A Module of the Technical Guidelines for Integrated Disease Surveillance
and Response in the African Region

This document was prepared by WHO Regional Office for Africa (AFRO), Harare, Zimbabwe, in collaboration with the Centers for Disease Control and Prevention (CDC), Atlanta, USA, and supported by USAID.

Developed by:
Wondi Alemu, MD, MPH, Chief IDSR Unit CSR, WHO African Regional Office (AFRO)
Mac W. Otten Jr, MD, MPH, Medical Epidemiologist, Global Immunization Division (CDC)
Helen Perry, MA, Educational Design Specialist, Division of Bacterial and Mycotic Diseases (CDC)

We gratefully acknowledge the contributions of the following organizations within WHO and CDC:

World Health Organization (WHO) Division of Communicable Disease Surveillance and Response (CSR)
World Health Organization Regional Office for Africa ( WHO/AFRO) Division of Prevention and Control of Communicable Diseases
	Communicable Disease Surveillance and Response (CSR) Vaccine Preventable Diseases (VPD) Tuberculosis Control Programme (TUB) Other Tropical Disease Control Programme (OTD) Leprosy Control Programme (LEP) Integrated Management of Childhood Illnesses Programme (IMCI) Regional Programme on AIDS (RPA) Roll Back Malaria/Malaria Control Programme (RBM/MAL)
Centers for Disease Control and Prevention (CDC) Epidemiology Program Office
	Division of International Health
National Center for Infectious Diseases
	Division of Bacterial and Mycotic Diseases
		Meningitis and Special Pathogens Branch Foodborne and Diarrhoeal Diseases Branch
	Division of Parasitic Diseases Division of Vector-borne Infectious Diseases
National Center for HIV, STD, and TB Prevention
	Division of HIV/AIDS Prevention, Surveillance and Epidemiology Division of Sexually Transmitted Disease Prevention Global AIDS Program
National Immunization Program
	Global Immunization Division
Office of Global Health

Cover design by: Diane Speight
Production management: Jeanette St. Pierre

HEALTH FACILITIES AND DISTRICT TEAMS SHOULD ROUTINELY Analyze the routine summary data for priority diseases that are reported to the district. Record the summary totals for each priority disease on a table and plot the total on the line graph. Observe trends on the line graph to see if they are increasing, decreasing or staying the same. Interpret the trends and refer to the technical guidelines for appropriate disease control and response actions.

MALARIA
	Reported <5 years old in-patient malaria cases and deaths
	Reported <5 years old in-patient malaria with severe anaemia
	Reported 5+ years old in-patient malaria cases and deaths
	Out-patient uncomplicated malaria cases
	Reported lab-confirmed out-patient uncomplicated malaria cases
PNEUMONIA
	Reported <5 years old in-patient pneumonia cases and deaths
	Reported <5 years old out-patient pneumonia cases
DIARRHEA
	Reported <5 years old in-patient diarrhea cases and deaths
	Reported <5 years old out-patient diarrhea cases
CHOLERA
	Reported total in-patient and out-patient cholera cases and deaths
DIARRHEA WITH BLOOD
	Reported in-patient diarrhea with blood cases and deaths
	Reported outpatient diarrhea with blood cases
MEASLES
	Reported total in-patient and out-patient measles cases
MENINGITIS
	Immediately-reported meningitis cases by week to detect N. meningiditis outbreaks in high risk districts
SEXUALLY TRANSMITTED INFECTIONS
	Male and female non-vesicular genital ulcer cases
	Male urethral discharge cases
HIV AND AIDS
	Reported new in-patient AIDS cases and deaths
	Reported new out-patient AIDS cases
	Number of first visit antenatal attendees and number accepting HIV testing for prevention of maternal-to-child transmission
	HIV seroprevalence from HIV testing for prevention of maternal-to-child transmission
TUBERCULOSIS
	Reported pulmonary smear + cases and treatment failures
	Reported new pulmonary smear+ cases by age group
	TB person analysis
LEPROSY
	Reported new leprosy cases
	Leprosy analysis and quality of surveillance program
ANALYZE THE DATA
	Each month or quarter: Analyze the inpatient and outpatient data for each disease separately. In-patients are more likely to have severe disease, and the diagnosis is often more accurate. Many disease control programs have objectives to reduce severe cases and deaths. Thus, information from analysis of inpatient data is more accurate for evaluating whether the disease control program is working.
	1.1	Review the updated graphs and tables and make sure they are complete and up-to-date.
	1.2	Compare the current information for each priority disease with previous months, seasons, or years.
	1.3	Decide if:
		The number of cases and deaths for each disease is the same, higher or lower than in previous months, seasons, or years. The case fatality rate is the same, higher or lower than in previous months, seasons or years. An action threshold has been reached that requires immediate action. Refer to the national technical guidelines for integrated disease surveillance for disease-specific action thresholds.
	1.4	Consider non-disease reasons for any increase or decrease in the data. For example, is the increase or decrease due to:
		A new health facility or hospital has opened in the catchment area resulting in a change in referral patterns. New clinicians in the area are using different diagnostic criteria or case definitions. Data recording errors A change in the number of health facilities reporting information. A seasonal variation. A change in screening or treatment programs that accounts for an increase in the number of people seeking care. A recent immigration or emigration or increase in refugee population. A change in the quality of services being offered at the health facility. For example, drugs are reliably available, lines are shorter, health workers are more helpful.
	1.5	Refer to disease-specific considerations to interpret any increase or decrease in the data. Also refer to the national technical guidelines for integrated disease surveillance and response.