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Shalash A, Abu-Rmeileh N, Kelly D, Elmusharaf K. Opportunities and challenges of using a health information system in adolescent health management: A qualitative study of healthcare providers' perspectives in the West Bank, occupied Palestinian territory. PLoS One 2024; 19:e0307207. [PMID: 39172938 PMCID: PMC11340989 DOI: 10.1371/journal.pone.0307207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 07/02/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND Adolescents are a critical demographic facing unique health challenges who are further impacted in humanitarian settings. This article focuses on the urgent need for a structured health information system (HIS) to address the gaps in data availability and evidence-based interventions for adolescent health. The study aims to identify opportunities and challenges in utilizing the HIS to enhance adolescent health in the West Bank by gathering insights from healthcare providers. METHODS Semi-structured key informant interviews were conducted with participants involved in the HIS regarding adolescent health in the West Bank. They were selected by purposive sampling. Nineteen interviews were conducted between July and October 2022, and thematic analysis was carried out using MAXQDA software. RESULTS The opportunities identified were the small-scale victories the participants described in building the HIS for adolescent health. These included institutional and individual capacity building, digitalizing parts of the HIS, connection fragmentation of adolescent health activities, multi-sectoral collaboration, reorienting services based on health information, working with limited resources, enhancing community engagement to encourage ownership and active participation, and taking strategic actions for adolescents for information. The challenges were the high workload of staff, lack of health information specialists, limited resources, lack of a unified system in data collection, lack of data on essential indicators, data quality, data sharing, and data sources and use. CONCLUSION This study showed the potential of the HIS with capacity building, digitization, and collaborative initiatives; it also suffers from issues like staff shortages, non-standardized data collection, and insufficient data for essential indicators. To maximize the impact of the HIS, urgent attention to staff shortages through comprehensive training programs, standardization of data collection systems, and development of a unified core indicator list for adolescent health is recommended. Embracing these measures will allow the HIS to provide evidence-based adolescent health programs, even in resource-constrained and complex humanitarian settings.
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Affiliation(s)
- Aisha Shalash
- Institute Community and Public Health, Birzeit University, Birzeit, West Bank, Palestine
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Niveen Abu-Rmeileh
- Institute Community and Public Health, Birzeit University, Birzeit, West Bank, Palestine
| | - Dervla Kelly
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Khalifa Elmusharaf
- Public Health Program, University of Birmingham, Dubai, United Arab Emirates
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Kawakyu N, Inguane C, Fernandes Q, Gremu A, Floriano F, Manaca N, Ramiro I, Felimone P, Alfandega JAA, Isidor XA, Missage SM, Wagenaar BH, Sherr K, Gimbel S. Determinants of translating routine health information system data into action in Mozambique: a qualitative study. BMJ Glob Health 2024; 9:e014970. [PMID: 39153750 PMCID: PMC11331841 DOI: 10.1136/bmjgh-2024-014970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 07/29/2024] [Indexed: 08/19/2024] Open
Abstract
INTRODUCTION Routine health information systems (RHISs) are an essential source of data to inform decisions and actions around health facility performance, but RHIS data use is often limited in low and middle-income country contexts. Determinants that influence RHIS data-informed decisions and actions are not well understood, and few studies have explored the relationship between RHIS data-informed decisions and actions. METHODS This qualitative thematic analysis study explored the determinants and characteristics of successful RHIS data-informed actions at the health facility level in Mozambique and which determinants were influenced by the Integrated District Evidence to Action (IDEAs) strategy. Two rounds of qualitative data were collected in 2019 and 2020 through 27 in-depth interviews and 7 focus group discussions with provincial, district and health facility-level managers and frontline health workers who participated in the IDEAs enhanced audit and feedback strategy. The Performance of Routine Information System Management-Act framework guided the development of the data collection tools and thematic analysis. RESULTS Key behavioural determinants of translating RHIS data into action included health worker understanding and awareness of health facility performance indicators coupled with health worker sense of ownership and responsibility to improve health facility performance. Supervision, on-the-job support and availability of financial and human resources were highlighted as essential organisational determinants in the development and implementation of action plans. The forum to regularly meet as a group to review, discuss and monitor health facility performance was emphasised as a critical determinant by study participants. CONCLUSION Future data-to-action interventions and research should consider contextually feasible ways to support health facility and district managers to hold regular meetings to review, discuss and monitor health facility performance as a way to promote translation of RHIS data to action.
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Affiliation(s)
- Nami Kawakyu
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Child, Family, & Population Health Nursing, University of Washington, Seattle, Washington, USA
| | - Celso Inguane
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Quinhas Fernandes
- Department of Global Health, University of Washington, Seattle, Washington, USA
- National Directorate of Public Health, Ministry of Health, Maputo City, Mozambique
| | - Artur Gremu
- Comité para Saúde de Moçambique, Chimoio, Mozambique
| | | | - Nelia Manaca
- Comité para Saúde de Moçambique, Beira, Mozambique
| | | | | | | | | | | | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Kenneth Sherr
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
- Department of Industrial & Systems Engineering, University of Washington, Seattle, Washington, USA
| | - Sarah Gimbel
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Child, Family, & Population Health Nursing, University of Washington, Seattle, Washington, USA
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Shrestha A, Poudel L, Shrestha S, Jha N, Kuikel BS, Shakya P, Kunwar RS, Pandey LR, Kc MB, Wilson EC, Deuba K. Multilevel determinants of antiretroviral therapy initiation and retention in the test-and-treat era of Nepal: a qualitative study. BMC Health Serv Res 2024; 24:927. [PMID: 39138448 PMCID: PMC11323673 DOI: 10.1186/s12913-024-11311-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 07/12/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND The transition to the "test-and-treat" policy in Nepal in 2017, coupled with the rapid initiation of antiretroviral therapy (ART) in 2020, necessitates an in-depth understanding of factors influencing ART initiation and retention. This study investigates these factors from the perspectives of healthcare providers, families/communities, and people living with HIV (PLHIV). METHODS Employing a qualitative design, in-depth interviews were conducted with 24 ART clients and 26 healthcare providers across different provinces of Nepal. A comprehensive interview guide facilitated the exploration of experiences and perceptions. Interviews were transcribed verbatim, and thematic analysis was applied to distill key insights. Guided by a socio-ecological model, interviews were analyzed to identify the barriers and facilitators to ART initiation and continuation at the individual, family/community, and health system levels. RESULTS Facilitators and barriers were identified at three levels. Individual-level facilitators included fear of death, perceived health benefits, knowledge about HIV/ART, confidentiality, and financial support. Barriers encompassed concerns about lifelong medication, side effects, denial of HIV status, fear of disclosure, and financial constraints. At the family/community level, support from family and community health workers facilitated ART adherence, while social stigma and discrimination posed barriers. The health system's role was dual; the provision of free treatment, a client tracking system and a robust drug supply chain were facilitators, whereas logistical challenges and service accessibility during the COVID-19 pandemic were notable barriers. CONCLUSIONS This study highlights the various factors that influence ART initiation and retention in Nepal during the test-and-treat era. Tailored interventions should focus on increasing awareness about HIV and ART, strengthening healthcare systems, ensuring availability of medications, and providing accessible treatment during service disruptions. Furthermore, these interventions should encourage supportive environments at the individual, community, and healthcare system levels. Taking this holistic approach is essential for effectively implementing ART and achieving long-term health outcomes in light of changing public health policies.
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Affiliation(s)
- Archana Shrestha
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
- Institute for Implementation Science and Health, Kathmandu, Nepal
| | - Lisasha Poudel
- Institute for Implementation Science and Health, Kathmandu, Nepal
| | - Soniya Shrestha
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Niharika Jha
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | - Bihari Sharan Kuikel
- Department of Public Health and Community Programs, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
| | | | | | - Lok Raj Pandey
- National Centre for AIDS & STD Control, Ministry of Health and Population, Kathmandu, Nepal
| | - Man Bahadur Kc
- National Centre for AIDS & STD Control, Ministry of Health and Population, Kathmandu, Nepal
| | - Erin C Wilson
- San Francisco Department of Public Health, San Francisco, CA, USA
| | - Keshab Deuba
- Public Health and Environment Research Centre (PERC), Lalitpur, Nepal.
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
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Madebo MM, Elitro YO, Sundako BB, Anore AJ, Ashegire M, Funga ML, Lalore MT, Samuel A. Practice of district health information data for decision making and associated factors among performance monitoring team at Hadiya Zone Public Health Facilities SNNPR, Ethiopia. PLOS DIGITAL HEALTH 2024; 3:e0000552. [PMID: 39102380 PMCID: PMC11299812 DOI: 10.1371/journal.pdig.0000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 06/18/2024] [Indexed: 08/07/2024]
Abstract
BACKGROUND Evidence based practice is a key tool to increase effectiveness and efficiency of healthcare providers worldwide and using health facility data at all levels is vital. But, it is poorly practiced in developing countries including Ethiopia. As a result, the purpose of this study was to evaluate the level of practice of District Health Information for decision making and associated factors among performance monitoring teams in Hadiya Zone public health facilities, South Nation Nationality People Republic, Ethiopia, in 2022. METHODS A facility based-cross sectional study was employed from May 3 to June 3, 2022. To obtain data, a pre-tested structured questionnaire with qualitative was employed. A multistage random sampling technique was employed to select performance monitoring team from public health facilities. Data was entered into a computer using Epi data version 4.6, and analyzed using SPSS version 25. Bivariable and multivariable analyses were used to identify determinants related to practice of district health information. For the qualitative section, thematic analysis was used. RESULTS The practice of district health information for decision making among performance monitoring team in this study was 48% (95% CI: [42.3, 54.1]). having standard sets of indicators [AOR = 4.055; 95% CI: (1.67, 9.86)], Being trained [AOR = 3.12; 95%CI: (1.385, 7.023)], having internet access [AOR = 3.23; 95% CI: (1.52, 6.9)], having positive attitudes [AOR = 2.667; 95% CI: (1.28, 5.56)], having low motivation [AOR = 0.202; 95% CI: (0.081, 0.504)], Sufficient skill [AOR = 3.239: 95%CI; (1.328, 8.164)] and having knowledge [AOR = 6.227; 95% CI: (2.12, 12.8)] were significantly associated with practice of District health information for decision making. CONCLUSION In general, this study found that the performance monitoring team at health facilities poorly practiced district health information. It requires major improvement to provide a consistent set of indicators, training, internet access, user attitudes, motivation, and necessary skills and knowledge, as well as to raise users' confidence in DHIS2.
