REPORT ON TRAINING OF SOUTHERN SECTOR DISTRICTS AND

REGIONAL TEAMS IN INTEGRATED DISEASE SURVEILLANCE AND

RESPONSE AT THE VOLTA REGIONAL HEALTH TRAINING CENTRE
6
TH
OCTOBER 2003-10
TH
OCTOBER 2003.
The Workshop started with an Opening Prayer by Mr. Paul Dumashie at about 10.30 am
Hereater! parti"ipants and the a"ilitators introdu"ed themsel#es. The $"ting %egional
dire"tor o Health &er#i"e! Dr. M"Damien Ded'o! hereater perormed the Opening
"eremony.
FACILITATORS( Dr. )awson $had'ie *ational +o,ordinator! Disease &ur#eillan"e
-nit! $""ra led The Team o a"ilitators. Other a"ilitators in"lude(
1. Dr. Okpata WHO %.P%.&.*T$T/0.
1. Dr. Mary $ma 2rantuo *$T/O*$) P%O3.&&/O*$) O33/+.%,/M+/! WHO
3. Mr. $ddo D/&.$&. &-%0./))$*+. -*/T! $++%$
4. Mr. $damu D/&.$&. &-%0./))$*+. -*/T! $++%$

INTRODUCTORY LECTURE
/n the /ntrodu"tory le"ture pre"eding the a"tual workshop! Dr. $had'ie! The Head!
*ational &ur#eillan"e -nit! took us through the Ob5e"ti#es and strategies or the
/ntegrated Disease &ur#eillan"e and %esponse.
OBJECTIVE( $""ording to him! the main ob5e"ti#e o integrating disease sur#eillan"e
is(
To gi#e health workers! espe"ially those who are in#ol#ed in disease
sur#eillan"e and "ontrol! appropriate knowledge! and skills in identiying
"ases o priority diseases and also pro"essing the data and using it or
a"tion.
The spe"ii" ob5e"ti#es or the Training in"lude! enabling parti"ipants to(
Dete"t! re"ord and report "ases o priority diseases.
$naly'e and interpret data on priority diseases.
/n#estigate and respond to suspe"ted outbreaks.
2e prepared or disease epidemi"s.
/n#estigate and respond to other priority diseases.
&uper#ise and pro#ide eedba"k.
2e able to monitor and e#aluate /D&% implementation.
STRATEGIES FOR ISDR
He also elaborated on the strategies to be adopted to do this. The strategies in"lude(
To strengthen the "apa"ity o the "ountry to "ondu"t ee"ti#e sur#eillan"e
a"ti#ities
To integrate multiple sur#eillan"e systems so that orms! personnel and resour"es
"an be used more ei"iently
To impro#e the use o /normation or de"ision,making
1
To impro#e the low o sur#eillan"e inormation between and within le#els o
health system in the implementation o ee"ti#e publi" health inter#ention.
To strengthen )aboratory +apa"ity and in#ol#ement in "onirmation o Pathogens
and monitoring o Drug sensiti#ity.
To in"rease the in#ol#ement o "lini"ians in the sur#eillan"e system.
To in#ol#e the "ommunity in the dete"tion! the in#estigation and the reporting o
publi" health problems! and in the implementation o ee"ti#e publi" health
a"tion.
ACTUAL TRAINING PROCESS
The main method employed during the Training process was Group
Discussions and plenary.
DAY ONE 6
TH
OCTOBER 2003.
MODULE ONE
This module was the /ntrodu"tion to the Workshop and to orient the sur#eillan"e teams
on the /ntegrate Diseases &ur#eillan"e training. /t was also to e6plain the need or the
/ntegration o Disease &ur#eillan"e and also the need to in"lude the +lini"ians in the
whole pro"ess. $""ording to the 3a"ilitators! Disease sur#eillan"e begins in the
"onsulting room hen"e there is the need to sensiti'e the "lini"ians on what to do when
they dete"t "ertain diseases.
$""ording to the Module! +ommuni"able Diseases "ontinue to be the ma5or "ause o
morbidity and mortality. These diseases are ad5udged as pre#entable! howe#er multiple
a"tors su"h as en#ironmental! so"ial and e"onomi" determinants hamper the ee"ti#e
pre#ention and "ontrol o these diseases.
Pre#ious disease sur#eillan"e systems were #erti"al and has not been able to address
these issues hen"e the need to adopt the re"ommendation and %esolutions arri#ed at the
47
th
WHO %egional +ommittee or $ri"a 8$3%9%+47%1: meeting on /ntegrated
.pidemiologi"al &ur#eillan"e o "ommuni"able diseases in 1;;7.
/n pursuan"e o this! these modules and a Te"hni"al <uideline has been de#eloped or
health workers know the basi" skills in epidemiologi"al "on"epts.
