Surveillance course participant/id

Mengenai panduan ini

Panduan ini terdiri atas ikhtisar singkat mengenai judul-judul sesi dan konsep-konsep utama dari kursus pelatihan tentang Surveilans.

Salinan dari panduan ini akan disediakan bagi setiap peserta yang menghadiri pelatihan Surveilans.

2014 Pedoman Teknis Surveilans Penyakit Hewan Menular (Technical guidelines for infectious animal disease surveillance) berperan sebagai buku referensi lengkap untuk kursus pelatihan ini, dan akan disediakan untuk seluruh peserta.

Panduan ini disusun menurut judul-judul sesi yang didasarkan pada urutan dan isi sesi pengajaran dalam suatu pelatihan tiga hari yang telah disiapkan untuk menyampaikan bahan ajar.

Sesi 1 Sambutan dan Pengantar

Struktur pelatihan

            Sesi           Judul sesi

            Sesi 1       Sambutan dan Pengantar            

            Sesi 2         Ikhtisar Surveilans

            Sesi 3         Tujuan-Tujuan Surveilans

            Sesi 4         Pengukuran Penyakit

            Sesi 5         Survei Terstruktur

            Sesi 6         Nilai agregasi surveilans dan kumpulan/ternak sentinel

            Sesi 7         Surveilans laboratorium, surveilans sindromik dan pelaporan negatif

            Sesi 8         Sistem pelaporan peternak (1)  

            Sesi 9         Sistem pelaporan peternak (2)    

            Sesi 10       Sistem pelaporan peternak (meningkatkan tingkat pelaporan); Pendekatan partisipatif terhadap surveilans

            Sesi 11       iSIKHNAS dan perannya dalam surveilans           

            Sesi 12       Evaluasi, Kesimpulan dan Penutupan Kursus            

Pengantar

Kursus ini dikembangkan sebagai bagian dari Kemitraan Australia-Indonesia untuk program Penyakit Menular yang Baru Muncul untuk meningkatkan pengumpulan, pengelolaan dan penggunaan informasi kesehatan hewan guna meningkatkan kapasitas pengendalian dan pencegahan penyakit yang efisien.

Pelatihan tentang surveilans ini dikembangkan untuk pelatihan para staf yang berperan dalam pengambilan keputusan terkait kegiatan-kegiatan surveilans, termasuk pula perencanaan dan pelaksanaannya.

Dampak keseluruhan dari peningkatan dalam pengendalian dan pencegahan penyakit hewan ini adalah tingkat kesehatan dan kesejahteraan masyarakat yang lebih baik.

Apa yang akan kita pelajari dalam pelatihan ini?

Selama tiga hari ke depan, kita akan membicarakan tentang:

• pendekatan yang berbeda-beda terhadap surveilans kesehatan hewan

• sistem pelaporan peternak, dan bagaimana hal ini dapat ditingkatkan

• mengakses hasil-hasil iSIKHNAS untuk digunakan dalam perencanaan, pengelolaan dan analisis kegiatan-kegiatan surveilans.

Dengan mempelajari setiap bidang ini, peserta akan memperoleh keterampilan baru.

Apa yang akan dapat anda lakukan di akhir dari pelatihan ini?

Peserta diharapkan dapat memahami pendekatan yang berbeda-beda terhadap surveilans penyakit hewan dan mampu menggunakan pengetahuan ini untuk berkontribusi pada surveilans yang efektif terhadap permasalahan kesehatan hewan demi hewan ternak dan pemiliknya di Indonesia.

Sesi 2: Ikhtisar mengenai Surveilans

Konsep-Konsep Utama

Surveilansadalah pengumpulan dan analisis infomasi yang sistmatis dan berkelanjutan terkait penyakit dan pendistribusian informasi yang tepat waktu untuk tujuan pengambilan keputusan yang sesuai

Proses surveilans melibatkan beragam langkah.

Data surveilans digunakan oleh para pembuat keputusan dalam berbagai aspek di pekerjaan mereka.

Surveilans adalah LEBIH dari sekedar mengamati penyakit saja.

Informasi surveilans bukan merupakan sesuatu yang bernilai kecuali masyarakat yang memerlukan informasi tersebut diberitahukan dan mereka dapat bertindak secara sesuai.

Berikut adalah langkah-langkah dalam proses surveilans:

1. mengetahui penyakit
2. melaporkan temuan-temuan
3. menyimpulkan dan menganalisis data
4. menghasilkan hasil yang kemudian diinterpretasikan
5. mengambil keputusan-keputusan berdasarkan data dan interpretasinya.

