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ORIGINAL ARTICLE
Open Access

National Assessment of Data Quality and Associated Systems-Level Factors in Malawi

Richael O'Hagan, Melissa A Marx, Karen E Finnegan, Patrick Naphini, Kumbukani Ng'ambi, Kingsley Laija, Emily Wilson, Lois Park, Sautso Wachepa, Joseph Smith, Lewis Gombwa, Amos Misomali, Tiope Mleme and Simeon Yosefe
Global Health: Science and Practice September 2017, 5(3):367-381; https://doi.org/10.9745/GHSP-D-17-00177
Richael O'Hagan
aDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Melissa A Marx
aDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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  • For correspondence: mmarx@jhu.edu
Karen E Finnegan
aDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Patrick Naphini
bCentral Monitoring and Evaluation Division, Ministry of Health, Lilongwe, Malawi.
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Kumbukani Ng'ambi
cMinistry of Lands, Housing and Urban Development, Lilongwe, Malawi.
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Kingsley Laija
dNational Statistical Office, Zomba, Malawi.
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Emily Wilson
aDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Lois Park
aDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Sautso Wachepa
dNational Statistical Office, Zomba, Malawi.
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Joseph Smith
dNational Statistical Office, Zomba, Malawi.
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Lewis Gombwa
dNational Statistical Office, Zomba, Malawi.
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Amos Misomali
aDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Tiope Mleme
dNational Statistical Office, Zomba, Malawi.
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Simeon Yosefe
bCentral Monitoring and Evaluation Division, Ministry of Health, Lilongwe, Malawi.
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Figures & Tables

Figures

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  • FIGURE 1
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    FIGURE 1

    Data Accuracy Verification Ratios for Antenatal Care, HIV Testing and Counseling, Family Planning, and Acute Respiratory Infection Indicators by District, Malawi, 2016

  • FIGURE 2
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    FIGURE 2

    Data Quality Assessment Recommendations to Strengthen the HMIS

    Abbreviation: HMIS, health management information system.

    Source: Malawi Ministry of Health (2007).27

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    FIGURE 3

    Agenda for Building Country Leadership for Data Use, Malawi

Tables

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    TABLE 1.

    Key for Hot Spot Table Coloring Scheme Indicating Systems Assessment Results and Recommended MOH Actions

    Percent of Facilities Responding Positively to QuestionaCorresponding ColorInterpretation
    80–100GreenNo specific action recommended. MOH can seek to identify actions that may improve or sustain facility compliance.
    60–80YellowMOH should undertake actions to improve compliance. The timing and nature of the action depend on the functional area and how critical the component is to HMIS functioning.
    <60RedMOH should seek to immediately identify underlying reason for low compliance and undertake action to increase compliance in the short-term.
    • Abbreviations: HMIS, health management information system; MOH, Ministry of Health.

    • ↵a “Positively” is defined as responding in affirmation to the question. For most questions, this included only those facilities that answered “yes”; depending on the context of the question, it may also include facilities that answered “partly.” This is indicated in the Results section of the article. Eight questions about stock-outs of registers and reports were worded in the inverse, so “no” answers were considered to be responding “positively.”

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    TABLE 2.

    Characteristics of Health Centers and Hospitals Selected for the Data Quality Assessment Compared With All Health Centers and Hospitals in Malawi, 2016

    Selected Health Centers (n=90)All Health Centers (N=466)P ValueSelected District Hospitals (n=13)Selected Rural Hospitals (n=3)All Hospitals (N=113)P Valuea
    Monthly outpatient department attendance, median (IQR) (March–May 2016)2240b (1371, 3174)2264 (1371, 3213).409595c (7276, 14737)1202 (779, 7032)5308 (2686, 9331).01
    Location.55.57
        Rural, No. (%)87 (97)455 (98)13 (100)3 (100)111 (98)
        Urban, No. (%)3 (3)11 (2)0 (0)0 (0)2 (2)
    Managing authority.11<.01
        Government, No. (%)73 (81)340 (73)13 (100)1 (33)48 (42)
        CHAM, No. (%)16 (18)108 (23)0 (0)2 (67)43 (38)
        Adventist Health Services, No. (%)1 (1)18 (4)0 (0)0 (0)22 (20)
    • Abbreviations: CHAM, Christian Health Association of Malawi; IQR, interquartile range.

