Surveillance data collection in IDSP

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Surveillance data collection in IDSP

• Integrated Disease Surveillance Programme (IDSP)
  district surveillance officers (DSO) course

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Outline of this session

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

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Surveys versus surveillance

• Survey
• Data collection at one point in time
• Prevalence data
• Surveillance
• Ongoing, routine data collection
• Incidence data

Concepts
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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

Concepts
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Example of a line listing for reporting
individual cases of measles
ID Date of onset Location Age Sex Vaccine status
1 12 Jan 06 Village A 2 Male Yes
2 13 Jan 06 Village B 3 Female Yes
3 14 Jan 06 Village B 1 Female No
4 14 Jan 06 Village B 5 Male Yes
5 14 Jan 06 Village B 3 Male No
6 14 Jan 06 Village B 2 Female Yes
7 15 Jan 06 Village A 1 Male Yes
8 16 Jan 06 Village C 12 Female No
9 16 Jan 06 Village B 4 Male Yes
Concepts
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Reporting of aggregated cases of diseases in
(place) during (time)
Disease Under 5 years of age Under 5 years of age 5 years of age and older 5 years of age and older
Disease Male Female Male Female
Diarrhea 2 1 4 3
Bloody diarrhea 0 0 1 0
Pneumonia 3 2 1 2
Fever 4 3 12 10
Fever / rash 1 0 0 0
Total encounters 10 6 18 15
Concepts
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Conditions under regular surveillance in
integrated disease surveillance programme (IDSP)
Type of diseases Condition 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
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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
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Types of case definitions in use
Case definition Criteria Users
Syndromic(suspect)S forms Clinical pattern Paramedical 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
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What is an epidemiologically linked case?

• One or few probable cases are confirmed by the
  laboratory
• 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
• These epidemiologically linked cases are
  reported on a separate section of the P form

Collection
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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

Collection
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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
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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
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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
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Revised malaria form (MF) 11(Revised to fit IDSP
format, to be ultimately merged)
The new malaria form takes into account IDSP
classification of fever cases for better
coordination
Collection
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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
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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
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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
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Applying the checklist Making sure all numbers
in the S form come from individual cases in the
S register
S register
S form
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Poor data entry on form SSome cells are not
filled
Male Male Female Female Total Total
Fever lt 7 days lt 5 yr gt 5 yr lt 5 yr gt 5 yr lt 5 yr gt 5 yr
1 Only fever  2      6    
2 With rash          
3 With bleeding          
4 With daze/ Semi-consciousness/ Unconsciousness            
Fever gt 7 days            
------- NIL -------
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Data entry on form S as recommended
Male Male Female Female Total Total
Fever lt 7 days lt 5 yr gt 5 yr lt 5 yr gt 5 yr lt 5 yr gt 5 yr
1 Only fever  2  NIL   NIL  6   2  6
2 With rash  NIL   NIL   NIL   NIL   NIL   NIL
3 With bleeding  NIL   NIL   NIL   NIL   NIL   NIL
4 With daze/ Semi-consciousness/ unconsciousness   NIL   NIL   NIL   NIL   NIL   NIL
Fever gt 7 days  2   NIL   NIL  6 2  6
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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
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Summary The flow of the S form
Form Stransmission
Form Scompletion
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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
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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
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Applying the checklist Making sure all numbers
in the P form come from individual cases in the
P register
P register
P form
Collection
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S, P and L1 forms converge at the block
level

• Block primary health centre (BPHC)
• Community health centre (CHC)

Collection
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Information from other reporting sources
Big labsL2 form
Small labsL1 form
HospitalsConsolidated P forms
Clinics and practitioners P forms
Quacks and traditional practitioners S forms
Collection
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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
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Take home messages

• IDSP is mostly based upon aggregated reporting
• Know the diseases under surveillance
• Understand the data flow of each of the case
  definition levels
• S forms
• P forms
• L1/2 forms

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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