Screening & Surveillance of Tropical Diseases Ketut Suarayasa Bagian IKM FKIK Untad

HUBUNGAN INTERAKSI HOST,AGEN,ENVIRONMENT (1) Pejamu : Umur, jenis kelamin, ras, Hereditas, perkembangan individu, Tingkah laku dan kebiasaan, Mekanisme pertahanan tubuh, Status gizi HOST Agen Fisik, Kimia, Psikologi dan biologis (infeksi bakteri, virus, parasit, atau jamur) Lingkungan Fisik (kelembaban, suhu, dll & Non Fisik (sosial) AGENT ENVIRONMENT

HUBUNGAN INTERAKSI HOST,AGEN,ENVIRONMENT (2) AGENT Mekanisme penularan : Kontak Langsung, Udara , Makanan dan Minuman , Vektor HOST ENVIRONMENT

Penyakit Tropis Penyakit yg terjadi didaerah Tropis, meliputi : Penyakit Infeksi oleh Bakteri : (TBC, difteria, pertusis, tetanus neonatorum, demam tifoid, kusta, pes, antraks, leptospirosis) Penyakit Infeksi oleh Virus : (DBD, chikungunya, campak, hepatitis, rabies, HIV-AIDS, varisela, flu burung, SARS, polio) Penyakit Infeksi oleh Parasit : (malaria, cacing, filariasis)

Populasi Sampel Screening : Sakit penyaringan kasus adalah cara untuk mengidentifikasi penyakit yang belum tampak melalui suatu tes atau pemeriksaan atau prosedur lain yang dapat dengan cepat memisahkan antara orang yang mungkin menderita penyakit dengan orang yang mungkin tidak menderita. Sakit

Populasi : Org Sehat Sampel Surveillance : Diamati terus & sistematis thd penyakit & fakt2 yg mempngruhi melalui tahapan proses Screening Sakit

Public Health Approach Implementation: How do you do it? Intervention Evaluation: What works? Risk Factor Identification: What is the cause? Sakit Surveillance: What is the problem? Problem Response

UKP – S u r v e i l a n s - UKM Response Segera Dx & Tinda-kan Distribusi Status Kesehatan mnrt Tempat, Waktu & Ciri2 Penduduk Monitoring & Re-alokasi logistik & BimTek Response Segera Dx & Tinda-kan Data out-come Mean atau Rate status kesehatan 1th kab/kota & msg2 wilayah kerja UPT Evaluasi & Alokasi logistik & BimTek Response Terencana Pengumpulan Pengolahan Penafsiran

Surveilans Definisi (SK.Menkes 1116/2003) Pengamatan terus menerus dan dilaksanakan secara sistematis terhadap penyakit atau masalah kesehatan serta faktor-faktor yang mempengaruhinya agar dapat dilakukan tindakan perbaikan atau penelitian, melalui kegiatan pengumpulan, pengolahan dan analisis/interpretasi data, desiminasi informasi dan komunikasi keberbagai pihak terkait 2/16/2019 PAEL 2007

WHO : Public Health Surveillance Ongoing, systematic collection, analysis, and interpretation of health-related data essential to the planning, implementation, and evaluation of public health practice, closely integrated with the timely dissemination of these data to those responsible for prevention and control.

Public Health Surveillance Systematic, ongoing Collection Analysis Interpretation Dissemination Link to public health practice

Purposes of Public Health Surveillance Assess public health status Define public health priorities Evaluate programs Stimulate research

Information for Action Surveillance Information for Action

Uses of Public Health Surveillance Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Uses of Public Health Surveillance Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

KLB Diare Puskesmas Bungku, 2009 2/16/2019 PAEL 2007

Uses of Public Health Surveillance Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

AREA MAP KASUS KLB CAMPAK PROP. SULSEL JAN S/D AREA MAP KASUS KLB CAMPAK PROP. SULSEL JAN S/D DESEMBER TAHUN 2004 DAN 2005 Keterangan 1. Makassar 2. Pare-par 3. Mamuju 4. Luwu 5. Majene 6. polmas 7. Tana Toraja 8. Pinrang 9. Enrekang 10. Sidrap 11. Wajo 12. Soppeng 13. Barru 14. Pangkep 15. Bone 16. Maros 17. Gowa 18. Sinjai 19. Bulukumba 20. Bantaeng 21. Jeneponto 22. Takalar 23. Selayar 24. Luwu Utara 25. Palopo 26.Mamasa 27.Luwu TIMUR 28. Mamuju Utara 2/16/2019 PAEL 2007

Wilayah Potensial DBD (LS 0’53’’687’’’ dan BT 119’51’’077’’’) P A N T M B R I S E U K J l g d e s a . h p n m i o r t b 6 1 2 W k y (LS 0’53’’687’’’ dan BT 119’51’’077’’’)

Tahun 2010 Tahun 2009 Tahun 2010 10 kelurahan endemis 14 kelurahan sporadis 12 kelurahan potensial 7 kelurahan bebas Tahun 2009 17 kelurahan endemis 11 kelurahan sporadis 7 kelurahan potensial 8 kelurahan bebas Tahun 2010 18 kelurahan endemis 11 kelurahan sporadis 4 kelurahan potensial 10 kelurahan bebas P A N T O L M B R I S E U K J l g d e s a . h p n m i o r t b 6 1 2 W k y i t D B D D i K o t a P a l u T a h u n 2 3

