INTEGRATED DISEASE SURVEILLANCE

INTEGRATED DISEASE SURVEILLANCE

INTEGRATED DISEASE SURVEILLANCE

Integrated Disease Surveillance is a comprehensive approach used by public health systems to monitor, detect, and respond to various diseases and health events in a coordinated manner.

Key terms in Integrated Disease Surveillance.

  1. Integrated Disease Surveillance and Response (IDSR): IDSR is a comprehensive strategy used by public health authorities to detect, monitor, and respond to disease outbreaks and public health events. It involves the systematic collection, analysis, interpretation, and dissemination of health-related data to support timely and effective public health interventions.

  2. Disease Outbreak: A sudden increase in the number of cases of a particular disease in a defined geographic area and time period that is greater than what is normally expected.

  3. Communicable Diseases: Also known as infectious diseases, these are illnesses caused by microorganisms such as bacteria, viruses, fungi, or parasites that can be transmitted from one person to another, directly or indirectly.

  4. Case Definition: A set of standardized criteria that define what constitutes a confirmed case of a particular disease. It helps health workers accurately identify and classify cases during disease surveillance.

  5. Priority Diseases: Diseases that are given special attention due to their significant impact on public health and the potential for rapid spread and serious consequences. Priority diseases vary by region and context.

  6. Supervision, Monitoring, and Evaluation: These are components of disease surveillance that involve overseeing and assessing the implementation of surveillance systems, tracking data quality and completeness, and evaluating the effectiveness of response strategies.

Integrated Disease Surveillance and Response (IDSR)

Integrated Disease Surveillance and Response is a strategy of the Word Health Organization African Regional Office (WHOAFRO) adopted by member states in 1998. 

The IDSR strategy aims at improving the availability and use of surveillance and laboratory data for control of priority infectious diseases that are the leading cause of death, disability and illness in the African region.

IDRS works in collaboration bodies under Center for Disease Control (CDC) in order to achieve the goal of disease surveillance and response. The outstanding bodies are:

  1. Division of emergency infectious and surveillance services (DEISS). It provides expertise to design, develop, implement, monitor and evaluate strategies for IDSR. They organize tools for the program like laboratory equipment.

  2. Division of epidemiology and surveillance capacity building: provides experts for strengthening target countries by giving information on disease outbreak.

  3. Global Immunization Division (GID) that provides experts in surveillance for vaccines for preventable disease and integrate data management for expanded program for immunization related surveillance, routine immunization.

In 1996, there was a big problem with a disease called Ebola. Because of that, Uganda decided to join the IDSR program. They made a CDC to look out for disease outbreaks. Other African countries, like Ethiopia, Ghana, and Burkina Faso, also use IDSR to handle outbreaks.

Specific objectives of Integrated Disease Surveillance and Response (IDSR)

According to WHO AFRO 1998, the objectives for IDSR include:

  •  To strengthen district level surveillance.
  •  To integrate laboratory with laboratory reports.
  •  To reduce duplicating of reporting on the outbreak.
  •  To share resources among disease control programs.
  •  To translate surveillance and laboratory data into specific and timely public health actions.

Basic Ingredient for IDSR

 The IDSR also identified basic ingredients for it to achieve the goals as follows:

To make IDSR work well, we need a few important things:

  1. Clear case definition and reporting mechanism.
  2. Efficient communication systems.
  3. Basic but sound epidemiological framework.
  4. Good laboratory report.
  5. Good feedback and rapid response.
  6. Nurses/Midwives attached to health centres to document the surveillance reports.

Detecting and Planning for Disease Outbreak

From the previous section where we introduced Integrated Disease Surveillance and Response (IDSR), you learned that the main group responsible for controlling diseases is the people who work in the Center for Disease Control (CDC), which is usually located in a hospital setting.

 You also learned about the important members of the team needed to make the work effective, including midwives like yourself who are stationed at the outskirts of the district. With the help of clear case definitions, you can accurately detect diseases and provide detailed reports to the CDC.

In the earlier part of our community health discussions, you learned how to carry out health assessments to identify health issues within the community and diagnose priority diseases. You also understood that in order to reach a diagnosis for a community health problem, you have to perform surveillance. This involves screening through laboratory tests and actively searching for cases.

