Section 6.2. Case Reporting, Data Management and Analysis
What this
section
is about
This section discusses sexually transmitted infection (STI) case reporting and the information flow from health facilities through the sub-national and national levels. It also reviews how to handle and analyse data.
Warm-up
questions
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Match the STI data analysis parameter with its description by putting a letter in each blank:
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___ Analysis by place
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a. Annual analysis of data could show an annual trend of disease stratified by age group and gender.
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___ Analysis by time
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b. Analysis to detect if there are any trends in case reports over time and
any inferences that can be made.
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___ Analysis by person
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c. Analysis to provide information about where clustering of disease might be occurring and any inferences that can be made.
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True or false? Interpretation of STI trends should be made independently from STI control programmes and the healthcare system.
True False
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The national level should send STI summary reports to CAREC:
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weekly
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monthly
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quarterly
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annually
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The national surveillance officers are responsible for:
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checking data for inconsistencies
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forwarding the results to the CAREC
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following up with any health facility site that has missing or inconsistent data
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all of the above
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List three ways to handle surveillance data so that patient confidentiality is protected.
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-
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Introduction
What you
will learn
By the end of this section you should be able to:
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describe how to plan your data collection and ensure confidentiality
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describe the flow of data from health facilities to the district and the national level
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discuss the roles and responsibilities of each person involved in data handling at each level
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discuss the analysis of STI data.
Planning Your Data Collection
Data management
system
The national level should develop forms that all sites will use, as well as co-ordinating training. A data management system should be developed at the national level. Clear lines of reporting must be specified. The roles of different workers, from the health facilities or sentinel sites through to the national level, should be clearly defined. The data management system should clearly explain how surveillance officers at both the sub-national and national levels:
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receive data
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record data
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check the data for completeness and consistency.
The national level should also design a method for the submission of the reports by mail, regular direct pick-up from the sites, hand delivery, e-mail, web-based submission and so on.
Confidentiality
and security
All STI surveillance data must be handled to ensure patient confidentiality (the protection of a patient’s personally identifying information) and privacy.
Specifically:
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train staff who record, store and report surveillance data in the importance of privacy and confidentiality of each patient’s data
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develop a written confidentiality policy for your surveillance and STI control programme
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protect the integrity of STI data to ensure that they cannot be modified
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restrict access to the data either through use of passwords or restricted access to computers
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lock all raw data in filing cabinets
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remove all personal identifying information before you report data from one level to another
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keep patients’ personal identifying information only at the health facility where it was collected, and do not allow unauthorised disclosure of the personal identifying information.
Secure the data to protect it from harm or loss. Back up on an external drive or CD-ROM every time data are added or edited.
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All STI data are confidential. The computer hardware should be password-protected. Access should be limited to data entry personnel.
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Provide safe cabinets for storing hard copies of forms or registers.
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Lock the cabinets and restrict access to authorised personnel only.
Collecting Data
At the health
facilities
STI data collection should be an integral part of STI case management.
Everyone involved must have clearly defined duties.
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The data collection process should interfere as little as possible with the patient’s care and case management.
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The data required should be data that are usually collected during case management.
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Data should be recorded on outpatient cards and transferred to the patient register and standard reporting forms.
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One individual needs to take responsibility for the actual reporting so that reports are made on time.
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A supervisor needs to ensure that the data are ready before they are sent to the sub-national or national levels.
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If personnel at sub-national levels have queries regarding the data, these queries should be investigated and answered.
Health facility
process
Here is the step-by-step process undertaken at the health facilities:
1. The doctor, midwife or nurse who diagnoses and provides care for the patient:
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is responsible for identifying cases and recording medical and demographic data onto patients’ charts
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must record the diagnoses according to standard case definitions to help record officers or other staff to correctly tally at the end of the month.
2. Depending on data requirements for reporting, the information may be transferred directly to standard reporting forms from the patients’ charts.
3. STI cases should be tabulated on a regular basis, usually weekly. Data entry clerks should be knowledgeable about the STI case definitions so they can decide whether or not a particular patient meets the definition if there is any question. The data entry clerk or other trained staff member:
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abstracts data from the patients’ charts onto the patient register or tally sheets
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only includes patients presenting for the first visit with a current episode of STI
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makes separate entries for each syndrome (because some patients will have more than one syndrome, this will result in a slight overestimation of the total number of people with STIs, but will yield a more reliable estimate of the magnitude and trends of the individual syndromes)
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transfers weekly totals from tally sheets, to standard monthly/quarterly reporting forms, to sub-national or national level
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makes a zero entry if there were no cases of a specific syndrome during that month/quarter (do not leave the space blank) so the district level will know the report is complete.
4. In some cases, the facility will include several clinics or sites. In that case, a supervising doctor or nurse should:
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make their comments and have problems investigated before the reports are submitted to sub-national/national authorities.
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The final reporting forms should be copied. A copy should be sent to the sub-national/national level while the original is kept on file at the health facility.
Note: reports should be signed and dated by the reviewing supervisory doctor/nurse at the facility.
At the sub-
national
level
When a responsible officer at the sub-national level carefully reviews facility forms, the quality of data received at the national level is high. Of course, the better the data quality, the better the national level can make decisions that will affect every health facility.
Sub-national-level data checking and editing should focus on:
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checking for completeness of data
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ensuring that all the variables indicated on the data collection forms are appropriately filled
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inconsistencies (for example, STIs in very young or old patients).
The reviewing surveillance officer should follow up with any health facility site that has missing or inconsistent data. This should be done before forwarding the forms to the regional or national level.
The officer combines the totals from all the reporting health facilities:
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If computers and software are available, a data entry clerk will enter data into a computerised database. If these resources are not available, data entry is done at the national level.
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A copy of the health facility reports should be kept at the sub-national level.
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The sub-national reporting forms should state the number of health facilities with complete reports.
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The original sub-national summary totals should be sent to the national level, following clear reporting lines. Annex 4.2 provides a sample form for this.
At the national
level
Check inconsistent data with the reporting sites. At the regional and national levels (depending on your country resources), a trained data entry clerk will enter reports into a computerised database. Then the data are analysed.
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