ELEMEN-ELEMEN

SURVEILANS
EPIDEMIOLOGI

Surveillance
Surveillance is the ongoing,
systematic collection, analysis and
interpretation of data; and
dissemination of information to
those who need to know in order
that action may be taken

3 elemen dasar Program surveilans

The ongoing
- Collection
- Analysis
- Feedback or disemination of data
(Eylenboosch and Noah, 1988)

Surveillance: General principle

Health Care System

Public Health Authority

Reporting

Data

Information

Analysis &
Interpretation

Evaluation

Feedback
Action

Decision

Surveillance: Data
Health Care System

Public Health Authority

HEALTH EVENT
Information

Disease
Syndrome (e.g., AFP, jaundice, VHF)
Public health issue (e.g., AMR)
Environment (e.g., animal vector, water)

Action

Decision

Surveilans: DATA2
Health events
contoh :
Disease DBD
Syndrome sindrom dari DBD adalah penurunan kadar
trombosit darah, panas tinggi di hari ke 1-2, panas turun
pada saat kritis di hari ke 3-4, lalu panas lagi saat masa
pemulihan di hari 5-6.
Public health issue Perubahan iklim adalah salah
satu ancaman kesehatan masyarakat paling serius
Enviroment DBD nyamuk aedes aegypty (vektor)

Surveillance: Data
Health Care System

DATA SOURCE
Notifiable disease reporting system

Public Health Authority

Information

Vital statistics
Survey
Laboratory

Action

Decision

Surveillance: Data
Health Care System

Public Health Authority

CASE DEFINITION
Clinical/laboratory

Information

Levels (suspected, probable, confirmed)

Indicators

Action

Decision

Report

Pos. specimen

Clinical specimen
Seek medical attention
Disease
Infected
Exposed

Case Definition

Important to clearly define condition

Ensures same criteria are used by all
Makes the data more comparable
Include person, place, time
May define suspected and confirmed
cases
May include symptoms, lab values,
time period, population as appropriate

Case Definition Examples

Weak Definition - Measles

Any person with a rash and fever, runny nose, or

conjunctivitis

Better Definition - Measles

Any person with a fever >101 F, runny nose,

conjunctivitis, red blotchy rash for at least 3 days,
and laboratory confirmation of IgM antibodies

Clinical, Probable, Confirmed Case Definitions

Outbreak Case Definition
Differs from routine surveillance
Epidemiologically linked cases often included

Surveilans: DATA5
Case Definition2
Unsur-unsur dari suatu definisi kasus yaitu:
Kriteria untuk waktu, tempat, dan orang
Diagnosis klinis dan laboratories
Hal-hal epidemiologi penyakit
Derajat diagnosis mengenai hal tertentu
(confirmed, suspect, probable)
Tinggi sensitifitas dan spesifisitas

Surveillance: General principle

Health Care System

Public Health Authority

Reporting

Data

Information

Analysis &
Interpretation

Evaluation

Feedback
Action

Decision

Surveillance: Reporting
Health Care System

Data

Public Health Authority

Reporting
frequency

Information

immediate
weekly
monthly ...

Action

Decision

Surveillance: Reporting
Health Care System

Data

Public Health Authority

Reporting
methods

Information

Paper
Telephone, Fax
E-mail ...

Action

Decision

Surveillance: Data flow

Clinical (suspected)

Peripheral level

+ Supportive
laboratory data +
epidemiological link
(probable)

Intermediate level

Central level

Regional/International level

Ministry
of Health

Diagnostic
Laboratory
(confirmed)

Regional reference laboratory

WHO

Surveillance: Tasks
Detect
Treat
Report

Peripheral level

Analyse
Investigate
Report
Respond
Feedback

Intermediate level

Central level

Regional/International level

Ministry
of Health

WHO

Analyse
Investigate
Confirm
Respond
Plan and Fund
Feedback
Analysis and feedback
Support
Policy and targets
Funding

Surveillance: General Principle

Health Care System

Public Health Authority

Reporting

Data

Information

Analysis &
Interpretation

Evaluation

Feedback
Action

Decision

Surveillance: Analysis & Interpretation

Health Care System

Data

Public Health Authority

Data characteristics
Data validation
Descriptive analysis
Hypothesis generation

Action

Decision

Surveillance: Analysis & Interpretation

Health Care System

Data

Public Health Authority

Data characteristics

Various sources of notifications

Various levels of quality

Continuous data collection subject to
change

Action

Decision

Surveillance: Analysis & Interpretation

Health Care System

Data

Public Health Authority

Data validation
Missing values
Bias
Duplication

Action

Decision

Surveillance: Analysis & Interpretation

Health Care System

Data

Public Health Authority

Descriptive analysis
Time
Place
Persons

Action

Decision

Surveillance: Analysis & Interpretation

Health Care System

Data

Public Health Authority

Hypothesis generation
related to time
related to place
related to persons

Action

Decision

Surveillance: General Principle

Health Care System

Public Health Authority

Reporting

Data

Information

Analysis &
Interpretation

Evaluation

Feedback
Action

Decision

Surveillance: Action
Health Care
System

Data

Public Health Authority

Information

Control
Feedback
Policy

Decision

Surveillance: Action
Health Care
System

Public Health Authority

Information

Data

Control
Rapid response
Case management
Prevention
immunization)

