RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / Name of the candidate and address /Dr. KARTHIK.C
POST GRADUATE STUDENT
DEPT OF COMMUNITY MEDICINE BANGALORE MEDICAL COLLEGE RESEARCH INSTITUTE
BANGALORE-02
2. / Name of the institution / BANGALORE MEDICAL COLLEGE AND RESEARCH INSTITUTE, BANGALORE
3. / Course of study and subject / MD Community Medicine
4. / Date of admission of the course / 23/08/2013
5. /
Title : Clinico-epidemiological study of communicable diseases covered under Integrated Disease Surveillance Project (IDSP) among inpatients in the paediatric ward of Vani Vilas Hospital, BMCRI, Bangalore.
6. Brief resume of the intended work
6.1 Need for the study:
India, the second most populous country with 1.21 billion of the world’s population,1 is plagued by a multitude of infectious diseases. It is further darkened by a high poverty rate of 37.2%, poor sanitation and relative inaccessibility to health care and preventive services.2 Surveillance is the continuous scrutiny of the factors that determine the occurrence and distribution of disease and other conditions of ill health. It is considered to be the backbone for disease prevention and control. It includes data collection, compilation, analysis, interpretation and distribution for action. Sentinel surveillance is a method of identifying the missing cases and thereby supplementing the notified cases.3
IDSP launched in Nov 2004, is a decentralized state based surveillance programme, wherein weekly disease surveillance data on epidemic prone disease are being collected from reporting units such as subcentres, primary health centres, community health centres, hospitals including government, private sector hospitals and medical colleges.4 By conducting a clinic-epidemiological study of the diseases covered under the integrated disease surveillance project (IDSP) among inpatients in a teaching hospital, the limitations, shortcomings and difficulties as a sentinel surveillance centre can be understood and this information will be utilized for future implementation of the programme.
All tertiary care centres are recognized as sentinel surveillance units but implementation of the programme is difficult due to lack of coordination of reporting system. Not many a study has been conducted to evaluate the sentinel surveillance component of IDSP and hence this study is undertaken.
6.2 Review of literature:
A study conducted in Mayurbanj district in Orissa (1997 to 2002) revealed erratic and untimely submission of reports which proved to be detrimental to the surveillance machinery. A revamped surveillance system with an eye to detect outbreaks in the nascent stages helped to limit the spread. During the study period, it witnessed a marked decrease in the number of outbreaks, due to the implementation of a more efficient surveillance system.5
A study conducted by Integrated Disease Surveillance Project (IDSP) units in Cooch Behar, West Bengal on improvement in IDSP reporting and performance, revealed that out of 56 units for P form return, 15 had no Medical Officers (MO). 20 MOs were untrained and it was proposed to fill the vacancies in the Primary Health Centres with new MOs and complete MOs’ training on IDSP. The Medical Laboratory Technicians were also trained as a result of which reporting status improved year by year. Later, in the year 2011 reporting status scaled up to 96% for S form, 94% for P form, and 100% for L form.6
A study conducted by Srivastava S et. al. in Nainital district of Uttarakhand, India, revealed that the timeliness and completeness of reports reflect the effectiveness of data collection and transmission and a proxy indicator of the alertness of the surveillance system. An alert system will have better timeliness and completeness in its approach towards disease control. It also gives one an idea about the reliability of the data.7
A study done by Krishnan regarding disease surveillance in India dealt with the issues that led to the impedance of surveillance work. The observations of his study showed that central assistance was proportionate to political affiliations, time constraints affected outbreak investigations. ‘Overworked’ clinicians resulted in poor maintenance of medical records like case sheets/prescription slips/provisional diagnosis/etc. At regional level though the labs are strengthened the lab diagnosis is not enhanced & there is increasing dependence on Centre. Frequent transfer/retirements of trained staff as well as insufficient epidemiological analysis proved detrimental to implementation of the programme.8
A study done by the IDSP units in Delhi, proved that the main reasons the disease surveillance activity in the country is not as effective as it should be, is because of the lack of integrity among parallel systems and the existing programmes do not cover non communicable diseases. It also laid emphasis to encompass medical colleges and large tertiary hospitals in the private sector into the reporting system as well as for utilization for laboratory facilities. The laboratory network needs to be improved and there is a need to present clear-cut thresholds for response at each level.9
6.3 Objectives of the study:
1. To conduct a clinico-epidemiological study of the communicable diseases covered under IDSP among the paediatric inpatients of Vani Vilas Hospital.
