Linked Data based Health Information Representation, Visualization and Retrieval System on the Semantic Web

Dissertation submitted in partial fulfillment of the requirements for the Degree of Master of Science in Geospatial Technologies.To better facilitate health information dissemination, using flexible ways to represent, query and visualize health data becomes increasingly important. Semantic Web technologies, which provide a common framework by allowing data to be shared and reused between applications, can be applied to the management of health data. Linked open data - a new semantic web standard to publish and link heterogonous data- allows not only human, but also machine to brows data in unlimited way. Through a use case of world health organization HIV data of sub Saharan Africa - which is severely affected by HIV epidemic, this thesis built a linked data based health information representation, querying and visualization system. All the data was represented with RDF, by interlinking it with other related datasets, which are already on the cloud. Over all, the system have more than 21,000 triples with a SPARQL endpoint; where users can download and use the data and – a SPARQL query interface where users can put different type of query and retrieve the result. Additionally, It has also a visualization interface where users can visualize the SPARQL result with a tool of their preference. For users who are not familiar with SPARQL queries, they can use the linked data search engine interface to search and browse the data. From this system we can depict that current linked open data technologies have a big potential to represent heterogonous health data in a flexible and reusable manner and they can serve in intelligent queries, which can support decision-making. However, in order to get the best from these technologies, improvements are needed both at the level of triple stores performance and domain-specific ontological vocabularies

Comprehensive Evaluation of Electronic Medical Record System Use and User Satisfaction at Five Low-Resource Setting Hospitals in Ethiopia

Background: Electronic medical record (EMR) systems are increasingly being implemented in hospitals of developing countries to improve patient care and clinical service. However, only limited evaluation studies are available concerning the level of adoption and determinant factors of success in those settings. Objective: The objective of this study was to assess the usage pattern, user satisfaction level, and determinants of health professional’s satisfaction towards a comprehensive EMR system implemented in Ethiopia where parallel documentation using the EMR and the paper-based medical records is in practice. Methods: A quantitative, cross-sectional study design was used to assess the usage pattern, user satisfaction level, and determinant factors of an EMR system implemented in Ethiopia based on the DeLone and McLean model of information system success. Descriptive statistical methods were applied to analyze the data and a binary logistic regression model was used to identify determinant factors. Results: Health professionals (N=422) from five hospitals were approached and 406 responded to the survey (96.2% response rate). Out of the respondents, 76.1% (309/406) started to use the system immediately after implementation and user training, but only 31.7% (98/309) of the professionals reported using the EMR during the study (after 3 years of implementation). Of the 12 core EMR functions, 3 were never used by most respondents, and they were also unaware of 4 of the core EMR functions. It was found that 61.4% (190/309) of the health professionals reported over all dissatisfaction with the EMR (median=4, interquartile range (IQR)=1) on a 5-level Likert scale. Physicians were more dissatisfied (median=5, IQR=1) when compared to nurses (median=4, IQR=1) and the health management information system (HMIS) staff (median=2, IQR=1). Of all the participants, 64.4% (199/309) believed that the EMR had no positive impact on the quality of care. The participants indicated an agreement with the system and information quality (median=2, IQR=0.5) but strongly disagreed with the service quality (median=5, IQR=1). The logistic regression showed a strong correlation between system use and dissatisfaction (OR 7.99, 95% CI 5.62-9.10) and service quality and satisfaction (OR 8.23, 95% CI 3.23-17.01). Conclusions: Health professionals’ use of the EMR is low and they are generally dissatisfied with the service of the implemented system. The results of this study show that this dissatisfaction is caused mainly and strongly by the poor service quality, the current practice of double documentation (EMR and paper-based), and partial departmental use of the system in the hospitals. Thus, future interventions to improve the current use or future deployment projects should focus on improving the service quality such as power infrastructure, user support, trainings, and more computers in the wards. After service quality improvement, other departments (especially inter-dependent departments) should be motivated and supported to use the EMR to avoid the dependency deadlock

Design and Development of a Linked Open Data-Based Health Information Representation and Visualization System: Potentials and Preliminary Evaluation

