Health Management Information System Research Articles

ADDRESSING PRIVACY AND ETHICAL CONSIDERATIONS IN HEALTH INFORMATION MANAGEMENT SYSTEMS (IMS)

This paper explores the crucial role of privacy and ethics in Health Information Management Systems (HIMS), addressing the inherent challenges and presenting innovative solutions through detailed case studies. We examine the significant privacy concerns, such as data breaches and unauthorized data sharing, alongside ethical issues like informed consent and equitable access to technology. Effective solutions including the Privacy-Preserving Distributed Analytics (PPDA) model and proactive bioethics committees, as demonstrated by institutions like Vanderbilt University Medical Center, illustrate successful strategies for managing these concerns. The paper emphasizes the importance of prioritizing privacy and ethics not merely as compliance requirements but as foundational elements essential to the trustworthiness and effectiveness of HIMS. It advocates for a continuous, proactive approach to address these issues as technology evolves and regulations change. Furthermore, we call for a collaborative effort among policymakers, healthcare providers, technologists, and patients to develop and refine HIMS that uphold the highest standards of privacy, ethics, and accessibility, thus enhancing the quality of care and health outcomes for all stakeholders.

Quality management practices enhance the legitimacy of organizations through improved performance: a perspective from oil processing industries

PurposeQuality management practices (QMP) have stood as one of the critical strategic differentiators for enhancing firm performance. The production and manufacturing industry is the main driving force of economic growth and social development for any developed or developing country. This study aims to focus on two primary dimensions of QMP: soft quality management practices (SQMP) and hard quality management practices (HQMP) from the socio-technical system perspectives. Based on institutional theory perspectives, the study explores the impact of SQMP and HQMP on quality performance (QP), innovation performance (IVP) and financial performance (FP) in Indian oil processing organizations.Design/methodology/approachA proposed research model is validated using 289 cross-sectional survey data collected from the senior officials of oil processing firms in India. Covariance-based structural equation modeling is used to verify the proposed theoretical model.FindingsSQMP, directly and indirectly, influenced QP and IVP while only indirectly to FP mediated through QP. HQMP directly impacted only QP while indirectly to IVP and FP mediated through QP.Research limitations/implicationsImpact of organizational legitimacy in proper utilization or application of QMP in achieving the firm sustainable growth. The future study may address the following Research Question (RQ) also: How do QMP enhance the legitimacy of organizations operating in the oil processing industries? Are there specific mechanisms or pathways through which improved performance contributes to enhanced organizational legitimacy? How does legitimacy impact the success and sustainability of organizations, particularly, within the context of the oil processing industries? Are there regulatory requirements or industry certifications that organizations must adhere to in order to maintain legitimacy?Practical implicationsSimilarly, manufacturing firms establish QMP of interaction and maintaining relationships with all the stakeholders, total employee empowerment and involvement, workforce commitment and workforce management, helping to control their reputations and maintain legitimacy (Li et al., 2023). Similarly, in the health industry, the health management information system (HMIS), which uses the DHIS2 platform, establishes that isomorphism legitimizes data QMP among health practitioners and, subsequently, data quality. Further, it was concluded that mimetic isomorphism led to moral and pragmatic legitimacy. In contrast, normative isomorphism led to cognitive legitimacy within the HMIS structure and helped to attain the correctness and timeliness of the data and reports, respectively (Msendema et al., 2023). Quality, flexibility and efficiency of Big Data Analytics through better storage, speed and significance can optimize the operational performance of a manufacturing firm (Verma et al., 2023).Social implicationsThe study provides the academician with the different dimensions of QMP. The study demonstrates how a firm develops multiple performance capabilities through proper QMP. Also, it shows how vital behavioral and managerial perspectives are to QMP and statistically solid tools and techniques. The study draws their importance to risk factors involved in the firms. Since the SQMP play a vital role, thus, emphasis on the behavioral dimension of quality requires more investigation and is in line with hard technological advancements in the quality field.Originality/valueThe study of the impact of HQMP and SQMP on performance is still not established. There are inconsistencies in the findings. The study of the impact of HQMP and SQMP in oil processing industries has not dealt with before. The effects of HQMP and SQMP on the firm’s FP have least been dealt. In context to the intended influence of QM implementation, QP has not been examined as a potential mediator between FP. Research carried out in the past is limited to American and European countries. However, a limited study was done in Asia, and no study has been conducted in the Indian context.

