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Ndlovu K, Mauco KL, Makhura O, Hu R, Motlogelwa NP, Masizana A, Lo E, Mphoyakgosi T, Moyo S. Experiences, Lessons, and Challenges With Adapting REDCap for COVID-19 Laboratory Data Management in a Resource-Limited Country: Descriptive Study. JMIR Form Res 2024; 8:e50897. [PMID: 38625736 PMCID: PMC11061793 DOI: 10.2196/50897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 10/10/2023] [Accepted: 11/02/2023] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic brought challenges requiring timely health data sharing to inform accurate decision-making at national levels. In Botswana, we adapted and integrated the Research Electronic Data Capture (REDCap) and the District Health Information System version 2 (DHIS2) platforms to support timely collection and reporting of COVID-19 cases. We focused on establishing an effective COVID-19 data flow at the national public health laboratory, being guided by the needs of health care professionals at the National Health Laboratory (NHL). This integration contributed to automated centralized reporting of COVID-19 results at the Ministry of Health (MOH). OBJECTIVE This paper reports the experiences, challenges, and lessons learned while designing, adapting, and implementing the REDCap and DHIS2 platforms to support COVID-19 data management at the NHL in Botswana. METHODS A participatory design approach was adopted to guide the design, customization, and implementation of the REDCap platform in support of COVID-19 data management at the NHL. Study participants included 29 NHL and 4 MOH personnel, and the study was conducted from March 2, 2020, to June 30, 2020. Participants' requirements for an ideal COVID-19 data management system were established. NVivo 11 software supported thematic analysis of the challenges and resolutions identified during this study. These were categorized according to the 4 themes of infrastructure, capacity development, platform constraints, and interoperability. RESULTS Overall, REDCap supported the majority of perceived technical and nontechnical requirements for an ideal COVID-19 data management system at the NHL. Although some implementation challenges were identified, each had mitigation strategies such as procurement of mobile Internet routers, engagement of senior management to resolve conflicting policies, continuous REDCap training, and the development of a third-party web application to enhance REDCap's capabilities. Lessons learned informed next steps and further refinement of the REDCap platform. CONCLUSIONS Implementation of REDCap at the NHL to streamline COVID-19 data collection and integration with the DHIS2 platform was feasible despite the urgency of implementation during the pandemic. By implementing the REDCap platform at the NHL, we demonstrated the possibility of achieving a centralized reporting system of COVID-19 cases, hence enabling timely and informed decision-making at a national level. Challenges faced presented lessons learned to inform sustainable implementation of digital health innovations in Botswana and similar resource-limited countries.
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Affiliation(s)
- Kagiso Ndlovu
- Department of Computer Science, University of Botswana, Gaborone, Botswana
| | - Kabelo Leonard Mauco
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Onalenna Makhura
- Department of Computer Science, University of Botswana, Gaborone, Botswana
| | - Robin Hu
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Audrey Masizana
- Department of Computer Science, University of Botswana, Gaborone, Botswana
| | - Emily Lo
- College of Arts and Sciences, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Sikhulile Moyo
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
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Mboussou F, Nkamedjie P, Oyaole D, Farham B, Atagbaza A, Nsasiirwe S, Costache A, Brooks D, Wiysonge CS, Impouma B. Rapid assessment of data systems for COVID-19 vaccination in the WHO African Region. Epidemiol Infect 2024; 152:e50. [PMID: 38497495 PMCID: PMC11022257 DOI: 10.1017/s0950268824000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/16/2023] [Accepted: 03/07/2024] [Indexed: 03/19/2024] Open
Abstract
Most countries in Africa deployed digital solutions to monitor progress in rolling out COVID-19 vaccines. A rapid assessment of existing data systems for COVID-19 vaccines in the African region was conducted between May and July 2022, in 23 countries. Data were collected through interviews with key informants, identified among senior staff within Ministries of Health, using a semi-structured electronic questionnaire. At vaccination sites, individual data were collected in paper-based registers in five countries (21.7%), in an electronic registry in two countries (8.7%), and in the remaining 16 countries (69.6%) using a combination of paper-based and electronic registries. Of the 18 countries using client-based digital registries, 11 (61%) deployed the District Health Information System 2 Tracker, and seven (39%), a locally developed platform. The mean percentage of individual data transcribed in the electronic registries was 61% ± 36% standard deviation. Unreliable Internet coverage (100% of countries), non-payment of data clerks' incentives (89%), and lack of electronic devices (89%) were the main reasons for the suboptimal functioning of digital systems quoted by key informants. It is critical for investments made and experience acquired in deploying electronic platforms for COVID-19 vaccines to be leveraged to strengthen routine immunization data management.
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Affiliation(s)
- Franck Mboussou
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Daniel Oyaole
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Bridget Farham
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ajiri Atagbaza
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Sheillah Nsasiirwe
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Donald Brooks
- World Health Organization, Department of Immunization, Vaccines & Biologicals, Geneva, Switzerland
| | | | - Benido Impouma
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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Mabona M, Zwane T, Raman J, Kuonza L, Mhlongo B, Phafane P. Evaluation of the malaria case surveillance system in KwaZulu-Natal Province, South Africa, 2022: a focus on DHIS2. Malar J 2024; 23:47. [PMID: 38350921 PMCID: PMC10865712 DOI: 10.1186/s12936-024-04873-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/08/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND South Africa set a target to eliminate malaria by 2023, with KwaZulu-Natal (KZN) Province the malaria-endemic province closest to achieving this goal. Objective two of the National Malaria Elimination Strategic Plan (NMESP) focused on strengthening surveillance systems to support the country's elimination efforts. Regular evaluations of the malaria surveillance systems against the targets of the NMESP objective are crucial in improving their performance and impact. This study aimed to assess whether the malaria surveillance system in KwaZulu-Natal Province meets the NMESP surveillance objective and goals. METHODS A mixed-methods cross-sectional study design was used to evaluate the malaria surveillance system, focusing on the District Health Information System 2 (DHIS2). The study assessed the data quality, timeliness, simplicity, and acceptability of the system. Key personnel from KZN's Provincial malaria control programme were interviewed using self-administered questionnaires to evaluate their perception of the system's simplicity and acceptability. Malaria case data from January 2016 to December 2020 were extracted from the DHIS2 and evaluated for data quality and timeliness. RESULTS The survey respondents generally found the DHIS2-based surveillance system acceptable (79%, 11/14) and easy to use (71%, 10/14), stating that they could readily find, extract, and share data (64%, 9/14). Overall data quality was good (88.9%), although some variables needed for case classification had low completeness and data availability. However, case notifications were not timely, with only 61% (2 622/4 329) of cases notified within 24 h of diagnosis. During the 5-year study period, the DHIS2 captured 4 333 malaria cases. The majority of cases (81%, 3 489/4 330) were categorized as imported, and predominately in males (67%, 2 914/4 333). CONCLUSION While the malaria surveillance system in KZN Province largely met the NMESP surveillance strategic goals, it failed to achieve the overarching surveillance objective of 100% notification of cases within 24 h of diagnosis. The majority of reported cases in KZN Province were classified as imported, emphasizing the importance of complete data for accurate case classification. Engaging with healthcare professionals responsible for case notification and disseminating aggregated data back to them is needed to encourage and improve notification timeliness.
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Affiliation(s)
- Maxwell Mabona
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa.
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa.
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa.
| | - Thembekile Zwane
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Jaishree Raman
- Centre for Emerging Zoonotic and Parasitic Diseases, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
- Wits Research Institute for Malaria Control, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, Gauteng, South Africa
- UP Institute for Sustainable Malaria Control, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Lazarus Kuonza
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Babongile Mhlongo
- KwaZulu-Natal Provincial Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Poncho Phafane
- KwaZulu-Natal Provincial Department of Health, Pietermaritzburg, KwaZulu-Natal, South Africa
- Division of Public Health Surveillance, National Institute for Communicable Diseases, A Division of the National Health Laboratory Service, Johannesburg, Gauteng, South Africa
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Asaduzzaman M, Mekonnen Z, Rødland EK, Sahay S, Winkler AS, Gradmann C. District health information system ( DHIS2) as integrated antimicrobial resistance surveillance platform: An exploratory qualitative investigation of the one health stakeholders' viewpoints in Ethiopia. Int J Med Inform 2024; 181:105268. [PMID: 37972481 DOI: 10.1016/j.ijmedinf.2023.105268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 11/19/2023]
Abstract
INTRODUCTION There is an unmet need for One Health (OH) surveillance and reporting systems for antimicrobial resistance (AMR) in resource poor settings. District health information system, version 2 (DHIS2), is a globally recognized digital surveillance platform which has not been widely utilized for AMR data yet. Our study aimed to understand the local stakeholders' viewpoints on DHIS2 as OH-AMR surveillance platform in Jimma, Ethiopia which will aid its further context specific establishment. METHODS We performed an exploratory qualitative study using semi-structured key informant interviews (KIIs) in Jimma Zone at Southwest Ethiopia. We interviewed 42 OH professionals between November 2020 and February 2021. Following verbatim transcription of the audio recordings of KIIs, we conducted thematic analysis. RESULTS We identified five major themes which are important for understanding the trajectory of OH-AMR surveillance in DHIS2 platform. The themes were: (1) Stakeholders' current knowledge on digital surveillance platforms including DHIS2. (2) Stakeholders' perception on digital surveillance platform including DHIS2. (3) Features suggested by stakeholders to be included in the surveillance platform. (4) Comments from stakeholders on system implementation challenges. (5) Stakeholders' perceived role in the process of implementation. Despite several barriers and challenges, most of the participants perceived and suggested DHIS2 as a suitable OH-AMR surveillance platform and were willing to contribute at their current professional roles. CONCLUSIONS Our study demonstrates the potential of the DHIS2 as a user friendly and acceptable interoperable platform for OH-AMR surveillance if the technology designers accommodate the stakeholders' concerns. Piloting at local level and using performance appraisal tool in all OH disciplines should be the next step before proceeding to workable format.
