—from Epidemiological Bulletin, Vol. 24 No. 2, June 2003—

Diagnosis on the Use of Bulletins for the Dissemination of
Epidemiological Information in the Region of the Americas

Introduction
The value of public health information in general – and epidemiological information in particular – depends in part on its efficient dissemination to those who can use it and benefit from it. An essential part of the work of epidemiologists is to ensure that the results of their activities are not only disseminated, but also that the information resulting from the analyses is interpreted and used by decision-makers and the general public.

First and foremost, the second essential public health function of any health system – public health surveillance - requires the timely dissemination of the information generated by existing networks, both to those who helped generate it and to those who can benefit from it. Bulletins and other types of periodic reports are the usual means for achieving this. Because they present the raw material required in rational decision-making, they are indispensable instruments used in information-based planning and in the design of prevention and control measures for public health problems. Further, the publication of epidemiological research findings in peer-reviewed journals, bulletins, or other publications that reach the scientific community, operational groups, and the general public, is a means of dissemination of the available information that transforms it into scientific knowledge. In addition, the different types of epidemiological publications brings all sorts of information of interest to professionals, guaranteeing the sharing of experiences and increasing epidemiological knowledge.

The management and diffusion of epidemiological information reflects to a certain extent the functioning of the health system. Indeed, the availability of information creates better conditions to define strategies that respond adequately to health problems. Unfortunately, despite new information technologies and methodologies that facilitate the collection and analysis of health data, the dissemination of the resulting information is still deficient. It can be presumed that it is partly due to the difficulty of achieving an efficient publication and distribution of the information. Indeed, communicating epidemiological information requires that elements of the health system related to data collection, validation, analysis, and regular presentation be managed effectively. Beyond the basic need for communications media, adequate media are required, able to answer the needs of the audience and presenting general characteristics – in terms of periodicity, content, and extension, among others – that contribute to achieving an important objective: rational decision-making based on available evidence.

Given the importance of information dissemination for surveillance and epidemiology in general, a need was identified to carry out an assessment of dissemination instruments in the Region of the Americas, particularly bulletins. This exercise intends to provide an overview of the countries’ current experience in terms of disseminating epidemiological information using this instrument, in particular surveillance data and information of interest to participants in epidemiological activities in the Region of the Americas.

Methodology
The information for a first description was obtained through a survey submitted to the authorities of the Ministries of Health and technical personnel of each country through the PAHO/WHO Representative Offices. Additional information was obtained through a search of existing Ministries of Health Web sites.

Results
Part of the information obtained is presented in table 1. In Canada and the United States, a Bulletin has been published since 1975 and 1951, respectively. Of the 17 countries of Latin America,1 16 publish epidemiological bulletins. Each of the 4 countries of the Latin Caribbean (Cuba, Haiti, Puerto Rico and the Dominican Republic) has a bulletin. Information was obtained on bulletins published in 3 of the 23 countries of the non-Latin Caribbean, and does not take into account that the epidemiological information from many of the small islands is published through the Caribbean Epidemiology Center (CAREC) in Trinidad. Although a majority of countries in the Region of the Americas use bulletins to disseminate epidemiological information, this situation is relatively recent since many of the existing bulletins were inaugurated at the end of the 1990s or at the beginning of 2000. Among the bulletins studied, the oldest is Venezuela’s Boletín Epidemiológico, established in 1945. It is also important to note that although the bulletins have some common characteristics, they vary in format, content, and periodicity. Some of the analyzed characteristics are presented below.

In all the countries, the responsible institution was identified as the public health entity (in general Ministries and Secretaries of Health), specifically the epidemiology offices or their equivalent; in some cases, as in Colombia and Cuba, National Institutes of Health participate.

The objectives of the bulletins are generally the same: to disseminate the data notified to the surveillance system, to report on the epidemiological situation, and describe the results of research and/or news of interest for epidemiology and public health. Furthermore, there is a certain homogeneity in the principal audiences of the bulletins. Among those identified were health managers from the different levels of health services, epidemiologists, and the technical personnel from health institutions, universities, libraries specializing in health, researchers, and international agencies. However, the periodicity selected to respond in a timely fashion to these objectives varies, from daily (Argentina’s Epinoticias) to annual (Boletín Epidemiológico Nacional, also from Argentina). The available information indicates that the weekly periodicity seems to be the most frequent. In countries that have more than one publication, as in Argentina, Canada, Colombia, Brazil, or Venezuela, a weekly Bulletin is often used to disseminate tables summarizing surveillance information. However, there are frequent delays in the weekly reports.

The distribution, when carried out efficiently, permits a timely use of the information contained in bulletins. It is dependent on characteristics of the country –geographical and technological among others –and it may represent an important difficulty for countries with a deficient distribution infrastructure, which sometimes leads to obsolescence and lack of use of the information. All the bulletins are published in printed format, with few exceptions such as Chile’s e-Vígia, which is only published in electronic format. In some cases, the printed versions are distributed among the public sector users and the electronic version is made available to the general public. More than two-thirds of the bulletins analyzed are available in electronic format, which facilitates the distribution, yet limits it to an audience with access to the Web.

Another important characteristic of the bulletins is the regularity of their publication, which often dictates its relevance and the timely use of the published information by users. Several countries reported interruptions in their bulletins’ publication, due to insufficient technical human resources or restructuring of the responsible units.

Despite the limitations that may exist in the quality and use of the bulletins, the majority of the countries do not carry out any periodic evaluation, of its content or use. Among those that have an established evaluation process, Colombia’s Informe Quincenal Epidemiológico Nacional reported bi-yearly evaluations; Cuba’s Boletín Epidemiológico Semanal del IPK indicated monthly evaluations by its Editorial Committee, and annually through readership surveys; Peru’s Boletín Epidemiológico Semanal reported weekly evaluations for timeliness, quality, representativeness, and coverage; and Venezuela’s Alerta Epidemiológico indicated evaluations at a periodicity defined by the epidemiological situation and users’ needs.

Conclusions
The information presented in table 1 reflects the work carried out by the countries in the Region of the Americas to disseminate epidemiological information through bulletins. It is important to point out recent efforts of countries with limited infrastructure or incipient surveillance systems, such as Paraguay, Bolivia, and Haiti, as well as those of countries with established networks, such as Venezuela or Brazil, which have maintained their bulletins during the last decades and expanded their scope.

The dissemination of epidemiological information through bulletins is highly sensitive to the adequate operation of the surveillance system and the permanent availability of financial and human resources devoted to their preparation and distribution. In the context of the different health systems of the countries of the Americas, weaknesses continue to exist in the dissemination of epidemiological information through this instrument, especially apparent in the lack of continuity and in publication and distribution delays.

A possible concern is that beyond the logistical problems, this situation reflects the limited availability –and resulting under-utilization – of epidemiological information at the decision-making levels. As a result, it is important to put the priority and the necessary resources into the generation, analysis, and dissemination of timely and accurate information. This information will feed epidemiological bulletins and other media that stimulate the managerial and political use of the information, such as health situation rooms. Whatever the particular situation of the different countries of the Region, this analysis illustrates that there already is a positive experience on which to develop a culture of use of epidemiological information as intelligence for public health. This will hopefully lead to adequate responses to the needs of the populations of the Americas.

(1) Argentina, Bolivia, Brasil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, México, Nicaragua, Panamá, Paraguay, Perú, Uruguay y Venezuela

Source: Prepared by PAHO’s Area of Health Analysis and Information Systems (AIS) in Washington, D.C. and at the PAHO/WHO Representations in the Dominican Republic and Honduras.

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Epidemiological Bulletin, Vol. 24 No. 2, June 2003