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)?

Apakah penyakit tsb mrpk prioritas?

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

Data apa yg dibutuhkan untuk mengembangkan indikator dan apa sumber data yg ada?

Apa indikator penyakit yang dipakai ?(mis. Jumlah kasus baru TB per 100,000 pop+ jumlah kasus kematian TB )

PRIORITAS

TUJUAN

DATA MINIMUM & SUMBER DATA

POPULASI

TARGET Populasi yang mana yang akan dideteksi kasusnya? (mis. semua? Kelompok risiko tinggi?)

INDIKATOR

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

Disentri

Polio

Malaria

AIDS

Tuberculosis

Mendeteksi letusan disentri melalui monitoring kasus incidens dari diare akut berdarah

Memonitor kemajuan eradikasi polio melalui monitoring incidens poliomyelitis dimana poliovirus yang ganas dapat ditemukan (diisolasi) pada anak-anak usia < 14 years

Memonitor incidens malaria yang konformatif (melalui pemerksaan laboratorium) termasuk incidens penyakit

akibat P. falciparum and resistensi obat antiparasit.

Mengukur incidens kasus AIDS sehingga kecenderungan kedepan dapat diprediksi dan pelayanan kesehatan dapat direncanakan

Memonitor kemampuan program TB untuk mendeteksi kasus, menjamin selesainya pengobatan dan kesembuhan

Contoh Tujuan Surveilens

Kasus disentri akut di sebuah kabupaten,January 1994- April 1995

0

20

40

60

80

100

120

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

Cases

1994

Tujuan: Mendeteksi KLB disentri melalui monitoring insidens kasus dari diare akut berdarah

1995

Memonitor perkembangan eradikasi polio melalui monitoring incidens poliomyelitis dimana poliovirus diisolasi pada anak-anak dibawah 14 tahun

0

50

100

150

200

250

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96

CasesNID

NID

Cases of poliomyelitis where wild poliovirus was isolated in children in a rural district, 1980-1996

Tujuan:

Memonitor insidens malaria (positif berdasarkan lab) dan proporsi akibat P. falciparum

0

100

200

300

400

500

600

1992 1993 1994 1995 1996

Others

Faciparum

Cases of malaria in a region, 1992-1996

Tujuan :

Mengukur insidens AIDS untuk memprediksi kecenderungan masa mendatang dan memfasilitasi perencanaan pelayanan kesehatan.

0

100

200

300

400

500

600

700

90 91 92 93 94 95 96 97 98 99 00 01 02 03 04

Cases of AIDS in a city district, 1990-2004

Tujuan:

Memonitor kemampuan program TB untuk memastikan penyelesaian pengobatan dan kesembuhan.

Treatment completion and cure in TB cases, 1994-1997

Objective:

0

200

400

600

800

1000

1200

1400

1600

1994 1995 1996 1997

Cases

Completion

Cure

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 Kesehatan

Autoritas Kesehatan Masyarakat

Data Informasi

KeputusanAksi

Umpan Balik

Pelaporan

EvaluasiAnalisis & Interpretasi

Surveillance: Data

Health Care System Public Health Authority

Information

DecisionAction

HEALTH EVENT

•Disease

•Syndrome (e.g., AFP, jaundice, VHF)

•Public health issue (e.g., AMR)

•Environment (e.g., animal vector, water)

Surveillance: Data

Health Care System Public Health Authority

Information

DecisionAction

DATA SOURCE

•Notifiable disease reporting system

•Vital statistics

•Survey

•Laboratory

Surveillance: Data

Health Care System Public Health Authority

Information

DecisionAction

CASE DEFINITION•Clinical/laboratory

•Levels (suspected, probable, confirmed)

•Indicators

Terpajan

Spesimen klinis

Sakit

Spesimen positif

Terinfeksi

Pencarian pengobatan

Laporan

Surveillance: General principle

Health Care System Public Health Authority

Data Information

DecisionAction

Feedback

Reporting

EvaluationAnalysis & Interpretation

Surveillance: Reporting

Health Care System Public Health Authority

Data Information

DecisionAction

Reporting frequency

•immediate

•weekly

•monthly ...

Surveillance: Reporting

Health Care System Public Health Authority

Data Information

DecisionAction

Reporting methods•Paper

•Telephone, Fax

•E-mail ...

Ministryof Health

WHO

Peripheral level

Intermediate level

Central level

Regional/International level

Surveillance: Data flow

Clinical (suspected)

+ Supportive laboratory data + epidemiological link (probable)

Diagnostic Laboratory (confirmed)

Regional reference laboratory

Ministryof Health

WHO

Peripheral level

Intermediate level

Central level

Regional/International level

Surveillance: Tasks

Detect TreatReport

AnalyseInvestigateReportRespondFeedback

AnalyseInvestigateConfirmRespondPlan and FundFeedback

Analysis and feedback SupportPolicy and targetsFunding

Surveillance: General Principle

Health Care System Public Health Authority

Data Information

DecisionAction

Feedback

Reporting

EvaluationAnalysis & Interpretation

Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

Data

DecisionAction

• Data characteristics

• Data validation

• Descriptive analysis

• Hypothesis generation

Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

Data

DecisionAction

• Various sources of notifications

•Various levels of quality

•Continuous data collection subject to change

Data characteristics

Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

Data

DecisionAction

• Missing values

• Bias

• Duplication

Data validation

Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

Data

DecisionAction

• Time

• Place

• Persons

Descriptive analysis

Surveillance: Analysis & Interpretation

Health Care System Public Health Authority

Data

DecisionAction

• related to time

• related to place

• related to persons

Hypothesis generation

Surveillance: General Principle

Health Care System Public Health Authority

Data Information

DecisionAction

Feedback

Reporting

EvaluationAnalysis & Interpretation

Surveillance: Action

Health Care System Public Health Authority

Data Information

Decision

• Control

• Feedback

• Policy

Surveillance: Action

Health Care System Public Health Authority

Data Information

Decision

Control• Rapid response

• Case management

• Prevention (e.g. immunization)

Surveillance: Action

Health Care System Public Health Authority

Data Information

Decision

Feedback• Epidemiological bulletin

• Reports

• Website, others

Surveillance: Action

Health Care System Public Health Authority

Data Information

Decision

Policy• Policy change

• Prediction, planning

• Epidemic preparedness

Surveillance: Action

Health Care System Public Health Authority

Data Information

DecisionAction

Evaluation• results of action

• results of surveillance

Surveillance: General Principle

Health Care System Public Health Authority

Data Information

DecisionAction

Feedback

Reporting

EvaluationAnalysis & Interpretation

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

Sistem komunikasi yg efisien

Definition kasus dan mekanisme pelaporan yg jelas

Epidemiologi dasar namun “berbunyi”

Umpan balik yg baik dan respons yg cepat

Ada dukungan laboratoris

Terima Kasih