CHAPTER - 3 INTEGRATED DISEASE SURVEILLANCE...

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CHAPTER - 3

INTEGRATED DISEASE SURVEILLANCE PROJECT

126

Outline of the Chapter Page no

1 The Geographic information of the state 129

2 Socio – demographic information of the state 130

3 Introduction of IDSP (Integrated Disease Surveillance

Project) in Gujarat.

133

3.1 Background, 133

3.2 Specific Objectives of IDSP Project 134

3.3 Overview of IDSP Project in Gujarat 134

4 Organization Structure of IDSP in state 136

4.1 State Surveillance Unit 136

4.2 District Surveillance Unit 140

4.3 Municipal Corporation and Medical Colleges 143

4.4 Private Sectors 143

4.5 IDSP Sub Committee 143

4.6 Reporting 143

4.7 Status of Contractual staff under IDSP 145

4.8 Status of Training of Medical and Paramedical staff

under IDSP

145

4.8.1 Training Programmes Completed in Previous years 145

4.8.2 Training completed during Financial Year 2011-12 146

4.9 Annual Action plan 147

5 Disease Surveillance Under IDSP 147

5.1 Definition and Overview 147

5.2 Importance of disease surveillance 148

CHAPTER :3

INTEGRATED DISEASE SURVEILLANCE PROJECT

127

5.3 Steps of disease surveillance 150

5.4 Indicators and Vision 152

5.5 Strategies for Surveillance 153

5.6 Urban Surveillance 154

6 Integration of various programme of IDSP 154

6.1 Why integration? 154

6.2 Integration with NRHM programme 154

6.3 Integration with NVBDCP programme 155

6.4 Integration with other programme 155

7 District wise Reporting Units 156

8 State Referral Network Plan 158

9 Achievement 174

10 Conclusion 176

128

Government of India launched Integrated Diseases Surveillance Project

on 4ty November 2004, with a view to establish a decentralize state based

system of surveillance for communicable and non-communicablediseases

and to improve the efficiency of existing surveillance system of diseases

control programme. Gujarat was included in phase 2 of IDSP and it was

launched in Gujarat on 8th November 2005. Evident from the weekly

surveillance data collected, complied and analyzed under IDSP shows

that the mortality and morbidity due to communicable disease have

drastically reduced in Gujarat state over last few years.

Hence in the present chapter, the researcher has tried to provide

information about Gujarat state and Integrated Diseases Surveillance

Project. Information about IDSP in Gujarat has been provided about its

objectives, organization structure, diseases surveillance and other

important aspects.

129

1. The Geographic Information of the State:

Gujarat is one of the leading states in India which is the northern-most

maritime state on the west Coast of India, situated between 20.1

degree to 24.7 degree North Latitude and between 68.4 to 74.4 degree

East Longitude. The area of State is 1,95,984 Sq.Kms. The 1600

Kms. Long coastline of Gujarat extends from Kutchh in North West to

Saurashtra and South Gujarat regions.

Map 3.1

MAP OF GUJARAT

The present political province of Gujarat is bounded by Arabian Sea

[West], Pakistan [North and North West], State of Rajasthan [North

East],State of Madhya Pradesh [East] and Maharashtra [South and South

East] as per the political province of Gujarat. On the Southern coast of

Saurashtra, there is a Div island. On the coast of South Gujarat, we have

Daman and while Dadra Nagar Haveli are on the Maharashtra border.

These are centrally administered Union Territories. The North-eastern

boarder of Gujarat is covered by mountain ranges in Banaskantha and

130

Sabarkantha district. Kutch and Saurashtra regions are largely dry and

warm. A large area of Kutch as very difficult areas covered by desert

land.

The climate in Gujarat ranges from humid in the coastal regions to

extreme in the interiors. Summers get extremely hot and winters cold in

areas like the desert of Kutch The coastal regions and the eastern belt of

Gujarat experience a mild pleasant climate with moderate rainfall during

the monsoons. Eastern part of State has green as well as hilly area with

average to heavy rainfall.

2. Socio-demographic information of the State

In year 2011 the population of Gujarat is 6, 03, 83, 628 which is 19.17 %

rise in decade (Provision). The State of Gujarat has total population of

506 lacs (2001 census), out of this, around 52 % is represented by male

and 48 % by female. There are total 317.4 lacs people (62.6 %)

representing from rural regions compared to only 189.3 lacs (37.3 %)

from urban. The overall literacy rate is 69.1 % in which male constitutes

79.6 % and female 57.8 %. The female belonging to rural regions have

significantly less literacy rate (47.8 % ) then those belonging to urban

regions (74.5%) Similar difference was found in case of male. There are

total 26 districts in Gujarat having 226 talukas out of those, around 43

talukas are tribal.

Table 3.1

Population Detail (2001) In lacs

Total 506.71

Male 263.86 52.07%

Female 242.85 47.93%

Rural 317.41 62.64%

Urban 189.30 37.36%

Table 3.1 Contd….

131

Table 3.1 Contd….

SC Population

Total 35.92 7.08%

Male 18.66 3.68%

Female 17.26 3.41%

ST Population

Total 74.81 17.76%

Male 37.90 7.47%

Female 36.91 7.28%

Source : Annual report of IDSP ( Integrated Disease Surveillance

Project ) 2011.

Table 3.2

District wise population in Gujarat State 2011.

Sr.

No.

District Name Total Rural Urban Percentage

Decadal

Growth

1 Ahmadabad 7208200 1149436 6058764 22.31

2 Amreli 1513614 1127808 385806 8.59

3 Anand 2090279 1456483 633793 12.57

4 Banaskanthha 3116045 2702668 413377 24.43

5 Bharuch 1550822 1022413 528409 13.14

6 Bhavnagar 2877961 1697808 1180153 16.53

7 Dahod 2126558 1935463 191095 29.95

8 Dangs 226769 202074 24695 21.44

9 Gandhinagar 1387478 787949 599529 12.15

10 Jamnagar 2159130 1188485 970645 13.38

11 Junagadh 2742291 1836049 906242 12.01

Table 3.2 Contd…..

132

Table 3.2 Contd…..

Sr.

No.

District Name Total Rural Urban Percentage

Decadal

Growth

12 Kachchh 2090313 1364472 725841 32.03

13 Kheda 2298934 1775716 523218 12.81

14 Mehsana 2027727 1513656 514071 9.91

15 Narmada 590379 528765 61614 14.77

16 Navsari 1330711 921599 409112 8.24

17 Panchmahal 2388267 2053832 334435 17.92

18 Patan 13427416 1061713 281033 13.53

19 Porbandar 586062 300236 285826 9.17

20 Rajkot 3799770 1591188 2208582 19.87

21 Sabarkanthha 2427346 2064318 363028 16.56

22 Surat 6079231 1235509 4843722 42.19

23 Surendranagar 1755873 1258880 496993 15.89

24 Vadodara 4157568 2097791 2059777 14.16

25 Valsad 1703068 1068993 634075 20.74

26 Tapi 806489 727513 78976 12.07

Total 60383628 34670817 25712811 19.17


Project ) 2011.

133

Table 3.3

Literary Rate in State 2011.

Effective Literacy Rate-Total

Total 79.31%

Male 87.23%

Female 70.73%

Effective Literacy Rate-Rural

Total 73.00%

Male 83.10%

Female 62.41%

Effective Literacy Rate-Urban

Total 87.58%

Male 92.44%

Female 82.08%

Source : Annual report of IDSP(Integrated Disease Surveillance Project )

2011.