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Affiliation(s)
| | | | | | - Adimasu Jemal Anore
- Health Informatics Technician Department, Hosanna College of Health Sciences, Hosanna, Ethiopia
| | - Muluken Ashegire
- Health Informatics Technician Department, Hosanna College of Health Sciences, Hosanna, Ethiopia
| | | | | | - Abriham Samuel
- Emergency Medical Technician Department, Hosanna College of Health Sciences, Hosanna, Ethiopia
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Arsenault C, Mebratie AD, Gelaw SK, Shamebo D. Routine data in a primary care performance dashboard, Ethiopia. Bull World Health Organ 2024; 102:465-475A. [PMID: 38933476 PMCID: PMC11197649 DOI: 10.2471/blt.23.291122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 06/28/2024] Open
Abstract
Objective To explore the feasibility of building a primary care performance dashboard using DHIS2 data from Ethiopia's largest urban (Addis Ababa), agrarian (Oromia) and pastoral (Somali) regions. Methods We extracted 26 data elements reported by 12 062 health facilities to DHIS2 for the period 1 July 2022 to 30 June 2023. Focusing on indicators of effectiveness, safety and user experience, we built 14 indicators of primary care performance covering reproductive, maternal and child health, human immunodeficiency virus, tuberculosis, noncommunicable disease care and antibiotic prescription. We assessed data completeness by calculating the proportion of facilities reporting each month, and examined the presence of extreme outliers and assessed external validity. Findings At the regional level, average completeness across all data elements was highest in Addis Ababa (82.9%), followed by Oromia (66.2%) and Somali (52.6%). Private clinics across regions had low completeness, ranging from 38.6% in Somali to 58.7% in Addis Ababa. We found only a few outliers (334 of 816 578 observations) and noted that external validity was high for 11 of 14 indicators of primary care performance. However, the 12-month antiretroviral treatment retention rate and proportions of patients with controlled diabetes or hypertension exhibited poor external validity. Conclusion The Ethiopian DHIS2 contains information for measuring primary care performance, using simple analytical methods, at national and regional levels and by facility type. Despite remaining data quality issues, the health management information system is an important data source for generating health system performance assessment measures on a national scale.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, NW Washington, DC20052, United States of America
| | - Anagaw Derseh Mebratie
- Department of Health Systems Management and Health Policy, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | | | - Dessalegn Shamebo
- Department of Development Economics, Ethiopian Civil Service University, Addis Ababa, Ethiopia
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Molenaar J, Beňová L, Christou A, Lange IL, van Olmen J. Travelling numbers and broken loops: A qualitative systematic review on collecting and reporting maternal and neonatal health data in low-and lower-middle income countries. SSM Popul Health 2024; 26:101668. [PMID: 38645668 PMCID: PMC11031824 DOI: 10.1016/j.ssmph.2024.101668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/27/2024] [Accepted: 04/02/2024] [Indexed: 04/23/2024] Open
Abstract
Data and indicator estimates are considered vital to document persisting challenges in maternal and newborn health and track progress towards global goals. However, prioritization of standardised, comparable quantitative data can preclude the collection of locally relevant information and pose overwhelming burdens in low-resource settings, with negative effects on the provision of quality of care. A growing body of qualitative studies aims to provide a place-based understanding of the complex processes and human experiences behind the generation and use of maternal and neonatal health data. We conducted a qualitative systematic review exploring how national or international requirements to collect and report data on maternal and neonatal health indicators are perceived and experienced at the sub-national and country level in low-income and lower-middle income countries. We systematically searched six electronic databases for qualitative and mixed-methods studies published between January 2000 and March 2023. Following screening of 4084 records by four reviewers, 47 publications were included in the review. Data were analysed thematically and synthesised from a Complex Adaptive Systems (CAS) theoretical perspective. Our findings show maternal and neonatal health data and indicators are not fixed, neutral entities, but rather outcomes of complex processes. Their collection and uptake is influenced by a multitude of system hardware elements (human resources, relevancy and adequacy of tools, infrastructure, and interoperability) and software elements (incentive systems, supervision and feedback, power and social relations, and accountability). When these components are aligned and sufficiently supportive, data and indicators can be used for positive system adaptivity through performance evaluation, prioritization, learning, and advocacy. Yet shortcomings and broken loops between system components can lead to unforeseen emergent behaviors such as blame, fear, and data manipulation. This review highlights the importance of measurement approaches that prioritize local relevance and feasibility, necessitating participatory approaches to define context-specific measurement objectives and strategies.
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Affiliation(s)
- Jil Molenaar
- Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
- University of Antwerp, Doornstraat 331, 2610, Wilrijk, Belgium
| | - Lenka Beňová
- Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Aliki Christou
- Institute of Tropical Medicine Antwerp, Nationalestraat 155, 2000, Antwerp, Belgium
| | - Isabelle L. Lange
- London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
- Center for Global Health, Technical University of Munich (TUM), Munich, Germany
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Pandya S, Kan L, Parr E, Twose C, Labrique AB, Agarwal S. How Can Community Data Be Leveraged to Advance Primary Health Care? A Scoping Review of Community-Based Health Information Systems. GLOBAL HEALTH, SCIENCE AND PRACTICE 2024; 12:e2300429. [PMID: 38626945 PMCID: PMC11057800 DOI: 10.9745/ghsp-d-23-00429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Community-based health information systems (CBISs) can provide critical insights into how community health systems function, and digitized CBISs may improve the quality of community-level data and facilitate integration and use of CBISs within the broader health system. This scoping review aims to understand how CBISs have been implemented, integrated, and used to support community health outcomes in low- and middle-income countries (LMICs). METHODS Both peer-reviewed and gray literature were included; relevant articles were identified using key terms and controlled vocabulary related to community/primary health care, health information systems, digital health, and LMICs. A total of 11,611 total records were identified from 5 databases and the gray literature. After deduplication, 6,985 peer-reviewed/gray literature were screened, and 95 articles/reports were included, reporting on 105 CBIS implementations across 38 countries. RESULTS Findings show that 55% of CBISs included some level of digitization, with just 28% being fully digitized (for data collection and reporting). Data flow from the community level into the health system varied, with digitized CBISs more likely to reach national-level integration. National-level integration was primarily seen among vertical CBISs. Data quality challenges were present in both paper-based and digitized CBISs, exacerbated by fragmentation of the community health landscape with often parallel reporting systems. CBIS data use was constrained to mostly vertical and digitized (partially or fully) CBISs at national/subnational levels. CONCLUSION Digitization can play a pivotal role in strengthening CBIS use, but findings demonstrate that CBISs are only as effective as the community health systems they are embedded within. Community-level data are often not being integrated into national/subnational health information systems, undermining the ability to understand what the community health needs are. Furthermore, stronger investments within community health systems need to be in place broadly to reduce fragmentation and provide stronger infrastructural and systemic support to the community health workforce.
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Affiliation(s)
- Shivani Pandya
- Center for Global Digital Health Innovation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lena Kan
- Center for Global Digital Health Innovation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emily Parr
- Center for Global Digital Health Innovation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Twose
- Welch Medical Library, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alain B Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Smisha Agarwal
- Center for Global Digital Health Innovation, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Taye BK, Gezie LD, Atnafu A, Mengiste SA, Kaasbøll J, Gullslett MK, Tilahun B. Effect of Performance-Based Nonfinancial Incentives on Data Quality in Individual Medical Records of Institutional Births: Quasi-Experimental Study. JMIR Med Inform 2024; 12:e54278. [PMID: 38578684 PMCID: PMC11031696 DOI: 10.2196/54278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 01/20/2024] [Accepted: 02/05/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Despite the potential of routine health information systems in tackling persistent maternal deaths stemming from poor service quality at health facilities during and around childbirth, research has demonstrated their suboptimal performance, evident from the incomplete and inaccurate data unfit for practical use. There is a consensus that nonfinancial incentives can enhance health care providers' commitment toward achieving the desired health care quality. However, there is limited evidence regarding the effectiveness of nonfinancial incentives in improving the data quality of institutional birth services in Ethiopia. OBJECTIVE This study aimed to evaluate the effect of performance-based nonfinancial incentives on the completeness and consistency of data in the individual medical records of women who availed institutional birth services in northwest Ethiopia. METHODS We used a quasi-experimental design with a comparator group in the pre-post period, using a sample of 1969 women's medical records. The study was conducted in the "Wegera" and "Tach-armacheho" districts, which served as the intervention and comparator districts, respectively. The intervention comprised a multicomponent nonfinancial incentive, including smartphones, flash disks, power banks, certificates, and scholarships. Personal records of women who gave birth within 6 months before (April to September 2020) and after (February to July 2021) the intervention were included. Three distinct women's birth records were examined: the integrated card, integrated individual folder, and delivery register. The completeness of the data was determined by examining the presence of data elements, whereas the consistency check involved evaluating the agreement of data elements among women's birth records. The average treatment effect on the treated (ATET), with 95% CIs, was computed using a difference-in-differences model. RESULTS In the intervention district, data completeness in women's personal records was nearly 4 times higher (ATET 3.8, 95% CI 2.2-5.5; P=.02), and consistency was approximately 12 times more likely (ATET 11.6, 95% CI 4.18-19; P=.03) than in the comparator district. CONCLUSIONS This study indicates that performance-based nonfinancial incentives enhance data quality in the personal records of institutional births. Health care planners can adapt these incentives to improve the data quality of comparable medical records, particularly pregnancy-related data within health care facilities. Future research is needed to assess the effectiveness of nonfinancial incentives across diverse contexts to support successful scale-up.
