Natural disasters increase the risk of morbidity and mortality caused by communicable
disease without a well-understood mechanism. The devastating earthquake in Nepal had
escalated the threat of disease outbreaks in these areas. Nepal is endemic for many
communicable diseases including cholera.
Evidence from past experiences has established the importance of infectious disease
surveillance to protect survivors during disasters. Real-time monitoring of morbidity can
provide early signs of outbreaks, providing an opportunity to prevent outbreaks.
Epidemiology and Disease Control Division (EDCD) of Nepal Government started
syndromic surveillance right after the earthquake along with pre-existing Early Warning
and Reporting System (EWARS). “Timeliness” and “Completeness” of reports were the
two major problems faced by these surveillance systems. The adaptation of electronic
records had shown improvement in timeliness and completeness of reports as well as
increased breadth and depth of information collected. The ICD coded health record used for surveillance had been demonstrated as an effective method. Health Management
Information System (HMIS)’s register number 1.3 (HMIS1.3), records socio-demographic,
geographic information along with ICD 10 coded working diagnosis, making it a perfect
record for syndromic surveillance. Hence, the study explored the opportunity of using
digitalized HMIS1.3 with minimal modification and transmitted via SMS for a surveillance
system.