Unit 3: Universal Case Reporting and Sentinel Surveillance for STIs

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Unit 3 Universal Case Reporting and Sentinel
Surveillance for STIs
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Warm Up Questions Instructions

• Take five minutes now to try the Unit 3 warm up
  questions in your manual.
• Please do not compare answers with other
  participants.
• Your answers will not be collected or graded.
• We will review your answers at the end of the
  unit.

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What You Will Learn

• By the end of this unit, for STI universal case
  reporting and sentinel surveillance, you should
  be able to
• discuss the purpose of each system of
  surveillance
• discuss the advantages and disadvantages of each
• define when each should be implemented
• define the population studied for each
• discuss reporting under IDS

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Two Case Reporting Approaches

• This unit compares and contrasts two different
  approaches to STI case reporting
• In universal STI case reporting, all healthcare
  facilities report all STI cases to public health
  authorities.
• In STI sentinel surveillance, selected sites
  collect more detailed data on STI cases.

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Universal STI Case Reporting

• Minimal data elements about STIs are collected
  from all health facilities.
• Two types of reports may be used
• syndromic reports, which provide data on
  patients set of symptoms (syndromes)
• aetiologic reports, which provide data on which
  micro-organism is causing symptoms. These
  determinations can only be made in a laboratory.
• General lack of lab support in the African region
  means that syndromic reports will be the primary
  method used.

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Advantages of Universal Case Reporting

• Universal case reporting provides the most
  readily available source of STI surveillance
  data.
• It provides data which is easy to collect from
  health facilities.
• It provides data on the burden of STIs at the
  health facility level, important for planning
  health services.
• When consistent, it can be used to track
  population-level STIs trends.

(This information can be found in Table 3.1 in
the text.)
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Disadvantages of Universal Case Reporting

• Universal case reporting is based on recognition
  of symptoms and thus provides a poor assessment
  of the true disease burden among women.
• It does not provide a direct estimate of the
  population burden of STIs because people with
  asymptomatic infection do not realise they are
  infected so they do not seek care.
• It is affected by fluctuations in health-seeking
  behaviours of the population not related to the
  burden of disease.

(This information can be found in Table 3.1 in
the text.)
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Reporting Form for Universal Case Reporting

• WHO recommends the IDS form for universal case
  reporting in the African region.
• This form is used for all priority communicable
  diseases.
• The STI syndromes reported in IDS are
• male urethral discharge
• male genital ulcer disease
• female genital ulcer disease

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STI Sentinel Surveillance

• A pre-arranged sample of health facilities and
  other sites agrees to report one or more
  notifiable conditions.
• More demographic and risk data on STI cases are
  collected and reported.

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STI Sentinel Surveillance, Cont.

• Site trends in STI case reports are used to infer
  trends at other health facilities.
• Take care in interpreting the results, since
  sentinel sites are not necessarily representative
  of the whole region.
• Health facilities known to be diligent in
  reporting STI cases are selected as the sentinel
  sites.
• Detailed high-quality data are collected from
  these sites.

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Sentinel Site Case Reporting

• STI cases are reported from a small number of
  sentinel sites using either the syndromic or
  aetiologic reporting.
• Syndromic case reporting
• More common in African countries, where lab
  support is not usually available.
• Same case definition at all sites, for easy
  comparison.
• Aetiologic
• Lab support must be available.
• Cases classified as confirmed or probable,
  depending on strength of laboratory evidence.

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Advantages of Sentinel Site Case Reporting

• Regular supervision, feedback and logistical
  support can be provided because sentinel sites
  are located in fewer facilities.
• Higher quality data can be obtained from a few
  sites with intensive support of training,
  supervision and logistics.
• Sentinel STI case reporting system is less
  expensive to run and maintain than a universal
  reporting system.
• It is more flexible than universal case
  reporting. Additional studies can be added
  without changing the basic structure.

(This information can be found in Table 3.2 in
the text.)
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Disadvantages of Sentinel Site Case Reporting

• Sentinel STI surveillance cannot provide minimum
  population-based estimates of disease burden.
• Sentinel sites are located in only a few health
  facilities and may not be representative of sites
  outside of their catchment areas.

(This information can be found in Table 3.2 in
the text.)
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Selection of Sentinel Sites

• Convenience sampling the selection of sites
  based on their availability and accessibility
• Probability sampling the selection of sites that
  ensures that each site has an equal probability
  of being selected
• Probability sampling gives more representative
  results, but it is more difficult and
  inconvenient.

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Selection of Sentinel Sites, Cont.

• Selection is influenced by
• the objectives of the system
• the structure of the countrys health system
• the extent to which STI case reporting is
  incorporated into primary healthcare
• The sites should
• see a large number of STI cases and provide care
• include both urban and rural areas
• have qualified staff
• include high-risk groups
• integrate STI surveillance with other
  surveillance activities
• include public and private sectors

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Developing the Reporting Forms

• The national AIDS/STI control programme should
  develop the forms.
• The same form should be used at all sites.
• Reporting forms should be simple.
• To protect patients privacy, reporting forms
  should not have personally identifying
  information.

