"The number of HIV cases is increasing from 1990-2008 in Indonesia, while in other countries like Thailand, Myanmar and India, the HIV prevalence has declined. So what should we do now in order to reduce the number of HIV cases in Indonesia?? We do not know who are at higher risk and the major mode of transmission!"
"I think what we should do now is to conduct a surveillance".
After reading the scenario, you may ask: Surveillance? hmmm...sounds familiar but I don't know what it means...So, what on earth is it?Why do we need to do a surveillance?
Yea, I'm sure you have come across with the word "surveillance" in my previous blog. Surveillance is defined as the ongoing, systemic collection, analysis and interpretation of health-related data (e.g. regarding agent/hazard, risk factor, exposure, health event) essential to the planning, implementation and evaluation of public health action to reduce morbidity and mortality, and improve health status. It can also serve as an early warning system for impending public health emergencies. Besides that, documentation of the impact of an intervention can be done through surveillance. It can also be used to monitor and clarify the epidemiology of health problems, to allow priorities to be set and to inform public health policy and strategies. By doing the surveillance, it can prevent and control a disease, especially if it is a sudden outbreak.
How do we get the data when we are doing surveillance?
There are a lot of sources, such as:
- mortality reports
- morbidity reports
- reports of individual case investigation
- reports of laboratory utilization (including laboratory test results)
- special surveys (e.g. hospital admissions, disease registers, and serologic surveys)
- information on animal reservoirs and vectors
- demographic data
- environmental data
(cont' of the scenario given above) "So, what is the result of the surveillance? How do we apply it?"
Let's look at the chart below:
The chart above is drawn after the collection and compilation data. This is the analysis. From the chart above, (interpretation of data) we can see that unsafe sex and injecting drug use are two major mode of transmission. In other words, those who are having unsafe sex and using injecting drugs have relatively higher risks to get infected with HIV, compared to normal people. We also know that HIV can be transmitted to other people through blood and mother-to-child transmission, although the risks are relatively lower than that of unsafe sex and injecting drug use. After that, we should disseminate the data to the public. Therefore, by using this surveillance data, we can raise the awareness of all parties and also take few actions (utilization of surveillance data), e,g. set health policy and strategies in reducing the numbers of injecting drug users, promoting use of condom, set our target population and give them education, promote the program of VCT(voluntary counselling and testing), PMTCT (prevention mother to child transmission), PTRM(program terapi rumatan methadone), etc. Through these, HIV cases can be reduced and the health status of the community, hence, will be improved.
So, from the scenario I created, do you have a clearer picture of what surveillance is, the steps of how to do it, how we utilize the information that we get from a surveillance and the purpose of doing it? Hope it helps =)
Reference:
1. Dr. Luthfan Lazuardi. Lecture: Surveillance, Response, and The Role of Public Health Informatics
2. http://www.who.int/topics/public_health_surveillance/en/
3. http://www.cdc.gov/ncphi/disss/nndss/phs/overview.htm
4. http://www.searo.who.int/LinkFiles/Publications_HIV_AIDS_Report2009.pdf
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