PRINSIP SURVEILLENS

PENYAKIT

WHO/CSR
 Surveillens

Surveillens adalah suatu sistem dalam

• Pengumpulan
• Penyusunan, Data  menghasilkan informasi
• Analisis
• Interpretasi
Yang berkesinambungan;
Dan disseminasi informasi kepada orang-orang
membutuhkan untuk kepentingan mengambil
Suatu tindakan

WHO/CSR
 Pertimbangan Untuk Suatu Surveillens
Penyakit
• Adakah kepentingan “public health” untuk
penyakit yang dimaksud ?

• Dapatkah suatu tindakan PH diambil bila

dilakukan surveilens pada penyakit yang
dimaksud ?

• Apakah data yang relevan dengan penyakit

tadi dapat diperoleh dengan mudah ?

• Apakah bermanfaat ?

WHO/CSR
PRIORITAS Apakah penyakit yang dimaksud
Merupkan prioritas ?

TUJUAN Apa tujuan dari surveillens ?

(e.g.untk monitor kasus dan kematian suatu penyakit
Dan untk mengevaluasi keberhasilan kontrol yang
diambil )
POPULASI Kelompok populasi mana yang akan di diteksi
TARGET kasus penyakitnya ? (e.g. semua? Atau hanya
Kelompok2 yang berisiko tinggi saja .)

INDIKATOR Indikator apa saja yang digunakan (e.g. jml kasus

baru TB per 100,000 pop + jml kematian pada pasien TB

DATA MINIMUM Data apa saja yang dibutuhkan untuk

DAN SUMBER Membangun indikator dan darimana sumbernya
DATA
WHO/CSR
 What are the
objectives of surveillance ?

WHO/CSR
WHO/CSR
 TUJUAN SURVEILLENS

• Deteksi adanya Epidemi (Outbreak/KLB)

• Memonitor trend penyakit-penyakit yang
endemis
• Mengevaluasi suatu tindakan intervensi
• Memonitor perkembangan dari suatu objek
kesehatan yang dikontrol
• Memonitor “performance” suatu program
• Memprediksi kejadian Epidemi (Outbreak)
• Mengistimasi dampak suatu penyakit untuk
masa akan datang
WHO/CSR
 Beberapa contoh dari tujuan surveillens

Disentry Menditeksi adalnya KLB disentri dgn memonitor insidens

kasus penyakit diare akut bercampur darah

Polio Memonitor perkembangan eradikasi polio dgn

memonitor insiden poliomyelitis pada anak kurang
dari 14 tahun

Malaria Memonitor insidens kaus malaria postif (konfimasi oleh

lab) termasuk insidens penyakit karena P. falciparum dan
yang berhubungan dgn resisteni terhadap.

AIDS Mengukur insiden kasus AIDS sehingga tred masa depan

dapat diprediksi dan dapat dilakuakn perencanaan
pelayanan kesehatan
Tuberculosis Memonitor kemampuan program TB untuk menditeksi
kasus , kepastian kelengkapan pengobatan dan
kesembuhan

WHO/CSR The image cannot

120
Cases
100 C a s e s o f a c u te b lo o d y d ia r r h o e a in a r u r a l d is t r ic t b y m o n t h ,
J a n u a r y 1 9 9 4 - A p r il 1 9 9 5

80

60

40

20 W H O /C S R

0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
250 T o m o n ito r p r o g r e s s t o w a r d s p o lio e r a d ic a tio n
b y m o n ito r in g th e in c id eNID
n c e o f p o lio m y e litis
w h e r e w ild p o lio v ir u s is is o la te d in c h ild r e n
u n d e r 1 4 y e a rs
Cases
200

150
NID

100

50
W H O /C S R

0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96
 T o m o n ito r th e in c id e n c e o f la b o r a to r y
600 c o n fir m e d m a la r ia a n d p r o p o r tio n d u e to P .
f a lc ip a r u m

