PUBLIC HEALTH

SURVEILLANCE

Haripurnomo Kushadiwijaya
 Principles of Surveillance

Methods of Surveillance

Analysis and Interpretation of

Data in Surveillance

Evaluation of Surveillance
Principles of Surveillance
Wide Spectrum Of Health Issues:
Infectious diseases, Chronic Conditions,
Reproductive Outcomes, Environmental
Health, Health Events
Concerns of
Related to occupation, injuries,
Public Health & Health Care
and behaviors
Practitioners

Analysis of surveillance data

(time, place, person)

Public health information

Rational Development of Health policy:

Variety of Intervention Strategies for Populations
in addition to
the need to provide Clinical preventive Services
for Individuals: Prophylaxis, Education, Inspections,
Controls
 Principles of Surveillance
Understanding of:

Public health surveillance < Epidemiological surveillance:

The ongoing systematic collection, analysis, and interpretation of

outcome-specific health data, closely integrated with the timely
dissemination of these data to those responsible for preventing
and controlling disease or injury (Thacker & Berkelman).

Public health surveillance systems should have the capacity to collect

and analyze data (Cates & Williamson), disseminate data
(Langmuir), and regularly evaluate the effectiveness of the use of
the disseminated data (Klaucke et al.)
Principles of Surveillance
Uses of surveillance:

Immediate detection of epidemics, newly emerging health

problems, changes in health practices, and changes in
antibiotic resistance

Annual dissemination for estimating magnitude of problem,

assessing control activities, setting research priorities,
testing hypotheses, facilitating planning, monitoring risk
factors, monitoring changes in health practices, and
documenting distribution and spread

Archival information for describing natural history of

diseases, facilitating epidemiological and laboratory
research, validating use of preliminary data, setting research
priorities, and documenting distribution and spread.
Methods of Surveillance
Sources of
Public Health Surveillance Data:

Reports of health events,

Reporting from laboratories and other health facilities,
Registries,
Vital Statistics,
Information on health status, risk factors, and
experiences of populations,
Information on potential exposure to environmental agents
 Methods of Surveillance
Establishment of Surveillance Systems:

Establish goals

Develop case definitions

Select appropriate personnel

Acquire tools and clearances for

Collection, analysis, and dissemination

Implement surveillance system

Evaluate surveillance activities

Analysis and Interpretation
of Data in Surveillance
Analysis and Dissemination of Surveillance Data:

Surveillance Data can be analyzed in terms of time, place, and person

Simple tabular and graphic techniques

can be applied for display and analysis

More sophisticated methods such as

cluster and time-series analyses and computer mapping techniques
may be appropriate after initial descriptive presentations

The timely dissemination of surveillance data to those who need

to know is critical to the usefulness of surveillance systems
Analysis and Interpretation
of Data in Surveillance
Standards:

(1) Core variables and other data elements

(2) Software application

(3) Data transmission

(4) Data access

(5) Confidentiality and security

Evaluation of Surveillance

Elements:

(1) Public health importance

(2) Objectives and usefulness

(3) Operation of the system

(4) Qualitative attributes

(5) Quantitative attributes

(6) Costs
 Evaluation of Surveillance

Public health
importance:
Influences on determining public health importance of an event
Measures of importance of health event
Political and public pressure
Attempts to quantify public health importance
 Evaluation of Surveillance

Objectives and usefulness:

Define the health event under surveillance

State explicitly the objectives of the surveillance system
Impact of the surveillance system on health event occurrence
Usefulness
 Evaluation of Surveillance

Operation of the
system:
Aspects of operation to be described
Questions for evaluation of the system operation
 Evaluation of Surveillance

Qualitative
attributes:
Types of qualitative attributes
a) Simplicity
b) Flexibility
c) Acceptability
 Evaluation of Surveillance

Quantitative
attributes:
Types of quantitative attributes (sensitivity, positive predictive
value, representativeness, and timeliness)
Measurement of quantitative attributes
 Evaluation of Surveillance

Costs:

Definition: cost is an e3stimation of the resources used to

operate the system
Direct personnel and resources costs
Indirect costs
Costs are judged relative to benefits
 Further reading:

Thacker, S.B. and D.F. Stroup, 1998 Public Health

Surveillance, Chapter 4 in Brownson, R.C. and
D.B. Petitti (Eds.) Applied Epidemiology: Theory to
Practice, Oxford University Press, New York

World Health Organization, 1999 WHO Recommende

Surveillance Standards, WHO, Geneva

Teutsch, S.T. and R.E. Churchill, 2000 Principles and

Practice of Public Health Surveillance (2nd Ed.),
Oxford University Press, Oxford