3. Introduction of IDSP (Integrated Disease Surveillance Project) in

Gujarat State

3.1 Background : -

During Plague outbreak in 1994, with huge morbidity and mortality,

the country sustained huge economic losses. Disease Surveillance was

also not able to detect early warning and response was also not as per

requirement to reduce the magnitude of the outbreak. Plague outbreak

had shown the need to establish a dedicated disease surveillance

system that has been also recommended by high power

committee.1977 National Surveillance Programme for Communicable

Diseases (NSPCD) piloted and Gujarat State also involved in this pilot

project.

134

3.2 Specific Objectives of IDSP Project :-

To integrateand decentralize surveillance activities.

To establish systems for data collection, reporting, analysis and

feedback using information technology.

To improve laboratory support for disease surveillance.

To develop Human resources for disease surveillance and action.

To involve all stakeholders including private sector, corporate sector

and communities in surveillance.

General objectives of the project is to establish a decentralize state based

system of surveillance for communicable and non communicable

diseases, so that timely and effective public health actions can be initiated

in response to health challenges in the country at state and nation level

and to improve the efficiency of existing surveillance system of disease

control programme and facilities sharing of relevant information with the

health administration, community and other stakeholders so as to detect

disease trends over time and evaluate control strategies.

3.3 Overview of IDSP Project in Gujarat State

The integrated disease surveillance (IDS) system which was initiated in

Kutch district after the earthquake was later expanded to cover entire

state. Government of India launched Integrated Diseases Surveillance

Project on 4th November 2004. The Gujarat State is front runner in

implementation of IDSP. State has successfully developed web based

weekly surveillance system capable of forecasting an epidemic. Analysis

of weekly surveillance data on regular basis, providing feedback to

reporting units and early actions by reporting units has lead containment

of diseases ultimately reducing mortality and morbidity. Before the IDSP

was established, the disease surveillance data was being collected on

monthly basis thus, there was no system of ongoing surveillance in the

state and because of that the system of early warning signal did not exist.

135

The Government of India initiated a decentralized State based Integrated

Disease Surveillance Project (IDSP) in the country in year 2004-05 in

response to a long felt need expressed by various expert committees.

IDSP (Phase 1) was launched by Govt. of India in Nov 2004. Gujarat

state was included in phase 2 of the project and IDSP was launched in

Gujarat on 8th Nov 2005. The project would be able to detect early

warning signals of impending outbreaks and help initiate an effected

response in a timely manner. It is also expected to provide essential data

to monitor progress of ongoing disease control programs and help

allocate health resources more optimally.

The mortality and morbidity due to communicable diseases have

drastically reduced in Gujarat state over last few years. This is evident

from the weekly surveillance data collected, compiled and analyzed under

Integrated Disease Surveillance Project Implemented in the state since

year 2003

Table 3.4

Phasing of IDSP

Phase 1 (2004-05) Phase 2 (2005-06) Phase 3 (2006-07)

Andhra Pradesh Chhattisgarh Uttar Pradesh

Himachal Pradesh Goa Bihar

Karnataka Gujarat Jammu and Kashmir

Madhya Pradesh Haryana Jharkhand

Maharashtra Rajasthan Punjab

Uttaranchal West Bengal Arunachal Pradesh

Tamil Nadu Manipur Assam

Mizoram Meghalaya Sikkim

Kerala Orissa AandN Nicobar

Table 3.4 Contd….

136

Table 3.4 Contd….

Phase 1 (2004-05) Phase 2 (2005-06) Phase 3 (2006-07)

9 States Tripura DandN Haveli

Chandigarh Daman and Diu

Pondicherry Lakshadweep

Delhi 12 States/UTs

Nagaland

14 States/UTs

Source : Annual report of IDSP ( Integrated Disease Surveillance Project)

2011.

4. Organization Structure of IDSP in State

4.1 State Surveillance Unit

Active and passive surveillance is done by grass root functionaries and

health facilities. No additional structure is created for surveillance system

except few support persons at the district and state level.

Secretary (Public Health) is overall in charge at the apex level.

Commissioner (Health, Medical Services and Medical Education) guide

and supervise surveillance activities at the state level. State Nodal Officer

is designated as State Surveillance Officer IDSP. State Nodal Officer is

designated by the State Government, a regular dedicated Govt. Officer

appointed for this post. State Surveillance Unit is headed by State Nodal

Officer and located at new location, Government Dispensary, Sector 3 A

New Gandhinagar, under commissionerate of Health. State Nodal Officer

is overall in charge of surveillance activities that monitors technical,

administrative and financial activities of the project. He is assisted by

contractual staff such as Epidemiologist (1) Entomologist [1] Consultant

–Training [1] Consultant –Finance [1] Data Manager [1] Data Entry

137

Operator (2) Administrative Assistant [1] and Helper (Administrative

assistant and Helper recruited through (NRHM).

State Nodal officer is responsible for all activities and finance, State

Surveillance officer, Epidemiologist and Medical Officer assists the State

Nodal Officer to monitor the IDSP activities. The Data Manager is

responsible to compile and manage data along with alert generation, The

Data entry is managed by 2 DEOs. One Administrative Asst. and One

Helper handles the clerical and administrative issues. Consultant Finance

has to manage work of Finance. Consultant Training will be recruited

soon. The functions of the State Surveillance unit includes:

Collation and analysis of data received from district and

transmitting to Central Surveillance Unit through website.

Coordinating activities of rapid response teams and deputing them

to the field.

Monitoring and reviewing the activities of the district surveillance

units including checks on validity of data, responsiveness and

functioning of the laboratories.

Coordinating the activities of the state public health laboratories,

medical colleges and other state level institutions.

Sending regular feedback to the district units on the trend analysis

of data in the form of alert as well as feedback letter.

Coordinating all training activities under the project.

Organizing meeting of the State IDSP subcommittee.

Develop State specific technical guidelines and technical support to

district and corporations.

138

Chart 3.1

Organgram of SSU, Gujarat


2012.

Secretory ( Public Health )

Commissioner ( Health )

MD NRHM

Additional Director ( Health )

State Surveillance Unit

State Nodal Officer ( IDSP ) and State Surveillance Officer

Conultant

Finance-1

Entomo

Logist

Epidemio

Logist-1

Consultant

Training-1

Micro

Biologist

Medical

Officer

Admin. Assit.

Data Manager

Data EntryOperator Data EntryOperator

Helper

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Table 3.5

Integrated Diseases Surveillance Project

Staff Positions SSU Gandhinagar as on 20th March 2012 Sr.

No

Name Designa

tion

Address Telephone/Fax

Number

Mobile No.

1 Dr.V.S.Dhr

uwey

State

Nodal

Officer

Sec-3/A, New Govt.

Dispensary,

Gandhinagar.IDSP.

079-23237376 9099024729

2 Dr.S.I.Patel Medical

Officer

Sec-3/A, New Govt.

Dispensary,

Gandhinagar.IDSP.

079-23236365 9824029647

3 Dr.Swaroop

Purani

Epidem-

ologist

Sec-3/A, New Govt.

Dispensary,

Gandhinagar.IDSP.

079-23236365 9375799186

4 Mr.P.T.Jos

hi

Entomo-

logist

Sec-3/A, New Govt.

Dispensary,

Gandhinagar.IDSP.

079-23236365 9428814457

5 Vaishali

Mandiwala

Conslun

-tant

(fin)

Sec-3/A, New Govt.

Dispensary,

Gandhinagar.IDSP.

