innovation in surveillance of communicable and non-communicable diseases
TRANSCRIPT
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 1 |
3rd National Scientific Conference on Epidemiology
Innovation in Surveillance of
Communicable and Non-Communicable
Diseases
Dr Nirmal Kandel , MBBS, MA (Anthropology), MPH, EMBA
Public Health Specialist
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 2 |
Outlines
Surveillance, Uses and Components
Traditional Surveillance Design
Advances
Stepwise Approach – NCDs Surveillance
Universal Health Coverage and Surveillance
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 3 |
What is Surveillance
• Systematic, ongoing…
– Collection
– Analysis
– Interpretation
– Dissemination
• …of health outcome data
Health action
• investigation
• control
• prevention
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 4 |
Why we do surveillance
Estimation the size of health problem
Detection of outbreaks
Characterize disease trends
Evaluate interventions and preventive programmes
Provide information for health planning and financing
Identifying training needs in terms of categories and levels
Identify and prioritize research needs
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 5 |
Surveillance Support Functions
Standards and guidelines
Trainings
Supervisions
Communication facilities
Resources (including logistics) all type
Monitoring and Evaluation (M & E) and Coordination
Surveillance System Structure
Legislation (laws and regulations); including IHR (2005)
Surveillance strategy
Improve preparedness for surveillance and response
Surveillance implementation and stakeholders
Networking and partnerships
Core Functions of Surveillance
Case detection, registration and Confirmation
Reporting
Data Analysis and interpretation
Epidemic preparedness
Response and control
Feedback and evaluate
Surveillance Quality
Completeness and Timeliness
Usefulness and Simplicity
Acceptability and Flexibility
Sensitivity and Specificity
Positive predictive value
Representativeness
Components of Surveillance System
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 6 |
Surveillance Design
Traditional disease notification
Outbreak investigation
Cluster investigation
Active and Passive Surveillance
Enhanced surveillance
Sentinel surveillance
Emerging infectious diseases
– diagnosis-based surveillance
– syndromic surveillance
Molecular biology and
surveillance
Event Based Surveillance
Non – Traditional Surveillance
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 7 |
Traditional Disease Surveillance
SOURCE: Figure courtesy of Dr. Larry Madoff
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 8 |
Advances in Surveillance
Syndromic Surveillance
Electronic Health Records
Non traditional approaches
Event Based surveillance and Early Warning System
Integrated Diagnostic System
Pre-symptomatic Detection
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 9 |
Before going quick question…think
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 10 |
Syndromic Surveillance
“Syndromic surveillance” is defined as the collection and analysis
of “health-related data that precede diagnosis and signal with
sufficient probability of a case or an outbreak to warrant further
public health response”
Source: Global Infectious Disease Surveillance and Detection: Assessing the Challenges -- Finding Solutions, Workshop Summary
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 11 |
Syndromic Analyses
Automated analyses identify unusual patterns and increases are investigated
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 12 |
Electronic Health Monitoring
SOURCE: Lombardo (2006)
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 13 |
Non Traditional Approaches
EIS and GOARN
Promed Mail
GPHIN
Health Map
MedIsy
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 14 |
EIS and DON
Event Information Sites (EIS) for National IHR Focal Points
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 15 |
Advances in Indonesia
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 16 |
Bulletins
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 17 |
GLEWS
One World – One Health and Emerging Disease Surveillance –
GLEWS - http://www.glews.net/
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 18 |
Surveillance Networks
Global Infectious Disease Surveillance and Early Warning Systems
– Promed
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 19 |
Framework for Internet Based Surveillance
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 20 |
Building Available Infrastructure
Source: Voxiva
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 21 |
How it works
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 22 |
Comprehensive Integrated Diagnostics System
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 23 |
Medical Tricorder
“integrated diagnostic
system” for field use
that can detect viruses,
bacteria, toxins,
The current prototype
relies on automated
real-time PCR
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 24 |
Host Based Pre-symptomatic Detection Event
Source: Johnston (2006)
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 25 |
Personalized Medicine Based Biosignatures
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 26 |
Some Innovations Used…….
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 27 |
Some Innovations Used…….
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 28 |
Use of Social Networks
I trace the passenger during
Pandemic 2009 H1N1 under
IHR (2005)
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 29 |
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 30 |
Step 3 (Biological)
Co
mp
lexit
y
Step 2 (Physical)
Step 1 (Verbal)
Core
Expanded
Optional
At each step
The WHO STEPwise approach to
surveillance of non-communicable disease risk factors
Sequential approach, step by step
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 31 |
• Coronary heart
disease
• Stroke
• Peripheral vascular
disease
• Several cancers
• COPD/emphysema
EndpointsIntermediate
Risk Factors
•Hypertension
•Blood lipids
•Obesity /
Overweight
• Diabetes
• Tobacco
• Diet
• Alcohol
• Physical Activity
Behavioural
Risk Factors
Non-modifiable
Risk Factors•Age•Sex
•Genes
Socio-economic,
Cultural & Environmental
Conditions
Figure 4 Example of Major Selected Non-Communicable
Disease (NCD) Risk Factors and Determinants
Source: World Health Organization (WHO)
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 32 | Age
Foetal
life Adult Life Adolescence Infancy and
childhood
•SES
•Nutrition
•Diseases
•Linear
growth
•Obesity
•Obesity
•Lack of
activity
•Diet
•Alcohol,
•Smoking
•SE potential
•Established adult risk factors
(behavioural/biological)
•SES
•Maternal
nutritional
status &
obesity,
•Fetal
growth
Accumulated
risk
Range of
individual
risk Accumulated
risk
Life course approach for the prevention of
non communicable diseases
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 33 |
Surveillance Focus
Risk factor surveillance - for estimation and Prevention
Actual Burden of Diseases – Hospital records (HMIS)
– Mortality Statistics (Verbal Autopsy)
– Insurance data
– Funeral Services
– Drug Data
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 34 |
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 35 |
Universal Health Coverage
Universal Health Coverage – is defined as ensuring that all people
can use the promotive, preventive, curative, rehabilitative and
palliative health services they need, of sufficient quality to be
effective, while also ensuring that the use of these services does not
expose the user to financial hardship.
Dr Nirmal Kandel, MBBS, MA (Anthropology), MPH, EMBA – Public Health Specialist 36 |
Thank You