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Affiliation(s)
- Biniam Kefiyalew Taye
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Ministry of Health, The Federal Democratic Republic of Ethiopia, Addis Ababa, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Asmamaw Atnafu
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Jens Kaasbøll
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Monika Knudsen Gullslett
- Faculty of Health & Social Sciences, Science Center Health & Technology, University of South-Eastern Norway, Notodden, Norway
| | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Morris R, Wang S. Building a pathway to One Health surveillance and response in Asian countries. SCIENCE IN ONE HEALTH 2024; 3:100067. [PMID: 39077383 PMCID: PMC11262298 DOI: 10.1016/j.soh.2024.100067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/27/2024] [Indexed: 07/31/2024]
Abstract
To detect and respond to emerging diseases more effectively, an integrated surveillance strategy needs to be applied to both human and animal health. Current programs in Asian countries operate separately for the two sectors and are principally concerned with detection of events that represent a short-term disease threat. It is not realistic to either invest only in efforts to detect emerging diseases, or to rely solely on event-based surveillance. A comprehensive strategy is needed, concurrently investigating and managing endemic zoonoses, studying evolving diseases which change their character and importance due to influences such as demographic and climatic change, and enhancing understanding of factors which are likely to influence the emergence of new pathogens. This requires utilisation of additional investigation tools that have become available in recent years but are not yet being used to full effect. As yet there is no fully formed blueprint that can be applied in Asian countries. Hence a three-step pathway is proposed to move towards the goal of comprehensive One Health disease surveillance and response.
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Affiliation(s)
- Roger Morris
- Massey University EpiCentre and EpiSoft International Ltd, 76/100 Titoki Street, Masterton 5810, New Zealand
| | - Shiyong Wang
- Health, Nutrition and Population, World Bank Group, Washington, DC, USA
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Kiyemba T, Makabayi-Mugabe R, Kirirabwa NS, Tumwesigye P, Zawedde-Muyanja S, Ocero A, Nkolo A, Quinto E, Turyahabwe S. A comparative analysis of two national tuberculosis reporting systems and their impact on tuberculosis case notification in Uganda. Afr Health Sci 2023; 23:13-20. [PMID: 38974286 PMCID: PMC11225490 DOI: 10.4314/ahs.v23i4.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/09/2024] Open
Abstract
Background Before 2018, the use of parallel tuberculosis (TB) reporting systems was resource intensive with duplication of efforts and hence the need to select one that contributed to better TB case notification at the National TB and Leprosy Program (NLTP) in Uganda. We sought to analyse the difference in reporting rates between the two systems in order to improve NTLP TB case notification rates, logistics management, and planning for better health service delivery initiatives. Methods We conducted a comparative study to assess TB case notification between the web-based DHIS2 and the district TB supervisor-led health management information system between January 2016 to December 2017. We used Poisson regression analysis to assess the statistical differences in reporting rates between the two reporting systems. Results The association between TB case notification and the type of reporting system was statistically significant (Prob > chi2 = 0.0000). The Incident Rate Ratio (IRR) for the web-enabled DHIS2 system versus the district TB supervisor-led health management information system was 1.106625. Conclusion The web-based integrated DHIS2 system was more effective in reporting missing TB cases. It presents an opportunity for better planning and allocation of resources for improved service delivery in a low-income setting.
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Affiliation(s)
- Timothy Kiyemba
- USAID/Defeat TB project, University Research Co., Kampala, Uganda
| | - Rita Makabayi-Mugabe
- USAID/Defeat TB project, University Research Co., Kampala, Uganda
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Stella Zawedde-Muyanja
- USAID/Defeat TB project, University Research Co., Kampala, Uganda
- Infectious Diseases Institute (IDI), Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew Ocero
- USAID/Defeat TB project, University Research Co., Kampala, Uganda
| | - Abel Nkolo
- USAID/Defeat TB project, University Research Co., Kampala, Uganda
| | - Ebony Quinto
- The National TB and Leprosy Program, Ministry of Health, Kampala, Uganda
| | - Stavia Turyahabwe
- The National TB and Leprosy Program, Ministry of Health, Kampala, Uganda
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Mc Kenna P, Broadfield LA, Willems A, Masyn S, Pattery T, Draghia-Akli R. Digital health technology used in emergency large-scale vaccination campaigns in low- and middle-income countries: a narrative review for improved pandemic preparedness. Expert Rev Vaccines 2023; 22:243-255. [PMID: 36814067 DOI: 10.1080/14760584.2023.2184091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Large-scale vaccination campaigns can benefit from using digital health tools, particularly in low- and middle-income countries (LMICs). Selecting the best tool to fit into a pre-existing digital landscape can be challenging. AREAS COVERED We conducted a narrative review in PubMed and the grey literature for data available within 5 years to provide an overview of digital health tools used in large-scale vaccination campaigns for outbreak response in LMICs. We discuss tools used along the typical steps of a vaccination process. Digital tool functionalities and technical specifications, open-source options, data privacy and security concerns, and lessons learned from the use of these tools are discussed. EXPERT OPINION The landscape of digital health tools for large-scale vaccination processes in LMICs is growing. For efficient implementation, countries should prioritize the appropriate tool(s) depending on their needs and available resources, develop a robust framework around data privacy and security, and select sustainable features. Improving internet connectivity and digital literacy in LMICs will facilitate adoption. This review may aid LMICs still needing to prepare large-scale vaccination campaigns in the selection of supporting digital health tools. Further research on impact and cost-effectiveness is needed.
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Affiliation(s)
- Paula Mc Kenna
- Global Public Health, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Lindsay A Broadfield
- Akkodis Belgium c/o Global Public Health, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Annik Willems
- Global Public Health, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Serge Masyn
- Global Public Health, Janssen Pharmaceutica NV, Beerse, Belgium
| | - Theresa Pattery
- Global Public Health, Janssen Pharmaceutica NV, Beerse, Belgium
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Mremi IR, Sindato C, Kishamawe C, Rumisha SF, Kimera SI, Mboera LEG. Improving disease surveillance data analysis, interpretation, and use at the district level in Tanzania. Glob Health Action 2022; 15:2090100. [PMID: 35916840 PMCID: PMC9351552 DOI: 10.1080/16549716.2022.2090100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
An effective disease surveillance system is critical for early detection and response to disease epidemics. This study aimed to assess the capacity to manage and utilize disease surveillance data and implement an intervention to improve data analysis and use at the district level in Tanzania. Mapping, in-depth interview and desk review were employed for data collection in Ilala and Kinondoni districts in Tanzania. Interviews were conducted with members of the council health management teams (CHMT) to assess attitudes, motivation and practices related to surveillance data analysis and use. Based on identified gaps, an intervention package was developed on basic data analysis, interpretation and use. The effectiveness of the intervention package was assessed using pre-and post-intervention tests. Individual interviews involved 21 CHMT members (females = 10; males = 11) with an overall median age of 44.5 years (IQR = 37, 53). Over half of the participants regarded their data analytical capacities and skills as excellent. Analytical capacity was higher in Kinondoni (61%) than Ilala (52%). Agreement on the availability of the opportunities to enhance capacity and skills was reported by 68% and 91% of the participants from Ilala and Kinondoni, respectively. Reported challenges in disease surveillance included data incompleteness and difficulties in storage and accessibility. Training related to enhancement of data management was reported to be infrequently done. In terms of data interpretation and use, despite reporting of incidence of viral haemorrhagic fevers for five years, no actions were taken to either investigate or mitigate, indicating poor use of surveillance data in monitoring disease occurrence. The overall percentage increase on surveillance knowledge between pre-and post-training was 37.6% for Ilala and 20.4% for Kinondoni indicating a positive impact on of the training. Most of CHMT members had limited skills and practices on data analysis, interpretation and use. The training in data analysis and interpretation significantly improved skills of the participants.