Background: Healthcare organizations around the world are challenged by pressures to reduce cost, improve coordination and outcome, and provide more with less. This requires effective planning and evidence-based practice by generating important information from available data. Thus, flexible and user-friendly ways to represent, query, and visualize health data becomes increasingly important. International organizations such as the World Health Organization (WHO) regularly publish vital data on priority health topics that can be utilized for public health policy and health service development. However, the data in most portals is displayed in either Excel or PDF formats, which makes information discovery and reuse difficult. Linked Open Data (LOD)—a new Semantic Web set of best practice of standards to publish and link heterogeneous data—can be applied to the representation and management of public level health data to alleviate such challenges. However, the technologies behind building LOD systems and their effectiveness for health data are yet to be assessed. Objective: The objective of this study is to evaluate whether Linked Data technologies are potential options for health information representation, visualization, and retrieval systems development and to identify the available tools and methodologies to build Linked Data-based health information systems. Methods: We used the Resource Description Framework (RDF) for data representation, Fuseki triple store for data storage, and Sgvizler for information visualization. Additionally, we integrated SPARQL query interface for interacting with the data. We primarily use the WHO health observatory dataset to test the system. All the data were represented using RDF and interlinked with other related datasets on the Web of Data using Silk—a link discovery framework for Web of Data. A preliminary usability assessment was conducted following the System Usability Scale (SUS) method. Results: We developed an LOD-based health information representation, querying, and visualization system by using Linked Data tools. We imported more than 20,000 HIV-related data elements on mortality, prevalence, incidence, and related variables, which are freely available from the WHO global health observatory database. Additionally, we automatically linked 5312 data elements from DBpedia, Bio2RDF, and LinkedCT using the Silk framework. The system users can retrieve and visualize health information according to their interests. For users who are not familiar with SPARQL queries, we integrated a Linked Data search engine interface to search and browse the data. We used the system to represent and store the data, facilitating flexible queries and different kinds of visualizations. The preliminary user evaluation score by public health data managers and users was 82 on the SUS usability measurement scale. The need to write queries in the interface was the main reported difficulty of LOD-based systems to the end user. Conclusions: The system introduced in this article shows that current LOD technologies are a promising alternative to represent heterogeneous health data in a flexible and reusable manner so that they can serve intelligent queries, and ultimately support decision-making. However, the development of advanced text-based search engines is necessary to increase its usability especially for nontechnical users. Further research with large data sets is recommended in the future to unfold the potential of Linked Data and Semantic Web for future health information systems development

Immunization data quality and factors influencing data generation, handling and use in Wogera District, Northern Ethiopia, 2020

Abstract Background: Data quality is a vital metric in health information systems to ascertain improved health of individuals and community as well. Immunization data are critical inputs in assessing national performance of expanded program on immunization and child health improvement. Inconsistent health data happens when variations arise in the report and re-count from the source documents. Aim: This study aimed to assess immunization data quality and factors influencing data generation, handling, and use. Methods: Both qualitative and quantitative data were used. Immunization recording and reporting documents were reviewed at 41 health facilities of primary health care units. Twenty health workforces were interviewed on healthcare data quality, generation, handling, and use. The Statistical Package for the Social Sciences (SPSS) for windows version 26 was used to perform quantitative data analysis and open code version 4.02 was used for qualitative data analysis. Data accuracy was presented using mean and standard deviation of data verification factor. Results: Over-reporting of immunization data elements was observed. The highest accuracy (75%) was reported for full immunization at health center level followed by 62.5% for measles. The difference between verification factor of ideal reports and observed values, indicates that there is over reporting in all immunization data elements by 44% (27-61%), 46% (=31-61%), 40% (12-61%), 37% (11-63%), and 38% (12-64%) in BCG, Penta 1, Penta 3, measles, and full immunization, respectively. Supervision, availability of recording and reporting tools, training, motivation, attitudes towards healthcare data, hard to reach areas and manual documentation were influencing factors of immunization data quality, generation, handling, and use. Conclusion: The study revealed that health facilities over-reported immunization data elements in primary health care units. Attentions should be given to address organization, behavioral, technical, and contextual factors influencing immunization data quality, generation, handling, and use. [Ethiop. J. Health Dev. 2021; 35(SI-3):56-64] Keywords: Immunization data quality, Factors influencing, Verification factor, Wogera distric

Embedding implementation research to strengthen efforts towards improving primary health care in resource limited settings

Immunization reaches more people than any other health service and it is a vital component of primary health care (PHC) (1,2). The Immunization Agenda 2030 emphasizes building strong national immunization programs integrated into primary health care services as the basis for achieving high vaccination coverage (2). In Ethiopia, immunization services are the backbone of PHC and are delivered in all public health facilities across the country (1). Even though the national EPI target is to reach a coverage of 90%(1), achieving and maintaining high immunization coverage is challenged by multifaceted demand and supply side implementation barriers (3–5). These barriers are related to community engagement, immunization service delivery, supply chain management, and surveillance and data management of the immunization program (5). Consequently, the national full vaccination coverage stalled at 43% (6)

Women's Independent Household Decision Making Power and its influence on their Autonomy in relation to Child Vaccinations: a mixed-method study among Women of Reproductive Age in Northwest Ethiopia

