Identifying Opportunities to Strengthen the Public Health Informatics Infrastructure: Exploring Hospitals' Challenges with Data Exchange.

Policy Points Even though most hospitals have the technological ability to exchange data with public health agencies, the majority continue to experience challenges. Most challenges are attributable to the general resources of public health agencies, although workforce limitations, technology issues such as a lack of data standards, and policy uncertainty around reporting requirements also remain prominent issues. Ongoing funding to support the adoption of technology and strengthen the development of the health informatics workforce, combined with revising the promotion of the interoperability scoring approach, will likely help improve the exchange of electronic data between hospitals and public health agencies. CONTEXT: The novel coronavirus 2019 (COVID-19) pandemic has highlighted significant barriers in the exchange of essential information between hospitals and local public health agencies. Thus it remains important to clarify the specific issues that hospitals may face in reporting to public health agencies to inform focused approaches to improve the information exchange for the current pandemic as well as ongoing public health activities and population health management. METHODS: This study uses cross-sectional data of acute-care, nonfederal hospitals from the 2017 American Hospital Association Annual Survey and Information Technology supplement. Guided by the technology-organization-environment framework, we coded the responses to a question regarding the challenges that hospitals face in submitting data to public health agencies by using content analysis according to the type of challenge (i.e., technology, organization, or environment), responsible entity (i.e., hospital, public health agency, vendor, multiple), and the specific issue described. We used multivariable logistic and multinomial regression to identify characteristics of hospitals associated with experiencing the types of challenges. FINDINGS: Our findings show that of the 2,794 hospitals in our analysis, 1,696 (61%) reported experiencing at least one challenge in reporting health data to a public health agency. Organizational issues were the most frequently reported type of challenge, noted by 1,455 hospitals. The most common specific issue, reported by 1,117 hospitals, was the general resources of public health agencies. An advanced EHR system and participation in a health information exchange both decreased the likelihood of not reporting experiencing a challenge and increased the likelihood of reporting an organizational challenge. CONCLUSIONS: Our findings inform policy recommendations such as improving data standards, increasing funding for public health agencies to improve their technological capabilities, offering workforce training programs, and increasing clarity of policy specifications and reporting. These approaches can improve the exchange of information between hospitals and public health agencies.

Why Predictive Modeling is Critical in the Fight against COVID-19 / ¿Por qué los modelos predictivos son cruciales en la lucha contra la COVID-19?

A number of predictive models and forecasting exercises have been developed by various organizations, such as research groups, academic institutions, hospitals, and consulting companies, with the main aim to support health systems in with COVID-19 strategic decision making, planning, and health policy formulation that help in the fight against COVID19. Predictive models are helpful for estimating the number of COVID-19 cases and deaths; the resources required, e.g., such as hospital patient beds and ICU beds; and the demand for supplies, such as personal protective equipment (PPE). Because predictive models for COVID-19 must rely on a rapidly changing situation and underlying data, they produce results that may change repeatedly as data areas data is updated and revised. Nevertheless, the predictive models are meaningful and can offer crucial insights to policymakers. It is important that we understand the strengths and weaknesses of predictive models in order to use them judiciously as support and reference tools for COVID-19 planning and action.

Los modelos predictivos son útiles para estimar el número de casos y de muertes por la COVID-19; los recursos necesarios, como las camas de hospital y de UCI; y la demanda de suministros, como la de equipos de protección personal (EPP). Dado que los modelos predictivos para la COVID-19 deben basarse en situaciones y datos subyacentes que cambian rápidamente, los resultados que producen pueden cambiar repetidamente a medida que se actualizan y revisan los datos. No obstante, los modelos predictivos tienen interés y pueden aportar perspectivas que son cruciales para los responsables de las políticas. Es importante que conozcamos los puntos fuertes y las limitaciones de los modelos predictivos para usarlos de forma juiciosa como elementos de apoyo y herramientas de referencia para la planificación y la actuación en torno a la COVID-19.

Public Health Informatics in Local and State Health Agencies: An Update From the Public Health Workforce Interests and Needs Survey.

