Improving timeliness in reporting, data sharing and utilization: a pilot roll-out of the district health management information system at health center IVs in Luwero District

OBJECTIVE: To pilot scale-up of district health management software (DHIS2) to health center fours (HCIVs) in Luwero district to improve timeliness in reporting, data sharing and utilization. DESIGN AND METHODS: This was a pre-and post-implementation study conducted between April-September, 2014 at three HCIVs in Luwero district. Qualitative and quantitative methods were used to collect the data. During pre-implementation, we assessed health worker’s knowledge, attitude and practices towards data sharing and utilization, and a total of 112 health workers (HWs) responded to the questionnaire while 6 key informant interviews were conducted to provide data on potential gaps that would hinder roll-out of DHIS2. After roll-out of the intervention, an evaluation was conducted after four months using a questionnaire with the same respondents. Qualitative data were analyzed manually following a thematic framework approach while quantitative data were analyzed using STATA statistical software. Timeliness reporting rates were extracted from the DHIS2 system for both before and after the implementation. RESULTS: Knowledge on data sharing and utilization increased from 68% to 96% and 45% to 95% respectively. Similarly, proportion of HWs with poor attitude on data sharing and utilization decreased from 20% to 3% and 18% to 4% respectively within the same period while 90% adhered to the set procedures in governing data access and 100% to the use of the electronic tool. Almost all HWs appreciated the fact that use of DHIS2 had lessened the burden for data sharing and utilization. Timeliness in reporting increased from 58% to 84% while inadequate equipment, limited internet and insufficient computing skills were reported. CONCLUSION: In summary, scale-up of DHIS2 to HC IVs was possible and roll-out will contribute to improved timeliness in reporting, data sharing and utilization at HCIVs.

A method of assessing age standardized weight for height in children seen cross sectionally

Weight-for-height standards in children are usually constructed on the basis that the expected weight for a given height does not depend on age, an assumption which is unjustified. The present paper investigates regression standards of age-standardized weight for age-standardized height, the standardization being achieved by expressing weight and height as fractions of the 50th centile for age from a suitable growth standard. The precise choice of standard is not critical. Data on 4631 children from five different countries, exhibiting a wide spectrum of growth status, show that throughout childhood until puberty, the following ratio is appropriate as a simple and convenient index of weight-for-height: age-standardized weight/(age-standardized height). During puberty a larger power than 2 is required, so the index as specified is inappropriate. Approximate values for the distribution centile of the index are suggested. The index may be used to assess degree of malnutrition or obesity, for the individuals or groups seen on a single occasion. A slide-rule is described which calculates the index directly, given the child's sex, age, height and weight. (Summary)

Carcinoma of the female breast in Jamaica

The incidence of breast cancer in Jamaican women is intermediate between the low levels of African countries and the high levels of USA, UK, and other Western industrial societies. The annual incidence in Jamaica has shown an upward trend from 1958 to 1974. Compared with Uganda, breast cancer in Jamaica conforms to a "westernized" pattern with regard to the shape of the age-specific incidence curve and stage of presentation. There are no obvious histological differences between breast cancer in Uganda, USA and Jamaica. The incidence of breast cancer in Jamaica appears diaproportionately high in view of the high proportion of early pregnancies occurring in Jamaican women. (AU)

A theoretical note on sex linkage and race differences in spatial visualization ability

Evidence on the poorer spatial visualization ability in various Negro populations compared to the white populations and the direction and magnitude of sex differences in spatial ability relative to other abilities suggests the genetic hypothesis that spatial ability is enhanced by a sex-linked recessive gene and that, since the 20-30 percent admixture of Caucasian genes in American Negroes came mostly from male white ancestors, relatively fewer X-linked than autosomal Caucasian genes were transmitted to the American Negro gene pool. The genetic model as explicitly formulated indicates the kinds of data which could substantiate or disprove the theory, but which do not now exist (AU)

Comparative radiology of the proximal gastro-intestinal tract in Jamaica

A study of the radiological appearances and pathological features of a series of 17 cases of hypertrophic pyloric stenosis of the adult revealed several interesting features. It was shown that the generally accepted radiological description of smooth, severe and regular narrowing and elongation of the pyloric canal is only present in a proportion of cases. The radiological picture is very variable and many cases presented with an irregular pyloric canal and antrum with only moderate degree of narrowing or of pyloric stenosis. The classical pathological changes are said to be those of hypertrophy and hyperplasia of the circular muscle of the pyloric canal and adjacent part of the antrum. The use of special staining techniques revealed varying amounts of fibrous tissue in the hypertrophied smooth muscle in every case, a feature only briefly referred to in one or two previous communications. The presence of fibrous tissue is compatible with the theory that hypertrophic pyloric stenosis of the adult is secondary to pyloric channel ulcer and further evidence is presented in support of this. In a significant proportion of cases, the pyloric muscle hypertrophy is complicated by the presence of a benign ulcer on the lesser curvature of the stomach. The significance of this is also discussed

Cancer of the bladder in Jamaica

The pattern of carcinoma of the bladder in Jamaica is presented. The high incidence squamous carcinoma in both sexes is discussed together with possible etiological factors. The incidence of urethral stricture in association with carcinoma is given (Summary)