Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
Département de Parasitologie, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop de Dakar, Dakar, Senegal.
BMC Health Serv Res. 2022 Jan 2;22(1):18. doi: 10.1186/s12913-021-07364-6.
BACKGROUND: As the global burden of malaria decreases, routine health information systems (RHIS) have become invaluable for monitoring progress towards elimination. The District Health Information System, version 2 (DHIS2) has been widely adopted across countries and is expected to increase the quality of reporting of RHIS. In this study, we evaluated the quality of reporting of key indicators of childhood malaria from January 2014 through December 2017, the first 4 years of DHIS2 implementation in Senegal. METHODS: Monthly data on the number of confirmed and suspected malaria cases as well as tests done were extracted from the Senegal DHIS2. Reporting completeness was measured as the number of monthly reports received divided by the expected number of reports in a given year. Completeness of indicator data was measured as the percentage of non-missing indicator values. We used a quasi-Poisson model with natural cubic spline terms of month of reporting to impute values missing at the facility level. We used the imputed values to take into account the percentage of malaria cases that were missed due to lack of reporting. Consistency was measured as the absence of moderate and extreme outliers, internal consistency between related indicators, and consistency of indicators over time. RESULTS: In contrast to public facilities of which 92.7% reported data in the DHIS2 system during the study period, only 15.3% of the private facilities used the reporting system. At the national level, completeness of facility reporting increased from 84.5% in 2014 to 97.5% in 2017. The percentage of expected malaria cases reported increased from 76.5% in 2014 to 94.7% in 2017. Over the study period, the percentage of malaria cases reported across all districts was on average 7.5% higher (P < 0.01) during the rainy season relative to the dry season. Reporting completeness rates were lower among hospitals compared to health centers and health posts. The incidence of moderate and extreme outlier values was 5.2 and 2.3%, respectively. The number of confirmed malaria cases increased by 15% whereas the numbers of suspected cases and tests conducted more than doubled from 2014 to 2017 likely due to a policy shift towards universal testing of pediatric febrile cases. CONCLUSIONS: The quality of reporting for malaria indicators in the Senegal DHIS2 has improved over time and the data are suitable for use to monitor progress in malaria programs, with an understanding of their limitations. Senegalese health authorities should maintain the focus on broader adoption of DHIS2 reporting by private facilities, the sustainability of district-level data quality reviews, facility-level supervision and feedback mechanisms at all levels of the health system.
背景:随着全球疟疾负担的减轻,常规卫生信息系统(RHIS)已成为监测消除疟疾进展的宝贵工具。第 2 版地区卫生信息系统(DHIS2)已在各国广泛采用,有望提高 RHIS 报告的质量。本研究评估了 2014 年 1 月至 2017 年 12 月(即 DHIS2 在塞内加尔实施的前 4 年)期间儿童疟疾关键指标报告的质量。
方法:从塞内加尔的 DHIS2 中提取每月确诊和疑似疟疾病例以及检测数量的数据。报告完整性的衡量标准是收到的月度报告数量与当年预期报告数量之比。指标数据的完整性衡量标准是非缺失指标值的百分比。我们使用具有报告月份自然三次样条项的准泊松模型来估算设施层面缺失的值。我们使用估算值来考虑由于缺乏报告而导致的疟疾病例漏报的百分比。一致性的衡量标准是缺乏中度和极端异常值、相关指标之间的内部一致性以及指标随时间的一致性。
结果:在研究期间,与公共设施 92.7%的数据在 DHIS2 系统中报告的情况形成对比,只有 15.3%的私人设施使用报告系统。在国家层面,设施报告的完整性从 2014 年的 84.5%增加到 2017 年的 97.5%。预期疟疾病例报告的百分比从 2014 年的 76.5%增加到 2017 年的 94.7%。在整个研究期间,与旱季相比,所有地区报告的疟疾病例百分比平均高出 7.5%(P<0.01),这与雨季有关。与卫生中心和卫生站相比,医院的报告完整性较低。中度和极端异常值的发生率分别为 5.2%和 2.3%。2014 年至 2017 年,确诊疟疾病例增加了 15%,而疑似病例和检测数量增加了一倍以上,这可能是由于转向对儿科发热病例进行普遍检测的政策变化所致。
结论:塞内加尔 DHIS2 中疟疾指标的报告质量随着时间的推移而提高,并且数据适用于监测疟疾规划的进展,同时了解其局限性。塞内加尔卫生当局应继续关注私营部门更广泛地采用 DHIS2 报告、地区一级数据质量审查的可持续性、各级卫生系统的设施监督和反馈机制。
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