Challenges for Routine Health System Data Management in a Large Public Programme to Prevent Mother-to-Child HIV Transmission in South Africa
Challenges for Routine Health System Data Management in a Large Public Programme to Prevent Mother-to-Child HIV Transmission in South Africa
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DOI：
10.1371/journal.pone.0005483
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发表时间：
2009-05-12
期刊：
影响因子：
3.7
通讯作者：
Rollins, Nigel
中科院分区：
文献类型：
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作者：
Mate, Kedar S.;Bennett, Brandon;Rollins, Nigel
背景：南非预防艾滋病毒母婴传播(PMTCT)指导方针最近的变化使人们对能够实现将艾滋病毒围产期传播率降至5%以下的国家目标抱有希望。虽然实现这一目标的计划努力正在进行中，但从临床站点获得完整和准确的数据以跟踪进展情况是一个重大挑战。我们评估了南非夸祖鲁-纳塔尔省三个区提交给地区卫生信息系统(DHIS)的常规预防母婴传播数据的完整性和准确性。方法/主要发现：我们调查了2007年1月至12月期间从三个区的所有316家诊所和医院报告的六个关键预防母婴传播数据元素的完整性和准确性。通过对随机选择的地点的访问，我们从诊所登记中重建了相同的六个预防母婴传播数据元素的报告，并评估了之前提交给卫生部的月度报告的准确性。只有50.3%的时间报告了数据元素，并且12.8%的时间是“准确的”(即，在重建值的10%以内)。数据元素“产前客户艾滋病毒检测”是最准确的数据元素(即与重建的值一致)19.8%，而“艾滋病毒阳性母亲所生婴儿的艾滋病毒聚合酶链式反应检测”最不准确，只有5.3%的诊所达到了准确性的定义。结论/意义：公共卫生系统收集和报告的数据不够完整，也不够准确，无法跟踪预防母婴传播治疗的过程表现或结果。系统的数据评估可以确定数据报告失败的严重程度，并指导现场具体改进数据管理。目前正在开发和测试解决方案，以提高数据质量。
Background: Recent changes to South Africa's prevention of mother-to-child transmission of HIV (PMTCT) guidelines have raised hope that the national goal of reducing perinatal HIV transmission rates to less than 5% can be attained. While programmatic efforts to reach this target are underway, obtaining complete and accurate data from clinical sites to track progress presents a major challenge. We assessed the completeness and accuracy of routine PMTCT data submitted to the district health information system (DHIS) in three districts of Kwazulu-Natal province, South Africa.Methodology/Principal Findings: We surveyed the completeness and accuracy of data reported for six key PMTCT data elements between January and December 2007 from all 316 clinics and hospitals in three districts. Through visits to randomly selected sites, we reconstructed reports for the same six PMTCT data elements from clinic registers and assessed accuracy of the monthly reports previously submitted to the DHIS. Data elements were reported only 50.3% of the time and were "accurate'' (i.e. within 10% of reconstructed values) 12.8% of the time. The data element "Antenatal Clients Tested for HIV'' was the most accurate data element (i.e. consistent with the reconstructed value) 19.8% of the time, while "HIV PCR testing of baby born to HIV positive mother'' was the least accurate with only 5.3% of clinics meeting the definition of accuracy.Conclusions/Significance: Data collected and reported in the public health system across three large, high HIV-prevalence Districts was neither complete nor accurate enough to track process performance or outcomes for PMTCT care. Systematic data evaluation can determine the magnitude of the data reporting failure and guide site-specific improvements in data management. Solutions are currently being developed and tested to improve data quality.