AbstractBackground: The importance of women’s empowerment in influencing health outcomes has received attention globally, but there is limited information in Ethiopia on the relationship between women's household decision making power and the autonomy of decision making in relation to child vaccinations.Aim: The study aimed to assess the role of women's household decision making power on their autonomy in relation to child vaccinations.Methods: A community based mixed method study design was conducted among women who had 12–23-month-old children in Wogera district, Ethiopia. The sample size was determined using a single population proportion formula for the quantitative aspect of the study and the data collection for the qualitative study continued until saturation. The quantitative data was collected using a piloted questionnaire. SPSS software was used for quantitative data analyses. X2-square test was conducted to explore the association between women's household decision making power and their autonomy in relation to decision making around child vaccinations. Framework analysis was employed to analyse qualitative data using open code software.Results: A total of 584 women participated in the quantitative study and 13 In-depth interviews (IDI) with 13 key informants (KII)were conducted for the qualitative study. Majority, 88.2% (95% CI: 85.7, 90.6) of the respondents have autonomy to vaccinate children. This study showed that nearly two-thirds, 61.6% of the women had household decision making power. Respondents of the qualitative study noted that women had low household decision making power. Women's household decision making power is associated with women's autonomy to vaccinate children (x2=92.775a, df=1, P<0.001).Conclusions: The overall level of women’s household decision making power was relatively low compared to EDHS reports whereas women's autonomy to chid vaccination was high. There was a strong relationship between women’s household decision making power and their autonomy in relation to child vaccinations. It is therefore important to implement activities, for example, provision of behavioural change communication (BCC) in the community, that can improve women’s household decision making power which in turn will influence child vaccination coverage. [Ethiop. J. Health Dev. 2021; 35(SI-3):86-97]Key words: Women, Household decision making power, Women's autonomy, Vaccinatio

The Implementation of Social and Behavior Change Communication Intervention to Improve Immunization Demand: A qualitative study in Awabel District, Northwest Ethiopia

AbstractBackground: Immunization coverage in Ethiopia is low, and dropout rates are high. Social Behavior Change Communication (SBCC) interventions were introduced as a means of combating the ‘demand-side’ immunization barriers. However, Little research exists in terms of the efficacy of the SBCC intervention, in terms of promoting uptake, and improving the immunization demands in Ethiopia.Aim: To explore the current implementation status, and perceived effectiveness of SBCC intervention, barriers and facilitators with new strategies aimed at effective implementation of the SBCC intervention in Awabel District, Northwest Ethiopia.Methods: A phenomenological qualitative study was conducted from January 1- October 31, 2020. In-dept interviews were conducted with fifteen key-informants using a piloted semi-structured interview guide. Participants were purposively selected, which comprised of mangers, Expanded Program of Immunization (EPI) focal personnel, Health Extension Workers (HEWs), Women Development Armies (WDAs), mothers and community representatives. Six vaccination sessions were observed. Coding was done to identify patterns. Thematic analysis was performed using Open Code 4. 02.Results: Interpersonal communication, community conversation, social mobilization and family modeling were used as SBCC approaches. HEWs were the key source of information. Religious leaders were among the major stakeholders that encourage immunization. SBCC was perceived as an effective measure to improve immunization demand. There were multiple barriers for implementation of SBCC interventions including limited resources, lack of awareness, geographic barriers, traditional beliefs, lack of incentives, and limited EPI staff and health facility operating hours. Engagement of fathers and religious leaders, strengthening the WDA, and allocation of more resources were listed as possible strategies to tackle barriers.Conclusion: The implementation of SBCC interventions is important to improve immunization demand. Despite its effectiveness, there are several multi-level barriers to its successful implementation. Further, greater investments are required to improve infrastructures, staff employment and capacity building. [Ethiop. J. Health Dev. 2021; 35(SI-3):49-55]Keywords: Immunization, SBCC, Ethiopi

Full immunization coverage and its determinants among children aged 12-23 months in Wogera district, Northwest Ethiopia

