Annexure-B: Detailed Technical Reports

The proposed IndiaCLEN research agenda has been accomplished under the following
Programs/ Initiatives of IPHIDE:

1. Infectious Disease & Disease Surveillance
2. Program Evaluation & Health Systems Research
3. Child Health Initiative
4. Neonatal Health Research Initiative
5. Micronutrient Health Research Initiative
















The major areas of focus under this initiative over the last 10 years have been: antimicrobial
resistance, tuberculosis, disease surveillance, acute respiratory infections (ARI), and HIV/AIDS.
Under the new IPHIDE focus has remained on ARI, tuberculosis and HIV/AIDS to explore new
paradigms for public health interventions. Following research projects were completed under
Infectious Disease & Disease Surveillance initiative:



Principal Investigator: Kurien Thomas
V.1.1. Integrated Disease Surveillance Program (IDSP)
V.1. I nfectious Disease & Disease Surveillance
Annexure-B: Detailed Technical Reports

Clinical Epidemiology Unit: Christian Medical College, Vellore
Grant period: 1
st
October 2004- 30
th
September 2006
Budget: $67,263

To set up a decentralized, state and district based Integrated Disease Surveillance Program
(IDSP) in the country to support public health delivery system in the country. The program is
expected to detect early warning signals of impending outbreaks and help initiate an effective
response in a timely manner.


To establish a decentralized state and district based system of surveillance for
communicable and non-communicable diseases and their risk factors so that timely and
effective public health actions can be initiated in response to health challenges in the
country at the state and national levels.
To improve the efficiency of the existing surveillance activities of disease control
programs and facilitate sharing of relevant information with the health administration,
community and other stakeholders so as to detect disease and risk factor trends over time
and evaluate control strategies.




Integrating and decentralizing surveillance activities
Strengthening public health laboratories
Using information technology optimally
Enhancing human resource development







IDS program envisaged to monitor a limited number of conditions based on state
perceptions including 13 core and 5 state priority conditions for which public health
response is available. The conditions selected initially for the surveillance program were
based on the following criteria: (1) Burden of disease in the community, (2) Availability
of public health response and (3) Special considerations and international commitments.
Goal
Components
Objectives
Methodology
Annexure-B: Detailed Technical Reports

Surveillance data was collected by routine reporting at the PHC by the ANMs and HWs.
State specific diseases (around 5) were added to the overall list of health conditions
under surveillance to include a total of not more than 15 disease conditions including the
state list.
Information related to geographical changes in prevalence is to be obtained by sentinel
surveillance. This form of surveillance is to be used for HIV, HBV, HCV, Water Quality,
Air Quality etc.
Special teams were developed to assess NCD risk factor surveillance.
The disease conditions that are included in the core list and state specific list of the
surveillance program will be reviewed once in two years based on disease burden and
availability of public health action and suitably modified.



Based on the information obtained from the state level workshops the following core
conditions were included in the IDS program for monitoring:

Regular Surveillance:
Vector Borne Disease : 1. Malaria
Water Borne Disease : 2. Acute Diarrheal Disease (Cholera)
: 3. Typhoid
Respiratory Diseases : 4. Tuberculosis
Vaccine Preventable Diseases : 5. Measles
Diseases under eradication : 6. Polio
Other Conditions : 7. Road Traffic Accidents
(Linkup with police computers)
Other International commitments : 8. Plague
Unusual clinical syndromes : 9. Meningoencephalitis / Respiratory
Distress (Causing death/ hospitalization)
Hemorragic fevers, other undiagnosed
conditions

Sentinel Surveillance :
Results
Annexure-B: Detailed Technical Reports

Sexually transmitted Blood borne diseases : 10 HIV/HBV, HCV
Other Conditions : 11 Water Quality
: 12 Outdoor Air Quality (Large Urban
centers)
Regular periodic surveys:
NCD Risk Factors :13 Anthropometry, Physical Activity,
Blood pressure, Tobacco, Nutrition

Additional state priorities:
In addition to the core diseases which will be under surveillance for all the states, each state
will be able to identify five additional conditions for which surveillance will be initiated. For
example:
Tamil Nadu List: Maharashtra List:
1). Blindness 1). Viral Hepatitis
2). Leprosy 2). Tetanus Neonatorum
3). Nutriton Vit A / Anemia 3). Diphtheria
4). Japanese Encephalitis 4). Leptospirosis
5). Leptospirosis 5). Dengue Fever

District and State Surveillance units were set up so that the program is able to respond in
a timely manner to surveillance challenges in the country including emerging epidemics.
Integration of surveillance activities in the country under various programs using only
existing infrastructure and personnel for its function
Induction of sentinel private practitioners / sentinel private hospitals / sentinel private
laboratories into the program in collaboration with the Indian Medical Association
Active participation of medical colleges in the surveillance activities facilitated
particularly in the urban regions.
High quality surveillance activities ensured at all levels by: (1) limiting the total number
of diseases under surveillance and reducing overload at the periphery, (2) developing user
friendly manuals, (3) developing formats for reporting, (4) developing case definitions,
(5) providing training to all essential personnel, and (6) setting a system of regular feed
back to the participants on the quality of surveillance activity.
Laboratory infrastructure strengthened particularly at the district level to enhance
diagnosis and investigations of epidemics and confirmation of disease conditions.
Effective use of the current information technology for communication, data entry,
analysis, reporting, feedback and actions.
Annexure-B: Detailed Technical Reports

Optimum social mobilization strategies developed based on the experience of the
National Polio Eradication Initiative.
Decentralization of the program and the primary administrative responsibility will be at
the district and state levels and coordinated by the center.


By setting up a decentralized, action oriented, integrated and responsive program, it is expected
that IDSP will avert a sufficient number of disease outbreaks and epidemics and reduce human
suffering and improve the efficiency of all existing health programs. Such a program will
provide essential data to monitor progress of ongoing disease control programs and help
optimally allocate health resources and allow monitoring of resource allocation to enhance equity
in health delivery.
Link for the Project Implementation Plan: http://nicd.nic.in/idsp_Docs/NPIP.pdf




Principal Investigator: Shally Awasthi
Clinical Epidemiology Unit: King George Medical University, Lucknow
Grant period: March 2004- June 2006
Budget: $211,126

The goal of this open labeled multi-centeric trial was to compare effectiveness of 3 days of oral
amoxicillin with 5 day course of cotrimoxazole in children with non-severe pneumonia.


To

compare the effectiveness of 3 days of oral amoxycillin and

5 days of co-trimoxazole
treatment in terms of clinical failure

in children with World Health Organization (WHO) defined
non-severe

pneumonia in primary health centers in rural India.


Expectations
V.1.2. Effectiveness of 3 Day Amoxycillin vs 5 Day Co-trimoxazole in the Treatment of
Non-Severe Pneumonia in Children Aged 2-59 Months: A Multi Centric Open Labelled
Trial (I SCAP Study Group)

Goal
Objectives

Methodology