Week 2 Community Assignment

Name: Patience Adeda

Country:: Nigeria

 

I have chosen to look into the surveillance system and reporting system mechanism (IDSR) of my country, Nigeria.

I have already joined the whasApp group /platform of my country

Background Information

Public health surveillance is ‘the on-going, systematic collection, analysis, interpretation and dissemination of health data (disease occurrence and disease potential) to help guide efficient and effective public health decision making and action’. Surveillance forms the backbone of the health care system and is an essential indicator of the performance of service provision. Today, communicable disease surveillance attains importance more than ever due to stark reductions in travel time and improved communication systems that essentially catalyse the rapid spread of pathogens. The International Health Regulations (IHR, 2005) amongst others is a landmark legislation and testament to the renewed initiative of countries to collaboratively reduce the burden of communicable diseases.

To overcome some of these challenges, the World Health Organization (WHO) advocated the Integrated Disease Surveillance and Response (IDSR) approach in 1998 (WHO 2000). Integrated disease surveillance is ‘a combination of active and passive systems using a single infrastructure that gathers information about multiple diseases or behaviours of interest’. The strategy aims to ‘strengthen surveillance and response at each level of the health system by building local capacities; leveraging strengths and expertise through partnerships and co-ordination; training personnel at all levels; developing and implementing plans of action; mobilizing resources; integrating multiple surveillance systems to ensure efficient use of resources; improve the use and flow of surveillance information; strengthen laboratory capacity and involvement; emphasize community and clinician participation; use data thresholds to trigger alerts.

Disease surveillance and notification was introduced in Nigeria in 1988 following a major outbreak of yellow fever in 1986/87 which claimed many lives in the country and also affected ten out of the then 19 states of the country. Prior to that time, there was no coordinated system of disease reporting and surveillance in the country, as some states were sending weekly, some were sending annual report and others not sending at all. As a result, the National Task Force on Epidemic Control was set up to find a lasting solution to disease notification in the country. The National Task Force identified poor disease surveillance and notification as a major national problem and as an important constraint to effective disease control in Nigeria. At the onset of its establishment, 42 diseases were officially designated as notifiable for routine monthly reporting, which was later reviewed to 22 in 1998.

A country where IDSR is functional is expected to use standard IDSR case definitions to identify and report notifiable diseases; collect and use surveillance data to alert higher levels and trigger local action; investigate and confirm suspected outbreaks or public health events using laboratory confirmation, when indicated; analyze and interpret data collected in outbreak investigation and from routine monitoring of other notifiable diseases; use information from the data analysis to implement an appropriate response; provide feedback within and across levels of the health care system and evaluate and improve the performance of surveillance and response system.

There are forty notifiable diseases both communicable and non-communicable diseases and public health related conditions selected by the Federal Ministry of Health for the IDSR system in Nigeria. These diseases were selected based on the following; top cause of high morbidity and mortality in the country, have epidemic potential, surveillance required internationally, availability of effective control and preventive intervention for addressing the public health problem they pose, could be easily identified using simple case definition and have intervention programmes supported by the WHO for prevention and control, eradication or elimination of the diseases.These diseases have been grouped into three categories; epidemic prone diseases, diseases targeted for eradication and elimination and other diseases of public health importance.

Data flow on Integrated Disease Surveillance & Notification (IDSR)

The flow of information in the IDSR system in Nigeria is from the health facility, where diseases that have epidemic potential and those which are targeted for eradication and elimination, are reported immediately to the focal persons in the health facility and thereafter to the LGA using designated IDSR reporting forms. The LGA receive data from the health facilities, collate and send to the next level which is the State Ministry of Health (SMoH).

At the LGA level, analysis and feedback to health facilities is expected to be done. The Epidemiology unit of the SMoH collates data from the LGAs and forwards it to the Epidemiology Division of the Federal Ministry of Health (FMoH). At the State Ministry of Health, analysis and feedback to the health facilities and public is done as well as planning appropriate operations and strategies for disease control. At the Federal Ministry of Health, data is collated and forwarded to the statistics division, analysis and feedback is carried out, as well as planning for appropriate intervention based upon the results of analysis.

The flow of data in the IDSR system begins with the detection and immediate notification of notifiable diseases seen at the health facility by clinicians to the LGA Disease Surveillance and Notification Officers (DSNO) at the LGA Department of Primary Health Care (PHC) which serves as a link between the health facility/communities and other levels of the IDSR network in Nigeria

IDSR Data Tools

The data tools include the following:

IDSR 001A (case-based reporting form) and 001B ( laboratory request form) : Used for immediate reporting of suspected individual cases of epidemic prone diseases and other events with potential to public health emergencies of international concern and diseases targeted for elimination and eradication.

IDSR 001C (line list form): Used for reporting case-based information of notifiable diseases when several cases occur during a short period of time (outbreak).

IDSR 002 (weekly summary reporting form): Used for routine reporting of total number of cases of all notifiable diseases and deaths resulting from these diseases weekly.

IDSR 003: This is a monthly summary reporting form.

Identify and collect relevant background documents and other sources of information for your selected country.

Perform a rapid review of these sources and evidence for data flow, tools, and performance of your country’s monitoring system.