OBJECTIVE: To characterize public health informatics (PHI) specialists and identify the informatics needs of the public health workforce. DESIGN: Cross-sectional study. SETTING: US local and state health agencies. PARTICIPANTS: Employees from state health agencies central office (SHA-COs) and local health departments (LHDs) participating in the 2017 Public Health Workforce Interests and Needs Survey (PH WINS). We characterized and compared the job roles for self-reported PHI, "information technology specialist or information system manager" (IT/IS), "public health science" (PHS), and "clinical and laboratory" workers. MAIN OUTCOME MEASURE: Descriptive statistics for demographics, income, education, public health experience, program area, job satisfaction, and workplace environment, as well as data and informatics skills and needs. RESULTS: A total of 17 136 SHA-CO and 26 533 LHD employees participated in the survey. PHI specialist was self-reported as a job role among 1.1% and 0.3% of SHA-CO and LHD employees. The PHI segment most closely resembled PHS employees but had less public health experience and had lower salaries. Overall, fewer than one-third of PHI specialists reported working in an informatics program area, often supporting epidemiology and surveillance, vital records, and communicable disease. Compared with PH WINS 2014, current PHI respondents' satisfaction with their job and workplace environment moved toward more neutral and negative responses, while the IT/IS, PHS, and clinical and laboratory subgroups shifted toward more positive responses. The PHI specialists were less likely than those in IT/IS, PHS, or clinical and laboratory roles to report gaps in needed data and informatics skills. CONCLUSIONS: The informatics specialists' role continues to be rare in public health agencies, and those filling that role tend to have less public health experience and be less well compensated than staff in other technically focused positions. Significant data and informatics skills gaps persist among the broader public health workforce.

Using linked electronic health records to report healthcare-associated infections.

BACKGROUND: Reporting of strategic healthcare-associated infections (HCAIs) to Public Health England is mandatory for all acute hospital trusts in England, via a web-based HCAI Data Capture System (HCAI-DCS). AIM: Investigate the feasibility of automating the current, manual, HCAI reporting using linked electronic health records (linked-EHR), and assess its level of accuracy. METHODS: All data previously submitted through the HCAI-DCS by the Oxford University Hospitals infection control (IC) team for methicillin-resistant and methicillin-susceptible Staphylococcus aureus (MRSA, MSSA), Clostridium difficile, and Escherichia coli, through March 2017 were downloaded and compared to outputs created from linked-EHR, with detailed comparisons between 2013-2017. FINDINGS: Total MRSA, MSSA, E. coli and C. difficile cases entered by the IC team vs linked-EHR were 428 vs 432, 795 vs 816, 2454 vs 2450 and 3365 vs 3393 respectively. From 2013-2017, most discrepancies (32/37 (86%)) were likely due to IC recording errors. Patient and specimen identifiers were completed for >98% of cases by both methods, with very high agreement (>97%). Fields relating to the patient at the time the specimen was taken were complete to a similarly high level (>99% IC, >97% linked-EHR), and agreement was fairly good (>80%) except for the main and treatment specialties (57% and 54% respectively) and the patient category (55%). Optional, organism-specific data-fields were less complete, by both methods. Where comparisons were possible, agreement was reasonably high (mostly 70-90%). CONCLUSION: Basic factual information, such as demographic data, is almost-certainly better automated, and many other data fields can potentially be populated successfully from linked-EHR. Manual data collection is time-consuming and inefficient; automated electronic data collection would leave healthcare professionals free to focus on clinical rather than administrative work.

Patients' intention to use online postings of ED wait times: A modified UTAUT model.

BACKGROUND: As health care becomes more reliant on technology, a better understanding of the factors that contribute to acceptance and use of technology is now critical. The Unified Theory of Acceptance and Use of Technology (UTAUT) has been applied to study a variety of technologies in different settings, and it is one of the most cited theories in Information Systems (IS) research. However, there has been limited application of UTAUT to health IT and, in particular, to patients' IT use. OBJECTIVES: The aim of this study is to adapt UTAUT to the context of patient acceptance and use of an Emergency Department (ED) wait-times website, and to empirically test the modified model and compare the results to those of the original UTAUT model. Specifically, it is proposed that there will be a significant relationship between facilitating conditions and behavioral intention. METHODS: A survey of patients in the ED of a Canadian hospital was conducted, yielding 118 completed surveys, and subsequently analyzed using Partial least squares (PLS). RESULTS: This study found that the modified UTAUT produced a substantial improvement in variance explained in behavioral intention compared to the original UTAUT (66% versus 46%). The modified-UTAUT model showed significant effects in performance expectancy (r = 0.302, p < 0.01) and facilitating conditions (r = 0.539, p < 0.001) on behavioral intention to use the website, while the effort expectancy impact was not significant. CONCLUSIONS: This study provides empirical support for the modified-UTAUT in the context of patients' intention to use an ED wait times website. Some results of this study support prior research, while some differ, such as the non-significant relationship between effort expectancy and behavioral intention and the finding that performance expectancy is not the main driver of intention to use. As proposed, facilitating conditions - having the resources necessary to view the website and having the ability to find the website - were the most important factors influencing behavioral intention. UTAUT is a key theoretical advance in IS research and by modifying it to the context of patient use, we contribute to both IS and health research.

