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Faculty of Medicine
Introduction to Community Medicine Course
(31505201)
Unit 4 Epidemiology
Introduction to Epidemiology
Sources of Data and methods of data collection
Epidemiological Surveillance
By
Hatim Jaber
MD MPH JBCM PhD
20 + 22 - 11- 2016
1
Introduction to unit 4 Epidemiology
• Definition , History of Epidemiology
Purpose/Use of Epidemiology
• Concepts in the infectious diseases
• Disease Causation
• Measurements of Morbidity and Mortality
• Levels of prevention and vaccination
• Screening for diseases and vaccination
• Sources of Data and methods of data collection
• Epidemiological Surveillance
• Epidemic Investigation and Management
2
World Antibiotic Awareness Week
• Antibiotics:
Handle
with care
• Date:
14 to 20
November
2016
3
Presentation outline
Time
Introduction and Definitions
12:00 to 12:10
Sources of data
12:10 to 12:20
Methods of collecting data
12:20 to 12:30
Routine and non routine health
data/information
12:30 to 12:50
Epidemiological Surveillance
Next lecture
4
Objectives
• Identify data and the sources for health information
• Describe the advantages and disadvantages of each
source
• Define what is a health information system (HIS) and
understand its components
• Describe the methods of data collection
• Define routine health data/information
• Discuss routine data collection methods
• Define non-routine data
• Discuss methods of collection for non-routine data
5
FROM REALITY TO ACTION
Real world
(Collection, coding)
Data
(Processing, interpretation, presentation)
Information
(Politics, commitment)
Action
Source: Oxford Handbook of Public Health Practice
6
Definitions and USE OF WORDS ‘DATA’,‘INFORMATION’
& Knowledge:
•
DATUM (singular) or DATA (plural) refers to raw numbers or other
measures, usually discrete and gives objective facts about events.
Data: the raw facts that are collected and form the basis
for what we know
• INFORMATION refers to what emerges when data are processed,
analyzed, interpreted and presented.
- Information is data transformed (contextualized, categorized,
corrected, calculated, condensed) into a message
• Information: the product of transforming the data by adding
order, context, and purpose
• Knowledge: the product of adding meaning to information by
making connections and comparisons and by exploring causes and
consequences
7
Definitions cont…..
• “data” means an organized collection of
individual measurements for each subject, in
respect of every variable of interest.
• Once this data has been collected, collated and
“summarized” it is called “Information”.
• Thus, information is a “factual presentation” i.e.
a “Summary of facts” from the data and as they
exist without any added element of
interpretation of facts.
8
“Why do programs need information?”
• Management level: Community - patient - facility – system
• Health-system function: Service delivery - resource
mobilization - financing – stewardship
• Health determinant: Health care - lifestyle - environment
Information is needed to:
• (1) understand the program status in all its complexity;
• (2) enhance program performance through evidence-based
decision making for all major functions (service delivery resource mobilization - financing - stewardship) at all levels
(from community to national level))
9
Definitions
• Health system
“all resources, organizations and actors that are involved
in the regulation, financing, and provision of actions
whose primary intent is to protect, promote or improve
health.” (WHO, 2000)
• Program
procedures
A set of
to conduct activities. The objective is
normally the solution to a problem
Neither a health system or program is a static phenomena. They
experience a continuous process of changes due to pressure
from both outside the system and from within the system.