079-23236365 9228243838

6 Mr.R.C.

Mochi

TB

Supervis

or

Sec-3/A, New Govt.

Dispensary,

Gandhinagar.IDSP.

079-23236365 9978927984

7 Mr. Ashok

Chauhan

Admin

Assistan

t

Sec-3/A, New Govt.

Dispensary,

Gandhinagar.IDSP.

079-23236365 9904280813

8 Er. Amit

Rami

Data

Manager

Sec-3/A, New Govt.

Dispensary,

Gandhinagar.IDSP.

079-23236365 9429319493

Table 3.5 Contd….

140

Table 3.5 Contd….

Sr.

No

Name Designa

tion

Address Telephone/Fax

Number

Mobile No.

9 Jyotsana

Dave

DEO Sec-3/A, New Govt.

Dispensary,

Gandhinagar.IDSP.

079-23236365 9904855766

10 Mr.Ashwin

Chaudhary

DEO Sec-3/A, New Govt.

Dispensary,

Gandhinagar.IDSP.

079-23236365 9723556432

11 Mr.Banesin

h Vaghela

Driver Sec-3/A, New Govt.

Dispensary,

Gandhinagar.IDSP.

079-23236365 9924824180

12 Mr.Jayesh

Parmar

Helper Sec-3/A, New Govt.

Dispensary,

Gandhinagar.IDSP.

079-23236365 9033362005


2012.

4.2 District Surveillance Unit

District Surveillance Units has been establish in all 26 districts. Chief

District Health Officer, who is head of health branch, is designated as

District Nodal Officer IDSP at the district level. Epidemic Medical

Officer working under direct guidance and supervision of chief District

Health Officer, is designated as District Surveillance Officer. He is

assisted by Data Manager and Date Entry Operator Finance is looked

after by Finance Assistant of NRHM. Epidemiologist is deployed, at

Bhavnagar district only.

Epidemic Medical Officer is the District Surveillance Officer. Data Entry

is done by the existing DEOs dealing with disease surveillance activities.

The data compilation, analysis, alert generation and feedback has been

done by data manager who is also responsible for management of IDSP

141

portal in regards to district level data including Urban and Corporation

area.

The functions of the district surveillance unit.

Collation and analysis of data received from districts and transmitting

to State Surveillance Unit.

To constitute rapid response teams and deputing them to the field

whenever needed.

Implementation and monitoring of all project activities in District

including Corporation and Urban area.

Coordinating with public health laboratories medical colleges,

NGOs and private sectors within the District.

Sending regular feedback to the reporting units on analysis of data.

Coordinating training and IES activities within the district.

Organizing meeting of the district IDSP subcommittee.

142

Chart 3.2

Organ Gram Of DSU


2012.

District Surveillance Unit

District Nodal Officer (CDHO)

District Surveillance Officer (EMO)

Epidemiologist(1)

Data Manager (1)

Data Manager (1)

Data Entry Operator (1)

Medical College Hospitals, Municipal Corporation`s Hospital, Sub-

District Hospital, CHCs, PHCs, S.C, Pvt. Hospitals and Laboratories.

143

4.3 Municipal Corporation and Medical Colleges

Seven Municipal Corporation (Ahmadabad, Vadodara, Surat, Bhavnagar,

Jamnagar, Junagadh and Rajkot) each having population of more than 5

lacs also carry out surveillance activities through urban health centers and

private hospitals and report directly to District surveillance Officer of the

same district.

Six Govt. Medical Colleges and Two Municipal Medical Colleges also

carry out surveillance activities. Data are collected from OPD and Wards

and submitted to district surveillance Officer of the same district.

4.4 Private Sectors

105 Private reporting units are submitting weekly surveillance report.

Orientation has been given to administrators and in-charge doctors of

Grant-in-aid hospitals are in plan during the year 2011 to increase the

number of reporting units. The SSU has planned to arrange workshops for

member of Indian medical association and private laboratories in year

2011.

4.5 IDSP Sub Committee

The state IDSP subcommittee is a part of state health society. The district

subcommittee is responsible for the regular running of the program at the

district level. The district IDSP sub committee is chaired by the Chief

District Health Officer.

4.6 Reporting

Reporting formats developed by central surveillance unit had been

continued in September 2009. The reporting formats “S”, “P”, and “L” as

prescribed by Govt. of India have been reproduced in sufficient quantity

and supplied to reporting units. After September, new P format was

introduced by the CSU, the data entry in new format was started to

perform immediately after its launch throughout the state.

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Table 3.6

Status on availability of human resource as on 31st December 2012.

No. Category Sanctioned Filled

up

Remarks

1 State Surveillance

Officer

- 1 RegularOfficer Additionally

Designated

2 State Nodal Officer - 1 Regular Officer Additionally

Designated

3 District Nodal Officer

(CDHO)

- 26 Chief District Health Officer

additionally designated

4 District Surveillance

Officer (DSO)

- 26 Epidemic Medical Officer

additionally designated

5 Medical Officer at State 2 (State) 2 At SSu

6 Consultant training 1 0 Contractual

7 Consultant Finance 1 1 Contractual

8 Epidemiologist 26 ( 1 at State) 4 Contractual

9 Entomologist 1 1 Contractual

10 Microbiologist 3 0 Contractual

11 Data Manager State level 1

District level

25

1

25

Contractual

Contractual

12 Data Entry Operator State level 2

District level 25

Medical college 7

2

21

6

Contractual

Contractual

Contractual


2012.

There are total 7214 S reporting units (syndromes surveillance), around

1780 P reporting units (surveillance based on presumptive diagnosis) and

1667 L reporting units (based on laboratory diagnosis) throughout the

state. This has included district and sub district hospitals, CHCs, PHCs,

145

SC and private hospitals and laboratories. Active surveillance is carried

out by Health Workers (Male and Female) in both urban and rural areas

who collect the surveillance data at grass-root functionaries.

4.7 Status of Contractual Staff under IDSP

A few contractual posts have been sanctioned in State and District

Surveillance Units under Integrated Disease Surveillance Project. Posts of

microbiology in 20 Districts have been sanctioned in district hospitals in

Govt. setup. Including two posts of microbiology at priority labs

Mahesana and Himmatnagar. One post at SSU sanctioned in project but

vacant. Recruitment of microbiologists and Epidemiologists are now

being done by State as GOI has decentralized the powers from 1st July

2010 to the State.

4.8 Status of Training of Medical and Paramedical Staff under IDSP

4.8.1 Training Programs Completed in Previous years

Training of RRT: Training of around 94 Members of State and District

Rapid Response Team is completed at Delhi and Pune.

FETP (Field Epidemiological Training Program): The training is

completed for batch-one during May 05, 2008 to May 17, 2008 in

Chandigarh. The DSOs were represented from Sabarkantha, Ahmedabad,

Amreli and Bhavnagar districts. The second batch trained during June 02,

2008 to June 14, 2008 in Chandigarh. The DSOs were represented from

Gandhinagar, Vadodara, Surat, Navsari, Valsad, Patan and Kheda

districts. The third batch, consisting the DSOs from Bharuch, Narmada,

Jamnagar, Dahod, Kutch, Tapi, Medical Officer Epidemic branch,

Gandhinagar; was trained during December 08, 2008 to December 12,

2008 in Chandigarh.

146

4.8.2 Training Completed during Financial Year 2011-12

1. Training of Medical and paramedical staffs of Medical Colleges,

District hospitals and CHC have been completed.

2. Training of all Medical, Ayahs and paramedical staff who never

trained before under IDSP have completed under IDSP.

