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 Evaluation of Surveillance Systems St Lukes-Roosevelt.

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1  Evaluation of Surveillance Systems St Lukes-Roosevelt

2 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

3 How do we show benefit, impact, change?  Surveillance  Ongoing  Surveys  One point in time

4 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

5 Key concept

6 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

7 What should be evaluated?  System attributes: determine priorities  Simplicity  Flexibility  Data quality  Acceptability  Sensitivity  Predictive value positive  Representativeness  Timeliness  Stability

8 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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10 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

11 What should be evaluated?  System attributes: determine priorities  Simplicity  Flexibility  Data quality: completeness and validity  Acceptability  Sensitivity  Predictive value positive  Representativeness  Timeliness  Stability

12 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

13 Contraceptive prevalence rates in Afghanistan, WHO

14 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

15 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

16 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

17 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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19 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

20 Epidemic curve, outbreak of mumps, Montreal

21 Epidemic curve, cholera

22 What should be evaluated?  System attributes: determine priorities  Simplicity  Flexibility  Data quality  Acceptability  Sensitivity  Predictive value positive  Representativeness  Timeliness  Stability: reliability and availability; resources

23 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

24 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

25 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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