Coronary restenosis refers to the re-narrowing or reoccurrence of blockage in a coronary artery that has previously been treated with a procedure such as angioplasty and stent placement. Angioplasty is a procedure used to open narrowed or blocked arteries by inflating a balloon-like device to widen the artery, and a stent may be placed to help keep the artery open. Restenosis can occur when the artery becomes narrowed again due to various factors, including the growth of scar tissue inside the artery, inflammation, or the formation of new plaque. Restenosis can lead to recurrent symptoms of chest pain (angina) or other complications. To help prevent restenosis, doctors may recommend lifestyle changes such as quitting smoking, adopting a heart-healthy diet, exercising regularly, and taking medications to manage risk factors such as high cholesterol, high blood pressure, and diabetes. In some cases, additional treatments or procedures may be necessary to address restenosis, such as repeat angioplasty, stent placement, or bypass surgery. It's essential for individuals who have undergone coronary artery procedures to follow their healthcare provider's recommendations for monitoring and managing their heart health to reduce the risk of restenosis. Arrhythmias are abnormal heart rhythms that can occur when the electrical impulses that coordinate the heartbeats are disrupted. There are different types of arrhythmias, including: 1. Atrial Fibrillation (AFib): This is the most common type of arrhythmia and occurs when the heart's upper chambers (atria) beat irregularly and out of sync with the lower chambers (ventricles). 2. Supraventricular Tachycardia (SVT): SVT is a fast heart rate originating above the ventricles, often in the atria. 3. Ventricular Tachycardia (VT): VT is a fast heart rate that starts in the heart's lower chambers (ventricles). 4. Ventricular Fibrillation (VFib): VFib is a life-threatening arrhythmia where the ventricles quiver instead of pumping blood effectively. 5. Bradycardia: This is a slow heart rate, usually below 60 beats per minute. Arrhythmias can be caused by various factors, including heart disease, high blood pressure, diabetes, smoking, excessive alcohol consumption, stress, certain medications, and structural abnormalities in the heart. Some arrhythmias may not cause any symptoms, while others can lead to symptoms such as palpitations, dizziness, chest pain, shortness of breath, and fainting. Treatment for arrhythmias depends on the type and severity of the condition. It may include lifestyle modifications, medications, medical procedures like cardioversion or ablation, or implantation of devices like pacemakers or implantable cardioverter-defibrillators (ICDs) to help regulate the heart's rhythm. If you experience symptoms of an arrhythmia or have been diagnosed with one, it's important to work closely with your healthcare provider to determine the best treatment plan and management strategies to help control

1. Course:
Basic Epidemiology
Epidemiological
Surveillance

2.  Group 1 members:
2
Name
1. Eyerusalem Kefiyalew
2. Eressa Waldagiorgis
3. Edo Lemecha
4. Dechasa Tumsa
5. Birhan Filipos
6. Ayantu Alemu
7. Amen Dereje
8. Aman Haji
9. Abigia Niguse

3. Presentation outlines
• Introduction
• Purposes
• Sources of data
• Criteria for identifying diseases
• Steps in planning surveillance
• Types of epidemiological surveillance
• Surveillance system attributes
• Evaluating epidemiological surveillance system
• Epidemiological surveillance process
3

4. Introduction
 Surveillance?
• French words: sur (over) & veiller (to watch)
• mean “close and continuous observation of one or
more persons for the purpose of direction, supervision,
or control
 Epidemiological surveillance?
• Is the systematic collection, analysis, interpretation and
timely dissemination of health data for the planning,
implementation and evaluation of public health
programmes.
4

5. Cont’d…
5

6. Cont’d…
 Epidemiological surveillance is the foundation
for immediate and long-term strategies for
combating infectious diseases.
6

7. Purposes of surveillance
 To prioritize problems and planning,
implementing and evaluating public health
programmes
 So that it provides information for plan, action,
decision making
 Main function of epidemiological surveillance is to
• serve as an early warning system
• providing timely information needed for action
7

8. Cont’d…
 Monitoring health events- for the following
purposes:
•To detect sudden changes in disease
occurrence and distribution
•To assist the planning, implementation &
evaluation health interventions and
programs
•To follow long-term trends and patterns of
disease
•To identify changes in agents and host
factors
•To detect changes in health care practices
8

9. Cont’d…
 Link to Public Health Action
• Investigation and control of planning
• Evaluating prevention and control measures
• Generating hypotheses and stimulating public
health research
• Testing hypotheses
• Archive of disease activity
9

