Integrated Training for Surveillance Officers

in Nigeria (ITSON)

Lesson 6_c:
Interpret Data
 Proportionate pneumonia & influenza
deaths, US, Nov. 2010 – Mar. 2015

Lesson 6: Interpret Data

 The surveillance cycle: Interpret data
Identify

Evaluate Report

Communicate Analyze/Interpret

Prepare/Respond 3

Lesson 6: Interpret Data

 Learning objectives

At the end of this lesson, participants will be able to:

• Describe and interpret summarized data using a
systematic process
• Describe the use of thresholds when analyzing
surveillance data
• List possible reasons for an observed increase in
reported cases

Lesson 6: Interpret Data

 What does it mean to interpret?

35

30

25

20
No. Cases

15

10

0
1 2 3 4 5 6 7 8 9 1011121314151617181920212223
Week

Lesson 6: Interpret Data

 Systematic process for interpreting
summarized data
1. Explain epidemiologic and statistical measures in
plain language
2. Compare the observed data to the expected data
3. Consider the quality of the data
4. Consider possible explanations for an apparent
increase in cases
5. Make inferences about disease occurrence from
summary data

Lesson 6: Interpret Data

 1. Explain epidemiologic and statistical
measures in plain language
Case Fatality Rate

Prevalence Age: Median = 28 Incidence

Range = (3-65)

In LGA M, the incidence rate for Attack

Mode diabetes in the adult population was Rate
4.0 per 1000 last year. The
prevalence was 6.9%.
Median Mean
Ratio
7

Lesson 6: Interpret Data

 How would you explain these data?

Cases of Measles by LGA, July

Rate per
LGA Cases Population 1,000 Pop.
A 10 800 12.5
B 18 8,200 2.2
C 33 5,500 6.0
D 57 8,245 6.9
E 23 3,000 7.7

Lesson 6: Interpret Data

 2. Compare what you observe with what
you expect

Trend of suspected measles cases in Nigeria, 2018 – 2020 (source: Monthly measles Sitrep)
9

Lesson 6: Interpret Data .

 Endemic versus epidemic

• Endemic
– The constant presence of an agent or health condition
within a geographic area or population in a given
period of time
Number of Cases of a
Disease

Time
10

Lesson 6: Interpret Data

 Endemic versus epidemic

• Epidemic
– Occurrence of more cases of disease than expected
– in a given area or among a specific group of people
– over a particular period of time
Number of Cases of a
Disease

Time
11

Lesson 6: Interpret Data

 Thresholds

• Alert threshold
– An alert threshold tells health workers and the
surveillance team that further investigation is needed
and preparation for response should start
• Epidemic threshold
– An epidemic threshold triggers a definite response
– It marks the specific data or investigation findings that
signal an action beyond confirming or clarifying the
problem

12

Lesson 6: Interpret Data

 Thresholds are markers that indicate
when action might be needed
National Diarrhoea Thresholds, Wakanda, 2015
1800

1600

1400 Epidemic Level

1200
No. of Cases

1000

800

600

400

200
Alert Level

0 Observed Cases
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52
Epidemiologic Week 13

Lesson 6: Interpret Data .

 Have the number of meningitis cases
exceeded the threshold?

Epidemic threshold level

Epidemic Threshold = 5 cases (Population less than

14
30,000)
Lesson 6: Interpret Data www.ncdc.gov.ng
 Consider the quality of the data you are
reviewing

Number of weeks LGA managed and failed to report on time, Bayelsa State, Weeks 1-20, 2020
15

Lesson 6: Interpret Data .

 What is the pattern in this graph?

