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DEVELOPMENT OF DEVELOPMENT OF EARLY WARNING OUTBREAK EARLY WARNING OUTBREAK
RECOGNITION SYSTEMRECOGNITION SYSTEM (EWORS) (EWORS) IN INDONESIAIN INDONESIA
INDONESIA MINISTRY OF HEALTHINDONESIA MINISTRY OF HEALTH
NATIONAL INSTITUTE OF HEALTH RESEARCH AND NATIONAL INSTITUTE OF HEALTH RESEARCH AND DEVELOPMENTDEVELOPMENT
14 Sept 200614 Sept 2006
EARLY WARNING OUTBREAK EARLY WARNING OUTBREAK RECOGNITION SYSTEMRECOGNITION SYSTEM ((EWORSEWORS))
is a hospital (health facility)-based computer
software for collecting and analyzing surveillance
data in order to early detect communicable disease
outbreaks
OUTBREAKS frequently happen in
Indonesia
Often reported lateNews about Outbreaks• Mass media
• Rumors
A health facility, symptom-based early warning system is urgently needed
Real-time, accurate, and responsive
EWORS
EWORS EWORS ……....
•• Is not designed to replace the existing surveillance Is not designed to replace the existing surveillance system, but as a complementing system. system, but as a complementing system.
•• EWORS software is not for commercial purposes.EWORS software is not for commercial purposes.
•• Developed and implemented for the first time in Developed and implemented for the first time in Indonesia.Indonesia.
OBJECTIVES of OBJECTIVES of developing EWORSdeveloping EWORS
To develop a standardized system that :To develop a standardized system that :
1. Able to collect and send real1. Able to collect and send real--time data.time data.
2. Easy to apply (menu driven and users friendly2. Easy to apply (menu driven and users friendly).).
3. Easy3. Easy to be interpreted by health providers (using key to be interpreted by health providers (using key function analysis to early detect the possibility of function analysis to early detect the possibility of outbreaks).outbreaks).
4. Using 4. Using syndromicsyndromic approach, approach, and not diagnosisand not diagnosis, to obtain a , to obtain a more accurate and reliable report.more accurate and reliable report.
5. Not imposing the integrity of health facilities and keeping 5. Not imposing the integrity of health facilities and keeping data confidential.data confidential.
6. Easy to be analyzed, for example, by time (day, week, 6. Easy to be analyzed, for example, by time (day, week, month, and year), by age group, by address, by symptoms, month, and year), by age group, by address, by symptoms, or by syndromes.or by syndromes.
STANDARD EWORS FORMSTANDARD EWORS FORM
Pertama kali merasakan keluhan:_________hari yang lalu
IN INDONESIA since 1998IN INDONESIA since 1998
EWORS NETWORK EWORS NETWORK
9 Implementing Hospitals
* Center for data collection at NIHRD
JAKARTAJAKARTA
MEDAN
PONTIANAKSAMARINDA
BALIKPAPAN
YOGYAKARTA
MAKASSAR
DENPASAR**
SIE
BAT
CHA
MEM
PKM
NPH
EWORS NETWORK IN CAMBODIA
NIPH/ NAMRU-2
SOT
STU
NEA
TAK
PUR
KRA
Planned Sites for 2004/5Current Sites
SIH
Long Xuyen, An Giang ProvinceHo Chi Minh City *
Vietnam
LUANG PRABANG
SAVANAKHET
CHAMPASAK
VIENTIANE*
Cambodia
IN SOUTH EAST ASIAIN SOUTH EAST ASIAEWORS NETWORKEWORS NETWORK
CAMBODIACAMBODIA(9 Hospitals)(9 Hospitals)
LAOLAO VIETNAM VIETNAM (9 Hospitals)(9 Hospitals)
LAO LAO (9 Hospitals)(9 Hospitals)
DIAGRAM ALUR PENGUMPULAN DATAFLOW CHART OF DATA COLLECTION DIAGRAM
Kejang
DehidrasiDemamDiare cairDiare berdarah/lendirGangguan kesadaranHematemesis/melena
IkterusKaku kuduk
KonjuntivitisLumpuhMalaise MenggigilMualMuntahPerdarahan kulitPerubahan warna urinPilekRuam kulitSakit kepalaSakit otot/sendi/tulangSakit perutSakit tenggorokanSesak nafas
Anuria/OligouriaBatukBatuk darahBubo-limfadenitis
Vesikel/bullae
PEDIATRIC OUTPATIENTSOUTPATIENTS
EMERGENCY CARE UNIT
HOST
SITE
(feedback)(feedback)
DinasKesehatan
Propinsi
DinasProvincial Health
OfficeEWORS Secretariat in
NIHRD
Data analysis and result interpretation
Data entry and analysis in health facility
Rumah Sakit/Fasilitas Kesehatan LainnyaHospital / Other health facilities
Fill out the Form
FLOWCHART OF DECISSION MAKING FLOWCHART OF DECISSION MAKING
AT THE CENTRAL LEVELAT THE CENTRAL LEVELData analysis based on :Data analysis based on :
-- Age groupAge group
-- Sex Sex
-- Time groupTime group
DECISSIONDECISSION
Outbreak Outbreak investigationinvestigation
No No investigationinvestigation
Rise in certain cases Rise in certain cases which may reflect the which may reflect the
beginning of an beginning of an outbreak outbreak
TREND ANALYSISTREND ANALYSIS
COMMUNICATION WITH HOSPITALS
COORDINATION MEETING
NIHRD
CDC
HEALTH SERVICE
DATA INTERPRETATIONDATA INTERPRETATION
APPEARANCES OF EWORS FEATURES APPEARANCES OF EWORS FEATURES
Opening page & Entry Opening page & Entry Data pageData page
EWORS data analysis EWORS data analysis facilityfacility
EWORS data are sensitive EWORS data are sensitive they they should be confidential should be confidential
EWORS e-data will only be forwarded to certain persons who are responsible for outbreak control.