TB-HIV co-infection in the Netherlands: estimating prevalence and under-reporting in national registration databases using a capture-recapture analysis.

BACKGROUND: Knowledge of the HIV status in patients with tuberculosis (TB) and vice versa is crucial for proper individual patient management, while knowledge of the prevalence of co-infection guides preventive and therapeutic strategies. The aim of the study was to assess if national disease databases on TB and HIV are adequate sources to provide this information. METHODS: A two way capture-recapture analysis to assess the completeness of the registers, and to obtain the prevalence of TB-HIV co-infection in the Netherlands in the years 2002-2012. RESULTS: HIV testing was performed in less than 50% of the patients with TB. Of the 932 TB-HIV infected patients, just 293 (31.4%) were registered in both registers. Under-reporting of TB-HIV co-infection ranged from 50% to 70% in the national TB register, and from 31% to 37% in the HIV database. Prevalence of TB-HIV co-infection in the Netherlands in 2012 was 7.1% (95% CI 6.0% to 8.3%), which was more than double of the prevalence estimated from the national TB database. CONCLUSIONS: TB-HIV co-infection is markedly under-reported in national disease databases. There is an urgent need for improved registration and preferably a routine data exchange between the two surveillance systems.

Evaluation of partnerships in a transnational family violence prevention network using an integrated knowledge translation and exchange model: a mixed methods study.

BACKGROUND: Family violence is a significant and complex public health problem that demands collaboration between researchers, practitioners, and policymakers for systemic, sustainable solutions. An integrated knowledge translation network was developed to support joint research production and application in the area. The purpose of this study was to determine the extent to which the international Preventing Violence Across the Lifespan (PreVAiL) Research Network built effective partnerships among its members, with a focus on the knowledge user partner perspective. METHODS: This mixed-methods study employed a combination of questionnaire and semi-structured interviews to understand partnerships two years after PreVAiL's inception. The questionnaire examined communication, collaborative research, dissemination of research, research findings, negotiation, partnership enhancement, information needs, rapport, and commitment. The interviews elicited feedback about partners' experiences with being part of the network. RESULTS: Five main findings were highlighted: i) knowledge user partner involvement varied across activities, ranging from 11% to 79% participation rates; ii) partners and researchers generally converged on their assessment of communication indicators; iii) partners valued the network at both an individual level and to fulfill their organizations' mandates; iv) being part of PreVAiL allowed partners to readily contact researchers, and partners felt comfortable acting as an intermediary between PreVAiL and the rest of their own organization; v) application of research was just emerging; partners needed more actionable insights to determine ways to move forward given the research at that point in time. CONCLUSIONS: Our results demonstrate the importance of developing and nurturing strong partnerships for integrated knowledge translation. Our findings are applicable to other network-oriented partnerships where a diversity of stakeholders work to address complex, multi-faceted public health problems.

Syndromic surveillance for influenza in the emergency department-A systematic review.

