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

TUJUAN

POPULASI
TARGET

Apakah penyakit yang dimaksud

Merupkan prioritas ?

Apa tujuan dari surveillens ?

(e.g.untk monitor kasus dan kematian suatu penyakit
Dan untk mengevaluasi keberhasilan kontrol yang
diambil )

Kelompok populasi mana yang akan di diteksi

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
DAN SUMBER
DATA

Data apa saja yang dibutuhkan untuk

Membangun indikator dan darimana sumbernya
WHO/CSR

What are the

objectives of surveillance ?

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

Dysentery

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
Tuberculosis

Mengukur insiden kasus AIDS sehingga tred masa depan

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

120
100

Cases

80
60
40
20
0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr

250
200
150
100

NID

Casesprog
To monitor
by monitoring t
where NID
wild poli
under 14 years

50
0
80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96

600

To monitor the incidence o

confirmed malariaOthers
and pro
falciparum
Faciparum

500
400
300
200
100
0
1992

1993

1994

1995

1996

700
600
500
400
300

To mea
future t
plannin

200
100
0
90 91 92 93 94 95 96 97 98 99 00 01 02 03 04

1600

Objective:
1400
1200

To monitor the ability of a TB programme t

ensure treatment completion and cure

1000

Cases
800 Treatment completion and cure in TB cases, 1994-1997
Completion
Cure
600
400
200
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. falciparum malaria 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

Evaluation

Analysis &
Interpretation

Feedback
Action

Decision

WHO/CSR

Surveillance: Data
Health Care System

Public Health Authority

HEALTH EVENT
Disease

Information

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

DATA SOURCE
Notifiable disease reporting system

Public Health Authority

Information

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

Evaluation

Analysis &
Interpretation

Feedback
Action

Decision

WHO/CSR

Surveillance: Reporting
Health Care System
Data

Reporting
frequency

Public Health Authority

Information

immediate
weekly
monthly ...

Action

Decision

WHO/CSR

Surveillance: Reporting
Health Care System
Data

Public Health Authority

Reporting
methods

Information

Paper
Telephone, Fax
E-mail ...

Action

Decision

WHO/CSR

Surveillance: Data flow

Clinical
(suspected)

Peripheral level

+ Supportive
laboratory data
+ epidemiological
link (probable)

Intermediate level

Central level

Regional/International level

Ministry
of Health

WHO

Diagnostic
Laboratory
(confirmed)
Regional reference
laboratory
WHO/CSR

Surveillance: Tasks
Detect
Treat
Report

Peripheral level

Analyse
Investigate
Report
Respond
Feedback

Intermediate level

Central level

Regional/International level

Ministry
of Health

WHO

Analyse
Investigate
Confirm
Respond
Plan and Fund
Feedback
Analysis and feedback
Support
Policy and targets
Funding WHO/CSR

Surveillance: General Principle

Health Care System

Public Health Authority

Reporting

Data

Information

Evaluation

Analysis &
Interpretation

Feedback
Action

Decision

WHO/CSR

Surveillance: Analysis & Interpretation

Health Care System
Data

Public Health Authority

Data characteristics
Data validation
Descriptive analysis
Hypothesis generation

Action

Decision
WHO/CSR

Surveillance: Analysis & Interpretation

Health Care System
Data

Public Health Authority

Data validation
Missing values
Bias
Duplication

Action

Decision
WHO/CSR

Surveillance: Analysis & Interpretation

Health Care System
Data

Public Health Authority

Descriptive analysis
Time
Place
Persons

Action

Decision
WHO/CSR

Surveillance: Analysis & Interpretation

Health Care System
Data

Public Health Authority

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

Evaluation

Analysis &
Interpretation

Feedback
Action

Decision

WHO/CSR

Surveillance: Action
Health Care System
Data

Public Health Authority

Information

Control
Feedback
Policy

Decision

WHO/CSR

Surveillance: Action
Health Care System
Data

Public Health Authority

Information

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

Decision

WHO/CSR

Surveillance: Action
Health Care System
Data

Public Health Authority

Information

Feedback
" Epidemiological bulletin
" Reports

Decision

" Website, others

WHO/CSR

Surveillance: Action
Health Care System
Data

Public Health Authority

Information

Policy
Policy change
Prediction, planning
Epidemic preparedness

Decision

WHO/CSR

Surveillance: Action
Health Care System
Data

Public Health Authority

Information

Evaluation
results of action
results of surveillance
Action

Decision

WHO/CSR

Surveillance: General Principle

Health Care System

Public Health Authority

Reporting

Data

Information

Evaluation

Analysis &
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

Surveillance: Ramuan Dasar

Adanya suatu kerjasama yang baik dari orangorang yang mempunyai motivasi
Definisi kasus dan mekanisme pelaporan yang
jelas
Sistem komunikasi yang efektif
Dasar tapi mempunyai nuansa epidemiology
Dukungan laboratorium
Umpan balik yang baik dan respons yang cepat
WHO/CSR

Terima Kasih

WHO/CSR