Prinsip Surveilens

Penyakit
 Surveillance

Surveillance is the ongoing systematic

collection, collation, analysis and
interpretation of data; and the
dissemination of information to
those who need to know in order
that action may be taken
 Pertimbangan Surveilens Penyakit
• Adakah kepentingan dari sisi kesehatan
masyarakat/ medis berkaitan dengan
penyakit (tertentu)?

• Dapatkah aksi/ intervensi kesehatan

masyarakat / medis dilakukan?

• Apakah data yang relevan mudah didapat?

• Apakah intervensi tersebut bernilai (aspek

uang, SDM, dll)?
 PRIORITAS Apakah penyakit tsb mrpk prioritas?

TUJUAN Apa tujuan surveilens ?

(mis. memonitor kasus dan kematian from dari DHF
sehingga dpt mengevaluasi program penanggulangan)

POPULASI Populasi yang mana yang akan dideteksi kasusnya

TARGET (mis. semua? Kelompok risiko tinggi?)

INDIKATOR Apa indikator penyakit yang dipakai ?

(mis. Jumlah kasus baru TB per 100,000 pop
+ jumlah kasus kematian TB )

DATA MINIMUM & Data apa yg dibutuhkan untuk mengembangkan

SUMBER DATA indikator dan apa sumber data yg ada?
Apa tujuan surveillance ?
 Tujuan surveilens

• Deteksi KLB, letusan, wabah (epidemi)

• Memonitor kecenderungan penyakit endemik
• Evaluasi intervensi
• Memonitor kemajuan pengendalian
• Memonitor kinerja program
• Prediksi KLB, letusan, wabah (epidemi)
• Memperkirakan dampak masa datang dari
penyakit
 Contoh Tujuan Surveilens
Disentri Mendeteksi letusan disentri melalui monitoring kasus
incidens dari diare akut berdarah

Polio Memonitor kemajuan eradikasi polio melalui

monitoring incidens poliomyelitis dimana poliovirus
yang ganas dapat ditemukan (diisolasi) pada anak-
anak usia < 14 years
Malaria Memonitor incidens malaria yang konformatif (melalui
pemerksaan laboratorium) termasuk incidens penyakit
akibat P. falciparum and resistensi obat antiparasit.
AIDS Mengukur incidens kasus AIDS sehingga kecenderungan
kedepan dapat diprediksi dan pelayanan kesehatan dapat
direncanakan
Tuberculosis Memonitor kemampuan program TB untuk mendeteksi
kasus, menjamin selesainya pengobatan dan
kesembuhan
Tujuan: Mendeteksi KLB disentri melalui
monitoring insidens kasus dari diare akut
berdarah

Kasus disentri akut di sebuah kabupaten,

January 1994- April 1995
120
Cases
100

80

60

40

20

0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr

1994 1995
Tujuan: Memonitor perkembangan eradikasi polio
melalui monitoring incidens poliomyelitis
dimana poliovirus diisolasi pada anak-anak
dibawah 14 tahun
Cases of poliomyelitis where wild poliovirus was isolated
in children in a rural district, 1980-1996
250
NID
Cases
200

150
NID

100

50

0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96
 Memonitor insidens malaria (positif
Tujuan :
berdasarkan lab) dan proporsi akibat P.
falciparum

Cases of malaria in a region, 1992-1996

600

500
Others
400
Faciparum
300

200

100

0
1992 1993 1994 1995 1996
 Mengukur insidens AIDS untuk memprediksi
Tujuan: kecenderungan masa mendatang dan
memfasilitasi perencanaan pelayanan
kesehatan.
Cases of AIDS in a city district, 1990-2004

700
600
500
400
300
200
100
0
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04
 Memonitor kemampuan program TB untuk
Objective: memastikan penyelesaian pengobatan dan
kesembuhan.