The science of surveillance is rapidly evolving due to changes in public health information and preparedness as national security issues, new information technologies and health reform. As the Emergency Department has become a much more utilized venue for acute care, it has also become a more attractive data source for disease surveillance. In recent years, influenza surveillance from the Emergency Department has increased in scope and breadth and has resulted in innovative and increasingly accepted methods of surveillance for influenza and influenza-like-illness (ILI). We undertook a systematic review of published Emergency Department-based influenza and ILI syndromic surveillance systems. A PubMed search using the keywords "syndromic", "surveillance", "influenza" and "emergency" was performed. Manuscripts were included in the analysis if they described (1) data from an Emergency Department (2) surveillance of influenza or ILI and (3) syndromic or clinical data. Meeting abstracts were excluded. The references of included manuscripts were examined for additional studies. A total of 38 manuscripts met the inclusion criteria, describing 24 discrete syndromic surveillance systems. Emergency Department-based influenza syndromic surveillance has been described worldwide. A wide variety of clinical data was used for surveillance, including chief complaint/presentation, preliminary or discharge diagnosis, free text analysis of the entire medical record, Google flu trends, calls to teletriage and help lines, ambulance dispatch calls, case reports of H1N1 in the media, markers of ED crowding, admission and Left Without Being Seen rates. Syndromes used to capture influenza rates were nearly always related to ILI (i.e. fever +/- a respiratory or constitutional complaint), however, other syndromes used for surveillance included fever alone, "respiratory complaint" and seizure. Two very large surveillance networks, the North American DiSTRIBuTE network and the European Triple S system have collected large-scale Emergency Department-based influenza and ILI syndromic surveillance data. Syndromic surveillance for influenza and ILI from the Emergency Department is becoming more prevalent as a measure of yearly influenza outbreaks.

[Information sources for causality assessment of health problems related to health foods and their usefulness].

Collecting adverse case reports suspected to be due to health foods and evaluation of the causality are important to secure safety, even if the causal relationship between health foods and reported health problem is uncertain. Case reports are mainly collected at three sites: public health centers, practical living information online network system(PIO-NET), and individual companies. The case reports from the three sources are not dealt with consistently. In this study, we investigated and characterized those case reports from the viewpoint of evaluating causality, using the causality association rating methods, namely, the dendritic and pointed methods, which we reported previously. Information in public health centers comprised 20 reports per year; approximately 40% were from health care providers and contained detailed medical data. PIO-NET information comprised 366 reports per year; 80% were self-reports from users, and few medical details were included. Company information covered 1,323 cases from 13 companies; more than 90% were from users and most of them were complaints. Case reports from public health centers and PIO-NET showed that the largerst number of victims were female aged >60, with allergy and gastrointestinal symptoms. When these case reports from the letter two sources were examined using the causality association rating systems, most were rated as "possible" and only a few were rated as "probable". As specific case reports from different information sources were examined in this study, we were able to identify several points that should be improved in our two rating methods. However, to ensure the safety of health foods, it will be necessary to collect a large number of high-quality case reports for evaluation by a suitable causality rating method, and to integrate those evaluated case reports into a single site.

Do we have the reliable data? An exploration of data quality for AIDS information system in China.

A national AIDS program evaluation system has been applied to the ranking of the performance of involved public health organizations in China since 2007. The system provides quantitative performance comparison information based on automatic mining of the data stored in a unified web-based national information system, China AIDS Comprehensive Response Information Management System (the CRIMS). Hence, the quality of the AIDS program evaluation system is directly related to the data quality in the CRIMS. This study aims to evaluate the performance of the AIDS program evaluation system. The research method is qualitative interview of public health practitioners in Jiangxi Province. The public health practitioners believed that the introduction and ongoing usage of the CRIMS has significantly transformed the practice of AIDS prevention and control. They believed that the AIDS program evaluation system has brought in increased accountability of public health. They suggested that the accuracy and completeness of AIDS program evaluation needs to go beyond the data from the CRIMS. Further research will continue to identify the unknown factors that undermine the performance of AIDS programs in China.

Alumni's perception of public health informatics competencies: lessons from the Graduate Program of Public Health, Faculty of Medicine, Universitas Gadjah Mada, Indonesia.

Public health informatics has been defined as the systematic application of information and computer science and technology to public health practice, research, and learning [1]. Unfortunately, limited reports exist concerning to the capacity building strategies to improve public health informatics workforce in limited-resources setting. In Indonesia, only three universities, including Universitas Gadjah Mada (UGM), offer master degree program on related public health informatics discipline. UGM started a new dedicated master program on Health Management Information Systems in 2005, under the auspice of the Graduate Program of Public Health at the Faculty of Medicine. This is the first tracer study to the alumni aiming to a) identify the gaps between curriculum and the current jobs and b) describe their perception on public health informatics competencies. We distributed questionnaires to 114 alumni with 36.84 % response rate. Despite low response rate, this study provided valuable resources to set up appropriate competencies, curriculum and capacity building strategies of public health informatics workforce in Indonesia.

