Epidemiologic

surveillance

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Session objectives and contents

Definition of surveillance
Purpose of surveillance
Types and Activities of surveillance
Sources of surveillance data
Characteristics of surveillance
Common limitations
Selection of disease for surveillance
The Integrated Disease Surveillance System
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 Definition of Surveillance
 Surveillance is an on-going systematic collection,
analysis, interpretation and dissemination of health-
related data essential to the planning, implementation,
and evaluation of public health practice.
 WHO defines surveillance as the continuous (ongoing)
analysis of the factors that determine the occurrence
and distribution of diseases and other health related
events through a systematic collection of data.

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 Surveillance ....
The essential characteristic of surveillance is
that it should be continuous.
The continuous nature of surveillance will
enable to establish baseline information
regarding the normal pattern of disease so that
unusual occurrences e.g: epidemic, seasonal,
cyclic or secular trends could be identified.
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 Surveillance can be conducted

Globally (as in AIDS surveillance system ), at

national, at regional level or at institutional
level.

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 Why do we undertake surveillance?
Principal purposes of surveillance are to:
Provide baseline information for:
priority setting
 planning and
evaluating disease control programmes
Enable early recognition, investigation and control
of outbreaks.
Provide information for understanding the
distribution of disease by time, place and person.

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 Why do we undertake surveillance?...

To detect sudden changes in disease occurrence

and distribution
To follow secular (long-term) trends of a disease
To identify changes in agents and host factors
Detect changes in health care practices

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 Why do we undertake surveillance?...

Generally

Estimate magnitude of the problem

Determine geographic distribution of illness
Describe the natural history of a disease
Detect epidemics
Generate hypotheses, stimulate research
Evaluate control measures
Monitor changes in infectious agents
Detect changes in health practices
Facilitate planning
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 Types of Surveillance
Passive surveillance
Active surveillance
Sentinel surveillance
Enhanced surveillance
Intensified surveillance

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 Passive Surveillance
• A condition in which health care providers send
reports based on a known set of regulations.
• Involves cases detected in the course of the
normal operation of the health services i.e., self
reporting.

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 Active Surveillance
A condition in which the health providers
collect reports of a disease by moving to the
community with a morbidity of interest.
Due to the expenses of active surveillance, it is
used only for specific purposes and for
limited periods of time.

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 Sentinel surveillance
Means of monitoring trends of health events in
chosen population groups and chosen sites in a
regular and consistent (Uniform) way.
Uses a pre-arranged sample of reporting sources
to represent all conditions in the specified
community.

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 Cont…

Enhanced surveillance
The collection of additional data about cases
reported under routine surveillance.
Intensified surveillance
 The upgrading from a passive to an active
surveillance system for a specified reason and for a
limited period (usually because of an outbreak ).
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 Surveillance Activities
• Core Activities:
 Detection
 Registration
 Confirmation (epidemiological and laboratory confirmation)
 Reporting (early warning)
 Analysis and interpretation of data
 Feedback
 Evaluation and monitoring
 Dissemination of the findings for appropriate action;
 Disease prevention and control
 Health planning and resource allocation
 Research and teaching 14
Sources of surveillance data include:
Census data
Mortality reports
Morbidity reports
Hospital data (discharge diagnoses, surgical logs, hospital
infection reports)
Absenteeism records (school, workplace)
Epidemic reports

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 Sources of surveillance data...

 Laboratory test result and reports

 Drug utilization records
 Special surveys (e.g., research data, serologic
surveys)
 Police records (especially for injury, alcohol-
related crime)
 Environmental data (hazard surveillance, water
and food testing)

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 Surveillance Characteristics

Continuous

Current/timely

Reporting

intervention

Purposeful/Orientation to action
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Attributes of a good surveillance system
 Simple
 Flexible
 Acceptable
 Sensitive; able to detect the problem
 Good predictive value positive; good yield
 Representative
 Timely
 Cost effective
Combination of active and passive mechanisms
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 Common limitations of surveillance
systems

Under reporting

 Lack of representativeness of reported cases

 Lack of timeliness

 Inconsistency of case-definitions

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Factors related with the selection of disease for
surveillance:

Magnitude of the disease

Feasibility of control measures
Resource availability

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 Critical Information in Surveillance
 Person: Age, sex
 Time: onset of disease, reporting period
 Place: woreda, region
 Risk factors
 Number of cases (magnitude)
 Treatment outcome: deaths, recovery
(seriousness)
 Mode of treatment: inpatient/outpatient

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 Case definition
It includes
– Criteria: Signs and symptoms with or without a laboratory
test
– Restriction by time, place and person can be done
depending on the nature of the disease
• Classification of case definition
1. Confirmed: a case definition by appropriate lab. Test
2. Probable: a case with typical clinical features of the
disease without laboratory confirmation
3. Possible/ Suspect: a case with few of the typical clinical
features.
Use case definition consistently!!
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 Major advantages of case definition
 Facilitate early detection and prompt
management of cases
 Useful in areas where there is no laboratory
 Facilitate observation of trends
 Facilitate comparison more accurately from
area to area

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 Improving Public Health Surveillance in Africa/
Ethiopia

• Using Integrated Disease Surveillance and

Response (IDSR) strategy

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 IDSR……
• An approach adopted to strengthen national diseases
surveillance system by coordinating & streamlining
all surveillance activities and ensuring timely action.

• IDSR initiative was launched by the WHO-AFRO

(Africa regional office for WHO) in the second half
of the 1990’s.

 Then has been adapted by many African countries

including Ethiopia.

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 IDSR……
• Simplified tools for data collection and
analysis, common channels for reporting and
feedback
• It helps to Strengthen the capacity to detect
and respond to communicable disease
threats and emergencies
• Integration to maximize effective utilization
of scarce resources

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 IDSR...
The overall objective of the IDSR is to
improve the ability of health workers to detect
and respond to priority communicable
diseases.
To make effective and timely decision-based
on good evidence.

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 IDSR….

• Ethiopia has been implemented IDSR strategy

for strengthening communicable disease
surveillance in the country since the year
2000.
• Ethiopia is one of the countries in Africa that
made good progress in IDSR implementation.

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 Surveillance ....

Reading assignment
• What are the priority diseases under the
integrated disease surveillance system in
Ethiopia?

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