Treatment completion and cure in TB cases, 1994-1997

1600
1400
1200
1000 Cases
800 Completion
600 Cure
400
200
0
1994 1995 1996 1997
Indikator Penyakit
• Ukuran yang digunakan untuk memonitor
sebuah penyakit, mis:

• Angka/ jumlah kasus

• Jumlah kasus malaria yang dilaporkan
• Jumlah kasus malaria P. falciparum yang
dilaporkan
• Rate
• Jumlah kasus ISPA pada Balita per 100,000
penduduk
• Proporsi
• Proporsi Balita dengan ISPA yang meninggal
Indikator Penyakit

• Dapat merupakan indikator dari

• Insidens penyakit
• Kasus TB per 100,000 penduduk

• Keefektifan (effectiveness) dari pengobatan

• Case fatality rate pada campak
Indikator Surveilens:

Specific (spesifik)
Measurable (dpt diukur)
Action oriented (orientasi pd aksi)
Realistic (realistis)
Timely (tepat waktu)
 Surveilens: prinsip umum

Sistem Pelayanan Autoritas Kesehatan

Kesehatan Masyarakat
Pelaporan
Data Informasi

Analisis &
Evaluasi Interpretasi

Umpan Balik
Aksi Keputusan
 Surveillance: Data

Health Care System Public Health Authority

HEALTH EVENT
Information
•Disease
•Syndrome (e.g., AFP, jaundice, VHF)
•Public health issue (e.g., AMR)
•Environment (e.g., animal vector, water)

Action Decision
 Surveillance: Data

Health Care System Public Health Authority

DATA SOURCE
Information
•Notifiable disease reporting system
•Vital statistics
•Survey
•Laboratory

Action Decision
 Surveillance: Data

Health Care System Public Health Authority

CASE DEFINITION
•Clinical/laboratory Information

•Levels (suspected, probable,

confirmed)
•Indicators

Action Decision
 Laporan

Spesimen positif

Spesimen klinis

Pencarian pengobatan

Sakit

Terinfeksi

Terpajan
 Surveillance: General principle

Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision
 Surveillance: Reporting

Health Care System Public Health Authority

Reporting
Data frequency Information

•immediate
•weekly
•monthly ...

Action Decision
 Surveillance: Reporting

Health Care Public Health Authority

System
Reporting
Data methods Information

•Paper
•Telephone, Fax
•E-mail ...

Action Decision
 Surveillance: Data flow
Peripheral level Clinical
(suspected)

+ Supportive
Intermediate level
laboratory data
+ epidemiological
link (probable)

Diagnostic
Central level Ministry
of Health Laboratory
(confirmed)

Regional/International level
Regional reference
WHO laboratory
 Surveillance: Tasks
Detect
Peripheral level
Treat
Report

Analyse
Investigate
Intermediate level Report
Respond
Feedback
Analyse
Investigate
Central level Ministry Confirm
of Health Respond
Plan and Fund
Feedback

Analysis and feedback

Support
Regional/International level Policy and targets
WHO
Funding
 Surveillance: General Principle

Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision
 Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

Data
• Data characteristics
• Data validation
• Descriptive analysis
• Hypothesis generation

Action Decision
 Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

Data Data characteristics

• Various sources of
notifications
•Various levels of quality
•Continuous data collection
subject to change
Action Decision
 Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

Data Data validation

• Missing values
• Bias
• Duplication

Action Decision
 Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

Data Descriptive analysis

• Time
• Place
• Persons

Action Decision
 Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

Data Hypothesis generation

• related to time
• related to place
• related to persons

Action Decision
 Surveillance: General Principle

Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision
 Surveillance: Action

Health Care Public Health Authority

System

Data Information

• Control
• Feedback
Decision
• Policy
 Surveillance: Action

Health Care Public Health Authority

System

Data Information

Control
• Rapid response
• Case management
• Prevention Decision
(e.g. immunization)
 Surveillance: Action

Health Care Public Health Authority

System

Data Information

Feedback
• Epidemiological bulletin
• Reports Decision
• Website, others
 Surveillance: Action

Health Care Public Health Authority

System

Data Information

Policy
• Policy change
• Prediction, planning
• Epidemic preparedness Decision
 Surveillance: Action

Health Care Public Health Authority

System

Data Information

Evaluation
• results of action
• results of surveillance

Action Decision
 Surveillance: General Principle

Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision
Fungsi Surveilens:
Fungsi inti
• Deteksi
• Pelaporan
• Investigasi & konfirmasi
• Analisis & interpretasi
• Aksi/ respons

Fungsi Penunjang
• Pelatihan
• Supervisi
• Sumber daya
• Standard / panduan
Surveilens: Unsur Dasar.

Jaringan yg baik dr orang2 yg bermotivasi tinggi

Definition kasus dan mekanisme pelaporan yg jelas

Sistem komunikasi yg efisien
Epidemiologi dasar namun “berbunyi”

Ada dukungan laboratoris

Umpan balik yg baik dan respons yg cepat
Terima Kasih