3. BHO and Mande training as block health team to develop analytical

skill at block level also completed.

4. FETP training for 18 officers of District and Corporation has been

planned at B. J. Medical College in same financial year.

Table : 3.7

Training status as on 31st December 2012 No Category Training

Days

Training

Load

Train

ed

Percent

age

1 Members of Rapid Response

Team

6 Days 105 94 95%

2 Block Health Officer 3 Days 179 171 96%

3 Medical Officer 3 Days 2117 1984 93%

4 Paramedical supervisor and

workers

2 Days 12311 12017 98%

5 Laboratory Technicians-DPHL 6 Days 54 51 94%

6 Laboratory Technicians-(CHC-

PHC)

3 Days 1003 988 99%

7 Medical College Doctors 2 Days 244 234 95.9%

8 Paramedical Staff of Medical

College Hospital

2 Days 320 320 100%

9 Hospital Doctors 2 Days 433 365 84.29%

10 Hospital Paramedical Staff 2 Days 1867 1309 70.1%

11 Block Health Team 1 Days 176 162 92%

12 DM and DEO 2 Days 60 60 100%


Project ) 2012.

147

4.9 Annual Action Plan

Integrated Disease Surveillance Project- Annul Action Plan for year

2013-14 had been prepared and submitted to ministry of Health and

Family Welfare, Government of India as a part of NRHM action plan

after approval by governing body of state health mission. Amount of

Rs.357.46 Laces through W.B. and 224.89 Laces as NRHM additionally

has been proposed for year 2013-14.

5. Disease Surveillance under IDSP

5.1 Definition and Overview

Surveillance is defined as “the ongoing systematic collection, collation,

analysis and interpretation of data; and the dissemination of information

to those who need to know in order that action may be taken”

Detecting disease and its distribution in time and space offers clues to the

silent background phenomena of amplification and transmission of

infectious agents. Surveillance is the first step in intervention and disease

control which serves to direct early outbreaks of diseases. Surveillance is

also essential for the early detection of emerging (new) and reemerging

(resurgent) diseases. Emerging infectious diseases encompass those

diseases which are caused by new pathogens (e.g. HIV/AIDS, V. cholera

O139, Hanta virus, Ebola virus, and recently Influenza A (H1N1)). The

reemerging diseases are those which are mainly due to the reappearance

of pathogens previously under controlled (e.g. Yesinia pests). The

diseases with increasing in incidence/prevalence (e.g. malaria

leptospirosis) are also included in the surveillance. The other categories

of disease those need routine surveillance such as recognized diseases

which are appearing in new territories ( e.g. Dengue Hemorrhagic Fever),

Zoon tic diseases affecting humans (e.g. anthrax), and diseases due to

pathogens showing newly acquired anti-microbiological resistance (e.g.

typhoid fever).

148

Community: Represented by basic village–level services such as trained

birth attendants, village leaders, school teachers, and village health

workers or similar care providers.

Health Facility : Defined by each country. For example, for surveillance

purpose, all institutions with outpatient and in-patient facilities are

defined as a “health facility”

5.2 Importance of disease surveillance

Communicable diseases are the most common causes of death, disability

and illness in any region. While these diseases present a large threat to the

well being of communities, there are well known interventions that are

available for controlling and preventing them.

1. Surveillance data can guide health personnel in the decision making

needed to implement the proper strategies for disease control and lead

to activities for preventing future cases.

2. Surveillance is a watchful, vigilant approach to information gathering

that serves to improve or maintain the health of the population. A

functional disease surveillance system is essential for defining

problems and taking action. Using epidemiological methods in the

service of surveillance equips district and local health staff to set

priorities, plan interventions, mobilize and allocate resources and

predict or provide early detection of out breaks.

3. Surveillance is basically collecting the critical data about disease

conditions so that action can be taken. Action may be in the form of

improvement of services when gaps are identified or in the from of out

breaks response when an out breaks is detected. The key output of a

good surveillance system is the early detection of out breaks.

4. Depending on the goal of the disease prevention program, the

surveillance activity objectives guides program managers towards

149

electing data that would be the most useful to collect and use for

making evidenced based decisions for public health actions.

5. A disease control program may want to know what progress is being

made with its prevention activities. The program collects the data of

various diseases including age, sex, and different time periods. If the

program‘s goal is to prevent out breaks, the surveillance unit can

monitor the epidemiology of a particular disease so that the program

can more accurately identify where the next cases might occur or the

populations at highest risk. In addition, improving laboratory support

for disease surveillance is essential for confirming causes of illness

and early detection outbreaks.

6. Investigation and laboratory confirming provide the most precise

information about where action must be taken to achieve an

elimination target. Monitoring populations at highest risk for a

particular disease can help to predict future outbreaks and focus

prevention activities in the areas where they are most needed. Too

often, however, surveillance data for communicable disease is neither

reported nor analyzed. As a result, the opportunity to take action with

an appropriate public health response and save lives is lost. Even in

cases where adequate information is collected, it is often not available

for use at the local level.

The outbreaks of plague in 1994, cholera in 1995 and dengue

hemorrhagic in 1996 highlighted the urgent need for disease

surveillance system so that early warning signals are recognized and

appropriate control measures are initiated in a timely manner. The

importance of surveillance can be understood with the more recent

example of pandemic Influenza A (H1N1) where routine surveillance

has been playing crucial role to curb this health problem.

150

5.3 Steps of disease Surveillance

These guidelines assume that all levels of the health system are involved

in conducting surveillance activities for detecting and responding to

priority diseases and conditions and include the following:

1. Identify cases: Using basic, standard case definition, Identify priority

diseases and conditions.

2. Report: suspected cases or conditions to the next level. If this is an

epidemic prone disease, or a disease targeted for control, elimination

or eradication, investigate and respond immediately.

3. Analyze and interpret ate data: Compile the data, and analyze it for

trends. Compare information with previous periods and summarize the

results.

4. Investigate and confirm suspected cases and out breaks: Take action to

ensure that the case or out breaks is confirmed including laboratory

confirmation wherever it is feasible. Gather evidence about what may

have caused the out breaks and use it to select appropriate control and

prevention strategies.

5. Respond: Mobilize resources and personnel to implement the

appropriate out break or public health response.

6. Provide feedback: Encourage future cooperation by communicating

with levels that reported outbreaks and cases about the investigation

outcome and success of response efforts.

7. Evaluate and improve the system: Assess the effectiveness of the

surveillance system in terms of timeliness, quality of information,

preparedness, thresholds, case management and overall performance.

Take action to correct problems and make improvements. There is a

role for each surveillance functions at each level of the health system.

The levels are defined as follows:

151

Types of Surveillance in IDSP as per new systemunder GOI`s new

Surveillance system. Depending upon level of expertise and specificity

surveillance in IDSP are following three categories:

Chart 3.3

Disease Surveillance


2012.

Chart 3.4

A dynamic Vision of Surveillance

Make Collect and Transmit

Decision Data

Feedback Analyze

Information Data


Project ) 2012.

On the basis of Provisional DiagnosisDone by MO

on the basis of Laboratory confirmation

on the basis of symptomsClinical patterns done byHealth worker

Presumptive Confirmed Syndromic

Passive Passive Active Surveillance

P – from L – from S – From

Step 2 Step 1

Step 4 Step 3

All levels use

information to

make decisions

152

5.4 Indicators and Vision:

To establish state based a comprehensive surveillance information

system covering public and private hospitals.

To build capacities to analyze and use surveillance information at all

levels to identify communicable disease out breaks early.