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Affiliation(s)
- Irene R Mremi
- SACIDS Foundation for One Health Sokoine University of Agriculture, Morogoro, Tanzania.,National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Calvin Sindato
- SACIDS Foundation for One Health Sokoine University of Agriculture, Morogoro, Tanzania.,Tabora Research Centre, National Institute for Medical Research, Tabora, Tanzania
| | - Coleman Kishamawe
- Mwanza Research Centre, National Institute for Medical Research, Mwanza, Tanzania
| | - Susan F Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Malaria Atlas Project, Geospatial Health and Development, Telethon Kids Institute, Perth Children's Hospital, Western, Nedlands, Western Australia, Australia
| | - Sharadhuli I Kimera
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Leonard E G Mboera
- SACIDS Foundation for One Health Sokoine University of Agriculture, Morogoro, Tanzania
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13
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Oyebola OG, Debra J, Thubelihle M. PMTCT Data Management and Reporting during the Transition Phase of Implementing the Rationalised Registers in Amathole District, Eastern Cape Province, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15855. [PMID: 36497931 PMCID: PMC9736313 DOI: 10.3390/ijerph192315855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/21/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND The National Department of Health, in March 2015, launched the implementation of Rationalisation of Register, aimed at reducing the amount of time invested in completing the registers and collecting data. Therefore, the number of registers used in the South African healthcare facilities was reduced from 56 to 6. OBJECTIVES This study explored the effect of the rollout of Rationalisation of Register on the documentation and reporting of Prevention of Mother-to-Child Transmission (PMTCT) programme data with the existing source documents during the transitional period, especially with routine data collected and reported at various health care system levels. METHODS A mixed-method research approach was used, and three source documents, namely: Tally sheet, Antenatal care (ANC) register, and Tick register used for collecting and reporting PMTCT data, were reviewed. An in-depth interview was conducted with healthcare workers in four sub-districts of the Amathole district, Eastern Cape province of South Africa. RESULTS All selected facilities completed the three source documents. The facilities consolidated their PMTCT data monthly before reporting to the District Health Information System (DHIS). Less than half of the facilities had already started using the rationalised registers. However, they did not transition entirely because they still use other registers, especially the ANC register. Reasons for not displaying facility performance include clinicians not properly completing the clients' information, and a shortage of staff to collect, report, and analyse data. CONCLUSIONS PMTCT data management and reporting were challenging during the transitioning phase of implementing the rationalised registers because of different timelines instituted in the facilities and non-availability of source documents in some facilities. Capacity of the clinic staff involved in data collection should be built on programme care pathways, data monitoring, data capturing into the Routine Health Information System and complemented with coaching, mentoring, and supportive supervision for improved programme outputs and outcomes.
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Affiliation(s)
- Oyebanji G. Oyebola
- School of Public Health, University of the Western Cape, Cape Town 7535, South Africa
| | - Jackson Debra
- School of Public Health, University of the Western Cape, Cape Town 7535, South Africa
- London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Mathole Thubelihle
- School of Public Health, University of the Western Cape, Cape Town 7535, South Africa
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14
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Joseph JJ, Mkali HR, Reaves EJ, Mwaipape OS, Mohamed A, Lazaro SN, Aaron S, Chacky F, Mahendeka A, Rulagirwa HS, Mwenesi M, Mwakapeje E, Ally AY, Kitojo C, Serbantez N, Nyinondi S, Lalji SM, Wilillo R, Al-mafazy AW, Kabula BI, John C, Bisanzio D, Eckert E, Reithinger R, Ngondi JM. Improvements in malaria surveillance through the electronic Integrated Disease Surveillance and Response (eIDSR) system in mainland Tanzania, 2013-2021. Malar J 2022; 21:321. [PMID: 36348409 PMCID: PMC9641756 DOI: 10.1186/s12936-022-04353-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 10/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tanzania has made remarkable progress in reducing malaria burden and aims to transition from malaria control to sub-national elimination. In 2013, electronic weekly and monthly reporting platforms using the District Health Information System 2 (DHIS2) were introduced. Weekly reporting was implemented through the mobile phone-based Integrated Disease Surveillance and Response (eIDSR) platform and progressively scaled-up from 67 to 7471 (100%) public and private health facilities between 2013 and 2020. This study describes the roll-out and large-scale implementation of eIDSR and compares the consistency between weekly eIDSR and monthly DHIS2 malaria indicator data reporting, including an assessment of its usefulness for malaria outbreak detection and case-based surveillance (CBS) in low transmission areas. METHODS The indicators included in the analysis were number of patients tested for malaria, number of confirmed malaria cases, and clinical cases (treated presumptively for malaria). The analysis described the time trends of reporting, testing, test positivity, and malaria cases between 2013 and 2021. For both weekly eIDSR and monthly DHIS2 data, comparisons of annual reporting completeness, malaria cases and annualized incidence were performed for 2020 and 2021; additionally, comparisons were stratified by malaria epidemiological strata (parasite prevalence: very low < 1%, low 1 ≤ 5%, moderate 5 ≤ 30%, and high > 30%). RESULTS Weekly eIDSR reporting completeness steadily improved over time, with completeness being 90.2% in 2020 and 93.9% in 2021; conversely, monthly DHIS2 reporting completeness was 98.9% and 98.7% in 2020 and 2021, respectively. Weekly eIDSR reporting completeness and timeliness were highest in the very low epidemiological stratum. Annualized malaria incidence as reported by weekly eIDSR was 17.5% and 12.4% lower than reported by monthly DHIS2 in 2020 and 2021; for both 2020 and 2021, annualized incidence was similar across weekly and monthly data in the very low stratum. CONCLUSION The concurrence of annualized weekly eIDSR and monthly DHIS2 reporting completeness, malaria cases and incidence in very low strata suggests that eIDSR could be useful tool for early outbreak detection, and the eIDSR platform could reliably be expanded by adding more indicators and modules for CBS in the very low epidemiological stratum.
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Affiliation(s)
| | | | - Erik J. Reaves
- U.S. President’s Malaria Initiative, U.S. Center for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | | | - Ally Mohamed
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Samwel N. Lazaro
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Sijenunu Aaron
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Frank Chacky
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Anna Mahendeka
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania ,grid.415734.00000 0001 2185 2147National Malaria Control Programme, Dodoma, United Republic of Tanzania
| | - Hermes S. Rulagirwa
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania
| | - Mwendwa Mwenesi
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania
| | - Elibariki Mwakapeje
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania
| | - Ally Y. Ally
- grid.415734.00000 0001 2185 2147Ministry of Health, Dodoma, United Republic of Tanzania
| | - Chonge Kitojo
- U.S. President’s Malaria Initiative, U.S. Agency for International Development, Dar es Salaam, United Republic of Tanzania
| | - Naomi Serbantez
- U.S. President’s Malaria Initiative, U.S. Agency for International Development, Dar es Salaam, United Republic of Tanzania
| | - Ssanyu Nyinondi
- RTI International, Dar es Salaam, United Republic of Tanzania
| | | | | | | | | | - Claud John
- U.S. President’s Malaria Initiative, U.S. Center for Disease Control and Prevention, Dar es Salaam, United Republic of Tanzania
| | - Donal Bisanzio
- grid.62562.350000000100301493RTI International, Washington, DC USA
| | - Erin Eckert
- grid.62562.350000000100301493RTI International, Washington, DC USA
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Moloko SM, Ramukumba MM. Healthcare providers’ views of factors influencing family planning data quality in Tshwane District, South Africa. Afr J Prim Health Care Fam Med 2022; 14:e1-e10. [DOI: 10.4102/phcfm.v14i1.3545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022] Open
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Byrne E, Sæbø JI. Routine use of DHIS2 data: a scoping review. BMC Health Serv Res 2022; 22:1234. [PMID: 36203141 PMCID: PMC9535952 DOI: 10.1186/s12913-022-08598-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 08/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background In regard to health service planning and delivery, the use of information at different levels in the health system is vital, ranging from the influencing of policy to the programming of action to the ensuring of evidence-informed practices. However, neither ownership of, nor access to, good quality data guarantees actual use of these data. For information to be used, relevant data need to be collected, processed and analysed in an accessible format. This problem of underused data, and indeed the absence of data use entirely, is widespread and has been evident for decades. The DHIS2 software platform supports routine health management for an estimated 2.4 billion people, in over 70 countries worldwide. It is by far the largest and most widespread software for this purpose and adopts a holistic, socio-technical approach to development and implementation. Given this approach, and the rapid and extensive scaling of DHIS2, we questioned whether or not there has been a parallel increase in the scaling of improved information use. To date, there has been no rigorous review of the documentation on how exactly DHIS2 data is routinely being used for decision-making and subsequent programming of action. This scoping review addresses this review gap. Methods The five-stage approach of Arksey and O’Malley progressed by Levac et al. and Peters was followed. Three databases (PubMed, Web of Science and Embase) were searched, along with relevant conference proceedings and postgraduate theses. In total, over 500 documents were reviewed and data from 19 documents were extracted. Results Overall, DHIS2 data are being used but there are few detailed descriptions of this usage in peer reviewed or grey literature. We find that, commonly, there exists a centralised versus decentralised pattern of use in terms of access to data and the reporting of data ‘up’ in the system. We also find that the different conceptualisations of data use and how data use is conceptualised are not made explicit. Conclusions We conclude with some suggestions for a way forward, namely: i) the need to document in more detail and share how data are being used, ii) the need to investigate how data were created and who uses such data, iii) the need to design systems based on work practices, and in tandem develop and promote forums in which ‘conversations’ around data can take place. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08598-8.
