Surveillance data collection

in IDSP

Integrated Disease Surveillance Programme (IDSP)

district surveillance officers (DSO) course
 Outline of this session

1. Principles of surveillance data collection

2. Diseases under surveillance
3. Practical organization of data collection

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 Surveys versus surveillance

• Survey
 Data collection at one point in time
 Prevalence data
• Surveillance
 Ongoing, routine data collection
 Incidence data

Concepts
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 Reporting methods

• Individual cases
 Each and every case is reported
 “Line listing” similar to an OPD register
• Aggregated cases
 Number of cases with selected characteristics
 Usual methods in place in the contact of the
Integrated Disease Surveillance Programme (IDSP)
 Requires aggregation of the individual cases

Concepts
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 Example of a line listing for reporting
individual cases of measles
ID Date of Location Age Sex Vaccine
onset status
1 12 Jan 06 Village A 2 Male Yes
2 13 Jan 06 Village B 3 Female Yes
3 14 Jan 06 Village B 1 Female No
4 14 Jan 06 Village B 5 Male Yes
5 14 Jan 06 Village B 3 Male No
6 14 Jan 06 Village B 2 Female Yes
7 15 Jan 06 Village A 1 Male Yes
8 16 Jan 06 Village C 12 Female No
9 16 Jan 06 Village B 4 Male Yes

Concepts
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 Reporting of aggregated cases of
diseases in (place) during (time)
Disease Under 5 years of age 5 years of age and older

Male Female Male Female

Diarrhea 2 1 4 3

Bloody 0 0 1 0
diarrhea
Pneumonia 3 2 1 2

Fever 4 3 12 10

Fever / rash 1 0 0 0

Total 10 6 18 15
encounters
Concepts
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 Conditions under regular surveillance in
integrated disease surveillance
programme (IDSP)
Type of diseases Condition under surveillance
Vector borne •Malaria
Water borne •Diarrhea (Cholera), Typhoid
Respiratory •Tuberculosis
Vaccine preventable •Measles
Under eradication •Polio
Other conditions •Road traffic accidents
International commitment •Plague
Unusual syndromes •Meningo-encephalitis, respiratory
distress, hemorrhagic fever
List
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Rationale for the use of case definitions

• Uniformity in case reporting at district, state

and national level
• Use of the same criteria by reporting units to
report cases
• Compatibility with the case definitions used
in WHO recommended surveillance standards
 Allow international information exchanges

Collection
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 Types of case definitions in use

Case definition Criteria Users

Syndromic Clinical pattern Paramedical personnel and
(suspect) members of community
“S” forms
Presumptive Typical history and Medical officers of primary
(Probable) clinical examination and community health
“P” forms centres
Confirmed Clinical diagnosis by a Medical officer and
“L1/L2” forms medical officer and Laboratory staff
positive laboratory
identification

Collection
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What is an epidemiologically linked case?

1. One or few probable cases are confirmed by the

laboratory
2. Other probable cases that most likely belong to
the same cluster are considered “epidemiologically
linked” if they had:
 Exposure to the same source
 Contact with a confirmed case
3. These “epidemiologically linked” cases are
reported on a separate section of the “P” form

Collection
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 Example of “epidemiologically
linked” cases
• Outbreak of 123 severe diarrhea cases with
dehydration among adults
• 7/12 rectal swabs confirmed the diagnosis of
cholera
• The non confirmed, probably cases become
“epidemiologically linked” cases and should
be reported as such in the separate section
of the “P” form

Collection
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 Summary of the data collection forms
used for the various levels of case
definition
• Form “S” (Suspect cases)
 Health workers (Sub centres)
• Form “P” (Probable cases)
 Doctors (Primary health centres, Community
health centres, Hospitals)
• Form “L” (Laboratory confirmed cases)
 Laboratories

Collection
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 Persons collecting information on
syndromic reports (“S” forms)
• Health worker, Male
• Health worker, Female
• Auxiliary nurse, midwife/ Public health nurse/ Lady
health visitors
• Accredited Social health Activities (ASHA)
• Anganwadi Worker
• Link worker
• Village Health Guide/Community Health Volunteer
• Panchayat/ Community member
Collection
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 Core sources of information
for “S” forms
• Health workers visit diary (40 houses / day)
 Require regular maintenance and entries
 May include information from other co-
workers/functionaries
• Sub centre out patient department register
 Usually records identifiers and drugs dispensed
• Not syndromes
 Age often inadequate, unclear or absent
 No summary
 Does not usually include diary entries
• Similar other diary and register with other workers
• Malaria slide register in some states
Collection
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 Revised malaria form (MF) 11
(Revised to fit IDSP format, to be
ultimately merged)

