Mugi Wahidin

Incidence and mortality estimates

2008, Indonesia
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
Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision
 Objectives of surveillance

• Epidemic (Outbreak) detection

• Monitoring trends in endemic disease
• Planning & Evaluating an intervention
• Monitor progress towards a control objective
• Monitor programme performance
• Epidemic (Outbreak) prediction
• Estimate future disease impact
Objective: To detect outbreaks of dysentery by
monitoring the incidence of cases of
acute bloody diarrhoea

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
Objective:

250Cases of poliomyelitis where wild poliovirus was isolated

NID
in children in a rural district, 1980-1996
Cases
200

150
NID

100

50

0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96
Objective:

600 Cases of malaria in a region, 1992-1996

500
Others
400
Faciparum
300

200

100

0
1992 1993 1994 1995 1996
Objective:

700 Cases of AIDS in a city district, 1990-2004

600
500
400
300
200
100
0
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04
Objective:

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
Community Vs Hospital based
◦ Community based surveillance: if cases under
surveillance taken from the community
◦ Health Facility based surveillance: if cases under
surveillance taken from health facilities
Active Vs Passive Surveillance
◦ Active surveillance : if the data designed and
collected by persons/institution who need the
information
◦ Passive surveillance: if the data designed and
collected by other persons/institution who need
the information
PRIORITY Is the disease a priority ?

OBJECTIVES What are the objectives of surveillance ?

(e.g. to monitor cases and deaths from
dengue fever so as to evaluate control measures)

TARGET What is the population in which we wish

POPULATION to detect cases ? (e.g. all? high risk groups ..)

INDICATORS What disease indicators will be used ?

(e.g. the number of new cases of TB per 100,000 pop
+ the number of deaths in TB cases)

MINIMUM DATA What data will be required to generate the

AND DATA indicators and what sources of data exist?
SOURCES
 Health Care System Public Health Authority

HEALTH EVENT
Information
•Disease
•Syndrome (e.g., AFP,)
•Public health issue (e.g., AI)
•Environment (e.g., animal vector)

Action Decision
 Health Care System Public Health Authority

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

Action Decision
1. Laporan penyakit
2. Statistik Vital
3. Surveilens Sentinel
4. Sentinel
5. Registrasi
6. Survei Kesehatan
 Health Care System Public Health Authority

CASE DEFINITION
•Clinical/laboratory Information

•Levels (suspected, probable,

confirmed)
•Indicators

Action Decision
Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision
Health Care System Public Health Authority
Reporting
Data frequency Information

•immediate
•weekly
•monthly ...

Action Decision
Health Care Public Health Authority
System
Reporting
Data methods Information

•Paper
•Telephone, Fax
•E-mail ...

Action Decision
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
 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
Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision
Health Care System Public Health Authority

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

Action Decision
Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision
Health Care Public Health Authority
System

Data Information

• Control
• Feedback
Decision
• Policy
Health Care Public Health Authority
System

Data Information

Control
• Rapid response
• Case management
• Prevention Decision
(e.g. immunization)
Health Care Public Health Authority
System

Data Information

Feedback
• Epidemiological bulletin
• Reports Decision
• Website, others
Health Care Public Health Authority
System

Data Information

Policy
• Policy change
• Prediction, planning
• Epidemic preparedness Decision
Health Care Public Health Authority
System

Data Information

Evaluation
• results of action
• results of surveillance

Action Decision
Health Care System Public Health Authority

Reporting
Data Information

Analysis &
Evaluation Interpretation

Feedback
Action Decision
Perencanaan PENGENDALIAN KANKER
a. Data INSIDENS DAN PREVALENS KANKER
TERTINGGI: orang, tempat, waktu
b. DATA MORTALITY: trend
Perencenaan:
a. Sumber daya manusia: TOT, pelatihan
b. Pogram intervensi: promosi, deteksi dini,
pengobatan, rehabilitatif
c. Peralatan: alat deteksi dini, pengobatan
d. Budget: dana terkait
e. Dll
1. Surveilans Faktor risiko
2. Surveilans Kasus
3. Registri PTM
 Dinkes kab/kota dan dinkes prvovinsi mengelola
surveilans FR
 Sumber data:
 Riskesdas
 Surkesda
 SKRT
 SDKI
 Survai lain
 Langkah kegiatan
1. Pengumpulan data: data Survai, survai sendiri (daerah),
mengacu WHO STEPS
2. Pengolahan dan analisa: waktu, regional, cluster
3. Interpretasi: makna analisa
4. Diseminasi: Dinkes, Pemda, stakeholder lain
 Dinkes kab/kota dan dinkes prvovinsi mengelola
surveilans kasus PTM
 Sumber data:
 RS (sentinel)
 Puskesmas (sentinel)
 Survai (Riskesdas)
 Langkah kegiatan
1. Pengumpulan data: kanker, penyakit jantung dan
stroke, DM, gagal ginjak kronik, asma, thalessemia,
dan PPOK
2. Pengolahan dan analisa: deskripitif (org,tempat,waktu),
analitik
3. Interpretasi: makna analisa
4. Diseminasi: Dinkes, Pemda, stakeholder lain
 Dinkes kab/kota/provinsi/unit kes
lain/akademisi mengelola regstri PTM
 Sumber data:
 RS - asuransi
 Puskesmas - catatan sipil
 Klinik - statistik
 Laboratorium
 Langkah kegiatan
1. Pengumpulan data: kanker, penyakit jantung dan
stroke, DM, gagal ginjak kronik, asma, thalessemia,
dan PPOK
2. Pengolahan verifikasi dan validasi
3. Analisa: deskripitif (org,tempat,waktu), analitik
4. Interpretasi: makna analisa
5. Diseminasi: Dinkes, Pemda, stakeholder lain
Kegiatan pengumpulan, penyimpanan,
pengolahan, analisa.  Informasi tentang
kasus kanker untuk mengasilkan statistik
keadaan kanker
 Kerangka pengendalian kanker:
Perencanaan dan Evaluasi Program
 Jenis REGISTRASI KANKER

