Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
D4I Project, Carolina Population Center, Chapel Hill, NC, USA.
Popul Health Metr. 2020 Oct 9;18(1):26. doi: 10.1186/s12963-020-00236-x.
Nationally representative household surveys are the gold standard for tracking progress in coverage of life-saving maternal and child interventions, but often do not provide timely information on coverage at the local and health facility level. Electronic routine health information system (RHIS) data could help provide this information, but there are currently concerns about data quality. This analysis seeks to improve the usability of and confidence in electronic RHIS data by using adjustments to calculate more accurate numerators and denominators for essential interventions.
Data from three sources (Ugandan Demographic and Health (UDHS) survey, electronic RHIS, and census) were used to provide estimates of essential maternal (> 4 antenatal care visits (ANC), skilled delivery, and postnatal care visit (PNC)) and child health interventions (diphtheria, pertussis, tetanus, and hepatitis B and Haemophilus influenzae type b and polio vaccination series, measles vaccination, and vitamin A). Electronic RHIS data was checked for quality and both numerators and denominators were adjusted to improve accuracy. Estimates were compared between the three sources.
Estimates of maternal health interventions from adjusted electronic RHIS data were lower than those of the UDHS, while child intervention estimates were typically higher. Adjustment of electronic RHIS data generally improved accuracy compared with no adjustment. There was considerable agreement between estimates from adjusted, electronic RHIS data, and UDHS for skilled delivery and first dose of childhood vaccination series, but lesser agreement for ANC visits and second and third doses of childhood vaccinations.
Nationally representative household surveys will likely continue being the gold standard of coverage estimates of maternal and child health interventions, but this analysis shows that current approaches to adjusting health facility estimate works better for some indications than others. Further efforts to improve accuracy of estimates from RHIS sources are needed.
全国代表性的家庭调查是跟踪救命母婴干预措施覆盖率进展的黄金标准，但往往无法提供关于地方和卫生机构层面覆盖率的及时信息。电子常规卫生信息系统 (RHIS) 数据可以帮助提供这些信息，但目前人们对数据质量存在担忧。本分析旨在通过调整计算救命母婴干预措施（≥4 次产前保健访视、熟练分娩和产后保健访视）和儿童健康干预措施（白喉、百日咳、破伤风、乙肝和流感嗜血杆菌 b 型和脊髓灰质炎疫苗系列、麻疹疫苗、维生素 A）更准确的分子和分母，提高电子 RHIS 数据的可用性和可信度。
使用来自三个来源的数据（乌干达人口与健康调查、电子 RHIS 和人口普查），以提供必要的母婴（>4 次产前保健访视、熟练分娩和产后保健访视）和儿童健康干预措施（白喉、百日咳、破伤风、乙肝和流感嗜血杆菌 b 型和脊髓灰质炎疫苗系列、麻疹疫苗、维生素 A）的估计值。对电子 RHIS 数据进行质量检查，并调整分子和分母以提高准确性。比较了三个来源的估计值。
调整后的电子 RHIS 数据中母婴健康干预措施的估计值低于 UDHS 的估计值，而儿童干预措施的估计值通常更高。与不调整相比，电子 RHIS 数据的调整通常可提高准确性。调整后的电子 RHIS 数据与 UDHS 对熟练分娩和儿童疫苗系列的第一剂的估计值具有相当大的一致性，但对 ANC 访视和儿童疫苗的第二剂和第三剂的一致性较小。
全国代表性的家庭调查可能仍将是母婴健康干预措施覆盖率估计的黄金标准，但本分析表明，目前调整卫生机构估计值的方法对某些指标的效果优于其他指标。需要进一步努力提高 RHIS 来源的估计值的准确性。
