Dr. Nyphonh ChanthakoummaneCountry Coordinator X-MBDS ProjectSenior Technical Officer, DOHP, MOH, Laos

MBDS Information Communication & Technology Forum

April 2nd -3rd ,2009Ploy Palace Hotel ,Mukdahan Province, Thailand

Outline

- National Surveillance System of Notifiable Selected Diseases

- Avian Influenza National Hotline

Flow Chart of Information of NSSNSD

P o rts / Im m igra tio n C h e ck P o in ts

D isp e n sa ries /V illa g e H e a lth P o s ts S u p p le m en ta rysu rve illa n ce

(A c tive case se a rch)

D is tric t H e a lth O fficeD is tric t S e c tio n fo r H yg ie ne

a n d E p id e m io lo gy

C a p ita l C ity / p ro v in cia l S e c tionfo r H yg ie n e a n d E p id e m io lo gy

N a tio n a l C e n te r fo r L ab o ra to rya n d E p id e m io lo gy

M O HD H P /C D C T a sk F o rceSpecial Task Force

During an Outbreak

Natl / ProvHospitals

Private Clinics

District Hosp

Active SurvPassive Surv

Active SurvPassive Surv

Weekly reportFax/phone

Weekly reportFax/phone/Radio

Weekly/monthly

Feed-back report

Conditions/Diseases under surveillanceLao P.D.R. (1)

1. Acute Flaccid Paralysis (AFP)2. Measles3. Neonatal tetanus4. Tetanus of all ages5. Diphtheria6. Pertussis7. Severe diarrhea (including cholera)

Conditions/Diseases under surveillance, Lao P.D.R. (2)

8. Dengue virus infection (DF/DHF/DSS)9. Total dysentery10. Food poisoning11. Typhoid fever12. Anthrax13. Total Hepatitis 14. Meningitis15. Encephalitis16. PlagueThe surveillance of SARS and Avian flu has been integrated and collaborated into the CDC Task Force located at NAHICO and DOHP

Activities :1. Daily (Nov. 2004) and Weekly Surveillance Report of Disease under

Surveillance currently performed,

2. Unusual event(s) reported any time.

3. In addition to Passive Surveillance, Regular Active Surveillance

by visiting health facilities currently performed,

4. Supplementary Surveillance (Community based active case search

periodically conducted).

5. Weekly Feed back report regularly done at national level and some provincial level

6. Regular supervision and monitoring combined with AFP case follow up

7. Annual National Meeting on Surveillance regularly conducted.

8. Border selective area co-operation, collaboration with DHP.

9. Early Warning System of potentially epidemic diseases currently monitored

10. Outbreak investigation

List of diseases under weekly surveillance Ministry of Health National Centre for Laboratory and Epidemiology Division of Epidemiology. Tel : 312351, Fax :350209

Form 004

Weekly report by phone/by fax

Province________________________, Week No._________________________

Conditions/Diseases Cases Deaths 1. Acute Flaccid Paralysis (AFP) 2. Measles 3. Neonatal tetanus 4. Tetanus of all ages 5. Diphtheria 6. Pertussis 7. Acute watery diarrhea (revised) 8. Dengue Fever (DF) 9. Dengue Hemorrhagic Fever (DHF) 10. Dengue Shock Syndrome (DSS) 11. Acute bloody diarrhea (revised) 12. Food poisoning 13. Typhoid fever 14. Anthrax 15. Unspecified hepatitis 16. Meningitis 17. Encephalitis 18. Plague 19. ARS (new) 20. Suspected d Human Avian Influenza (new) 21. Suspected Severe Acute Respiratory Syndrome (SARS) – (new)

Province:_____________________ Date:___________________ Chief of Provincial Hygiene and Epidemiology section: ________________________ Reporter _____________

Information Sharing Network intra and inter-country

Data and information shared through:

Fax/phone

Written feed-back weekly report

E-mail/internet (nclep@laotel.com)

with WHO, FAO, MBDS/Bureau of

Epidemiology,Thailand, ASEAN-DS.Net,

DengueNet, JICA, Japan Embassy.