EWORS DATA ANALYSESEWORS DATA ANALYSES
Trend / fluctuation of symptoms :
• Yearly for the last five years
• Monthly for the last 12-24 months .
• Weekly for the last 3 – 5 months.
• Daily for the last month.
Examples of outbreaks Examples of outbreaks analysesanalyses
01 January 2005-31 December 2005
Sanglah Hospital
Cough, Fever, CoryzaFeverCoughCough, Fever
Fever 01 January 2005-31 December 2005 Sanglah Hospital
Fever 01 January 2005 - 31 December 2005 Sanglah Hospital
Distribution of fever cases in Bali Province 01 January 2005 – 31 December 2005
5 dominant symptoms Sanglah Hospital, 01 January 2000 – 31 December 2005
FeverCoughCoryzaDiarhheaVomit
5 dominant symptomsSanglah Hospital, 01 January 2002 – 31 December 2005
Fever Cough Coryza Vomit Diarhhea
Cases with fever, petechiae, rash,myalgia/arthralgia, chills and headacheSanglah Hospital, 01 January 2003 – 31 December 2005
FeverFever + (chills and/or headache)Fever + petechiaeFever + (petechiae and/or rash and/or myalgia/arthralgia)Fever + rash
Cases with fever, petechiae, rash,myalgia/arthralgia, chills and headacheSanglah Hospital, 01 January 2003 – 31 December 2005
FeverFever + (chills and/or headache)Fever + petechiaeFever + (petechiae and/or rash and/or myalgia/arthralgia)Fever + rash
Cases with fever, petechiae, rash, myalgia/arthralgia, chills and headacheSanglah Hospital, 01 November 2003 – 31 January 2004
FeverFever + (chills and/or headache)Fever + petechiaeFever + (petechiae and/or rash and/or myalgia/arthralgia)Fever + rash
FeverFever + (chills and/or headache)Fever + petechiaeFever + (petechiae and/or rash and/or myalgia/arthralgia)Fever + rash
Cases with fever + (petechiae and/or rash and/or myalgia)Bali Province, 01 November 2003 – 31 January 2004
Cases with fever + (petechiae and/or rash and/or myalgia)Bali Province, 01 November 2003 – 31 January 2004
Example of mapping. Clustering of cases by geographic areas can be seen.
The smallest unit is sub-districts.
EWORS EWORS sitesite in Dr in Dr PirngadiPirngadi Hospital, Medan, North Hospital, Medan, North SumatraSumatra
Filling up EWORS form in outpatient clinic in Dr Pirngadi Hospital, Medan.
Entering data by EWORS operator in one of the hospital.Entering data by EWORS operator in one of the hospital.
Obstacles(after about 6 years implementation)
• Problems of menpower at the central and provincial levels.
• Sustainability of the program at the provinces, after the pilot project finished (adoption into the existing system).
• Un-optimal utility of EWORS data at the central and provincial level.
• Insufficient information dissemination or promotion on EWORS.
EWORS CONCEPTORS & EWORS CONCEPTORS & PROGRAMMERSPROGRAMMERS
• Andrew Lee Corwin, MPH, DrPH
• Dr Cyrus H. Simanjuntak
• Dra Ria Purwita Larasati, MKes
• Jeffryman Farid, Skom
• Asep Suryadi, Skom
MOH EWORS TEAMMOH EWORS TEAM• Gemala, PhD
• Hadi Siswoyo, MD
• Delima, MD
• Whinnie Lestari, MD
• Armedi, MD Asep Suryadi, Skom
• Handoyo, MD, MPH
• Endang Widyaswati, MD
• Ika Trisia, MD
• Darmawali Handoko, MD
• Meda Permana & Junaedi
THANK YOU FOR YOUR ATTENTION