10
11
Definitions
• Health Information System (HIS):
A health-information system (HIS), similar to a health
management information system (HMIS)
“…a system that provides specific information support
to the decision-making process at each level of an
organization” (Hurtubise, 1984)
• Data Systems
“a way of talking about the whole set of M&E indicators in a
performance monitoring-and-evaluation plan, and all of the
data and other information that need to be gathered and
understood in an orderly fashion that makes sense and help in
program management and implementation”
12
The Health Information System:
Data for Planning, Monitoring and Evaluation
Routine
TYPE
National
Level
District
Level
Aggregated Service Statistics
Aggregated Mgmt Data
Aggregated Surveillance Data
Financial Data
Vital Registration Systems
Aggregated Service Statistics
Aggregated Mgmt Data
Sentinel Sites
Observation Checklist
Self-Evaluation (e.g. COPE)
Non-Routine
USE
Policy-Making
Strategic Planning
Program Tracking
Disease Surveillance
Technical & Logistical Support
Planning (Access)
Management (Quality/Efficiency)
Supervision (Performance)
Disease Surveillance
Facility/
Client
Client Records
Financial Records
Supply Records
Facility logbooks/data records
Aggregated Community
Data
Client Mgmt and Follow-Up
Health Unit Management
Work Planning/Priority Setting
Community
Birth and Death Records
School Records
CBD logbooks
Drug Revolving Fund records
Client Mgmt and Follow-up
Supplies Management
Community Awareness
Population-based surveys
e.g. DHS
Facility-based surveys
e.g. Situation Analysis, SPA
Rapid
Assessment
Methods
Special Studies
e.g. EPI cluster surveys,
KAP studies, etc.
Census
13
14
HIS subsystems or information systems
•
Tools or HIS subsystems or information systems: are The various data
collection and processing mechanisms that comprise a health information
system
• Epidemiological surveillance for notifiable infectious diseases, certain
environmental conditions, and risk factors;
• Routine service reporting from the basic health services at community
level, health centers, dispensaries, first-level hospitals, referral
hospitals, and special and tertiary hospitals;
• Special program reporting systems such as Tuberculosis Control,
Leprosy Control, Malaria Control, Maternal and Child Health and Family
Planning, Expanded Program on Immunization, and HIV/AIDS
prevention;
• Administrative systems including health-program budget management,
health-financial systems, health-personnel systems, health supply and
logistic systems, health-training programmes, health-research
management, health-documentation management, and managing
external health resources for health; and
• Vital registration of births, deaths, and migration.
• Demographic:
• Population
15
Minimum Information required by a Public Health
Specialist in most Settings
• General Information : Location, Governmental and Societal patterns,
geographical and topographical features, roads & other communications,
languages, physical and climatic characteristics of the block / district.
• Socio - demographic profile : Population size, age & sex constitution,
distribution of population in different areas of the district, fertility indicators,
growth rate, education, occupations and economic strata.
• Morbidity and Mortality : Incidence or prevalence of mortality, morbidity
and diseases with epidemic potential; demographic indices as infant mortality
and maternal mortality rates.
• Health Related indicators : water supply, disposal of excreta, housing
patterns, food availability.
• Health Services : Strength and location / distribution of various categories
of health care personnel, governmental and non - governmental; availability,
location and adequacy of health care supplies, equipment and other logistics.
• Preventive / Promotive Health programs : Availability, locations and
adequacy of major programs as immunization, HIV - AIDS / TB
16
Types of Information
• Surveillance
– Epidemiological
– Behavioral
•
•
•
•
•
•
•
•
Routine service reporting
Special program reporting systems
Administrative systems
Vital registration systems
Facility surveys
Household surveys
Censuses
Research and special studies
17
Frequency of Data Collection
• ROUTINE or continuous data collection
– Health facility-based (patient information and service
statistics)
– Community-based (service-statistics)
– Program-based (administrative)
– Vital registration
– Sentinel reporting/demographic surveillance
• NON-ROUTINE or periodic data collection
–
–
–
–
Household or facility-based surveys
Population census
Rapid-assessment procedures (RAP)
Special studies/research
18
Geographic System Levels
• National
• Sub-national (e.g. district)
• Program area
19
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I. Sources of Data
• There are different sources of data on health
and health related conditions in the
community. Each source has advantages and
limitations.
The information obtained from these sources is
used for health planning, programming and
evaluation of health services. The major
sources are the following.