Kita sangat beruntung karena saat ini seluruh langkah menengah (pelaporan, penyimpulan dan analisis, persiapan hasil) dapat dikerjakan oleh iSIKHNAS.

iSIKHNAS adalah sistem informasi kesehatan hewan Indonesia yang baru. Sistem ini menggunakan teknologi sehari-hari secara sederhana namun cerdas, untuk mengumpulkan data dari lapangan dan segera menyediakannya bagi para pemangku kepentingan dalam bentuk yang siap digunakan dan bermakna.

Baca lebih lanjut tentag bagaimana informasi surveilans digunakan dalam Pedoman Teknis Surveilans Penyakit Hewan Menular, hal 5-6.

Sesi 3: Tujuan-tujuan surveilans

Video

[Tautan YouTube Sesi 3 Tujuan-Tujuan Surveilans]

Konsep-Konsep Utama

Tujuan-tujuan surveilans dapat dikelompokkan ke dalam dua kategori: surveilans pada penyakit-penyakit yang memang sudah ada dan surveilans pada penyakit-penyakit yang tidak ada.

Setiap kegiatan surveilans harus memiliki suatu tujuan yang spesifik Tidak ada negara yang mampu melakukan surveilans tanpa adanya tujuan, atau hanya berdasarkan keinginan melakukannya saja.

Ada banyak alasan dilakukannya surveilans, tetapi mereka dapat dikelompokkan ke dalam dua kategori utama, masing-masing memiliki dua sub-kategori, seperti yang ditunjukkan dalam diagram di atas.

Melakukan surveilans terhadap penyakit-penyakit yang memang sudah ada mudah untuk dimengerti. Memahami seberapa banyak penyakit yang kita miliki, dan dimana saja, merupakan sesuatu yang penting. Para pengambil keputusan harus memutuskan berapa anggaran yang dibutuhkan untuk kegiatan-ekgiatan pengendalian penyakit, dan dimana anggaran tersebut akan digunakan. Menemukan setiap kasus dari sebuah penyakit tertentu menjadi sesuatu yang sangat penting di akhir dari program pemberantasan yang dicanangkan, atau dimana keberadaan penyakit tersebut adalah sangat penting untuk alasan-alasan kesehatan masyarakat (seperti rabies).

Melakukan surveilans terhadap penyakit-penyakit yang tidak kita miliki terkadang terlihat tidak terlalu penting, namun kita perlu melakukannya guna mengkonfirmasi bahwa penyakit tersebut memang tidak ada, atau untuk menemukannya lebih dini jika penyakit tersebut sampai masuk.Sekali lagi, pengetahuan ini sangatlah penting bagi para pengambil keputusan, yang perlu mengetahui apabila mereka dapat menghentikan program-program pengendalian berbiaya besar yang tidak lagi dibutuhkan. Kadang-kadang, dengan menunjukan tidak adanya penyakit dapat membuka kesempatan baru dalam bidang perdagangan.

Sesi 4: Pengukuran penyakit

Video

[Tautan internet]

Konsep-Konsep Utama

Definisi kasus

Tanda dan sindrom

Tanda: hal-hal yang dapat diukur atau diamati tentang kesehatan hewan yang bersangkutan

Sindrom: kumpulan tanda

Pengukuran penyakit

Prevalensi: "potret" jumlah penyakit yang ada pada sebuah populasi di satu titik tertentu pada suatu waktu tertentu.

Insiden: kasus-kasus baru dari suatu penyakit yang terjadi di sebuah populasi di dalam satu periode waktu tertentu (ada beberapa jenis pengukuran).

Ketika kita mengukur suatu penyakit, kita harus memastikan bahwa semua orang membicarakan hal yang sama. Inilah mengapa kita menggunakan istilah definisi kasus, karena hal ini memberikan kita sebuah standar kriteria untuk memutuskan apa yang disebut kasus dan apa yang tidak Kriteria untuk sebuah definisi kasus dapat berdasarkan satu atau lebih tanda-tanda klinis, atau informasi lain mengenai situasi yang bersangkutan (data epidemiologis), atau data laboratorium, atau kombinasi dari hal-hal tersebut.

Prevalensi adalah pengukuran terhadap seberapa besar penyakit ada di dalam sebuah populasi pada suatu waktu tertentu. Pengukuran ini menggunakan jumlah kasus (yang ditentukan menggunakan definisi kasus yang sesuai) DAN "populasi berisiko", yang adalah jumlah hewan (atau kumpulan, atau kawanan, atau desa, atau yang digunakan oleh definisi kasus) yang bisa menjadi kasus.

