challenges in information systems and research in global health. the case of manhiça health...
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Challenges in information systems and research in global health. The case of Manhiça Health Research Center in Mozambique. Aponte J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)TRANSCRIPT
Challenges in information systems
and research in global health.
The case of Manhiça Health
Research Center in Mozambique
John Aponte, MD, MSc
CRESIB – Hospital Clinic Barcelona
CISM - Mozambique
Fighting disease
Promoting development
Collaborative programmeMinisterio da Saude - Faculdade de Medicina (UEM)
Fundacio Clinic de Barcelona - Spanish Agency for International Cooperation
Centro de Investigação em Saúde daManhiçaMoçambique
Study area
0 100 200
Kilometers
000000000 100100100100100100100100100200200200200200200200200200
KilometersKilometersKilometersKilometersKilometersKilometersKilometersKilometersKilometers000000000 505050505050505050
KilometersKilometersKilometersKilometersKilometersKilometersKilometersKilometersKilometers
100100100100100100100100100
LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000
M O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U E
Maputo ProvinceMaputo ProvinceMaputo ProvinceMaputo ProvinceMaputo ProvinceMaputo ProvinceMaputo ProvinceMaputo ProvinceMaputo Province
Manhica DistrictManhica DistrictManhica DistrictManhica DistrictManhica DistrictManhica DistrictManhica DistrictManhica DistrictManhica District
DSS SiteDSS SiteDSS SiteDSS SiteDSS SiteDSS SiteDSS SiteDSS SiteDSS Site
MozambiqueMozambiqueMozambiqueMozambiqueMozambiqueMozambiqueMozambiqueMozambiqueMozambique
4
Research
Tackling the main causes of
morbidity and mortality in children
under the age of 5 years and
pregnant women in sub saharan
Africa: the most vulnerable
population groups
Rank
based on
proportion
Age Group
0–27
days1
28 d – 11
months2
12–59
months3
6-14
years4
1 Premat
(31%)
Malaria
(22.6%)
Malaria
(31.4%)
Malaria
(18.2%)
2 Neonatal
asphyxia
(16.3%)
Pneumoni
(19.1%)
Malnutriti
(20.1%)
Open
wounds,
burns, etc.
(10.4%)
3 Septicaeia
(14.6%)
Malnutritin
(10.0%)
Pneumon
(10.4%)
Trauma
(10.4%)
4 Pneumoni
(10.6%)
Diarrhoea
(8.0%)
Diarrhoea
(6.0%)
Pneumoa
(9.1%)
5 No
consensus
(7.3%)
Meningitis
(7.5%)
No
consensus
(5.7%)
Meningitis
(9.1%)
Paediatric deaths in communitty
Total Fertility Rate 5,1
IMR 88,9
Neonatal MR 41,8
5q0 172,7
Life Expectancy 55 y
The Problem…
• In many places in south saharan Africa, people
can live and die without being registered ever..
• How to optimize resources?
6
Demographic Platform
- 85 000 under control by follow up (DSS)-Births-Deaths-Pregnancies-Migration
- Personal identification by an unique permanent number
- House visits 2/year
- Key informants weekly
- Daily maternal services (3)
10 5 0 5 10
0-4
10-14
20-24
30-34
40-44
50-54
60-64
70-74
80-84
S. Masculino S.femenino
7
Geographical Platform
- Well defined study areaManhiça (1996)Mantchiana, Palmeira (2002)Ilha Josina (2002)Taninga (2006)Palmeira (2009)
- Identification of Households in the study area and GPS position
- Map generation
- Geographical distrubution of risk factors and confounders
Incidence of Malaria by ACD
8
Morbidity Surveillance Platform
- Passive Case Detection Surveillance
Hospital system operating for all paediatric attendances round
the clock
Manhiça Hospital (24 hours/day)
Maragra health centre
Ilha Josina, Taninga, Palmeria and Malavene health post
- Active Case Detection Cohorts
Based on the localization of individuals in DSS
- Cross sectional studies
Random samples from targeted population from DSS
Interactions
Permanent
ID
Number
Demographical
Morbidity Surveillance
Research Specific
Activities
Modular system that allows to measure the incidence/prevalence of several diseases as well as risk factors which allows to evaluate theeffect of specific health interventions
Geographical
Tools
• In 1996 the infrastructure available in the zone
was minimum
• Unreliable electrical supply
• No phones
• No support for technology
• Paper was the only reliable tool
Challenges for the future
Paper free work –>
Now days the infrastructure has change and
make possible new alternatives
- Capture of information using mobile devices
- Electronic CRFs for clinical trials
- Lab information systems to process all information
from the labs
Tools to identify people at health facilities ->
- Identification based on finger prints