An in-depth, exploratory assessment of the implementation of the National Health Information System at a district level hospital in Tanzania.

BACKGROUND: A well functioning Health Information System (HIS) is crucial for effective and efficient health service delivery. In Tanzania there is a national HIS called Mfumo wa Taarifa za Uendeshaji Huduma za Afya (MTUHA). It comprises a guideline/manual, a series of registers for primary data collection and secondary data books where information from the registers is totalled or used for calculations. METHODS: A mix of qualitative methods were used. These included key informant interviews; staff interviews; participant observations; and a retrospective analysis of the hospital's 2010 MTUHA reporting documents and the hospital's development plan. RESULTS: All staff members acknowledged data collection as part of their job responsibilities. However, all had concerns about the accuracy of MTUHA data. Access to training was limited, mathematical capabilities often low, dissemination of MTUHA knowledge within the hospital poor, and a broad understanding of the HIS's full capabilities lacking.Whilst data collection for routine services functioned reasonably well, filling of the secondary data tools was unsatisfactory. Internal inconsistencies between the different types of data tools were found. These included duplications, and the collection of data that was not further used. Sixteen of the total 72 forms (22.2%) that make up one of the key secondary data books (Hospital data/MTUHA book 2) could not be completed with the information collected in the primary data books.Moreover, the hospital made no use of any of the secondary data. The hospital's main planning document was its development plan. Only 3 of the 22 indicators in this plan were the same as indicators in MTUHA, the information for 9 more was collected by the MTUHA system but figures had to be extracted and recalculated to fit, while for the remaining 10 indicators no use could be made of MTUHA at all. CONCLUSION: The HIS in Tanzania is very extensive and it could be advisable to simplify it to the core business of data collection for routine services. Alternatively, the more comprehensive, managerial aspects could be sharpened for each type of facility, with a focus upon the hospital level. In particular, hospital planning documents need to be more closely aligned with MTUHA indicators.

Avoiding scrotal haematoma after repair of extensive scrotal hernias by postoperative scrotal compression through scrotal suspension by scrotal-abdominal skin suture.

Scrotal haematoma and oedema are the most frequent complications of scrotal surgery and are associated with high morbidity. Through early postoperative compression on the scrotal sac these complications can be avoided. Compression can be assured by the following simple surgical method independent of the quality of the postoperative care: extending the scrotal sac over the abdominal wall and fixing it with skin sutures under tension at the lower abdominal wall over a pile of gauzes. This method was shown to be effective after hernia repair of scrotal hernias but also seems promising for other scrotal surgery.