1. Unit 4: Reporting, Data Management and Analysis #4-4-1

2. Warm Up Questions: Instructions v Take five minutes now to try the Unit 4 warm up questions in your manual. v Please do not compare answers with other participants. v Your answers will not be collected or graded. v We will review your answers at the end of the unit. #4-4-2

3. What You Will Learn v By the end of this unit you should be able to: © describe how to plan your data collection and ensure confidentiality © describe the flow of data from health facilities to district to national level © discuss the roles and responsibilities of each person involved in data handling at each level #4-4-3

4. What You Will Learn, Cont. v By the end of this unit you should be able to: © discuss the analysis of STI data © explain using the IDS strategy to plan STI data collection and reporting #4-4-4

5. Two Types of Case Reporting  The type of case reporting affects data collection. In universal case reporting, a minimum set of data elements essential for reporting a case are collected. In sentinel site surveillance case reporting, the Ministry of Health decides what should be collected, and chooses sentinel sites. (The information above can be found in Table 4.1 in the text.) #4-4-5

6. Planning Your Data Collection  The national level provides training and forms to all sites. WHO recommends the IDS form, which collects the same information for all priority communicable diseases.  The national level develops a data management system so that: Clear lines of reporting are specified. The roles of different staff members are defined. Data can be recorded, checked and submitted regularly and consistently. #4-4-6

7. Confidentiality and Security v Train staff in the importance of patient privacy. v Restrict access to data using passwords, and lock raw data in filing cabinets. v Protect personal identifying information. © Remove it before passing data on to next level. © Don’t allow unauthorised disclosure of information. #4-4-7

8. Data Collection Process at the Health Facility 1. Clinician records patient’s medical and demographic information and makes a diagnosis based on case definitions. 2. Information is transferred to standard reporting forms or log books. 3. Data clerk hand-tabulates STI cases on a regular basis (usually monthly). #4-4-8

9. Data Collection Process at the Health Facility, Cont. 4. Clinic supervisor reviews monthly tallies before reports are submitted to district authorities. 5. Complete final report form in triplicate with two copies to be sent to district and one copy to be kept at the health facility. #4-4-9

10. Data Collection Process at the District Level v District level officers should: © Check for data completeness and inconsistencies © Contact the health facilities in case of problems © Enter data into computer database (sometimes done at national level) © Produce report © Keep one copy of report at district © Send two copies of reports to national level #4-4-10

11. Data Collection Process at the National Level v Reporting districts are contacted about inconsistent, incomplete or untimely data. v Data entry clerk enters data into computerised database (if available). v Data are analysed. #4-4-11

12. Figure 4.1. Data Collection and Flow #4-4-12

13. Data Entry v To ensure correct data entry, do one or more of the following: © Double-enter data © Use data entry software such as Epi Info™ © Check for implausible values © Place a tick on forms once they have been entered #4-4-13

14. Data Analysis v STI case reporting serves as a proxy for measuring HIV transmission. © STIs and sexually transmitted HIV are similarly acquired. © There are readily available tests to measure recently acquired infections for some STIs. © Recently acquired STIs help estimate HIV incidence. v When analysed correctly, STI surveillance data: © indicate where HIV could be occurring © indicate where HIV programmes are failing #4-4-14

15. Data Analysis, Cont. v Analyse data by the following categories to identify sites that are not reporting consistently: © Reporting site © Type of facility © District © Gender © Age group v Also, analyse data separately for each syndrome or disease. #4-4-15

16. Types of STI Data Analysis #4-4-16  Analysis to understand the STI epidemic should be done using three parameters: person place time  Details about these types of analysis are presented in the following three slides, and in Table 4.2 in the text.

17. #4-4-17 Analysis by person:  Annual analysis of data to show trends in specific STI syndromes  In the case of aetiologic surveillance, diseases stratified by age group and gender Types of STI Data Analysis, Cont.

18. #4-4-18 Analysis by place:  Analysis to provide information on where clustering of disease might be occurring and any inferences that can be made  Stratified analysis by region or geographical area to show if there are significant differences between places Types of STI Data Analysis, Cont.

19. #4-4-19 Analysis by time:  Analysis to detect if there are trends in case reports over time and if any inferences can be made  Data for a specific quarter should be compared with the same quarter in the previous year Types of STI Data Analysis, Cont.