(e.g.
Decision

Surveillance: Action
Health Care
System

Data

Public Health Authority

Information

Feedback
Epidemiological bulletin
Reports
Website, others

Decision

Surveillance: Action
Health Care
System

Data

Public Health Authority

Information

Policy
Policy change
Prediction, planning
Epidemic preparedness
Decision

Surveillance: Action
Health Care
System

Data

Public Health Authority

Information

Evaluation
results of action
results of surveillance

Action

Decision

Surveillance: General Principle

Health Care System

Public Health Authority

Reporting

Data

Information

Analysis &
Interpretation

Evaluation

Feedback
Action

Decision

Surveilans: Evaluasi1
Terdapat beberapa aspek yang perlu diperhatikan
dalam evaluasi sistem surveilans, yaitu:
Tingkat Kepentingan Ditinjau dari Kesehatan
Masyarakat
Tujuan utama dari surveilens dan kegunaanya
Atribut Kualitatif
Atribut Kuantitatif
Biaya

Surveilans: Evaluasi2
Beberapa ukuran dalam menilai tingkat pentingnya suatu
fenomena kesehatan :
Besaran masalah jumlah keseluruhan kasus, insidens,
dan prevalens.
Tingkat keparahan case fatality rate dan angka
kematian.
Tingkat kesakitan kunjungan dokter dan hari rawat.
Kematian prematur
Biaya ekonomi biaya pelayanan kesehatan, biaya
kehilangan produktivitas
Preventability tingkat usaha pencegahan yang bisa
dilakukan.

Indikator

Surveilans: Indikator
Specific (spesifik)
Measurable (dpt diukur)
Action oriented (orientasi pd aksi)
Realistic (realistis)
Timely (tepat waktu)

Indikator Penyakit
Ukuran yang digunakan untuk
memonitor sebuah penyakit adalah
Angka/jumlah kasus
Rate
Proporsi

Contoh :
Angka/ jumlah kasus
Jumlah kasus malaria yang dilaporkan
Jumlah kasus malaria P. falciparum yang
dilaporkan
Rate
Jumlah kasus ISPA pada Balita per
100,000 penduduk
Proporsi
Proporsi Balita dengan ISPA yang
meninggal

Indikator Penyakit
Dapat merupakan indikator dari
Insidens penyakit
Kasus TB per 100,000 penduduk
Keefektifan (effectiveness) dari pengobatan
Case fatality rate pada campak

Sumber Data

10 sumber data untuk sistem surveilans sesuai

anjuran WHO (Kelsey,47) :
1. Registrasi mortalitas
2. Laporan morbiditas
3. Laporan epidemiologi
4. Investigasi laboratorium
5. Investigasi kasus individu
6. Investigasi lapangan epidemik
7. Survey
8. Studi reservoir binatang dan distribusi
vektor
9. Penggunaan biologik dan obat
10.Pengetahuan populasi dan lingkungan

Sumber data dalam surveilans

(Kepmenkes RI No.1116/Menkes/SK/VIII/2003) :
Data kesakitan unit pelayanan kesehatan dan masyarakat.
Data kematian unit pelayanan kesehatan serta laporan kantor
pemerintah dan masyarakat.
Data demografi unit statistik kependudukan dan masyarakat
Data geografi unit unit meteorologi dan geofisika
Data laboratorium unit pelayanan kesehatan dan masyarakat.
Data kondisi lingkungan
Laporan wabah
Laporan penyelidikan wabah/KLB
Laporan hasil penyelidikan kasus perorangan
Studi epidemiology dan hasil penelitian lainnya
Data hewan dan vektor sumber penular penyakit unit
pelayanan kesehatan dan masyarakat.
Laporan kondisi pangan

Manfaat data surveilans

1. Menyajikan estimasi kuantitatif
besar masalah kesehatan
2. Menggambarkan riwayat alamiah
penyakit
3. Mendeteksi epidemik
4. Pendokumentasian distribusi dan
penyebaran peristiwa kesehatan

Manfaat data surveilans

5. Memfasilitasi riset epidemiologik
dan laboratorium
6. Pengujian hipotesis
7. Evaluasi ukuran pemberantasan dan
pencegahan
8. Pemantauan perubahan agen
infeksius
9. Deteksi perubahan dalam praktek
kesehatan
10.Perencanaan

Masalah Data
Tidak tersedianya atau kesulitan
memperoleh data yang diinginkan
Data tidak lengkap
Ketidakserasian data yang diperoleh
dari berbagai sumber
Kemungkinan bias/kesalahan
Banyak kasus dengan fenomena
gunung es (iceberg phenomen)

Sumber Daya
Berdasarkan Kepmenkes RI
No.1116/Menkes/SK/VIII/2003

Sumber Daya Manusia

a. Tenaga ahli epidemiologi (S1,S2,S3).
b. Tenaga pelaksana surveilans epidemiologi terlatih
asisten epidemiologi lapangan, dan petugas
puskesmas terlatih surveilans epidemiologi.
c. Manajer unit kesehatan yang mendapat orientasi
epidemiologi
d. Jabatan fungsional epidemiologi.
e. Jabatan fungsional entomologi
f. Jabatan fungsional sanitarian
g. Jabatan fungsional statistisi
h. Sumber daya manusia laboratorium
i. Sumber daya manusia lainnya yang terkait

Sarana
a. Jaringan elektromedia
b. Komunikasi (telepon, faksimili, SSB dan
telekomunikasi lainnya)
c. Komputer dan perlengkapannya
d. Referensi surveilans epidemiologi, penelitian dan
kajian kesehatan
e. Pedoman pelaksanaan surveilans epidemiologi
dan program aplikasi komputer
f. Formulir perekaman data surveilans epidemiologi
sesuai dengan pedoman (kab/kota,puskesmas dan
RS)
g. Peralatan pelaksanaan surveilans
h. Sarana transportasi

Pembiayaan

APBN
APBD Kabupaten/Kota
APBD Propinsi
Bantuan Luar Negeri
Bantuan Nasional dan Daerah
Swadaya masyarakat

Terima kasih