DATA COLLECTION, ANALYSIS AND

PRESENTATION

9 FEBRUARY 2010

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Introduction

Definition A health Information System (HIS) can be defined

as a combination of people, equipment and procedures organized to provide health information to health workers and others in a way that enables them to make informed decisions.

This is the data that is routinely provided by health facilities. It is collected by health workers on a day to day basis.

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…introduction

A Health Information System is made up of three elements:

An input data

A processing component in which input data are transformed into output information

An output (information for the user

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…introduction

Sources of data in put for the HIS are the health units at the district and the lowest levels of the Local government structures and the community as well.

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…introduction

Principles underlying a good HIS; Data collection should conform with data

requirements (relevant) and with processing capabilities.

The information collected should be simple to obtain

Feedback of information to the providers of the health data is very important. This is backbone to a sound HIS.

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….introduction

One way upward flow of information to the central (district, national) level is very dangerous.

Lack of feedback to the providers of the data will lead to low morale and they will not put in any effort into their work leading to poor quality of the data.

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….introduction

Providers of health information or data collectors (health workers in the health facilities) should not only feed information into the district and national HIS, but should also be users of their own data.

Analysis should be done at the local level as well to include coverage estimation and use of targets at all levels.

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FEEDBACK AND LOCAL ANALYSIS IN HIS DATA

Central

Regional

District

Health Facilities Local Analysis

Feedback

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DATA COLLECTION (INPUT)

Purpose and tools

For effective planning and wise use of resources, health planners need to know the scope of the problems they are dealing with. Examples;

How many people use the services offered?

What are the most common ailments affecting people in the health service area?

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…data collection

Which ones would it be most effective to tackle?

Without having a basis of sound information, health planners run risk of ad hoc management, with no clear strategy or informed reasoning for the decisions they take.

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…data collection

Data collection can be quite simple, requiring a pen or pencil.

May require several people

Use of pre-printed forms, calculators, computers and all the accessories that come with computers

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…data collection

Methods Routine data collection

Periodic data collection

Choice of method depends upon the frequency of the occurrence of the event being studied and on the costs involved.

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….data collection

Periodic data Survey, one-time costs, can appear expensive but

may be less expensive than routine data collection.

Allow for filling in gaps in basic knowledge about the community

May combine data from both sources so as to obtain more data at the community level.

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…data collection

Forms used for data collection should be simple and always in supply.

Kinds of data and Common formsMorbidity forms Outpatient tally sheets and summary forms

Disease notification forms

Outpatient register (details by patient, including treatment)

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…data collection

Inpatient care forms Inpatient cards Maternity/delivery register Admission and discharge forms

Preventive activity forms Antenatal attendance registers Family planning Growth monitoring attendance, weight and children

at risk Immunization forms

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…data collection

Supply and stock forms Essential drugs Vaccines Other supplies (needles, syringes, gloves

Others Laboratory forms Temperature charts Environmental health forms

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…data collection

Recording and reporting Data collection should be standardized to ease

analysis and for comparison purpose.

Sets of forms designed for data collection as outlined. Other forms include monthly report forms, annual summary sheets for outpatients, immunization, family planning, maternal and child health and growth monitoring data.

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….data collection

In each health facility, activities should be instantly recorded by tallying and summed up at the end of the day. The sum of totals make a weekly or monthly total for each activity.

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…data collection

Sources of error Forgetting to tally E.g.; During immunization before

or after

Misclassification; recording in the wrong category

Miscalculations

Figure cooking; Forgets to fill in forms or forms get lost

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…data collection

Due to the ease with which errors can be made, there is need to check on all the instruments used for data collection on a periodic basis

Are the forms used to collect data being filled in correctly?

Are the reagents used for laboratory tests still active?

Have the scales been properly adjusted?

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…data collection

Quality of diagnosis In Outpatients use of clinical picture, history or physical

examination.

Diagnosis more difficult if multiple diseases occur at the same time.

Chronic and acute conditions may appear at the same time

In areas with stable malaria, the symptoms may be vague due to frequent attacks.

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…data collection

In areas where malaria is endemic, there is a tendency to record every patient with fever as malaria which leads to over reporting.

Many patients with malaria treat themselves (drug shops, shops)

Laboratories, X-ray facilities and others aid diagnosis

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…data collection

Cause of death may not be established.

Signs and symptoms before death as observed in health care facility or reported by relatives may be used to establish cause of death.

