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  1. Article ; Online: Implementing electronic decision-support tools to strengthen healthcare network data-driven decision-making

    Diego Rios-Zertuche / Alvaro Gonzalez-Marmol / Francisco Millán-Velasco / Karla Schwarzbauer / Ignez Tristao

    Archives of Public Health, Vol 78, Iss 1, Pp 1-

    2020  Volume 11

    Abstract: Abstract Background Ministries of health in low- and middle-income countries often lack timely quality data for data-driven decision making in healthcare networks. We describe the design and implementation of decision-support electronic tools by the ... ...

    Abstract Abstract Background Ministries of health in low- and middle-income countries often lack timely quality data for data-driven decision making in healthcare networks. We describe the design and implementation of decision-support electronic tools by the Ministry of Health of the State of Chiapas, in Mexico, as part of Salud Mesoamerica Initiative. Methods Three electronic decision-support tools were designed through an iterative process focused on streamlined implementation: 1) to collect and report health facility data at health facilities; 2) to compile and analyze data at health district and central level; and, 3) to support stratified sampling of health facilities. Data was collected for five composite indicators measuring availability of equipment, medicines, and supplies for maternal and child health. Quality Assurance Teams collected data, evaluated results and supported quality improvement. Data was also analyzed at the central level and health districts for decision-making. Results Data from 300 health facilities in four health districts was collected and analyzed (November 2014—June 2015). The first wave revealed gaps on availability of equipment and supplies in more than half of health facilities. Electronic tools provided the ministry of health officers new ways to visualize data, identify patterns and make hypothesis on root-causes. Between the first and second measurement, the number of missing items decreased, and actions performed by quality improvement teams became more proactive. In the final measurement, 89.7—100% of all health facilities achieved all the required items for each indicator. Conclusions Our experience could help guide others seeking to implement electronic decision-support tools in low- and middle-income countries. Electronic decision-support tools supported data-driven decision-making by identifying gaps on heatmaps and graphs at the health facility, subdistrict, district or state level. Through a rapid improvement process, the Ministry of Health met targets of externally verified indicators. Using available information technology resources facilitated prompt implementation and adoption of technology.
    Keywords Decision-support tools ; Maternal health ; Health information systems ; Decision-making ; Data-driven ; Evidence-based ; Public aspects of medicine ; RA1-1270
    Subject code 360
    Language English
    Publishing date 2020-06-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Access and use of oxytocin for postpartum haemorrhage prevention

    Ali H Mokdad / Aruna M Kamath / Alexandra M Schaefer / Erin B Palmisano / Casey K Johanns / Alvaro Gonzalez Marmol / Mauricio Dinarte Mendoza / Karla Schwarzbauer / Paola Zúñiga-Brenes / Diego Ríos-Zertuche / Emma Iriarte / Bernardo Hernandez Prado

    BMJ Open, Vol 10, Iss

    a pre-post study targeting the poorest in six Mesoamerican countries

    2020  Volume 3

    Abstract: ObjectivesHaemorrhage remains the leading cause of maternal mortality in Central America. The Salud Mesoamérica Initiative aims to reduce such mortality via performance indicators. Our objective was to assess the availability and administration of ... ...