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Affiliation(s)
- Elaine Byrne
- HISP Centre and Department of Informatics, University of Oslo, Gaustadalléen 30, N-0373, Oslo, Norway.
| | - Johan Ivar Sæbø
- HISP Centre and Department of Informatics, University of Oslo, Gaustadalléen 30, N-0373, Oslo, Norway
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17
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Kusyanti T, Wirakusumah FF, Rinawan FR, Muhith A, Purbasari A, Mawardi F, Puspitasari IW, Faza A, Stellata AG. Technology-Based (Mhealth) and Standard/Traditional Maternal Care for Pregnant Woman: A Systematic Literature Review. Healthcare (Basel) 2022; 10:healthcare10071287. [PMID: 35885813 PMCID: PMC9322765 DOI: 10.3390/healthcare10071287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/08/2022] [Accepted: 06/15/2022] [Indexed: 11/16/2022] Open
Abstract
The world of health has changed significantly since the advent of smartphones. Smartphones have been widely known to facilitate the search for health information in the mobile Health (mHealth) system, which is used to improve the quality of life for patients, such as communication between doctors and patients. This systematic literature review aims to identify the use of mHealth as a digital communication tool for pregnant women by comparing technology-based and standard-based pregnancy care. The method used is a systematic review of articles related to pregnancy care that utilize mHealth for pregnant women. The articles were obtained from the database based on the PICO framework; we searched articles using seven databases. The selection was adjusted to the inclusion criteria, data extraction, study quality evaluation, and results from synthesis. From the disbursement, 543 articles were obtained and 10 results were obtained after the screening. After a critical appraisal was carried out, four articles were obtained. Advantages can be in the form of increasing knowledge of pregnant women who use mHealth due to the availability of information needed by pregnant women in the mHealth application. mHealth also provides information about their babies, so the impact of mHealth is not only for mothers. mHealth is a promising solution in pregnancy care compared to the standard of maternal care.
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Affiliation(s)
- Tatik Kusyanti
- Doctoral Study Program, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia
- Department of Midwifery, Bandung Health Polytechnic, Jl. Sederhana No. 2, Bandung 40161, Indonesia
- Center of Excellence, Bandung Health Polytechnic, Jl. Pajajaran 56, Bandung 40171, Indonesia
- Correspondence:
| | - Firman Fuad Wirakusumah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia;
- Department of Obstetrics and Gynecology, Dr. Hasan Sadikin General Hospital, Jl. Pasteur No. 38, Bandung 40161, Indonesia
| | - Fedri Ruluwedrata Rinawan
- Center for Health System Study and Health Workforce Education Innovation, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia;
- Department of Public Health, Faculty of Medicine, Universitas Padjadjaran, Jalan Ir. Soekarno KM. 21, Jatinangor, Sumedang 45363, Indonesia
- Indonesian Society for Remote Sensing Branch, Gedung Labtek IX-C lt.3 Jalan Ganesha 10, Institut Teknologi Bandung, Bandung 40132, Indonesia
| | - Abdul Muhith
- Department of Nursing Science, Universitas Nahdlatul Ulama, Surabaya 60237, Indonesia;
| | - Ayi Purbasari
- Informatics Engineering Study Program, Faculty of Engineering, Universitas Pasundan, Jl. Dr. Setiabudi No. 193, Bandung 40153, Indonesia;
| | - Fitriana Mawardi
- Department of Family and Community Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia;
| | - Indriana Widya Puspitasari
- Master of Midwifery Study Program, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia; (I.W.P.); (A.G.S.)
| | - Afina Faza
- Master of Public Health Study Program, Faculty of Medicine, Universitas Padjadjaran, Jalan Eyckman No. 38 Gedung RSP Unpad Lantai 4, Bandung 40161, Indonesia;
- School of Economic and Business, Telkom University, Bandung 40257, Indonesia
| | - Alyxia Gita Stellata
- Master of Midwifery Study Program, Faculty of Medicine, Universitas Padjadjaran, Jl. Eyckman No. 38, Bandung 40161, Indonesia; (I.W.P.); (A.G.S.)
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Sunny FA, Fu L, Rahman MS, Karimanzira TTP, Zuhui H. What influences Bangladeshi Boro rice farmers' adoption decisions of recommended fertilizer doses: A case study on Dinajpur district. PLoS One 2022; 17:e0269611. [PMID: 35671320 PMCID: PMC9173630 DOI: 10.1371/journal.pone.0269611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/24/2022] [Indexed: 11/18/2022] Open
Abstract
Due to the combined effect of biotic and abiotic constraints, rising population pressure, and inelastic demand in the crop and horticulture sector, Bangladesh has had to adopt heavily subsidized and intensified fertilizer policies to enhance crop productivity, achieve and sustain self-sufficiency in food production, and food security provision. Although the initiative has played a vital role in boosting production, it has also invigorated the unbalanced amount of fertilizer application practices raising questions about maintaining biodiversity and ecosystem services while feeding the nation's population. Further research in this area must thus be applied to monitor and improve this sector. This study attempts to understand the issue by investigating the factors influencing Boro rice farmers' adoption decisions of recommended fertilizer doses. The study employs an ordered probit model with a sample selection approach. The investigation is based on collected data from 405 randomly selected farmers using a face-to-face interview method. The farmers were classified into low, middle, high and non-adopter groups. The study revealed that farmers' age, land typology, soil water retention, knowledge, and availability of cow dung significantly influenced farmers' decision to apply fertilizers. However, farmers' carry an aversion to following recommendations for fertilizer application due to their ambiguity about the whole system, their current fertilizer application-seeking behavior, and the lack of understanding of the environmental benefits of adoption. These issues urge policy interventions to initiate village-based demonstration programs that synthesize better synergies between recommended dose adoption, yield amelioration, sustainable soil care, and economics.
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Affiliation(s)
- Faruque As Sunny
- School of Management, Zhejiang University, Hangzhou, Zhejiang, China
| | - Linlin Fu
- Institute of Rural Development, Zhejiang Academy of Agricultural Sciences, Hangzhou, Zhejiang, China
| | - Md Sadique Rahman
- Department of Management and Finance, Sher-e-Bangla Agricultural University, Dhaka, Bangladesh
| | | | - Huang Zuhui
- China Academy of Rural Development, Zhejiang University, Hangzhou, Zhejiang, China
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19
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Emina J, Etinkum R, Aissaoui A, Gbomosa CN, Elamurugan K, Rajendra KL, El Mowafi IM, Kobeissi L. Feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child, and adolescent health indicators in humanitarian settings: results from a multi-methods assessment in the Democratic Republic of Congo. Reprod Health 2022; 19:129. [PMID: 35655229 PMCID: PMC9161767 DOI: 10.1186/s12978-022-01415-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 04/05/2022] [Indexed: 11/11/2022] Open
Abstract
Background Reliable and rigorously collected sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) data in humanitarian settings are often sparse and variable in quality across different humanitarian settings, and there is a lack of consensus about a core set of indicators that humanitarian actors including national health systems should report on. To address this gap in quality data, the World Health Organization (WHO) developed a core set of indicators for monitoring and evaluating SRMNCAH services and outcomes and assessed their feasibility in four countries, including the Democratic Republic of Congo (DRC) with the goal of aggregating information from global consultations and field-level assessments to reach consensus on a set of core SRMNCAH indicators among WHO partners. Methods The feasibility assessment in the DRC focused on the following constructs: relevance/usefulness, feasibility of measurement, systems and resources, and ethical issues. The multi-methods assessment included five components; a desk review, key informant interviews, focus group discussions, facility assessments, and observational sessions. Results The findings suggest that there is widespread support among stakeholders for developing a standardized core list of SRMNCAH indicators to be collected among all humanitarian actors in the DRC. There are numerous resources and data collection systems that could be leveraged, built upon, and improved to ensure the feasibility of collecting this proposed set of indicators. However, the data collection load requested from donors, the national government, international and UN agencies, and coordination/cluster systems must be better harmonized, standardized, and less burdensome. Conclusions Despite stakeholder support in developing a core set of indicators, this would only be useful if it has the buy-in from the international community. Greater harmonization and coordination, alongside increased resource allocation, would improve data collection efforts and allow stakeholders to meet indicators’ reporting requirements. In humanitarian settings, data collection is often unreliable and not standardized—especially with regards to sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH). In order to address this gap in data quality, the World Health Organization proposed a list of core indicators to four countries, including the Democratic Republic of Congo (DRC). The goal was to use the findings from the DRC context to contribute to the determination of a core set of indicators. This study had two components: a feasibility assessment and a multi-methods assessment. The feasibility assessment in the DRC focused on the relevance of the proposed indicators, the feasibility of measurement, the resources in place, and ethical issues. The multi-methods assessment included a desk review, interviews with key informants, and focus groups and facility assessments. The findings showed that partners in the DRC supported developing a standard set of SRMCAH indicators that can be used among all humanitarian partners in the country. There are many systems in place that could be used or strengthened to improve data collection. However, the findings also showed that there must be better collaboration and coordination between the different partners in the DRC, as well as increased resources, to alleviate burden on frontline staff. In conclusion, though there is a desire to harmonize indicators, more input and resources are needed from the international community to aid in the standardization of data collection in order to meet local reporting requirements and ease burden on local staff.
