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
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