Uses of Public Health Surveillance Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

TOXIC SHOCK SYNDROME (TSS) United States, 1983-1998 160 National Center for Infectious Diseases (NCID) data* National Electronic Telecommunications System for Surveillance (NETSS) data 140 120 Reported Cases 100 80 60 40 20 1989 1992 Year (Quarter) 1983 *Includes cases meeting the CDC definition for confirmed and probable cases for staphylococcal TSS. 1984 1985 1986 1987 1988 1990 1991 1993 1994 1995 1996 1997 1998

Uses of Public Health Surveillance Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

INTERVENSI

Uses of Public Health Surveillance Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Pertussis (Whooping Cough) United States, 1998 300 600 900 1,200 1,500 1,800 2,100 2,400 Reported Cases <1 1–4 5–9 10–14 15–19 20–29 30–39 40–49 50–59 >60 Age Group (Years) Source: CDC. Summary of notifiable diseases. 1998.

Hubungan Curah Hujan dg Kejadian DBD di Kota Palu th 2009

Uses of Public Health Surveillance Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Evaluasi Program Intervensi atau Pengendalia n 2/16/2019 PAEL 2007

Gerakan 3M Gerakan 3M

Uses of Public Health Surveillance Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Trends in Plasmid-Mediated Resistance to Penicillin and Tetracycline United States, 1988-1997 2 4 6 8 10 12 PPNG TRNG PPNG & TRNG Percent Source: Gonococcal Isolate Surveillance Project (GISP) 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 Year Note: "PPNG" (penicillinase-producing ) and "TRNG" (tetracycline-resistant) N. gonorrhoeae refer to plasmid-mediated resistance to penicillin and tetracycline, respectively.

Uses of Public Health Surveillance Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Breast Cancer Screening

Uses of Public Health Surveillance Estimate magnitude of the problem Determine geographic distribution of illness Portray the natural history of a disease Detect epidemics/define a problem Generate hypotheses, stimulate research Evaluate control measures Monitor changes in infectious agents Detect changes in health practices Facilitate planning

Obesity United States, 1987-1998

Physical Activity Georgia 1998 Source: BRFSS 1998

KOMPONEN SURV EPID Adanya tujuan yg jelas & terukur Memiliki konsep atau mekanisme surv epid dlm mencapai tujuan Proses kegiatan pengumpulan, pengolahan data, analisis & distribusi informasi epid Memiliki indikator kinerja Pendukung surv epid, adanya tim teknis, sumber daya Memiliki jejaring surv epid 2/16/2019 PAEL 2007

SUMBER DATA Data kesakitan dr unit pelayanan kes & masy Data pelayanan kes masy Data kematian (unit pelayanan kes) Data demografi Data geografi dr unit meteorogi & geofisika Data kondisi lingk Lap wabah Lap. Penyelidikan wabah/KLB Lap hasil penyelidikan kasus perorangan Studi epid & hasil penelitian Lap kondisi pangan Data & informasi 2/16/2019 PAEL 2007

DATA PENDUKUNG SURVEILANS DATA DEMOGRAFI CAKUPAN PROGRAM DATA BMG  Curah Hujan, Peta Wilayah HASIL PENELITIAN KEPUSTAKAAN 2/16/2019 PAEL 2007

Data Sources/Methods Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources

SITUASI KASUS HIV AIDS MENURUT GOLONGAN UMUR TAHUN 2002 - 2010

Passive vs. Active Surveillance - Provider-initiated Active - Health Department-initiated

Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources

Salmonella—serotypes of isolates United States, 1973-1998 Enteritidis Typhimurium Other Unknown Outbreak caused by contaminated pasteurized milk, IL 3,000 6,000 9,000 12,000 15,000 18,000 21,000 24,000 27,000 30,000 Reported isolates 1973 1978 1983 1988 1993 1998 Source: CDC. Summary of notifiable diseases. 1998. Year

PENGAMBILAN DAN PEMERIKSAAN SMEAR GO & SIPILIS TAHUN 2008 -2010 NO TAHUN JML SLIDE LOKASI HASIL KET POSITIF NEGATIF 1 2 3 2008 2009 2010 208 188 22 21 180 14 37 140 190 35 LP Petobo Rutan Maesa Raja Moili Eks Tondo Masomba LP Petobo 10 4 7 5 198 178 20 17 179 36 133 186 Sipilis GO 44 50

Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources Data Kemenkes, SKDI, RS, dll

Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources Data Puskesmas & jejaringnya

Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources Laporan mingguan, bulanan, Kohort Ibu, dll

Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources Oleh Puskesmas, PT, lembaga penelitian lain

Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources Dinkes kab/kota, Prop, pusat

Data Sources Notifiable diseases Laboratory specimens Vital records Sentinel surveillance Registries Surveys Administrative data systems Other data sources BMKG, BPS, Kepustakaan, hasil penelitian, dll

Information Loop of Public Health Surveillance Summaries, Interpretations, Recommendations Reports Health Agencies Health Care Providers Public Analysis

ANALISIS & INTERPRETASI Manfaat Analisa & interpretasi: Menentukan golongan beresiko Mengetahui penularan penyakit Program Pemberantasan Rekomendasi: Tindakan-tindakan untuk mencapai tujuan 2. Perbaikan program pemberantasan

TERIMA KASIH