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Affiliation(s)
- Muhammad Asaduzzaman
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - Zeleke Mekonnen
- School of Medical Laboratory Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Ernst Kristian Rødland
- Department of Climate and Environmental Health, Norwegian Institute of Public Health, Norway
| | - Sundeep Sahay
- Department of Informatics, University of Oslo, Norway
| | - Andrea Sylvia Winkler
- Centre for Global Health, Faculty of Medicine, University of Oslo, Norway; Center for Global Health, Department of Neurology, Faculty of Medicine, Technical University of Munich, Germany
| | - Christoph Gradmann
- Department of Community Medicine and Global Health, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
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McQuide PA, Brown AN, Diallo K, Siyam A. The transition of human resources for health information systems from the MDGs into the SDGs and the post-pandemic era: reviewing the evidence from 2000 to 2022. Hum Resour Health 2023; 21:93. [PMID: 38041066 PMCID: PMC10691099 DOI: 10.1186/s12960-023-00880-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/22/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND This review paper offers a policy-tracing trend analysis of national experiences among low- and middle-income countries in strengthening human resources for health information systems (HRHIS). This paper draws on evidence from the last two decades and applies a modified Bardach's policy analysis framework. A timely review of the evidence on HRHIS and underlying data systems is needed now more than ever, given the halfway mark of the Global Strategy on Human Resources for Health: Workforce 2030 and the protracted COVID-19 pandemic and other global health emergencies, over and above the increasing need for health and care workers to provide essential health services. MAIN TEXT Considering World Health Assembly resolutions and HRH-related global developments between 2000 and 2022, we targeted peer-reviewed and gray literature covering the inception, impact, bottlenecks, and gaps of HRHIS. We also considered results from a Bill and Melinda Gates Foundation-funded project that assessed HRH data systems in 21 countries and the use of HRH data and information for policy, planning, and management. Aligned with the National Health Workforce Accounts (NHWA), we identify priority themes related to digital priorities for HRHIS and governance/leadership and present case studies of five countries that pursued different pathways to successfully develop their HRHIS. Over the last two decades, considerable progress has been achieved through a scaled-up implementation of HRHIS combined with the skills needed to analyze and use data, sustain systems functionality, and make systematic improvements over time. Global health development aid investments and technical innovations have led to advancements in HRHIS, district health information software (DHIS2), and partner collaborations during the HIV/AIDS, Ebola, and COVID-19 crises. Although the progressive implementation of NHWA continues to steer country-level efforts through standardized indicators and regular reporting, traditional challenges remain, such as data systems fragmentation, lack of interoperability between systems, and underutilization of reported data. Encouragingly, some countries demonstrate strong governance and leadership capacities and others strong HRHIS digital capacities. Both HRH and health service data are needed to inform on-demand decisions during times of emergencies and pandemics as well as during routine essential health services delivery. Evidence-based examples from distinctive countries demonstrate that reliable HRHIS is achievable for better planning and management of the health and care workforce.
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Affiliation(s)
- Pamela A McQuide
- Global Health Workforce Consultant, IntraHealth International, 6340 Quadrangle Drive, Suite 200, Chapel Hill, United States of America.
| | | | - Khassoum Diallo
- Coordinator Data, Evidence and Knowledge Management UHL Division, World Health Organization, Geneva, Switzerland
| | - Amani Siyam
- Health Information System, Regional Office for South-East Asia, World Health Organization, Geneva, Switzerland
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Odeny BM, Njoroge A, Gloyd S, Hughes JP, Wagenaar BH, Odhiambo J, Nyagah LM, Manya A, Oghera OW, Puttkammer N. Development of novel composite data quality scores to evaluate facility-level data quality in electronic data in Kenya: a nationwide retrospective cohort study. BMC Health Serv Res 2023; 23:1139. [PMID: 37872540 PMCID: PMC10594801 DOI: 10.1186/s12913-023-10133-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/10/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND In this evaluation, we aim to strengthen Routine Health Information Systems (RHIS) through the digitization of data quality assessment (DQA) processes. We leverage electronic data from the Kenya Health Information System (KHIS) which is based on the District Health Information System version 2 (DHIS2) to perform DQAs at scale. We provide a systematic guide to developing composite data quality scores and use these scores to assess data quality in Kenya. METHODS We evaluated 187 HIV care facilities with electronic medical records across Kenya. Using quarterly, longitudinal KHIS data from January 2011 to June 2018 (total N = 30 quarters), we extracted indicators encompassing general HIV services including services to prevent mother-to-child transmission (PMTCT). We assessed the accuracy (the extent to which data were correct and free of error) of these data using three data-driven composite scores: 1) completeness score; 2) consistency score; and 3) discrepancy score. Completeness refers to the presence of the appropriate amount of data. Consistency refers to uniformity of data across multiple indicators. Discrepancy (measured on a Z-scale) refers to the degree of alignment (or lack thereof) of data with rules that defined the possible valid values for the data. RESULTS A total of 5,610 unique facility-quarters were extracted from KHIS. The mean completeness score was 61.1% [standard deviation (SD) = 27%]. The mean consistency score was 80% (SD = 16.4%). The mean discrepancy score was 0.07 (SD = 0.22). A strong and positive correlation was identified between the consistency score and discrepancy score (correlation coefficient = 0.77), whereas the correlation of either score with the completeness score was low with a correlation coefficient of -0.12 (with consistency score) and -0.36 (with discrepancy score). General HIV indicators were more complete, but less consistent, and less plausible than PMTCT indicators. CONCLUSION We observed a lack of correlation between the completeness score and the other two scores. As such, for a holistic DQA, completeness assessment should be paired with the measurement of either consistency or discrepancy to reflect distinct dimensions of data quality. Given the complexity of the discrepancy score, we recommend the simpler consistency score, since they were highly correlated. Routine use of composite scores on KHIS data could enhance efficiencies in DQA at scale as digitization of health information expands and could be applied to other health sectors beyondHIV clinics.
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Affiliation(s)
- Beryne M Odeny
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA.
| | - Anne Njoroge
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
| | - Steve Gloyd
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Bradley H Wagenaar
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | | | | | | | | | - Nancy Puttkammer
- International Training and Education Center for Health (I-TECH), Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
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Walle AD, Demsash AW, Ferede TA, Wubante SM. Healthcare professionals' satisfaction toward the use of district health information system and its associated factors in southwest Ethiopia: using the information system success model. Front Digit Health 2023; 5:1140933. [PMID: 37528904 PMCID: PMC10389655 DOI: 10.3389/fdgth.2023.1140933] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/29/2023] [Indexed: 08/03/2023] Open
Abstract
Background Ethiopia has the potential to use the district health information system, which is a building block of the health system. Thus, it needs to assess the performance level of the system by identifying the satisfaction of end users. There is little evidence about users' satisfaction with using this system. As a result, this study was conducted to fill this gap by evaluating user satisfaction and associated factors of district health information system among healthcare providers in Ethiopia, using the information system success model. Methods An institutional-based cross-sectional study was conducted from November to December 2022 in the Oromia region of southwest Ethiopia. A total of 391 health professionals participated in the study. The study participants were selected using a census. Using a self-administered questionnaire, data were collected. Measurement and structural equation modeling analyses were used to evaluate reliability, the validity of model fit, and to test the relationship between the constructs, respectively, using analysis of moment structure (AMOS) V 26. Results System quality had a positive direct effect on the respondent's system use (β = 0.18, P-value < 0.001), and satisfaction (β = 0.44, P-value < 0.001). Service quality had also a direct effect on the respondent's system use (β = 0.37, P-value < 0.01), and satisfaction with using the district health information system (β = 0.36, P-value < 0.01). Similarly, system use had also a direct effect on the respondent's satisfaction (β = 0.53, P-value < 0.05). Moreover, computer literacy had a direct effect on the respondent's system use (β = 0.63, P-value < 0.05), and satisfaction (β = 0.51, P-value < 0.01). Concussions The overall user satisfaction with using the district health information system in Ethiopia was low. System quality, service quality, and computer literacy had a direct positive effect on system use and user satisfaction. In addition, system use and information quality had a direct positive effect on healthcare professionals' satisfaction with using the district health information system. The most important factor for enhancing system use and user satisfaction was computer literacy. Accordingly, for the specific user training required for the success of the district health information system in Ethiopia, the manager should offer additional basic computer courses for better use of the system.
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Affiliation(s)
- Agmasie Damtew Walle
- Department of Health Informatics, College of Health Science, Mettu University, Mettu, Ethiopia
| | | | - Tigist Andargie Ferede
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Sisay Maru Wubante
- Department of Health Informatics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Angeles G, Silverstein H, Worges M, Hotchkiss DR, Wisniewski JM, Lusamba Dikassa PS, Weiss W, Ahsan KZ. Area-specific covid-19 effects on health services utilization in the Democratic Republic of the Congo using routine health information system data. BMC Health Serv Res 2023; 23:575. [PMID: 37270545 DOI: 10.1186/s12913-023-09547-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/14/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Since March 2020, the COVID-19 pandemic has shocked health systems worldwide. This analysis investigated the effects of the pandemic on basic health services utilization in the Democratic Republic of the Congo (DRC) and examined the variability of COVID effects in the capital city Kinshasa, in other urban areas, and in rural areas. METHODS We estimated time trends models using national health information system data to replicate pre-COVID-19 (i.e., January 2017-February 2020) trajectories of health service utilization, and then used those models to estimate what the levels would have been in the absence of COVID-19 during the pandemic period, starting in March 2020 through March 2021. We classified the difference between the observed and predicted levels as the effect of COVID-19 on health services. We estimated 95% confidence intervals and p-values to examine if the effect of the pandemic, nationally and within specific geographies, was statistically significant. RESULTS Our results indicate that COVID-19 negatively impacted health services and subsequent recovery varied by service type and by geographical area. COVID-19 had a lasting impact on overall service utilization as well as on malaria and pneumonia-related visits among young children in the DRC. We also found that the effects of COVID-19 were even more immediate and stronger in the capital city of Kinshasa compared with the national effect. Both nationally and in Kinshasa, most affected services had slow and incomplete recovery to expected levels. Therefore, our analysis indicates that COVID-19 continued to affect health services in the DRC throughout the first year of the pandemic. CONCLUSIONS The methodology used in this article allows for examining the variability in magnitude, timing, and duration of the COVID effects within geographical areas of the DRC and nationally. This analytical procedure based on national health information system data could be applied to surveil health service disruptions and better inform rapid responses from health service managers and policymakers.
