Routine health management information system data in Ethiopia: consistency, trends, and challenges.

Background: Ethiopia is investing in the routine Health Management Information System. Improved routine data are needed for decision-making in the health sector. Objective: To analyse the quality of the routine Health Management Information System data and triangulate with other sources, such as the Demographic and Health Surveys. Methods: We analysed national Health Management Information System data on 19 indicators of maternal health, neonatal survival, immunization, child nutrition, malaria, and tuberculosis over the 2012-2018 time period. The analyses were conducted by 38 analysts from the Ministry of Health, Ethiopia, and two government agencies who participated in the Operational Research and Coaching for Analysts (ORCA) project between June 2018 and June 2020. Using a World Health Organization Data Quality Review toolkit, we assessed indicator definitions, completeness, internal consistency over time and between related indicators, and external consistency compared with other data sources. Results: Several services reported coverage of above 100%. For many indicators, denominators were based on poor-quality population data estimates. Data on individual vaccinations had relatively good internal consistency. In contrast, there was low external consistency for data on fully vaccinated children, with the routine Health Management Information System showing 89% coverage but the Demographic and Health Survey estimate at 39%. Maternal health indicators displayed increasing coverage over time. Indicators on child nutrition, malaria, and tuberculosis were less consistent. Data on neonatal mortality were incomplete and operationalised as mortality on day 0-6. Our comparisons with survey and population projections indicated that one in eight early neonatal deaths were reported in the routine Health Management Information System. Data quality varied between regions. Conclusions: The quality of routine data gathered in the health system needs further attention. We suggest regular triangulation with data from other sources. We recommend addressing the denominator issues, reducing the complexity of indicators, and aligning indicators to international definitions

EFFECTS OF SINTERING, AGEING AND CRYOGENIC TREATMENTS ON STRUCTURAL AND MECHANICAL PROPERTIES OF AA2014-B4C COMPOSITE

Bu çalışmada, gaz atomizasyon yöntemi ile üretilen AA2014 alaşım tozlarına, basınçlı infiltrasyon yöntemiyle, %10 ve %20 B4C takviye edilerek kompozit yapı elde edilmeye çalışılmıştır. Üretilen AA2014-B4C kompozit yapısına uygulanan; sıvı faz sinterleme, yaşlandırma ve kriyojenik soğutma işlemlerinin sertliğe ve mikro yapıya etkileri belirlenmeye çalışılmıştır. Mikro yapıların incelemelerinde SEM ve MAP analizlerinden yararlanılarak, ısıl işlemlerin mikro yapı etkileri belirlenmeye çalışılmıştır. Kriyojenik soğutma işlemi sonrasında elde edilen sertlik değerleri, sinterleme ve yaşlandırma sonrasında elde edilen sertlik değerlerinden yüksek çıkması, kriyojenik işlemin bilhassa yaşlandırılabilir alaşımlar üzerinde etkin rol oynayabileceğini göstermektedir.In this study, powders of gas atomized AA2014 and solid B4C were mixed and then used in an infiltration system. To attain particulate reinforced aluminum composites, fine particles of B4C were added in right proportions of 10% and 20% respectively. Micro structures of AA2014-B4C composite were then analyzed systematically, where at first hardness measurement were applied after liquid phase sintering, ageing and cryogenic cooling. Samples were then analyzed with scanning electron microscopy (SEM) techniques to determine the effect of several heat treatment steps on the microstructure. It was found that hardness values particularly obtained right after cryogenic cooling treatment were considerably higher than that of sintering and ageing treatments. These results show that, application of cryogenics may play an effective role in the behaviour of age-hardenable alloys

Households' dietary habits and food consumption patterns in Hamishkoreib locality, Kassala State, Sudan

Background: Hamishkoreib is among the localities that have suffered most from chronic food insecurity in Kassala State, Sudan. This study was designed to determine the dietary habits and food consumption patterns in this locality. Methods: A descriptive cross-sectional survey was conducted among 403 households in the Hamishkoreib locality from June 2014 to February 2015. Sociodemographic and dietary information was collected through a modified food frequency questionnaire. The collected data were analyzed using SPSS 16.0 to estimate the frequency of variables. Results: Among 403 households, the incidence of informal education and illiteracy was 93.3%. Charcoal production and firewood cutting as the main source of income was reported by 66.6%. Three meals per day were consumed by 83.4% of households. They depended largely on cereal foods, particularly sorghum in the form of kissra and assida. Milk and dairy products were dominant in breakfast and dinner. Meat was consumed by 67.7% of households just once per week. However, chicken, fish, and eggs were rarely consumed (1.5%, 0.7%, and 19.8% respectively). Most (85.3%) households related poor or rare consumption of these protein- rich foods to culture, while 14.7% related it to financial reasons or illness. These types of food were mainly consumed by men and were not allowed to be consumed by women and children. Tea and coffee were excessively consumed in the morning and during the day. Fruit and vegetable consumption was low. Conclusion: The study revealed consumption of an unbalanced diet with insufficient proteins and micronutrients. There was excessive consumption of tea and coffee, which had a negative impact on food intake and absorption. The paper recommends launching a major nutrition program to encourage diversity of food consumption and to improve the capacity building of households

Exploring data quality and use of the routine health information system in Ethiopia: a mixed-methods study.

OBJECTIVE: A routine health information system (RHIS) enables decision making in the healthcare system. We aimed to analyse data quality at the district and regional level and explore factors and perceptions affecting the quality and use of routine data. DESIGN: This was a mixed-methods study. We used the WHO toolkit for analysing data quality and interviewed staff at the point of data generation and along with the flow of data. Data were analysed using the Performance of Routine Information System Management framework. SETTING: This study was performed in eight districts in four regions of Ethiopia. The study was nested within a 2-year programme of the Operational Research and Coaching for government Analysts. PARTICIPANTS: We visited 45 health posts, 1 district hospital, 16 health centres and 8 district offices for analysis of routine RHIS data and interviewed 117 staff members for the qualitative assessment. OUTCOME MEASURES: We assessed availability of source documents, completeness, timeliness and accuracy of reporting of routine data, and explored data quality and use perceptions. RESULTS: There was variable quality of both indicator and data element. Data on maternal health and immunisation were of higher quality than data on child nutrition. Issues ranged from simple organisational factors, such as availability of register books, to intricate technical issues, like complexity of indicators and choice of denominators based on population estimates. Respondents showed knowledge of the reporting procedures, but also demonstrated limited skills, lack of supportive supervision and reporting to please the next level. We saw limited examples of the use of data by the staff who were responsible for data reporting. CONCLUSION: We identified important organisational, technical, behavioural and process factors that need further attention to improve the quality and use of RHIS data in Ethiopia