It is useful to record not only cause of death but the associated causes and complications

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DATA ANALYSIS

Health statistics may be presented as absolute numbers but often they are represented as rates (number of events are related to the population involved)

In order to simplify comparisons, rates are usually expressed in relation to an arbitrary total (e.g. 1000, 100,000 or 1,000,000)

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…data analysis

No. of persons affected or

number of events

Rate = __________________ x 1000

Population at risk

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….analysis

Crude Rates Rates which are calculated with the total population

in an area as the denominator

Crude rates from different populations cannot be easily compared because of the striking differences in the age and sex structure of the population

E.g.; The crude death rate may be relatively high in a population with a high proportion of elderly persons compared with the rate in a younger population.

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…analysis

If the death rate is to be used as an indicator of the health status of a population, adjustment of the crude rate must be done.

Standardization of the crude rate for age, sex or other parameter of the population is necessary.

The adjustment is made to a standard population

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…analysis

Crude rates

Crude birth rate = No. of live births in a year x 1000 Mid-year population

Crude death rate= No. of deaths in a year x 1000 Mid year population

Natural Increase rate = No. of live births – No. of deaths in a year

____________________ x 1000 Mid-year population

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…analysis

Specific rates Rates that are calculated using data from specific

segments of the population.

They use the particular population at risk as the denominator

E.g.; the age specific death rate in a total population may be analyzed separately for each sex in 1-year age groups or in 5-year or 10-year age groups

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…analysis

No of deaths in people of a specific age/sex

Age/sex specific death rate =________________ x 1000

No of people in the specified

age/sex group

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…analysis

Specific rates

Fertility rate = Total no. of births in a year

No. of women aged 15-49 years

Annual no. of deaths due to pregnancy,

Maternal Mortality = childbirth and puerperal conditions x 100,000

Ratio (MMR)

Total no. of births in a year

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…analysis

Vital Statistics Rates calculated from vital statistics are used to reflect the health

status of a community as a whole or to study the health problems and needs of specific groups. E.g. the rates of maternal deaths, stillbirth and perinatal mortality are of value in the analysis of obstetric problems and obstetric services.

The overall health of the community may be assessed using standardized death rates.

The mortality rates of the most susceptible age groups are more sensitive indicators

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…analysis

Infant Mortality Rate (IMR)

IMR = Annual no. of deaths in the first year _______________________ X 1000

No. of live births in a year

The IMR is widely accepted as one of the most useful single measure of the health status of the community.

The IMR is usually very high in communities where health and social services are poorly developed.

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…analysis

IMR Responds dramatically to simple measures like

establishment of maternal and child health (MCH) services

MCH services can bring down the rate from 200-300/1000 live births to 50-100/1000 live births

Developed countries range 10-40/1000 live births

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…analysis

The IMR is usually subdivided into two, the neonatal and post neonatal death rates.

Annual no. of deaths in the first 28 daysNeonatal mortality rate = ______________________________ x

1000No. of live births in a year

Annual no. of deaths between 28 days and 1 yrPost neonatal mortality rate = ____________________________ x

1000No. of live births in a year

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…analysis

The neonatal death rate is a result of problems related to maternal and obstetric factors.

Pregnancy (Congenital abnormalities, low birth weight)

Delivery (birth injuries, suffocation)

After delivery (tetanus, other infections)

Post neonatal mortality rate is related to a variety of environmental factors and more so to child care

Improvements in MCH bring a fall in both rates

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…analysis

Under 5 Mortality Rate (U5MR) The IMR taken by itself underestimates the loss of

child life.

Annual no. of deaths under 5 years U5MR = _____________________________ x 1000

No. of live births in a year

UNICEF advocates the use of U5MR as the single most important indicator of the state of the world’s children.

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…analysis

U5MR reflects the following; Nutritional health and the health knowledge of the mothers

The level of immunization and Oral Rehydration Therapy (ORT) use

The availability of MCH services (including prenatal care)

Income and food availability in the family

The availability of clean water and safe sanitation

The overall safety of the child’s environment.

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…analysis

Morbidity Statistics (data about occurrence of sickness within the community)

It provides more detailed assessment of the health of the community

It is more difficult to collect and interpret than records of births and deaths

Anybody can easily recognize and record births and deaths

Collection of morbidity data depends on the extent to which individuals recognize departures from health and also on the availability of facilities for the diagnosis of illness.

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…analysis

The quality of morbidity statistics depends on the extent of coverage and the degree of sophistication of the medical services

Unlike vital events (birth, death) occur only on one occasion in the lifetime of any person, sickness may occur repeatedly in the same person.

Also one person may suffer from several diseases at the same time.

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…analysis

Morbidity rates are used to describe the pattern of sickness in a community.

Incident rates; describe the frequency of occurrence of new cases of a disease or spells of illness.

Incident rates; defined in terms of numbers of persons who start an episode of sickness in a particular period or alternatively in terms of the number of episodes during that period.