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Table 3.3. Core and AdditionalData Elements
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Implementing Surveillance

• Site staff should be trained in data collection
  using the standard reporting forms.
• There should be enough forms at sites.
• There should be supervision from the national
  AIDS/STI control programme.
• There should be a system of data transfer to the
  central office.
• Sentinel sites should be monitored for data
  quality.

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Combined Universal and Sentinel Surviellance Case
Reporting

• Universal case reporting through IDS provides
  basic estimates of incidence and prevalence.
• Sentinel case reporting supplements universal
  reporting by providing epidemiological and
  clinical detail on a subset of cases.
• Sentinel sites should report through both the
  universal and sentinel reporting systems.
• Universal case reporting through IDS should be
  the priority. If this is not possible, sentinel
  surveillance can be conducted instead.

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Syphilis Screening at Sentinel Sites

• Distinct from sentinel STI case reporting
• Data are collected from routine clinical syphilis
  screening programs.
• Prevalence can be calculated for all tested
  patients, or by demographic or risk group.
• Examples of sentinel sites include
• antenatal clinics
• STI clinics

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In Summary

• STI surveillance can occur through universal case
  reporting, sentinel surveillance or a combination
  of the two.
• Sentinel surveillance gives higher quality data
  than universal case reporting, at lower cost.
• Sentinel surveillance data are not representative
  of the general population, while universal case
  reporting data can be.
• Through IDS, priority is given to universal case
  reporting.

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Warm Up Review

• Take a few minutes now to look back at your
  answers to the warm up questions at the beginning
  of the unit.
• Make any changes you want to.
• We will discuss the questions and answers in a
  few minutes.

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Answers to Warm Up Questions

• 1. Which of the following is an advantage of
  universal STI case reporting?
• a. It is the most readily available source of
  surveillance data and easy to collect from health
  facilities.
• b. It provides data on the burden of STIs at the
  health facility level, which is important for
  planning health services provisions.
• c. Under stable conditions and consistent
  reporting, data arising from STI case reporting
  can serve as a proxy for population dynamics of
  STIs.
• d. All of the above

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Answers to Warm Up Questions

• 1. Which of the following is an advantage of
  universal STI case reporting?
• a. It is the most readily available source of
  surveillance data and easy to collect from health
  facilities.
• b. It provides data on the burden of STIs at the
  health facility level, which is important for
  planning health services provisions.
• c. Under stable conditions and consistent
  reporting, data arising from STI case reporting
  can serve as a proxy for population dynamics of
  STIs.
• d. All of the above

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Answers to Warm Up Questions, Cont.

• 2. True or false? Data collected from sentinel
  sites can be easily generalised to a broader
  population.

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Answers to Warm Up Questions, Cont.

• 2. True or false? Data collected from sentinel
  sites can be easily generalised to a broader
  population. False

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Answers to Warm Up Questions, Cont.

• 3. In countries where information about STIs is
  obtained through a universal reporting system,
  sentinel STI surveillance
• a. is unnecessary
• b. should replace universal reporting as the
  primary method to study STIs
• c. should supplement information obtained from
  the universal reporting system

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Answers to Warm Up Questions, Cont.

• 3. In countries where information about STIs is
  obtained through a universal reporting system,
  sentinel STI surveillance
• a. is unnecessary
• b. should replace universal reporting as the
  primary method to study STIs
• c. should supplement information obtained from
  the universal reporting system

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Answers to Warm Up Questions, Cont.

• 4. True or false? Supervision and feedback are
  easier to provide for a sentinel surveillance
  system than for a universal system.

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Answers to Warm Up Questions, Cont.

• 4. True or false? Supervision and feedback are
  easier to provide for a sentinel surveillance
  system than for a universal system. True

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Answers to Warm Up Questions, Cont.

• 5. True or false? Universal case reporting
  provides a poor assessment of the true disease
  burden among women.

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Answers to Warm Up Questions, Cont.

• 5. True or false? Universal case reporting
  provides a poor assessment of the true disease
  burden among women. True

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Answers to Warm Up Questions, Cont.

• 6. What system of surveillance is recommended for
  reporting all priority communicable diseases?

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Answers to Warm Up Questions, Cont.

• 6. What system of surveillance is recommended for
  reporting all priority communicable diseases?
  Integrated Disease Surveillance

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Small Group Discussion Instructions

• Get into small groups to discuss these questions.
  
• Choose a speaker for your group who will report
  back to the class.

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Small Group Reports

• Select one member from your group to present your
  answers.
• Discuss with the rest of the class.

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Case Study Instructions

• Try this case study individually.
• Well discuss the answers in class.

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Case Study Review

• Follow along as we go over the case study in
  class.
• Discuss your answers with the rest of the class.

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Questions, Process Check

• Do you have any questions on the information we
  just covered?
• Are you happy with how we worked on Unit 3?
• Do you want to try something different that will
  help the group?

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