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Data Managment

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DATA MANAGEMENT

Integrated Disease Surveillance Project aims at collecting, compiling, analyzing and using data on various target diseases for surveillance and rapid response to prevent or control spread of diseases in the communities. As data are computerized, it becomes necessary to standardize formats used for recording and reporting information at various levels. Under IDSP, data are collected on epidemic prone diseases on weekly basis (Monday–Sunday).

The following Formats (Annexure 1) were used under IDSP initially:

‘S’ form - Reporting Format for Syndromic Surveillance, filled by Health Worker.

‘P’ form- Reporting Format for Presumptive Surveillance, filled by Medical Officer.

‘L1, L2, L3’ forms - Reporting Format for Laboratory Surveillance. 

‘W’ form - Reporting Format for Water Quality Monitoring, filled by Health Workers and Laboratory Personnel at PHCs, CHCs and in various other laboratories in the district.

In due course of time for operational ease, the L1, L2 & L3 formats were merged as single ‘L’ Format and the ‘W’ format was discontinued. The ‘P’ format was also simplified in 2009.

Presently under IDSP the information is collected on three specified reporting formats (Annexure – 2), namely “S” (suspected cases), “P” (presumptive cases) and “L” (laboratory confirmed cases).  ‘S’ form is filled by the health workers to report data on suspected cases/syndromes. ‘ P’ form is filled up by Medical Officers to report data on probable/clinically suspected cases. ‘L’ form is designed to collect data on lab confirmed cases. 

Flow of Information

The information flow followed to ensure timely reporting of data relating to target diseases is depicted in the schematic diagram below.

The weekly data gives information on the disease trends and seasonality of diseases. Whenever there is a rising trend of an illness in any area, it is investigated by the Rapid Response Teams (RRT) to diagnose and control the outbreak. Data analysis and actions are being undertaken by respective State/District Surveillance Units. Emphasis is now being laid on reporting of surveillance data from Major Hospitals and also from Infectious Disease Hospitals. 

Evolution of Data Reporting Formats

It was repeatedly felt that the forms used by IDSP (before 2007) to collect data need simplification. A stakeholder meeting was held in August 2007 and some modifications were suggested in the IDSP formats. These modifications were also discussed with CDC Team which reviewed IDSP during 10-17 September 2007. A meeting was held in April 2008 to finalize the simplification of formats of IDSP. 

Experts from different organizations attended the meeting and discussed in detail the modifications suggested by experts in earlier meetings. Amongst many changes suggested, it was decided that in ‘S’ form, the age and gender specific data for cases will not be collected to improve reporting and minimize errors. Further, in continuation, a meeting was held under the Chairmanship of Additional Secretary & MD (NRHM) on 19th December 2008 to examine IDSP proposal and after detailed deliberations, the simplified formats were approved on 1st January 2009. In the meeting it was decided that ‘in the proposed ‘P’ and ‘L’ forms, the data element on deaths may be deleted as it is being captured in the new NRHM-HMIS formats’. Presently no mortality data is being collected in ‘P’ format under IDSP.

Also by 2008-09, after the Joint Review Mission, it was agreed that following the voluminous syndromic data at states and center was a futile exercise; instead the CSU and SSU should give more stress on analysis of data reported in “P” and “L” formats. Since then the syndromic data is being analysed at the district and sub-districts levels only as alerts for investigating the increased number or clustering of cases of any syndrome (e.g. fevers, diarrheas, cough or jaundice or any other unusual syndromes). 

The list of conditions under surveillance was also revised giving more focus on outbreak prone conditions (Annexure 3, appended old and new list of conditions under surveillance). 

Current Status

Currently about 90% Districts are reporting weekly disease surveillance data under IDSP. The revised P and L forms have been made available on IDSP portal to enable on-line data entry. The data entry on IDSP portal is consistently improving. A committee consisting of IDSP Epidemiologists and experts from NCDC monitor the status of receipt of weekly surveillance data; analyze data on a sample basis, and share the analysis with state surveillance units to promote similar analysis at the state and district levels. Further, CSU is undertaking regular video conferencing to discuss reporting issues and seek clarifications on discrepancies in data such as sudden increase in the number of reported cases including actions taken.

The year wise weekly reporting of S,P and L forms by all the districts through IDSP Protal is shown below.

In the restructured and extended IDSP beyond March 2010, there were critical revisions to the Project outcome and component indicators.  Agreement was made to revise the Results Framework Document with a view to reducing the number of original indicators focusing on critical expected outcomes of the project. The old key indicators used up to March 2010 and revised indicators used beyond March 2010 are Annexed 4. With regards to data management, a new indicator was introduced in the revised Results Framework Document: “% of districts providing surveillance reports timely and consistently i.e. within one week after the last date of every reporting week for at least 40 weeks (80% of week at any given time) each year and should have desegregated collated forms of P {i. PHCs, ii. Other Govt. Hospitals and iii. Private hospitals separately}, L (PHC labs, district Public Health lab and referral laboratories) and S reporting units”

Overall the percentage of districts providing surveillance reports timely and consistently has improved over last two years. The State wise timely and consistently reporting status for P and L forms is shown in graphs below. Year-wise cases of selected few diseases based on P-form through Portal during 2009-13 under IDSP (as on Dec. 2013)

Note: The figures indicated are provisional and subject to change. The State wise and year wise details of the above disease conditions is at Annexure 5.