Epidemiological

Surveillance

Adhanom G. (MPH)
Dep't of Epidemiology & Biostatistics 12/18/23 1
At the end of this session students will be able to:
 Define surveillance
 Describe the types of surveillance
 Discuss the activities of surveillance
 Identify public health important diseases that are

under surveillance in Ethiopia

Dep't of Epidemiology & Biostatistics 12/18/23 2

 Surveillance = French word, ‘watching with attention,
suspicion and authority’.

 WHO defined surveillance as the continuous (ongoing)

scrutiny of the factors that determine the occurrence
and distribution of diseases and other health related
events through a systematic collection of data.

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 Prediction and early detection of outbreaks, diseases,
injuries, hazards, etc.
 To provide scientific baseline data and information
for priority setting, planning, implementing and
evaluating disease control program.
 To define the magnitude and distribution of diseases
by time, person and place.

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 Data collection and recording
 Data compilation, analysis and interpretation
 Reporting and notification
 Dissemination of information

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Information Loop of Public Health Surveillance

Public

Reports

Health Care
Summaries,
Providers
Interpretations,
Recommendations
Health
Agencies

Analysis

Dep't of Epidemiology & Biostatistics 12/18/23 6

Surveillance is based on two mechanisms for the
detection of disease:
1) Passive case detection-detection in course of normal
operation of health services-via self-reporting of
patients to health institutions.
2) Active case detection-active search for cases by
special surveys or other non-routine health services.
(people undertaking surveillance facilitate data
collection)

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Passive case detection

Health workers
detect diseases
when people come
to health facilities

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Active case detection

Health workers going out

searching for health
problems in the
community


Dep't of Epidemiology & Biostatistics 12/18/23 9
 Active Surveillance
 Passive Surveillance
 Sentinel Surveillance

Dep't of Epidemiology & Biostatistics 12/18/23 10

“a method of data collection usually on a specific
disease, for relatively limited period of time and with
involvement of persons who conduct the surveillance
activity”.
 involves collection of data from communities such as:
-house-to-house surveys or
- mobilizing communities to central
point.

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 Sending out a letter
 Alerting the public directly, usually through local
media, to visit a health facility
 Asking patients of the particular disease if they know
anyone else with the same condition.
 Conducting a survey of the entire population.

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 Discus the advantage and disadvantage of Active
Surveillance.

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Advantages:
 the collected data is complete and accurate
 information collected is timely.
Disadvantages:
 it requires good organization,
 it is expensive
 requires skilled human power
 it is for short period of time (not a continuous
process)
 it is directed towards specific disease conditions

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• Periodic evaluation of an ongoing program
• Programs with limited time of operation such as
eradication program.
• In unusual situations such as:
– New disease discovery
– New mode of transmission
– high-risk season/year is recognized.
– disease is found to affect a new subgroup of the population.
– reappearing eradicated disease.

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“a mechanism for routine surveillance based on passive
case detection and on the routine recording and
reporting system”.
 data is generated with out intervention, solicitation
or contact by the health agency carrying out the
surveillance.
 information provider comes to the health
institutions for medical or other help.
 It involves collection of data as part of routine
provision of health services.

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Advantages:
 covers a wide range of problems
 does not require special arrangement
 it is relatively cheap
 covers a wider area

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Disadvantages:
 The information generated is to a large extent
unreliable, incomplete and inaccurate.
 data is not available on time (mostly)
 Most of the time, you may not get the kind of
information you desire
 It lacks representativeness as it is mainly from health
institutions
 There is no feed back system

Dep't of Epidemiology & Biostatistics 12/18/23 18

 Surveillance that uses a pre-arranged sample of reporting
sources to report all cases of one or more conditions.
Usually the sample sources are selected to be those most
likely to see cases of the specified condition, diagnose it
and report appropriately.

 Provides a practical alternative to population-based

surveillance, in developing countries.

 health officials define homogenous population subgroups

and the regions to be sampled.
 They then identify institutions that serve the population
subgroups of interest, and that can and will obtain data
regarding the condition of interest.

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Advantages:
• relatively inexpensive
• provides a practical alternative to population-based
surveillance
• can make productive use of data collected for other
purposes

Disadvantages:
• the selected population may not be representative of
the whole population
• use of secondary data may lead to data of lesser quality
and timeliness

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• Mortality registration
• Morbidity registration
• Epidemic reporting
• Reports of laboratory utilization (Including lab test
results)
• Reports of individual case investigations
• Reports of epidemic field investigations
• Special surveys
• Information on animal reservoir and vector distribution
• Report of biologics and drug utilization
• Knowledge of the population and environment

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 Using a combination of both active and passive
surveillance techniques.
 Timely notification
 Timely and comprehensive action
 Availability of a strong laboratory service for

accurate diagnoses of cases

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 The integrated disease surveillance system is a
relatively new strategy, which is being implemented
in Ethiopia.

 In this strategy several activities from the different

vertical programs are coordinated and streamlined
in order to make best use of scarce resources.

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Some of the challenges facing disease surveillance are:
 Failure to report diseases of epidemic potential in
time.
 Incomplete reporting of notifiable diseases.
 Late reporting of notifiable diseases.
 Inadequate data analysis, especially at peripheral
level.
 Failure to use available information to follow disease
trends.
 Inadequate laboratory involvement in case
detection.

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• Poor feedback to health workers and communities.
• Duplication of reports.
• Under utilization of surveillance information in
decision-making.
• Shortage of technical personnel
• High turn-over of technical staff
• Lack of motivation by health workers.
• Under developed communication systems
• Inadequate resources

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 Deficiencies in data collection
◦ Lack of diagnostic accuracy,
◦ Based on passive case detection only, leading to:
 Lack of completeness and
 Lack of representativeness)
 Deficiencies in reporting/ notification
◦ multiplicity of case reporting forms, leading to:
 Lack compliance,
 Lack of timeliness
 Deficiencies in data analysis
◦ central than local level, results in national indicators of health
status rather than local indicators
 Deficiencies in dissemination
◦ aggregate information
◦ no feedback system
◦ lack of follow-up for action

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(A) Epidemic Prone Diseases
_ Cholera
_ Diarrhea with blood (Shigella)
_ Meningitis
_ Measles
_ Plague
_ Viral Haemorrhagic fevers
_ Yellow fever
_ Relapsing fever
_ Endemic Typhus
_ Malaria

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(B) Diseases Targeted For Elimination/Eradication
 Acute flaccid paralysis (AFP/Polio)
 Neonatal Tetanus
 Leprosy
 Dracunculiasis (Guinea worm)

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(C) Other Diseases of Public Health Importance
 Pneumonia in children less than 5 yrs of age
 Diarrhea in children less than 5 yrs of age
 New AIDS cases
 Sexually Transmitted Infections (STIs)
 Onchocerciasis
 Tuberculosis

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