Reliable sources (if they exist) that describe the data flow and data tools used in your country’s monitoring system: The Technical Guidelines for Integrated Disease Surveillance and Response in Nigeria documents provided explicit information on this.
Evidence that will help you identify strengths and gaps (through SWOT analysis) of the performance of your country’s monitoring system: The document also provides indicators for evaluation of IDSR performance

Questions on the IDSR Operation in Nigeria

How does data flow? From the community to health facility to LGA to State Epidemiology Unit to FMOH and then to WHO. There is a feedback at each level.
What are the different reporting layers? The reporting layers are community, health facility, LGA health office, State Epidemilogy Unit, FMOH and WHO
What are the requirements for timeliness and reporting frequencies? Some diseases require immediate reporing while others require weekly and monthly reporting.
Who first collects the data, prepares paper reports, enters data into electronic systems, receives and reviews reports? The LGA DSNO in conjuction with focal person at the health facility
What measures and procedures are in place for data verification, cleaning and feedback? At each layer data is cross checked and verified before being relayed to the next level.
What process is followed if data seems to be wrong? Trace back is done until the very first layer of data collection is reached
Who are relevant players/stakeholders at each level? At the community level (community informants, traditional leaders, filed volunteers), at the health facility level (health workers, ward focal person), at LGA level (DSNO/ADSNO), at State level (DSNO, Epidemiologist, DPH), at FMOH level (Minister, DPH, Epidemiologist), WHO (Country Rep,)
What do they do with the data? At level the stakeholders are expected to analyze the data and use the information for action and feedback.

 

Summarize the quality of the available evidence.

Summarize the quality and completeness of your findings. Were you able to answer the questions you listed? Yes

What is the strength or level of evidence for what you have found? The procedures presented by this technical guideline have been assessed by various researchers and have been reported in the the literature.

Can you identify gaps in the sources you reviewed?

Yes, there gaps in the operation of the IDSR as reported by some researchers.

Describe the data flow of your country:

Map out the data flow of your context, drawing on your findings. Prepare a flow chart showing data flows and data tools being used across all levels.

An ill person either referred or not, presents with a medical condition that requires attention. Information about the patient is recorded in a register. The register is updated daily to include information for both inpatients and outpatients. At a minimum, the following data is collected: the patient’s ID number, date of onset of illness, date of presentation at the facility, date of discharge (inpatient only), village (location), age, sex, diagnosis, treatment, and outcome. If the clinician suspects a disease or condition that is targeted for elimination or eradication, or if the disease has high epidemic potential, the disease is reported immediately to the designated health workers in the health facility and at the LGA level. The health facility should begin a response to the suspected outbreak. At the same time, the LGA takes steps to investigate and confirm the outbreak. The investigation results are used to plan a response action with the health facility. Periodically, once weekly, monthly, quarterly or annually, the health facility summarizes the number of cases and deaths for each routinely reported priority diseases and conditions and report the totals to the LGA. The health facility performs some analysis of the data such as keeping trend lines for selected priority diseases or conditions and observing whether certain thresholds are passed to alert staff to take action. One action that is taken if an outbreak is suspected is to obtain laboratory confirmation. Laboratory specimens are obtained and the following data is documented: type of specimen, date obtained, date sent to the lab, condition of specimen when received in the lab (good or poor), adequacy of specimen (adequate or not adequate) and lab results. At the LGA level, data is compiled monthly for each of the priority diseases and conditions. The LGA prepares analyses of time, place and characteristics of the patients such as age and sex for both outpatients and inpatients. These results are sent to either the state level or the FMOH (EPID/HER division). The LGA uses the data to plot graphically the routine surveillance trends and epidemic curves for priority diseases and conditions. In addition, the LGA maintains a log of suspected outbreaks reported by health facilities. This list documents the nature of the potential outbreak, the number of possible cases, the dates of investigations and actions taken by the LGA. It also includes any findings of investigations led by LGA, State or national levels. The LGA surveillance focal point provides disease-specific data and information to each disease prevention programme. Feedback on surveillance performance indicators, laboratory results and basic data analysis should be given to the lower levels.

Note:

1. Every State shall establish a functional State public health laboratory. Where this is not immediately possible, shall identify and designate a State public laboratory from an established clinical laboratory within the State.

2. Every LGA shall identify a PHC in each ward to collate and submit ALL surveillance data from ALL health facilities within their respective wards to the LGAs

The data flow chart and tools used at the different levels is on page 20 of the Technical guideline (please refer to page 20 of the IDSR Technical Guideline).

Make a SWOT analysis

Make a SWOT analysis for the monitoring system in your country. Analyze the Strengths, Weaknesses, Opportunities, and Threats.

Strength: The IDSR reporting system allows timely reporting of epidemic prone diseases
Weakness: Data utilization at the lower layers and the two-way feedback mechanism is still less satisfactory
Opportunities: It is possible to scale up the IDSR system to include surveillance for single case-based disease such as measles and AFP.
Threats: Non reporting by clinicians and non active participation by private health facilities

 

Summarize what you learned from all of the other steps

The IDSR system is yet to be perfected in terms of its operation and data utilization. An effective monitoring system is needed to ensure its smooth running.