Health surveillance systems monitor communicable diseases, injuries, birth defects and other health conditions to help public health agencies set priorities and plan programs. Surveillance can take many forms, from mandatory disease reporting to monitoring of health behaviors. In Bangladesh, the Institute of Epidemiology, Disease Control and Research conducts various surveillance activities including monitoring priority communicable diseases, outbreak investigations, and influenza and Nipah virus surveillance.

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UNIT- 3
HEALTH
BEHAVIOUR
SURVEILLANCE
Mrs. D. Melba Sahaya Sweety RN,RM
PhD Nursing , MSc Nursing (Pediatric Nursing), BSc Nursing
Associate Professor
Department of Pediatric Nursing
Enam Nursing College, Savar,
Bangladesh.

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INTRODUCTION
Health surveillance is the mechanism that
health agencies use to monitor the health of their
communities. Its purpose is to provide a factual basis
from which agencies can appropriately set priorities,
plan programs, and take actions to promote and protect
the health of the people.
Surveillance systems today take many forms.
The oldest and most well-established systems are those
that monitor the occurrence of communicable diseases
through required reporting by such health care
providers as physicians, laboratories, and hospitals.
Hospital infection control personnel serve a dual role
conducting surveillance in the hospital and reporting
cases of notifiable disease to public health authorities.
More recently established surveillance systems
monitor a broader variety of health conditions,
including injuries, birth defects, chronic diseases, and
health behaviors.

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DEFINITION
Public health surveillance is
“the ongoing, systematic
collection, analysis, and
interpretation of health-
related data essential to
planning, implementation,
and evaluation of public
health practice.” — Field
Epidemiology

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Other Uses of Health Surveillance
are
 Testing hypotheses
 Archive of disease activity
Purposes and Uses of Health Surveillance
To learn more about the natural
history, clinical spectrum, and
epidemiology of a disease (who is at
risk, when and where it occurs, the
exposures or risk factors that are
critical to its occurrence)
Surveillance will provide a
baseline of data which can be
use to assess prevention and
control measures when they are
developed and implemented.
Estimate magnitude
and scope of health
problems
Assess
effectiveness of
programs and
control measures
Develop hypotheses
and stimulate
research

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Passive Surveillance. the
health departments
passively receives reports of
suspected injury or illness.it is
Simple and inexpensive and
Limited by incompleteness of
reporting and variability of
quality
Active Surveillance
An active surveillance system is
one where health facilities are
visited and health care providers
and medical records are
reviewed in order to identify a
specific disease or condition
Types of Health Surveillance
Sentinel Surveillance. Instead of
attempting to gather surveillance data from
all health care workers, a sentinel
surveillance system selects, either
randomly or intentionally, a small group of
health workers from whom to gather data.
or Reporting of health events by health
professionals who are selected to represent
a geographic area or a specific reporting
group and It Can be active or passive
Syndromic surveillance. It is
the analysis of medical data to detect
or anticipate disease outbreaks, and it
Focuses on one or more symptoms
rather than a physician-diagnosed or
laboratory-confirmed disease

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Health Behavior Surveillance of USA
In USA the US department of Health and human resources
conducted The Behavioral Risk Factor Surveillance System (BRFSS)
but it is operated by Centers for Disease Control It is a state-based
system of telephone health surveys that collects information on
health risk behaviors, preventive health practices, and health care
access primarily related to chronic disease and injury. The survey
was established in 1984. Data are collected monthly in all 50 states,
the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and
Guam.
By collecting behavioral health risk data at the state and local level,
BRFSS has become a powerful tool for targeting and building health
promotion activities.
BRFSS’s objective is to collect uniform state-specific data on health
risk behaviors, chronic diseases and conditions, access to health care,
and use of preventive health services related to the leading causes of
death and disability in the United States.

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Health Behavior Surveillance of Bangladesh
Disease Surveillance Systems of
Bangladesh
Institute of
Epidemiology,
Disease Control and
Research and
National influenza
centre (NIC),
Bangladesh is
responsible for
disease surveillance
system of
Bangladesh

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Surveillance activities of IEDCR are
Health Behavior Surveillance of Bangladesh
Priority communicable
disease surveillance (PCDS)
The diseases selected for reporting under
this surveillance are: (1) Diarrhoeal
diseases (Acute watery diarrhoea and
Bloody dysentery), (2) Malaria, (3)
Kala-azar, (4) Tuberculosis, (5) Leprosy,
(6) Encephalitis and (7) Unknown
diseases.
These diseases were selected for
reporting from all levels to the national
head quarter on a weekly basis, but on a
daily basis during an outbreak situation.
Upazila Health and Family Planning
Officer (UH&FPO) and Civil Surgeons
(CS) are responsible for conducting this
surveillance locally.
Institutional disease
surveillance (IDS) It covers all
the medical college hospitals and
specialized institutes in Bangladesh.
The diseases selected for reporting
were both communicable and non-
communicable diseases. Priority
communicable diseases were
scheduled for reporting on a weekly
basis and the other disease profiles on
a monthly basis. Directors and
Superintendents of the hospitals and
institutes are responsible for
conducting this surveillance locally.