10. Sources of surveillance data
• Mortality and
Morbidity reports
• Epidemic reports
• Reports of
laboratory results
• Reports of individual
case investigations
10
• Reports of epidemic
investigations
• Special surveys (e.g.,
hospital admissions, disease
registers, and serologic surveys)
• Information on animal
reservoirs and vectors
• Demographic data
• Environmental data

11. Criteria for identifying disease for
epidemiological surveillance
 The current impact of the health event
• Morbidity (high Incidence or prevalence rate)
• Mortality (high overall or age specific death
rates)
• Severity (case fatality rate, hospitalization rate,
disability rate, years of potential life lost, quality
adjusted life years lost)
• Health care costs 11

12. Cont’d…
 Having high epidemic potential (anthrax,
avian human influenza, cholera, measles,
meningococcal meningitis, pandemic
influenza, smallpox, SARS, viral hemorrhagic
fever, and yellow fever)
 Required internationally under IHR2005
(smallpox, poliomyelitis due to wild-type
poliovirus, human influenza caused by a new
subtype, SARS)
12

13. Cont’d…
 Targeted for eradication or elimination
(poliomyelitis due to wild-type poliovirus,
dracunculiasis, neonatal tetanus
 Have a significant public health importance
(malaria, relapsing fever, typhoid fever, typhus
and severe malnutrition);
 Diseases that have available effective control
and prevention measures for addressing the
public health problem they pose
 Can easily be identified using simple case
definitions
13

14. Steps in planning surveillance
I. Establish objectives
II. Develop case definitions
III. Determine data source or data collection
mechanisms
IV. Develop data collection instruments
V. Field test methods
VI. Develop and test analytic approach
VII. Develop dissemination mechanism
VIII.Ensure use of analysis and interpretation
14

15. Types of Surveillance
1. Passive Surveillance
2. Active Surveillance
3. Sentinel Surveillance
15

16. Passive Surveillance
 A mechanism for routine survey based on
passive case detection and on the routine
recording and reporting system.
 It involves collection of data as part of routine
provision of health services.
Advantages:
•Covers a wide range of problems
•Does not require special arrangement
•It is relatively cheap
•Covers a wider area
16

17. Cont’d…
Disadvantage
• The information generated is to a large extent
unreliable, incomplete and
inaccurate/secondary data
• You may not get the kind of information you
desire
• It lacks representativeness as it is mainly from
health institutions
• There is no feed back system
• The denominator is unknown
17

18. Active surveillance
 A method of data collection usually on a specific
disease, for relatively limited period of time.
 It involves collection of data through:
• House-to-house surveys or
• Mobilizing communities to some central point
where data can be collected.
Example: Investigation of out-breaks
18

19. Cont’d…
 Active surveillance is appropriate for;
• Periodic evaluation of an ongoing program
• Programs with limited time of operation such
as eradication program.
• In unusual situations such as
•new disease discovery
•new mode of transmission
•when a high-risk season/year is recognized.
•when a d/se is found to affect a new
subgroup of the populatiion.
•when a previously eradicated disease
reappears.
19

20. Cont’d…
Advantages
• The collected data is complete and accurate
• Information collected is timely.
• The required information is gathered
Disadvantages
• It requires good organization
• It is expensive
• Requires skilled human power
• It is for short period of time
• It is directed towards specific disease
conditions 20

21. Sentinel Surveillance
 It uses a pre-arranged sample of reporting
sources
 This is carried out by:
• Selecting sample sources most likely to see
cases of the specified condition.
• Identifying institutions that serve the popn
subgroups and that can obtain data regarding
the condition of interest.
• Sentinel surveillance provides a practical
alternative to popn-based surveillance, in
developing countries.
21

22. Cont’d…
Advantages
• Relatively inexpensive
• Provides a practical alternative to population-
based surveillance
• Can make productive use of data collected for
other purposes
Disadvantages
• The selected population may not be
representative of the whole population
• Use of secondary data may lead to data of
lesser quality and timeliness
22

23. Surveillance System Attributes
23

24. Evaluating Epidemiological Surveillance
system
Why we evaluate??????
• To ensure that it is serving a useful
epidemiological function and meeting its
objectives.
• To improve the system’s operation and
efficiency. Every surveillance system should
be evaluated periodically
24