22
Data Sources: Population




Census
Vital registration system
Sample household surveys
Special population surveys
- Demographic (elderly, youth)
- Risk groups ( IDUs)
- Occupational (farmer, skilled labor)
- Area-based (catastrophe-affected)
 Biomarkers
23
1. Census:
• Census is defined as a periodic count or
enumeration of a population.
• Census data are necessary for accurate description of
population’s health status and are principal source of
denominator for rates of disease & death.
• It provides information on:
• Size and composition of a population
• The trends anticipated in the future.
• .Age, sex and size of the population
• Mortality, fertility
• Language, ethnicity
• Housing
24
1. Census: cont…
• The amount of data collected may vary, from as little as
population size and age / sex structure on one end to a
large number of:
• social, economic, demographic and health related
variables on the other end;
however, a fairly developed census mechanism would
usually provide information regarding:
total population, density according to per square
kilometers of land area, decadal growth rate, literacy
rate, economic conditions, occupational
characteristics, and selected indicators of mortality
like overall death rate and infant mortality rate.
25
1. Census: cont…
• From these data different health indices could be
calculated:
• Crude birth rate,
• crude death rate,
• age specific mortality rate and sex specific mortality rate
are some of the examples of the indicators that could be
calculated
Limitation
• Conducting nationwide census is very expensive and it
generates a large amount of data which takes a very long
time to compile and analyze. .
• It is carried in intervals of many years (10 years).
Therefore it can’t assess yearly changes
26
1. Census: cont…
Sample Surveys
• In sample surveys, instead of covering the whole
population as is done in census, only a sample, which
is representative of the population, is studied and
inferences about the population strength and
composition are made.
• Sample surveys are quite relevant in underdeveloped
countries where full fledged census is not possible;
they are also useful in countries where census
mechanism is present because they give interim
information without waiting for the census which is
generally done after 10 years.
27
In Jordan census was conducted
in……………..
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29
30
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2. Vital statistics:
• Vital statistics means the ongoing recording of all vital
events’ such as births, deaths, marriages etc. Registration of
Births and Deaths is a legal requirement in our country
• This is a system by which all births and deaths occurring
nation wide are registered, reported and compiled centrally.
The main characteristics of vital statistics are:
• Comprehensive – all births and deaths should be registered.
• Compulsory by law – should be enforced by law.
• Compiled centrally so that it can serve as a source of
information.
• Continuous – it should be an ongoing process.
32
2. Vital statistics: cont….
• (a) Death Certificate : It is one of the most
important source of information about the
distribution of a number of diseases.
33
2. Vital statistics: cont….
• (b) Birth Certificates : These are useful for epidemiologic
research as well as health services management;
• they provide a denominator data for calculating
various important rates IMR, MMR, etc.
• Ideally, a birth certificate should contain information about
date, place of birth, details of parents, domiciliary/
institutional birth, sex of newborn birth attendant’s details,
type of delivery and complications if any, age of mother
and birth order of the child.
• (c) Other vital events : These include registration of
marriages and divorces; reporting of still births; an
reporting of fetal deaths.
34
35
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3. Health Service Records
• All health institutions report their activities to the
Ministry of Health.
• The Ministry compiles, analyzes and publishes it
in the health service directory. It is therefore the
major source of health information .
Advantages:
• Easily obtainable
• Available at low cost
• Continuous system of reporting
• Causes of illness and death available.
37
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3. Health Service Records cont…
Limitations:
• Lack of completeness – health service coverage is low.
• Lack of representativeness – a small proportion of diseased
population seeks medical advice. Those patients who
remained at home are not reported.
• Lack of denominator – catchment area is not known in the
majority of cases.
• Lack of uniformity in quality.
• Diagnosis varies across the level of health institutions.
• Lack of compliance with reporting.
• Irregularity and incompleteness of published compilations.
39
3. Health Service Records cont…
• Notification of Infectious Diseases
• There are some internationally notifiable
diseases. WHO member
• states report on Plague, Cholera, and Yellow
fever.