Insiden memberitahukan kepada kita tentang seberapa cepat penyakit beredar di dalam suatu populasi. Disini kita menghitung jumlah kasus baru yang terjadi dalam satu waktu tertentu. Jika kita tidak menyertakan informasi tentang populasi berisiki, maka pengukuran kita adalah hanya tentang insiden. Jika kita menyertakan populasi berisiko di awal dari periode waktu, maka hal ini adalah insiden kumulatif. Jika kita memiliki lebih banyak informasi tentang seberapa kali tepatnya setiap anggota populasi berada dalam risiko selama periode waktu tersebut kemudian kita dapat menghitung tingkat insiden.

Sesi 5 Survei terstruktur

Key concepts

Structured surveys are a way of gathering information about individuals. A sample of the population is studied.

A representative survey is one where every element in the population has the same chance of being sampled. Representative surveys are very good for estimating disease prevalence.

A risk-based survey is one where certain elements of the population are much more likely to be sampled than others. This is useful when you want to show evidence of absence of disease. Resources are allocated to look hard for disease where it is likely to be.

A survey is a data collection tool used to gather information about individuals. There are many, many types of survey. Surveys collect information from a subset or sample of the population.

A representative survey is arranged so that every element of the population has the same chance of being selected for the survey. These types of surveys have to be carefully planned, to make sure that this is the case. Representative structured surveys are particularly good for providing unbiased estimates of prevalence (how much disease is present).

Sometimes you do not want every element of the population to have an equal chance of being selected. Sometimes, you want to find disease, if it is there. Surveys like this are called "risk-based", because high-risk sites or individuals are more likely to be sampled than are low-risk ones. These types of surveys cannot provide unbiased estimates of prevalence. They can also provide good evidence for disease freedom. The planning and analysis of risk-based surveys needs expert advice.

Conducting a survey is less expensive than doing a census, where every member of the population is studied. Because you have control over the design of a survey, you control the quality of the data. Surveys can be repeated, to see how the situation changes over time

Session 6 Aggregation point surveillance, and sentinel herds/flocks

Key concepts

Aggregation point surveillance

This is surveillance that is conducted at places where animals are brought together for other reasons, such as abattoirs or markets. Many animals can be sampled. However, you do not have control over the number, type, or origin of the animals available for sampling, and the animals may not be completely representative of the population.

Sentinel surveillance

Sentinel herd or flock surveillance involves the repeated testing of susceptible animals that are located in an area of high importance. This type of surveillance only suits certain diseases (for example, vector-borne diseases), and tends to be very expensive.

Aggregation point surveillance is conducted at places where animals are brought together, such as at abattoirs, livestock markets, or dipping facilities. Animals that are sent to the aggregation point tend to be healthier than the general population, so the results may show a ‘healthy animal bias’. If disease is found in any of the samples, it can be hard to trace back to find where the animal came from. Aggregation point surveillance can provide estimates of prevalence of certain diseases (recognising the possibility of bias). It can provide a way of monitoring the progress of a disease control program. Aggregation point surveillance can also assist in providing confidence in freedom from certain diseases.

Sentinel herd or flock surveillance involves the repeated testing of a group of susceptible animals that are strategically located in an area of high risk or importance. Sentinel herd surveillance tends to be very expensive, and not very well-liked by farmers, as the repeated sampling can be inconvenient for them, and they must keep the same animals for a long time. However, it can provide very good information about the presence or absence or spread of certain diseases in the area where the herd or flock is located.

Session 7 Laboratory surveillance, syndromic surveillance, and negative reporting

Key concepts

Laboratories do more than process samples collected as part of active surveillance activities. They are also a source of passive surveillance data.

Syndromic surveillance is the analysis of reported signs or syndrome data, looking for unusual patterns.

The absence of reports of priority disease could mean no disease present, but could also mean that no one was looking. Submission of a negative report confirms the absence of priority disease in the reporter's area.

Syndromic surveillance and negative reporting are particularly useful for priority diseases.

iSIKHNAS makes collecting and analysing passive surveillance data very easy.

Passive surveillance data comes from activities that are conducted for purposes other than surveillance. Active surveillance consists of activities that are conducted for the purpose of obtaining surveillance data. Passive surveillance data can be very useful, and is usually quite inexpensive compared to the cost of active surveillance. Data from laboratory submissions from disease investigations is passive surveillance data. Analysis of the information accompanying a laboratory submission along with the investigation results can form an important part of a country’s animal health surveillance system. If information about the signs or syndrome affecting the animals is collected, analysis of these data for trends and patterns can be performed, and this is called syndromic surveillance. Syndromic surveillance is very useful for early warning of the incursion of important diseases that we do not have, and is also good for providing evidence of absence of important diseases.