Ensure that all out breaks will have high quality investigation by

multi-specialty aroid response teams supported by laboratory

confirmation.

Deployment of epidemiologist at all 26 districts.

Ensure functional IT systems and on-line data entry and analysis.

District supported by a well performing laboratory with EQAS and

State Referral Lab. Network.

Training of Municipal Corporation staff to strengthen Urban

Surveillance .

Training of BHOs for data analysis.

Table 3.8 : Indicators

Component Indicators for each component

Surveillance

Prepareness

80 % of districts should have full time

epidemiologist.

80 % of with fully it system and online data entry

and use of toll free no 1075.

50 % Develop priority labs and referral labs at

least.

Out break

investigation and

response

50 % referral labs maintain EQAS atanderds.

50 % Out break detection by system with in week.

80 % Out break/rumor must be verified.

50 % of Out break sample should reach lab.

Table No. 3.8 Contd…

153


Component Indicators for each component

Analysis and use

of data

50 % of Out break sample should reach lab.

80 % districts undertake weekly surveillance and

data analysis.

80 % district must provide feedback to sub unit

and policy makers.


Project ) 2012.

5.5 Strategies for Surveillance

1. Decentralization: Currently, the process of data entry is being

performed only at district and state level; however, in near future the

facility could be extend to the block level to make the process of

surveillance more accurate and simple.

2. Co-ordination: All the relevant agencies should have health

coordination to make the process of surveillance and outbreak

investigation more accurate.

3. Capacity building of the staff: Ongoing training and education is

necessaryto improve the quality of task performed by public health staff.

4. Rapid Response Teams at District and Peripheral Level: Ideal RRT

should be formed and active throughout the district to improve the quality

of outbreakinvestigation along with preventing and controlling measures.

5. Integration of all activities from grass root level (sub center) up to the

state is most important. Integration of private and public health programs,

integration of both communicable and non communicable diseases,

integration of both rural and urban health system and lastly integration of

both private and public medical colleges with IDSP is necessary.

154

6. Strengthening labs: Recently the referral lab network plan is in process

for approval.

7. Strong connectivity through use of IT and

8. Rated Disease Surveillance Programme.

5.6Urban Surveillance

Surveillance in urban areas is well established under Integrated Disease

Surveillance Project. State Government has sanctioned urban health

projects for 141 Municipalities and Towns. The contractual staff has been

appointed in these urban areas. Similarly six Municipal Corporations

have well established network of urban health centers. All these are

covered under surveillance; however, training of manpower working in

urban areas except Surat and Vadodara municipal corporation have

organized during the year 2011.

6. Integration of various programs of IDSP

6.1Why integration?

Integration of the various vertical programs information flow into a single

channel, currently, the same staff are reporting communicable diseases

like Malaria, TB, JE, Diarrhea, Hepatitis, Typhoid etc. in all different

formats. By integrating the flow of information, duplication can be

minimized and workload can be reduced. Integration of data from public

sector as well as private sector gives true picture of disease pattern in

community.

6.2Integration with NRHM program:

1. Involvement of ASHA in disease surveillance

2. Involvement of existing human resources under NRHM

3. Provision of Additional manpower for IDSP

4. Use of flexible funds to improve disease surveillance at all levels

5. Involvement of village Sanitation Committee to detect and control

outbreaks

155

6. Effective utilization of passive surveillance data

7. Monitoring and evaluation

6.3Integration with NVBDCP programm:

1. All acute fibril illness those can cause outbreaks are include in MF-11

and has been regularly sent to State/Districts IDSP/NVBDCP officials

2. District Malaria Officer sends copy of reports to DSO on routinely

bases

3. DSO also share IDSP data as well as weekly report with District

Malaria Officer on routine bases

4. District Malaria Officer is part of the district RRT

6.4Integration with other programs:

6.4.1 NACO

• Sentinel data regarding HBV, HCV, and HIV is shared with IDSP

• NACO BB lab facilities for confirmation of HBV, HCV is coordinated

with IDSP

6.4.2 RNTCP

• Consulting under RNTCP help for routine disease surveillance

• There is good coordination of work between QA Network under

RNTCP and IDSP QA

• Adoption of Public-Private partnership model

6.4.3 NPSP

• Consultants under NPSP can help IDSP for effective polio

surveillance .

156

7. District wise Reporting Units.

Table : 3.9

District wise Reporting Units District Name

Pvt. RU

B L O C k

CHC PHC Govt. Lab

Id Hospital

MC/G.H.H.C /CORPO

Pvt. Hospital

UHC Pvt. Lab

SC

Ahmedabad 6 7 10 36

2 1 38 6 57 6 240

Amreli 0 7 13 38 1 0 1 0 0 0 247 Anand 2 5 10 45 59 0 0 2 5 2 274 Banaskantha 2 10 16 77 2 0 0 2 0 0 424 Bharuch 0 6 7 38 0 0 0 0 0 0 200 Bhavnagar 9 7 14 44 2 0 16 1 9 1 320 Dahod 27 7 12 63 0 0 0 27 0 0 332 Dang 0 1 1 9 7 0 1 0 0 0 47 Gandhinagar 7 4 7 5 0 0 2 5 0 2 156 Jamnagar 4 7 12 36 0 0 13 4 0 4 265 Junagadh 0 10 15 57 72 0 0 0 0 0 390


157


District Name

Pvt. RU

B L O C k

CHC PHC Govt. Lab

Id Hospital

MC/G.H.H.C /CORPO

Pvt. Hospital

UHC Pvt. Lab

SC

Kutch 12 7 13 39 0 0 2 11 0 0 278 Kheda 2 10 11 50 63 0 2 2 0 2 332 Mehsana 6 8 11 50 0 5 1 6 0 0 288 Narmada 0 4 4 21 1 0 2 0 0 0 135 Navsari 2 5 10 36 0 0 2 2 0 2 281 Panchmahal 0 9 11 64 0 0 1 0 0 0 400 Patan 1 11 32 41 0 0 0 0 1 0 210 Porbandar 4 2 3 10 1 1 0 2 0 2 84 Rajkot 12 7 14 45 0 0 1 12 15 0 330 Sabarkantha 1 10 20 65 0 0 2 1 0 0 413 Surat 5 9 13 47 1 0 137 6 37 0 340 Surendranagar 0 7 12 31 0 0 4 0 6 0 200 Tapi 0 4 5 30 0 0 0 0 0 0 222 Vadodara 3 11 17 80 2 1 23 2 0 0 465 Valsad 0 5 9 40 0 0 3 0 0 0 331

Source : Annual report of IDSP ( Integrated Disease Surveillance Project ) 2012.

158

8. State Referral Network Plan

Integrated Disease Surveillance Project in Gujarat plans to strengthen the

public health laboratories in the state at various levels in phased manner

to provide diagnostic facilities for epidemic prone diseases. In the first

phase, referral lab network proposed to develop in 8 medical colleges.

The two priority district reference laboratories at district Hospital

Mahesana and Sabarkantha are identified. Strengthening of these priority

district reference laboratories have been completed; however

microbiologists are still not appointed on contract basis for these two

laboratories.

Table 3.10

Referral lab network in 2012

Sr.

No.

Name of Institution Govt./Mun.

Corp./Private

District linked

1 B.J. Medical College,

Ahmadabad

Govt. Ahmadabad Rural,

Mehsana, Sabarkanthha,

Banaskanthha,

Gandhinagar, Patan.