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Affiliation(s)
- Gustavo Angeles
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hannah Silverstein
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Matt Worges
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - David R Hotchkiss
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Janna M Wisniewski
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Paul Samson Lusamba Dikassa
- Tulane International LLC, Kinshasa, Democratic Republic of the Congo
- Kinshasa School of Public Health, The University of Kinshasa, DRC, Kinshasa, Democratic Republic of the Congo
| | - William Weiss
- Department of International Health, The John Hopkins University, Baltimore, MD, USA
| | - Karar Zunaid Ahsan
- Public Health Leadership Program, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, Chapel Hill, USA
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Farnham A, Loss G, Lyatuu I, Cossa H, Kulinkina AV, Winkler MS. A roadmap for using DHIS2 data to track progress in key health indicators in the Global South: experience from sub-saharan Africa. BMC Public Health 2023; 23:1030. [PMID: 37259137 DOI: 10.1186/s12889-023-15979-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 05/23/2023] [Indexed: 06/02/2023] Open
Abstract
High quality health data as collected by health management information systems (HMIS) is an important building block of national health systems. District Health Information System 2 (DHIS2) software is an innovation in data management and monitoring for strengthening HMIS that has been widely implemented in low and middle-income countries in the last decade. However, analysts and decision-makers still face significant challenges in fully utilizing the capabilities of DHIS2 data to pursue national and international health agendas. We aimed to (i) identify the most relevant health indicators captured by DHIS2 for tracking progress towards the Sustainable Development goals in sub-Saharan African countries and (ii) present a clear roadmap for improving DHIS2 data quality and consistency, with a special focus on immediately actionable solutions. We identified that key indicators in child and maternal health (e.g. vaccine coverage, maternal deaths) are currently being tracked in the DHIS2 of most countries, while other indicators (e.g. HIV/AIDS) would benefit from streamlining the number of indicators collected and standardizing case definitions. Common data issues included unreliable denominators for calculation of incidence, differences in reporting among health facilities, and programmatic differences in data quality. We proposed solutions for many common data pitfalls at the analysis level, including standardized data cleaning pipelines, k-means clustering to identify high performing health facilities in terms of data quality, and imputation methods. While we focus on immediately actionable solutions for DHIS2 analysts, improvements at the point of data collection are the most rigorous. By investing in improving data quality and monitoring, countries can leverage the current global attention on health data to strengthen HMIS and progress towards national and international health priorities.
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Affiliation(s)
- Andrea Farnham
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Basel, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Georg Loss
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Isaac Lyatuu
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Herminio Cossa
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Basel, Switzerland
- University of Basel, Basel, Switzerland
- Manhiça Health Research Centre, Maputo, Mozambique
| | - Alexandra V Kulinkina
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Mirko S Winkler
- Swiss Tropical and Public Health Institute, Kreuzstrasse 2, 4123 Allschwil, Basel, Switzerland
- University of Basel, Basel, Switzerland
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10
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Ayele W, Gage A, Kapoor NR, Kassahun Gelaw S, Hensman D, Derseh Mebratie A, Nega A, Asai D, Molla G, Mehata S, Mthethwa L, Mfeka-Nkabinde NG, Joseph JP, Pierre DM, Thermidor R, Arsenault C. Quality of routine health data at the onset of the COVID-19 pandemic in Ethiopia, Haiti, Laos, Nepal, and South Africa. Popul Health Metr 2023; 21:7. [PMID: 37210556 PMCID: PMC10199286 DOI: 10.1186/s12963-023-00306-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 05/14/2023] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, governments and researchers have used routine health data to estimate potential declines in the delivery and uptake of essential health services. This research relies on the data being high quality and, crucially, on the data quality not changing because of the pandemic. In this paper, we investigated those assumptions and assessed data quality before and during COVID-19. METHODS We obtained routine health data from the DHIS2 platforms in Ethiopia, Haiti, Lao People's Democratic Republic, Nepal, and South Africa (KwaZulu-Natal province) for a range of 40 indicators on essential health services and institutional deaths. We extracted data over 24 months (January 2019-December 2020) including pre-pandemic data and the first 9 months of the pandemic. We assessed four dimensions of data quality: reporting completeness, presence of outliers, internal consistency, and external consistency. RESULTS We found high reporting completeness across countries and services and few declines in reporting at the onset of the pandemic. Positive outliers represented fewer than 1% of facility-month observations across services. Assessment of internal consistency across vaccine indicators found similar reporting of vaccines in all countries. Comparing cesarean section rates in the HMIS to those from population-representative surveys, we found high external consistency in all countries analyzed. CONCLUSIONS While efforts remain to improve the quality of these data, our results show that several indicators in the HMIS can be reliably used to monitor service provision over time in these five countries.
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Affiliation(s)
- Wondimu Ayele
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Anna Gage
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
| | | | | | - Anagaw Derseh Mebratie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adiam Nega
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Daisuke Asai
- World Health Organization, Vientiane, Lao People's Democratic Republic
| | - Gebeyaw Molla
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Suresh Mehata
- Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Londiwe Mthethwa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Jean Paul Joseph
- Division d'Épidémiologie et de Laboratoire, Zanmi Lasante, Mirebalais, Plateau Central, Haiti
| | - Daniella Myriam Pierre
- Programme National de Lutte contre les IST/VIH/SIDA (PNLS) Unite de Coordination des Maladies Transmissibles (UCMIT), Ministère de la Sante Publique et de la Population (MSPP), Port-au-Prince, Haiti
| | - Roody Thermidor
- Studies and Planning Unit, Ministry of Public Health and Population, Port-au-Prince, Haiti
| | - Catherine Arsenault
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA.
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Belizán M, Rodriguez Cairoli F, Mazzoni A, Goucher E, Zaraa S, Matthews S, Pingray V, Stergachis A, Xiong X, Berrueta M, Buekens P. Data collection systems for active safety surveillance of vaccines during pregnancy in low- and middle-income countries: developing and piloting an assessment tool (VPASS). BMC Pregnancy Childbirth 2023; 23:172. [PMID: 36915061 PMCID: PMC10010225 DOI: 10.1186/s12884-023-05417-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 01/31/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND There is an urgent need for active safety surveillance to monitor vaccine exposure during pregnancy in low- and middle-income countries (LMICs). Existing maternal, newborn, and child health (MNCH) data collection systems could serve as platforms for post-marketing active surveillance of maternal immunization safety. To identify sites using existing systems, a thorough assessment should be conducted. Therefore, this study had the objectives to first develop an assessment tool and then to pilot this tool in sites using MNCH data collection systems through virtual informant interviews. METHODS We conducted a rapid review of the literature to identify frameworks on population health or post-marketing drug surveillance. Four frameworks that met the eligibility criteria were identified and served to develop an assessment tool capable of evaluating sites that could support active monitoring of vaccine safety during pregnancy. We conducted semi-structured interviews in six geographical sites using MNCH data collection systems (DHIS2, INDEPTH, and GNMNHR) to pilot domains included in the assessment tool. RESULTS We developed and piloted the "VPASS (Vaccines during Pregnancy - sites supporting Active Safety Surveillance) assessment tool" through interviews with nine stakeholders, including central-level systems key informants and site-level managers from DHIS2 and GNMNHR; DHIS2 in Kampala (Uganda) and Kigali (Rwanda); GNMNHR from Belagavi (India) and Lusaka (Zambia); and INDEPTH from Nanoro (Burkina Faso) and Manhica (Mozambique). The tool includes different domains such as the system's purpose, the scale of implementation, data capture and confidentiality, type of data collected, the capability of integration with other platforms, data management policies and data quality monitoring. Similarities among sites were found regarding some domains, such as data confidentiality, data management policies, and data quality monitoring. Four of the six sites met some domains to be eligible as potential sites for active surveillance of vaccinations during pregnancy, such as a routine collection of MNCH individual data and the capability of electronically integrating individual MNCH outcomes with information related to vaccine exposure during pregnancy. Those sites were: Rwanda (DHIS2), Manhica (IN-DEPTH), Lusaka (GNMNHR), and Belagavi (GNMNHR). CONCLUSION This study's findings should inform the successful implementation of active safety surveillance of vaccines during pregnancy by identifying and using active individual MNCH data collection systems in LMICs.
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Affiliation(s)
- Maria Belizán
- 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
| | - Agustina Mazzoni
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Erin Goucher
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | - Sabra Zaraa
- School of Pharmacy, University of Washington, Seattle, WA, 98195, USA
| | - Sarah Matthews
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | - Verónica Pingray
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Andy Stergachis
- School of Pharmacy, University of Washington, Seattle, WA, 98195, USA.,School of Public Health, University of Washington, Seattle, WA, 98195, USA
| | - Xu Xiong
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
| | - Mabel Berrueta
- Instituto de Efectividad Clínica y Sanitaria (IECS), Dr. Emilio Ravignani 2024 (C1014CPV), Buenos Aires, Argentina
| | - Pierre Buekens
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, 70112, USA
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12
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Khatun F, Distler R, Rahman M, O'Donnell B, Gachuhi N, Alwani M, Wang Y, Rahman A, Frøen JF, Friberg IK. Comparison of a palm-based biometric solution with a name-based identification system in rural Bangladesh. Glob Health Action 2022; 15:2045769. [PMID: 35343885 PMCID: PMC8967207 DOI: 10.1080/16549716.2022.2045769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Unique identifiers are not universal in low- and middle-income countries. Biometric solutions have the potential to augment existing name-based searches used for identification in these settings. This paper describes a comparison of the searching accuracy of a palm-based biometric solution with a name-based database. Objective To compare the identification of individuals between a palm-based biometric solution to a name-based District Health Information Software 2 (DHIS2) Android application, in a low-resource setting. Methods The study was conducted in Chandpur district, Bangladesh. Trained data collectors enrolled 150 women of reproductive age into two android applications – i) a name-based DHIS2 application, and ii) a palm-based biometric solution – both run on tablets. One week after enrollment, a different research team member attempted to re-identify each enrolled woman using both systems. A single image or text-based name was used for searching at the time of re-identification. We interviewed data collectors at the end of the study. Results Significantly more women were successfully identified on the first attempt with a palm-based biometric application (84%) compared with the name-based DHIS2 application (61%). The proportion of identifications that required three or more attempts was similar between name-based (7%, CI 3.7–12.3) and palm-based biometric system (5%, CI: 1.9–9.4). However, the total number of attempts needed was significantly lower with the palm-based solution (mean 1.2 vs. 1.5, p < 0.001). In a group discussion, data collectors reported that the palm-based biometric identification system was both accurate and easy to use. Conclusion A palm-based biometric identification system on mobile devices was found to be an easy-to-use and accurate technology for the unique identification of individuals compared to an existing name-based application. Our findings imply that palm-based biometrics on mobile devices may be the next step in establishing unique identifiers in remote and rural settings where they are currently absent.
