1. Surveillance data collection in IDSP Integrated Disease Surveillance Programme (IDSP) district surveillance officers (DSO) course

2. 2 Outline of this session 1.Principles of surveillance data collection 2.Diseases under surveillance 3.Practical organization of data collection

3. 3 Surveys versus surveillance Survey  Data collection at one point in time  Prevalence data Surveillance  Ongoing, routine data collection  Incidence data Concepts

4. 4 Reporting methods Individual cases  Each and every case is reported  “Line listing” similar to an OPD register Aggregated cases  Number of cases with selected characteristics  Usual methods in place in the contact of the Integrated Disease Surveillance Programme (IDSP)  Requires aggregation of the individual cases

5. 5 Example of a line listing for reporting individual cases of measles IDDate of onset LocationAgeSexVaccine status 112 Jan 06Village A2MaleYes 213 Jan 06Village B3FemaleYes 314 Jan 06Village B1FemaleNo 414 Jan 06Village B5MaleYes 514 Jan 06Village B3MaleNo 614 Jan 06Village B2FemaleYes 715 Jan 06Village A1MaleYes 816 Jan 06Village C12FemaleNo 916 Jan 06Village B4MaleYes Concepts

6. 6 Reporting of aggregated cases of diseases in (place) during (time) DiseaseUnder 5 years of age5 years of age and older MaleFemaleMaleFemale Diarrhea2143 Bloody diarrhea 0010 Pneumonia3212 Fever431210 Fever / rash1000 Total encounters 1061815 Concepts

7. 7 Conditions under regular surveillance in integrated disease surveillance programme (IDSP) Type of diseasesCondition under surveillance Vector borne Malaria Water borne Diarrhea (Cholera), Typhoid Respiratory Tuberculosis Vaccine preventable Measles Under eradication Polio Other conditions Road traffic accidents International commitment Plague Unusual syndromes Meningo-encephalitis, respiratory distress, hemorrhagic fever List

8. 8 Rationale for the use of case definitions Uniformity in case reporting at district, state and national level Use of the same criteria by reporting units to report cases Compatibility with the case definitions used in WHO recommended surveillance standards  Allow international information exchanges Collection

9. 9 Types of case definitions in use Case definitionCriteriaUsers Syndromic (suspect) “S” forms Clinical patternParamedical personnel and members of community Presumptive (Probable) “P” forms Typical history and clinical examination Medical officers of primary and community health centres Confirmed “L1/L2” forms Clinical diagnosis by a medical officer and positive laboratory identification Medical officer and Laboratory staff More specificity Collection

10. 10 Collection What is an epidemiologically linked case? 1.One or few probable cases are confirmed by the laboratory 2.Other probable cases that most likely belong to the same cluster are considered “epidemiologically linked” if they had:  Exposure to the same source  Contact with a confirmed case 3.These “epidemiologically linked” cases are reported on a separate section of the “P” form

11. 11 Collection Example of “epidemiologically linked” cases Outbreak of 123 severe diarrhea cases with dehydration among adults 7/12 rectal swabs confirmed the diagnosis of cholera The non confirmed, probably cases become “epidemiologically linked” cases and should be reported as such in the separate section of the “P” form

12. 12 Summary of the data collection forms used for the various levels of case definition Form “S” (Suspect cases)  Health workers (Sub centres) Form “P” (Probable cases)  Doctors (Primary health centres, Community health centres, Hospitals) Form “L” (Laboratory confirmed cases)  Laboratories Collection

13. 13 Persons collecting information on syndromic reports (“S” forms) Health worker, Male Health worker, Female Auxiliary nurse, midwife/ Public health nurse/ Lady health visitors Accredited Social health Activities (ASHA) Anganwadi Worker Link worker Village Health Guide/Community Health Volunteer Panchayat/ Community member Collection

14. 14 Core sources of information for “S” forms Health workers visit diary (40 houses / day)  Require regular maintenance and entries  May include information from other co- workers/functionaries Sub centre out patient department register  Usually records identifiers and drugs dispensed Not syndromes  Age often inadequate, unclear or absent  No summary  Does not usually include diary entries Similar other diary and register with other workers Malaria slide register in some states Collection

