Technical Guidelines for Integrated Disease Surveillance ... - PHRplus

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Case-based surveillance reporting form(from health facility/worker to district health team and laboratory)1. District Case ID No.:2. _____________________ ____________________ ____________________ ____________________Reporting Health Facility Sub-district District Region3. Disease: Cholera Diarrhea with Measles Meningitis Viral Yellow ______________Blood/Shigella Hemorrhagic Fever Fever Other4. Name of 5. Date of Age:patient: _________________________ birth: _____/______/______ (If DOB_____years______monthsunknown)6. Sex: M=Male F=Female7. Patient’s residence: Community/Sub-district _______________________ Urban/Rural: U=Urban R=RuralTown/City: ______________________________District ofresidence: _______________________________8. Locating information:_________________________________________________________________(If applicable, name of mother and father if neonate or child/landlord)(For cases of measles, yellow fever, and meningitis)9. Date seen at health facility: ______/_______/______ 12. Number of vaccine doses received(For measles, YF–documented by card.10. Date health facilitynotified district:______/_______/______For meningitis, by history.)9=unknown11. Date of onset: ______/_______/______ Date of last vaccination: ______/_______/______(measles, yellow fever, and meningitis only)Additional variable______________________ 13. In/Outpatient: 1=Inpatient 14. Outcome: 1=Alive2=Outpatient 2=DeadAdditional variable ___________________________________________ 9= unknown15. Person completing Name: ___________________________formSignature: ________________________Date sent form to district:_____/______/_____Date: ____________________________16. Final classification: 1=Confirmed (Lab test Pos)(To be completed by district)2=Discarded (Lab test Neg.)3=Suspected (Lab test Not Done)144Technical Guidelines for Integrated Disease Surveillance and Response in Ghana
If laboratory specimen collectedFor health facility: If lab specimen is collected, complete the following information. And send a copy of this form to the lab with the specimen.17. Date of specimen collection: ______/_______/______ 18. Type of Specimen: Stool Blood CSF ________Date specimen sent to lab: ______/_______/______ OtherTime specimen sent to lab: ______/_______/______For the laboratory: Complete this section and return the form to district team and clinician.19. Date specimen received by lab: ______/_______/______ 20. Specimen condition: Adequate Not adequateTime specimen received by lab: ______/_______/______ (Circle as appropriate)21. Results: Circle below as appropriate:Disease/ Type of test Results (+ve=positive) Disease/ Type of ResultsCondition (-ve=negative) Condition testCholeraMeningitisN. meningitidis*S. pneumoniaH. influenzaN. meningitidisS. pneumoniaH. influenzaShigellaDysenteriaePlagueCultureDirect ExamCultureCultureCultureLatexLatexLatexCulture+ve+ve-ve-ve__________Method used forDirect Exam+ve -ve+ve -ve+ve+ve-ve-ve+ve -ve+ve -veSD type 1 Other shig No shigYellow FeverMeaslesRubellaRVFEbolaCCHFLassaMarburgCulture +ve -veIFA>1: 64 +ve -ve* If N. meningitidis is +ve specify serotype _______________________________IgMIgMIgMIgMIgMIgMIgMIgM+ve+ve-ve-ve+ve -ve Virus detection+ve+ve-ve +ve-ve +ve-ve-ve+ve -ve +ve -ve+ve+ve-ve +ve-ve +ve-ve-veOther lab results: ___________________________________________________________________________________22. Date lab sent results to district: ______/_______/______23. Name of lab sending results:_______________________ Other pending tests: _______________________Name of person reporting:_______________________Signature of person reporting:_______________________Date lab results sent to24. Date district received lab results: ______/_______/______ clinician by district: ______/_______/______NOTE: District is responsible for ensuring lab results get to clinicians. Failure to do so will undermine cooperationwith clinicians on reporting of cases in the future.Annex 8: Case-based Surveillance Report Form145
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Technical Guidelines forIntegrated
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3.3.1 Review the updated charts, ta
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7.1.2 Monitor timeliness and comple
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List of TablesTable 1: Surveillance
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AcronymsAFROAFPAIDSCBSCBSWCDCDHMTE-
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An ill person presents to medical a
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How are surveillance functions desc
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4.0 Investigate** 5.0 Respond 6.0 P
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National4.0 Investigate** 5.0 Respo
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In general, the health of Ghanaians
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How does Ghana’s MOH/GHS support
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1.0 Identify Cases of Priority Dise
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1.2 Improve district procedures for
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Section 2Report Priority Diseases a
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Name of diseaseRoutine summary repo
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Identify and train CBS volunteers o
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Clinicians, ward nurses or other re
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3.0 Analyse DataAnalysing trends of
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3. Label all the rows and columns,