However, absence of reports of signs or syndromes consistent with priority disease could just mean that no one was looking for disease (absence of surveillance!). However, submission of a negative report confirms that the surveillance system is operational and that priority diseases were not observed.

Session 8 Farmer reporting system (1)

Key concepts

The farmer reporting system is a passive surveillance approach that relies on farmers observing sick animals and seeking help from para-veterinarians or veterinarians.

It has comprehensive coverage of the population.

Good for detecting disease, providing evidence of disease freedom, and case-finding for disease with obvious clinical signs.

The basic steps in the farmer reporting system are:

• animal becomes sick

• farmer notices sick animal

• farmer decides to get help

• farmer contacts para-veterinarian or veterinarian

• para-veterinarian or veterinarian examines animal (disease investigation)

• samples collected and submitted (sometimes)

• information about case are recorded

Surveillance information is of no value unless people who need to know about it are informed and can act on it, so this last step is very important. Fortunately, iSIKHNAS means that information can be recorded quickly and easily, and becomes immediately available to those who need to know about it.

The farmer reporting system is continuous and ongoing. It has excellent population coverage, and because it is a passive surveillance system, there are few costs associated with the generation of the surveillance data. This system is one of the best ways of finding out about new or emerging diseases, and it can provide good evidence for freedom from disease. It can also be good for finding cases of disease. However, it is not particularly useful for determining prevalence of disease, although it can provide some idea about changing levels of disease in an area.

Session 9 Farmer reporting system (2)

Key concepts

There are multiple steps between an animal becoming sick and submission of disease reports.

Considering these steps helps us to determine what affects farmer reporting.

iSIKHNAS handles the passive surveillance data from the farmer reporting system very well.

Farmers are not all equally likely to notice and report disease. This is why the farmer reporting system cannot give truly reliable estimates of disease prevalence. A low number of disease reports might mean that there is not much disease in the area, or it could mean that a new veterinarian or para-veterinarian is working in the area, and the farmers do not yet trust this person.

The farmer reporting system will not be very good at detecting disease if farmers are reluctant or unable to report disease to the veterinary authorities. A very important part of this workshop is the work that your group will be doing in thinking about the factors that might affect farmer reporting. Here are some reasons it is worthwhile trying to improve the farmer reporting rates:

• Indonesia is very fortunate, because iSIKHNAS captures information about all farmer disease reports, not just the ones that result in laboratory submissions.

• The information from field and laboratory submissions is linked, so field diagnoses can easily be confirmed or updated.

• Reporting is standardised. Everyone submitting to iSIKHNAS records data in the same way, so data can be compared from all over the country.

• Summary and analysis is instantaneous. Data is available right away to those who need it, in a form they can use.

Improving farmer reporting rates will help give iSIKHNAS more data to work with.

Session 10 Farmer reporting system (improving reporting rates); Participatory approaches to surveillance

Key concepts

Participatory approaches to surveillance can be very good for detecting cases of disease or contributing to evidence of disease freedom.

Extensive and ongoing training is needed for the practitioners, and this can be expensive.

Managing and making use of the surveillance information can be difficult.

Principles of participatory approaches:

• farmers have valuable technical knowledge

• visitors ("technical experts") are not familiar with local situations

• flexibility in approach is important - must adapt to suit individual circumstances

• social context of a disease is important

• information is collected in a variety of ways, then cross-checked.

Participatory approaches use participatory methods, which are a set ("toolbox") of excellent communication skills and strategies, and include:

• semi-structured interviewing

• focus-group discussions

• ranking and scoring activities

• visualisation techniques.

Participatory approaches to disease surveillance involve the use of participatory methods in disease surveillance activities.

Session 11 iSIKHNAS and its role in surveillance

Key concepts

iSIKHNAS is Indonesia's integrated real-time information system for collecting, managing, reporting and using data to support animal health and production.

iSIKHNAS gets the right information, at the right time, to the right people, in the right form to enable good evidence-based decision-making.

iSIKHNAS belongs to the Government of Indonesia.

Wiki (documentation) - www.isikhnas.com/wiki

Online data access - www.isikhnas.com

There are many ways to get data into and out of iSIKHNAS, including: SMS, instant messaging, web browser, email.

There is immediate access to the data for all registered users (except farmers who only have access to their own data, for privacy).

The automated output reports can be customised for different needs. Users get the data they need for their job, when they need it.

The focus of this session is exploring iSIKHNAS, so that you can find the information you need. And if you need reports that are not currently available, we will request that these be created for you.