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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 ([email protected])
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)