Berbasis rumah sakit Berbasis populasi

• Di RS o di Suatu populasi
• Mengabaikan asal o Batasan demografis jelas
pasien o Populasi sbg denominator
 Utk administrasi RS : o Sumber data : semua
pelayanan, fasilitas, fasilitas yg mencatat kasus
pendidikan profesi, kanker (PKM, klinik, lab,
yayasan, asuransi, catatan
sipil, kelurahan, RS)
 insidens, prevalens, mortality
 Bahan perencanaan program
kanker di masyarakat
Sumber informasi/data kasus Registrasi kanker
berbasis populasi

CLINICS

LABORATORI
ES
VITAL STATISTICS
DEATH
HOSPITA CERTIFICATES
L
 REGISTRASI KANKER

• Sejak tahun 1970 sudah mulai dikembangkan di

Semarang, tetapi terhenti (proyek).
• Belum ada registrasi kanker berbasis populasi yang
sustain
• Negara-negara lain sudah mengembangkan registrasi
kanker
• Data Indonesia sangat berpengaruh terhadap data Asia
dan dunia
DKI Jakarta

Capital city of Indonesia : Jakarta

Sumber Data Reg ca DKI Jakarta

Rumah Sakit 79 (sudah)

Laboratorium 90

Puskesmas 44 (301 )

Catatan Sipil

Klinik Swasta : 2

Yayasan : YKI, YKAKI, YKPJ

46
 ALUR REGISTRASI KANKER
KEMENKES

-Pusdasurv Tim Reg Ca nasional

-PP & PL Nasionla
-Yanmedik
-Pusat data kanker

Dinkes Prov Tim Reg Ca Provinsi

-RS Provinsi
-Univ/statistik

-Sudinkes
-RS Regional/kota Tim Reg Ca kota Tim Reg Ca kota
-Univ/Statistik

PKM
RS PKM RS
Lab

Lab
Yysn Asuransi
Asuransi
YysnRo
Klinik/RS khusus

Klinik/RS khusus
Abstrak RS
32 variabel
Abstrak PKM
18 Variabel
Software:
Sistem registrasi Kanker
di Indonesia (SRiKandI)
Cancer Incidence in Jakarta,
2005-2007
1.Pengumpulan
2.verifikasi,
3.validasi,
4.pengolahan,
5.analisa data
1. Fromulir abstrak diisi oleh institusi (PKM, RS,
LAB)
2. Formulir abstrak diverifikasi
 PKM : oleh dokter PKM
 RS : oleh PA/dokter terlatih
 Lab : oleh PA
3. Abstrak dapat diinput ke software SRIKANDI
4. Abstrak/file SRIKANDI dilaporkan ke Tim
Registrasi Kanker di Sudinkes 3 bulanan
(bersama pertemuan reguler Sudinkes)
 Tim registrasi Kanker Sudinkes/Kota
◦ menerima abstrak/file SRIKANDI dari institusi
◦ Menginput ke dalam software SRIKANDI (kalau belum
diinput)
◦ Memvalidasi data, menghilangkah data dobel
 Tim registrasi Kanker Provinsi
◦ menerima file data SRIKANDI dari tim sudinkes
◦ Menggabungkan data dari 5 wilayah/kota
◦ memvalidasi data, menghilangkah data dobel
 Tim registrasi Kanker Nasional
◦ menerima file data SRIKANDI dati tim Provinsi (dan
daerah lain)
◦ Menggabungkan data2 yang ada
◦ memvalidasi data, menghilangkah data dobel
 Tim Registrasi kanker Sudinkes dapat
mengolah data yang ada di wilayahnya
 Tim Registrasi Provinsi mengolah dan
menganalisa data tingkat provinsi
 Tim Registrasi nasional mengolah dan
menganalisa data nasional

 Morbiditas (Insidens kanker) : jenis, trend

 Mortalitas (kematian kanker)
 Perencanaan dan evaluasi program