2 N.H.L Medical College

Ahmadabad

Muni.Corp. Ahmedabad Municipal

Corporation area, Kheda,

Anand

3 Govt. Medical College

Vadodara

Govt. Narmada, Vadodara

Municipal Corporation,

Panchmahal, Dahod,

Bharuch.


Surat

Govt. Surat Rural, Tapi,

Navsari, Valsad, Dangs


159


Sr.

No.

Name of Institution Govt./Mun.

Corp./Private

District linked


Rajkot

Govt. Rajkot Rural, Rajkot

Corporation Kutch,

Surendranagar


Bhavnagar

Govt. Bhavnagar Rural,

Bhavnagar Corporation,

Amreli, Junagadh,

Junagadh Corporation,


Jamnagar

Govt. Jamnagar Rural,

Jamnagar Corporation,

Porbandar

8 Surat Municipal

Corporation Medical

College(SMIMER)

Muni.Corp. Surat Municipal

Corporation Area

9 Civil Hospital

Mahesana

Govt. Mahesana District

10 Civil Hospital

Himmatnagar

Govt. Sabarkanthha District

Source :Annual report of IDSP ( Integrated Disease Surveillance Project )

2012.

To provide access to diagnostic facilities for epidemic prone diseases to

the remaining districts and to provide referral diagnostic services to the

state, functional laboratories at Govt. Medical colleges and private sector

has to identify and to link them to adjoining districts. In this regard,

following laboratories are identified as reference laboratories both from

Govt. sector as well as from Municipal Corporation. Referral Lab

160

Network plan has been implemented in Gujarat whenever RRT required

in concern district as per referral lab network plan attached medical

college send their rapid response team to the affected area.

Table 3.11

Test Performed under Referral lab network plan in 2012.

Sr.

No.

Name of the Disease Name of the test

1 Enteric Fever Typhus Dot Test

Blood Culture

2 Lepotspirosis Rapid Dot Test

3 Dengue IgM Elisa

4 Meningococcal Meningitis Rapid Latex Agglutination Test

5 Diphtheria Diphtheria Culture

6 Cholera Culture for Vibrio cholera

7 Viral Hepatitis A IgM Elisa

8 Viral Hepatitis E IgM Elisa

9 Measles IgM Elisa

10 Hepatitis B Anti HBc

Source : Annual report of IDSP (Integrated Disease Surveillance Project)

2012.

161

Table 3.12

Year wise Cases of Malaria P.F.in Gujarat Year 2008-2012

Sr No District 2008 2009 2010 2011 2012

1 Ahmadabad 59 23 9 39 59

2 Amreli 997 554 499 388 285

3 Anand 82 140 92 74 232

4 Banaskanthha 281 144 90 174 242

5 Bharuch 524 179 130 218 174

6 Bhavnagar 276 188 112 36 123

7 Dahod 421 435 1264 2584 2007

8 Dangs 22 25 21 21 23

9 Gandhinagar 171 80 126 133 107

10 Jamnagar 1722 526 276 442 318

11 Junagadh 664 533 262 238 165

12 Kachchh 1196 447 275 325 274

13 Kheda 161 102 47 69 166

14 Mehsana 178 113 52 35 67

15 Narmada 202 187 206 531 187

16 Navsari 427 324 394 629 626

17 Panchmahal 488 398 261 357 484

18 Patan 369 110 48 131 191

19 Porbandar 458 155 148 105 109

20 Rajkot 992 429 353 1080 808


162


Sr No District 2008 2009 2010 2011 2012

21 Sabarkanthha 675 376 137 121 255

22 Surat 733 391 533 483 309

23 Surendranagar 597 144 81 226 796

24 Tapi - - - 19 97

25 Vadodara 442 214 120 316 362

26 Valsad 204 221 149 550 1342

27 Ahmedabad MOH 2181 1358 1235 1772 3208

28 Bhavnagar MOH 202 139 162 90 146

29 Gandhinagar MOH - - - - 185

30 Jamnagar MOH 844 309 585 612 263

31 Junagadh MOH - - - - 65

32 Rajkot MOH 817 321 456 1484 831

33 Surat MOH 3528 4848 3875 7501 7069

34 Vadodara MOH 565 398 256 438 969

35 Total 20478 13811 12257 21221 22543


2012.

Table 3.12 shows that

1. During 2008 to 2012 the highest number of cases of Malaria P.F was

in Surat MOH.

2. The lowest number of cases of Malaria P.F in 2007, Dang, 2009-10 it

was in Ahmedabad and in 2011-12 it were again in Dang.

163

Table 3.13

Year wise Cases of Malaria P.V. in Gujarat Year 2008-2012

Sr No District 2008 2009 2010 2011 2012

1 Ahmadabad 502 360 322 401 647

2 Amreli 2443 2124 2283 1922 2374

3 Anand 695 962 1079 680 1311

4 Banaskanthha 4111 1413 875 2523 4679

5 Bharuch 1017 564 713 907 1326

6 Bhavnagar 982 1070 876 612 908

7 Dahod 1604 1167 2616 7051 8868

8 Dangs 302 54 25 274 389

9 Gandhinagar 550 529 548 641 1035

10 Jamnagar 4496 3380 2662 3476 3416

11 Junagadh 3225 2206 1967 2002 1940

12 Kachchh 2816 1724 2065 2962 3980

13 Kheda 508 307 276 389 932

14 Mehsana 910 702 500 608 975

15 Narmada 401 430 315 626 727

16 Navsari 524 411 768 1324 1867

17 Panchmahal 1583 1172 777 1166 2625

18 Patan 2295 979 687 1556 3257

19 Porbandar 677 483 508 587 822

20 Rajkot 2734 2438 1726 3010 5427

21 Sabarkanthha 2210 1496 537 501 1134

22 Surat 1119 961 1286 1997 2059

23 Surendranagar 3090 1628 1314 2177 3519


164


Sr No District 2008 2009 2010 2011 2012

24 Tapi 12 463

25 Vadodara 1404 1085 1092 1519 2002

26 Valsad 717 763 533 2285 4017

27 Ahmedabad MOH 2727 3628 3957 5034 8225

28 Bhavnagar MOH 100 104 152 174 387

29 Gandhinagar MOH 355

30 Jamnagar MOH 486 601 547 822 802

31 Junagadh MOH 82

32 Rajkot MOH 532 465 506 1170 1429

33 Surat MOH 4232 4943 10354 14593 14453

34 Vadodara MOH 776 911 829 1465 2747

35 Total 49768 39055 42694 64466 89179


2012.


1. During 2008 the highest number of cases of Malaria P.V was in

Jamanagar.

2. During 2009-2012 the highest number of cases of Malaria P.V was in

Surat MOH.

3. During 2008 the lowest number of cases of Malaria P.V was in

Bhavnagar.

4. During 2009-10 the lowest number of cases of Malaria P.V was in

Dang, and 2011-12 it was according to Tapi and Junagadh MOH.

