Surveillance of Infectious Diseases

For the surveillance of infectious diseases the UNRWA Health Department has developed an Epi Info based surveillance system. The system builds on the routine weekly reports from the Health Centres as well as "outbreak reports" and "case investigation reports"25. The physician at the Health Centre uses a daily tally sheet to record cases of infectious diseases. These are forwarded to the Area and Field Health Office weekly.

The routine weekly report from the Health Centres thus consists of the following information:

  • date, week and year
  • name of Field
  • name of Area
  • name and code of Health Centre
  • name and code of disease
  • number of cases
As a rule the weekly reports do not contain names or registration numbers of the patients26.
At the Area and Field Health Office these data are fed into the Epi Info in order to be assembled and compared, and to enable the Health Department to apply measures of prevention and control of infectious diseases where necessary. The Department intends to expand this reporting system structure to all parts of their programme including MCH and non-communicable diseases.

At present, the Health Department is in the process of decentralizing data handling to exploit the possibilities for using Epi Info on the Field level. Field Offices are encouraged to use Epi Info for routine infectious disease reporting. The Headquarters receives only a monthly diskette copy of the data in order to do comparative analysis of infectious diseases across all Fields. On the Health Centre level though, there are no plans to computerize data handling.

In order to improve the quality of the data and the surveillance system, the Health Department has created standardized definitions of the reportable infectious diseases. This ensures a 'common language' and thus improves the reliability of the data obtained. Another quality control mechanism employed by the Health Department is routines for controlling the timeliness of the return of data from the field.

Epi Info allows for the rapid processing and analysis of data, and can provide statistical calculations based on data collected from the reporting sites. These are collected in a unified manner for the five Fields of UNRWA operations and thus offers opportunities for comparisons. The reliability and validity of UNRWA routine health data seem high. With the Epi Info access to the data is good and possibilities of crossing data fed into the computer is in principle endless. The basic question, then, is which data, at what level of aggregation, are fed into the computer? If, for example, information about the type of treatment and health-service is linked to the type of disease, it is possible to study the success of certain types of treatment. Such research would need data with a unit of analysis on an individual level as well as on a village or UNRWA Area level. Although data on an individual level are not computerized, the Agency has conducted research based on sample survey of individual medical records by designing appropriate research protocols.

25.) Cases of highly infectious diseases must be reported within 24 hours to the Area and Field Health Office, but these are also reported on the weekly report form. These diseases are: Acute Flaccid Paralysis, suspected and laboratory confirmed Cholera, Poliomyelitis, Meningococcal Meningitis, and Tetanus Neonatorum. There are however diseases for which a case investigations form is also forwarded. This form includes name and sex, place of birth, address, residency in camp, occupation, and travelling the last who months. These diseases are: Acute Flaccid Paralysis, suspected and laboratory confirmed Cholera, Poliomyelitis, Mening, Meningitis, Tetanus Neonatorum, HIV-AIDS (Serologically confirmed), Meningitis, Sexually Transmitted Diseases, and Pulmonary Tuberculosis. In cases of food poisoning the information is extended to include data on symptoms and food and drink history.
26.) An exemption are those diseases for which a "case investigation form" is forwarded

al@mashriq                       960428/960613