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1.1 Public Health and Surveillance of Congenital Anomalies

Public Health Surveillance

What comes to mind when you think of public health? Define public health.

Response:

  • According to CDC, “public health is the science of protecting and improving the health of families and communities through education, policies, services and research. Public health is concerned with protecting the health of the population, such as individuals living in a neighborhood, city, country, region, or world”(6).

What comes to mind when you think of surveillance? Define surveillance.

Possible responses:

  • Surveillance means to monitor. It is focused and systematic observation.
  • Police monitoring
  • Weather monitoring

Can anyone give me a definition of public health surveillance?

Public health surveillance is the:

  • ongoing
  • systematic collection
  • analysis and interpretation of health data,
  • for public health purposes.

Origins of Public Health Data

Hidden Aspects of Death

Watch a video by Jay Walker, chairman of TEDMED, which shows how the first official compilation of public health data revealed unexpected statistical trends.

 

Purposes of Surveillance Data

What are some purposes for which surveillance data could be used?

Some of these purposes include:

  • To assess the prevalence of certain conditions in a country
  • To identify areas with high or low rates, to try and identify epidemics or clusters of illness and disease
  • To disseminate public health information for assessment and public health response
  • To plan, implement and evaluate health strategies:
    • For example, surveillance data are critical to help determine whether a programme is having an impact, to evaluate if new strategies are necessary, and to identify problem areas and target populations that require more intensive intervention and follow-up
  • To integrate data with the decision-making process for the prevention or care of adverse health conditions
  • To document burden, to develop public health priorities
  • To develop political and social will
  • To document the burden of congenital anomalies to plan for services

Terms for Congenital Anomalies

Congenital anomalies are abnormalities of structure or function that are identified before birth, at birth, or later in life and are of prenatal origin.

What are some other terms used to refer to congenital anomalies?

Possible responses:

  • Congenital anomalies
  • Congenital abnormalities
  • Congenital malformations:
    • the use of this term to refer to congenital anomalies in general is not appropriate because malformations are only one type of congenital anomaly, which in addition include, as mentioned in the ICD-10, Chapter XVII, deformations, disruptions and dysplasias.

Which term do you prefer to use and why?

Tell participants:

  • For the remainder of the course, we will be using the preferred term since it is the term most commonly used in this region. Given the stigmatization of people with disabilities, it is important to discuss that congenital anomalies is preferred terminology at WHO, but for clarity the terms are used interchangeably with congenital anomalies, in this material.

Outcomes of Surveillance

Considering the objectives of a congenital anomalies surveillance programme, what do you think are some of the desired outcomes of surveillance?

Objectives of a congenital anomalies surveillance programme include:

  • To collect systematic, valid, reliable and timely data on congenital anomalies
  • To define the magnitude and distribution of congenital anomalies by time, person and place
  • To identify high-risk populations or identify clusters (aggregation of cases)
  • To monitor trends in the prevalence of different types of congenital anomalies in a defined population
  • To provide scientific data and information for priority setting, planning, implementing and evaluating congenital anomalies programmes
  • To refer affected infants to appropriate services in a timely manner
  • To disseminate findings and interpretations to appropriate partner organizations and government agencies in a timely fashion
  • To provide a basis for epidemiologic research and prevention programmes
  • To inform public health and health-care policies and programmes
  • To plan for needed services among the affected population
  • Ultimately, the purpose of a congenital anomalies surveillance programme can be to evaluate programmes; to define, characterize and help support prevention efforts for these congenital anomalies and their associated complications; and to help identify resources for individuals living with a congenital anomaly.

Group Discussion 1.1

How do you think surveillance programmes can be used to assess congenital anomalies?

Possible responses:

  • To measure the burden of congenital anomalies and identify high-risk populations
  • To identify disparities in prevalence and outcomes by factors, which could include race/ethnicity, maternal age, socioeconomic level or geographic region
  • To assess the impact of prenatal screening and diagnosis, and other changes in diagnostic technologies, on the birth prevalence of congenital anomalies
  • To describe short-term and long-term outcomes for children with congenital anomalies, and provide information relevant to long-term management of individuals who are affected by serious congenital anomalies
  • To inform public health and health-care policies and programmes and plan for needed services in the population

References

  1. World Health Organization. Congenital anomalies. Fact sheet No 370. October 2012 (http://www.who.int/mediacentre/factsheets/fs370/en/index.html, accessed 29 April 2015).
  2. Resolution WHA63.17. Birth defects. In: Sixty-third World Health Assembly, Geneva,17–21 May 2010. Geneva: World Health Organization; 2010 (http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R17-en.pdf, accessed 29 April 2015).
  3. International statistical classification of diseases and related health problems, 10th revision. Geneva: World Health organization; 2015 (http://apps.who.int/classifications/icd10/browse/2015/en, accessed 24 February 2015).
  4. World Health Organization, National Center on Birth Defects and Developmental Disabilities from the United States Centers for Disease Control and Prevention (CDC), International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). Birth defects surveillance: a manual for programme managers. Geneva: World Health Organization; 2014 (https://www.cdc.gov/ncbddd/birthdefectscount/documents/bd-surveillance-manual.pdf, accessed 10 February 2015).
  5. World Health Organization, National Center on Birth Defects and Developmental Disabilities from the United States Centers for Disease Control and Prevention(CDC), International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). Birth defects surveillance: atlas of selected congenital anomalies. Geneva: World Health Organization; 2014 (http://apps.who.int/iris/bitstream/10665/127941/1/9789241564762_eng.pdf?ua=1, accessed 10 February 2015).
  6. CDC Foundation. What is public health? (http://www.cdcfoundation.org/content/what-public-health, accessed 24 February 2015).
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