500
Others
400
Faciparum
300

200
W H O /C S R

100

0
1992 1993 1994 1995 1996
700 T o m e a s u r e th e in c id e n c e o f A ID S to p r e d ic t
f u tu r e tr e n d s a n d f a c ilita t e h e a lth s e r v ic e
600 p la n n in g
500
400
300
200
100
0
90 91 92 93 94 95 96 97 98 99 00 01 02W H O /C03S R 04
O1600
b je c tiv e : T o m o n ito r th e a b ilit y o f a T B p r o g r a m m e to
e n s u r e t r e a t m e n t c o m p le tio n a n d c u r e
1400
T r e a t m e n t c o m p le t io n a n d c u r e in T B c a s e s , 1 9 9 4 - 1 9 9 7
1200
1000 Cases
800 Completion
600 Cure
400
200
W H O /C S R

0
1994 1995 1996 1997
 Disease Indicators

• The measures that you use to monitor a disease

e.g.
• Number
– No of cases of malaria reported
– No of cases of P. falciparummalaria reported
• Rate
– Number of cases of ARI in children under 5 years per
100,000 population
• Ratio
– Proportion of children with ARI who die

WHO/CSR
 Disease Indicators

• Dapat berupa indikator dari :

– Insidens penyakit
• Kasus TB per 100,000 population

– Effectifitas dari pengobtan

• Case fataality rate pada campak

WHO/CSR
 Surveillance: Indicators

Specific = khusus
Measurable = dapat diukur
Action oriented = berorientasi pada suatu tindakan
Realistic = realistis
Timely = sesuai waktunya

WHO/CSR
 Surveillance: General principle

Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision

WHO/CSR
 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

WHO/CSR
 Surveillance: Data

Health Care System Public Health Authority

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

Action Decision

WHO/CSR
 Surveillance: Data

Health Care System Public Health Authority

CASE DEFINITION
•Clinical/laboratory Information

•Levels (suspected, probable,

confirmed)
•Indicators

Action Decision

WHO/CSR
 Report

Pos. specimen

Clinical specimen

Seek medical attention

Disease

Infected

Exposed
WHO/CSR
 Surveillance: General principle

Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision

WHO/CSR
 Surveillance: Reporting

Health Care System Public Health Authority

Reporting
Data frequency Information

•immediate
•weekly
•monthly ...

Action Decision

WHO/CSR
 Surveillance: Reporting

Health Care System Public Health Authority

Reporting
Data methods Information

•Paper
•Telephone, Fax
•E-mail ...

Action Decision

WHO/CSR
 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
WHO/CSR
 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
WHO Policy and targets
Funding WHO/CSR
 Surveillance: General Principle

Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision

WHO/CSR
 Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

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

Action Decision

WHO/CSR
 Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

Data Data validation

• Missing values
• Bias
• Duplication

Action Decision

WHO/CSR
 Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

Data Descriptive analysis

• Time
• Place
• Persons

Action Decision

WHO/CSR
 Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

Data Hypothesis generation

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

Action Decision

WHO/CSR
 Surveillance: General Principle

Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision

WHO/CSR
 Surveillance: Action

Health Care System Public Health Authority

Data Information

• Control
• Feedback
Decision
• Policy
WHO/CSR
 Surveillance: Action

Health Care System Public Health Authority

Data Information

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

WHO/CSR
 Surveillance: Action

Health Care System Public Health Authority

Data Information

Feedback
" Epidemiological bulletin
" Reports Decision
" Website, others
WHO/CSR
 Surveillance: Action

Health Care System Public Health Authority

Data Information

Policy
• Policy change
• Prediction, planning
• Epidemic preparedness Decision

WHO/CSR
 Surveillance: Action

Health Care System Public Health Authority

Data Information

Evaluation
• results of action
• results of surveillance

Action Decision

WHO/CSR
 Surveillance: General Principle

Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision

WHO/CSR
 Surveillance: Function
Core function
• Detection
• Reporting
• Investigation & confirmation
• Analysis & interpretation
• Action / response

Support function
• Training
• Supervision
• Resources
• Standards / guidelines
WHO/CSR
 Surv
eillance:RamuanDasar
A
dany
asuatukerjasamay
a ngbaikdariorang-
orangyangmempuny
a imotivasi
Definisikasusdanmekanismepelaporany
a ng
jelas
Sistemkomunikasiyangefektif

Dasartapimempuny
a inuansaepidemiology
Dukunganlaboratorium

Umpanbaliky
a ngbaikdanresponsyangcepat
WH
O /CSR
Terima Kasih

WHO/CSR
WHO/CSR