Assessing the Influence of Behavioural Factors of Community Health Promoters on Use of Community Based Health Information Systems in Selected Counties, Kenya

Globally, health management information systems (HMIS) in strengthening health systems have gained recognition due to potential of technology to improve access to quality care in underserved communities. In Kenya, the functionality of Community based- Health Management Information System (CBHMIS) currently stands at 55% down from 64% in year 2015. The aim of this paper was to determine the influence of behavioral factors of community units personnel on CBHMIS. As a nested study, with a broader aimt to establish the operational status of CBHMIS and its use in selected counties in Kenya; The main objective of this research was: To establish whether behavioural factors of Community Health Promoters (CHPs) influence CBHMIS use in Kenya. A mixed method design. was adopted, Kiambu, Kajiado and Nairobi counties formed the study location, a target population of 156 active community units was considered to arrive at a total sample of 122 community units and out of 7800CHPs a sample of 366 respondents was drawn. Multistage sampling was used to identify the CUs, and systematic random sampling to identify 366 respondents. Quantitative data tools were semi-structured closed ended questionnaires. Qualitative data tools included observation checklist, Focus Group Discussion and Key Informant Interviews guides. Quantitative data was analyzed using SPSS to generate univariate and bivariate analysis at p<0.05 significance level; Qualitative data was analyzed using content analysis based on key themes generated from the objectives. Results were presented in form of graphs, tables, figures, and narration. This study showed that the use of Community based- Health Management Information System stood at 56.6%. Behavioural factors were found to significantly influence use of Community based- Health Management Information System. Further, of the total variations in the use of Community based- Health Management Information System, behavioral factor explains 13.7% (R<sup>2</sup> = .137). Results show that the model was valid (F<sub>(1, 363)</sub> = 58.579, <I>P </I>= .001) hence the explanatory variable (X<sub>2</sub>, Behavioral factors) is good in explaining total variations in Use of CbHMIS by community units. This implies that the use of CbHMIS by Community Units (CU) improves significantly when the community units have better behavioural factors. In conclusion, behavioural factors of CHPs have strong and significant influence on the CBHMIS use. Motivation of CHPs is key as a motivator to CBHMIS use, as well as. provision of material support including reporting tools and IEC materials and capacity development technical, computer and electronic reporting skills to enhamce CHP operations and processes.

The Health Management Information System and HIV and AIDS monitoring: Insights from Ethiopia

Background: A well-performing health information system (HIS) provides timely, complete, accurate and easily retrievable data. However, HIS in low- and middle-income countries (LMICs), including Ethiopia, is highly complex and influenced by pressures from donors, politics and technical factors. Hence, these countries experience persistent challenges in producing quality data and difficulties using health management information system (HMIS) data from their HISs.Objectives: This study aimed to evaluate how HMIS was perceived and utilised in HIV and AIDS monitoring in Ethiopia, and views regarding the influence of determinants on the use of HMIS.Method: A qualitative evaluative case study using focus group discussions with data producers and users was conducted in selected health facility in Addis Ababa. A purposive critical case sampling was used to recruit participants.Results: Key findings revealed that HIV and AIDS-specific indicators, information and communication technology (ICT) and other related resources were critical barriers to the successful use of the HMIS. Participants believed these technical issues impacted the quality of data adversely and, subsequently, the conversion of that data to information and using it to monitor the HIV and AIDS programme’s performance.Conclusion: Technical factors affected all strategic decisions taken by the organisation. The health facilities did not process information as expected. However, staff performed the HMIS tasks with the tools available as they tried to make sense of data.Contribution: This study contributed to the body of knowledge by identifying the technical factors on data quality and use of HMIS for HIV and AIDS monitoring.

Assessing intersectional gender analysis in Nepal’s health management information system: a case study on tuberculosis for inclusive health systems

