A Case Study of the Health Information System in Gaborone : Information Flow and Managers’ Information Use

Background: Developing countries experiences an increasing burden of disease as well as challenges financial and human resources. Good information about the current situation of the health situation is important in planning, monitoring, evaluation, resource allocation, and need assessments. A well functioning health information system for gathering, processing, analysing and using health information will facilitate this. Objectives: Three main areas have been examined in this thesis; an analysis of the simplicity, user-friendliness, overlap, relevance, completeness and effectiveness of data collection tools used in the Gaborone district, what this information is used for and how managers use it. The last objective has been to identify improvement possibilities the information flow between health facilities in Gaborone district and the selected health programmes. Methodology: This thesis focuses on information flow between and information use among managers. Through a case study of HIS in the capital area, Gaborone, focusing on selected health programmes (Mental Health, Prevention of Mother To Child Transmission, Mother and Child Health, and Expanded Programme on Immunization) data were collected over a 12 weeks period. 10 observations, in a total of eight facilities and administrations, in Gaborone health district were performed. The study resulted in eight semi-structured interviews of managers in the national, district and facility levels of Botswana. Monthly reports from the PMTCT, Mental Health, EPI, MCH health programmes were collected from the facilities under observation. Results: The information flow is diverse and fragmented, differing from programme to programme. Two coexisting HIS was identified, one formal and informal system. The SOURCE-analysis mainly revealed a problem of overlapping data collection tools. The form of the EPI programme is the only one amongst the assessed programmes that satisfy all the SOURCE criterions. The study revealed data quality discrepancies, in terms of incorrectness, incompleteness, inconsistencies and un-timeliness of delivering reports. Un-timeliness is one of the major constraints of the HIS according to the informants. An equal pattern of information use was seen among all the interviewed managers. Facility and district level seems to have a lower degree of information use than the national level. The findings are however not distinct. Human and technical resources vary from programme to programme and facility to facility. Conclusion: The challenges of overlap, data quality, informal information channels and coordination were perceived to be interconnected and they all contributed to managers’ non-access to and use of information. It is argued that the HIS of Gaborone is unsuccessful

An observational study comparing HPV prevalence and type distribution between HPV-vaccinated and -unvaccinated girls after introduction of school-based HPV vaccination in Norway.

BackgroundMany countries have initiated school-based human papillomavirus (HPV) vaccination programs. The real-life effectiveness of HPV vaccines has become increasingly evident, especially among girls vaccinated before HPV exposure in countries with high vaccine uptake. In 2009, Norway initiated a school-based HPV vaccination program for 12-year-old girls using the quadrivalent HPV vaccine (Gardasil®), which targets HPV6, 11, 16, and 18. Here, we aim to assess type-specific vaginal and oral HPV prevalence in vaccinated compared with unvaccinated girls in the first birth cohort eligible for school-based vaccination (born in 1997).MethodsThis observational, cross-sectional study measured the HPV prevalence ratio (PR) between vaccinated and unvaccinated girls in Norway. Facebook advertisement was used to recruit participants and disseminate information about the study. Participants self-sampled vaginal and oral specimens using an Evalyn® Brush and a FLOQSwab™, respectively. Sexual behavior was ascertained through a short questionnaire.ResultsAmong the 312 participants, 239 (76.6%) had received at least one dose of HPV vaccine prior to sexual debut. 39.1% of vaginal samples were positive for any HPV type, with similar prevalence among vaccinated and unvaccinated girls (38.5% vs 41.1%, PR: 0.93, 95% confidence interval [CI]: 0.62-1.41). For vaccine-targeted types there was some evidence of lower prevalence in the vaccinated (0.4%) compared to the unvaccinated (6.8%) group (PR: 0.06, 95%CI: 0.01-0.52). This difference remained after adjusting for sexual behavior (PR: 0.04, 95%CI: 0.00-0.42). Only four oral samples were positive for any HPV type, and all of these participants had received at least one dose of HPV vaccine at least 1 year before oral sexual debut.ConclusionThere is evidence of a lower prevalence of vaccine-targeted HPV types in the vagina of vaccinated girls from the first birth cohort eligible for school-based HPV vaccination in Norway; this was not the case when considering all HPV types or types not included in the quadrivalent HPV vaccine