Similarly, when you’re dealing with infectious diseases, you will follow similar guidelines. You’ll select and conduct surveillance activities to gather information, analyze it, interpret the findings, and create a report for the CDC to take action.

To carry out these activities effectively, you need to organize your team, which will consist of:

  • District Health Officer: This is an important leader who oversees health activities in the district.
  • Community Health Workers: These are the frontline workers who engage directly with the community and gather information.
  • Laboratory Technician: This person handles lab tests and analysis, which is crucial for confirming diseases.
  • Subordinate Nurses: You’ll work with at least one nurse who assists you in carrying out various tasks.

Together, this team will collaborate and follow the outlined guidelines until the final step of report writing. This coordinated effort ensures timely and accurate response to disease outbreaks and contributes to safeguarding public health.

Priority Diseases in Uganda and their Case Definition

Activity:

  1. Write down the most common priority diseases that you have ever participated in managing.
  • Measles
  • Tuberculosis
  • Poliomyelitis
  • Tetanus
  • Cholera
  • Hepatitis B
  1. Outline the case definition of the diseases.
  • Measles: A fever accompanied by a rash, cough, and red, watery eyes.
  • Tuberculosis: Persistent cough for more than two weeks, chest pain, and weight loss.
  • Poliomyelitis: Muscle weakness or paralysis, often affecting the legs.
  • Tetanus: Muscle stiffness and spasms, usually starting with the jaw muscles.
  • Cholera: Profuse watery diarrhea and vomiting, leading to dehydration.
  • Hepatitis B: Jaundice, fatigue, abdominal pain, and dark urine.

As a quick reminder, priority diseases are communicable diseases caused by biological agents or their products.

 They spread from one person to another and are called priority diseases because of their serious impact on humans. Many of these diseases can lead to disasters, increase illness and death, and even cause economic problems for a country.

In Uganda, there have been several outbreaks of diseases that have resulted in loss of lives. Some of these diseases include:

  • Measles: Common among children aged 1 to 3 years. Symptoms include rash, cough, and red, watery eyes.
  • Tuberculosis: Affects people of all age groups and is characterized by a persistent cough, chest pain, and weight loss.
  • Poliomyelitis: Recent research shows an increasing trend in this disease, which causes muscle weakness or paralysis, often in the legs.
  • Tetanus: Affects people of all ages, usually starting with stiffness and spasms in the jaw muscles.
  • Cholera: Common during rainy seasons and can become a disaster. Symptoms include severe watery diarrhea and vomiting, leading to dehydration.
  • Hepatitis B: Rampant throughout the country, presenting symptoms like jaundice, fatigue, abdominal pain, and dark urine.

Case Definitions

A case definition of a disease is a standardized set of criteria that outlines the specific characteristics and symptoms that an individual must meet in order to be classified as having that particular disease.

It serves as a clear guideline for healthcare professionals and public health authorities to accurately identify and classify cases of the disease.

In simpler terms, a case definition is like a checklist that helps healthcare workers determine whether a person’s symptoms and characteristics match those of a specific disease. If they meet the criteria in the checklist, they can be considered a “case” of that disease. This is important for accurate disease tracking, monitoring, and response.

DISEASECLINICAL PRESENTATION
Measles– High fever that gets serious quickly – Rash appears 3 to 5 days after fever, followed by Koplik’s rash around the mouth and forehead 2 to 4 days after infection.
Tetanus– Symptoms show up around 5 to 10 days after infection – Common symptoms include jaw stiffness, restlessness, difficulty swallowing, headache, fever – Other symptoms: sore throat, neck stiffness, abdominal rigidity, raised eyebrow.
Poliomyelitis– Symptoms start 3 to 5 days after infection – Early symptoms: slight headache, sore throat, vomiting in younger children – Older children: symptoms appear 7 to 14 days – Major symptoms: fever, severe headache, stiff neck and back, deep muscle pain, brain damage leading to paralysis of certain muscles.
Tuberculosis– Patient may appear well or have a cough – Cough might produce green or yellow sputum in the morning – Night sweats and shortness of breath – Pneumothorax (air in pleural space) in young adults – Weight loss.
Cholera– Symptoms begin 1 to 3 days after infection – Range from mild, uncomplicated diarrhea to severe – Common symptoms: sudden, painless watery diarrhea and vomiting – Severe cases: loss of more than 1/4 of fluid an hour, eye sickness, intense thirst, muscle cramps, weakness, minimal urine.
Hepatitis– Acute viral form: sudden onset with poor appetite, feeling ill, nausea, vomiting, and often fever – Person develops joint pains with itchy red hives on the skin – Dark urine, jaundice (yellowing of skin and eyes) with general itching, liver enlargement.

