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Published byBerenice Gibbs Modified over 9 years ago
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Evaluation of Surveillance Systems St Lukes-Roosevelt
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Problems with our field Programs often do more harm than good Programs don’t collect data, so no benefit shown The data we do collect is often not useful for improving program quality or guiding policy
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How do we show benefit, impact, change? Surveillance Ongoing Surveys One point in time
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Definition Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data regarding a health-related event for use in public health action to reduce morbidity and mortality to improve health *CDC, Atlanta GA
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Key concept
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Why evaluate a surveillance system? Ensure that problems of public health importance are being monitored efficiently and effectively Recommendations about the system should focus on improving quality, efficiency, and usefulness
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What should be evaluated? System attributes: determine priorities Simplicity Flexibility Data quality Acceptability Sensitivity Predictive value positive Representativeness Timeliness Stability
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What should be evaluated? System attributes: determine priorities Simplicity: combine a practical structure with ease of use Flexibility Data quality Acceptability Sensitivity Predictive value positive Representativeness Timeliness Stability
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What should be evaluated? System attributes: determine priorities Simplicity Flexibility: ability to adapt to changing information needs or operating conditions with minimal time, effort, cost Data quality Acceptability Sensitivity Predictive value positive Representativeness Timeliness Stability
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What should be evaluated? System attributes: determine priorities Simplicity Flexibility Data quality: completeness and validity Acceptability Sensitivity Predictive value positive Representativeness Timeliness Stability
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What should be evaluated? System attributes: determine priorities Simplicity Flexibility Data quality Acceptability: willingness of persons or organizations to participate Sensitivity Predictive value positive Representativeness Timeliness Stability
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Contraceptive prevalence rates in Afghanistan, WHO
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What should be evaluated? System attributes: determine priorities Simplicity Flexibility Data quality Acceptability Sensitivity: ability to detect cases OR ability to detect outbreaks Predictive value positive Representativeness Timeliness Stability
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Incidence* of Shigella Dysentery Central Bosnia, 1991-1993 RegionPrewarMay-July 1993 Sarajevo City 0.3 4.0 (+1250%) Zenica City 0.3 4.4 (+1690%) Tuzla Region 0.5 0.4 (-10%) *Cases per 100,000 per month
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What should be evaluated? System attributes: determine priorities Simplicity Flexibility Data quality Acceptability Sensitivity Predictive value positive: proportion of persons identified as cases who truly are cases Representativeness Timeliness Stability
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What should be evaluated? System attributes: determine priorities Simplicity Flexibility Data quality Acceptability Sensitivity Predictive value positive Representativeness: system accurately describes events over time and space (time, person, place) Timeliness Stability
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What should be evaluated? System attributes: determine priorities Simplicity Flexibility Data quality Acceptability Sensitivity Predictive value positive Representativeness Timeliness: speed between steps; appropriateness in delays Stability
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Epidemic curve, outbreak of mumps, Montreal
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Epidemic curve, cholera
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What should be evaluated? System attributes: determine priorities Simplicity Flexibility Data quality Acceptability Sensitivity Predictive value positive Representativeness Timeliness Stability: reliability and availability; resources
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Steps in evaluating a surveillance system Stakeholder engagement Describe the system: importance, purpose, resources Focus the evaluation design **Gather evidence regarding performance Justify and state conclusions, make recommendations
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Malaria Surveillance Purpose (CDC): (a) identify local transmission; (b) guide prevention recommendations for travelers Additional benefits (JE) Identify emerging species; treatment failures; local outbreaks Historically Tracking elimination Case definition Malaria cases confirmed by blood film, rapid diagnostic tests, PCR
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Malaria Surveillance The system **National Malaria Surveillance System National Notifiable Disease Surveillance System (1878 cholera, smallpox, plague, yellow fever at overseas consules) Direct CDC consultation
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