    • ↵a Comparing combined district and rural hospitals with all hospitals.

    • ↵b For 18 selected facilities, there were missing outpatient attendance data for at least 1 month.

    • ↵c For 2 facilities, there were missing outpatient attendance data for at least 1 month

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    TABLE 3.

    Data Quality Dimension Scores for Availability and Completeness, by Facility Type, Malawi, 2016

    Health Centers (n=90)District Hospitals (n=13)Rural Hospitals (n=3)DHOs (n=16)
    Availability score, median (IQR)0.92 (0.79, 1.00)0.96 (0.88, 1.00)0.75 (0.71, 0.79)0.94 (0.71, 1.16)
    Completeness score, median (IQR)0.88 (0.71, 1.00)0.92 (0.79, 1.00)0.75 (0.67, 0.83)0.99 (0.98, 1.00)
    • Abbreviations: DHO, district health office; IQR, interquartile range.

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    TABLE 4.

    Data Accuracy Verification Ratios Comparing DHIS 2 to Facility Registers and DHIS 2 to DHO Reports by Facility Type, Malawi, 2016

    Facility RegistersDHO Reports to DHIS 2 (n=16)Facility Registers to DHIS 2 (n=106)
    Health Centers (n=90)District Hospitals (n=13)Rural Hospitals (n=3)
    ANC ratio, median (IQR)1.00 (0.97, 1.13)a1.00 (0.88, 1.06)1.08 (0.00, 2.50)1.00 (0.98, 1.13)1.00 (0.96, 1.10)
    FP ratio, median (IQR)0.99 (0.82, 1.36)b0.93 (0.80, 1.08)0.23c1.00 (0.95, 1.08)0.94 (0.70, 1.07)
    HTC ratio, median (IQR)1.00 (0.99, 1.05)0.77 (0.61, 0.93)0.99 (0.93, 1.00)1.00 (0.96, 1.01)1.00 (0.97, 1.05)
    ARI ratio, median (IQR)0.87 (0.33, 1.18)0.61 (0.20, 0.94)0.08 (0.07, 0.42)1.00 (0.83, 1.00)0.73 (0.27, 1.05)
    • Abbreviations: ANC, antenatal care; ARI, acute respiratory infection; DHIS 2, District Health Information System 2; DHO, district health office; FP, family planning; HTC, HIV testing and counseling; IQR, interquartile range.

    • ↵a n=89.

    • ↵b n=86.

    • ↵c Only 1 selected rural hospital provided family planning services.

    • View popup
    TABLE 5.

    Key Findings for Systems Assessment Functional Areas, by Health Systems Level, Malawi, 2016

    Functional AreaIndicatorHealth Centers (n=90) No. (%)Hospitals (n=16) No. (%)DHOs (n=16) No. (%)
    Staff responsibilitiesStaff members have received training for HMIS-related functions52 (58)13 (81)15 (94)
    Indicator definitionsWritten definitions for all 4 indicators of interest (ANC, FP, HTC, ARI) available in facility or DHO39 (43)12 (75)9 (56)
    Reporting guidelinesReporting guidelines available at facility that describe what should be reported, how reports are to be submitted, to whom, and when90 (34)8 (50)6 (38)
    Data useRegularly use data to calculate indicators48 (53)12 (75)12 (75)
    Registers and reporting formsNo stock-outs of any registers or reporting forms during the past 12 months23 (26)6 (38)-
    Registers and reporting formsSufficient copies of data collection tools available in the DHO to meet the needs of all health facilities in the district--7 (44)
    Display of routine dataOne or more information displays present at time of assessmenta83 (92)15 (94)13 (81)
    Internal data quality checksConsistency checks of collected data routinely conducted37 (41)7 (44)7 (44)
    SupervisionRegular supervisory visits from district47 (52)10 (63)4 (25)
    Computerized registersFacility uses computerized registers9 (10)15 (94)-
    • Abbreviations: ANC, antenatal care; ARI, acute respiratory infection; DHO, district health office; FP, family planning; HMIS, health management information system, HTC, HIV testing and counseling.