The importance of public sector health facility-level data for monitoring changes in maternal mortality risks among communities: the case of pakistan.

This paper illustrates the importance of monitoring health facility-level information to monitor changes in maternal mortality risks. The annual facility-level maternal mortality ratios (MMRs), complications to live births ratios and case fatality ratios (CFRs) were computed from data recorded during 2007 and 2009 in 31 upgraded public sector health facilities across Pakistan. The facility-level MMR declined by about 18%; both the number of Caesarean sections and the episodes of complications as a percentage of live births increased; and CFR based on Caesarean sections and episodes of complications declined by 29% and 37%, respectively. The observed increases in the proportion of women with complications among those who come to these facilities point to a reduction in the delay in reaching facilities (first and second delays; Thaddeus & Maine, 1994); the decrease in CFRs points to improvements in treating obstetric complications and a reduction in the delay in receiving treatment once at facilities (the third delay). These findings point to a decline in maternal mortality risks among communities served by these facilities. A system of woman-level data collection instituted at health facilities with comprehensive emergency obstetric care is essential to monitor changes in the effects of any reduction in the three delays and any improvement in quality of care or the effectiveness of treating pregnancy-related complications among women reaching these facilities. Such a system of information gathering at these health facilities would also help policymakers and programme mangers to measure and improve the effectiveness of safe-motherhood initiatives and to monitor progress being made toward achieving the fifth Millennium Development Goal.

El visado de inspección de medicamentos en España: situación actual desde la perspectiva de los profesionales sanitarios a partir de la introducción de su modalidad electrónica / Validation Inspection of prescription drugs in Spain: Current situation from a health professional perspective after its introduction in electronic form

Objetivo: Conocer la situación actual del visado de inspección de medicamentos (VIM) en España, desde la perspectiva de los profesionales sanitarios a partir de la introducción de su modalidad electrónica. Diseño: Observacional, transversal, en 2 fases, combinando técnicas cualitativas y cuantitativas. Emplazamiento: Sistema sanitario público: atención primaria (AP), especializada (AE) y administración. Participantes: Microgestores, médicos de AP, endocrinólogos; mesogestores, inspectores médicos, farmacéuticos de AP; macrogestores; responsables de direcciones de farmacia de las consejerías de salud de comunidades autónomas (CCAA). Método: Entrevistas telefónicas semiestructuradas; saturación de información (fase 1) y Computer Assisted Telephone Interviewing (CATI) (fase 2). Análisis de contenido, comparación con la literatura médica y normativa. Resultados: El VIM presenta 3 modalidades: manual, electrónica y electrónica vinculada a prescripción electrónica. Los participantes del mismo nivel de gestión perciben de manera similar el fin último del VIM. Existen diferencias en la situación del visado electrónico (VE) entre CCAA. Está más implementado en AP que en AE (63 frente a 37%), con grado similar en ámbitos urbano y rural. Seis de las 17 CCAA presentaron un acceso sencillo y público a la legislación correspondiente. Conclusiones: El VIM se percibe como una herramienta para el control del gasto en medicamentos y como una carga administrativa adicional en AP. El ritmo de implementación del VE difiere entre CCAA así como el acceso a la normativa pertinente(AU)

Aims: To assess the current situation of the inspection validation of prescriptions (IVP) in Spain since the introduction of the electronic procedure (EP) from the healthcare professionals’ perspective. Design: Observational, cross sectional study, in two phases; combining qualitative and quantitative techniques. Setting: Primary Care (PC), Secondary Care (SC) and the health care management sector. Participants: Primary care physicians (PCPs), endocrinologists, medical inspectors, pharmacists and health Authorities of Autonomous Communities (AACC). Method: Semi-structured surveys and Computer Assisted Telephone Interviewing. Results: The IVP presents three modalities in Spain: manual, electronics and electronics linked to electronic prescription. The participants of the same level of management perceive in a similar way the purpose of the IVP, and there exist differences between the different levels of interviewed managers. Differences exist in the situation of EP between AACC. It is more implemented in primary care (PC) than in specialized (63% vs 37%), with similar degree in urban and rural areas. Six of 17 AACC presented a public access to the corresponding legislation. Conclusion: The IVP is perceived as a tool for the economic control in expenditure on drugs and as additional administrative load in PC. The rhythm of implementation of EP differs between AACC as well as the access to the regulation(AU)

Automated biosurveillance data from England and Wales, 1991-2011.