This module also mentioned the Target audien"e or ee"ti#e implementation o the
/ntegrated Disease &ur#eillan"e as(
1. Pri#ate and Publi" pra"titioners 8Do"tors! *urses! Medi"al $ssistants et":
1. Publi" Health Oi"ers 8Do"tors! Te"hni"al Oi"ers! Publi" Health *urses!
+ommunity Health *urses! et":
3. .n#ironmental Health workers
4. )aboratory Workers
=. Data9%e"ords managers
>. &tudents 8"lini"al! publi" health! .n#ironmental health! )aboratory et":
?. 0eterinary Health workers
MODULE TWO
The module 1 targets +ase dete"tion! re"ording! summary and %eporting o "ases o
priority Diseases. The Te"hni"al <uideline de#eloped! is to be the guide or "lini"ians in
reporting these Diseases o Priority to enhan"e the su""ess o the /ntegrated Disease
&ur#eillan"e. &tandard "ase deinitions and "ase dete"tion pro"edures were also spe"iied
in the guideline and are to ser#e as "ru"ial part o Disease sur#eillan"e.
1
3orms were also designed to aid "lini"ians to report these diseases promptly. Parti"ipants
were taken through how to properly eel these orms to enable proper analysis and a"tion
to be taken. <uidelines on "olle"tion o spe"imen were also mentioned. Parti"ipants were
inormed about the need to in"orporate the )aboratory a"ti#ities in to the whole pro"ess
sin"e this unit are responsible or "onirmation o the Diseases and also guides in the
spe"imen "olle"tion
DAY TWO 7
!
OCTOBER 2003
FIELD E"ERCISE AND CONTINUATION OF MODULE TWO
Parti"ipants were di#ided in to two main groups. <roup One #isited the Ho Distri"t
Hospital whilst <roup 1 0isited the 0olta %egional Hospital. The ield trip was to enable
parti"ipants to dete"t and report the priority Diseases and also to assess the "urrent
situation o reporting and make suggestions. The ollowing were the obser#ations
presented by the #arious groups
This ield trip was to enable Parti"ipants to ha#e a pra"ti"al eel o "ase dete"tion! "ase
deinition! and reporting o the Priority Diseases.
REGIONAL HOSPITAL GROUP
$t the %egional Hospital! it was reali'ed that due to the use o the 3older! enough
2iographi" inormation "an be "olle"ted about the Patient and hen"e "an be useul in
Disease sur#eillan"e a"ti#ities. Howe#er! in the +onsulting %oom %egisters and the
$dmission and Dis"harge %egisters! enough 2iographi" /normation "annot be re"orded.
$lso there was no "olumn or remarks hen"e re"eipt numbers and other remarks were put
in the $dditional Diagnoses "olumn. With regards to the onset o the Diseases! ma5ority
o the olders in#estigated spe"iy this. This was highly re"ommended sin"e it assists in
Disease sur#eillan"e a"ti#ities.
DISTRICT HOSPITAL GROUP.
$t the Distri"t Hospital! it was reali'ed that in some o the +onsulting %oom %egisters!
the ull diagnoses were not written! instead they were shorten! or e6ample! Malaria was
written Mal. The &e"ondary diagnoses "olumn was also used to write %e"eipt numbers
i.e. it was used as a %emark "olumn.
Howe#er! the way the olders were arranged was re"ommended. /t was also highly
re"ommended that the Hospital is using olders or both Outpatient and /npatient
a"ti#ities. The group re"ommended that i other a"ilities "an adopt the system it would
be benei"ial to both "lini"ians and the patients.
$ter the group presentations! the parti"ipants broke to their working groups.
MODULE THREE
This module also emphasi'ed the need or Data organi'ation! pro"essing! analysis!
presentation and /nterpretation at the peripheral le#els. /t also emphasi'ed the need or
timely reporting o the priority Diseases to enable a"tion to be taken early! sin"e response
to epidemi"s is the most essential element in the /ntegrated Disease sur#eillan"e and
%esponse s"heme.
DAY THREE #
TH
OCTOBER 2003.
3
The .6er"ises on this module three was "ontinued until 2reak ast. $ter the 2reak!
module 3our was started. During plenary se"tion! a lot o issues were raised whi"h
bothers on the reporting o Diseases. +lini"ians were also reminded to write eligibly in
order to enable proper reportage o the disease and thereby ensuring proper "ase dete"tion
or a"tions to be taken.
DAY FOUR $
TH
OCTOBER 2003.
The module 3our and i#e were treated on the Day our.
MODULE FOUR
This module dwelt on /n#estigation and responding to suspe"ted Disease outbreaks.
Parti"ipants were en"ouraged ater going through the e6er"ises to(
1. /n#estigate all rumours and suspi"ions o outbreaks9epidemi"s promptly.
1. 0eriy the e6isten"e o an outbreak
3. +hara"teri'e the outbreak in terms o persons! pla"e and time.
4. Draw and ormulate hypothesis
=. Outline the appropriate response measures
>. Prepare an outbreak response report to the appropriate @uarters.
/n the in#estigation pro"ess! sin"e "lini"ians most at times are the irst to see these "ases!
there is the need or them to notiy the Distri"t Health Dire"torate and must also be
in#ol#ed espe"ially in the response team that is supposed to respond to the outbreak.