2. To estimate the burden and outcome of communicable diseases coming under IDSP among paediatric inpatients of Vani Vilas Hospital.
3. To identify gaps in programme implementation and find solutions.
7.1 Materials and methods:
Study design:
Prospective study.
Study area:
Paediatrics ward, Vani Vilas Hospital, Bangalore Medical College and Research Institute (BMCRI), Bangalore.
Study population:
All the patients with communicable diseases covered under IDSP admitted in the paediatrics wards, Vani Vilas Hospital, (BMCRI), Bangalore.
Inclusion criteria:
Records of inpatients of the paediatric ward treated for communicable diseases conditions covered under the IDSP programme .
Exclusion criteria:
1. All the patients admitted and treated for disease conditions that are not covered under IDSP.
2. Cases admitted in the neonatal ward.
Study period:
October 2013 to May 2015
Study sample size:
All the patients with communicable diseases covered under IDSP admitted in Vani Vilas Hospital paediatrics ward from the period of October 2013 to May 2015. An estimated 250 to 350 patients are admitted per month which amounts to an annual census of 2500 to 2600 cases. Communicable diseases account to nearly one half (1250 to 1800) of this number.
Sampling method:
Universal sampling method.
Methodology for data collection:
Data collection will be started after obtaining clearance from the Ethics committee. This is a record based study. Data from all the records and the L (Lab) forms from the laboratory satisfying the inclusion criteria pertaining to the communicable disease henceforth mentioned (malaria, acute diarrheal diseases, typhoid, tuberculosis, measles, polio, meningoencephalitis, hepatitis, leptospirosis, HIV, anthrax, dengue),10 will be collected on a weekly basis (Monday to Sunday) and analyzed every Monday for their completeness and thoroughness in recording and notification.
Methodology for data analysis:
Data will be analyzed using descriptive statistics and chi-square test. Suitable statistical software will be utilized for analysis and will be presented in the form of tables, figures, graphs, diagrams wherever necessary.
7.8 Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so please describe briefly.
No laboratory investigations or interventions will be carried out
7.9 Has ethical clearance has been obtained from your institution in case of 7.8?
8. List of references
1. United Nations development programme [cited 2013 Sep 22 ] URL:http://www.in.undp.org/india/en/home.html
2. Integrated Disease Surveillance Project Government of India, Ministry of Health and Family Welfare. 2012 Oct 4. [cited 2013 Sep 22 ] URL:http://www.idsp.nic.in/
3. Park K. Park’s textbook of preventive and social medicine. 22nd ed.Jabalpur: M/s Banarasidas Bhanot Publishers; 2013. p. 38,90,427.
4. Suresh K. Integrated disease surveillance project (IDSP) through a consultant's lens. Indian J.Prev.Soc.Med 2008 jul-sep;52(3).
5. Monitoring Supervision IDSP [cited 2013 Sep 22] URL:http://www.nic.in/IDSP/MonitoringSupervisionIDSP
6. Glimpses of IDSP works, West Bengal (WB) done by IDSP units in WB 2011. 2012.Team IDSP ,SSU, Swasthya bhavan 2012 Mar 28.
7. Srivastava et al. Completeness and timeliness of reporting under IDSP in rural surveillance unit of Nainital district of Utarakhand,India.2009 jul-dec;p 140-41.
8. Krishnan SK. Disease surveillance in India .National Professional Officer (Communicable Diseases Surveillance) [cited 2013 Sep 22 ] URL:www.indmedica.com/journels/ppt/Dr.s%20krishnan.ppt
9. Orientation workshop handbook. Integrated disease surveillance project(IDSP). Nirman Bhavan, New Delhi: Government of India, Ministry of Health and Family Welfare; 2004. 4 p.
9. / Signature of the candidate10. / Remarks of the Guide / Disease surveillance is essential for disease prevention and control. Teaching hospitals are sentinel surveillance centers. This study is to analyze the surveillance and reporting of communicable diseases among inpatients of pediatric ward. This will help in improving sentinel surveillance under IDSP programme.
11
11.1
11.2 / Name and designation of Guide
Signature /
Dr.Shobha
Assistant Professor
Department of Community Medicine
Bangalore Medical College and Research
Institute, Bangalore.
11.3
11.4 / Head of the Department
Signature /
Dr.Ranganath.T.S
Professor and H.O.D
Dept of Community Medicine
Bangalore Medical College and
Research Institute, Bangalore.
12.1
12.2 / Remarks of the,
Director cum Dean
Signature