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Affiliation(s)
- Jacques Emina
- University of Kinshasa, Kinshasa, Democratic Republic of Congo.,Population and Health Research Institute, Kinshasa, Democratic Republic of Congo
| | - Rinelle Etinkum
- Population and Health Research Institute, Kinshasa, Democratic Republic of Congo
| | - Anya Aissaoui
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,NORImpact Consultancy AS, Rytterfaret 17A, Hafrsjord, Norway
| | - Cady Nyombe Gbomosa
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,Institute for Population Health, University of Ottawa, Ottawa, ON, Canada
| | - Kaeshan Elamurugan
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada. .,NORImpact Consultancy AS, Rytterfaret 17A, Hafrsjord, Norway.
| | - Kanya Lakshmi Rajendra
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,NORImpact Consultancy AS, Rytterfaret 17A, Hafrsjord, Norway
| | - Ieman Mona El Mowafi
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada.,NORImpact Consultancy AS, Rytterfaret 17A, Hafrsjord, Norway.,Institute for Population Health, University of Ottawa, Ottawa, ON, Canada.,Cambridge Reproductive Health Consultants, Cambridge, MA, USA
| | - Loulou Kobeissi
- Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland
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20
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Simba D, Sukums F, Kumalija C, Asiimwe SE, Pothepragada SK, Githendu PW. Perceived Usefulness, Competency, and Associated Factors in Using District Health Information System Data Among District Health Managers in Tanzania: Cross-sectional Study. JMIR Form Res 2022; 6:e29469. [PMID: 35604763 PMCID: PMC9171597 DOI: 10.2196/29469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/14/2021] [Accepted: 12/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Tanzania introduced District Health Information Software (version 2; DHIS2) in 2013 to support existing health management information systems and to improve data quality and use. However, to achieve these objectives, it is imperative to build human resource capabilities to address the challenges of new technologies, especially in resource-constrained countries. Objective This study aimed to determine the perceived usefulness, competency, and associated factors in using DHIS2 data among district health managers (DHMs) in Tanzania. Methods This descriptive cross-sectional study used a quantitative approach, which involved using a self-administered web-based questionnaire. This study was conducted between April and September 2019. We included all core and co-opted members of the council or district health management teams (DHMTs) from all 186 districts in the country. Frequency and bivariate analyses were conducted, and the differences among categories were measured by using a chi-square test. P values of <.05 were considered significant. Results A total of 2667 (77.96%) of the expected 3421 DHMs responded, of which 2598 (97.41%) consented and completed the questionnaires. Overall, the DHMs were satisfied with DHIS2 (2074/2596, 79.83%) because of workload reduction (2123/2598, 81.72%), the ease of learning (1953/2598, 75.17%), and enhanced data use (2239/2598, 86.18%). Although only half of the managers had user accounts (1380/2598, 53.12%) and were trained on DHIS2 data analysis (1237/2598, 47.61%), most claimed to have average to advanced skills in data validation (1774/2598, 68.28%), data visualization (1563/2598, 60.16%), and DHIS2 data use (1321/2598, 50.85%). The biggest challenges facing DHMs included the use of a paper-based system as the primary data source (1890/2598, 72.75%) and slow internet speed (1552/2598, 59.74%). Core members were more confident in using DHIS2 compared with other members (P=.004), whereas program coordinators were found to receive more training on data analysis and use (P=.001) and were more confident in using DHIS2 data compared with other DHMT members (P=.001). Conclusions This study showed that DHMs have appreciable competencies in using the DHIS2 and its data. However, their skill levels have not been commensurate with the duration of DHIS2 use. This study recommends improvements in the access to and use of DHIS2 data. More training on data use is required and should involve using cost-effective approaches to include both the core and noncore members of the DHMTs. Moreover, enhancing the culture and capacity of data use will ensure the better management and accountability of health system performance.
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Affiliation(s)
- Daudi Simba
- Department of Community Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Felix Sukums
- Directorate of Information and Communication Technology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Claud Kumalija
- Health Management Information System Unit, Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, United Republic of Tanzania
| | - Sarah Eden Asiimwe
- The Global Fund to Fight HIV, Tuberculosis and Malaria, Geneva, Switzerland
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Aktar B, Rajendra KL, Clark E, Messier K, Aissaoui A, Elamurugan K, Hasan MT, Farnaz N, Kaiser A, Awal A, El Mowafi IM, Kobeissi L. Feasibility of establishing a core set of sexual, reproductive, maternal, newborn, child, and adolescent health indicators in humanitarian settings: results from a multi-methods assessment in Bangladesh. Reprod Health 2022; 19:121. [PMID: 35598010 PMCID: PMC9124416 DOI: 10.1186/s12978-022-01424-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/29/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Reliable and rigorously collected sexual, reproductive, maternal, newborn, child, and adolescent health (SRMNCAH) data in humanitarian settings is often sparse and varies in quality across different humanitarian settings. To address this gap in quality data, the World Health Organization (WHO) developed a core set of indicators for monitoring and evaluating SRMNCAH services and outcomes, and assessed their feasibility in Bangladesh, Afghanistan, Jordan, and the Democratic Republic of Congo. METHODS The feasibility assessments aggregated information from global consultations and field-level assessments to reach a consensus on a set of core SRMNCAH indicators among WHO partners. The feasibility assessment in Bangladesh focused on the following constructs: relevance/usefulness of the core set of indicators, the feasibility of measurement, availability of systems and resources, and ethical issues during data collection and management. The field-level multi-methods assessment included five components; a desk review, key informant interviews, focus group discussions, and facility assessments including observations of facility-level data management. RESULTS The findings suggest that there is widespread support among stakeholders for developing a standardized core set of SRMNCAH indicators to be collected among all humanitarian actors in Bangladesh. There are numerous resources and data collection systems that could be leveraged, built upon, and improved to ensure the feasibility of collecting this proposed set of indicators. However, the data collection load requested from donors, the national government, international and UN agencies, coordination/cluster systems must be better harmonized, standardized, and less burdensome. CONCLUSION This core set of indicators would only be useful if it has the buy-in from the international community that results in harmonizing and coordinating data collection efforts and relevant indicators' reporting requirements.
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Affiliation(s)
- Bachera Aktar
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
| | - Kanya Lakshmi Rajendra
- NOR Impact AS, Rogaland, Norway
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Emily Clark
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- NOR Impact AS, Rogaland, Norway
| | - Kassandre Messier
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Cambridge Reproductive Health Consultants, Cambridge, MA, USA
| | - Anya Aissaoui
- NOR Impact AS, Rogaland, Norway
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Kaeshan Elamurugan
- NOR Impact AS, Rogaland, Norway
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Md Tanvir Hasan
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Nadia Farnaz
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Adrita Kaiser
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Abdul Awal
- BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
- New Mexico Institute of Mining and Technology, Socorro, NM, USA
| | - Ieman Mona El Mowafi
- NOR Impact AS, Rogaland, Norway
- Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
- Cambridge Reproductive Health Consultants, Cambridge, MA, USA
- Institute for Population Health, University of Ottawa, Ottawa, ON, Canada
| | - Loulou Kobeissi
- Department of Sexual and Reproductive Health and Research (SRH), World Health Organization, Geneva, Switzerland
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22
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Debie A, Khatri RB, Assefa Y. Successes and challenges of health systems governance towards universal health coverage and global health security: a narrative review and synthesis of the literature. Health Res Policy Syst 2022; 20:50. [PMID: 35501898 PMCID: PMC9059443 DOI: 10.1186/s12961-022-00858-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/13/2022] [Indexed: 01/15/2023] Open
Abstract
Background The shift in the global burden of disease from communicable to noncommunicable was a factor in mobilizing support for a broader post-Millennium Development Goals (MDGs) health agenda. To curb these and other global health problems, 193 Member States of the United Nations (UN) became signatories of the Sustainable Development Goals (SDGs) and committed to achieving universal health coverage (UHC) by 2030. In the context of the coronavirus disease 2019 (COVID-19) pandemic, the importance of health systems governance (HSG) is felt now more than ever for addressing the pandemic and continuing to provide essential health services. However, little is known about the successes and challenges of HSG with respect to UHC and health security. This study, therefore, aims to synthesize the evidence and identify successes and challenges of HSG towards UHC and health security. Methods We conducted a structured narrative review of studies published through 28 July 2021. We searched the existing literature using three databases: PubMed, Scopus and Web of Science. Search terms included three themes: HSG, UHC and health security. We synthesized the findings using the five core functions of HSG: policy formulation and strategic plans; intelligence; regulation; collaboration and coalition; and accountability. Results A total of 58 articles were included in the final review. We identified that context-specific health policy and health financing modalities helped to speed up the progress towards UHC and health security. Robust health intelligence, intersectoral collaboration and coalition were also essential to combat the pandemic and ensure the delivery of essential health services. On the contrary, execution of a one-size-fits-all HSG approach, lack of healthcare funding, corruption, inadequate health workforce, and weak regulatory and health government policies were major challenges to achieving UHC and health security. Conclusions Countries, individually and collectively, need strong HSG to speed up the progress towards UHC and health security. Decentralization of health services to grass root levels, support of stakeholders, fair contribution and distribution of resources are essential to support the implementation of programmes towards UHC and health security. It is also vital to ensure independent regulatory accreditation of organizations in the health system and to integrate quality- and equity-related health service indicators into the national social protection monitoring and evaluation system; these will speed up the progress towards UHC and health security. Supplementary Information The online version contains supplementary material available at 10.1186/s12961-022-00858-7.
