Introduction to the Integrated Disease Surveillance Project

1
Introduction to the Integrated Disease
Surveillance Project

• IDSP training module for state and district
  surveillance officers
• Module 1

2
Learning objectives

• Define surveillance and explain important
  terminology in surveillance
• List all the components of the surveillance
  activities
• Specify the major objectives of the Integrated
  Disease Surveillance Project
• List types of surveillance carried out under the
  Integrated Disease Surveillance Project by
  different categories of staff
• Name all reporting units in the rural and urban
  areas of a district
• List all conditions under surveillance through
  primary health centre/community health
  centresystem

3
Health goals - India

• Eradicate polio 2005
• Eliminate leprosy and yaws 2005
• Establish IDSP, NHA/Health Stats 2005
• Zero-level growth of HIV/AIDS 2007
• Eliminate Kala-Azar 2010
• ? Mortality by 50 - TB, malaria and other 2010
• ? Prevalence of blindness to 0.5 2010
• ? IMR to 30/1000, MMR to 100/100,000 2010
• Eliminate lymphatic filariasis 2015

4
Public health surveillance

• Surveillance is defined as the ongoing
  systematic collection, collation, analysis and
  interpretation of data and dissemination of
  information to those who need to know in order
  that action be taken

5
Important information in surveillance

• Who get the disease?
• How many get them?
• Where they get them?
• When they get them?
• Why they get them?
• What needs to be done as public health response?

6
Why do we need to do surveillance? (1/2)

• Recognize cases or cluster of cases to trigger
  intervention to prevent transmission or reduce
  morbidity and mortality
• Assess the public health impact of health events
  or determine and measure trends
• Demonstrate the need for public health
  intervention programme and resources during
  public health planning

7
Why do we need to do surveillance? (2/2)

• Monitor effectiveness of prevention and control
  measures and prevent outbreaks
• Identify high risk groups or geographical areas
  to target interventions an guide analytic studies
• Develop hypotheses that lead to analytic studies
  about risk factors for disease causation,
  propagation or progression

8
Key elements of a surveillance system

• Detection and notification of health events
• Investigation and confirmation
• Collection of data
• Analysis and interpretation of data
• Feedback and dissemination of results
• Response Action for prevention and control

9
1997-8 National Surveillance Programme for
Communicable Diseases (NSPCD)

• Nodal point
• National Institute for Communicable Diseases
• Implementing agencies
• States and union territories
• Main components
• Infrastructural strengthening - Laboratories
• Human resources development
• Uniform and regular reporting
• Monitoring and evaluation
• Operational - 101 districts (Merged in IDSP
  Phase-I)

10
Objectives of NSPCD

• Strengthen district and state capabilities to
  promptly identify and respond to disease
  outbreaks
• Establish an early warning mechanism
• Laboratory strengthening and networking for rapid
  confirmation of diagnosis
• Effective use of surveillance data using rapid
  means for communication
• Institute appropriate and timely response for
  prevention and control of outbreaks

11
Objectives of NSPCD

• Improving technical capabilities of medical and
  paramedical personnel
• Up-gradation of laboratories at district, state
  and regional level
• Improving communication and data processing
  system
• Constitution of rapid response teams at district
  and state levels for early response
• Collaboration with ICMR, WHO and other concerned
  agencies/departments

12
Weaknesses in disease surveillance

• Lack of integration of private sector
• Poor laboratory capacity
• Blind spots in urban areas
• Slow, inefficient sharing of surveillance
  information at district level
• Limited capacity to undertake analysis and
  response at district level
• Non-inclusion of non communicable diseases

13
Surveillance strategy in the Integrated Disease
Surveillance Project (1/2)

• District level is the basic functional unit for
  integrating surveillance functions
• All surveillance activities are coordinated and
  streamlined
• Resources are combined to collect information
  from single focal point at each level
• Several activities are combined into one
  integrated activity to take advantage of similar
  surveillance functions, skills, resources and
  target populations

14
Surveillance strategy in the Integrated Disease
Surveillance Project (2/2)

• Integrates public and private sector by involving
  private practitioners and communities
• Addresses communicable and non communicable
  diseases
• Covers both rural and urban health systems
• Collaborates with private and public medical
  colleges

