Surveillance Systems

In 2012, half of all adults in the US had one or more chronic health conditions; at least 25% had two or more chronic health conditions. Seven of the top ten causes of death in 2010 were chronic diseases; two of the seven chronic diseases, heart disease and cancer, account almost for over 50% of all deaths. Chronic disease is one of the most costly contributors in healthcare expenditures; once diagnosed many patients must be followed for a lifetime. In lower-income countries chronic disease is now the biggest contributor to mortality. Socioeconomic inequalities are a major driver of the chronic disease epidemic. Chronic disease in the US, such as cancer, heart disease, renal end stage disease and diabetes are tracked in national datasets but are not linked. Chronic diseases share many risk factors, major risk factors, e.g. tobacco, diet, alcohol, and physical inactivity are already known, their interactions with comorbidities are important and clinical practice indicates that the chronic disease epidemic may be addressed more effectively using a holistic approach. However, this approach has not yet been implemented in disease surveillance activities as data collection is still disease specific. Data collection is still one disease at a time, without connecting our disease surveillance efforts to get better, more complete and encompassing data. Health inequities result in lower quality of healthcare, worse healthcare outcomes for minority racial/ ethnic populations and people with low socioeconomic status, increased direct and indirect healthcare costs, and decreased productivity.

Objective

Utilize existing data sets and data sources to address health equity and improve the management of chronic disease

Since 2009, Houston Health Department (HHD) uses an electronic disease surveillance system (Maven) to receive ELRs from reporting facilities in the Houston jurisdiction. Currently, two large hospital systems, a blood bank, two large commercial labs, and two public health labs are sending ELRs to Maven. The overall percentage of disease reports received via ELR was over 50%. We hypothesize that the implementation of ELR has improved the timeliness and completeness of disease surveillance.

Objective

Review 5 years of surveillance data post electronic lab reporting (ELR) implementation and 8 years of data prior to ELR, to evaluate timeliness and completeness of disease surveillance.

The widespread adoption of Electronic Health Records and the formation of Health Information Exchanges has opened up new possibilities for public health monitoring. Since 2009, The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) has been developing two public health surveillance systems for chronic diseases. The first is the NYC Macroscope, which is built on a distributed query network (the Hub) of 740 New York City ambulatory practices all using proprietary software from one EHR vendor (eClinicalWorks). The second model, Query Health, still in its initial phase, accesses data collected by Healthix, the largest NYC HIE. This study compares these two models for potential disease surveillance and public health application.

Objective

To compare two clinical surveillance systems in development in New York City, one built on a distributed query network of electronic health records (EHRs) and the other accessing data from a Health Information Exchange (HIE).

Improving surveillance and response is a critical component of the Global Health Security Agenda. While it is impossible to predict where the next Ebola outbreak will occur, it is very likely that another outbreak will occur in the DRC. Of the 20 known outbreaks, 7 have occurred in the DRC, one as recently as 2014. To rapidly detect and respond to an Ebola outbreak, we sought to develop a real-time surveillance and response system for use in DRC and similar settings. RTI International developed Coconut Surveillance mobile software, which is currently used for real-time malaria surveillance and response in Zanzibar, Africa, where malaria elimination efforts are underway. We took this system and adapted it for Ebola as a possible tool for surveillance and response to Ebola and other (re)emerging diseases. Plans include pilot testing functionality at clinical sites in DRC, where surveillance infrastructure is limited at the local level. Coconut Surveillance is a mobile disease surveillance and rapid response system currently used for malaria elimination activities. It receives suspected positive case alerts from the field via mobile phones and uses mobile software to guide surveillance officers through a follow-up process. Coconut Surveillance runs on Android mobile devices that are used to coordinate work in the field as well as provide decision support during data collection and case management. In addition to standard case information, the GPS coordinates of the case’s household are captured as well as malaria status of all household members. Data are collected and accessed off-line, and are synchronized with a shared database when Internet connectivity is available. This tool has been used successfully in Zanzibar for more than three years and has been recognized as one of the most advanced applications of its kind.

Objective

We will describe a real-time mobile surveillance and case management system designed to organize data collected by multiple officers about cases and their contacts. We will discuss this surveillance system and its application for Ebola and other infectious diseases in the Democratic Republic of the Congo (DRC) and other similar settings. We will review the technology, results, challenges, lessons-learned, and applicability to other contexts.

Stillbirth remained a neglected issue absent from mention in Millennium Development Goals. An estimated 2.6 million babies are stillborn every year with highest rate in Pakistan, 43.1 stillbirths/1000 births. There is lack of good quality prospective population based data in Pakistan regarding burden, timing and causes of stillbirths.

Objective

To determine burden, timing and causes of stillbirths in a prospective cohort of pregnant from a low income community setting in peri urban Karachi

In the Kingdom of Swaziland, a baseline assessment found that multiple functional units within the Ministry of Health (MoH) perform PHS activities. There is limited data sharing and coordination between units; roles and responsibilities are unclear. The Epidemiology and Disease Control Unit (EDCU) is mandated to coordinate efforts and strengthen PHS through implementing Integrated Disease Surveillance and Response (IDSR) to fulfill requirements of International Health Regulations (2005) (IHR[2005]), and the Global Health Security Agenda (GHSA).

Objective

To enable coordination of Swaziland Ministry of Health units for public health surveillance (PHS).

School-based influenza surveillance has been considered for real-time monitoring of influenza, as children 5-17 years old play an important role in community-level transmission.

Objective

To determine if all-cause and cause-specific school absences improve predictions of virologically confirmed influenza in the community.

Poliomyelitis a disease targeted for eradication since 1988 still pose public health challenge. The Eastern Mediterranean and African Regions out of the six World Health Organization (WHO) Regions are yet to be certified polio free. The certification of the WHO Africa region is largely dependent on Nigeria, while the WHO Eastern Mediterranean is dependent on Pakistan and Afghanistan. Surveillance for acute flaccid paralysis (AFP) is one of the critical elements of the polio eradication initiative. It provides the needed information to alert health managers and clinician to timely initiate actions to interrupt transmission of the polio disease and evidence for the absence of the wild polio virus. One of the core assignments of the certification committee in all regions is to review documentation to verify the absence of wild poliovirus. Good and complete documentation is the proxy indication of the quality of the system while poor documentation translates to possibilities of missing wild poliovirus in the past. We evaluated the performance of the AFP surveillance system in Bauchi, which is among the 11 high risks states for wild polio virus in Nigeria to identify and address gaps in the surveillance system.

Objective

To identify and address gaps in acute flaccid surveillance for polio eradication in Buchi state

Despite the significance of disease reporting to any health system, Grenada like most countries struggle with underreporting of notifiable diseases by physicians. In order to improve the national disease surveillance system in Grenada, it is critical understand the reasons for any underreporting. The study was conducted to determine physicians’ knowledge of notifiable reporting and to identify the barriers to reporting.

Objective

The study was carried out to determine physicians’ knowledge of notifiable reporting and to identify the barriers to reporting in Grenada