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Affiliation(s)
- Fatema Khatun
- Norwegian Institute of Public Health, Oslo, Norway.,International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Monjur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Noni Gachuhi
- Intellectual Ventures, Global Good Fund, Bellevue, WA, USA
| | | | | | - Anisur Rahman
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - J Frederik Frøen
- Norwegian Institute of Public Health, Oslo, Norway.,University of Bergen, Bergen, Norway
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13
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Kinkade C, Russpatrick S, Potter R, Saebo J, Sloan M, Odongo G, Singh T, Gallagher K. Extending and Strengthening Routine DHIS2 Surveillance Systems for COVID-19 Responses in Sierra Leone, Sri Lanka, and Uganda. Emerg Infect Dis 2022; 28:S42-S48. [PMID: 36502427 DOI: 10.3201/eid2813.220711] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic challenged countries to protect their populations from this emerging disease. One aspect of that challenge was to rapidly modify national surveillance systems or create new systems that would effectively detect new cases of COVID-19. Fifty-five countries leveraged past investments in District Health Information Software version 2 (DHIS2) to quickly adapt their national public health surveillance systems for COVID-19 case reporting and response activities. We provide background on DHIS2 and describe case studies from Sierra Leone, Sri Lanka, and Uganda to illustrate how the DHIS2 platform, its community of practice, long-term capacity building, and local autonomy enabled countries to establish an effective COVID-19 response. With these case studies, we provide valuable insights and recommendations for strategies that can be used for national electronic disease surveillance platforms to detect new and emerging pathogens and respond to public health emergencies.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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15
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Blair AH, Openshaw M, Mphande I, Jana O, Malirakwenda R, Muller A, Rankin S, Baltzell K. Assessing Combined Longitudinal Mentorship and Skills Training on Select Maternal and Neonatal Outcomes in Rural and Urban Health Facilities in Malawi. J Transcult Nurs 2022; 33:704-714. [PMID: 36062416 PMCID: PMC9561805 DOI: 10.1177/10436596221118113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Despite successful efforts to improve clinical access and skilled birth
attendance in Malawi, it still faces high rates of maternal and neonatal
mortality. In 2017, the UCSF-GAIN partnership began a nurse-midwifery
clinical education and longitudinal mentorship program. While it has
received positive reviews, it is unclear whether routinely collected
indicators can assess such a program’s impact. Method: A longitudinal review of the Malawian DHIS2 database explored variables
associated with maternal and newborn care and outcomes before and after the
intervention. Data were analyzed using generalized estimating equations
(GEE) to account for facility-level correlations over time. Results: Quality issues with DHIS2 data were identified. Significant changes
potentially associated with the GAIN intervention were noted. Discussion: The GAIN approach appears to be associated with positive trends in maternal
and neonatal care. National summary databases are problematic, however, for
evaluating targeted interventions and the provision of care to specific
outcomes.
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Affiliation(s)
| | | | | | | | | | - Anna Muller
- University of California, San Francisco, USA
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Gesicho M, Babic A. Designing a Dashboard for HIV-data Reporting Performance by Facilities: Case Study of Kenya. Stud Health Technol Inform 2022; 295:238-241. [PMID: 35773852 DOI: 10.3233/shti220706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Health management information systems implemented in low-and middle-income countries (LMICs) have provided availability of HIV-data. As such, dashboards have become increasingly popular as they provide a potentially powerful avenue for deriving insights at glance. This promotes use of data for decision-making by various stakeholders such as Ministries of Health as well as international donor organizations. Nonetheless, despite the use of dashboards in LMICs, their potential may go unrealized with underutilization of good design principles. In various LMICs, health facilities are required to submit HIV-indicator data on time for its use in decision-making. Hence, dashboards can be utilized in assessing facility reporting performance overtime in order to identify where interventions are needed. In this study, we applied good design principles in developing a dashboard, which presents the performance of facilities in reporting HIV-indicator data overtime (2011-2018). Timeliness and completeness in reporting were used as performance indicators and were extracted from the District Health Information Software Version 2 (DHIS2) in Kenya. Results for the system usability scale used in evaluating the dashboard was 87, which meant the dashboard usability was good.
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Affiliation(s)
- Milka Gesicho
- Department of Information Science and Media Studies, University of Bergen, Norway
| | - Ankica Babic
- Department of Information Science and Media Studies, University of Bergen, Norway
- Department of Biomedical Engineering, Linköping University, Sweden
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Byson LF. Data Entry Form Designing Tools and Software Usability in DHIS2. Stud Health Technol Inform 2021; 284:254-258. [PMID: 34920521 DOI: 10.3233/shti210718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The advent of configurable software has shifted the implementation of software solutions from total reliance on software developers to towards increased participation of end-users. End-users are now able to create software solutions without the need for writing code but through configuration and customisation. Despite the increasing use of configurable software challenges on designing the software platform architecture, process of testing and usability exists in configurable software. The research aimed at evaluating how available interface elements influence usability in DHIS2. Empirical data was collected by studying the design of custom data collection forms for routine health data collection with two groups of users. 80% and 90% were recorded as completion rates of the designed task and overall efficiency of 86.23% and 89.94% was achieved between the two groups. Lack of relevant editing features, increased distance between related objects, lack of conformity to Keep It Simple, Stupid (KISS) and minimalistic design principle were found to be the major challenges affecting the usability.
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Nyondo T, Msigwa G, Cobos D, Kabadi G, Macha T, Karugendo E, Mugasa J, Semu G, Levira F, Fruchtman CS, Mwanza J, Lyatuu I, Bratschi M, Kumalija CJ, Setel P, de Savigny D. Improving quality of medical certification of causes of death in health facilities in Tanzania 2014-2019. BMC Health Serv Res 2021; 21:214. [PMID: 34511104 PMCID: PMC8436444 DOI: 10.1186/s12913-021-06189-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/18/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monitoring medically certified causes of death is essential to shape national health policies, track progress to Sustainable Development Goals, and gauge responses to epidemic and pandemic disease. The combination of electronic health information systems with new methods for data quality monitoring can facilitate quality assessments and help target quality improvement. Since 2015, Tanzania has been upgrading its Civil Registration and Vital Statistics system including efforts to improve the availability and quality of mortality data. METHODS We used a computer application (ANACONDA v4.01) to assess the quality of medical certification of cause of death (MCCD) and ICD-10 coding for the underlying cause of death for 155,461 deaths from health facilities from 2014 to 2018. From 2018 to 2019, we continued quality analysis for 2690 deaths in one large administrative region 9 months before, and 9 months following MCCD quality improvement interventions. Interventions addressed governance, training, process, and practice. We assessed changes in the levels, distributions, and nature of unusable and insufficiently specified codes, and how these influenced estimates of the leading causes of death. RESULTS 9.7% of expected annual deaths in Tanzania obtained a medically certified cause of death. Of these, 52% of MCCD ICD-10 codes were usable for health policy and planning, with no significant improvement over 5 years. Of certified deaths, 25% had unusable codes, 17% had insufficiently specified codes, and 6% were undetermined causes. Comparing the before and after intervention periods in one Region, codes usable for public health policy purposes improved from 48 to 65% within 1 year and the resulting distortions in the top twenty cause-specific mortality fractions due to unusable causes reduced from 27.4 to 13.5%. CONCLUSION Data from less than 5% of annual deaths in Tanzania are usable for informing policy. For deaths with medical certification, errors were prevalent in almost half. This constrains capacity to monitor the 15 SDG indicators that require cause-specific mortality. Sustainable quality assurance mechanisms and interventions can result in rapid improvements in the quality of medically certified causes of death. ANACONDA provides an effective means for evaluation of such changes and helps target interventions to remaining weaknesses.
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Affiliation(s)
- Trust Nyondo
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Gisbert Msigwa
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
- Bloomberg Philanthropies Data for Health Initiative, Vital Strategies, New York, NY, USA
| | - Daniel Cobos
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
| | - Gregory Kabadi
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
- Bloomberg Philanthropies Data for Health Initiative, Vital Strategies, New York, NY, USA
| | - Tumaniel Macha
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | | | - Joyce Mugasa
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Geofrey Semu
- Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | | | - James Mwanza
- Bloomberg Philanthropies Data for Health Initiative, Vital Strategies, New York, NY, USA
| | - Isaac Lyatuu
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, Tanzania
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Martin Bratschi
- Bloomberg Philanthropies Data for Health Initiative, Vital Strategies, New York, NY, USA
| | - Claud J Kumalija
- Ministry of Health, Community Development, Gender, Elderly, and Children, Dodoma, Tanzania
| | - Philip Setel
- Bloomberg Philanthropies Data for Health Initiative, Vital Strategies, New York, NY, USA
| | - Don de Savigny
- Bloomberg Philanthropies Data for Health Initiative, Vital Strategies, New York, NY, USA.
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland.