15
Objectives of the Integrated Disease Surveillance
Project

• To establish a decentralized district based
  system of surveillance for communicable and
  non-communicable diseases so that timely and
  effective public health actions can be initiated
  in response to health changes in the urban and
  rural areas
• To integrate existing surveillance activities to
  avoid duplication and facilitate sharing of
  information across all disease control programmes
  and other stake holders so that valid data is
  available for health decision making in the
  district, state and national levels

16
Important components where additional inputs will
be provided

• Strengthening of laboratories
• Improved information management system
• Human resource development
• Developing supporting structure for integration

17
What is integration?

• Sharing of surveillance information of disease
  control programmes
• Developing effective partnership with heath and
  non health sectors in surveillance
• Including communicable and non communicable
  diseases in the surveillance system
• Working with the private sector and non
  governmental organization
• Bringing academic institutions and medical
  colleges into disease surveillance

18
Classification of surveillance in IDSP

• Syndromic
• Diagnosis made on the basis clinical pattern by
  paramedical personnel and members of community
• Presumptive
• Diagnosis is made on typical history and clinical
  examination by medical officers
• Confirmed
• Clinical diagnosis by medical officer and or
  positive laboratory identification

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Conditions under regular surveillance
Type of disease Disease
Vector borne diseases Malaria
Water borne diseases Diarrhea (Cholera)
Water borne diseases Typhoid
Respiratory diseases Tuberculosis
Vaccine preventable diseases Measles
Disease under eradication Polio
Other conditions Road traffic accidents
International commitment Plague
Unusual syndromes Meningo-encephalitis Respiratory distress Hemorrhagic fever
20
Other conditions under surveillance
Type of surveillance Categories Conditions
Sentinel surveillance STDs HIV/HBV/HCV
Sentinel surveillance Other conditions Water quality
Sentinel surveillance Other conditions Outdoor air quality
Regular surveys Non communicable disease risk factors Anthropometry
Non communicable disease risk factors Physical activity Blood pressure
Non communicable disease risk factors Physical activity Blood pressure
Non communicable disease risk factors Tobacco, blood pressure
Nutrition
Blindness
Additional state priorities Additional state priorities Up to five diseases
21
State-specific diseases

• Madhya Pradesh, Uttaranchal
• Diphtheria, neonatal tetanus, leprosy
• Maharashtra
• Diphtheria, neonatal tetanus, leptospirosis
• Andhra Pradesh
• Filariasis
• Karnataka
• Filariasis, KFD HGS, leptospirosis
• Tamil Nadu
• Leprosy, leptospirosis
• Kerala
• Leptospirosis
• Mizoram
• Cancer, substance abuse, acid peptic disease,
  pneumonia

22
The limited number of conditions under
surveillance

• Limited number of core diseases
• Improves quality of surveillance
• Reduces workload
• Diseases of regional importance
• Under surveillance in addition to the core list
• Review and modification of the list according to
  needs at least once in two years
• Viral hepatitis and acute respiratory tract
  infection
• Also under consideration at various levels
• May be included subsequently

23
Surveillance activities at each level
Activities Periphery District State
Detection and notification of cases -
Consolidation of data
Analysis and interpretation
Investigation and confirmation
Feedback
Dissemination
Action
24
Reporting units for disease surveillance
Public sector (Exhaustive) Private (Sentinel)
Rural Community health centres District hospitals Practitioners Hospitals
Urban Urban hospitals ESI Railways Medical colleges Nursing homes Hospitals Medical colleges Laboratories
25
Role of district surveillance officers and
medical officers

• Supervision and quality control of active
  surveillance by field staff
• Passive surveillance for diseases on the list
• Supervision of compilation and transmission of
  periodical reports
• Integration of sentinel private practitioners
• Emergency response to surveillance reports
  received
• Facilitation of outbreak investigation and
  response

26
Phases of implementation for the Integrated
Disease Surveillance Project

• Phase I (2004-05)
• Madhya Pradesh, Andhra, Himachal, Karnataka,
  Kerala, Maharashtra, Mizoram, Tamil Nadu
  Uttaranchal
• Phase II (2005-06)
• Chattisgarh, Goa, Gujarat, Haryana, Orissa,
  Rajasthan, West Bengal, Manipur, Meghalaya,
  Tripura, Chandigarh, Pondicherry, Nagaland, Delhi
• Ph III (2006-07)
• UP, Bihar, JK, Punjab, Jharkhand, Arunachal,
  Assam, Sikkim, AN Island, DN Haveli, Daman
  Diu, Lakshadweep