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Outbreak Management Plan at National, State and District Levels in Kuwait

Discuss about the Infectious Disease Outbreak Management.

In 2006, Kuwait adopted World Health Organization (WHO) STEPs surveillance activities in order to control and monitor or eradicate large burdens of chronic diseases and be able to detect outbreaks of most epidemic-prone diseases so as to reach international eradication standards (Altawalah, & Al-Nakib, 2014). In that case, surveillance has become a national function where various activities that represent a national communicable disease surveillance system have been carried out. In some instances, the government has been also involving the academic institution to perform researchers that are highly specific in terms of the target (Turner, Reeder, & Wallace, 2013 . Establishment of surveillance activities within a vertical program has enabled the government to remain close to its function. This has made the country to prevent inefficient field worker participation, extra costs, poor methods and instruments used and poor reporting schedules and forms (Altawalah, & Al-Nakib, 2014).

Kuwait normally practices a multiple disease approach in its surveillance where similar functions and processes are used in different diseases. The surveillance should be based on collecting only the required data that help in achieving the goals (El-Sabban, Al-Feeli, & Shehab, 2016). However, different data from different diseases is collected. Eradication or elimination programs have very active surveillances which aim to detect all cases (El-Sabban, Al-Feeli, & Shehab, 2016).  The outcomes of all diseases are also taken into consideration. Some specific diseases also require repeated collection of data before making any conclusions or recommendations (Turner, Reeder, & Wallace, 2013) .

The surveillance system used in Kuwait is the WHO STEPs style that focuses on establishing the risk factors that normally determine major diseases in the country. Some of the most common diseases in the country include coronary heart disease, diabetes, stroke, influenza and pneumonia, breast cancer, hypertensions, kidney diseases and chronic respiratory diseases (Razvi, & Srikanth, 2013).  The STEP approach is designed to help the country to develop and strengthen the capacity of conducting the best and proper surveillance (Razvi, & Srikanth, 2013). In addition, this system has helped Kuwait to have an advancement of chronic diseases surveillance as it is easy to use and less costly. The system allows the nation to expand on core variables and major risk factors. In addition, the country is able to incorporate optional treatment and prevention modules for the benefit of both national and local interests (Razvi, & Srikanth, 2013).

Public Health Management of Disasters in Kuwait

The STEP system involves three major processes which include gathering key information on major risk factors using a questionnaire, then moving to basic physical measurement and finally into the more complex biochemical analysis (Razvi, & Srikanth, 2013).  This approach emphasizes that it is better to use small data that have good and correct information than to have a large amount of disorganized poor data (El-Sabban, Al-Feeli, & Shehab, 2016). The following are the major premises of the STEPs approach; a collection of standardized information and flexibility to be used in different parts of the country with different situations and settings. In the majority of the situations, STEPs surveillance system uses the sample of the population thus allowing the results to interpret the whole general population (Razvi, & Srikanth, 2013).

At the national level, the policies making and allocation of resources are often done. The national government in Kuwait plays a role of supporting other levels by providing services that are not available at lower levels such as laboratory facilities and high epidemiological skills ("WHO recommended surveillance standards,", 2016). This enables the national government to deal with outbreaks of national importance in a more coordinated style. In addition, the high-risk areas can be isolated by the central government by determining the trend and spread extents ("WHO recommended surveillance standards,", 2016). Furthermore, the central government deals with other countries and international agencies during a respond of an outbreak that has an international value and in the management of certain diseases outbreaks that have an international regulatory goal or targets to international elimination ("WHO recommended surveillance standards,", 2016). It is the work of a central government to have access to national archives and data that can be used to identify abnormal organisms and diseases in order to declare a national outbreak.

The district level act as an intermediate where the data collected during an outbreak at local areas are linked to the central government (Karki, 2015). The major functions of the district level in outbreak management are control of the ongoing analysis of information from the local areas and perform surveillance at the district level in order to demonstrate changes in disease trends. The analysis is then associated with interventions and investigations (Karki, 2015). In addition to that, the district level performs interventions and analyzed the outcomes as compared to other districts or previous managements. In many cases, professionals at this level are given tasks in the areas of program management (Karki, 2015). Most of the tasks managed here must be providing a high level of usefulness so as to maintain an outbreak at this level. If the district does not have special equipment, they always refer to national levels for help (Karki, 2015).