• Moreover, every country has its own list of
notifiable diseases.
• The major problems related to this source (health
service records) are low compliance and delays
in reporting.
40
4. Health Surveys
What is a Survey ?
A Survey collects information
Is a Census from all the population
Is a Poll if for political information
Is a Sample Survey if from just a
sample of a population
41
4. Health Surveys cont…
•
Health surveys are
studies conducted on a representative
sample population to obtain more comprehensive data
for monitoring the health status of a population.
There are two types of health surveys:
• 1. Surveys of specific diseases:
These are studies conducted on each specific disease.
Examples are:
•
EPI target diseases
• Diarrheal Diseases
• HIV/AIDS
• Tuberculosis / Leprosy
• 2. Surveys of general health status:
These are studies on general health status of the population.
They are based on interview, physical examination and laboratory tests.
They are expensive.
42
4. Health Surveys cont…
• Advantages of surveys based on interview:
• They are more representative of the health
condition of the community.
• The denominator is known.
• Data are more uniform in quality.
• Limitations:
• Data accuracy is dependent on the memory and
cooperation of the interviewee.
• Surveys are expensive.
43
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Information from Special Populations
• Information from Special Populations
• Some groups have well maintained and extensive health data (e.g.
uniformed services, factories, mines, occupational groups,
Insurance policy holders, persons covered by various health
insurance programs etc
• Records of Hospitals and Health Services
• In developing countries with inadequate notifications of morbidity
and mortality, hospital records are important tool for the
epidemiologist as well as the health administrator.
• Even in countries with a well developed system of notification,
hospital records are often used for epidemiological assessments
and clinical research. In addition to hospitals, records from other
health services (national health program offices,
Community/Primary Health centers) also provide valuable data.
45
Other Sources of Information
Depending on the information needs, the epidemiologist
may need data from the:
• Epidemiological studies: valuable but expensive
• meteorological / environmental departments;
• from governmental offices regarding availability of
medical/ paramedical manpower and available training
facilities;
• or data of controlled drugs and their utilization may
have to be obtained from the relevant Drug
Controller’s office.
46
II. Methods of data collection
• The main methods of collecting information
are:
• 1. Observation
• 2. Interview and questionnaires
• 3. Documentary sources - Clinical records and
other personal records, death certificates,
publications etc.
47
48
49
“Surveillance”
50
The word
“Surveillance”
• The word "sur-veillance" means (in
French) "to watch from above"
("veiller" = "to watch" and "sur" =
above") (i.e. a God's-eye view looking down from on-high)
• The term is often used for all forms of
observation, not just visual observation.
51
Definition of Surveillance
Public health surveillance (sometimes called
epidemiological surveillance) is :
the ongoing systematic collection, analysis, and
interpretation of outcome-specific data essential to the
planning, implementation, and evaluation of public health
practice, closely integrated with timely dissemination of
these data to those who need to know.
Outcomes may include diseases, injury, and disability, as well as risk
factors, vector exposures, environmental hazards, or other exposures.
The final link of surveillance chain is the application of these data to
prevent and control human diseases and injury.
52
Surveillance Principle
Surveillance is: “Information for Action”
“If you don't use it, then
do not ask for it!”