    Abstract ObjectivesHaemorrhage remains the leading cause of maternal mortality in Central America. The Salud Mesoamérica Initiative aims to reduce such mortality via performance indicators. Our objective was to assess the availability and administration of oxytocin, before and after applying Salud Mesoamérica Initiative interventions in the poorest health facilities across Central America.DesignPre-post study.Setting166 basic-level and comprehensive-level health facilities in Belize, Guatemala, Honduras, Mexico, Nicaragua and Panama.ParticipantsA random sample of medical records for uncomplicated full-term deliveries (n=2470) per International Classification of Diseases coding at baseline (July 2011 to August 2013) and at first-phase follow-up (January 2014 to October 2014).InterventionsA year of intervention implementation prior to first-phase follow-up data collection focused on improving access to oxytocin by strengthening supply chains, procurement, storage practices and pharmacy inventory monitoring, using a results-based financing model.Primary and secondary outcome measuresOxytocin availability (primary outcome) and administration (secondary outcome) for postpartum haemorrhage prevention.ResultsAvailability of oxytocin increased from 82.9% to 97.6%. Oxytocin administration increased from 83.6% to 88.4%. Significant improvements were seen for availability of oxytocin (adjusted OR (aOR)=8.41, 95% CI 1.50 to 47.30). Administration of oxytocin was found to be significantly higher in Honduras (aOR=2.96; 95% CI 1.00 to 8.76) in reference to Guatemala at follow-up.ConclusionAfter interventions to increase health facility supplies, the study showed a significant improvement in availability but not administration of oxytocin in poor communities within Mesoamerica. Efforts are needed to improve the use of oxytocin.
    Keywords Medicine ; R
    Subject code 360
    Language English
    Publishing date 2020-03-01T00:00:00Z
    Publisher BMJ Publishing Group
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  3. Article ; Online: Performance of passive case detection for malaria surveillance

    Diego Rios-Zertuche / Keith H. Carter / Katie Panhorst Harris / Max Thom / Maria Paola Zúñiga-Brenes / Pedro Bernal-Lara / Álvaro González-Marmol / Casey K. Johanns / Bernardo Hernández / Erin Palmisano / Rebecca Cogen / Paulami Naik / Charbel El Bcheraoui / David L. Smith / Ali H. Mokdad / Emma Iriarte

    Malaria Journal, Vol 20, Iss 1, Pp 1-

    results from nine countries in Mesoamerica and the Dominican Republic

    2021  Volume 12

    Abstract: Abstract Background In malaria elimination settings, available metrics for malaria surveillance have been insufficient to measure the performance of passive case detection adequately. An indicator for malaria suspected cases with malaria test (MSCT) is ... ...

    Abstract Abstract Background In malaria elimination settings, available metrics for malaria surveillance have been insufficient to measure the performance of passive case detection adequately. An indicator for malaria suspected cases with malaria test (MSCT) is proposed to measure the rate of testing on persons presenting to health facilities who satisfy the definition of a suspected malaria case. This metric does not rely on prior knowledge of fever prevalence, seasonality, or external denominators, and can be used to compare detection rates in suspected cases within and between countries, including across settings with different levels of transmission. Methods To compute the MSCT, an operational definition for suspected malaria cases was established, including clinical and epidemiological criteria. In general, suspected cases included: (1) persons with fever detected in areas with active malaria transmission; (2) persons with fever identified in areas with no active transmission and travel history to, or residence in areas with active transmission (either national or international); and (3) persons presenting with fever, chills and sweating from any area. Data was collected from 9 countries: Belize, Colombia (in areas with active transmission), Costa Rica, Dominican Republic, El Salvador, Guatemala, Honduras, Nicaragua, and Panama (September–March 2020). A sample of eligible medical records for 2018 was selected from a sample of health facilities in each country. An algorithm was constructed to assess if a malaria test was ordered or performed for cases that met the suspected case definition. Results A sample of 5873 suspected malaria cases was obtained from 239 health facilities. Except for Nicaragua and Colombia, malaria tests were requested in less than 10% of all cases. More cases were tested in areas with active transmission than areas without cases. Travel history was not systematically recorded in any country. Conclusions A statistically comparable, replicable, and standardized metric was proposed to measure suspected malaria cases with a test (microscopy or rapid diagnostic test) that enables assessing the performance of passive case detection. Cross-country findings have important implications for malaria and infectious disease surveillance, which should be promptly addressed as countries progress towards malaria elimination. Local and easy-to-implement tools could be implemented to assess and improve passive case detection.
    Keywords Passive case detection ; ABER ; Annual blood examination rate ; Malaria surveillance ; Malaria elimination ; Malaria indicators ; Arctic medicine. Tropical medicine ; RC955-962 ; Infectious and parasitic diseases ; RC109-216
    Subject code 616
    Language English
    Publishing date 2021-04-01T00:00:00Z
    Publisher BMC
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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