    • ↵a Evaluated the following displays: maternal health, child health, facility utilization, disease surveillance, map of catchment area, summary of demographic data.

    • View popup
    TABLE 6.

    Association of Selected Facility Characteristics With Data Quality Dimensions, Mean (P Value)

    Facility CharacteristicData Quality Dimension
    Availability Score DifferenceCompleteness Score DifferenceAccuracy Difference
    ANCFPHTCARI
    Partner support1.27 (.12)0.02 (.57)0.04 (.78)0.11 (.54)−0.07 (.30)−0.04 (.82)
    Statistical clerk employed0.03 (.39)0.01 (.69)−0.08 (.58)−0.08 (.65)−0.07 (.25)−0.36 (.07)
    Managing authoritya0.08 (.07)0.08 (.09)−0.22 (.15)−0.58 (.26)−0.03 (.49)−0.11 (.71)
    Facility locationb−0.13 (.25)−0.09 (.42)−0.14 (.08)−0.05 (.84)−0.18 (.18)−0.12 (.79)
    Regular supervision visits from district−0.02 (.43)−0.01 (.78)0.18 (.16)0.07 (.67)−0.08 (.18)0.22 (.21)
    Regular supervision visits from central level0.04 (.22)0.04 (.31)−0.02 (.87)−0.14 (.47)0.13 (.04)0.19 (.33)
    Supervisory visit within last 6 months0.07 (.05)0.03 (.35)−0.39 (.03)−0.09 (.60)0.06 (.37)0.21 (.29)
    Consistency checks of data routinely conducted−0.08 (.64)0.05 (.76)−0.05 (.45)0.09 (.14)−0.15 (.43)0.14 (.46)
    Facility uses computerized registers for one or more service areas0.02 (.66)−0.00 (.96)----
    Facility uses computerized registers for designated service area (ANC, FP, HTC, outpatient department)--−0.23 (.23)−0.58 (.31)−0.05 (.77)−0.32 (.15)
    Facility has appropriate and adequate space for secure organization and storage of registers and reports0.02 (.73)0.02 (.65)−0.66 (.18)0.15 (.62)0.05 (.65)−0.08 (.78)
    Facility uses its data to track performance toward meeting targets0.06 (.04)0.08 (.02)0.07 (.59)−0.27 (.13)0.08 (.24)−0.03 (.88)
    Programmatic decisions taken by the facility are based on analyzed data/results0.04 (.23)0.02 (.56)-0.37 (.13)−0.21 (.38)−0.01 (.94)0.08 (.71)
    • Abbreviations: ANC, antenatal care; ARI, acute respiratory infection; CHAM, Christian Health Association of Malawi; FP, family planning; HTC, HIV testing and counseling.

    • ↵a Difference between facilities managed by the government and facilities managed by CHAM or Adventist Health Services.

    • ↵b Difference between urban and rural facilities.

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Global Health: Science and Practice: 5 (3)
Global Health: Science and Practice
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September 27, 2017
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National Assessment of Data Quality and Associated Systems-Level Factors in Malawi
Richael O'Hagan, Melissa A Marx, Karen E Finnegan, Patrick Naphini, Kumbukani Ng'ambi, Kingsley Laija, Emily Wilson, Lois Park, Sautso Wachepa, Joseph Smith, Lewis Gombwa, Amos Misomali, Tiope Mleme, Simeon Yosefe
Global Health: Science and Practice Sep 2017, 5 (3) 367-381; DOI: 10.9745/GHSP-D-17-00177

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National Assessment of Data Quality and Associated Systems-Level Factors in Malawi
Richael O'Hagan, Melissa A Marx, Karen E Finnegan, Patrick Naphini, Kumbukani Ng'ambi, Kingsley Laija, Emily Wilson, Lois Park, Sautso Wachepa, Joseph Smith, Lewis Gombwa, Amos Misomali, Tiope Mleme, Simeon Yosefe
Global Health: Science and Practice Sep 2017, 5 (3) 367-381; DOI: 10.9745/GHSP-D-17-00177
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