Supervision, Monitoring, and Evaluation of Disease Outbreak

The terms “supervision,” “monitoring,” and “evaluation” might sound familiar to you, as they often relate to managerial tasks you’ve likely encountered in your workplace. These concepts are also crucial in your role as a midwife, where evidence-based practices are key. You’ve already been introduced to programs like family planning that involve a lot of supervision, monitoring, and evaluation at your health unit.

When it comes to disease outbreaks, supervision, monitoring, and evaluation are equally important. These activities are typically overseen by supervisors and technical experts, such as senior public health officers. Since you’re part of the collaborative team during an outbreak, you also have a role to play in these activities.

Here’s how you contribute:

  1. Collection and Sharing of Data: You gather data related to the outbreak and share it on a weekly basis to create a comprehensive report. This report helps provide a clear picture of the situation.

  2. Daily Monitoring and Evaluation: You’re involved in the ongoing monitoring and evaluation process at the operational site. This happens at all levels until the outbreak is under control. Your responsibility here is to document all the information collected and evaluated.

It’s important to note that an officer from the Center for Disease Control (CDC) is usually required to supervise outbreak control activities in the field. This ensures that everything is being done effectively to manage the outbreak.

Roles of a Nurse in IDSR

Before we proceed with outlining the roles, let’s engage in the activity:

Activity

  1. Why is it important to involve a nurse in IDSR programs? 
  • Answer: Nurses are vital in IDSR programs as they assume significant roles in healthcare delivery. Their involvement is crucial due to their extensive patient interactions and responsibilities in various healthcare settings. Nurses often serve as the frontline healthcare providers, offering care, education, and support to patients. Their presence in IDSR ensures early detection, prompt response, and effective management of disease outbreaks, leading to improved community health outcomes.
Roles
  1. Assessment and Reporting: Evaluate and report priority disease cases from lower levels to higher levels of authority.

  2. Coordination of Activities: Facilitate the smooth coordination of IDSR activities among stakeholders, including community members and technical personnel at the CDC.

  3. Planning and Preparation: Strategize and prepare for effectively managing disease outbreaks within the community.

  4. Assistance in Monitoring and Evaluation: Actively participate in monitoring and evaluating disease outbreak programs.

  5. Assessment, Analysis, and Reporting: Analyze, interpret, and compile straightforward reports for priority disease outbreaks using your knowledge in epidemiology.

  6. Engagement in Immunization Programs: Participate in immunization initiatives aimed at protecting the community against vaccine-preventable diseases. The Center for Disease Control and Prevention (CDC) advocates for early childhood vaccination against preventable diseases, a role that nurses fulfill.

Let’s summarize what you’ve learned.

What Have We Learned? 

Throughout this section, we delved into Integrated Disease Surveillance and Response (IDSR) in comprehensive detail. We covered its aims, objectives, and foundational requirements for effective implementation. 

Major priority diseases were identified, with detailed case definitions provided for each. We explored the crucial aspects of supervisory monitoring and evaluation within IDSR and highlighted key individuals involved in these activities. Lastly, we delved into the roles a nurse plays in IDSR, emphasizing the importance of their involvement.

Now, it’s time to evaluate your understanding through a self-test. Attempt to answer the questions and consider discussing the information with your colleagues as you review your notes.

Self-Test:

  1. Which organization is directly involved in the implementation of IDSR in Uganda?
  2. Outline the measures you would take when planning for an epidemic disease outbreak.
  3. Utilizing a table, explain the case definition for the following diseases:
    • Tetanus
    • Tuberculosis
    • Cholera
    • Hepatitis “B”
  4. State one activity you would perform when monitoring and evaluating disease outbreaks in your workplace.
  5. Enumerate two major roles you would play in the IDSR program as a nurse.
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