AbstractBackground: Immunization is considered one of the most affordable health initiatives for children. Though there is good progress in Ethiopia, the amount of fully vaccinated children, is still below the target. Possible challenges include women having home visits and men’s’ involvement in vaccination uptake. Therefore, this study aimed to determine full immunization coverage and its determinants among children aged 12- 23 months in Wogera districts, Northwest Ethiopia.Aim: This study aimed to determine the full immunization coverage and its determinants among children aged 12-23 months, and to assess the level of immunization coverage and its determinants in Wogera districts, Northwest Ethiopia.Methods: A community-based cross-sectional study was conducted in Wogera district from May 28-June 25/2020. Cluster sampling method was used to recruit 598 study participants. Interviewer administered questionnaire was used to collect data. A bivariable and multivariable logistic regression analysis was done to identify factors associated with full immunization. Odds ratios with 95% Confidence intervals were used to determine significant variables.Results: A total of 584 mothers who had children aged 12-23 months participated in this study. The full immunization coverage was 76.5% (95%CI 73.2-79.8). Mother age >40 years (AOR=7.37, 95% CI: 1.65, 32); mothers who initiate vaccine uptake(woman empowerment) (AOR=1.57, 95% CI: 1.13-2.39); mothers who had 1-3 ANC visit (AOR=2.51, 95% CI:1.14, 5.52), and 4+ ANC follow up (AOR=2.73,95% CI: 1.26, 5.91); r health extension worker's home visit during the first weeks of postpartum period (AOR=1.76,95% CI:1.10, 2.84), and males involved in child immunization (AOR=3.27, 95% CI:1.84, 5.81) was positively associated with being fully vaccinated , however, birth order of 6 and above (AOR=0.35, 95% CI: 0.14, 0.86) was negatively associated with being fully vaccinated.Conclusion: In this study, the full immunization coverage is found to be suboptimal, and it is far from the expected national target coverage. Maternal health care uptake; women empowerment; home visits by HEW during the first week of the postpartum period and male involvement in child immunization were found to be predictors of being fully vaccinated. [Ethiop. J. Health Dev. 2021; 35(SI-3):16-27]Keywords: Full immunization, Children12-23 months, Northwest Ethiopia, Male involvemen

The Burden of Internal Conflict on Expanded Programs on Immunization in Northwest Ethiopia: Implementation Science Study

AbstractBackground: Despite the rapid progress in immunization service delivery systems worldwide, populations in areas of conflict often have limited or no access to lifesaving vaccines. Hence, evidence generation and translation for context-specific strategies and tailored action would be important, before, during and after an acute humanitarian emergency.Aim: To explore factors affecting immunization service delivery during and after conflict among internally displaced communities in Northwest Ethiopia.Methods: Qualitative and quantitative (record review) methods were applied, phenomenological study design and in-depth interviews were applied to collect the lived experiences of participants in the affected areas. Transcribed and translated data were analyzed and thematized using open code software. A Twenty-four-month record review of quantitative data was analyzed descriptively using an excel sheet to develop immunization coverage trends for tracer antigens.Results: We found that the immunization program had seriously deteriorated during and after the conflict in the study area. The monthly EPI service report in the affected areas showed a decline with the lowest records in December and January when the internal conflict was peak. Security problems, displacement of health workers, destruction of health infrastructures, mixing of the displaced community in the host community and poor coordination among stakeholders and partners, clients having other emergent needs and shortages of resources were important factors for immunization services.Conclusion: Vaccination service delivery was found to have significantly declined in the study area. Security problems affected not only the service utilizers but also the service providers’ wing as well. Coordination of stakeholders and strong leadership systems are crucial in maintaining optimum vaccination service delivery even at the time of conflict. [Ethiop. J. Health Dev. 2021; 35(SI-3):39-48]Key words: Conflict, internally displaced, Immunization service

Implementation fidelity and challenges of optimal cold chain management in Assossa district health system, Benshangul-Gumuz region, Western Ethiopia

AbstractIntroduction: Preventive programs which have proven to be effective in clinical trials may not necessarily impact the health and wellbeing of the community unless they are implemented with fidelity. While cold chain is the backbone of immunization programs, limited studies exist to explain fidelity implementation which likely contributes to a lack of evidence-based instructional practices of cold chain management.Aim: This study aimed to explore the fidelity implementation and challenges of optimal cold chain management in the Benshangul-gumuz region.Methods: A qualitative approach was utilized to explore the underlying challenges to optimum implementation of cold chain management in Benshangul-gumuz region. Observational techniques and key informant interviews with 12 key-informants were conducted. Data was collected at all levels of the health system including, the regional health bureau, Ethiopian Pharmaceuticals Supply Agency hub, district health offices, Health centers, and health posts. Data analysis and interpretation was performed using the framework analysis approach. Open Code 4.02 software was used for analysis.Findings: This study identified three main themes including adherence to intervention, human resource development, and availability and use of resources. The findings also revealed that a significant number of the employees were not adhering to the optimal cold chain management guidelines. Staff development, availability and utilization of equipment and related finances were major fidelity implementation challenges of cold chain management.Conclusions: Across the health facilities under study, implementation fidelity of cold chain management was considered poor. Human resource development, proper allocation and effective management of logistics and related finance could facilitate optimal cold chain management practices, and efforts to save lives through delivery of safe and quality vaccines. [Ethiop. J. Health Dev. 2021; 35(SI-3):03-08]Keywords: Cold chain management, Implementation fidelity, Challenges, Ethiopi