However:
“Good
surveillance does not necessarily ensure
the making of the right decisions, but it reduces
the chances of the wrong ones”
A. D. Langmuir (1963)
53
History
• In 1950, the term “surveillance” was restricted
to public health practice to watching contacts of
serious communicable diseases”
–
–
–
54
To early detect symptoms
To institute prompt treatment
Example: Smallpox
Surveillance, surveys, registries and HMIS:
• Surveillance is systematic ongoing
collection, collation, and analysis of data, and
the timely dissemination of information to
those who need to know so that action can
be taken
• A survey is a one data collection episode
• Registries are not for immediate action
• Health Management Information Systems
(HMIS) for annual reports
55
Note the Differences:
• Registers are archival health information
• Surveillance is dynamic as compared with
surveys: Interplay between epidemiologic
studies and control activities
• Surveillance is not mere:
–
–
–
Reporting
Monitoring
Data collection
56
Continuous versus Periodic Data Collection
Continuous Data
Collection
Periodic
Collection
Data Collection
Small team
Large team or multiple teams
Data accessibility
Initially slow
Faster turnaround
Data usefulness for
trend analysis
Ongoing results
Results only after three rounds
of data collection
Evaluation of health
intervention
Continuous monitoring of Timing of collection often not
impact
linked to intervention
Budget
Line item in health
budget
One-off investment at each
cycle
57
Goals and Uses of Surveillance
• Detect outbreaks or epidemics
–
–
Detect changes in trends over time, portray natural
history of diseases
Evaluate control measures
• Estimate magnitude of morbidity and mortality
– Ensure equity in health care (mortality and morbidity)
• Facilitate planning
–
Making projections, understanding burden of disease
and justifying allocation and or redirection of resources
• Stimulate epidemiologic research
–
–
58
Generate/ Test hypotheses (e.g. changes in health practice)
Identify risk factors (in-depth studies)
Uses of Public Health
Surveillance
•
•
•
•
•
•
•
•
•
Estimate magnitude of the problem
Portray the natural history of a disease
Determine distribution and spread of illness
Detect outbreaks
Generate hypotheses, stimulate research
Evaluate control and prevention measures
Monitor changes in infectious agents
Detect changes in health practices
Facilitate planning
59
Objectives of Surveillance
• Early detection and prediction of outbreaks
• Description of the magnitude of disease
• Understanding risk factors for diseases
• Monitoring trends of endemic disease
• Monitor programme performance and progress
towards a control objective
• Estimate future disease impact
60
Added values of Surveillance
• High-quality surveillance increases credibility of
public health care providers:
–
–
–
–
–
–
61
Encourages transparency
Reduces over-reaction
Attract donors
Encourages implementation of new interventions; new
conjugate meningococcal vaccines
Facilitates better management of disease control and
other public health programs
SAVES LIVES !!!!
Importance of Good Reporting
Health Care System
Event
Public Health Authority
Reporting
Feedback
Intervention
62
Data
Information
Delayed Detection Means Delayed
Response
First
Case
Late
Detection
Delayed
Response
90
80
70
CASES60
Opportunity
for control
50
40
30
20
10
39
37
35
33
31
29
27
25
23
21
19
17
15
13
11
9
7
5
3
1
0
DAY
63
Early Detection…
– Suspect and probable
– Case-based data
– Immediate or weekly
70
CASES60
Opportunity
for control
50
40
30
20
10
39
37
35
33
31
29
27
25
23
21
19
17
15
13
9
11
7
0
5
• Temporal component
• Defined thresholds
• Notification of cases
Delayed
Response
80
3
– Count of cases (?)
– Attack rates (stratified)
– Case-fatality rates
Late
Detection
90
1
• Early warning indicators:
First
Case
DAY
Early
Rapid
Detection Response
90
80
First
70 Case
Potential
Cases Prevented
60
50
40
30
20
10
DAY
64
39
37
35
33
31
29
27
25
23
21
19
17
15
13
11
9
7
5
3
1
0
Types of Surveillance
•Surveillance may be based on many
different data sources
•can be classified in a number of ways,
•including: i) the means by which data
are collected (active versus passive
surveillance );
65
Active vs. Passive Surveillance
• Active Surveillance:
Health department solicits reports
• Passive Surveillance:
Reports are initiated by source for data
66
Surveillance of Disease vs. Persons
• Surveillance of Disease:
“ The continuing scrutiny of all aspects of
occurrence and spread of disease that are
pertinent to its effective control”
• Surveillance of Persons:
“ The continuing scrutiny of disease contacts,
high risk groups in order to promote prompt
recognition of infection or illness”
67
Levels of Surveillance
• National:
–
–
–
Periphery: (e.g., PHCC catchment area, city)
Intermediate: Provincial
Central
• International:
–
68
International Health Regulations 2005
Special Surveillance Programs
• Natural and man-made disasters (emergencies)
• During Special events of mass gatherings
–
–
(Pilgrims to Makkah ‫الحج‬
Olympics
–
–
Emerging pathogens
Antimicrobial resistance
• Laboratory-based surveillance:
• Infection control
• Behavioural risk factors
• Others
69
Systems of Disease Surveillance
• Notifiable disease reporting systems
• Laboratory-based surveillance
• Hospital-based surveillance
• Population-based surveillance
• Vital records (birth and death certificates)
• Registries
70
Routine and sentinel surveillance
• Sentinel surveillance; The surveillance of
a specified health event in only sample
of the population at risk using a sample
of possible reporting sites. The sample
should be representative of the total
population at risk.