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Figure 4: Meningitis cases from Bol
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The first step in analysing data by
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3.2.3.3 Calculate case fatality rat
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Table 6: Alert and epidemic/action
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3.4 Use the analysis results to imp
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4.0 Investigate Reported Outbreaks
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4.4 Prepare to conduct an investiga
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Review laboratory results with the
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Draw a histogram representing the c
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If the shape of the curve suddenly
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5.0 Prepare and Respond to Outbreak
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Periodically review and update othe
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3. Select appropriate communication
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Improve safe disposal of human wast
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Table 7: Daily water needs per pers
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Recommendations for improving epide
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6.0 Provide FeedbackData are report
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The newsletter can be produced simp
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7.0 Evaluate and Improve Surveillan
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Table 8 lists possible indicators t
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Priority diseases are recorded in t
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Indicators for measuring quality of
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Section 8Community-based Surveillan
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members to take action in the event
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Participate in information dissemin
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Section 9Summary Guidelines for Spe
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Analyse and interpretdataReferenceT
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Buruli UlcerBackground Buruli ulce
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Cholera may cause severe dehydratio
Page 107 and 108: Respond to epidemicthresholdIf a su
Page 109 and 110: In Ghana, the disease was endemic i
Page 111 and 112: ReferenceA guide to eliminating lep
Page 113 and 114: Promote environmental sanitation: c
Page 115 and 116: Surveillance goal Use a rapid late
Page 117 and 118: OnchocerciasisBackground Filarial
Page 119 and 120: Poliomyelitis (Acute flaccid paraly
Page 122 and 123: Public health action Conduct activ
Page 124 and 125: The global HIV pandemic has been a
Page 126 and 127: Respond toepidemicAnalyse and inter
Page 128 and 129: Public health action Case finding
Page 131 and 132: Annex 1Using Assessment Results to
Page 133: Tally, compile and report summary t
Page 136 and 137: Diseases of special public health f
Page 138 and 139: Pneumonia in childrenless than 5 ye
Page 140 and 141: Other diseases of public health imp
Page 143 and 144: Annex 5Laboratory Tests for Confirm
Page 145 and 146: Suspected disease orconditionCholer
Page 147 and 148: Suspected disease orconditionDiagno
Page 153: Annex 6List of Laboratories for Con
Page 157: Annex 8Case-based Surveillance Repo
Page 161: 16. When the investigation of the c
Page 164 and 165: (For reporting from health facility
Page 166 and 167: 13. For vaccine-preventable disease
Page 169 and 170: Annex 11Total Number of Patients Se
Page 171: Annex 12Year ___________ Quarter __
Page 174 and 175: Analysis, interpretations, comments
Page 176 and 177: C. Location of Lesion(s)19. Upper l
Page 179 and 180: Annex 15Monthly Registration of Bur
Page 181: Classification a Location of Lesion
Page 185: Annex 17Managing Public Health Surv
Page 189 and 190: Annex 19Sample Tables for Person An
Page 191 and 192: Annex 20Log of Suspected Outbreaks
Page 193: Instructions for filling suspected
Page 196 and 197: INITIAL CLINICAL HISTORYPlease use
Page 198 and 199: SPECIMEN COLLECTIONDate Sent toDate
Page 200 and 201: 186Technical Guidelines for Integra
Page 202 and 203: 188Technical Guidelines for Integra
Page 205 and 206: Annex 25Treat Cases During an Outbr
Page 207 and 208: Also give home-based fluids as foll
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3. Give vitamin A to children with
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Annex 26Preparing Disinfectant Solu
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If the health facility does not kee
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Message:DO YOU PREPARE FOOD SAFELY?
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Reducing exposure to mosquitoesPERS
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Annex 30Estimating Vaccine Supplies
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Annex 31Recommended Immunization Pr
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Lab analysis and results:With text,
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District Epidemic Management Commit
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Annex 35Checklist for Supervising S
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Activity Supervisory Question Answe
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Annex 36Indicators for Monitoring t
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