifying training needs in terms of categories and levels  Identify and prioritize research needs
  • 5. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 5 | Surveillance Support Functions Standards and guidelines Trainings Supervisions Communication facilities Resources (including logistics) all type Monitoring and Evaluation (M & E) and Coordination Surveillance System Structure Legislation (laws and regulations); including IHR (2005) Surveillance strategy Improve preparedness for surveillance and response Surveillance implementation and stakeholders Networking and partnerships Core Functions of Surveillance Case detection, registration and Confirmation Reporting Data Analysis and interpretation Epidemic preparedness Response and control Feedback and evaluate Surveillance Quality Completeness and Timeliness Usefulness and Simplicity Acceptability and Flexibility Sensitivity and Specificity Positive predictive value Representativeness Components of Surveillance System
  • 6. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 6 | Surveillance Design  Traditional disease notification  Outbreak investigation  Cluster investigation  Active and Passive Surveillance  Enhanced surveillance  Sentinel surveillance  Emerging infectious diseases – diagnosis-based surveillance – syndromic surveillance  Molecular biology and surveillance  Event Based Surveillance  Non – Traditional Surveillance
  • 7. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 7 | Traditional Disease Surveillance SOURCE:Figure courtesy of Dr. Larry Madoff
  • 8. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 8 | Advances in Surveillance  Syndromic Surveillance  Electronic Health Records  Non traditional approaches  Event Based surveillance and Early Warning System  Integrated Diagnostic System  Pre-symptomatic Detection
  • 9. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 9 | Before going quick question…think
  • 10. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 10 | Syndromic Surveillance “Syndromic surveillance” is defined as the collection and analysis of “health-related data that precede diagnosis and signal with sufficient probability of a case or an outbreak to warrant further public health response” Source: Global Infectious Disease Surveillance and Detection:Assessing the Challenges -- Finding Solutions,Workshop Summary
  • 11. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 11 | Syndromic Analyses Automated analyses identify unusual patterns and increases are investigated
  • 12. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 12 | Electronic Health Monitoring SOURCE: Lombardo (2006)
  • 13. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 13 | Non Traditional Approaches  EIS and GOARN  Promed Mail  GPHIN  Health Map  MedIsy
  • 14. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 14 | EIS and DON Event Information Sites (EIS) for National IHR Focal Points
  • 15. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 15 | Advances in Indonesia
  • 16. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 16 | Bulletins
  • 17. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 17 | GLEWS  One World – One Health and Emerging Disease Surveillance – GLEWS - http://www.glews.net/
  • 18. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 18 | Surveillance Networks  Global Infectious Disease Surveillance and Early Warning Systems – Promed
  • 19. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 19 | Framework for Internet Based Surveillance
  • 20. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 20 | Building Available Infrastructure Source:Voxiva
  • 21. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 21 | How it works
  • 22. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 22 | Comprehensive Integrated Diagnostics System
  • 23. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 23 | Medical Tricorder “integrated diagnostic system” for field use that can detect viruses, bacteria, toxins, The current prototype relies on automated real-time PCR
  • 24. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 24 | Host Based Pre-symptomatic Detection Event Source: Johnston (2006)
  • 25. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 25 | Personalized Medicine Based Biosignatures
  • 26. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 26 | Some Innovations Used…….
  • 27. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 27 | Some Innovations Used…….
  • 28. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 28 | Use of Social Networks I trace the passenger during Pandemic 2009 H1N1 under IHR (2005)
  • 29. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 29 |
  • 30. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 30 | Step 3 (Biological) Complexity Step 2 (Physical) Step 1 (Verbal) Core Expanded Optional At each step The WHO STEPwise approach to surveillance of non-communicable disease risk factors Sequential approach, step by step
  • 31. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 31 | • Coronary heart disease • Stroke • Peripheral vascular disease • Several cancers • COPD/emphysema Endpoints Intermediate Risk Factors •Hypertension •Blood lipids •Obesity / Overweight • Diabetes • Tobacco • Diet • Alcohol • Physical Activity Behavioural Risk Factors Non-modifiable Risk Factors •Age •Sex •Genes Socio-economic, Cultural & Environmental Conditions Figure 4 Example of Major Selected Non-Communicable Disease (NCD) Risk Factors and Determinants Source: World Health Organization (WHO)
  • 32. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 32 | Age Foetal life Adult LifeAdolescenceInfancy and childhood •SES •Nutrition •Diseases •Linear growth •Obesity •Obesity •Lack of activity •Diet •Alcohol, •Smoking •SE potential •Established adult risk factors (behavioural/biological) •SES •Maternal nutritional status & obesity, •Fetal growth Accumulated risk Range of individual risk Accumulated risk Life course approach for the prevention of non communicable diseases
  • 33. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 33 | Surveillance Focus  Risk factor surveillance - for estimation and Prevention  Actual Burden of Diseases – Hospital records (HMIS) – Mortality Statistics (Verbal Autopsy) – Insurance data – Funeral Services – Drug Data
  • 34. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 34 |
  • 35. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 35 | Universal Health Coverage Universal Health Coverage – is defined as ensuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship.
  • 36. Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 36 | Thank You