20. Interpreting Trends v When interpreting data that seem odd, consider the following factors: © Changes in health-seeking behaviour related to availability of healthcare facilities, introduction of user fees, etc. © Changes in reporting practices © Changes in case definitions v Unexpected fluctuations should be investigated by contacting local sites to determine local changes that may explain the trends. #4-4-20

21. Analysing Universal & Sentinel Site Data v Be cautious in interpreting sentinel site surveillance data, since individual sites may not be representative of the larger region. v Data should be clearly summarised in tables, graphs or charts to help identify patterns. #4-4-21

22. In Summary v Surveillance data collection occurs at the health facility level, while data processing takes place at the district and national levels. v It is extremely important to ensure patient confidentiality. v STI data analysis should generally focus on three parameters: person, place or time. #4-4-22

23. Warm Up Review v Take a few minutes now to look back at your answers to the warm up questions at the beginning of the unit. v Make any changes you want to. v We will discuss the questions and answers in a few minutes. #4-4-23

24. Answers to Warm Up Questions 1. Match the STI data analysis parameter with its description by putting a letter in each blank: #4-4-24 ___ Analysis by placea.Annual analysis of data could show an annual trend of disease stratified by age group, and gender. ___ Analysis by timeb.Analysis to detect if there are any trends in case reports over time and any inferences that can be made. ___ Analysis by personc.Analysis to provide information about where clustering of disease might be occurring and any inferences that can be made.

25. Answers to Warm Up Questions 1. Match the STI data analysis parameter with its description by putting a letter in each blank: #4-4-25 _c_ Analysis by placea.Annual analysis of data could show an annual trend of disease stratified by age group, and gender. _b_ Analysis by timeb.Analysis to detect if there are any trends in case reports over time and any inferences that can be made. _a_ Analysis by personc.Analysis to provide information about where clustering of disease might be occurring and any inferences that can be made.

26. Answers to Warm Up Questions, Cont. 2. True or false? Interpretation of STI trends should be made independently from STI control programmes and the healthcare system. #4-4-26

27. Answers to Warm Up Questions, Cont. 2. True or false? Interpretation of STI trends should be made independently from STI control programmes and the healthcare system. False #4-4-27

28. Answers to Warm Up Questions, Cont. 3. The district office should send case reports to the national level: a. weekly b. monthly c. quarterly d. annually #4-4-28

29. Answers to Warm Up Questions, Cont. 3. The district office should send case reports to the national level: a. weekly b. monthly c. quarterly d. annually #4-4-29

30. Answers to Warm Up Questions, Cont. 4.District surveillance officers are responsible for: a.checking data for inconsistencies (for example, STIs in very old or very young patients) b.forward the results to the national level c.following up with any health facility site that has missing or inconsistent data d.all of the above #4-4-30

31. Answers to Warm Up Questions, Cont. 4.District surveillance officers are responsible for: a.checking data for inconsistencies (for example, STIs in very old or very young patients) b.forward the results to the national level c.following up with any health facility site that has missing or inconsistent data d.all of the above #4-4-31

32. Answers to Warm Up Questions, Cont. 5. True or false? Health facilities should report their data directly to the national level. #4-4-32

33. Answers to Warm Up Questions, Cont. 5. True or false? Health facilities should report their data directly to the national level. False #4-4-33

34. Answers to Warm Up Questions, Cont. 6. List three ways to handle surveillance data so that patient confidentiality is protected. #4-4-34

35. Answers to Warm Up Questions, Cont. 6. List three ways to handle surveillance data so that patient confidentiality is protected. The computer hardware should be password-protected. Access should be limited to data entry personnel. Provide safe cabinets for storing forms that have been entered. Lock the cabinets and restrict access to authorised personnel only. #4-4-35

36. Small Group Discussion: Instructions v Get into small groups to discuss these questions. v Choose a speaker for your group who will report back to the class. #4-4-36

37. Small Group Reports v Select one member from your group to present your answers. v Discuss with the rest of the class. #4-4-37

38. Case Study: Instructions v Try this case study individually. v We’ll discuss the answers in class. #4-4-38

39. Case Study Review v Follow along as we go over the case study in class. v Discuss your answers with the rest of the class. #4-4-39

40. Questions, Process Check v Do you have any questions on the information we just covered? v Are you happy with how we worked on Unit 4? v Do you want to try something different that will help the group? #4-4-40