Dr Mfonfu Daniel
Independent researcher
Tel: +237
677601207,Email: dmfonfu@yahoo.com
Website: www.mfonfudaniel.blogspot.com
EPIDEMIOLOGICAL
SURVEILLANCE SOFTWARE
Conceived and
Programmed by Dr Mfonfu Daniel,
1.
Introduction:
Generally in epidemiological surveillance all health
institutions should declare weekly the number of cases and deaths of diseases
with epidemic potential; and others placed under epidemiological surveillance
by the Ministry of Public Health.
Some diseases with epidemic potentials are:
Cholera ; Meningitis; Measles ; Neonatal
Tetanus; Maternal tetanus; Acute Flaccid Paralysis; Typhoid Fever; Pertussis;
Dysentery; Malaria, Common Cold, Haemorrhagic fever; Ebola, HIV/ADS; etc.
Each week several health facilities send the
declaration of cases and deaths of diseases to the higher level where synthesis
is made.
2. Definition of epidemiology
Epidemiology
is the
study of the distribution and determinants of health-related states or events
in specified populations, and the application of this study to the control of
health problems.
a)
Study—Epidemiology is the
basic science of public health. It's a highly quantitative discipline based on
principles of statistics and research methodologies.
b)
Distribution—Epidemiologists study
the distribution of frequencies and patterns of health events within groups in
a population. To do this, they use descriptive epidemiology, which
characterizes health events in terms of time, place, and person.
c)
Determinants—Epidemiologists also
attempt to search for causes or factors that are associated with increased risk
or probability of disease. This type of epidemiology, where we move from
questions of "who," "what," "where," and
"when" and start trying to answer "how" and
"why," and “what next” is referred to as analytical epidemiology.
d)
Health-related states—Although infectious diseases were clearly the focus of much of
the early epidemiological work, this is no longer true. Epidemiology
as it is practiced today is applied to the whole spectrum of health-related
events, which includes chronic disease, environmental problems, behavioral
problems, and injuries in addition to infectious disease.
e)
Populations—One of the most important
distinguishing characteristics of epidemiology is that it deals with groups of
people rather than with individual patients.
f)
Control—Finally,
although epidemiology can be used simply as an analytical tool for studying
diseases and their determinants, it serves a more active role. Epidemiological
data steers public health decision making and aids in developing and evaluating
interventions to control and prevent health problems. This is the primary
function of applied, or field, epidemiology.
g) The goal of epidemiology is to
identify subgroups of the population who are at a higherrisk of disease than
usual and who will benefit the most from disease specificinterventions.
Epidemiological information can be used to develop prevention strategiesaccording
to:
·
Time
(peaks at a particular season);
·
Place
(limited to specific geographic areas); or
·
Person
(groups at risk).
3. Definition of surveillance
Surveillance
is “collection and analysis of data for action” Epidemiological Surveillance (Public health surveillance)is defined as
the on-going and systematic collection, analysis, interpretation,
and dissemination of data about cases of a disease and it is used as a basis
for planning, implementing, prevention, control and evaluating disease.
Types of Surveillance:
a)
Passive Surveillance: Surveillance is passive
when data/ reports are sent by designated health facilities or individuals
on their own, periodically as a routine
b)
Active Surveillance: Surveillance is active
when a designated official, usually external to the health facility visits
periodically and seeks to collect data from individuals or registers, log
books, medical records at a facility to ensure that no reports/data are
incomplete or missing.
c)
Institutional surveillance
refers to the collection of data (actively or passively) from pre-identified
and designated fixed facilities regardless of size.
d)
Community-based surveillance refers
to the collection of data from individuals and households at the
village/locality level rather than from institutions or facilities. Analysis of
surveillance data helps us to know the following:
-
Where the disease is occurring (place)
-
When the disease is occurring (time)
-
In whom the disease is occurring
(person)
4. Use of epidemiological surveillance
i)
Detection
of epidemics
ii)
Quantitative
estimates of the magnitude of a health problem
iii)
Shows
the natural history of a disease by indicating the incidence rate over a period
of time
iv)
v)
Making
decisions
vi)
Setting
priorities,
vii)
Planning
viii)
Implementation
of interventions
ix)
Monitoring
of health intervention programs
x)
Evaluation
of control and prevention measures
5. Definition of the health system:
The health
system of in most countries is the District Health System. This Health System
is pyramidal with three levels: the central level or strategic –Ministry of
Public Health, the intermediate level or regional – The Regional level with the
Regional Delegation of Public Health, and the peripheral or operational
level – The Health District.