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21
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Malembaka EB, Altare C, Bigirinama RN, Bisimwa G, Banywesize R, Tabbal N, Boerma T. The use of health facility data to assess the effects of armed conflicts on maternal and child health: experience from the Kivu, DR Congo. BMC Health Serv Res 2021; 21:195. [PMID: 34511092 PMCID: PMC8436447 DOI: 10.1186/s12913-021-06143-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/02/2021] [Indexed: 11/12/2022] Open
Abstract
Background In conflict-affected settings, data on reproductive, maternal, newborn and child health (RMNCH) are often lacking for priority setting and timely decision-making. We aimed to describe the levels and trends in RMNCH indicators within Kivu provinces between 2015 and 2018, by linking conflict data with health facility (HF) data from the District Health Information System 2 (DHIS2). Methods We used data from the DHIS2 for the period 2015–2018, the 2014 Demographic and Health Survey, the 2018 Multiple Indicators Cluster Survey and the Uppsala Conflict Data Program. Health zones were categorised in low, moderate and high conflict intensity level, based on an annual conflict death rate. We additionally defined a monthly conflict death rate and a conflict event-days rate as measures of conflict intensity and insecurity. Outcomes were completion of four antenatal care visits, health facility deliveries, caesarean sections and pentavalent vaccine coverage. We assessed data quality and analyzed coverage and trends in RMNCH indicators graphically, by conflict categories and using HF data aggregated annually. We used a series of fixed-effect regression models to examine the potential dose-response effect of varying conflict intensity and insecurity on RMNCH. Results The overall HF reporting was good, ranging between 83.3 and 93.2% and tending to be lower in health zones with high conflict intensity in 2016 and 2017 before converging in 2018. Despite the increasing number of conflict-affected health zones over time, more in North-Kivu than in South-Kivu, we could not identify any clear pattern of variation in RMNCH coverage both by conflict intensity and insecurity. North-Kivu province had consistently reported better RMNCH indicators than South-Kivu, despite being more affected by conflict. The Kivu as a whole recorded higher coverage than the national level. Coverage of RMNCH services calculated from HF data was consistent with population-based surveys, despite year-to-year fluctuation among health zones and across conflict-intensity categories. Conclusions Although good in general, the HF reporting rate in the Kivu was negatively impacted by conflict intensity especially at the beginning of the DHIS2’s rolling-up. Routine HF data appeared useful for assessing and monitoring trends in RMNCH service coverage, including in areas with high-intensity conflict. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06143-7.
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Affiliation(s)
- Espoir Bwenge Malembaka
- Ecole Régionale de Santé Publique (ERSP), Faculté de Médecine, Université Catholique de Bukavu, Bukavu, DR, Congo. .,Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium.
| | - Chiara Altare
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
| | - Rosine Nshobole Bigirinama
- Ecole Régionale de Santé Publique (ERSP), Faculté de Médecine, Université Catholique de Bukavu, Bukavu, DR, Congo
| | - Ghislain Bisimwa
- Ecole Régionale de Santé Publique (ERSP), Faculté de Médecine, Université Catholique de Bukavu, Bukavu, DR, Congo
| | - Robert Banywesize
- Division Provinciale de la Santé du Sud-Kivu, Ministère Provincial de Santé Publique, Bukavu, DR, Congo
| | | | - Ties Boerma
- Centre for Global Public Health, Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
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22
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Lyatuu I, Loss G, Farnham A, Lyatuu GW, Fink G, Winkler MS. Associations between Natural Resource Extraction and Incidence of Acute and Chronic Health Conditions: Evidence from Tanzania. Int J Environ Res Public Health 2021; 18:6052. [PMID: 34199822 DOI: 10.3390/ijerph18116052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 05/29/2021] [Accepted: 05/31/2021] [Indexed: 12/03/2022]
Abstract
Natural resource extraction projects are often accompanied by complex environmental and social-ecological changes. In this paper, we evaluated the association between commodity extraction and the incidence of diseases. We retrieved council (district)-level outpatient data from all public and private health facilities from the District Health Information System (DHIS2). We combined this information with population data from the 2012 national population census and a geocoded list of resource extraction projects from the Geological Survey of Tanzania (GST). We used Poisson regression with random effects and cluster-robust standard errors to estimate the district-level associations between the presence of three types of commodity extraction (metals, gemstone, and construction materials) and the total number of patients in each disease category in each year. Metal extraction was associated with reduced incidence of several diseases, including chronic diseases (IRR = 0.61, CI: 0.47–0.80), mental health disorders (IRR = 0.66, CI: 0.47–0.92), and undernutrition (IRR = 0.69, CI: 0.55–0.88). Extraction of construction materials was associated with an increased incidence of chronic diseases (IRR = 1.47, CI: 1.15–1.87). This study found that the presence of natural resources commodity extraction is significantly associated with changes in disease-specific patient volumes reported in Tanzania’s DHIS2. These associations differed substantially between commodities, with the most protective effects shown from metal extraction.
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23
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Mørkrid K, Bogale B, Abbas E, Abu Khader K, Abu Ward I, Attalh A, Awwad T, Baniode M, Frost KS, Frost MJ, Ghanem B, Hijaz T, Isbeih M, Issawi S, Nazzal ZAS, O’Donnell B, Qaddomi SE, Rabah Y, Venkateswaran M, Frøen JF. eRegCom-Quality Improvement Dashboard for healthcare providers and Targeted Client Communication to pregnant women using data from an electronic health registry to improve attendance and quality of antenatal care: study protocol for a multi-arm cluster randomized trial. Trials 2021; 22:47. [PMID: 33430935 PMCID: PMC7802344 DOI: 10.1186/s13063-020-04980-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 12/16/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND This trial evaluates interventions that utilize data entered at point-of-care in the Palestinian maternal and child eRegistry to generate Quality Improvement Dashboards (QID) for healthcare providers and Targeted Client Communication (TCC) via short message service (SMS) to clients. The aim is to assess the effectiveness of the automated communication strategies from the eRegistry on improving attendance and quality of care for pregnant women. METHODS This four-arm cluster randomized controlled trial will be conducted in the West Bank and the Gaza Strip, Palestine, and includes 138 clusters (primary healthcare clinics) enrolling from 45 to 3000 pregnancies per year. The intervention tools are the QID and the TCC via SMS, automated from the eRegistry built on the District Health Information Software 2 (DHIS2) Tracker. The primary outcomes are appropriate screening and management of anemia, hypertension, and diabetes during pregnancy and timely attendance to antenatal care. Primary analysis, at the individual level taking the design effect of the clustering into account, will be done as intention-to-treat. DISCUSSION This trial, embedded in the implementation of the eRegistry in Palestine, will inform the use of digital health interventions as a health systems strengthening approach. TRIAL REGISTRATION ISRCTN Registry, ISRCTN10520687 . Registered on 18 October 2018.
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Affiliation(s)
- Kjersti Mørkrid
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
| | - Binyam Bogale
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Eatimad Abbas
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | | | - Itimad Abu Ward
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Amjad Attalh
- The Palestinian Ministry of Health, Ramallah, Palestine
| | - Tamara Awwad
- Institute of Community and Public Health, Birzeit University, Ramallah, Palestine
| | - Mohammad Baniode
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Kimberly Suzanne Frost
- Health Information Systems Programme, Department of Informatics, University of Oslo, Oslo, Norway
| | - Michael James Frost
- Health Information Systems Programme, Department of Informatics, University of Oslo, Oslo, Norway
| | - Buthaina Ghanem
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Taghreed Hijaz
- Palestinian National Institute of Public Health, Ramallah, Palestine
- The Palestinian Ministry of Health, Ramallah, Palestine
| | - Mervett Isbeih
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Sally Issawi
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Zaher A. S. Nazzal
- Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Brian O’Donnell
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
- The Palestinian Ministry of Health, Ramallah, Palestine
| | - Sharif E. Qaddomi
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Yousef Rabah
- Palestinian National Institute of Public Health, Ramallah, Palestine
| | - Mahima Venkateswaran
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - J. Frederik Frøen
- Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213 Oslo, Norway
- Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
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24
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Gesicho MB, Were MC, Babic A. Evaluating performance of health care facilities at meeting HIV-indicator reporting requirements in Kenya: an application of K-means clustering algorithm. BMC Med Inform Decis Mak 2021; 21:6. [PMID: 33407380 PMCID: PMC7789797 DOI: 10.1186/s12911-020-01367-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background The ability to report complete, accurate and timely data by HIV care providers and other entities is a key aspect in monitoring trends in HIV prevention, treatment and care, hence contributing to its eradication. In many low-middle-income-countries (LMICs), aggregate HIV data reporting is done through the District Health Information Software 2 (DHIS2). Nevertheless, despite a long-standing requirement to report HIV-indicator data to DHIS2 in LMICs, few rigorous evaluations exist to evaluate adequacy of health facility reporting at meeting completeness and timeliness requirements over time. The aim of this study is to conduct a comprehensive assessment of the reporting status for HIV-indicators, from the time of DHIS2 implementation, using Kenya as a case study.
Methods A retrospective observational study was conducted to assess reporting performance of health facilities providing any of the HIV services in all 47 counties in Kenya between 2011 and 2018. Using data extracted from DHIS2, K-means clustering algorithm was used to identify homogeneous groups of health facilities based on their performance in meeting timeliness and completeness facility reporting requirements for each of the six programmatic areas. Average silhouette coefficient was used in measuring the quality of the selected clusters. Results Based on percentage average facility reporting completeness and timeliness, four homogeneous groups of facilities were identified namely: best performers, average performers, poor performers and outlier performers. Apart from blood safety reports, a distinct pattern was observed in five of the remaining reports, with the proportion of best performing facilities increasing and the proportion of poor performing facilities decreasing over time. However, between 2016 and 2018, the proportion of best performers declined in some of the programmatic areas. Over the study period, no distinct pattern or trend in proportion changes was observed among facilities in the average and outlier groups. Conclusions The identified clusters revealed general improvements in reporting performance in the various reporting areas over time, but with noticeable decrease in some areas between 2016 and 2018. This signifies the need for continuous performance monitoring with possible integration of machine learning and visualization approaches into national HIV reporting systems.
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Affiliation(s)
- Milka Bochere Gesicho
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway. .,Institute of Biomedical Informatics, Moi University, Eldoret, Kenya.
| | - Martin Chieng Were
- Vanderbilt University Medical Center, Nashville, USA.,Institute of Biomedical Informatics, Moi University, Eldoret, Kenya
| | - Ankica Babic
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway.,Department of Biomedical Engineering, Linköping University, Linköping, Sweden
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Kaur J, Verma VC, Kumar V, Singh R, Bhatia T, Sahu S, Manak M, Buttolia HK, Choudhary B, Sharma YS, Shah SK, Kumar P, Kaur J, Deshpande S, Singh H. i-MANN: A Web-Based System for Data Management of Mental Health Research in India. Indian J Psychol Med 2020; 42:S15-S22. [PMID: 33487798 PMCID: PMC7802041 DOI: 10.1177/0253717620969064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND National Mental Health Program (NMHP) was launched by the government with an aim to improve mental health of the society through precise and focused interventions and policies. In order to provide reliable data and evidence for NMHP, there is a strong requirement of a comprehensive system for integrative collection, storage, and analysis of data generated by this program. METHODS Data collection tools, questionnaires, instruments, and scales provided by the National Coordinating Unit were digitized using the District Health Information Software 2 (DHIS2) framework (version 2.30). The rules for data validation and automated scoring were implemented as per the scales. The developed system (i-MANN, ICMR-Mental Health Assessment National Network) is based on modular architecture with role-based access to data input forms and dashboards. RESULTS The data are stored on a centralized server at ICMR. i-MANN captures data on basic and advanced demographic details followed by category specific forms from 15 multicentric ICMR-funded projects. Data collection module is divided into 12 categories containing 93 scales/instruments with built-in validation rules, scoring patterns, and indicators. As of August 2020, the system contains 17,690 records. CONCLUSIONS i-MANN is the first web-based, modular, robust, and extendable system for collection, integration, management, and analysis of data on mental health in India.
