Evaluation criteria for the district health management information systems: lessons from the Ministry of Health, Kenya.

BACKGROUND: The District Health Management Information Systems (DHMISs) were established by the Ministry of Health (MoH) in Kenya more than two decades ago. Since then, no comprehensive evaluation has been undertaken. This can partly be attributed to lack of defined criteria for evaluating them. OBJECTIVE: To propose evaluation criteria for assessing the design, implementation and impact of DHMIS in the management of the District Health System (DHS) in Kenya. METHODS: A descriptive cross-sectional study conducted in three DHSs in Kenya: Bungoma, Murang'a and Uasin Gishu districts. Data was collected through focus group discussions, key informant interviews, and documents' review. The respondents, purposely selected from the Ministry of Health headquarters and the three DHS districts, included designers, managers and end-users of the systems. RESULTS: A set of evaluation criteria for DHMISs was identified for each of the three phases of implementation: pre-implementation evaluation criteria (categorised as policy and objectives, technical feasibility, financial viability, political viability and administrative operability) to be applied at the design stage; concurrent implementation evaluation criteria to be applied during implementation of the new system; and post-implementation evaluation criteria (classified as internal - quality of information; external - resources and managerial support; ultimate - systems impact) to be applied after implementation of the system for at least three years. CONCLUSIONS: In designing a DHMIS model there is need to have built-in these three sets of evaluation criteria which should be used in a phased manner. Pre-implementation evaluation criteria should be used to evaluate the system's viability before more resources are committed to it; concurrent (operational) - implementation evaluation criteria should be used to monitor the process; and post-implementation evaluation criteria should be applied to assess the system's effectiveness.

Termination of photorefractoriness in the chukar partridge (alectoris graeca chukar) by low light intensity.

Adult females were maintained under controlled conditions (22 degrees C, 60% relative humidity and 16 h light/day) within bioclimatic chambers throughout the test. For 6 weeks prior to photostimulation photorefractory birds were exposed to a light intensity of 1, 3, 5 or 7 lux. The intensity was then increased to 50 lux. Control birds were kept in 8L : 16D and changed to 16L : 8D, the light intensity remaining at 50 lux. The time to first egg and the rate of egg production were recorded. A decrease in light intensity alone was able to terminate photorefractoriness in chukar partridge and the threshold light intensity required for a complete termination of refractoriness was less than 1 lux. Light intensities of 1, 3 or 5 lux resulted in a partial termination of refractoriness but 7 lux was completely ineffective in terminating photorefractoriness. The termination of photorefractoriness was therefore not an all-or-nothing response.

Participation of the eyes in the photostimulation of chickens.

This study examined the participation of the eyes in the photosexual response of chickens to incandescent and fluorescent light. Intact and blinded female chickens were exposed to short photoperiods (8L:16D) of incandescent and fluorescent light and the age at first egg and the early rate of egg production. Blinding prevented this response. It was concluded that the eye is not essential to the photosexual response of chickens but that it may modify the response to light in certain conditions.

A circadian rhythm in photosensitivity as the basis for the testicular response of Japanese quail to intermittent light.

In order to examine the relationship between the circadian rhythm in photosensitivity and intermittent light in stimulating testicular development, Japanese quail were exposed to intermittent light providing a single dark period interruption varying from .5 to 10 hr in duration. The treatment lasted for 3 weeks. Changes in the cloacal gland size were monitored throughout the test and testis weights were taken at the end of the test (7 and 11 weeks of age). The results indicated that quail have a circadian rhythm in photosensitivity occurring approximately 12 hr after the onset of light (dark-light interface) which lasts for 4 to 6 hr. Testicular stimulation occurred only when light was given within the photosensitive phase. However, this rhythm is subject to phase shifting by night interrupting light flashes. This resulted in variable testicular responses depending upon the relationship between the position of the new photosensitive phase and the available light. Photostimulation of the testes was proportional to the duration of light within the photosensitive phase up to a maximum of 4 hr of light. Intermittent light may be as effective as a single, long photoperiod in stimulating testes development providing that an adequate amount of light is given during the photosensitive phase.

Elevated temperature effects on catecholamines and serotonin in brains of male Japanese quail.