Outbreak detection systems for use with very large multiple surveillance databases must be suited both to the data available and to the requirements of full automation. To inform the development of more effective outbreak detection algorithms, we analyzed 20 years of data (1991-2011) from a large laboratory surveillance database used for outbreak detection in England and Wales. The data relate to 3,303 distinct types of infectious pathogens, with a frequency range spanning 6 orders of magnitude. Several hundred organism types were reported each week. We describe the diversity of seasonal patterns, trends, artifacts, and extra-Poisson variability to which an effective multiple laboratory-based outbreak detection system must adjust. We provide empirical information to guide the selection of simple statistical models for automated surveillance of multiple organisms, in the light of the key requirements of such outbreak detection systems, namely, robustness, flexibility, and sensitivity.

Identifying clinical/translational research cohorts: ascertainment via querying an integrated multi-source database.

BACKGROUND: Ascertainment of potential subjects has been a longstanding problem in clinical research. Various methods have been proposed, including using data in electronic health records. However, these methods typically suffer from scaling effects-some methods work well for large cohorts; others work for small cohorts only. OBJECTIVE: We propose a method that provides a simple identification of pre-research cohorts and relies on data available in most states in the USA: merged public health data sources. MATERIALS AND METHODS: The Utah Population Database Limited query tool allows users to build complex queries that may span several types of health records, such as cancer registries, inpatient hospital discharges, and death certificates; in addition, these can be combined with family history information. The architectural approach incorporates several coding systems for medical information. It provides a front-end graphical user interface and enables researchers to build and run queries and view aggregate results. Multiple strategies have been incorporated to maintain confidentiality. RESULTS: This tool was rapidly adopted; since its release, 241 users representing a wide range of disciplines from 17 institutions have signed the user agreement and used the query tool. Three examples are discussed: pregnancy complications co-occurring with cardiovascular disease; spondyloarthritis; and breast cancer. DISCUSSION AND CONCLUSIONS: This query tool was designed to provide results as pre-research so that institutional review board approval would not be required. This architecture uses well-described technologies that should be within the reach of most institutions.

Willingness to share personal health record data for care improvement and public health: a survey of experienced personal health record users.

BACKGROUND: Data stored in personally controlled health records (PCHRs) may hold value for clinicians and public health entities, if patients and their families will share them. We sought to characterize consumer willingness and unwillingness (reticence) to share PCHR data across health topics, and with different stakeholders, to advance understanding of this issue. METHODS: Cross-sectional 2009 Web survey of repeat PCHR users who were patients over 18 years old or parents of patients, to assess willingness to share their PCHR data with an-out-of-hospital provider to support care, and the state/local public health authority to support monitoring; the odds of reticence to share PCHR information about ten exemplary health topics were estimated using a repeated measures approach. RESULTS: Of 261 respondents (56% response rate), more reported they would share all information with the state/local public health authority (63.3%) than with an out-of-hospital provider (54.1%) (OR 1.5, 95% CI 1.1, 1.9; p = .005); few would not share any information with these parties (respectively, 7.9% and 5.2%). For public health sharing, reticence was higher for most topics compared to contagious illness (ORs 4.9 to 1.4, all p-values < .05), and reflected concern about anonymity (47.2%), government insensitivity (41.5%), discrimination (24%). For provider sharing, reticence was higher for all topics compared to contagious illness (ORs 6.3 to 1.5, all p-values < .05), and reflected concern for relevance (52%), disclosure to insurance (47.6%) and/or family (20.5%). CONCLUSIONS: Pediatric patients and their families are often willing to share electronic health information to support health improvement, but remain cautious. Robust trust models for PCHR sharing are needed.

[The possibility of using neural networks for the 3D visualization of hygienic studies of the health status on the example of the physical development of the child population].

In the course of the research the possibility of using 3d visualization of the results of hygienic investigations using software package STATISTICA Neural Networks as exemplified by the physical development of children in the Kursk region has been demonstrated, assessment of the possibility of application the proposed method has been done.