• Passive surveillance; Routine surveillance
where reports are awaited and no attempt
make actively seek reports from the
participants in the system.
71
Sentinel Surveillance
• Often provides an early alert for outbreaks
– Most useful for diseases that occur frequently
– Not intended to capture all cases
• Focal points: Clinics, hospitals or laboratories
– Strategic locations
– Representative to population (socio-demographic)
– High risk groups
• Less sites but better quality of data bring attention
to problems in practices, procedures or systems
• Useful for research activities
72
Reporting Channels
WHO / HQ
WHO/ EMRO
National Communicable Diseases Surveillance
District / Region
PHC PHC PHC PHC PHC
73
Reportable Diseases
• Vary from one country to another
– Differences within countries
– Changes over time
• Adding one single disease to the list could cost
•
•
a lot: Money, time, avoidable confusion
Variables collected should be indicators of
potential or arising problems rather than
identifying risk factors
Report only confirmed cases?
74
Frequency of Reporting Diseases
• Weekly? Appropriate most times
• Monthly? Less sensitive
• Quarterly? At national level
• Daily?
– Daily reporting could be cumbersome
– Daily reporting may be required during
emergencies, disasters
• Avoid inconsistencies in case definitions
• Reporting suspected vs. confirmed cases
75
Data Collection Forms
• Should be (for line-listing):
– Simple
– Minimum content
– Layout easy to understand
– Easy to reproduce
• Special data collection forms:
–Special surveillance programs (e.g., Malaria, vector control)
– During outbreaks (Locally acquired or imported?)
– Eradication activities
76
Public Health Laboratories
• Fully linked to epidemiological surveillance
• Ability to confirm diagnosis of epidemic – prone
•
diseases of national interest
Monitor and report selected pathogens
– Meningococcal meningitis and other bacterial
meningitis
– Cholera, Shigellosis and salmonellosis
– Viral Hemorrhagic fevers, etc
• Monitor antimicrobial resistance
77
Analysis of
Surveillance Data
78
Key Indicators
• Absolute numbers
• Proportions
• Rates
• Percentages
• Threshold
79
Information Management
80
Evaluation of
Surveillance Systems
81
Goals of Evaluation of Surveillance
• To improve existing surveillance systems
• To modify systems because of changes in
– Priorities
– Epidemiology
– Diagnostics
• To optimize the use of available resources
82
International Health Regulations
2005
• Current: Notification to WHO of a case of cholera,
plague or yellow fever...............
• IHR 2005
–
–
–
–
–
83
Public health emergencies of international importance
Obligation to establish core capacities
Assistance to States
Context specific & flexible recommended measures
External advice (emergency and review committees)
regarding IHR
Information Loop of Public Health
Surveillance
Public
Reports
Summaries,
Interpretations,
Recommendations
Health Care
Providers
Health
Agencies
Analysis
84
National Notifiable Disease
Surveillance
• Reporting mandated by state
law/regulation
• Health care providers, laboratories
report to local HD (county)
• County HD submits reports to State
• Reports transmitted to CDC primarily
through National Electronic
Telecommunications System for
Surveillance (NETSS)
85
86
DEFINITIONS
• Disease notification is a process of reporting
the occurrence of disease or other healthrelated conditions to appropriate and
designated authorities.