The local areas provide a point of contact between the health care services and the ill people where an outbreak had occurred (Jhaveri, 2015). This is where direct management of an outbreak happens. The patients are normally seen by nurses, clinical officers, and doctors. It is good to understand that, most of the staffs in this level see epidemiological surveillance as administrative or not as important as patient treatment. In that case, the major task at local areas is a diagnosis of the diseases, case management, reporting of cases treated and those that are not plus tabulating and graphing the data (Kanungo, 2013). Certain conditions can be troublesome and thus need national attention. The local areas also identify the exact needs of the patients who need attention. Isolation at the local level is also done, health promotion and direct prevention (Kanungo, 2013) .

Disasters, whether man-made or natural, can occasionally pose serious health threats that can lead to loss of life, mental illness and disabilities (Otomo, & Burkle, 2014). Poor or lack of preparedness can lead to more severe outcomes, venality and poor or lack of ability to deal with health threats. Kuwait has developed a clear public health system that collaborates with corporate institutions in planning and emergency preparing for any future possible man-made or natural calamities (Ghazi, 2016).  Some of the most common natural disasters include floods, drought, tornadoes, earthquakes, and terrorism. Kuwait has experienced a number of disasters starting from natural to manmade disasters. Some of this includes the bombing of Shia mosque in 2015, the wedding at Jahra in 2009 where at least 57 people were killed and 90 others wounded and road accidents. Due to these incidences, the public health in Kuwait has been increasing capacities of human actors in managing public health emergencies (Otomo, & Burkle, 2014).

The country is establishing a system that will enhance the community’s capacity in terms of psychological aid in case of a disaster so as to help the affected ones in post-disaster management (Regens, & Mould, 2014). In addition, the public health sector in Kuwait is strengthening health care workers knowledge, skills, and attitude in managing any disaster that may rise. In addition, the group has been trained on how to assess and manage psychological cases during and after the disaster (Regens, & Mould, 2014).

The public health has also been advocating for disaster risk management. This is to enable the government to see the need to expand health care facilities and ready manpower in case of any disaster (Ghazi, 2016). This is done by looking possible disasters that may happen, how they have been solved by other countries or previously, how they can be solved and who are involve. This is to be able to determine the country disaster containment capacity and checking where they may need help (Regens, & Mould, 2014).

The public health care also provides the basic services so as to improve the health status of the affected people (Otomo, & Burkle, 2014). These services include national education, proper community rehabilitation centers ad provision of a good foundation for disaster responses (Otomo, & Burkle, 2014). The policies and strategies developed by public health care concerning the primary health care in Kuwait contribute in reducing vulnerability in relation to household’s preparation after a disaster. The public health care educates and general communities about the risk areas and methods of avoidance of manmade disasters like terrorism (Otomo, & Burkle, 2014).

After a disaster the public health access the local needs and possible health risks of the community, actual actions that need to be addressed and how to avoid possible health hazards available and prepare a more active community that can reduce any possible future occurrence of an emergency (Regens, & Mould, 2014). The public health should have a clear structure that shows how the post-psychotic trauma is handled and possible rehabilitation systems (Ghazi, 2016)

The public health normally responds to any disease outbreak with an intention to determine the nature and origin of the outbreak (Al Turki, 2015). The nature of the investigation is normally influenced by the state policies, reporting requirements and availability of resources. In Kuwait, after an outbreak the, the public health officer or the public health nurse normally performs the outbreak investigations (Al Turki, 2015).

The initial step includes assessment of the outbreak which involves taking and collecting the initial data such as time the outbreak started, the total number of affected and non-affected people, symptoms experienced and the duration they take, The setting the outbreak begin with, whether food is involved and any laboratory test that might be have been done (Geng, Zhang, & Yang, 2013).  When starting an outbreak certain attributes are checked such as severity of the cases and the source of the outbreak plus mode of transfusion.