BackgroundTuberculosis (TB) remains a major public health problem in Nepal, high in settings marked by prevalent gender and social inequities. Various social stratifiers intersect, either privileging or oppressing individuals based on their characteristics and contexts, thereby increasing risks, vulnerabilities and marganilisation associated with TB. This study aimed to assess the inclusiveness of gender and other social stratifiers in key health related national policies and the Health Management Information System (HMIS) of National Tuberculosis Programme (NTP) by conducting an intersectional analysis of TB cases recorded via HMIS.MethodsA desk review of key policies and the NTP’s HMIS was conducted. Retrospective intersectional analysis utilized two secondary data sources: annual NTP report (2017–2021) and records of 628 TB cases via HMIS 6.5 from two TB centres (2017/18–2018/19). Chi-square test and multi-variate analysis was used to assess the association between social stratifers and types of TB, registration category and treatment outcome.ResultsGender, social inclusion and concept of intersectionality are incorporated into various health policies and strategies but lack effective implementation. NTP has initiated the collection of age, sex, ethnicity and location data since 2014/15 through the HMIS. However, only age and sex disaggregated data are routinely reported, leaving recorded social stratifiers of TB patients static without analysis and dissemination. Furthermore, findings from the intersectional analysis using TB secondary data, showed that male more than 25 years exhibited higher odds [adjusted odds ratio (aOR) = 4.95, 95% confidence interval (CI): 1.60–19.06, P = 0.01)] of successful outcome compared to male TB patients less than 25 years. Similarly, sex was significantly associated with types of TB (P < 0.05) whereas both age (P < 0.05) and sex (P < 0.05) were significantly associated with patient registration category (old/new cases).ConclusionsThe results highlight inadequacy in the availability of social stratifiers in the routine HMIS. This limitation hampers the NTP’s ability to conduct intersectional analyses, crucial for unveiling the roles of other social determinants of TB. Such limitation underscores the need for more disaggregated data in routine NTP to better inform policies and plans contributing to the development of a more responsive and equitable TB programme and effectively addressing disparities.

Boosting Contraceptive Uptake in Urban Uganda: Older Women Benefit When Layering Adolescent and Youth Interventions Onto Existing Family Planning Programming.

Uganda has a large young population with a high unmet need for family planning (FP). Although there have been many efforts to improve access to and uptake of contraception, improvements have been slow. The Ministry of Health Uganda partnered with The Challenge Initiative (TCI) to implement a novel multipronged approach layering adolescent and youth sexual reproductive health (AYSRH) onto a functioning general FP program for women of reproductive age in 3 local governments of Buikwe, Mukono, and Iganga. We describe the approach and aim to determine whether layering AYSRH interventions onto an existing program resulted in increased contraceptive uptake among adolescents and youth aged 10-24 years and among women aged 25-49 years. We analyzed service statistics from the Uganda Health Management Information System to assess contraceptive uptake for adolescents and youth (aged 10-24 years) and older women (aged 25-49 years) before and after the implementation of the AYSRH approach in 3 areas (Buikwe, Iganga, and Mukono) compared to 11 areas where only the general FP program was implemented and the Uganda country total. This analysis showed that before the start of TCI's support, levels of contraceptive uptake were similar in all local governments. However, after implementation, there was an increase in uptake for general FP program only areas (1.7-point advantage over country total) and an even greater increase in general FP+AYSRH areas (2.4-point advantage over FP only programming). This was observed in both adolescents and youth aged 10-24 years and among women aged 25-49 years. The layering of TCI's AYSRH interventions onto a well-functioning FP platform not only increased contraceptive uptake among adolescents and youth aged 10-24 years but also boosted uptake among women older than age 25 years.

Changes in stillbirths and child and youth mortality in 2020 and 2021 during the COVID-19 pandemic.

The COVID-19 pandemic has been extensively studied for its impact on mortality, particularly in older age groups. However, the pandemic effects on stillbirths and mortality rates in neonates, infants, children and youth remain poorly understood. This study comprehensively analyses the pandemic influence on young mortality and stillbirths across 112 countries and territories in 2020 and 104 in 2021. Using data from civil registers and vital statistics systems (CRVS) and the Health Management Information System (HMIS), we estimate expected mortality levels in a non-pandemic setting and relative mortality changes (p-scores) through generalized linear models. The analysis focuses on the distribution of country-specific mortality changes and the proportion of countries experiencing deficits, no changes and excess mortality in each age group. Results show that stillbirths and under-25 mortality were as expected in most countries during 2020 and 2021. However, among countries with changes, more experienced deficits than excess mortality, except for stillbirths, neonates and those aged 10-24 in 2021, where, despite the predominance of no changes, excess mortality prevailed. Notably, a fifth of examined countries saw increases in stillbirths and a quarter in young adult mortality (20-24) in 2021. Our findings are highly consistent between females and males and similar across income levels. Despite global disruptions to essential services, stillbirths and youth mortality were as expected in most observed countries, challenging initial hypotheses. However, the study suggests the possibility of delayed adverse effects that require more time to manifest at the population level. Understanding the lasting impacts of the COVID-19 pandemic requires ongoing, long-term monitoring of health and deaths among children and youth, particularly in low- and lower-middle-income countries.