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Health Behavior Surveillance of Bangladesh
Surveillance activities of IEDCR are
Surveillance through emergency outbreak investigations
IEDCR responds to any unusual health events or diseases reported directly or indirectly to the Director, IEDCR on
an emergency basis. National Rapid Response Team (NRRT), which is formed by the experts from IEDCR,
conducts the outbreak investigations with the help of District Rapid Response Team (DRRT) and Upazila Rapid
Response Team (URRT). Concerned UH&FPO, CS, Directors and Superintendants of the hospitals are responsible
for reporting of any kind of outbreak situations.
Acute meningo-encephalitis surveillance (AMES)
AMES started from October 2007 in collaboration with the partner organizations. Rajshahi, Khulna and Chittagong
medical college hospitals were selected initially for the study. The meningo-encephalitis diseases selected for
reporting under this surveillance are: (1) Japanese Encephalitis, (2) Nipah, (3) Dengue, (4) Other bacterial causes
of encephalitis. The concerned surveillance physicians, Directors and Superintendants of the selected hospitals are
responsible for conducting the surveillance locally and sending the reports bi-weekly.

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Health Behavior Surveillance of Bangladesh
Surveillance activities of IEDCR are
Hospital based Nipah
surveillance
IEDCR in collaboration with ICDDR,B
has started Nipah surveillance in ten
selected hospitals since February 2006.
The concerned surveillance physicians,
Directors and Superintendants of the
hospitals are responsible for sending
monthly report according to the case
definition of suspected Nipah cases in
the prescribed form to the central level.
Samples from the sites are collected and
tested on a periodic basis. Data from the
surveillance are stored and analyzed at
the central level.
Hospital Based Influenza
Surveillance
IEDCR in collaboration with ICDDR,B
has started hospital based influenza
surveillance in twelve selected hospitals
across the country since May 2007. Six
of them are public and six are private
hospitals. The objectives were to
identify individuals and clusters of
people who have life threatening
infections with influenza virus and to
identify clusters of patients / health care
workers / poultry workers with severe
acute respiratory illnesses (SARI) and
influenza-like-illnesses (ILI).
Event based
disease
surveillance
It is a process of
investigating
unofficial reports
of disease events
to verify the
truth.

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Surveillance activities of IEDCR are
Health Behavior Surveillance of Bangladesh
Sentinel surveillance (SS) IEDCR started the surveillance in eight selected unions form one of
the upazilas of eight selected districts. The diseases selected for reporting under this surveillance system
are:(1) Diarrheal diseases (Acute watery diarrhea and Bloody dysentery), (2) Malaria, (3) Kala-azar, (4)
Tuberculosis, (5) Diphtheria, (6) Filaria,(7) Hepatitis, (8) Measles, (9) Meningitis, (10) Pneumonia, (11)
Polio, (12) Sexually transmitted diseases (STDs), (13) Tetanus, (14) Typhoid, (15) Upper respiratory
tract infections (URTIs) and (16) Whooping cough.
Sentinel surveillance for influenza-like-illness (ILI)
IEDCR will start the sentinel surveillance for influenza-like-illness (ILI) in eighteen more district
hospitals throughout the country. Data will be collected from outdoor patient departments (OPDs) for
suspected ILI cases and samples will also be collected and tested periodically. IEDCR will be
responsible for overall coordination and subsequent report preparation periodically.

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Surveillance activities of
IEDCR are
Health Behavior Surveillance of Bangladesh
High risk group
avian influenza
surveillance
(among live-bird
handlers)
The live bird handlers are
another high risk group
for avian influenza other
than the poultry workers
and cullers.
HIV serological and
behavioural surveillance
survey (BSS) was conducted in
people who inject drugs (PWID) and
female sex workers (FSWs) and the
geographical areas were limited to
Dhaka and Hili and all brothels of
Bangladesh. It was conducted between
3rd February and 22nd May 2016 and
the surveillance design was based on the
2013 updated guidelines for second
generation HIV surveillance of WHO
and UNAIDS

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CONCLUSION
Disease surveillance is an integral part of public
health system. It is an epidemiological method for
monitoring disease patterns and trends. International Health
Regulation (IHR) 2005 obligates WHO member countries to
develop an effective disease surveillance system.
Bangladesh is a signatory to IHR 2005. Institute of
Epidemiology, Disease Control and Research (IEDCR
<www.iedcr.gov.bd>) is the mandated institute for
surveillance and outbreak response on behalf of Government
of the People’s Republic of Bangladesh. The IEDCR has a
good surveillance system including event-based surveillance
system, which proved effective to manage public health
emergencies. Routine disease profile is collected by
Management Information System (MIS) of Directorate
General of Health Services (DGHS). Expanded Program of
Immunization (EPI) of DGHS collect surveillance data on
EPI-related diseases. Disease Control unit, DGHS is
responsible for implementing operational plan of disease
surveillance system of IEDCR. The surveillance system
maintain strategic collaboration with icddrr,b

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