There should be a clear process on how to take actions when an outbreak is detected. Levels of inspection usually vary from a site inspection and a case of series to large analytical epidemiological investigation that consists of data collection of a large number of patients (Ibrahim, Al Gibali, Sakran, & Al Ansari, 2013). Disease outbreak investigation steps normally differ depending on the fact that, disease outbreaks are different in nature (Geng, Zhang, & Yang, 2013). A complete investigation may not be needed mostly when the outbreak is similar from person to person. There are two major types of disease outbreaks, those that are transmitted person to person and food outbreaks. This creates two major modes of transmission, person to person which include airborne and contact transmission or food transmission which may also include waterborne transmission (Ibrahim, Al Gibali, Sakran, & Al Ansari, 2013).

One of the initial responses to an outbreak is to establish if actually, the outbreak is occurring. In this, it is normally good to consider the population number of the community and check the affected and those that are not (House, 2014). After that, the public health officer should conduct a site visit which may be useful in spacemen collection and ensuring prevention measures are at place. The public health officer then resents the specimen collected and the report for laboratory investigation so as to confirm the diagnosis (House, 2014). All other aspects are further investigated deeply. After that, a case is formulated newly, collect the specimen result and present the case findings (Jhaveri, 2015) . The public health office analyses the case to determine the source of infection which involves determining the first patient, the incubation period, the mode of transmission and any other possible characteristic of the causal organism. After that, the environmental investigation and food sampling are done to check and inspect the entry mechanism or the possible way the causal organism or substances may have existed (House, 2014).

Finally .an epidemiological analytical study may be better so as to test the hypothesis. Outbreak monitoring is then done after which if the outbreak in contained it is declared over. The public health officer communicates to the public and finally files a report (Geng, Zhang, & Yang, 2013).

The epidemic curve is one the most used histogram in epidemiology that provides a visual display of the magnitude of disease outbreaks and also showing their time trend. This tool act as a basic investigative instrument since they provide a large number of information needed to discuss and present trends of an outbreak (Liu, & Deng, 2015). The epidemic curves normally show the magnitude of the disease outbreak over time in a very simple and more comprehended way (Liu, & Deng, 2015).  This usually makes the public health officer performing the investigation to distinguish and differentiate those outbreaks that are epidemic and those that are endemic. Using the epidemic curves it is possible for one to note any correlated events on any graph (Liu, & Deng, 2015).

The shape displayed by some epidemic curves may also be used to show and provide clues and tips about pattern relating to the spread extends in a certain population (Liu, & Deng, 2015). In addition, the curves are used to show the exact position where you are in the course of the epidemic period, that is, if you are at the increasing rate, the decreasing rate or if the outbreak has ended. This is crucial information since it predicts how much cases will occur in the near future (Schanzer, Vachon, & Pelletier, 2013). When performing an analysis, the curve can also be used to ask and answer questions like; how long did it take for the health ministry to know the existence of the problem? Are the current plans and interventions working? (Schanzer, Vachon, & Pelletier, 2013)

The most important another aspect of the epidemic curve is that any outliers cases that do not fit in the drawn curve can be used to provide very crucial cues (Liu, & Deng, 2015).  If the decrease and the incubation period of the disease are known, the epidemic curves can be used to predict probable time the disease will be affecting people. In that case, the curve will be used to develop and create questionnaires that are highly convenient and working (Liu, & Deng, 2015).

The incubation period is normally defined as the time a person is exposed to causative agent until the time that person develops or shows the first symptom which is a characteristic of all disease agents (Nsoesie, Leman, & Marathe, 2014). To determine and know the period of exposure for any outbreak, a public health officer may need to know the average incubation period for a certain disease and the range of all the incubation periods (Nsoesie, Leman, & Marathe, 2014). There are two types of incubation periods that are usually reported which include maximum and minimum incubation periods.

To determine the period of exposure one need to know the peak of the outbreak presented as the time period where the highest number of cases occurred.  Then count from that highest point the average incubation period if the infection and take the date (Schanzer, Vachon, & Pelletier, 2013).  After that, one should now identify the earliest case that was presented in the outbreak and count back the lowest incubation period. Finally one need to note the date of the maximum incubation period by identifying the ask cause of the outbreak and counting back the time period (Schanzer, Vachon, & Pelletier, 2013).