Modelling spatiotemporal variation in under-five malaria risk in Ghana in 2016–2021

BackgroundGhana is among the top 10 highest malaria burden countries, with about 20,000 children dying annually, 25% of which were under five years. This study aimed to produce interactive web-based disease spatial maps and identify the high-burden malaria districts in Ghana.MethodsThe study used 2016–2021 data extracted from the routine health service nationally representative and comprehensive District Health Information Management System II (DHIMS2) implemented by the Ghana Health Service. Bayesian geospatial modelling and interactive web-based spatial disease mapping methods were employed to quantify spatial variations and clustering in malaria risk across 260 districts. For each district, the study simultaneously mapped the observed malaria counts, district name, standardized incidence rate, and predicted relative risk and their associated standard errors using interactive web-based visualization methods.ResultsA total of 32,659,240 malaria cases were reported among children < 5 years from 2016 to 2021. For every 10% increase in the number of children, malaria risk increased by 0.039 (log-mean 0.95, 95% credible interval = − 13.82–15.73) and for every 10% increase in the number of males, malaria risk decreased by 0.075, albeit not statistically significant (log-mean − 1.82, 95% credible interval = − 16.59–12.95). The study found substantial spatial and temporal differences in malaria risk across the 260 districts. The predicted national relative risk was 1.25 (95% credible interval = 1.23, 1.27). The malaria risk is relatively the same over the entire year. However, a slightly higher relative risk was recorded in 2019 while in 2021, residing in Keta, Abuakwa South, Jomoro, Ahafo Ano South East, Tain, Nanumba North, and Tatale Sanguli districts was associated with the highest malaria risk ranging from a relative risk of 3.00 to 4.83. The district-level spatial patterns of malaria risks changed over time.ConclusionThis study identified high malaria risk districts in Ghana where urgent and targeted control efforts are required. Noticeable changes were also observed in malaria risk for certain districts over some periods in the study. The findings provide an effective, actionable tool to arm policymakers and programme managers in their efforts to reduce malaria risk and its associated morbidity and mortality in line with the Sustainable Development Goals (SDG) 3.2 for limited public health resource settings, where universal intervention across all districts is practically impossible.

The Red Cross Red Crescent Health Information System (RCHIS): an electronic medical records and health information management system for the red cross red crescent emergency response units

BackgroundThe Red Cross and Red Crescent Movement (RCRC) utilizes specialized Emergency Response Units (ERUs) for international disaster response. However, data collection and reporting within ERUs have been time-consuming and paper-based. The Red Cross Red Crescent Health Information System (RCHIS) was developed to improve clinical documentation and reporting, ensuring accuracy and ease of use while increasing compliance with reporting standards.Case presentationRCHIS is an Electronic Medical Record (EMR) and Health Information System (HIS) designed for RCRC ERUs. It can be accessed on Android tablets or Windows laptops, both online and offline. The system securely stores data on Microsoft Azure cloud, with synchronization facilitated through a local ERU server. The functional architecture covers all clinical functions of ERU clinics and hospitals, incorporating user-friendly features. A pilot study was conducted with the Portuguese Red Cross (PRC) during a large-scale event. Thirteen super users were trained and subsequently trained the staff. During the four-day pilot, 77 user accounts were created, and 243 patient files were documented. Feedback indicated that RCHIS was easy to use, requiring minimal training time, and had sufficient training for full utilization. Real-time reporting facilitated coordination with the civil defense authority.ConclusionsThe development and pilot use of RCHIS demonstrated its feasibility and efficacy within RCRC ERUs. The system addressed the need for an EMR and HIS solution, enabling comprehensive clinical documentation and supporting administrative reporting functions. The pilot study validated the training of trainers’ approach and paved the way for further domestic use of RCHIS. RCHIS has the potential to improve patient safety, quality of care, and reporting efficiency within ERUs. Automated reporting reduces the burden on ERU leadership, while electronic compilation enhances record completeness and correctness. Ongoing feedback collection and feature development continue to enhance RCHIS’s functionality. Further trainings took place in 2023 and preparations for international deployments are under way. RCHIS represents a significant step toward improved emergency medical care and coordination within the RCRC and has implications for similar systems in other Emergency Medical Teams.