Confirmed Cholera Cases in Wakanda State, Weeks 1-26

60

50

40
Cases

30

20

10

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26
Week
16

Lesson 6: Interpret Data

 4. What factors can explain an observed
increase in the number of cases?
35

30

25

No. 20
Cases
15

10

0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

Week
17

Lesson 6: Interpret Data

 What can account for an apparent
increase in cases? ...1/2
• True increase in disease occurrence
– Outbreak/epidemic
– Seasonal pattern
– Sudden increase in size of population
• Change in reporting procedures or surveillance
system
• Change in case definition
• Increase or improvement in laboratory testing/
diagnostic procedure
18

Lesson 6: Interpret Data

 What can account for an apparent
increase in cases? ...2/2
• Increased awareness of disease (public and/or
providers)
• Increased access to health care
• New health care provider, reporter, or clinic
• Laboratory or diagnostic error
• Batch reporting

19

Lesson 6: Interpret Data

 Salmonellosis rates (per 100,000) by
year, Wakanda State, 1967–1997

30
Outbreak caused by
Reported Cases per 100,000 Population

contaminated
25
pasteurized milk, IL

20

15

10

0
1967 1972 1977 1982 1987 1992 1997
20

Lesson 6: Interpret Data .

 Weekly trends of Lassa fever confirmed
cases in Nigeria, 2016 - 2018

21

Lesson 6: Interpret Data Source: www.ncdc.gov.ng

 5. Make inferences about disease
occurrence from summary data
Confirmed Cases of Lassa fever by Week, Nigeria – 2018

22

Lesson 6: Interpret Data Source: www.ncdc.gov.ng

 What might explain this increase?

Reported Cases of Disease Y, by Month, Country X, 2012

180

160

140

120

100
Cases 80

60

40

20

0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Month 23

Lesson 6: Interpret Data MMWR Summary of Notifiable Diseases, 2012

 What might explain this increase?

Reported Cases of Disease Y, by Month, Country X, 2012

180

160

140

120

100
Cases 80

60

40

20

0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Month 24

Lesson 6: Interpret Data MMWR Summary of Notifiable Diseases, 2012

 What might explain this increase?

Reported Cases of Disease Y, by Month, Country X, 2012

180

160 2012
140 2011
120
2010
100
Cases 80

60

40

20

0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Month 25

Lesson 6: Interpret Data MMWR Summary of Notifiable Diseases, 2012

 What does this map tell you?

26

Lesson 6: Interpret Data .

 Exercise 4: Interpret data
See Page: 74

1. Review the meningitis data in the table.

Note: alert threshold = 5/100,000
epidemic threshold = 15/100,000
2. Calculate the attack rate for weeks 7 through 10
for LGA B. The remaining attack rates have been
calculated for you
3. Prepare a graph that summarizes the meningitis
attack rate data for LGA B
4. Interpret the data you have analyzed
27

Lesson 6: Interpret Data

 Answer to Q3 exercise 4: Graph
Meningococcal Meningitis Cases per 100,000 by
Week, LGA B, Epidemiologic Weeks 1–10
25

20
Cases per 100,000

Epidemic threshold = 15/100,000

15

10
Alert threshold = 5/100,000
5

0
1 2 3 4 5 6 7 8 9 10
Epidemiologic Week
28

Lesson 6: Interpret Data

 Points to remember

• Data must be interpreted for it to be useful

• Explain epidemiologic and statistical results in
plain language
• For surveillance and outbreak data, compare what
you observe with what you expect
• Consider the quality of the data
• If observed > expected, consider all explanations,
including both true increases and artificial
• Use summary data to identify patterns
29

Lesson 6: Interpret Data

 The surveillance cycle: Interpret data
Identify

Evaluate Report

Communicate Analyze/Interpret

Prepare/Respond 30

Lesson 6: Interpret Data

 How I can use this at my job

TOPIC HOW CAN I USE THIS AT MY JOB

Introduction to public health surveillance  

Identify priority diseases, conditions and

 
events
Report priority disease ,events and
 
conditions
Role of Laboratory  

Collect and Organize Data  

Analyze Data  

Interpret Data  

Outbreak investigation (Descriptive

 
Epidemiology)
31

Lesson 6: Interpret Data