Endogenous level and turnover of brain norepinephrine (NE), epinephrine (E), dopamine (DA), and serotonin (5-HT) in male Japanese quail were determined after acute (6 h) and chronic (5 wk) exposure to thermal (34 degrees C) and cyclic temperature (10--34 degrees C) stress. alpha-Methyl-p-tyrosine (alpha-MT) and p-chlorophenylalanine (PCPA) were used to study the turnover of the monoamine levels. The differences between the monoamine levels of drug-treated birds and control (22 degrees C) birds were regarded as changes in turnover. High ambient temperature (34 degrees C) stress for 6 h increased brain NE turnover. However, chronic exposure (5 wk) to 34 degrees C, and to cyclic temperatures (10--34 degrees C), did not increase turnover of brain NE. Also, acute and chronic heat exposures did not significantly change E turnover. High acute temperature stress had no effect on brain DA turnover, although chronic exposure of birds to 34 and 10--34 degrees C resulted in a retarded turnover. The central 5-HT turnovers increased when birds were subjected to acute 34 degrees C stress. Five weeks of exposure to 34 and 10--34 degrees C caused declines in 5-HT turnovers. Thus, the results indicate that NE and 5-HT turnovers increase during acute thermal exposure, but acclimation to thermal stress for 5 wk reduces the turnover of brain NE, 5-HT, and DA.

Function and histology of testes from aged coturnix maintained on different photoperiods.

The prolonged effects of short, medium, and long photoperiods on longevity, cloacal gland size and function, and the testicular morphology of the aged coturnix were studied. In all testes, the effects of aging were characterized histologically by decreased tubular sperm concentration, increased abnormal sperm and cellular debris, as well as dislodgement of maturing sperm from Sertoli cells. However, testicular abnormality in the long photoperiod quail was more pronounced than in the short photoperiod quail whose testes were judged to be morpholoigcally in better condition, thus indicating an aging-photoperiod relationship. Aging had little or no effect on the cloacal gland function, although its size similar to the testicular histology, was affected by different photoperiods. Cloacal gland size and function can indicate sexual potency, but not necessarily the reproductive capabilities of aged coturnix. Also, an increased incidence of cataract formation was recorded in aged coturnix, unrelated to photoperiods.

Growth and maturation of testes in young coturnix and modification by exogenous FSH, LH, and testosterone--a stereologic evaluation.

Groups of coturnix males kept on continuous light from hatch were used in a study of testicular development. Testes were sampled from birds 4, 11, 18, 25, 32 days, and 4 months of age. Exogenous FSH at 1 and 2 mg., and LH and testosterone at 0.5 and 1.0 mg., were given daily for 3 days before the birds were killed for study at 4, 18, and 32 days of age. The following parameters were recorded: testes weights and volume, seminiferous tubular length and the ratio of length per mm.3 volume, supporting or Sertoli cell nuclear volume, volume of gonocytes, pre-leptotene spermatogonia, primary spermatocytes, and total intratubular volume. The stimulatory effect of exogenous LH and FSH on testes weight and volume, length/unit volume ratio of seminiferous tubules, and total intratubular component of the testes was most apparent at 4 days of age. The inhibitory effect of testosterone was significant at 18 and 32 days in all of these parameters. At 4 days, the 0.5-mg. level reduced the volume of the Sertoli cells and the gonial cell group. Full spermatozoa production was observed when the total length of the seminiferous tubules reached 30 m. It may be concluded from this study that young coturnix are similar to the chick in response to exogenous LH and FSH at 4 days of age. This response was observed even though the coturnix were on continuous light.

The cloacal gland--an external indicator of testicular development in coturnix.

The quantitative relationship between cloacal gland size and testes weight during the stages of initial growth, involution and recrudescence is described. Cloacal gland foam was found to be a reliable indicator of testes size and function. The mean testes weight associated with the first presence of cloacal gland foam was 377 mg. and this occurred at a mean age of 29 days. The physical measurement of the cloacal gland provides a valuable noninvasive method of predicting testicular activity especially suited for long term experiments involving multiple measurements where a few coturnix may be used repeatedly (as their own control) rather than periodic killing of a large group of animals.

Eyes have a role in photoperiodic control of sexual activity of coturnix.

In blinded Japanese quail (Coturnix coturnix japonica) encephalic photoreception of the stimulus from long photoperiods is sufficient to induce and maintain normal gonadal function in females (egg laying) and in males (enlargement of the cloacal gland). However, the termination of sexual activity by short days is dependent on these birds having experienced long days at the time of blinding.