165

Table 3.14

Year wise Cases of Cholera in Gujarat Year 2008-2012

Sr

No

District 2008 2009 2010 2011 2012

1 Ahmadabad 0 0 0 3 0

2 Amreli 0 0 0 0 0

3 Anand 0 0 9 2 4

4 Banaskanthha 0 0 0 0 0

5 Bharuch 0 0 20 0 0

6 Bhavnagar 0 0 0 0 1

7 Dahod 0 0 0 34 0

8 Dangs 0 0 0 0 1

9 Gandhinagar 0 0 0 3 0

10 Jamnagar 0 0 0 0 1

11 Junagadh 0 0 0 1 0

12 Kachchh 0 0 0 0 0

13 Kheda 0 2 24 8 4

14 Mehsana 0 0 0 0 0

15 Narmada 0 0 2 10 0

16 Navsari 0 0 0 12 0

17 Panchmahal 4 0 0 0 0

18 Patan 0 0 0 0 0

19 Porbandar 0 0 0 0 0

20 Rajkot 0 0 1 0 3


166


Sr

No

District 2008 2009 2010 2011 2012

21 Sabarkanthha 0 0 0 0 1

22 Surat 0 0 0 0 4

23 Surendranagar 0 0 0 1 0

24 Tapi 0 0 0 0 0

25 Vadodara 1 1 2 82 0

26 Valsad 0 0 0 0 0

27 Ahmedabad MOH 84 26 94 155 28

28 Bhavnagar MOH 3 0 21 38 14

29 Gandhinagar MOH 0 0 0 0 0

30 Jamnagar MOH 6 1 36 32 1

31 Junagadh MOH 0 0 0 0 0

32 Rajkot MOH 1 1 10 57 0

33 Surat MOH 13 19 87 118 120

34 Vadodara MOH 10 0 12 17 1

35 Total 122 50 318 573 183

Source : Annual report of IDSP (Integrated Disease Surveillance Project )

2012.


1. During 2008-2012 the highest number of cases of Cholera was in

Ahmadabad.

2. During 2008-2012 the lowest number (ZERO) of cases of Cholera was

in many District and MOH.

167

Table 3.15

Year wise Cases of Acute Diarrheal Disease in Gujarat Year 2008-

2012

SR

No

District Name 2008 2009 2010 2011 2012

1 Ahmadabad 16409 12619 14248 15084 12435

2 Amreli 22498 18607 17124 19071 18875

3 Anand 13009 12330 13578 15523 15895

4 Banaskanthha 30421 27904 39490 45198 39752

5 Bharuch 12453 11936 12430 11995 12102

6 Bhavnagar 29384 22586 23633 22347 19918

7 Dahod 25210 22384 31916 25463 28453

8 Dangs 15124 11057 12167 10817 7525

9 Gandhinagar 14922 11562 13794 15901 16067

10 Jamnagar 26262 28477 25612 24404 19864

11 Junagadh 29543 27370 27587 29526 33138

12 Kachchh 15578 14791 17432 13991 14651

13 Kheda 26480 21733 24749 26248 20187

14 Mehsana 25736 22046 25235 24716 29440

15 Narmada 9978 8562 8320 6496 5718

16 Navsari 19421 16493 20601 18892 21949

17 Panchmahal 27497 25979 32627 27352 28102

18 Patan 11273 11518 15310 14674 12766

19 Porbandar 7117 4379 6113 6899 9378


168


SR

No

District Name 2008 2009 2010 2011 2012

20 Rajkot 45659 48068 43108 42268 36673 21 Sabarkanthha 26346 23617 28938 28401 23211 22 Surat 31740 26897 33942 29516 1515 23 Surendranagar 30171 25496 29444 30306 29973 24 Tapi 0 0 0 1217 10698 25 Vadodara 26977 22452 20396 21760 19530 26 Valsad 2863 25474 25556 20350 18567 27 Ahmedabad MOH 15357 18230 21763 46561 44517 28 Bhavnagar MOH 3539 4513 16009 15477 12683 29 Gandhinagar MOH 0 0 0 0 1522 30 Jamnagar MOH 3644 4591 4586 3996 3205 31 Junagadh MOH 0 0 0 0 1506 32 Rajkot MOH 18823 11291 10285 15738 12105 33 Surat MOH 13719 15306 21147 29209 24822 34 Vadodara MOH 15492 8762 9317 14250 12416 35 Total 638412 567030 646457 673646 633158Source : Annual report of IDSP (Integrated Disease Surveillance Project )

2012.


1. During 2008,2009 and 2010 the highest number of cases of Acute

Diarrheal was in Rajkot.

2. During 2011-12 the highest number of cases of Acute Diarrheal was in

Ahmedabad MOH.

3. During 2008-11 the lowest number (ZERO) of cases of Acute

Diarrheal was in many District and in 2012 it was in Junagadh.

169

Table 3.16

Year wise Cases of Dengue in Gujarat Year 2008-2012

Sr

No

District Name 2008 2009 2010 2011 2012

1 Ahmadabad 9 1 11 1 30 2 Amreli 0 0 36 0 8 3 Anand 0 1 4 23 48 4 Banaskanthha 0 0 2 0 19 5 Bharuch 1 1 0 2 4 6 Bhavnagar 7 0 1 1 39 7 Dahod 0 0 0 0 4 8 Dangs 0 0 0 0 0 9 Gandhinagar 1 13 27 24 92 10 Jamnagar 0 0 0 1 22 11 Junagadh 1 0 0 12 14 12 Kachchh 0 0 6 6 17 13 Kheda 0 0 2 0 39 14 Mehsana 0 1 0 0 42 15 Narmada 0 0 0 0 4 16 Navsari 0 2 1 13 10 17 Panchmahal 6 0 0 0 2 18 Patan 0 0 0 2 5 19 Porbandar 0 0 0 0 3 20 Rajkot 0 0 3 35 43 21 Sabarkanthha 0 0 2 0 10 22 Surat 0 0 4 2 0 23 Surendranagar 0 0 0 8 66 24 Tapi 0 0 0 0 0 25 Vadodara 0 0 0 20 19 26 Valsad 2 0 6 8 9


170


Sr

No

District Name 2008 2009 2010 2011 2012

27 Ahmedabad MOH 543 310 159 1274 1047

28 Bhavnagar MOH 132 82 261 380 36


30 Jamnagar MOH 0 0 0 0 7

31 Junagadh MOH 17 58 485 935 0

32 Rajkot MOH 0 0 0 0 29

33 Surat MOH 167 57 223 670 84

34 Vadodara MOH 28 79 255 187 49

35 Total 920 615 1605 3725 1811


2012.


1. During 2008-09 the highest number of cases of Dengue was in

Ahmedabad.

2. In 2010 the highest number of cases of Dengue was in Junagadh.

3. During 2011-12 the highest number of cases of Dengue was in

Ahmedabad.

4. During 2008-2012 the lowest number (ZERO) of cases of Dengue was

in many District and MOH.

171

Table 3.17

Year wise Cases of Enteric Fever in Gujarat Year 2008-2012

Sr

No

District 2008 2009 2010 2011 2012

1 Ahmadabad 224 217 398 301 334

2 Amreli 927 901 1114 1921 1574

3 Anand 78 69 1072 1337 1574

4 Banaskanthha 969 611 675 615 942

5 Bharuch 46 51 77 70 66

6 Bhavnagar 485 404 764 1100 1031

7 Dahod 0 147 200 55 155

8 Dangs 394 244 242 720 414

9 Gandhinagar 500 582 558 586 746

10 Jamnagar 3 2 4 259 260

11 Junagadh 54 39 64 0 8

12 Kachchh 290 250 354 613 952

13 Kheda 647 315 609 643 638

14 Mehsana 289 358 471 800 1063

15 Narmada 15 110 235 122 328

16 Navsari 33 22 145 248 612

17 Panchmahal 209 439 632 1842 1265

18 Patan 432 388 321 496 703

19 Porbandar 204 190 58 171 435


172


Sr

No

District 2008 2009 2010 2011 2012

20 Rajkot 157 89 274 435 394

21 Sabarkanthha 694 872 951 824 1020

22 Surat 279 504 405 484 283

23 Surendranagar 489 425 202 393 909

24 Tapi 0 0 0 6 104

25 Vadodara 1 4 72 338 363

26 Valsad 147 291 122 308 649

27 Ahmedabad MOH 2483 3312 3438 3152 3481

28 Bhavnagar MOH 480 4338 576 593 1277


30 Jamnagar MOH 400 340 396 438 875


32 Rajkot MOH 196 150 260 271 561

33 Surat MOH 668 748 803 859 1433

34 Vadodara MOH 770 338 389 638 719

35 Total 12563 12850 15878 20648 25234


2012.


