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125
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
Source : Annual report of IDSP ( Integrated Disease Surveillance
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
Source : Annual report of IDSP ( Integrated Disease Surveillance Project)
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
139
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
Source : Annual report of IDSP ( Integrated Disease Surveillance Project)
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
Source : Annual report of IDSP ( Integrated Disease Surveillance Project)
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.
144
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
Source : Annual report of IDSP ( Integrated Disease Surveillance Project)
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%
Source : Annual report of IDSP ( Integrated Disease Surveillance
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 re- emerging
(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
Source : Annual report of IDSP ( Integrated Disease Surveillance Project)
2012.
Chart 3.4
A dynamic Vision of Surveillance
Make Collect and Transmit
Decision Data
Feedback Analyze
Information Data
Source : Annual report of IDSP ( Integrated Disease Surveillance
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
Table No. 3.8 Contd…
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.
Source : Annual report of IDSP ( Integrated Disease Surveillance
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
Table No. 3.9 Contd…
157
Table No. 3.9 Contd…
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.
4 Govt. Medical College
Surat
Govt. Surat Rural, Tapi,
Navsari, Valsad, Dangs
Table No. 3.10 Contd…
159
Table No. 3.10 Contd…
Sr.
No.
Name of Institution Govt./Mun.
Corp./Private
District linked
5 Govt. Medical College
Rajkot
Govt. Rajkot Rural, Rajkot
Corporation Kutch,
Surendranagar
6 Govt. Medical College
Bhavnagar
Govt. Bhavnagar Rural,
Bhavnagar Corporation,
Amreli, Junagadh,
Junagadh Corporation,
7 Govt. Medical College
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
Table No. 3.12 Contd…
162
Table No. 3.12 Contd…
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
Source :Annual report of IDSP ( Integrated Disease Surveillance Project )
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
Table No. 3.13 Contd…
164
Table No. 3.13 Contd…
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
Source :Annual report of IDSP ( Integrated Disease Surveillance Project )
2012.
Table 3.13 shows that
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
Table No. 3.14 Contd…
166
Table No. 3.14 Contd…
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.
Table 3.14 shows that
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
Table No. 3.15 Contd…
168
Table No. 3.15 Contd…
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.
Table 3.15 shows that
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
Table No. 3.16 Contd…
170
Table No. 3.16 Contd…
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
29 Gandhinagar MOH 6 10 117 121 10
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
Source : Annual report of IDSP (Integrated Disease Surveillance Project )
2012.
Table 3.16 shows that
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
Table No. 3.17 Contd…
172
Table No. 3.17 Contd…
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
29 Gandhinagar MOH 0 0 0 0 65
30 Jamnagar MOH 400 340 396 438 875
31 Junagadh MOH 0 0 0 0 1
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
Source : Annual report of IDSP (Integrated Disease Surveillance Project )
2012.
Table 3.17 shows that
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
Table No. 3.18 Contd…
174
Table No. 3.18 Contd…
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
29 Gandhinagar MOH 0 0 0 0 100
30 Jamnagar MOH 117 99 241 219 128
31 Junagadh MOH 0 0 0 0 51
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
Source : Annual report of IDSP (Integrated Disease Surveillance Project )
2012.
Table 3.18 shows that
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.
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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
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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.