1. SEARO –CSR EWAR CASE STUDY Implementation of an EWAR Part 1 - Introduction

2. SEARO –CSR EWAR CASE STUDY Objectives To discuss critically the pros and cons of an existing surveillance system in terms of EWAR. To introduce the case study that we will follow during the course To divide the participants in workgroups

3. SEARO –CSR EWAR CASE STUDY Implementation of an EWAR In the light of the International Health Regulations (IHR) Countryland, a country in Asia has started the revision of it’s surveillance system. Introduction Background The Health System CD The National Surveillance System

4. SEARO –CSR EWAR CASE STUDY Implementation of an EWAR As an expert epidemiologist WHO has asked you to participate in a mission to strengthen early detection of outbreaks of communicable diseases. Specifically, your terms of reference state that you should revise the routine surveillance system and propose a plan of action to strengthen the early warning function. Introduction Background The Health System CD The National Surveillance System

5. SEARO –CSR EWAR CASE STUDY Background Before your visit, you collect some background information IndicatorYearEstimate Total Population (thousands)20003,113 Population Aged 15-49 (thousands)20001,668 Annual Population Growth1990-2000-0.7 % of Population Urbanized200038 Average Annual Growth Rate of Urban Population1990-20000.1 Unemployment Rate19989.1 Crude Birth Rate (births per 1,000 pop.)200020 Crude Death Rate (deaths per 1,000 pop.)20006 Maternal Mortality Rate (per 100,000 live births)199865 Life Expectancy at Birth199873 Total Fertility Rate19982.5 Infant Mortality Rate (per 1,000 live births)200029 Introduction Background The Health System CD The National Surveillance System

6. SEARO –CSR EWAR CASE STUDY The health system Administratively the country is divided in 40 districts grouped in 10 Prefectures. Primary health care is delivered through a network of Health Posts (staffed by nurses or midwives) and Health Centres (staffed by family practitioners). The secondary level care is assured by polyclinics in district towns, 40 district hospitals and 10 regional hospitals. Tertiary care is only provided in the capital, at the University Hospital. Introduction Background The Health System CD The National Surveillance System

7. SEARO –CSR EWAR CASE STUDY Communicable Diseases In the last 5 years, outbreaks of cholera and poliomyelitis have affected a large part of the country. In 2000 among the notifiable diseases, influenza, unspecified gastro-enteritis, common cold, scabies and hepatitis were the most commonly reported. Viral hepatitis is endemic. Although the measles immunisation coverage reported by the Ministry of Health (MOH) is 89%, the measles incidence in the under five is one of the highest in Asia. Introduction Background The Health System CD The National Surveillance System

8. SEARO –CSR EWAR CASE STUDY Communicable Diseases The prevalence of tuberculosis is high with an estimated incidence of 27 per 100 000 per year. Zoonoses are a public health concern. In 2000 58 cases of anthrax and 69 cases of visceral leishmaniosis were reported to the Institute of Public Health (IPH). Introduction Background CD The Health System The National Surveillance System Introduction Background The Health System CD The National Surveillance System

9. SEARO –CSR EWAR CASE STUDY You want to have a clear picture of how the system is organized. What elements do you need to describe the surveillance system?

10. SEARO –CSR EWAR CASE STUDY The National Surveillance System Introduction Background Epidemiology The Health System The National Surveillance System Communicable Disease law 73 notifiable diseases Health centre/post Department of Epidemiology and Biostatistics at the IPH monthly District Epidemiologist Public Health Directorate (district level)

11. SEARO –CSR EWAR CASE STUDY List of infectious diseases under surveillance in 2002. Can you comment the list?

12. SEARO –CSR EWAR CASE STUDY List of infectious diseases under surveillance in 2002. What are the possible problems of a system based on specific diagnosis detection?

13. SEARO –CSR EWAR CASE STUDY List of infectious diseases under surveillance in 2002. How do you notify in this system an unknown haemorrhagic fever?

14. SEARO –CSR EWAR CASE STUDY List of infectious diseases under surveillance in 2002. What are the limits of this surveillance system to early detect outbreaks?

15. SEARO –CSR EWAR CASE STUDY The reporting system Introduction Background Epidemiology The Health System The National Surveillance System After this first analysis, you stress the need for reinforcing the Early Warning System. You propose to create a working group for developing a specific protocol and a plan of action.