25. Evaluating Epidemiological Surveillance system
 Evaluation of surveillance system should be
addressed the following facts;
• The epidemiological importance of the health
event under surveillance
• The objectives and operation of the system
• The system’s usefulness
• Attributes or qualities of the surveillance
system, including simplicity, flexibility,
acceptability, sensitivity, predictive value
positive, representativeness, and timeliness
• Cost or resource requirements for system
operation
25

26. Risk
assessment
Plan of action
Prioritization
Implementation
In-depth
assessment
Monitoring and
evaluation
A structured approach
to surveillance and response strengthening
26

27. Limitations of Surveillance Systems
 Under reporting
 Lack of knowledge of the reporting requirement
 Negative attitude toward reporting
 Misconceptions that result from lack of
knowledge or negative attitude
 Lack of Representativeness of Reported Cases
 Lack of Timeliness
 Inconsistency of Case Definitions
27

28. Ways to Improve a Surveillance System
 Uses a combination of passive and active
mechanisms
 Improve Awareness of Practitioners
 Simplify Reporting
 Frequent Feedback
 Widen the Net
 Incorporate strong laboratory services for
accurate diagnosis
28

29. Analysis of surveillance data
 Descriptive analysis: distribution by time, place
and person
Frequency of events
Calculate rates- need proper denominator
 Observe trends: comparison current data with
expected value, identify differences, and assess
the relevance of the difference
 Draw graphs to show long term (secular) trends
29

30. Dissemination of surveillance data
 Disseminate surveillance data to all stakeholders
(health providers, community and decision
makers)
 Disseminate report locally, nationally or globally;
as necessary as well timely & regularly
 Disseminate through appropriate media:
newsletter or bulletin (paper or electronic)
30

31. Epidemiological Surveillance in Ethiopia
 In 1998, FMOH customized and implemented
IDSR strategies, that was;
• Mainly focus on epidemic disease
• No nutritional and weak laboratory
surveillance
• Lack of appropriate preparedness recovery
• Surveillance data comes monthly
• Lack of representativeness
• Weak early warning system
• No event based surveillance
31

32. Public Health Emergency Management
 Public Health Emergency Management was
designed under EPHI in 2009 following the re-
structuring:
• is the process of anticipating, preventing,
preparing for, detecting, responding to,
controlling and recovering from consequences of
public health threats in order that health and
economic impacts are minimized
 Public Health Emergencies: are events or
disasters that threaten the health of communities
or groups of people.
32

33. Cont’d…
 What are Public Health Emergencies?
1. Epidemics of communicable diseases
2. Drought and malnutrition
3. Food contaminations
4. Flooding
5. Conflict and displaced populations
6. Accidents including chemical spills, radiation
7. Earthquake, volcano
33

34. Cont’d…
 PHEM was designed constituting;
• Multi hazard PH emergency management
system
• Helps to detect unusual health events timely
and institute appropriate response measures
promptly
• Strong early warning system
• Laboratory play active role in surveillance
• Incorporates event based surveillance
34

35. Cont’d
 Components of PHEM
1. Early warning
2. Preparedness
3. Response
4. Recovery
35

36. Diseases under Surveillance in
Ethiopia
Immediately Reportable
1. Acute Flaccid Paralysis
2. Anthrax
3. Avian Human Influenza
4. Cholera
5. Dracunculiasis/Guinea warm
6. Measles
7. Neonatal tetanus
8. Pandemic Influenza A(H1N1)
9. Rabies
10. Small pox
11. SARS
12. Viral Hemorrhagic Fever(VHF)
13. Yellow Fever
14. Maternal death
15. Prenatal Death
Weekly Reportable
1. Dysentery
2. Malaria
3. Meningitis
4. Relapsing fever
5. Typhoid Fever
6. Epidemic typhus
7. Severe Acute Malnutrition
8. Scabies
36

37. Timeline of Reporting
37

38. SURVEILLANCE FLOW CHART
National level
Region/Zone
Woreda
health facility
Community
Private,NGO,and
other health facility
Community
Hospital
Community
Legend
Upward
transmission of
reports, data &
information
Feedback and
information
sharing
38

39. Surveillance data reporting methods
Health
Facility
EPHI
Woreda
Zone
Region
• Paper
• Telephone
Telephone
Fax
Telephone
E-mail
Fax
E-mail
Fax
Rumor-Phone
Telephone
Papers
39

40. END
THANK YOU!
40