Quantitative and qualitative verification of data quality in the childbirth registers of two rural district hospitals in Western Kenya.

OBJECTIVE: to verify the data quality of childbirth registers and explore factors that influence quality at two rural district hospitals in Western Kenya. DESIGN: a retrospective comparative case study for data quality of the 2006 childbirth registers by quantitative and qualitative methods. SETTING: Siaya and Bondo District Hospitals. METHODS: after confirming the physical condition and availability of childbirth registers, the total number of births; number of complete/incomplete data; and number of complete data that were illegible, incorrectly coded, inappropriate and unrecognised were verified quantitatively to evaluate accuracy and completeness. Data categories and instructions were examined qualitatively to assess the relevance, completeness and accuracy of the data. Semi-structured interviews were conducted with key informants to capture their views and factors that influence data quality. FINDINGS: the childbirth registers used by the two hospitals were not developed by the Ministry of Health, and their supply to Bondo was interrupted. Of the 30 data categories in the registers, five for Siaya and 23 for Bondo were more than 20% incomplete. Data for number of antenatal consultations and use of human immunodeficiency virus drugs were at least 50% incomplete for both hospitals. The percentage of illegible, incorrectly coded and inappropriate data was relatively low, and only the place of residence had unrecognised data. Data categories in the registers did not correspond well with those of monthly reports, and inappropriate instructions suggested hidden inaccuracy among apparently valid data. Organisational impediments of the health information system in general, perinatal and intrapartum contexts were identified. KEY CONCLUSIONS: data quality of the childbirth registers was unsatisfactory. Influential factors were primarily organisational and technical, which may have had an adverse effect on midwives' record keeping behaviour. IMPLICATIONS FOR PRACTICE: data quality of the registers can be improved by re-examining technical challenges and organisational impediments at different levels. Midwives' awareness of data quality needs to be increased by sharing the purpose of the childbirth registers. Strong political commitment is also indispensable for putting these findings into action.

Surfing the net for public health resources.

OBJECTIVES: To identify public health open educational resources (OER) available online, map the identified OER to The Public Health Skills and Career Framework (PHSCF), and triangulate these findings with public health practitioners. STUDY DESIGN: Systematic online search for public health OER. METHODS: An online search was undertaken using a pre-defined set of search terms and inclusion/exclusion criteria. Public health OER were then mapped against the UK PHSCF. The findings of the search were discussed with public health specialists to determine whether or not they used these resources. RESULTS: A number of public health OER were identified, located on 42 websites from around the world. Mapping against the UK PHSCF demonstrated a lack of coverage in some areas of public health education. It was noted that many of the OER websites identified were not those generally used in practice, and those sites preferred by public health specialists were not identified by the online search. CONCLUSIONS: Public health OER are available from a number of providers, frequently universities and government organizations. However, these reflect a relatively small pool of original OER providers. Tagging of websites does not always identify their public health content. In addition, users of public health OER may not use search engines to identify resources but locate them using other means.

Capture-recapture to estimate completeness of tuberculosis surveillance in two communities in South Africa.

BACKGROUND: Reliable surveillance is essential for any tuberculosis (TB) control programme; however, under-registration of TB cases due to under-notification of patients on treatment or failure to initiate treatment has been well-documented internationally. OBJECTIVE: To determine the contribution of capture-recapture methods in estimating the completeness of bacteriologically confirmed pulmonary TB registration in two high-incident communities in South Africa. METHODS: Record linkage between the TB treatment register and two laboratory sputum TB result registers and three-source log-linear capture-recapture analysis. RESULTS: The number of bacteriologically confirmed pulmonary TB cases in the TB treatment register was 243, with an additional 63 cases identified in the two laboratory databases, resulting in 306 TB cases. The observed completeness of the TB treatment register was 79%. The log-linear model estimated 326 (95%CI 314-355) TB cases, resulting in an estimated completeness of registration of 75% (95%CI 68-77). CONCLUSION: Capture-recapture can be useful in evaluating the completeness of TB control surveillance and registration, including in resource-limited settings; however, methodology and results should be carefully assessed. Interventions are needed to increase the completeness of registration and to reduce the number of initial defaulters.