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Affiliation(s)
- Ayal Debie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box 196, Gondar, Ethiopia.
| | - Resham B Khatri
- School of Public Health, The University of Queensland, Brisbane, Australia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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Wambua S, Malla L, Mbevi G, Kandiah J, Nwosu AP, Tuti T, Paton C, Wambu B, English M, Okiro EA. Quantifying the indirect impact of COVID-19 pandemic on utilisation of outpatient and immunisation services in Kenya: a longitudinal study using interrupted time series analysis. BMJ Open 2022; 12:e055815. [PMID: 35273053 PMCID: PMC8914407 DOI: 10.1136/bmjopen-2021-055815] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 01/31/2022] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE In this study, we assess the indirect impact of COVID-19 on utilisation of immunisation and outpatient services in Kenya. DESIGN Longitudinal study. SETTING Data were analysed from all healthcare facilities reporting to Kenya's health information system from January 2018 to March 2021. Multiple imputation was used to address missing data, interrupted time series analysis was used to quantify the changes in utilisation of services and sensitivity analysis was carried out to assess robustness of estimates. EXPOSURE OF INTEREST COVID-19 outbreak and associated interventions. OUTCOME MEASURES Monthly attendance to health facilities. We assessed changes in immunisation and various outpatient services nationally. RESULTS Before the first case of COVID-19 and pursuant intervention measures in March 2020, uptake of health services was consistent with historical levels. There was significant drops in attendance (level changes) in April 2020 for overall outpatient visits for under-fives (rate ratio, RR 0.50, 95% CI 0.44 to 0.57), under-fives with pneumonia (RR 0.43, 95% CI 0.38 to 0.47), overall over-five visits (RR 0.65, 95% CI 0.57 to 0.75), over-fives with pneumonia (RR 0.62, 95% CI 0.55 to 0.70), fourth antenatal care visit (RR 0.86, 95% CI 0.80 to 0.93), total hypertension (RR 0.89, 95% CI 0.82 to 0.96), diabetes cases (RR 0.95 95% CI, 0.93 to 0.97) and HIV testing (RR 0.97, 95% CI 0.94 to 0.99). Immunisation services, first antenatal care visits, new cases of hypertension and diabetes were not affected. The post-COVID-19 trend was increasing, with more recent data suggesting reversal of effects and health services reverting to expected levels as of March 2021. CONCLUSION COVID-19 pandemic has had varied indirect effects on utilisation of health services in Kenya. There is need for proactive and targeted interventions to reverse these effects as part of the pandemic's response to avert non-COVID-19 indirect mortality.
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Affiliation(s)
- Steven Wambua
- Population Health Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Lucas Malla
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - George Mbevi
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Joel Kandiah
- Mathematics Institute, University of Warwick, Coventry, UK
| | - Amen-Patrick Nwosu
- Nuffield Department of Clinical Medicine, Oxford Centre for Global Health Research, Oxford, UK
| | - Timothy Tuti
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
| | - Chris Paton
- Nuffield Department of Clinical Medicine, Oxford Centre for Global Health Research, Oxford, UK
| | - Bernard Wambu
- Division of Neonatal and Child Health, Kenya Ministry of Health, Nairobi, Kenya
| | - Mike English
- Health Services Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Oxford Centre for Global Health Research, Oxford, UK
| | - Emelda A Okiro
- Population Health Unit, KEMRI-Wellcome Trust Research Programme Nairobi, Nairobi, Kenya
- Nuffield Department of Clinical Medicine, Oxford Centre for Global Health Research, Oxford, UK
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24
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Mwamlima TG, Mwakasungula SM, Mkindi CG, Tambwe MM, Mswata SS, Mbwambo SG, Mboya MF, Draper SJ, Silk SE, Mpina MG, Vianney JM, Olotu AI. Understanding the role of serological and clinical data on assessing the dynamic of malaria transmission: a case study of Bagamoyo district, Tanzania. Pan Afr Med J 2022; 43:60. [PMID: 36578806 PMCID: PMC9755714 DOI: 10.11604/pamj.2022.43.60.35779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/01/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction naturally acquired blood-stage malaria antibodies and malaria clinical data have been reported to be useful in monitoring malaria change over time and as a marker of malaria exposure. This study assessed the total immunoglobulin G (IgG) levels to Plasmodium falciparum schizont among infants (5-17 months), estimated malaria incidence using routine health facility-based surveillance data and predicted trend relation between anti-schizont antibodies and malaria incidence in Bagamoyo. Methods 252 serum samples were used for assessment of total IgG by enzyme-linked immunosorbent assay and results were expressed in arbitrary units (AU). 147/252 samples were collected in 2021 during a blood-stage malaria vaccine trial [ClinicalTrials.gov NCT04318002], and 105/252 were archived samples of malaria vaccine trial conducted in 2012 [ClinicalTrials.gov NCT00866619]. Malaria incidence was calculated from outpatient clinic data of malaria rapid test or blood smear positive results retrieved from District-Health-Information-Software-2 (DHIS2) between 2013 and 2020. Cross-sectional data from both studies were analysed using STATA version 14. Results this study demonstrated a decline in total anti-schizont IgG levels from 490.21AU in 2012 to 97.07AU in 2021 which was related to a fall in incidence from 58.25 cases/1000 person-year in 2013 to 14.28 cases/1000 person-year in 2020. We also observed a significant difference in incidence when comparing high and low malaria transmission areas and by gender. However, we did not observe differences when comparing total anti-schizont antibodies by gender and study year. Conclusion total anti-schizont antibody levels appear to be an important serological marker of exposure for assessing the dynamic of malaria transmission in infants living in malaria-endemic regions.
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Affiliation(s)
- Tunu Guntram Mwamlima
- Ifakara Health Institute, Bagamoyo, Tanzania
- Department of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
- Corresponding author: Tunu Guntram Mwamlima, Ifakara Health Institute, Bagamoyo, Tanzania.
| | | | | | | | | | | | | | - Simon John Draper
- Department of Biochemistry, University of Oxford, Oxford OX1 3QU, United Kingdom
| | | | | | - John-Mary Vianney
- Department of Life Science and Bio-Engineering, The Nelson Mandela African Institution of Science and Technology, Arusha, Tanzania
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Arsenault C, Yakob B, Kassa M, Dinsa G, Verguet S. Using health management information system data: case study and verification of institutional deliveries in Ethiopia. BMJ Glob Health 2021; 6:bmjgh-2021-006216. [PMID: 34426404 PMCID: PMC8383857 DOI: 10.1136/bmjgh-2021-006216] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/03/2021] [Indexed: 11/05/2022] Open
Abstract
Health management information systems (HMIS) are a crucial source of timely health statistics and have the potential to improve reporting in low-income countries. However, concerns about data quality have hampered their widespread adoption in research and policy decisions. This article presents results from a data verification study undertaken to gain insights into the quality of HMIS data in Ethiopia. We also provide recommendations for working with HMIS data for research and policy translation. We linked the HMIS to the 2016 Emergency Obstetric and Newborn Care Assessment, a national census of all health facilities that provided maternal and newborn health services in Ethiopia. We compared the number of visits for deliveries and caesarean sections (C-sections) reported in the HMIS in 2015 (January–December) to those found in source documents (paper-based labour and delivery and operating theatre registers) in 2425 facilities across Ethiopia. We found that two-thirds of facilities had ‘good’ HMIS reporting for deliveries (defined as reporting within 10% of source documents) and half had ‘very good’ reporting (within 5% of source documents). Results were similar for reporting on C-section deliveries. We found that good reporting was more common in urban areas (OR: 1.30, 95% CI 1.06 to 1.59), public facilities (OR: 2.95, 95% CI 1.38 to 6.29) and in hospitals compared with health centres (OR: 1.71, 95% CI 1.13 to 2.61). Facilities in the Somali and Afar regions had the lowest odds of good reporting compared with Addis Ababa and were more likely to over-report deliveries in the HMIS. Further work remains to address remaining discrepancies in the Ethiopian HMIS. Nonetheless, our findings corroborate previous data verification exercises in Ethiopia and support greater use and uptake of HMIS data for research and policy decisions (particularly, greater use of HMIS data elements (eg, absolute number of services provided each month) rather than coverage indicators). Increased use of these data, combined with feedback mechanisms, is necessary to maintain data quality.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Bereket Yakob
- Fenot project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia
| | - Munir Kassa
- Minister's Office, Ministry of Health, Addis Ababa, Ethiopia
| | - Girmaye Dinsa
- Fenot project, School of Population and Public Health, University of British Columbia, Addis Ababa, Ethiopia.,Department of Public Health and Health Policy, Haramaya University, Hararamaya, Ethiopia
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Nessa A, Uddin SM, Azad AK. Initiation of Population-Based Cervical and Breast Cancer Screening in Bangladesh. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2021. [DOI: 10.1007/s40944-021-00550-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tahsina T, Hossain AT, Ruysen H, Rahman AE, Day LT, Peven K, Rahman QSU, Khan J, Shabani J, Kc A, Mazumder T, Zaman SB, Ameen S, Kong S, Amouzou A, Lincetto O, El Arifeen S, Lawn JE. Immediate newborn care and breastfeeding: EN-BIRTH multi-country validation study. BMC Pregnancy Childbirth 2021; 21:237. [PMID: 33765946 PMCID: PMC7995709 DOI: 10.1186/s12884-020-03421-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Immediate newborn care (INC) practices, notably early initiation of breastfeeding (EIBF), are fundamental for newborn health. However, coverage tracking currently relies on household survey data in many settings. "Every Newborn Birth Indicators Research Tracking in Hospitals" (EN-BIRTH) was an observational study validating selected maternal and newborn health indicators. This paper reports results for EIBF. METHODS The EN-BIRTH study was conducted in five public hospitals in Bangladesh, Nepal, and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data on EIBF and INC practices (skin-to-skin within 1 h of birth, drying, and delayed cord clamping). To assess validity of EIBF measurement, we compared observation as gold standard to register records and women's exit-interview survey reports. Percent agreement was used to assess agreement between EIBF and INC practices. Kaplan Meier survival curves showed timing. Qualitative interviews were conducted to explore barriers/enablers to register recording. RESULTS Coverage of EIBF among 7802 newborns observed for ≥1 h was low (10.9, 95% CI 3.8-21.0). Survey-reported (53.2, 95% CI 39.4-66.8) and register-recorded results (85.9, 95% CI 58.1-99.6) overestimated coverage compared to observed levels across all hospitals. Registers did not capture other INC practices apart from breastfeeding. Agreement of EIBF with other INC practices was high for skin-to-skin (69.5-93.9%) at four sites, but fair/poor for delayed cord-clamping (47.3-73.5%) and drying (7.3-29.0%). EIBF and skin-to-skin were the most delayed and EIBF rarely happened after caesarean section (0.5-3.6%). Qualitative findings suggested that focusing on accuracy, as well as completeness, contributes to higher quality with register reporting. CONCLUSIONS Our study highlights the importance of tracking EIBF despite measurement challenges and found low coverage levels, particularly after caesarean births. Both survey-reported and register-recorded data over-estimated coverage. EIBF had a strong agreement with skin-to-skin but is not a simple tracer for other INC indicators. Other INC practices are challenging to measure in surveys, not included in registers, and are likely to require special studies or audits. Continued focus on EIBF is crucial to inform efforts to improve provider practices and increase coverage. Investment and innovation are required to improve measurement.