The new malaria form takes into account

IDSP classification of fever cases for
better coordination

Collection
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Completion and transmission of form “S”

• Completion
 Health worker (Female) usually completes the form on the
basis of registers
• Ideally the new IDSP “S” register
• Or other registers (OPD, house visits)
• Transmission
 Health worker (Male) usually takes the form to health
supervisor/ inspector at the PHC on MONDAY
 In some places:
• The form reaches the block PHC directly
• The form is communicated to the district by phone

Collection
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Problems associated with completion and
transmission of form “S”
• While compiling records for “S” forms the core
registers may not be consulted (although it should)
• The report may cover a period modified to suit
convenience of meeting date
• Incomplete information usually gets dropped

Collection
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 Check list for “S” form completion

 Filled in time (Friday-Saturday)

 Filled using figures from registers only
 Tally mark by health worker
 Entries in the “S” form can traced back to
individual cases in the registers
 Each cell filled in individually
 Detection of rising trends of disease

Collection
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Applying the checklist: Making sure all
numbers in the “S” form come from
individual cases in the “S” register

S register

S form

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 Poor data entry on form “S”:
Some cells are not filled
Male Female Total

Fever < 7 days < 5 yr > 5 yr < 5 yr > 5 yr < 5 yr > 5 yr

1 Only fever 2 6

2 With rash

3 With bleeding

4 With daze/ Semi-

consciousness/
Unconsciousness
Fever > 7 days

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 Data entry on form “S”
as recommended
Male Female Total

Fever < 7 days < 5 yr > 5 yr < 5 yr > 5 yr < 5 yr > 5 yr

1 Only fever 2 NIL NIL 6 2 6

2 With rash NIL NIL NIL NIL NIL NIL

3 With bleeding NIL NIL NIL NIL NIL NIL

4 With daze/ Semi- NIL NIL NIL NIL NIL NIL

consciousness/
unconsciousness
Fever > 7 days 2 NIL NIL 6 2 6

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 First level of consolidation:
The sector primary health centre (PHC)
• Sector PHC
 Approximate population: 20-30,000
 Sometimes more
• Target date for receipt of forms is MONDAY
 5-6 “S” forms expected
• Transmission to the block PHC or community health
centre (CHC) on Tuesday
 “S” forms forwarded
 PHC “P” form added
 Responsibility: Pharmacist (Usually)
• Often a weak link
Collection
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 Summary: The flow of the “S” form
District surveillance
unit

Block primary Form “S”

health centre transmission

Sector primary
health centre

House visits Register in Other registers

Form “S” register outpatient clinic and records
completion in sub-centre
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 Sources of data for “P” form

• Primary health centre outpatient register

 Records name of the patient
 Social status (e.g., Below poverty line)
• Primary health centre pharmacist
 Register with name, outpatient number etc.
• At some places there is a medical officers
individualized register as well
• New IDSP “P” register
Collection
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 Completion of the “P” form in primary
health centres (PHCs)
• Focal person:
 Pharmacist
 Public health nurse
• Various combinations in practice to fill “P” form
 Pharmacist register does not have diagnosis
 OPD registers do not have any disease/treatment info
 Doctors register generally incomplete and do not cover all
patients
• Checklists similar to the one used for the “S” Form
can be used to assure data quality at this level

Collection
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Applying the checklist: Making sure all
numbers in the “P” form come from
individual cases in the “P” register
“P” register

“P” form

Collection
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 “S”, “P” and “L1” forms
converge at the block level
District surveillance
unit
• Block primary health
centre (BPHC)
'L1' form
from community • Community health
health centre
centre (CHC)
"P" form from
community health centre

"P" form from

primary
health
centre

Revised "MF 11" "S" form from

form from sub centres Collection
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sub-centres
Information from other reporting sources

Big
labs
“L2” form

Small labs
“L1” form

Hospitals
Consolidated “P” forms

Clinics and practitioners

“P” forms

Quacks and traditional practitioners Collection

“S” 28
forms
 Reporting units

• All government entities should be part of the

reporting network
• All local health institutions should be made part of
the network in phases
• Gradually the data should be disaggregated by
reporting unit to pinpoint the source and demarcate
local trend line for particular diseases
• Ultimately we need to report incidences in relation
with the denominator
 CDC: Count, divide compare
 Compare rates rather than numbers
Collection
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 Take home messages

1. IDSP is mostly based upon aggregated

reporting
2. Know the diseases under surveillance
3. Understand the data flow of each of the
case definition levels
• “S” forms
• “P” forms
• “L1/2” forms

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 Additional reading

• Section 2 and 3 of IDSP operations manual

• Module 5 of training manual
• Format and guidelines for reporting of
information on disease surveillance
(electronic manual)
• IDSP manual

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