• A notifiable disease is any disease that is
required by law to be reported to government
authorities.
87
DEFINITIONS
• A notifiable disease is one for which regular,
frequent, and timely information regarding
individual cases is considered necessary for
the prevention and control of the disease.
• Physicians are required by law to report cases
of certain infectious diseases. Unfortunately,
many do not.
88
REASONS FOR SURVEILLANCE
• Evaluate the effectiveness of control and preventative health
measures
• Monitor changes in infectious agents e.g. trends in
development of antimicrobial resistance
• Support health planning and the allocation of appropriate
resources within the healthcare system.
• Identify high risk populations or areas to target interventions
• Provide a valuable archive of disease activity for future
reference.
89
Notification: when and how
• IDSR form 001: For immediate/case based
reporting of diseases.
• Immediate reporting allows for timely action
to be taken to prevent the re-emergence or
rapid transmission of epidemic prone diseases
or events, especially diseases due to highly
pathogenic and lethal infectious.
90
Notification: when and how
• Make the initial report by the fastest means
possible (telephone, text message, facsimile, email, radiophone).........................
• Follow up the initial verbal report with a written
report of the case-based report form.
• IDSR 001A when the case is suspected and IDSR
001B when there is laboratory confirmation.
• Below is a list of diseases/events requiring
immediate reporting.
91
Diseases/Events reported with form
IDSR 001
• Acute Flaccid
Paralysis (AFP)
• Acute hemorrhagic
fever syndrome
(Ebola, Marburg, Lassa
Fever, RVF,
Crimean-Congo)
• Adverse event
following
immunization
(AEFI)
• Anthrax
• Chikungunya
• Cholera
• Cluster of SARI
• Diarrhoea with
blood (Shigella)
• Dracunculiasis
• Influenza due to
new subtype
• Maternal death
• Measles
• Meningococcal
meningitis
• Neonatal tetanus
• Plague
• Rabies (confirmed
cases)
•
•
•
•
•
SARS
Smallpox
Typhoid fever
Yellow fever
Any public health
event of
international
concern (infectious,
zoonotic, food borne,
chemical, radio
nuclear or due to an
unknown condition)
92
Notification: when and how
• IDSR form 002: For weekly reporting of new
cases of epidemic/pandemic prone diseases.
• IDSR form 003: For routine monthly
notification of other diseases of public health
importance.
93
Diseases that require monthly
reporting
•
•
•
•
•
•
•
•
•
Acute viral hepatitis •
AIDS (New Cases) •
Buruli ulcer
•
Diabetes mellitus •
Diarrhoea with
severe dehydration
in children under 5 •
years of age
HIV (new
•
detections)
•
Hypertension
•
Influenza-like illness
Injuries (Road
Traffic Accidents)
Leprosy (quarterly)
Lymphatic Filariasis
Malaria
Malnutrition in
children under 5
years
Mental health
(Epilepsy)
Noma
Onchocerciasis
Severe pneumonia
in children under
5years of age
• Sexually
transmitted
diseases (STIs)
• Trachoma
• Trypanosomiasis
• Tuberculosis
(quarterly)
• Underweight
Newborns (less
than 2500 g)
94
CHAIN OF REPORTING
HCP
WHO/CDC
DNO
LG MOH
FMOH
SMOH
Key:
HCP: Health care providers
DNO: Disease notification officer
LG MOH: Local Government Medical Officer of Health
SMOH: State Ministry of Health
FMOH: Federal Ministry of Health
95
Surveillance Team Needs to Work Together
Tabloids
Newsp apers
96
Lack of
coordination in
outbreak team
Scientific TV/Radio
press
WHO/EMC
97