1. During 2008-12 the highest number of cases of Enteric Fever was in

Ahmedabad .

2. During 2008-12 the lowest number (ZERO) of cases of Enteric Fever

was in many cities of Gujarat and in 2012 it was in Junagadh MOH.

173

Table 3.18

Year wise Cases of Viral Hepatitis in Gujarat Year 2008-2012

Sr.

No

District 2008 2009 2010 2011 2012

1 Ahmadabad 42 31 54 61 287

2 Amreli 99 126 72 95 381

3 Anand 4 1 32 48 2068

4 Banaskanthha 138 13 148 528 413

5 Bharuch 185 1195 228 238 374

6 Bhavnagar 716 266 115 474 566

7 Dahod 1 16 7 4 116

8 Dangs 47 44 81 686 756

9 Gandhinagar 456 783 1131 1417 2071

10 Jamnagar 54 93 112 180 250

11 Junagadh 345 440 290 239 1493

12 Kachchh 220 84 100 68 264

13 Kheda 563 340 391 490 2830

14 Mehsana 159 268 267 239 2201

15 Narmada 35 182 256 119 534

16 Navsari 25 52 122 403 631

17 Panchmahal 120 192 261 108 714

18 Patan 196 181 125 132 1923

19 Porbandar 67 63 42 34 74

20 Rajkot 193 232 223 764 2679

21 Sabarkanthha 253 296 857 439 637

22 Surat 79 89 76 352 162


174


Sr.

No

District 2008 2009 2010 2011 2012

23 Surendranagar 274 220 175 158 7740

24 Tapi 0 0 0 0 61

25 Vadodara 20 2 25 155 746

26 Valsad 254 314 364 496 1249

27 Ahmedabad MOH 1438 2241 3675 4486 13626

28 Bhavnagar MOH 279 211 125 300 876


30 Jamnagar MOH 117 99 241 219 128


32 Rajkot MOH 290 228 130 287 776

33 Surat MOH 264 348 641 907 1118

34 Vadodara MOH 1208 2280 733 1846 6512

35 Total 8141 10051 11099 15972 54407


2012.


1. During 2008-12 the highest number of Viral Hepatitis was in

Ahmedabad.

2. During 2008-11 the lowest number (ZERO) of Viral Hepatitis was in

many cities of Gujarat and in 2012 it was in Junagadh MOH.

9.Achievement

Achievement in IDSP program

The mortality and morbidity due to communicable diseases have

drastically reduced in Gujarat state over last few years. This is

evident from the weekly surveillance data collected, complied and

175

analyzed under Integrated Disease Surveillance Project

implemented in the state since year 2005.

All outbreaks are investigated/reviewed by state /district RRT.

National Review Meeting in 2008.

Reporting system has been shifted to new GOI web portal from

week no.35 on words during the year of 2009.

The reporting status for Panel forms is reached to 99% which is

highest in the country.

Village level surveillance system has been established under

syndrome surveillance by female and male health workers from

sub-centers, syndromic surveillance reached to 94% which is

highest in the country.

The quality of weekly alerts at both state as well as districts level

has been improved and block level mapping has been started from

1st week of 2011. The system of receiving regular weekly feedback

is established at both states as well as district level.

The state as well as district IDSP has played crucial role in

surveillance for pandemic Influenza A(H1N1). The activities

include daily reporting of cases and deaths, daily reporting of

clustered cases of ARI, contact tracing, health status monitoring

and daily reporting to NCDC, Delhi.

Toll Free Number 1075 connectivity is strengthened for outbreak

and H1N1 information.

Training of municipal corporation staff under IDSP is successfully

completed during the year of 2009.

The training for medical and para-medical staff which was pending

since last year was completed during 2009.

FETP course for DSO completed successfully during the year.

Epidemiologist and Entomologist are trained through NCDC.

176

Community surveillance pilot project has been completed in Nizar

block Tapi.

Referral lab network plan has been established and made functional

10 laboratories (8 Medical colleges lab and 2 Priority lab in

Districts).

Data Managers and Data Entry Operators training completed in

state.

Excellent performance of Gujarat IDSP Program, World Bank has

selected for Funding 2010-12.

We received e-governance award in 2007.

Gujarat IDSP has been ranked NO 1 in World bank review 2010.

9. Conclusion :

Gujarat is one of the leading states in India having long coastline.

There are total 26 districts in Gujarat having 226 talukas out of those

around 43 talukas are tribal. At present there are 33 districts and 248

takukas in Gujarat1.

Before the IDSP was established, the diseases surveillance data was

being collected on monthly basis.Thus there was no system of ongoing

surveillance in the state and because of that, the system of early

warning signal did not exist. So the Government of India initiated a

decentralized state based Integrated Diseases Surveillance Project

(IDSP) in the country on 4th November 2004. IDSP phase 1 was

launched by Government of India in November 2004. Gujarat state

was included in phase 2 of the Project and IDSP was launched in

Gujarat on 8th November 2005. The Gujarat state is front runner in

implementation of IDSP. Phase 3 of IDSP was launched by

Government of India during 2006-07. Basic objectives of IDSP are –

to integrated and decentralized surveillance activities, to establish data

177

system using information technology, to develop human resources for

diseases surveillance and action, to involve all stake holder in

surveillance etc.

Secretary (Public Health) is over all in charge at the apex level.

Commissioner (Health, Medical Services and Medical Education)

guide and supervise surveillance activities at the state level. State

nodal officer is designated as state surveillance officer IDSP. State

nodal officer is responsible for all activities and finance District

Surveillance Units has been established in all districts of Gujarat states

and chief District health officer, who is head of health branch, is

designated as district nodal officer IDSP at the district level. Seven

municipal Corporations of Gujarat state carry out Surveillance

activities through urban health centers and private hospitals and report

directly to District Surveillance officer of the same district.

Government Medical colleges and Municipal medical colleges of

Gujarat state also carry out Surveillance activities. About 105 private

reporting units are submitting weekly Surveillance report the reporting

formats “S”, “P” and “L” have been develop by Central Surveillance

Unit. There are many “S”. “P” and “L” reporting units throughout

Gujarat state.

The mortality and morbidity due to Communicable diseases have

drastically reduced in Gujarat state over last few years due to IDSP.

Integration of IDSP with NRHM program, NVBDCP program and

other programs have resulted in minimizing duplication and reducing

workload. IDSP in Gujarat plans to strengthen the public health

laboratories in the state at various levels in phased manner to provide

diagnostic facilities for epidemic prone diseases.

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IDSP has shown remarkable progress to reduce diseases in Gujarat

state as well as district IDSP has played crystal role in Surveillance for

pandemic influenza A (H1N1), successful training of municipal

corporation staff, medical and paramedical staff under IDSP etc.

Gujarat IDSP has been ranked No.1 in the World Bank review 2010.

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Reference:

1. www.marugujarat.com.

CHAPTER - 3 INTEGRATED DISEASE SURVEILLANCE...

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