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Affiliation(s)
- Jasmine Kaur
- Division of Biomedical Informatics (BMI), Indian Council of Medical Research, Ansari Nagar, New Delhi, Delhi, India
- Data Management Laboratory, Indian Council of Medical Research, New Delhi, Delhi, India
- School of Computational & Integrative Sciences, Jawaharlal Nehru University, New Delhi, Delhi, India
- Data Science Laboratory, Amity Institute of Integrative Science & Health, Amity University, Gurgaon, Haryana, India
| | - Vijay C Verma
- Division of Biomedical Informatics (BMI), Indian Council of Medical Research, Ansari Nagar, New Delhi, Delhi, India
- Data Management Laboratory, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Vinit Kumar
- Division of Biomedical Informatics (BMI), Indian Council of Medical Research, Ansari Nagar, New Delhi, Delhi, India
- Data Management Laboratory, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Ravinder Singh
- Division of Non-Communicable Diseases (NCD), Indian Council of Medical Research, New Delhi, Delhi, India
| | - Triptish Bhatia
- National Co-ordination Unit (NCU), Dept. of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Sushree Sahu
- National Co-ordination Unit (NCU), Dept. of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Madhur Manak
- Division of Biomedical Informatics (BMI), Indian Council of Medical Research, Ansari Nagar, New Delhi, Delhi, India
- Data Management Laboratory, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Harish Kumar Buttolia
- Division of Biomedical Informatics (BMI), Indian Council of Medical Research, Ansari Nagar, New Delhi, Delhi, India
- Data Management Laboratory, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Bhavik Choudhary
- Division of Biomedical Informatics (BMI), Indian Council of Medical Research, Ansari Nagar, New Delhi, Delhi, India
- Data Management Laboratory, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Yogesh Singh Sharma
- Division of Biomedical Informatics (BMI), Indian Council of Medical Research, Ansari Nagar, New Delhi, Delhi, India
- Data Management Laboratory, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Santosh Kumar Shah
- Division of Biomedical Informatics (BMI), Indian Council of Medical Research, Ansari Nagar, New Delhi, Delhi, India
- Data Management Laboratory, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Prabhat Kumar
- Division of Biomedical Informatics (BMI), Indian Council of Medical Research, Ansari Nagar, New Delhi, Delhi, India
- Data Management Laboratory, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Jasleen Kaur
- Division of Biomedical Informatics (BMI), Indian Council of Medical Research, Ansari Nagar, New Delhi, Delhi, India
- Data Management Laboratory, Indian Council of Medical Research, New Delhi, Delhi, India
| | - Smita Deshpande
- National Co-ordination Unit (NCU), Dept. of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
- Dept. of Psychiatry, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Harpreet Singh
- Division of Biomedical Informatics (BMI), Indian Council of Medical Research, Ansari Nagar, New Delhi, Delhi, India
- Data Management Laboratory, Indian Council of Medical Research, New Delhi, Delhi, India
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Abstract
Bangladesh has made remarkable progress in digital health in recent years. Through one of the world’s largest deployments to date of the open-source District Health Information Software 2 (DHIS2), the country now has a national public sector health data warehouse. Information from previously fragmented data systems is now unified in a common data repository, enabling data exchange for health information systems and decision-making. Work is ongoing to create lifetime electronic health records for all citizens that can be transferred between health facilities. Extensive customization of open-source software has laid the foundations for a national digital networking system. Initiatives have focused on producing digital solutions to aid priorities such as strengthening the health system as a whole as well as supporting specific technical interventions, for example improving the civil registration and vital statistics system. Digital solutions have also supported the Bangladesh health workforce strategy through a set of registries that electronically captures and maintains human resource information for the entire public health sector, including monitoring staff attendance through the use of low-cost biometric fingerprint time-attendance machines. Citizens are encouraged to engage in shaping health services via a web-based complaints and suggestions system, and a new system to raise health awareness via public digital displays has started in Dhaka. Strong support at the highest political level has been critical to the success of efforts to introduce these innovations. The endeavour has also generated a cadre of enthusiastic eHealth proponents, who are focused on further strengthening and expanding the existing systems and on harnessing the vast amount of information amassed at the central data repository through big data analysis, artificial intelligence and machine learning.
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Affiliation(s)
| | | | - Abul Kalam Azad
- Directorate General of Health Services, Ministry of Health and Family Welfare, Dhaka, Bangladesh
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27
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Magee LA, Strang A, Li L, Tu D, Tumtaweetikul W, Craik R, Daniele M, Etyang AK, D’Alessandro U, Ogochukwu O, Roca A, Sevene E, Chin P, Tchavana C, Temmerman M, von Dadelszen P. The PRECISE (PREgnancy Care Integrating translational Science, Everywhere) database: open-access data collection in maternal and newborn health. Reprod Health 2020; 17:50. [PMID: 32354365 PMCID: PMC7191679 DOI: 10.1186/s12978-020-0873-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
In less-resourced settings, adverse pregnancy outcome rates are unacceptably high. To effect improvement, we need accurate epidemiological data about rates of death and morbidity, as well as social determinants of health and processes of care, and from each country (or region) to contextualise strategies. The PRECISE database is a unique core infrastructure of a generic, unified data collection platform. It is built on previous work in data harmonisation, outcome and data field standardisation, open-access software (District Health Information System 2 and the Baobab Laboratory Information Management System), and clinical research networks. The database contains globally-recommended indicators included in Health Management Information System recording and reporting forms. It comprises key outcomes (maternal and perinatal death), life-saving interventions (Human Immunodeficiency Virus testing, blood pressure measurement, iron therapy, uterotonic use after delivery, postpartum maternal assessment within 48 h of birth, and newborn resuscitation, immediate skin-to-skin contact, and immediate drying), and an additional 17 core administrative variables for the mother and babies. In addition, the database has a suite of additional modules for 'deep phenotyping' based on established tools. These include social determinants of health (including socioeconomic status, nutrition and the environment), maternal co-morbidities, mental health, violence against women and health systems. The database has the potential to enable future high-quality epidemiological research integrated with clinical care and discovery bioscience.
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Affiliation(s)
- Laura A. Magee
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
| | - Amber Strang
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
| | - Larry Li
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Domena Tu
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Warancha Tumtaweetikul
- Department of Obstetrics & Gynaecology, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rachel Craik
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
| | - Marina Daniele
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
| | - Angela Koech Etyang
- Centre of Excellence in Women & Child Health, East Africa, Aga Khan University, Nairobi, Kenya
| | - Umberto D’Alessandro
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Ofordile Ogochukwu
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Anna Roca
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | - Esperança Sevene
- Department of Physiological Science, Clinical Pharmacology, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | - Paulo Chin
- Centro de Investigação em Saúde de Manhiça, Manhiça, Mozambique
| | | | - Marleen Temmerman
- Centre of Excellence in Women & Child Health, East Africa, Aga Khan University, Nairobi, Kenya
| | - Peter von Dadelszen
- Department of Women and Children’s Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, Becket House, Room BH.05.11, 1 Lambeth Palace Road, London, SE1 7EU UK
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Farnham A, Cossa H, Dietler D, Engebretsen R, Leuenberger A, Lyatuu I, Nimako B, Zabre HR, Brugger F, Winkler MS. Investigating Health Impacts of Natural Resource Extraction Projects in Burkina Faso, Ghana, Mozambique, and Tanzania: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e17138. [PMID: 32266876 PMCID: PMC7177430 DOI: 10.2196/17138] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/03/2020] [Accepted: 02/22/2020] [Indexed: 11/13/2022] Open
Abstract
Background Natural resource extraction projects offer both opportunities and risks for sustainable development and health in host communities. Often, however, the health of the community suffers. Health impact assessment (HIA) can mitigate the risks and promote the benefits of development but is not routinely done in the developing regions that could benefit the most. Objective Our study aims to investigate health and health determinants in regions affected by extractive industries in Burkina Faso, Ghana, Mozambique, and Tanzania. The evidence generated in our study will inform a policy dialogue on how HIA can be promoted as a regulatory approach as part of the larger research initiative called the HIA4SD (Health impact assessment for sustainable development) project. Methods The study is a concurrent triangulation, mixed methods, multi-stage, multi-focus project that specifically addresses the topics of governance and policy, social determinants of health, health economics, health systems, maternal and child health, morbidity and mortality, and environmental determinants, as well as the associated health outcomes in natural resource extraction project settings across four countries. To investigate each of these health topics, the project will (1) use existing population-level databases to quantify incidence of disease and other health outcomes and determinants over time using time series analysis; (2) conduct two quantitative surveys on mortality and cost of disease in producer regions; and (3) collect primary qualitative data using focus groups and key informant interviews describing community perceptions of the impacts of extraction projects on health and partnership arrangements between the projects and local and national governance. Differences in health outcomes and health determinants between districts with and without an extraction project will be analyzed using matched geographical analyses in quasi-Poisson regression models and binomial regression models. Costs to the health system and to the households from diseases found to be associated with projects in each country will be estimated retrospectively. Results Fieldwork for the study began in February 2019 and concluded in February 2020. At the time of submission, qualitative data collection had been completed in all four study countries. In Burkina Faso, 36 focus group discussions and 74 key informant interviews were conducted in three sites. In Ghana, 34 focus group discussions and 64 key informant interviews were conducted in three sites. In Mozambique, 75 focus group discussions and 103 key informant interviews were conducted in four sites. In Tanzania, 36 focus group discussions and 84 key informant interviews were conducted in three sites. Quantitative data extraction and collection is ongoing in all four study countries. Ethical approval for the study was received in all four study countries prior to beginning the fieldwork. Data analyses are underway and results are expected to be published in 2020 and 2021. Conclusions Disentangling the complex interactions of resource extraction projects with their host communities requires an integrative approach drawing on many methodologies under the HIA umbrella. By using complementary data sources to address the question of population health in project areas from several angles, bias and missing data will be reduced, generating high-quality evidence to aid countries in moving toward sustainable development. International Registered Report Identifier (IRRID) DERR1-10.2196/17138
