1.3 Surveillance

Expected time: 1 hour

Surveillance Programmes

Possible responses:

  • Occupational health surveillance programme
  • Environmental public health surveillance programme
  • Behavioural risk factor surveillance system
  • Laboratory-based surveillance
  • Chronic disease surveillance
  • Congenital anomalies surveillance programme
  • Infectious diseases surveillance
  • Vaccine-preventable disease surveillance

Population-Based and Hospital-Based Programmes

There are two main types of surveillance programmes often used for congenital anomalies surveillance. These are population-based and hospital-based programmes.

  • Population-based surveillance programmes capture pregnancy outcomes of interest for the condition under surveillance, such as congenital anomalies, in a population living in a defined geographical area.
  • Hospital-based surveillance programmes capture pregnancy outcomes of interest for the condition under surveillance, such as congenital anomalies that occur in selected hospitals in a well-defined location.

Countries with limited resources may choose to start with a hospital-based surveillance programme and expand it over time into a population-based programme. Population-based and hospital-based surveillance programmes are discussed in more detail in WHO/CDC/ICBDSR Birth defects surveillance: a manual for programme managers (4).

Group Discussion 1.2

Divide participants into groups of 3–4 and have them discuss within their groups which type of surveillance programme would be best suited for the following scenarios. After each smaller group has had time to discuss, review responses with the whole group.

Scenario 1
You are a public health professional in a country with few resources, where 48% of births occur in the home. You are asked to set up a surveillance programme to assess the prevalence of neural tube defects among the population.

Possible response:

  • Because there are few resources and 52% of births occur in hospital settings, it may be best to begin with a select number of large maternity hospitals. Once the hospital-based surveillance is well established, one can then begin to identify neonates with congenital anomalies born at home who are taken to hospitals or local clinics for services, to assess the possibility of implementing a population-based surveillance programme. If the country has community health workers and midwives who can cover home births and report to the surveillance programme, a population-based programme can be considered.

Scenario 2
You are public health professional in a country where 95% of the total births occur in hospitals (only resident mothers are considered in the programme). You are asked to assess the prevalence of neural tube defects among the population.

Possible response:

  • Because most of the births in hospitals are to resident mothers, the programme would be considered a population-based surveillance programme. The programme could implement a way to capture the 5% of births from resident mothers that occur at home or at other facilities, which would help in the referral of children to services.
References
  1. World Health Organization. Congenital anomalies. Fact sheet No 370. October 2012 (http://www.who.int/mediacentre/factsheets/fs370/en/index.htmlExternal, 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.pdfCdc-pdfExternal, 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/enExternal, 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.pdfCdc-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=1Cdc-pdfExternal, accessed 10 February 2015).
  6. CDC Foundation. What is public health? (http://www.cdcfoundation.org/content/what-public-healthExternal, accessed 24 February 2015).