Building consensus on common features and interoperability use cases for community health information systems: a Delphi study

IntroductionInformation systems for community health have become increasingly sophisticated and evidence-based in the last decade and they are now the most widely used health information systems in many low-income and...

A pilot study of implementing an adapted model for integration of interventions for people with alcohol use disorders in Tanzanian primary healthcare facilities

BackgroundEnsuring that evidence-based interventions for people with alcohol use disorders (AUD) are acceptable, effective, and feasible in different socio-cultural and health system contexts is essential. We previously adapted a model of integration of AUD interventions for the Tanzanian primary healthcare system. This pilot study aimed to assess the impact on AUD detection and the acceptability and feasibility of the facility-based components of this model from the perspective of healthcare providers (HCPs).MethodsThis mixed-methods study comprised a pre-post quasi-experimental study and a qualitative study. The integrated model included training HCPs in managing AUD, introducing systematic screening for AUD, documentation of AUD service utilization, and supportive supervision. We collected information on the number of people identified for AUD three months before and after piloting the service model. A non-parametric trend test, a distribution-free cumulative sum test, was used to identify a change in the identification rate of AUD beyond that observed due to secular trends or, by chance, three months before and after implementing the integrated AUD facility-based interventions. The Mann-Kendal test was used to assess the statistical significance of the trend. We conducted three focus group discussions exploring the experience of HCPs and their perspectives on facilitators, barriers, and strategies to overcome them. The focus group discussions were analyzed using thematic analysis.ResultsDuring the pre-implementation phase of the facility-based interventions of the adapted AUD model, HCPs assessed 322 people for AUD over three months, ranging from a minimum of 99 to a maximum of 122 per month. Of these, 77 were identified as having AUD. Moreover, HCPs screened 2058 people for AUD during implementation; a minimum of 528 to a maximum of 843 people were screened for AUD per month for the three months. Of these, 514 screened positive for AUD (AUDIT ≥ 8). However, this change in screening for AUD was not statistically significant (p-value = 0.06). HCPs reported that knowledge and skills from the training helped them identify and support people they would not usually consider having problematic alcohol use. Perceived barriers to implementation included insufficient health personnel compared to needs and inconvenient health management information systems. HCPs proposed strategies to overcome these factors and recommended multisectoral engagement beyond the health system.ConclusionsAlthough the change in the trend in the number of people screened for AUD by HCPs post-implementation was not statistically significant, it is still feasible to implement the facility-based components of the adapted integrated AUD model while addressing the identified bottlenecks and strategies for implementation. Therefore, a large-scale, adequately powered implementation feasibility study is needed. Findings from this study will be used to finalize the adapted model for integrating AUD interventions for future implementation and larger-scale evaluation.

Electronic Health Record Adoption in Oral and Dental Health Centres in Turkey

The digitalisation studies in public hospitals in Turkey started with the Health Transformation Program in 2003. The Ministry of Health has been measuring the dissemination of meaningful usage and adoption of electronic health record (EHR) using Electronic Medical Record Adoption Model (EMRAM) and Outpatient Electronic Medical Record Adoption Model (O-EMRAM). Using a comprehensive survey, our study intends to measure the stage of EHR adoption in oral and dental health centres (ODHCs) providing primary healthcare services in Turkey. The results obtained were classified by basic and comprehensive EHR functions and benchmarked against the studies addressing EHR adoption in primary healthcare institutions of other countries. In 2021, 167 ODHCs/oral and dental health hospitals (ODHHs) actively operating in Turkey completed the O-EMRAM survey. The data obtained from the survey results were analysed with QlikView Personal Edition. The availability and prevalence of medical information systems and EHR functions and their use were measured. It is observed that 59 (40.7%) of ODHCs/ODHHs have comprehensive EHR functions, while the remaining 86 (59.3%) have basic EHR functions. Under these circumstances, it can be stated that all ODHCs/ODHHs in Turkey use at least basic EHR functions. All ODHCs/ODHHs in Turkey have at least basic EHR functions. The integration of e-prescription, electronic authorisation system and e-Pulse used throughout Turkey and Health Information Management System Society (HIMSS) used in ODHCs/ODHHs can be listed as one of the decisive factors in this result. ODHCs/ODHHs still have a long way to go in adopting EHR, but the current circumstances are also promising. It is considered that this study will serve as a baseline for future measurements and produce a notable result for decision-makers.

