Routine Disease Reporting and Case Management

Module 1 : Field Disease Reporting and Case Management

Overview

This is the first and most fundamental of the iSIKHNAS modules. Conducted over two days, the course introduces district level technical staff to the iSIKHNAS system, its philosophy and the key functions of the system. It concentrates on developing skills in the reporting of routine and priority disease events by veterinary field staff and Pelsa (village reporters), response reports, treatments, specimen submissions to the lab and outcome reports. It also includes many useful system queries for use in the field.

Field disease reporting is central to Indonesia's new animal health information system, iSIKHNAS where village reporters (Pelsa) and district field veterinary staff (Dinas) report cases of disease by sending simple coded messages from their mobile phones. Reports can either be for General Signs (Tanda Umum) using the U SMS message format or reports of suspected priority diseases using the P message - Priority Syndrome report (Sindrom Prioritas). The messages sent from the field ensure that the relevant veterinary staff are alerted and the data is also immediately included in the available for analysis by decision makers at every level.

Village reporters (Pelsa) assist in this vital reporting role and it is important for Dinas staff to be fully aware of the role and responsibilities and appreciate the work of the Pelsa in their area.

When Pelsa report health problems it is important for field staff to respond to these with either a phone call in the first instance, and a visit if the report is a Priority Syndrome report or seems important after talking to the Pelsa. A Response (R) message is sent to iSIKHNAS to give details of this follow-up by Dinas staff. Lab samples (SLAB) might be taken and associated with the case. Treatments (OB) might be given and these too need to be recorded with the case ID. Eventually, details about the case outcome (PK) may be known and these can be recorded as well.

Training Approach

• Each new message or function
  • Presentation using IM, powerpoint
  • Error diagnostics, Scenario practice
  • Q&A and troubleshooting

Training curriculum

Overview of iSIKHNAS

• What is it and what benefits does it bring to Dinas livestock services?
• How is it managed?
• What change will occur as a result? How will it affect staff and current operations?
• What is planned for the future? The bigger picture.

How does it work?

• Coded messages - in brief
• Codes: Standardising the information we report.
  • Signs and syndromes, species, locations, lab related codes, drugs
• Queries: How to look up codes?

Translating current core routine activities into iSIKHNAS reports

• Report new cases (U and P)
  • General Signs of disease
  • Syndromes
• Respond to Pelsa reports (R)
  • Working with Pelsa
  • Understanding Pelsa reporting role
  • Providing good service
• Treat problems (OB)
• Submit samples to the lab (LAB)
• Report case outcomes (PK)

Combined whole-case scenarios

• Performance check

Conclusion

• When to use, who to use?
• What can we do with the data?
• How to access the data?
  • Security - web and phone
• Where to get help or more information?

Training Materials

Introduction

SMS Messages

Scenarios

Report a new case: Signs of general or routine disease

U [sign,sign...] [species] [number of animals] {location} {differential diagnosis,differential diagnosis...}

Core activities of Dinas field staff

Core activities:

• Report new cases
• Respond to Pelsa reports
• Treat problems
• Submit samples to the lab
• Report case outcomes
• Keep additional notes

Report a new case: Signs of general or routine disease

U [sign,sign...] [species] [number of animals] {location} {differential diagnosis,differential diagnosis...}

• Use CKT [name of sign] to look up a general sign codes.
• Use Kode SP to look up species codes.
• Use CKL [name of location] to look up the location code for a village.
• Use CKP [name of disease] to look up the disease codes for the differential diagnoses.

Training Notes

• 2 ‘list’ style entries – tanda and diagnosa which need to be separated by a comma if multiple entries are required
• Signs recognition practice may be necessary
• General signs versus Priority syndrome awareness raising will be important
• Differential diagnosis vs definitive diagnosis - discussion
• Avoid using 'other signs', ‘tanda lain’
• Repeating sequence (species, number of animals) for multiple species with similar signs
• Codes for specific signs can be queried using CKT [nama tanda]. Sign codes can be found by CKT [freetext] query which allows users to query the code for signs which start with similar letters or match the freetext entry. Eg CKT kembung returns kembung KBG and other options with similar letter configurations.
• When to use optional location code – pelsa with several villages, dinas almost always
• New location codes – imperfect at the moment but will gradually be updated locally
• AH staff vs Pelsa reporters – different message formats - no diagnosis for pelsa.
• U report from Dinas does not require an R report. U report from Dinas is U and R together.
• Diagnostic strengthening training for Dinas staff will be available in the near future
• 100% response rate should be the target – mostly by telephone perhaps.

Report a new case: Priority syndrome or important disease

P [syndrome] [species] [number of animals] {location} {diagnosis,diagnosis...}

• Use Kode SIN to look up the syndrom code.
• Use Kode SP to look up species codes.
• Use CKL [name of location] to look up the location code for a village.
• Use CKP [name of disease] to look up the disease codes for the differential diagnoses.