15. 15 Revised malaria form (MF) 11 (Revised to fit IDSP format, to be ultimately merged) Collection The new malaria form takes into account IDSP classification of fever cases for better coordination

16. 16 Completion and transmission of form “S” Completion  Health worker (Female) usually completes the form on the basis of registers Ideally the new IDSP “S” register Or other registers (OPD, house visits) Transmission  Health worker (Male) usually takes the form to health supervisor/ inspector at the PHC on MONDAY  In some places: The form reaches the block PHC directly The form is communicated to the district by phone Collection

17. 17 Problems associated with completion and transmission of form “S” While compiling records for “S” forms the core registers may not be consulted (although it should) The report may cover a period modified to suit convenience of meeting date Incomplete information usually gets dropped Collection

18. 18 Check list for “S” form completion Filled in time (Friday-Saturday) Filled using figures from registers only Tally mark by health worker Entries in the “S” form can traced back to individual cases in the registers Each cell filled in individually Detection of rising trends of disease Collection

19. 19 Applying the checklist: Making sure all numbers in the “S” form come from individual cases in the “S” register S register S form

20. 20 Poor data entry on form “S”: Some cells are not filled MaleFemaleTotal Fever < 7 days< 5 yr> 5 yr< 5 yr> 5 yr< 5 yr> 5 yr 1 Only fever 2 6 2 With rash 3 With bleeding 4 With daze/ Semi- consciousness/ Unconsciousness Fever > 7 days ------- NIL -------

21. 21 MaleFemaleTotal Fever < 7 days< 5 yr> 5 yr< 5 yr> 5 yr< 5 yr> 5 yr 1 Only fever 2 NIL 6 2 6 2 With rash NIL 3 With bleeding NIL 4 With daze/ Semi- consciousness/ unconsciousness NIL Fever > 7 days 2 NIL 62 6 Data entry on form “S” as recommended

22. 22 First level of consolidation: The sector primary health centre (PHC) Sector PHC  Approximate population: 20-30,000  Sometimes more Target date for receipt of forms is MONDAY  5-6 “S” forms expected Transmission to the block PHC or community health centre (CHC) on Tuesday  “S” forms forwarded  PHC “P” form added  Responsibility: Pharmacist (Usually) Often a weak link Collection

23. 23 Summary: The flow of the “S” form Form “S” completion Form “S” transmission

24. 24 Sources of data for “P” form Primary health centre outpatient register  Records name of the patient  Social status (e.g., Below poverty line) Primary health centre pharmacist  Register with name, outpatient number etc. At some places there is a medical officers individualized register as well New IDSP “P” register Collection

25. 25 Completion of the “P” form in primary health centres (PHCs) Focal person:  Pharmacist  Public health nurse Various combinations in practice to fill “P” form  Pharmacist register does not have diagnosis  OPD registers do not have any disease/treatment info  Doctors register generally incomplete and do not cover all patients Checklists similar to the one used for the “S” Form can be used to assure data quality at this level Collection

26. 26 Applying the checklist: Making sure all numbers in the “P” form come from individual cases in the “P” register “P” register “P” form Collection

27. 27 “S”, “P” and “L1” forms converge at the block level Collection Block primary health centre (BPHC) Community health centre (CHC)

28. 28 Information from other reporting sources Quacks and traditional practitioners “S” forms Clinics and practitioners “P” forms Hospitals Consolidated “P” forms Small labs “L1” form Big labs “L2” form Collection

29. 29 Reporting units All government entities should be part of the reporting network All local health institutions should be made part of the network in phases Gradually the data should be disaggregated by reporting unit to pinpoint the source and demarcate local trend line for particular diseases Ultimately we need to report incidences in relation with the denominator  CDC: Count, divide compare  Compare rates rather than numbers Collection

30. 30 Take home messages 1.IDSP is mostly based upon aggregated reporting 2.Know the diseases under surveillance 3.Understand the data flow of each of the case definition levels “S” forms “P” forms “L1/2” forms

31. 31 Additional reading Section 2 and 3 of IDSP operations manual Module 5 of training manual Format and guidelines for reporting of information on disease surveillance (electronic manual) IDSP manual