The effect of COVID-19 on malaria cases in Zambia: a mixed effect multilevel analysis

BackgroundThe burden of Malaria in Zambia remains a challenge, with the entire population at risk of contracting this infectious disease. Despite concerted efforts by African countries, including Zambia, to implement malaria policies and strategies aimed at reducing case incidence, the region faces significant hurdles, especially with emerging pandemics such as COVID-19. The efforts to control malaria were impacted by the constraints imposed to curb its transmission during the COVID-19 pandemic. The aim of the study was to assess the effect of the COVID-19 pandemic on malaria cases in Zambia and the factors associated by comparing the COVID-19 period and the pre-COVID-19 era.MethodsThis was a cross-sectional panel study in which routinely collected programmatic data on malaria was used. The data were extracted from the Health Management Information System (HMIS) for the period January 2018 to January 2022. The period 2018 to 2022 was selected purely due to the availability of data and to avoid the problem of extrapolating too far away from the period of interest of the study. A summary of descriptive statistics was performed in which the number of cases were stratified by province, age group, and malaria cases. The association of these variables with the COVID-19 era was checked using the Wilcoxon rank-sum test and Kruskal‒Wallis test as applicable. In establishing the factors associated with the number of malaria cases, a mixed-effect multilevel model using the Poisson random intercept and random slope of the COVID-19 panel. The model was employed to deal with the possible correlation of the number of cases in the non-COVID-19 panel and the expected correlation of the number of cases in the COVID-19 panel.ResultsA total of 18,216 records were extracted from HMIS from January 2018 to January 2022. Stratifying this by the COVID-19 period/era, it was established that 8,852 malaria cases were recorded in the non-COVID-19 period, whereas 9,364 cases were recorded in the COVID-19 era. Most of the people with malaria were above the age of 15 years. Furthermore, the study found a significant increase in the relative incidence of the COVID-19 panel period compared to the non-COVID-19 panel period of 1.32, 95% CI (1.18, 1.48, p < 0.0001). The observed numbers, as well as the incident rate ratio, align with the hypothesis of this study, indicating an elevated incidence rate ratio of malaria during the COVID-19 period.ConclusionThis study found that there was an increase in confirmed malaria cases during the COVID-19 period compared to the non-COVID-19 period. The study also found Age, Province, and COVID-19 period to be significantly associated with malaria cases.

Diphtheria-Associated Myocarditis: Clinical Profiles and Mortality Trends in a Tertiary Care Hospital in Pakistan.

Corynebacterium diphtheriae infection, causing diphtheria, is a public health concern, particularly in developing nations like Pakistan. Despite immunization efforts, recent outbreaks since 2022 have emphasized the continuing threat. This study focuses on describing the clinical characteristics of children with diphtheria-induced myocarditis and exploring the association between early cardiac abnormalities, future fatality rates, and contributing factors. A one-year cross-sectional study was undertaken at Lady Reading Hospital MTI Peshawar, encompassing 73 pediatric patients diagnosed with diphtheria-associated myocarditis. Data, including demographic characteristics, cardiac enzymes, and serial ECG and echocardiography data, were gathered from the health management information system (HMIS). Institutional Ethical Committee approval was obtained, and informed consent was waived due to its retrospective nature. Gender distribution within the study was balanced, with 35 males (47.9%) and 38 females (52.1%). ECG data revealed various prevalence rates: 27.4% for rhythm abnormalities, 20% for conduction abnormalities, 6.8% for ischemia alterations, and 20.5% for normal findings. Treatment measures included anti-diphtheria serum (ADS) in 87.7% and temporary pacemaker placement (TPM) in 13.7% of patients. Echo findings indicated a variety of cardiac dysfunctions: 53.4% with no dysfunction, 9.6% mild malfunction, 6.8% with moderate dysfunction, and 30.1% with severe dysfunction. The categorization of creatine kinase (CK), lactate dehydrogenase (LDH), and troponin I (Trop I) gave insights into the biochemical aspects. This study gives a full insight into the clinical symptoms of diphtheria-induced myocarditis in children. The findings can help establish a foundation for ongoing study into potential gender-related trends in clinical outcomes, contributing to improved care and preventative methods.

Barriers to healthcare data quality and recommendations in public health facilities in Dire Dawa city administration, eastern Ethiopia: a qualitative study.