Avian InfluenzaNational Hotline

Why work on Piloting a National Hotline:

Reporting of suspected outbreaks in Poultry in Laos was slow

Limited reports of poultry deaths because of perceived stigma

There is an awareness of AI however people still have questions

Overview

OverviewPurpose:

The AI HOTLINE is center for public to get answer to their questions and concerns about AI and allows people to call in and report poultry deaths without delay.

Tool for AI surveillance, rapid respond to outbreak, and to reach all people includes backyard farmers.

Establishment The National Avian Influenza (AI) Hotline was officially

launched on 18th February, 2008.

Advertise since February 2008

Radio TV Print Stickers, posters, etc Transit (Tuk-Tuk, buses, etc) Phone refill card Officials/Vet, head of villages Trainings

To provide information about Avian Influenza through a simple single point of access to the public

To provide feedback for the government / line ministries about attitudes and concerns of the public and relevant data collection for research

To provide support for reporting of suspected AI cases

Objective

Management

Human resources:

Two call operators and one project officer.

Two call operators work in different shift (7 a.m. - 1 p.m.) and (12 p.m. - 6 p.m.).

Set up messages receivers after hours (from 6 p.m. to 7 a.m.). Callers could leave voice message up to 100 massages.

Management

Training and skills:

Call operators have been trained in technical information such as Overview of AI, Animal issues, Human issues, Current Situation, Telephone counseling skills…etc.,

Call operators answer the question on AI based on the pre-approved (technically correct) Q&A.

Training curriculum for the Hotline staffs.

ManagementDaily Activities:

Answer of basic questions and concerns about Avian Influenza and related issues for the general public.

Check back if information by callers are true.

Input data into daily report.

Daily and weekly report compiled includes:Reports for suspected AIQuestions asked on AISource of hearing about the hotlineCalls received after hours

NAHICO

NAHCNational Animal

Health Center

NCLENational CenterOf Laboratory

& Epidemiology

AI Hotline 166V V WVillage Volunteer Work

CallersCallers

Provincial Department of Agriculture and

Forestry

Reporting Process

Provincial Health Department

(Surveillance Unit)

OutcomesThere is an increasing number of people awareness of

AI hotline.

Many people call in directly and report poultry deaths and ask for information on AI.

Other animal sickness is also being reported (Pigs and Cows…).

The designed Microsoft Access as Data base could operate both English and Laos and call operators could be used as a sources of AI information.

OutcomesSimply use of Microsoft excel to keep daily records

for all calls.

Call operators check back very carefully when getting suspected information from callers before sending out report.

Call operators are able to give answer and information on AI confidently.

Call operators calmly and patiently advice all callers who call to disturbs, tell lies and rude calls.

Total Call Volume March 2008 – February 2009

-

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

AI calls # calls reporting Total other calls

1,496 (10%)

416 (3%)

12,856 (87%)

0

50

100

150

200

250

300

350

AI Calls

# reports

Monthly AI call March 2008 – February 2009

Source of information about 166March 2008 - February 2009

20

6 7 6 5 4 3 21

13

30

0

5

10

15

20

25

30

35

Radio

Rumor

Phone

card

Newsp

aper

Poste

r

Trai

ning

Wor

ker

Calend

ar TV

Handb

ook

Other

Challenges

There is still huge number of wrong purposes, fake calls and call to disturb.

Unclear on reporting process

There is no feedback after sending reports out.

Unclear on AI hotline’s role and responsibility

What are the next steps?

Expanding hotline to other diseases and increasing call operator capacity.

Survey on possibility of using SMS system to alert local officials or officials involve (included VVW…) on AI as a tool for rapid response when there is an outbreak.

Identify formally reporting structure for hotline reports (human and animal health)

Identify reporting back structure

What are the next steps?

Train persons to be casual call operators (used for rapid expansion if needed or as needed when permanent call operators are on leave)

Develop database on Microsoft Access to be used to keep for all purposes (keep data, report system and monitoring and sources of information)