Stewart J C, Schroeder D G, Marsh D R, Allhasane S, Kone D
CARE, Atlanta, GA 30303, USA.
Health Policy Plan. 2001 Sep;16(3):248-55. doi: 10.1093/heapol/16.3.248.
Between 1987 and 1998 Save the Children conducted a child survival programme in Mali with the goal of reducing maternal and child morbidity and mortality. An integral part of this programme was a computerized demographic surveillance and health information system (HIS) that gathered data on individuals on an on-going basis.
To assess the overall coverage and quality of the data in the HIS, to identify specific health districts that needed improvements in data collection methods, and to determine particular areas of weakness in data collection.
Random samples of 20 mothers with children <5 years were selected in each of 14 health districts. Mothers were interviewed about pregnancies, live births, deaths of children <5, and children's growth monitoring and immunization status. The Lot Quality Assurance Method (LQAS) was used to identify districts in which records and interview results did not meet predetermined levels of acceptability. Data collected in the interviews were combined to estimate overall coverage and quality.
When all variables were analyzed, all 14 lots were rejected, and it was estimated that 52% of all events occurring in the community were registered in ProMIS. Much of this poor performance was due to immunization and growth monitoring data, which were not updated due to printer problems. Coverage of events increased (92%) when immunizations and growth monitoring were excluded, and no lots were rejected. When all variables were analyzed for quality of data recorded, six lots were rejected and the overall estimation was 83%. With immunizations and growth monitoring excluded, overall quality was 86% and no lots were rejected.
The comprehensive computerized HIS did not meet expectations. This may be due, in part, to the ambitious objective of complete and intensive monitoring of a large population without adequate staff and equipment. Future efforts should consider employing a more targeted and streamlined HIS so that data can be more complete and useful.
1987年至1998年间，救助儿童会在马里开展了一项儿童生存计划，目标是降低孕产妇和儿童的发病率及死亡率。该计划的一个重要组成部分是一个计算机化的人口监测和健康信息系统（HIS），该系统持续收集个人数据。
评估HIS中数据的总体覆盖范围和质量，确定在数据收集方法上需要改进的特定卫生区，并确定数据收集的特定薄弱环节。
在14个卫生区中，每个区随机抽取20名有5岁以下儿童的母亲。就怀孕、活产、5岁以下儿童死亡以及儿童生长监测和免疫状况对母亲进行访谈。采用批量质量保证方法（LQAS）来确定记录和访谈结果未达到预定可接受水平的地区。将访谈中收集的数据合并起来，以估计总体覆盖范围和质量。
对所有变量进行分析时，所有14个批次均被拒绝，据估计社区中发生的所有事件中有52%在ProMIS中登记。这种糟糕的表现很大程度上归因于免疫和生长监测数据，由于打印机问题这些数据未得到更新。排除免疫和生长监测后，事件的覆盖率提高到了92%，且没有批次被拒绝。对记录的数据质量进行所有变量分析时，有6个批次被拒绝，总体估计为83%。排除免疫和生长监测后，总体质量为86%，没有批次被拒绝。
综合计算机化的HIS未达到预期。这可能部分归因于在没有足够人员和设备的情况下，对大量人口进行全面和密集监测的目标过于雄心勃勃。未来的努力应考虑采用更具针对性和简化的HIS，以便数据能够更完整、更有用。