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…analysis

No. of persons starting an episode of illness in a defined period

Incidence rate (persons) =________________________ x 1000

Average no. of persons exposed to risk during that period

No. of episodes of illness starting during defined period

Incident rate (episodes) = _____________________ x 1000

Average no. of persons exposed to risk during the period

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…analysis

Prevalence rate; defined as the number of persons who are currently sick at a specified point in time

No of persons who are sick at a

given time

Prevalence rate = _________________________ x 1000

Average no. of persons exposed to risk

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…analysis

Fatality rate; the number of deaths in relation to the number of new cases of a particular disease.

It is a measure of the severity of the disease, efficacy of therapy (treatment) and the state of the host immunity.

No of deaths ascribed to a specified diseaseFatality rate = _________________________________ x 1000

No. of reported cases of the specified disease

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DATA PRESENTATION Data gathered from immunization, antenatal care,

growth monitoring and morbidity and others.

Collection of data becomes more meaningful if analysis is done regularly and locally.

Presentation of data numerically and graphically enhances insight into what is going on in the catchment population

Aim is to produce a precise and accurate demonstration of the information

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…data presentation Information is summarized to simplify and

highlighted to draw attention to the most important features

Numerical presentation An arrangement of the figures in order of magnitude,

so that the range of the data from the smallest to the largest is clearly displayed.

Simple statistical calculations can be made; mean, median, mode, range, standard deviation

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…data presentation

Tabulation Data are sorted, arranged, condensed and set out in

such a way as to bring out the essential points.

The raw data are classified, compressed and grouped into a frequency distribution

E.g.; data may be classified into 5 year or 10 year age groups, with a record of the number of persons in each group.

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…presentation

For effective presentation the following must be observed;

Title; should clearly describe the material contained in the text. Features of the title (i) What is the material contained in the table? (ii) Where is the location of the study? (iii) When was the study carried out?

Labeling; Each row and each column should be clearly labeled and the units of measurement stated. If a rate is used, the base of measurement and the number of observations must be stated.

Totals; The totals of columns and rows should be shown

Footnotes; abbreviations and symbols should be explained in footnotes

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…presentation

Graphic presentation These provide simple, visual aid such that the

reader rapidly appreciates the important features of the data.

Bar chart; A bar, the length of which is proportional to the

absolute or relative frequency of events Represents each item in the group Useful in representing discrete variables.

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…presentation

Histogram A special type of bar chart used to display numerical

variables.

The variable of interest is shown on one axis as a continuous scale split into classes.

Adjoining bars are drawn, their areas representing the frequency of events. If the class intervals are constant, the frequency is given on the other axis.

A population pyramid is a histogram showing age and sex of a population

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…presentation

Pie Chart Consists of a circle which is divided into

sectors, with the area of each sector proportional to the value of each variable

Graphs; shows two variables, one on the horizontal axis and the other on the vertical axis

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Report preparation

Annual report Summarizes and discusses all information collected in the

year

Comparisons should be made with previous years and with other areas in the same year as this facilitates meaningful interpretation of data.

Information which is vague or not useful should be left out

Statistics and Data should be interpreted and conclusions drawn

Executive summary should be provided.

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…report

Minimum list of contents for a district HIS annual report1. Executive summary

2. Population and Health services- Assess quality of the HIS data (reporting rate)- Population projected for current year- Health facilities: number, population per facility, service

offered- Health staff by major categories- PHC areas covered, numbers of active Community health care workers, trained TBAs, NGO activities- Environmental health services- drug supply.

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…report

3. Inpatient statistics- number of beds by ward, admissions, mean length of stay, bed occupancy

- Minor and major surgery activities

- Leading inpatient diagnoses and mortality (case fatality rates)

- Notifiable diseases, including HIV/AIDS

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…report

4. Outpatient statistics- Leading diagnoses (number, percentages, incidence) and Outpatient attendances by age- Seasonality of diseases- Laboratory data on malaria, intestinal worms, schistosomiasis, anaemia

5. Antenatal care and maternity- Attendance at the ANC and mean number of visits per attendant (and time of first visit)- Tetanus toxoid immunization- coverage of births by institution- data on abnormal deliveries, still births and maternal deaths

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…report

6. Nutritional status of children- Birth weight from health facilities: mean, percentage low birth weight

- Attendance at growth monitoring sessions (in clinics and communities) and percentage underweight by age and by month

7. Immunization- Number of vaccinations given and estimates of coverage- Number of cases of EPI diseases

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…report

8. Family Planning- Number of new visits and revisits and estimate of coverage- Number and types of supplied methods

Dissemination of reports Very important component of the HIS Those who provide data to the HIS should receive

first All data users in the district should receive Report submitted to the national (central) last