Field Test of IDS Generic Guidelines

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Field Test of IDS Generic Guidelines

• Morogoro, Tanzania,
• October 9 to 12 2000
• Helen Perry, MA (CDC/EPO/DIH)
• Peter Nsubuga, MD, MPH (CDC/EPO/DIH)
• Kathy Cavallaro, MS (NCID/BMD)

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Agenda

• Overview of the structure of the IDS Generic
  Guidelines
• Overview of the presentation of the results of
  the field test
• Presentations of the field test results
• Discussion

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Facilitators

• CDC
• Helen Perry MA, DIH/EPO
• Peter Nsubuga MD, DIH/EPO
• Kathy Cavallaro MS, DBMD/NCID
• WHO-AFRO
• Mac Otten MD, IDS/EPI
• Chris Tetteh MD, EPI Consultant to Tanzania

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Selection of Participants

• Dr. N. Eseko and Dr. M. Kibona,
• Epidemiology Section, Ministry of Health,
  Tanzania
• 22 District Participants from 5 Regions
• Morogoro
• Iringa (3 hrs West of Morogoro)
• Tanga (3 hrs North East)
• Arusha (4 hrs North)
• Kilimanjaro (4 hrs North)
• WHO Representatives (2)
• Ministry of Health (2)

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Pre-test Schedule
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Protocol

• Facilitated desk review of each of 8 sections
• Overview (plenary)
• Group discussion (2 groups)
• Group presentations (plenary)
• Discussion (plenary)
• Individual evaluation
• Exit interviews by facilitators

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Demographics of Participants

• Total of 26 participants
• 11 (42) Medical Doctors
• 9 District or Municipal Medical Directors
• 9 District Health Officers
• 2 Clinicians, 1 Environmental Health Officer
• 3 National level/WHO country staff
• 5 Have Masters Degrees
• All speak English and Swahili

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Individual Evaluation

• 5 point scale for each of 8 criteria
• Strongly disagree
• Disagree
• No Opinion
• Agree
• Strongly agree
• Written comments

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8 Criteria

• Organization of section
• Layout and flow
• Readable words and phrases
• Relevant information
• Clear (understandable) activities
• Doable (Activities can be done)
• Require extra resources to do the activities
• Easy to find information in outbreak (Searchable)

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Outstanding Issues

• Completion of district analysis book
• Disease-specific guidelines
• Alert and action thresholds
• Indicators and targets
• Resources

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Analysis Book for District and Health Facility

• Relationship to guidelines and task analysis
• Incorporate into Section 3
• Analysis book and guidelines have technical
  concord
• Appropriate recommendations
• Minimum recommendations for health facility,
  district
• Impact on existing recommendations (e.g., case
  definitions, specific recommendations,
  supervision)
• Evaluation of a pilot version

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Disease Specific Guidelines

• Consistent terms
• Revise to agree with new tools in guidelines
• Analysis book requirements
• Quality surveillance indicators
• District point-of-view
• African health care setting point-of-view
• Describe alert and action thresholds

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Alert and Action Thresholds

• Alert
• Notify, inform
• Investigate
• Confirm
• Treat
• Prepare

• Action
• Improve case management
• Community education
• Community mobilization
• Immunize
• Identify high risk populations

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Indicators and Targets

• Harmonize the variety of indicators in IDS
• Indicators for each level
• Sources of data
• Relationship to supervision
• Setting and using targets
• Systematic process for refining indicators

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Resources

• Needs further inquiry to define district needs
  based on target audience and field test results
• Training
• Supervision
• Communication
• Laboratory access
• Supplies and equipment
• Include in guidelines how to advocate for
  resources

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Next Steps

• Decide actions and timeline for addressing
  outstanding issues within partnership
• Decide what is adaptable
• Testing next version
• Digest Morogoro results and agree on changes
• Make edit changes
• Make technical changes
• Prepare next version