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Affiliation(s)
- Tazeen Tahsina
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh.
| | - Aniqa Tasnim Hossain
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Harriet Ruysen
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Ahmed Ehsanur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Louise T Day
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Kimberly Peven
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Qazi Sadeq-Ur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Jasmin Khan
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Josephine Shabani
- Department of Health Systems, Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Ashish Kc
- Department of Women's and Children's Health, International Maternal and Child Health, Uppsala University, Uppsala, Sweden
| | - Tapas Mazumder
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Sojib Bin Zaman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Shafiqul Ameen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Stefanie Kong
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
| | - Agbessi Amouzou
- Johns Hopkins University, Bloomberg School of Public Health, Baltimore, USA
| | | | - Shams El Arifeen
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research Bangladesh, (icddr,b), 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene & Tropical Medicine, London, UK
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Berrueta M, Ciapponi A, Bardach A, Cairoli FR, Castellano FJ, Xiong X, Stergachis A, Zaraa S, Meulen AST, Buekens P. Maternal and neonatal data collection systems in low- and middle-income countries for maternal vaccines active safety surveillance systems: A scoping review. BMC Pregnancy Childbirth 2021; 21:217. [PMID: 33731029 PMCID: PMC7968860 DOI: 10.1186/s12884-021-03686-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Most post-licensure vaccine pharmacovigilance in low- and middle-income countries (LMICs) are passive reporting systems. These have limited utility for maternal immunization pharmacovigilance in LMIC settings and need to be supplemented with active surveillance. Our study's main objective was to identify existing perinatal data collection systems in LMICs that collect individual information on maternal and neonatal health outcomes and could be developed to inform active safety surveillance of novel vaccines for use during pregnancy. METHODS A scoping review was performed following the Arksey and O'Malley six-stage approach. We included studies describing electronic or mixed paper-electronic data collection systems in LMICs, including research networks, electronic medical records, and custom software platforms for health information systems. Medline PubMed, EMBASE, Global Health, Cochrane Library, LILACS, Bibliography of Asian Studies (BAS), and CINAHL were searched through August 2019. We also searched grey literature including through Google and websites of existing relevant perinatal data collection systems, as well as contacted authors of key studies and experts in the field to validate the information and identify additional sources of relevant unpublished information. RESULTS A total of 11,817 records were identified. The full texts of 264 records describing 96 data collection systems were assessed for eligibility. Eight perinatal data collection systems met our inclusion criteria: Global Network's Maternal Newborn Health Registry, International Network for the Demographic Evaluation of Populations and their Health; Perinatal Informatic System; Pregnancy Exposure Registry & Birth Defects Surveillance; SmartCare; Open Medical Record System; Open Smart Register Platform and District Health Information Software 2. These selected systems were qualitatively characterized according to seven different domains: governance; system design; system management; data management; data sources, outcomes and data quality. CONCLUSION This review provides a list of active maternal and neonatal data collection systems in LMICs and their characteristics as well as their outreach, strengths, and limitations. Findings could potentially help further understand where to obtain population-based high-quality information on outcomes to inform the conduct of maternal immunization active vaccine safety surveillance activities and research in LMICs.
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Affiliation(s)
- Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina.
| | - Agustin Ciapponi
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Federico Rodriguez Cairoli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Fabricio J Castellano
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | | | - Sabra Zaraa
- University of Washington, Seattle, WA, 98195-7631, USA
| | | | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
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29
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Wangdi K, Sarma H, Leaburi J, McBryde E, Clements ACA. Evaluation of the malaria reporting system supported by the District Health Information System 2 in Solomon Islands. Malar J 2020; 19:372. [PMID: 33069245 PMCID: PMC7568381 DOI: 10.1186/s12936-020-03442-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background District Health Information Systems 2 (DHIS2) is used for supporting health information management in 67 countries, including Solomon Islands. However, there have been few published evaluations of the performance of DHIS2-enhanced disease reporting systems, in particular for monitoring infectious diseases such as malaria. The aim of this study was to evaluate DHIS2 supported malaria reporting in Solomon Islands and to develop recommendations for improving the system. Methods The evaluation was conducted in three administrative areas of Solomon Islands: Honoria City Council, and Malaita and Guadalcanal Provinces. Records of nine malaria indicators including report submission date, total malaria cases, Plasmodium falciparum case record, Plasmodium vivax case record, clinical malaria, malaria diagnosed with microscopy, malaria diagnosed with (rapid diagnostic test) (RDT), record of drug stocks and records of RDT stocks from 1st January to 31st December 2016 were extracted from the DHIS2 database. The indicators permitted assessment in four core areas: availability, completeness, timeliness and reliability. To explore perceptions and point of view of the stakeholders on the performance of the malaria case reporting system, focus group discussions were conducted with health centre nurses, whilst in-depth interviews were conducted with stakeholder representatives from government (province and national) staff and World Health Organization officials who were users of DHIS2. Results Data were extracted from nine health centres in Honoria City Council and 64 health centres in Malaita Province. The completeness and timeliness from the two provinces of all nine indicators were 28.2% and 5.1%, respectively. The most reliable indicator in DHIS2 was ‘clinical malaria’ (i.e. numbers of clinically diagnosed malaria cases) with 62.4% reliability. Challenges to completeness were a lack of supervision, limited feedback, high workload, and a lack of training and refresher courses. Health centres located in geographically remote areas, a lack of regular transport, high workload and too many variables in the reporting forms led to delays in timely reporting. Reliability of reports was impacted by a lack of technical professionals such as statisticians and unavailability of tally sheets and reporting forms. Conclusion The availability, completeness, timeliness and reliability of nine malaria indicators collected in DHIS2 were variable within the study area, but generally low. Continued onsite support, supervision, feedback and additional enhancements, such as electronic reporting will be required to further improve the malaria reporting system.
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Affiliation(s)
- Kinley Wangdi
- Department of Global Health, Research School of Population Health, College of Health and Medicine, The Australian National University, 62 Mills Road, Canberra, ACT 2601, Australia.
| | - Haribondu Sarma
- National Centre of Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - John Leaburi
- National Vector Borne Disease Control Programme, Ministry of Health and Medical Services, Honiara, Solomon Islands
| | - Emma McBryde
- Australian Institute of Tropical Health & Medicine, Centre for Biosecurity in Tropical Infectious Diseases, James Cooks University, Townsville, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Bentley, Australia.,Telethon Kids Institute, Nedlands, Australia
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30
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Bucher SL, Cardellichio P, Muinga N, Patterson JK, Thukral A, Deorari AK, Data S, Umoren R, Purkayastha S. Digital Health Innovations, Tools, and Resources to Support Helping Babies Survive Programs. Pediatrics 2020; 146:S165-S182. [PMID: 33004639 DOI: 10.1542/peds.2020-016915i] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2020] [Indexed: 11/24/2022] Open
Abstract
The Helping Babies Survive (HBS) initiative features a suite of evidence-based curricula and simulation-based training programs designed to provide health workers in low- and middle-income countries (LMICs) with the knowledge, skills, and competencies to prevent, recognize, and manage leading causes of newborn morbidity and mortality. Global scale-up of HBS initiatives has been rapid. As HBS initiatives rolled out across LMIC settings, numerous bottlenecks, gaps, and barriers to the effective, consistent dissemination and implementation of the programs, across both the pre- and in-service continuums, emerged. Within the first decade of expansive scale-up of HBS programs, mobile phone ownership and access to cellular networks have also concomitantly surged in LMICs. In this article, we describe a number of HBS digital health innovations and resources that have been developed from 2010 to 2020 to support education and training, data collection for monitoring and evaluation, clinical decision support, and quality improvement. Helping Babies Survive partners and stakeholders can potentially integrate the described digital tools with HBS dissemination and implementation efforts in a myriad of ways to support low-dose high-frequency skills practice, in-person refresher courses, continuing medical and nursing education, on-the-job training, or peer-to-peer learning, and strengthen data collection for key newborn care and quality improvement indicators and outcomes. Thoughtful integration of purpose-built digital health tools, innovations, and resources may assist HBS practitioners to more effectively disseminate and implement newborn care programs in LMICs, and facilitate progress toward the achievement of Sustainable Development Goal health goals, targets, and objectives.
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Affiliation(s)
- Sherri L Bucher
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana; .,Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana
| | | | - Naomi Muinga
- Kenya Medical Research Institute Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jackie K Patterson
- Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Anu Thukral
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok K Deorari
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Santorino Data
- Department of Pediatrics and Child Health, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Rachel Umoren
- Division of Neonatology, Department of Pediatrics, School of Medicine, Seattle, Washington.,Department of Global Health, School of Medicine, University of Washington, Seattle, Washington; and
| | - Saptarshi Purkayastha
- Department of Data Science and Health Informatics, School of Informatics and Computing, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana
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