1. Surveillance of Communicable Diseases for Decision-Making, Egypt 2006-13 Funded by the European Union Mahmoud Hassan Authors: Mahmoud Hassan (1), M. Abdel-Razik (2), H. Ibrahim (2), S. Refaey (1), A. Kandeel (1) (1) Ministry of Health, Cairo, Egypt (2) Public Health and Community Medicine Department, Faculty of Medicine, Cairo University, Egypt

2. Funded by the European Union Introduction Public Health Surveillance: It is ongoing, systematic collection, analysis, interpretation & dissemination of data regarding health-related events It is used for decision-making & public health action to reduce morbidity, mortality and to improve health

3. Funded by the European Union Introduction The central epidemiology and surveillance unit (ESU) at MOH have National Electronic Disease Surveillance System (NEDSS) that record data on communicable diseases (CD) from all Egypt Research problem: There is limitation in utilization of ESU available data to Guide decision-making in public health programs

4. Funded by the European Union Objective Describe the epidemiological profile (person, time and place) for 15 CD in Egypt (2013) Categorize Egypt governorates according to reported cases into high, medium and low risk for priority 15 CD Demonstrate summary reports that help decision-making and action –taking to reduce incidence of 15 CD in Egypt

5. Funded by the European Union Methods A.Study Setting MOH-HQ Surveillance System in Epidemiology and Surveillance Unit. B.Study Design Health system research study that use the time series analysis and ranking method for notifiable CD (2006-2013)

6. Funded by the European Union Methods C.Sources of Data CD Surveillance data recorded in MOH Central Agency for Public Mobilization and Statistics (CAPMAS) (2006-2014) Institute of national planning- Human development report, 2010 Information and Decision Support Center Report on Egypt Governorates Description by Information, 2010

7. Funded by the European Union Methods D.Sample Size All selected 15 CD surveillance data for eight years period 2006- 2013 for all Egypt governorates were submitted to data entry and analysis (361,055 recorded cases)

8. Funded by the European Union Methods E.Data Management Descriptive epidemiology for each disease by time person and place Ranking Governorates (1-27) according to CD risk index (2006- 2013)

9. Funded by the European Union Methods E.Data Management Choropleth Mapping were presented to display the aggregation of information as (red color for high risk governorates/districts, yellow color for medium risk and green color for low risk governorates/districts). Matrixes were used to demonstrate the summary of information to policy makers

10. Funded by the European Union The priority 15 communicable diseases according to total reported counts in year 2006  Undifferentiated acute Hepatitis  Bloody diarrhea (Dysentery)  Typhoid/ paratyphoid  Brucellosis  Hepatitis (A)  Tuberculosis  Rubella  Meningitis  Hepatitis (C)  Measles  Rabies  Acute flaccid paralysis  Hepatitis (B)  Avian influenza  Mumps

11. Funded by the European Union Profile of Typhoid/Paratyphoid disease in Egypt, 2013: Crude incidence rate and age standardized rate by sex Gender Number of reported cases Crude rate (per 100 000) Age standardized rate (per 100 000) Male29636.9 Female30997.5 Total60627.2 11

12. Funded by the European Union Incidence rate of Typhoid/Paratyphoid in Egypt 2013 by age and sex 12

13. Funded by the European Union Number and incidence rates of reported cases of Typhoid/Paratyphoid by year, Egypt, 2006-2013 13

14. Funded by the European Union Trend of reported cases of Typhoid/Paratyphoid in Egypt, 2006-2013 14

15. Funded by the European Union Incidence rates of reported cases of Typhoid/Paratyphoid by Governorates, Egypt, 2013 15

16. Funded by the European Union Incidence rates per 100,000 population, incidence rate scores and rank order of Typhoid/paratyphoid by governorates and year - Egypt, 2006-2013 16 High risk governorate Medium risk governorate low risk governorate Rank order incidence rate incidence score Years Average score

17. Funded by the European Union 17 Risk Index for Typhoid/paratyphoid, by governorates – Egypt, 2006-2013 High Risk Index Low Risk Index Medium Risk Index

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20. Funded by the European Union Diseases GenderAge GroupsMonths Trends Top Governorate Males Females <1 1-4 5-14 15-2425-4445-64 ≥65 January February March April May June July August September October November December Undifferentiated acute Hepatitis 75119134254  Damietta Bloody Diarrhea (Dysentery) 78416135552  Cairo Typhoid/ paratyphoid 770468894  Ismailia Brucellosis640125784  Menia Hepatitis (A)4309104100  Suez Tuberculosis520103575  Suez Rubella0.1 0.50.40.20.10.0  Port Said Meningitis218421112  Menoufia Hepatitis (C )0.80.40.0 0.20.71.91.0  South Sinai Measles113521000  South Sinai Rabies0.10.0 0.10.20.0 0.1  Red Sea Acute Flaccid Paralysis 112710000  Matrouh Hepatitis (B)0.30.10.00.10.00.20.40.30.1  Assiut Avian Influenza0.20.30.10.40.2 0.30.40.2  Damietta Mumps28162117825310 ▲Red Sea 20  Decrease,  increase,  no change, ▲ re-emerging

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22. Funded by the European Union Conclusion Proper analysis and presentation of surveillance data are pivotal for information necessary for decision-making It guides for specific interventions to high risk areas for environmental sanitation and/or improving the immunization program

23. Funded by the European Union Recommendation Epidemiologic analysis of surveillance data to inform the policy makers about epidemiological profile, priority governorates for intervention. Feed-back of surveillance information to maximize efforts of prevention and control (quarterly meeting) Set priority interventions for prevention of groups of CDs – The priority communicable diseases could be grouped into environmental related/water borne and health system related – Multi-sectorial approach to reduce environmental risks

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