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Affiliation(s)
- Andrea Farnham
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Hermínio Cossa
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,Manhiça Health Research Centre, Maputo, Mozambique
| | - Dominik Dietler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Andrea Leuenberger
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Isaac Lyatuu
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Belinda Nimako
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,University of Health and Allied Sciences, Ho, Ghana
| | - Hyacinthe R Zabre
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland.,Research Institute of Health Sciences, Ouagadougou, Burkina Faso
| | - Fritz Brugger
- Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Mirko S Winkler
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Bogale B, Mørkrid K, O'Donnell B, Ghanem B, Abu Ward I, Abu Khader K, Isbeih M, Frost M, Baniode M, Hijaz T, Awwad T, Rabah Y, Frøen JF. Development of a targeted client communication intervention to women using an electronic maternal and child health registry: a qualitative study. BMC Med Inform Decis Mak 2020; 20:1. [PMID: 31906929 PMCID: PMC6945530 DOI: 10.1186/s12911-019-1002-x] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 12/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Targeted client communication (TCC) using text messages can inform, motivate and remind pregnant and postpartum women of timely utilization of care. The mixed results of the effectiveness of TCC interventions points to the importance of theory based interventions that are co-design with users. The aim of this paper is to describe the planning, development, and evaluation of a theory led TCC intervention, tailored to pregnant and postpartum women and automated from the Palestinian electronic maternal and child health registry. METHODS We used the Health Belief Model to develop interview guides to explore women's perceptions of antenatal care (ANC), with a focus on high-risk pregnancy conditions (anemia, hypertensive disorders in pregnancy, gestational diabetes mellitus, and fetal growth restriction), and untimely ANC attendance, issues predefined by a national expert panel as being of high interest. We performed 18 in-depth interviews with women, and eight with healthcare providers in public primary healthcare clinics in the West Bank and Gaza. Grounding on the results of the in-depth interviews, we used concepts from the Model of Actionable Feedback, social nudging and Enhanced Active Choice to compose the TCC content to be sent as text messages. We assessed the acceptability and understandability of the draft text messages through unstructured interviews with local health promotion experts, healthcare providers, and pregnant women. RESULTS We found low awareness of the importance of timely attendance to ANC, and the benefits of ANC for pregnancy outcomes. We identified knowledge gaps and beliefs in the domains of low awareness of susceptibility to, and severity of, anemia, hypertension, and diabetes complications in pregnancy. To increase the utilization of ANC and bridge the identified gaps, we iteratively composed actionable text messages with users, using recommended message framing models. We developed algorithms to trigger tailored text messages with higher intensity for women with a higher risk profile documented in the electronic health registry. CONCLUSIONS We developed an optimized TCC intervention underpinned by behavior change theory and concepts, and co-designed with users following an iterative process. The electronic maternal and child health registry can serve as a unique platform for TCC interventions using text messages.
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Affiliation(s)
- Binyam Bogale
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
- Center for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway
| | - Kjersti Mørkrid
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Brian O'Donnell
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Buthaina Ghanem
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Itimad Abu Ward
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Khadija Abu Khader
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Mervett Isbeih
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Michael Frost
- Health Information Systems Program, Department of Informatics, University of Oslo, Oslo, Norway
| | - Mohammad Baniode
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | | | - Tamara Awwad
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - Yousef Rabah
- The Palestinian National Institute of Public Health, World Health Organization, Ramallah, Palestine
| | - J Frederik Frøen
- Global Health Cluster, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway.
- Center for Intervention Science in Maternal and Child Health (CISMAC), University of Bergen, Bergen, Norway.
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Seyyedsalehi MS, Nahvijou A, Rouhollahi M, Teymouri F, Mirjomehri L, Zendehdel K. Clinical Cancer Registry of the Islamic Republic of Iran: Steps for Establishment and Results of the Pilot Phase. J Registry Manag 2020; 47:200-206. [PMID: 34170898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Despite the importance of clinical cancer registries in improving the quality of cancer care and clinical research, few reports on clinical cancer registries are available from low- and middle-income countries. We designed a program to establish a clinical cancer registry in Iran. PATIENTS AND METHODS We established a clinical cancer registry at the Cancer Institute of Iran as a pilot center. We defined the organizational structure, developed minimal data sets and data dictionaries, verified data sources and registration processes, and developed the necessary registry software. During the pilot phase, we studied the clinical characteristics and outcomes of patients with cancer in 4 sites (breast, colorectal, stomach, and esophagus) who were admitted to the Cancer Institute of Iran in 2014. RESULTS We registered 1,117 patients (650 breast, 199 colorectal, 163 stomach, and 105 esophageal cancer patients) in the pilot phase of this program. Completeness of the registry in the pilot phase was 99%. Overall, 15.57% of patients were at stage IV at diagnosis, 30.43% were at stage III, and 43.6% were diagnosed at an earlier stage (stages 0-II). Stage was unknown in 10.3% of patients. Five-year observed survival for breast, colorectal, stomach, and esophageal cancers was 78.57% (95% CI, 74%-82%), 57.91% (95% CI, 49%-65%), 17.97% (95% CI, 12%-24%), and 18.44% (95% CI, 11%-26%), respectively. DISCUSSION This registry provides important information that can be the basis for evaluation and improvement of quality of care among Iranian patients. This registry will be scaled up to the national level as an important resource for measuring quality of care and conducting clinical cancer research in Iran.
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Battle KE, Gumbo A, Hamuza G, Kwizombe C, Banda AT, Chipeta S, Phiri MD, Kamanga B, Kawonga J, Mafuleka T, Malpass A, Mfune P, Mhango M, Munthali L, Silungwe G, Siwombo M, Twalibu H, Zakaliya A, Kayange M, Taylor C. Consultative meeting that examined alignment and discrepancies between health facility and household survey data in Malawi. Malar J 2019; 18:411. [PMID: 31818297 PMCID: PMC6902581 DOI: 10.1186/s12936-019-3050-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
Malawi is midway through its current Malaria Strategic Plan 2017–2022, which aims to reduce malaria incidence and deaths by at least 50% by 2022. Malariometric data are available with health surveillance data housed in District Health Information Software 2 (DHIS2) and household survey data from two recent Malaria Indicator Surveys (MIS) and a Demographic and Health Survey (DHS). Strengths and weaknesses of the data were discussed during a consultative meeting in Lilongwe, Malawi in July 2019. The first 3 days included in-depth exploration and analysis of surveillance and survey data by 13 participants from the National Malaria Control Programme, district health offices, and partner organizations. Key indicators derived from both DHIS2 and MIS/DHS sources were analysed with three case studies, and presented to stakeholders on the fourth day of the meeting. Applications of the findings to programmatic decision-making and strategic plan evaluation were critiqued and discussed.
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Affiliation(s)
- Katherine E Battle
- Malaria Atlas Project, Big Data Institute, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Austin Gumbo
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Gracious Hamuza
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Collins Kwizombe
- U.S. President's Malaria Initiative, United States Agency for International Development, Lilongwe, Malawi
| | | | | | - Mphatso D Phiri
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Jacob Kawonga
- Central Monitoring Evaluation Division, Lilongwe, Malawi
| | - Taonga Mafuleka
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | - Ashley Malpass
- U.S. President's Malaria Initiative, United States Agency for International Development, Lilongwe, Malawi
| | | | | | | | - Godfrey Silungwe
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
| | | | | | - Allison Zakaliya
- Organized Network of Services for Everyone's (ONSE) Health, Management Sciences for Health, Lilongwe, Malawi
| | - Michael Kayange
- National Malaria Control Programme, Ministry of Health, Lilongwe, Malawi
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Maïga A, Jiwani SS, Mutua MK, Porth TA, Taylor CM, Asiki G, Melesse DY, Day C, Strong KL, Faye CM, Viswanathan K, O'Neill KP, Amouzou A, Pond BS, Boerma T. Generating statistics from health facility data: the state of routine health information systems in Eastern and Southern Africa. BMJ Glob Health 2019; 4:e001849. [PMID: 31637032 PMCID: PMC6768347 DOI: 10.1136/bmjgh-2019-001849] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 08/28/2019] [Accepted: 09/11/2019] [Indexed: 10/26/2022] Open
Abstract
Health facility data are a critical source of local and continuous health statistics. Countries have introduced web-based information systems that facilitate data management, analysis, use and visualisation of health facility data. Working with teams of Ministry of Health and country public health institutions analysts from 14 countries in Eastern and Southern Africa, we explored data quality using national-level and subnational-level (mostly district) data for the period 2013-2017. The focus was on endline analysis where reported health facility and other data are compiled, assessed and adjusted for data quality, primarily to inform planning and assessments of progress and performance. The analyses showed that although completeness of reporting was generally high, there were persistent data quality issues that were common across the 14 countries, especially at the subnational level. These included the presence of extreme outliers, lack of consistency of the reported data over time and between indicators (such as vaccination and antenatal care), and challenges related to projected target populations, which are used as denominators in the computation of coverage statistics. Continuous efforts to improve recording and reporting of events by health facilities, systematic examination and reporting of data quality issues, feedback and communication mechanisms between programme managers, care providers and data officers, and transparent corrections and adjustments will be critical to improve the quality of health statistics generated from health facility data.