The Health
District is divided into Health Areas with principal or leading health centres or
Medical Centres. The Health Area and its Health Centre is the entry point of
the population into the health system. The leading health centre declares cases
of diseases to the District Health Service.
In other very
large countries after the Health District there are Health Zones before the
Health Areas
6. Epidemiological surveillance cycle
The
epidemiological surveillance cycle shows its cyclic functions in Fig 1. The
epidemiological surveillance cycle shows the treatment of data and use of the
results at all levels of the health system instead of forwarding raw data to
hierarchy. The epidemiological surveillance cycle represent the routine Health
Management Information System (HMIS) that should be carried out at all levels
of the Health system as shown in Fig II.
7. Difficulties of epidemiological
surveillance
It has always been believed that surveillance data
collected at local level are sent to the higher level or international level for
analysis and feedback before action is taken at the lower level, which is
contrary to the notion of ‘data collection for action.’ At the level of the
Health District and Region or Province the staff face a lot of difficulties in
making synthesis of all the data from Health Areas because manual synthesis is
tedious, thus surveillance data are never available. Moreover unqualified or
recalcitrant staff is usually assigned to compile statistical data. In this
computer era health statistics should no longer be processed manually at all
levels of the health system. Simple software
should be elaborated to enable health personnel to make synthesis and analysis
health data at lower levels in order to use the results to control diseases
before external assistance is available.
8. Solution to epidemiological surveillance
data analysis
It is for this reason that I decided to produce a software for
epidemiological surveillance to make the synthesis and analysis of weekly
declaration or notification data because in
this computer era health statistics should no longer be processed manually at
all levels of the health system for the sake humanity so that decisions and interventions
should be made based on sound and appropriate judgement.
9. Description of the software
The epidemiological surveillance software is an
excel folder made of the follow sheets:
i.
Guide – gives the detail directives on
how to use the software; it should be read carefully.
ii.
Cases and Deaths: It is the only sheet to
be filled.
iii.
Cases – The sheet fills automatically.
It could be considered as incidence sheet.
iv.
Deaths - It fills automatically. It
could be considered as morbidity sheet.
v.
Case fatality rate per week - It fills
automatically.
vi.
Case fatality per Unit of Health Care –
It fills automatically.
10. Use of the software
This software is essentially for the local recording
and analysing of data from weekly declaration, studying the trends or patterns of
evolution of incidence of a disease under surveillance through epidemic curves,
taking decisions, and intervening precisely and early.
THIS SOFTWARE IS VERY USEFUL DURING AN EPIDEMIC
One of the advantages of the software is that late
data can be inserted in the correct corresponding week.
The software can be used at the level of big health
institutions which are divided into wards, and health areas that are divided
into quarters or zones according to the health system.
The software facilitates the treatment and
transmission of data from the lower level to the higher level.
The epidemic curves in the software could be printed
and pasted on the walls or put in reports of health services.
More often only questionnaires are developed and
inserted in the internet; simple excel programmes are not developed to analyse
the data, because the process of developing them have been mystified. Let us
try to make simple tools for the analysis of health statistics.
11. Conclusion
Taking into consideration the tediousness and the
absence of health statistics at various levels of the health system I decided
to produce this software on epidemiological surveillance to make the synthesis
and analysis of weekly declaration or notification data in order to help
humanity take decisions and carry out interventions based on sound, pertinent
and relevant reflection.
I can establish simple software for synthesis and
analysis of any questionnaire for the appreciation of health events in any given
community. I am available for any consultancy.
I am providing this software to health personnel for
the sake of humanity. I hope you will appreciate my effort and appreciate my
effort by inviting.
I have included the English and French versions of
this software for download and use. Thanks
Reference
1) The
Johns Hopkins and the International Federation of Red Cross and Red Crescent
Societies, Epidemiology and surveillance, Public health guide for emergencies
Epidemiology and surveillance - Johns Hopkins Bloomberg ...www.jhsph.edu/.../Ch...Johns
Hopkins Bloomberg School of Public Health
2) EXCITE
| Epidemiology in the Classroom | An Introduction to Epidemiology http://www.cdc.gov/excite/classroom/intro_epi.htm
4) An
Introduction to Applied Epidemiology and Biostatistics, U.S. DEPARTMENT OF
HEALTH AND HUMAN SERVICES, Centers for Disease Control and Prevention (CDC),