Training Notes

• Priority codes and definitions – There are six defined syndromes but should also be referred to as a tool for reporting important disease, not just listed priority diseases
• There is one additional undefined Priority syndrome where signs don’t fit into the syndrome description but reporter feels urgent response is required (if suspected to be zoonotic, highly contagious, high mortality etc)
• Positive Consequences - Those who report P should be thanked for staying alert, even if their report turns out to be false alarm, as it will in many cases, at least it shows reporter is alert and conscious of importance of distinguishing important from routine disease
• Differential diagnosis vs definitive diagnosis
• 100% should be visited quickly after a telephone call to ask for further details
• Repeating sequence (species, number of animals) for multiple species with similar syndrome
• Location code will be required for reports by Dinas staff
• List style entry for differential diagnoses – multiple diseases should be separated by a comma
• Disease codes can be found by using CKP [nama penyakit]
• Additional Priority Syndrome has been added which allows Pelsa to report urgent looking case (zoonosis, high morbidity/mortality or contagious) without having a clear syndrome is an alert for unknown or exotic disease.

Response action to Pelsa report

R [Case ID] [visited (K/T)] [differential diagnosis,differential diagnosis...] {other diagnoses}

• Use the Case ID from the alert SMS you are responding to.
• Use CKP [name of disease] to look up the disease codes for the differential diagnoses.

Training Notes

• Dinas - What questions to ask the pelsa to get a clearer picture of the case - communication activity
• Friendly, efficient response is important.
• An R report is equivalent to a DINAS U or DINAS P
• List sytle entry for diagnoses – multiple entries are separated by a comma
• Disease codes can be found by CKP [nama penyakit]
• ‘diagnosa lain’ is optional and for freetext diagnosis if code not found in disease list
• Is the case important? Priority? Zoonosis? High morbidity/mortality? New/Unknown? If yes then FULL INVESTIGATION - forms for investigation exist in various departments these have been integrated into iSIKHNAS system. See Priority Disease Investigation and Response module

Treatments

OB [case ID] ([drug code] [dose per animal] [total animals]...)

• Use the Case ID from the alert SMS you are responding to.
• Use CKO [name of drug] to look up the drug codes.

Training Notes

• Drug codes can be found by using SMS kode search (CKO)
• Number of animals,
• Dose per animal
• Repeated sequence possible for multiple treatments
• Traditional treatments can be reported at the discretion of kabupaten policy.

Specimen submission to laboratory

LAB [case ID] ([specimen type] [specimen form] {section} [number of specimens]...) [lab ID]

• Use CKJS [specimen type] to look for a specimen type code.
• Use KODE BS to find the specimen form code.
• Use KODE SL to find the lab section code.
• Use CKI LAB [location code] to find the laboratory code.

Training Notes

• Separate messages using the same Case ID if samples are to be sent to different locations
• Lab section code is optional
• Repeating sequence possible for multiple specimens going to the same lab
• Separate messages required (using the same Case ID) for specimens being sent to different labs.
• Must remind staff to label specimens properly with the Case ID so that this is entered in the LabInfo system and the connection between the two systems can begin.

Case outcome report

PK [case ID] [outcome code]

• Use the Case ID from the original case report.
• Use Kode PK to find the outcome code.

Training Notes

• If unknown, Case ID can be found out by LAPD usually
• Helps to ‘close’ a case
• May come in response to questioning of pelsa/farmer during visit (with perhaps the help of LAPD) or someone volunteering the information in a passing manner
• Repeating sequence - ([outcome code] [number of animals])
• Pelsa may also use this at the discretion of the Kabupaten. This will need to be set through the user permissions management section on the website
• Collects data to help with monitoring treatments, diagnoses and follow up rates
• Not really interested in whether the animal has been sold
  • SB is Recovered
  • MS is Still sick
  • MT is Dead due to the disease or slaughtered due to the disease.

Case comments

KOM [case ID] [comment]

• Use the Case ID from the original alert.
• Freetext entry for comments.

Training Notes

• Add freetext notes that cannot be included in the case file by any coded means using few and only commonly used abbreviations.

Field disease reports: Pelsa

Pelsa are the eyes and ears of the veterinary services and provide an important link between the community and animal health services. Dinas staff should liaise closely with pelsa, encourage their contribution and nurture the relationship. They should assist them when they need help and offer advice which will help them to offer a good service to their fellow farmers.

Pelsa are being recruited and trained in recognising and reporting general signs of disease as well as priority syndromes. They use a simpler version of the U and P messages which does not require the differential diagnosis required of Dinas staff. When Pelsa report disease from the field their message to iSIKHNAS prompts an automatic alert to the Dinas staff with responsibility for that area. Dinas staff must respond efficiently to these reports and then report the response (telephone call or visit) to iSIKHNAS. Failing to respond to these reports will threaten the strength of the system in your area.

While both Pelsa and Dinas staff can send U and P messages, there is one clear difference between the format of these two messages. Most Dinas field staff will be required to offer an opinion of what the problem is likely to be (differential diagnoses) and the message will not be accepted until this information is included.

So, the Pelsa format for a U (General Signs) alert looks like this

U [sign,sign...] [species] [number of animals] {location}

The Dinas format for a U (General Signs) alert looks like this

U [sign,sign...] [species] [number of animals] {location} {differential diagnosis,differential diagnosis...}

Routine general signs report

U [sign,sign...] [species] [number of animals] {location}

• Use CKT [name of sign] to look up a general sign codes.
• Use Kode SP to look up species codes.
• Use CKL [name of location] to look up the location code for a village.

Priority Syndrome report

P [syndrome] [species] [number of animals] {location}

• Use Kode SIN to look up a syndrome code
• Use Kode SP to look up species codes.
• Use CKL [name of location] to look up the location code for a village.

No priority syndromes sighted

PNEG

Pelsa are the only reporters to use this message.

Useful links

• Pelsa Training module
• Pelsa User Manual