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Affiliation(s)
- Abdoulaye Maïga
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Safia S Jiwani
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Martin Kavao Mutua
- Department of Research, African Population and Health Research Center, Nairobi, Kenya
| | - Tyler Andrew Porth
- Division of Data, Research and Policy, Data and Analytics Section, UNICEF, New York City, New York, USA
| | | | - Gershim Asiki
- Department of Research, African Population and Health Research Center, Nairobi, Kenya
| | - Dessalegn Y Melesse
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Candy Day
- Health System Trust, Westville, South Africa
| | - Kathleen L Strong
- Maternal, Newborn, Child and Adolescent Health Department, World Health Organization, Geneva, Switzerland
| | - Cheikh Mbacké Faye
- West Africa Regional Office, African Population and Health Research Center, Nairobi, Kenya
| | - Kavitha Viswanathan
- Information Evidence and Research, World Health Organization, Geneva, Switzerland
| | | | - Agbessi Amouzou
- International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Bob S Pond
- Independent Consultant, Portland, Oregon, USA
| | - Ties Boerma
- Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada
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Craig AT, Joshua CA, Sio AR, Donoghoe M, Betz-Stablein B, Bainivalu N, Dalipanda T, Kaldor J, Rosewell AE, Schierhout G. Epidemic surveillance in a low resource setting: lessons from an evaluation of the Solomon Islands syndromic surveillance system, 2017. BMC Public Health 2018; 18:1395. [PMID: 30572942 PMCID: PMC6302379 DOI: 10.1186/s12889-018-6295-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 12/04/2018] [Indexed: 11/29/2022] Open
Abstract
Background Solomon Islands is one of the least developed countries in the world. Recognising that timely detection of outbreaks is needed to enable early and effective response to disease outbreaks, the Solomon Islands government introduced a simple syndromic surveillance system in 2011. We conducted the first evaluation of the system and the first exploration of a national experience within the broader multi-country Pacific Syndromic Surveillance System to determine if it is meeting its objectives and to identify opportunities for improvement. Methods We used a multi-method approach involving retrospective data collection and statistical analysis, modelling, qualitative research and observational methods. Results We found that the system was well accepted, highly relied upon and designed to account for contextual limitations. We found the syndromic algorithm used to identify outbreaks was moderately sensitive, detecting 11.8% (IQR: 6.3–25.0%), 21.3% (IQR: 10.3–36.8%), 27.5% (IQR: 12.8–52.3%) and 40.5% (IQR: 13.5–65.7%) of outbreaks that caused small, moderate, large and very large increases in case presentations to health facilities, respectively. The false alert rate was 10.8% (IQR: 4.8–24.5%). Rural coverage of the system was poor. Limited workforce, surveillance resourcing and other ‘upstream’ health system factors constrained performance. Conclusions The system has made a significant contribution to public health security in Solomon Islands, but remains insufficiently sensitive to detect small-moderate sized outbreaks and hence should not be relied upon as a stand-alone surveillance strategy. Rather, the system should sit within a complementary suite of early warning surveillance activities including event-based, in-patient- and laboratory-based surveillance methods. Future investments need to find a balance between actions to address the technical and systems issues that constrain performance while maintaining simplicity and hence sustainability. Electronic supplementary material The online version of this article (10.1186/s12889-018-6295-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adam T Craig
- University of New South Wales, Sydney, NSW, 2052, Australia.
| | - Cynthia A Joshua
- Solomon Islands Ministry of Health and Medical Services, Chinatown, Honiara, Solomon Islands
| | - Alison R Sio
- Solomon Islands Ministry of Health and Medical Services, Chinatown, Honiara, Solomon Islands
| | - Mark Donoghoe
- University of New South Wales, Sydney, NSW, 2052, Australia
| | | | - Nemia Bainivalu
- Solomon Islands Ministry of Health and Medical Services, Chinatown, Honiara, Solomon Islands
| | - Tenneth Dalipanda
- Solomon Islands Ministry of Health and Medical Services, Chinatown, Honiara, Solomon Islands
| | - John Kaldor
- University of New South Wales, Sydney, NSW, 2052, Australia
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Abstract
BACKGROUND Following the launch of District Health Information System 2 across facilities in Kenya, more health facilities are now capable of carrying out malaria parasitological testing and reporting data as part of routine health information systems, improving the potential value of routine data for accurate and timely tracking of rapidly changing disease epidemiology at fine spatial resolutions. OBJECTIVES This study evaluates the current coverage and completeness of reported malaria parasitological testing data in DHIS2 specifically looking at patterns in geographic coverage of public health facilities in Kenya. METHODS Monthly facility level data on malaria parasitological testing were extracted from Kenya DHIS2 between November 2015 and October 2016. DHIS2 public facilities were matched to a geo-coded master facility list to obtain coordinates. Coverage was defined as the geographic distribution of facilities reporting any data by region. Completeness of reporting was defined as the percentage of facilities reporting any data for the whole 12-month period or for 3, 6 and 9 months. RESULTS Public health facilities were 5,933 (59%) of 10,090 extracted. Fifty-nine per Cent of the public facilities did not report any data while 36, 29 and 22% facilities had data reported at least 3, 6 and 9 months, respectively. Only 8% of public facilities had data reported for every month. There were proportionately more hospitals (86%) than health centres (76%) and dispensaries/clinics (30%) reporting. There were significant geographic variations in reporting rates. Counties along the malaria endemic coast had the lowest reporting rate with only 1% of facilities reporting consistently for 12 months. CONCLUSION Current coverage and completeness of reporting of malaria parasitological diagnosis across Kenya's public health system remains poor. The usefulness of routine data to improve our understanding of sub-national heterogeneity across Kenya would require significant improvements to the consistency and coverage of data captured by DHIS2.
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Affiliation(s)
- Joseph K Maina
- a Malaria Public Health Department , Kenya Medical Research Institute-Wellcome Trust Research Programme , Nairobi , Kenya
| | - Peter M Macharia
- a Malaria Public Health Department , Kenya Medical Research Institute-Wellcome Trust Research Programme , Nairobi , Kenya
| | - Paul O Ouma
- a Malaria Public Health Department , Kenya Medical Research Institute-Wellcome Trust Research Programme , Nairobi , Kenya
| | - Robert W Snow
- a Malaria Public Health Department , Kenya Medical Research Institute-Wellcome Trust Research Programme , Nairobi , Kenya.,b Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine , University of Oxford , Oxford , UK
| | - Emelda A Okiro
- a Malaria Public Health Department , Kenya Medical Research Institute-Wellcome Trust Research Programme , Nairobi , Kenya
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Scott TP, Coetzer A, Fahrion AS, Nel LH. Addressing the Disconnect between the Estimated, Reported, and True Rabies Data: The Development of a Regional African Rabies Bulletin. Front Vet Sci 2017; 4:18. [PMID: 28265562 PMCID: PMC5316526 DOI: 10.3389/fvets.2017.00018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 02/02/2017] [Indexed: 10/31/2022] Open
Abstract
It is evident that rabies continues to be a neglected tropical disease; however, a recent global drive aims to eliminate canine-mediated human rabies by 2030. Global efforts have been vested into creating and developing resources for countries to take ownership of and overcome the challenges that rabies poses. The disconnect between the numbers of rabies cases reported and the numbers estimated by prediction models is clear: the key to understanding the epidemiology and true burden of rabies lies within accurate and timely data; poor and discrepant data undermine its true burden and negate the advocacy efforts needed to curb this lethal disease. In an effort to address these challenges, the Pan-African Rabies Control Network is developing a regional rabies-specific disease surveillance bulletin based on the District Health Information System 2 platform-a web-based, open access health information platform. This bulletin provides a data repository from which specific key indicators, essential to any rabies intervention program, form the basis of data collection. The data are automatically analyzed, providing useful outputs for targeted intervention. Furthermore, in an effort to reduce reporting fatigue, the data submitted, under authority from the respective governments, can automatically be shared with approved international authorities. The implementation of a rabies-specific bulletin will facilitate targeted control efforts and provide measurements of success, while also acting as a basis for advocacy to raise the priority of this neglected disease.
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Affiliation(s)
- Terence P Scott
- Department of Microbiology and Plant Pathology, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa; Global Alliance for Rabies Control, Manhattan, KS, USA
| | - Andre Coetzer
- Department of Microbiology and Plant Pathology, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa; Global Alliance for Rabies Control, Manhattan, KS, USA
| | - Anna S Fahrion
- Department of Control of Neglected Tropical Diseases, World Health Organization , Geneva , Switzerland
| | - Louis H Nel
- Department of Microbiology and Plant Pathology, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa; Global Alliance for Rabies Control, Manhattan, KS, USA
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Kariuki JM, Manders EJ, Richards J, Oluoch T, Kimanga D, Wanyee S, Kwach JO, Santas X. Automating indicator data reporting from health facility EMR to a national aggregate data system in Kenya: An Interoperability field-test using OpenMRS and DHIS2. Online J Public Health Inform 2016; 8:e188. [PMID: 28149444 DOI: 10.5210/ojphi.v8i2.6722] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction:Developing countries are increasingly strengthening national health
information systems (HIS) for evidence-based decision-making. However, the
inability to report indicator data automatically from electronic medical
record systems (EMR) hinders this process. Data are often printed and
manually re-entered into aggregate reporting systems. This affects data
completeness, accuracy, reporting timeliness, and burdens staff who support
routine indicator reporting from patient-level data.
Method: After conducting a feasibility
test to exchange indicator data from Open Medical Records System (OpenMRS)
to District Health Information System version 2 (DHIS2), we conducted a
field test at a health facility in Kenya. We configured a field-test DHIS2
instance, similar to the Kenya Ministry of Health (MOH) DHIS2, to receive
HIV care and treatment indicator data and the KenyaEMR, a customized version
of OpenMRS, to generate and transmit the data from a health facility. After
training facility staff how to send data using DHIS2 reporting module, we compared
completeness, accuracy and timeliness of automated indicator reporting with
facility monthly reports manually entered into MOH DHIS2.
Results: All 45 data values in the
automated reporting process were 100% complete and accurate while in manual
entry process, data completeness ranged from 66.7% to 100% and accuracy
ranged from 33.3% to 95.6% for seven months (July 2013-January 2014). Manual
tally and entry process required at least one person to perform each of the
five reporting activities, generating data from EMR and manual entry
required at least one person to perform each of the three reporting
activities, while automated reporting process had one activity performed by
one person. Manual tally and entry observed in October 2013 took 375
minutes. Average time to generate data and manually enter into DHIS2 was
over half an hour (M=32.35 mins, SD=0.29) compared to less than a minute for
automated submission (M=0.19 mins, SD=0.15). Discussion and
Conclusion: The results indicate that indicator data
sent electronically from OpenMRS-based EMR at a health facility to DHIS2
improves data completeness, eliminates transcription errors and delays in
reporting, and reduces the reporting burden on human resources. This
increases availability of quality indicator data using available resources
to facilitate monitoring service delivery and measuring progress towards set
goals.
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