Maintaining good quality of healthcare data at various levels is a critical challenge in developing countries. The barriers to healthcare data quality remain largely unexplored in eastern Ethiopia. This study aimed to assess the barriers to quality of healthcare data in urban public health facilities in the Dire Dawa city administration from 7 April to 7 May 2019. An institutional-based qualitative exploratory approach was used among 17 purposefully selected key informants. In-depth interviews were inductively coded using the ATLAS.ti 7.5.4 version software. Inductive analysis was used by semantically analyzing the explicit content of the data to determine our themes. Several key themes and subthemes with different barriers, some of which are mutually non-exclusive, were identified. These include: Organizational Barriers: Lack of an adequate health management information system and data clerk staff, poor management commitment, lack of post-training follow-up, work overload, frequent duty rotation, lack of incentives for good performers, lack of targeted feedback, and poor culture of information use. Behavioral/Individual Barriers: Gaps in the skill of managers and health professionals, lack of adequate awareness of each indicator and its definitions, inadequate educational competence, lack of feeling of ownership, poor commitment, lack of daily tallying, and lack of value for data. Technical Barriers: Lack of a standard form, diverse and too many data entry formats, manual data collection, shortage of supplies, failure to repair system break down in a timely manner, interruption in electricity and network, delay in digitizing health information systems, lack of post-training follow-up, and inadequate supervision. External Barriers: Poor collaboration between stakeholders, dependence on the software program of non-governmental organizations, and very hot weather conditions. Diverse and complex barriers to maintenance of data quality were identified. Developing standardized health management information system implementation plans, providing advanced supervisory-level training, supportive supervision, and site-level mentorship may be very effective in identifying and resolving bottleneck data quality issues. Healthcare managers should understand the imperative of data quality and accept responsibility for its improvement and maintenance. Interventions targeted only at supplies will not fully overcome limitations to data quality. Motivation of staff and recognition of best performance can motivate others and can create cooperation among staff.

Trends and Inequalities in Maternal and Newborn Health Services for Unplanned Settlements of Lusaka City, Zambia.

Living conditions and other factors in urban unplanned settlements present unique challenges for improving maternal and newborn health (MNH), yet MNH inequalities associated with such challenges are not well understood. This study examined trends and inequalities in coverage of MNH services in the last 20 years in unplanned and planned settlements of Lusaka City, Zambia. Geospatial information was used to map Lusaka's settlements and health facilities. Zambia Demographic Health Surveys (ZDHS 2001, 2007, 2013/2014, and 2018) were used to compare antenatal care (ANC), institutional delivery, and Cesarean section (C-section) coverage, and neonatal mortality rates between the poorer 60% and richer 40% households. Health Management Information System (HMIS) data from 2018 to 2021 were used to compute service volumes and coverage rates for ANC1 and ANC4, and institutional delivery and C-sections by facility level and type in planned and unplanned settlements. Although the correlation is not exact, our data analysis showed close alignment; and thus, we opted to use the 60% poorer and 40% richer groups as a proxy for households in unplanned versus planned settlements. Unplanned settlements were serviced by primary centers or first-level hospitals. ZDHS findings show that by 2018, at least one ANC visit and institutional delivery became nearly universal throughout Lusaka, but early and four or more ANC visits, C-sections, and neonatal mortality rates remained worse among poorer than richer women in ZDHS. In HMIS, ANC and institutional delivery volumes were highest in public facilities, especially in unplanned settlements. The volume of C-sections was much greater within facilities in planned than unplanned settlements. Our study exposed persistent gaps in timing and use of ANC and emergency obstetric care between unplanned and planned communities. Closing such gaps requires strengthening outreach early and consistently in pregnancy and increasing emergency obstetric care capacities and referrals to improve access to important MNH services for women and newborns in Lusaka's unplanned settlements.

Improving medical record completeness at Wallaga University Referral Hospital: a multidimensional quality improvement project

BackgroundAppropriately documented medical records enhance coordination, patient outcomes and clinical research.ObjectiveThe aim of this project was to improve Wallaga University Referral Hospital’s (WURH) medical record completeness rate from 53% to...

Methodologies and key considerations for implementing the International Classification of Diseases-11th revision morbidity coding: insights from a national pilot study in China.

