Malaria Consortium Chad Country Office, Angle Bureau de L'Entente Des Eglises (EEMET), Rue 2175, Porte 0150, B.P. 6180, N'Djamena, Chad.
Malaria Consortium, The Green House, 244-254 Cambridge Heath Road, London, E2 9DA, UK.
BMC Med Inform Decis Mak. 2021 Nov 22;21(1):326. doi: 10.1186/s12911-021-01684-7.
Quality data from Health Management Information Systems (HMIS) are important for tracking the effectiveness of malaria control interventions. However, HMIS data in many resource-limited settings do not currently meet standards set by the World Health Organization (WHO). We aimed to assess HMIS data quality and associated factors in Chad.
A cross-sectional study was conducted in 14 health facilities in Massaguet district. Data on children under 15 years were obtained from the HMIS and from the external patient register covering the period January-December 2018. An additional questionnaire was administered to 16 health centre managers to collect data on contextual variables. Patient registry data were aggregated and compared with the HMIS database at district and health centre level. Completeness and accuracy indicators were calculated as per WHO guidelines. Multivariate logistic regressions were performed on the Verification Factor for attendance, suspected and confirmed malaria cases for three age groups (1 to < 12 months, 1 to < 5 years and 5 to < 15 years) to identify associations between health centre characteristics and data accuracy.
Health centres achieved a high level of data completeness in HMIS. Malaria data were over-reported in HMIS for children aged under 15 years. There was an association between workload and higher odds of inaccuracy in reporting of attendance among children aged 1 to < 5 years (Odds ratio [OR]: 10.57, 95% CI 2.32-48.19) and 5- < 15 years (OR: 6.64, 95% CI 1.38-32.04). Similar association was found between workload and stock-outs in register books, and inaccuracy in reporting of malaria confirmed cases. Meanwhile, we found that presence of a health technician, and of dedicated staff for data management, were associated with lower inaccuracy in reporting of clinic attendance in children aged under five years.
Data completeness was high while the accuracy was low. Factors associated with data inaccuracy included high workload and the unavailability of required data collection tools. The results suggest that improvement in working conditions for clinic personnel may improve HMIS data quality. Upgrading from paper-based forms to a web-based HMIS may provide a solution for improving data accuracy and its utility for future evaluations of health interventions. Results from this study can inform the Ministry of Health and it partners on the precautions to be taken in the use of HMIS data and inform initiatives for improving its quality.
健康管理信息系统（HMIS）的质量数据对于跟踪疟疾控制干预措施的有效性非常重要。然而，许多资源有限的环境中的 HMIS 数据目前不符合世界卫生组织（WHO）制定的标准。我们旨在评估乍得的 HMIS 数据质量及其相关因素。
在马萨盖特区的 14 个卫生设施中进行了一项横断面研究。从 HMIS 和涵盖 2018 年 1 月至 12 月期间的外部患者登记簿中获取了 15 岁以下儿童的数据。还向 16 名卫生中心管理人员发放了一份额外的问卷，以收集有关背景变量的数据。将患者登记簿数据汇总，并在区和卫生中心层面与 HMIS 数据库进行比较。根据世卫组织的指导方针，计算了完整性和准确性指标。对三个年龄组（1 至 <12 个月、1 至 <5 岁和 5 至 <15 岁）的就诊、疑似和确诊疟疾病例的验证因素进行了多变量逻辑回归，以确定卫生中心特征与数据准确性之间的关联。
卫生中心在 HMIS 中实现了高水平的数据完整性。在 HMIS 中，15 岁以下儿童的疟疾数据被高估。在报告 1 至 <5 岁（优势比 [OR]：10.57，95%置信区间 2.32-48.19）和 5-<15 岁（OR：6.64，95%置信区间 1.38-32.04）儿童的就诊人数方面，工作量与准确性较低之间存在关联。在登记簿中出现工作量和库存不足的情况，以及报告确诊疟疾病例的准确性较低之间也存在类似的关联。同时，我们发现，有卫生技术人员和专门的数据管理人员，与五岁以下儿童就诊人数报告的准确性较低有关。
数据完整性较高，准确性较低。与数据不准确相关的因素包括工作量大以及缺乏所需的数据收集工具。结果表明，改善诊所工作人员的工作条件可能会提高 HMIS 数据质量。从基于纸张的表格升级到基于网络的 HMIS 可能是提高数据准确性及其对未来健康干预措施评估的有用性的一种解决方案。本研究的结果可以为卫生部及其合作伙伴提供有关在使用 HMIS 数据时应采取的预防措施的信息，并为改善其质量的举措提供信息。