References

Al Turki, Y. (2015). Ebola virus disease outbreak in West Africa and challenge of Hajj and Umrah in Saudi Arabia. Journal Of Taibah University Medical Sciences, 10(2), 248-249. doi.org/10.1016/j.jtumed.2014.10.001

Altawalah, H., & Al-Nakib, W. (2014). WHO Collaborating Centre for Acquired Immunodeficiency Syndrome for the Eastern Mediterranean Regional Office, Faculty of Medicine, Kuwait University, Kuwait. Medical Principles And Practice.

El-Sabban, F., Al-Feeli, H., & Shehab, K. (2016). Perception of Body Weight Gain among First- Year Kuwait University Students. Obesity Research - Open Journal, 3(1), 10-17.

Geng, X., Zhang, J., & Yang, G. (2013). Investigation of an Adenovirus-Induced Respiratory Disease Outbreak. Advances In Infectious Diseases, 03(04), 257-262.

Ghazi, S. (2016). Knowledge, attitude, and practice of cupping therapy among Saudi patients attending primary health care in Makkah, Kingdom of Saudi Arabia. International Journal Of Medical Science And Public Health, 5(5), 966.

House, T. (2014). Correction: Epidemiological dynamics of Ebola outbreaks. Life, 3. https://dx.doi.org/10.7554/elife.05419

Ibrahim, K., Al Gibali, O., Sakran, M., & Al Ansari, K. (2013). Measles Outbreak in Qatar Qatar Medical Journal, 2010(2), 12..doi.org/10.5339/qmj.2010.2.12

Jhaveri, R. (2015). Outbreak Management. Clinical Therapeutics, 37(11), 2400-2401. doi.org/10.1016/j.clinthera.2015.10.003

Kanungo, R. (2013). Infectious disease outbreak management: Lessons learned from the H1N1 outbreak. Indian Journal Of Medical Microbiology, 28(1), 1. https://dx.doi.org/10.4103/0255-0857.58718

Karki, R. (2015). Management of disease outbreak in Nepal. The Lancet, 386(9991), 335-336. https://dx.doi.org/10.1016/s0140-6736(15)61403-9

Liu, Q., & Deng, C. (2015). Analysis of dynamical behaviors for a delayed  sis epidemic model with incubation period. International Journal Of Applied Mathematics, 28(5). https://dx.doi.org/10.12732/ijam.v28i5.3

Nsoesie, E., Leman, S., & Marathe, M. (2014). A Dirichlet process model for classifying and forecasting epidemic curves. BMC Infectious Diseases, 14(1). https://dx.doi.org/10.1186/1471-2334-14-12

Otomo, Y., & Burkle, F. (2014). Breakout Session 1 Summary: Frameworks and Policies  Relating to Medical Preparedness and Health Management in Disasters. Disaster Medicine And Public Health Preparedness, 8(04), 359-360. https://dx.doi.org/10.1017/dmp.2014.72

Principles of Epidemiology: Lesson 6, Section 2|Self-Study Course SS1978|CDC. (2017). Cdc.gov. Retrieved  from https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson6/section2.html

Raja, M. (2016). Measles Outbreak Investigation Report Western Area. MOJ Public Health, 4(6). https://dx.doi.org/10.15406/mojph.2016.04.00101

Razvi, S., & Srikanth, S. (2013). One WHO STEPS Stroke tool for all settings?. The Lancet Neurology, 6(5), 386-387. https://dx.doi.org/10.1016/s1474-4422(07)70090-x

Regens, J., & Mould, N. (2014). Prevention and Treatment of Traumatic Brain Injury Due to Rapid-Onset Natural Disasters. Frontiers In Public Health, 2. https://dx.doi.org/10.3389/fpubh.2014.00028

Schanzer, D., Vachon, J., & Pelletier, L. (2013). Age-specific Differences in Influenza A Epidemic Curves: Do Children Drive the Spread of Influenza Epidemics?. American Journal Of Epidemiology, 174(1), 109-117. https://dx.doi.org/10.1093/aje/kwr037

Turner, A., Reeder, B., & Wallace, J. (2013). A Resource Management Tool for Public Health Continuity of Operations During Disasters. Disaster Medicine And Public Health Preparedness, 7(02), 146-152. https://dx.doi.org/10.1017/dmp.2013.24

WHO recommended surveillance standards, (2016). Retrieved ,from https://www.who.int/csr/resources/publications/surveillance/WHO_CDS_CSR_ISR_99_2_EN/en/

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