The aim of this study was to disseminate insights from a nationwide pilot of the International Classification of Diseases-11th revision (ICD-11). The strategies and methodologies employed to implement the ICD-11 morbidity coding in 59 hospitals in China are described. The key considerations for the ICD-11 implementation were summarized based on feedback obtained from the pilot hospitals. Coding accuracy and Krippendorff's alpha reliability were computed based on the coding results in the ICD-11 exam. Among the 59 pilot hospitals, 58 integrated ICD-11 Coding Software into their health information management systems and 56 implemented the ICD-11 in morbidity coding, resulting in 3723959 diagnoses for 873425 patients being coded over a 2-month pilot coding phase. The key considerations in the transition to the ICD-11 in morbidity coding encompassed the enrichment of ICD-11 content, refinement of tools, provision of systematic and tailored training, improvement of clinical documentation, promotion of downstream data utilization, and the establishment of a national process and mechanism for implementation. The overall coding accuracy was 82.9% when considering the entire coding field (including postcoordination) and 92.2% when only one stem code was considered. Krippendorff's alpha was 0.792 (95% CI, 0.788-0.796) and 0.799 (95% CI, 0.795-0.803) with and without consideration of the code sequence, respectively. This nationwide pilot study has enhanced national technical readiness for the ICD-11 implementation in morbidity, elucidating key factors warranting careful consideration in future endeavors. The good accuracy and intercoder reliability of the ICD-11 coding achieved following a brief training program underscore the potential for the ICD-11 to reduce training costs and provide high-quality health data. Experiences and lessons learned from this study have contributed to WHO's work on the ICD-11 and can inform other countries when formulating their transition plan.

Evaluation of Emergency Contraceptive Pill Use with Health Management Information Systems Data in Pakistan.

According to the WHO, all clients should have access to a range of contraceptive methods, including at least one short-term, one long-term, one permanent, and one emergency method of contraception. While there are data on the contraceptive method mix available for many low- and middle-income countries, there are limited data on emergency contraception (EC). This is likely due to some surveys not routinely collecting this information, how survey questions are asked, dual method use, and/or low levels of reported use of EC pill (ECP). Even with low reported use in surveys, contraceptive social marketing statistics from DKT International. show a trend in recent years of increasing product sales of ECPs. To understand a more complete scope of ECP use, we use Pakistan as a case study and analyze Pakistan's Demographic Health Survey (DHS) surveys and Pakistan's Contraceptives Logistics Management Systems. Based on commodities dispensed data for ECPs in 2021, about 0.4 percent of all married women in Pakistan use ECPs. While there is currently a small proportion of women, it is growing and the use of ECPs is not zero as indicated by the DHS. Therefore, where available, countries should review their health management information systems data alongside survey data for ECP use.

Pattern, Outcome and Associated Factors of Oncologic Emergencies Among Patients Visiting Saint Paul ‘s Hospital Millennium Medical College Adult Emergency Department: One Year Cross Sectional Study

Introduction: Cancer patients are at high risk of developing a wide range of medicalemergencies.Patients with cancer face unique disease and treatment-related complications that promptfrequent visits to the emergency department (ED), constituting a significant patient andhealth care burden, resulting in more utilization of resources and ED overcrowding, whichmay hamper the administration of quality and focused care.Objective: The study aimed to assess the patterns, outcomes, and associated factors ofoncologic emergencies among patients visiting Saint Paul's Hospital Millennium MedicalCollege adult emergency department from March 1/2021, to April 30/2022.Methods: A retrospective institutional-based cross-sectional study was used. Data wascollected using a standardized data extraction tool by trained data collectors from patientmedical records and health management information system registry books using asystematic sampling method. A total of 173 cancer patients were included. Data wasanalyzed using SPSS version 25.0.Results: A total of 173 cancer patients were included in the study. The mean age of thestudy participants was 53.05 ± 14.801 years. 56.6% were females, and 43.4% were males.The most prevalent primary tumors were those of the gastrointestinal tract (49.7%) andgenitourinary system (19.1%). About 39.9% of the cases had metastasis. Only 39.3% ofcases started cancer treatment. Oncologic emergencies account for 68.8% of the cases. Themost frequently observed oncologic emergencies were structural (Mass effect) in 64.7% ofcases and hematologic emergencies in 34.45%. About 19.3% of patients with oncologicemergencies have died. The commonest cause of death was due to Gastrointestinalmalignancies, seen in 34.6% of the cases. Those with Hematologic Emergencies had a 4.2times risk of death as compared to patients with local mass effects (P value &lt; 0.006).Conclusion: Oncologic emergencies comprised 68.8% of the cases, of which 19.3% resultedin mortality. There should be a well-organized system with chemotherapy, radiotherapy,and palliative care facility service for patients with oncologic emergencies to reduce patientmortality.