MODULE FIVE
This module was designed to address the issues in#ol#ed in responding promptly and
appropriately to outbreaks9epidemi"s. /t emphasi'ed the need to draw epidemi"
preparedness plan to assist to respond promptly to the outbreaks.
DAY FIVE 10
TH
OCTOBER 2003.
The module = was "ontinued until breakast. $ter breakast! the Module &e#en was
treated with parti"ipants.
MODULE SEVEN
This module was aimed at ensuring proper super#ision and eedba"k. /t elaborates on
how to plan and "ondu"t super#isory #isits! )og in all suspe"ted outbreaks and rumours!
"omplete an outbreak response report and also list the key elements to be in"luded in a
publi" health bulletin.
/t was also emphasi'ed that! it is more sui"idal to reuse to pro#ide eedba"k to the
"ommunity! the "lini"ians! and any interested indi#idual! organi'ation or body with
regards to the outbreak o a disease. The &uper#ision and eedba"k pro#ide the
opportunity to moti#ate and also assist in training.
Parti"ipants were en"ouraged to monitor and e#aluate the sur#eillan"e system through the
use o these reports and eedba"ks in order to impro#e upon the system at all le#els.
$ter this module! the perorman"e /ndi"ators on /ntegrated Disease sur#eillan"e was
introdu"ed and dis"ussed.
INTEGRATED MANAGEMENT OF THE CHILDHOOD ILLNESSES
4
This &ession was handled by the *ational Proessional Oi"er,/M+/! WHO! Mrs. Mary
*.$. 2rantuo.
The /M+/ is a broad strategy aimed at redu"ing +hild 8i.e. under = yrs: morbidity and
mortality in the de#eloping "ountries in"luding <hana. /t en"ompasses inter#entions to
pre#ent illness and redu"e deaths rom the most "ommon "hild health problems and
promote "hild health and de#elopment.
The /M+/ programme o"uses on the "hild as a whole rather than on a single disease or
"ondition. The rationale or this programme emanates rom the a"t that(
1. 10.;million under,i#e deaths were re"orded in 1001
1. Ma5ority o these death was in the de#eloping "ountries
3. ?0A o all deaths due to Perinatal "onditions! pneumonia! Diarrhoea! malaria!
measles! H/0 and malnutrition.
4. 3or many "hildren! a single diagnosis may not be appropriate and hen"e the need
or integrated approa"h to the "are o si"k "hildren.
=. %esear"h has shown that more than =0A o the deaths in "ommunity and thus
there is the need or inter#ention at the health a"ilities as well as in the
"ommunity.
&trategies or the /M+/ programme in"lude
1. /ntegrating all pre#ious programmes e.g. .P/! $%/! +DD and Malaria and thereby
impro#ing upon the health! growth and de#elopment o the "hild.
1. .nsuring an e#iden"e,based programme thereby enhan"ing monitoring the
progress o the implementation o the /M+/ programme.
3. /n"orporating +ost,ee"ti#eness in the programme through "ombining
"ommunity and health a"ility inter#entions.
The priority areas or the impro#ing +hild health under this programme in"lude
*eonatal Health "are
Pre#ention and "ontrol o growth and nutritional problems
Pre#ention and "ontrol o /ne"tious diseases and /n5uries
+lini"al "are o the si"k and in5ured "hild
Health related inter#entions.
/M+/ /MP).M.*T$T/O* /* <H$*$
The /ntrodu"tion phase began in 1;;7 through 1000 and a"ti#ities in"lude
Orientation! planning and $daptation o generi" materials.
.arly /mplementation Phase started in 1000 up to 1001 and o"used on our
Distri"ts.
The .6pansion phase also in"luded
17 Distri"ts by 1001
30 Distri"ts by 1003 o whi"h Ho distri"t is one
/n"lusion in Pre,ser#i"e edu"ation by 1004.
The /M+/ programme has been linked with the /ntegrated Disease &ur#eillan"e and
%esponse a"ti#ities and Health Management /normation &ystem in order to ensure
Monitoring /M+/ "ase Management through the /ntegrated Disease
&ur#eillan"e and %esponse 3orms
Monitoring perorman"e o Health workers through the
/M+/9%2M .6it /nter#iews
=
Monitoring pra"ti"es o mothers and "aregi#ers towards under,
i#e.
CLOSING CEREMONY
$ter the /M+/ le"ture! the Training session was oi"ial "losed by the $g. %egional
Dire"tor o Health &er#i"es! Ho. He also emphasi'ed that sin"e Disease sur#eillan"e
begins in the +onsulting room! +lini"ians must not eel relu"tant to report to the Publi"
Health Oi"er to enable a"tion to be taken thereby pre#enting urther damages that the
epidemi"s might "ause. He also shared the sentiments the "lini"ians that when "lini"ians
are posted to the #arious a"ilities a proper orientation be gi#en them on the need or
reporting o these priority Diseases. When this is done! it is belie#ed that proper and
ee"ti#e measures "an be taken to address issues o epidemi"s.
On his note the Training session was de"lared ormally "losed.
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