Innovations in Monitoring Vital Events:Mobile Phone SMS Support to Improve Coverage of Birth and Death Registration: A Scalable Solution

Civil Registration (CR) of births and deaths is an essential component of any health information system.\ud Globally, across low income countries, CR suffers from unacceptably poor quality coverage. This Health\ud Information Systems Knowledge Hub (HIS Hub) working paper summarises and reports the results, conclusions and outlook from a small six-month project that investigated the potential of introducing a mobile phone step into the routine CR system in a rural district in Tanzania. The project developed a computer application that could receive SMS messages—from existing basic mobile phones of community-based CR officers—and feed them directly to the District Registrar’s office and computer. The message contained the details from the birth or death notification form. The system provided instant access to notifications and automatic feedback to the Village Executive Officer (VEO) if the family that experienced the birth or death event failed to register the event for certification. It also prompted the VEO to follow up with the family by conducting a questionnaire, administered by mobile phone, to determine and communicate the reasons for the non-registration. The District Civil Registrar was also able to monitor trends in these notifications via a user-friendly webbased browser and dashboard. The system was tested for six months and validated against an independent prospective household surveillance system that monitors pregnancies, births and deaths in the same period. In summary, the findings showed that the routine CR system notified only 28% of total births in the period. Adding the SMS step increased this to 51% of births. The routine CR system notified only 2.1% of deaths in the period. Adding the SMS step increased this to 14% of deaths. The SMS step therefore made significant improvements in the notification step (and modest improvements in the registration step) of routine CR. However, both notifications and registrations still fell well short of reality at community level. The most important finding of this pilot is that the current CR system in at least the study district, and likely in most of rural Tanzania, is essentially unable to provide adequate registration coverage for births and deaths, and that coverage is so low that even log order improvements are insufficient to lift it to satisfactory levels (in excess of 90%). This, as yet, says nothing regarding the quality of the data. No overwhelming reason is provided by families for the low reporting rate, suggesting that the problems are highly systemic and will need a radical redesign of CR processes to solve. To the extent that similar problems prevail in other low-income countries, it is clear that whatever these processes will be, some form of scalable real-time mobile communication such as SMS will greatly facilitate coverage levels. This pilot shows\ud that such technology is feasible. But these results also emphasise the need for an end-to-end overhaul of the\ud architecture and processes of how CR systems are built and integrated into the information fabric of a country. Small incremental technical fixes will not suffice\u

The cost of treating stroke in urban and rural Tanzania: a 6-month pilot study

Background: Economic evaluations have significant roles in informing funding decisions. They provide the means to choose which programme of care to fund among the many competing for resources. Unlike in higher-income countries, published studies on economic evaluations of stroke in Sub-Saharan Africa are rare.Objective: To pilot a method for estimating the cost of treating stroke in rural and urban Tanzania that will assist with future economic evaluations of stroke.Methods: The pilot study was conducted as part of the Tanzania Stroke Incidence Study. Incident cases were reported by resident community informants. Cost data were summarised from project documents and data on out-ofpocket payments were collected by interviewing patients/carers. Productivity losses relating to post-stroke occupations were also estimated in monetary terms using standard monthly salary estimates by job category and gender.Results: Sixteen incident cases (11 rural and 5 urban) were identified and followed-up for six monthsin 2005/2006. The overall mean cost per case was TZS 256,338 (USD 220) and included diagnostic tests (blood, ECG, echocardiogram, chest X-ray, CT scans), hospitalisation cost (registration, inpatient stay and drugs), transport cost to designated hospitals, physiotherapy and out-of-pocket payments to other points of care. Costs were more than four-fold higher in the urban district than in the rural district. Mean productivity loss per patient was TZS 247,930 (USD 213) and was more than double in the urban district than in the rural district.Conclusion: This is the first published research investigating the cost of treating stroke in Tanzania. A bigger sample, long-term follow up and modeling are required for better estimates of stroke economic burden.Keywords: Cost analysis, Stroke, Tanzania, Sub-Saharan Africa, Populations Rural/Urba

Data Resource Profile: The sentinel panel of districts: Tanzania's national platform for health impact evaluation.

The Sentinel Panel of Districts (SPD) consists of 23 districts selected to provide nationally representative data on demographic and health indicators in Tanzania. The SPD has two arms: SAVVY and FBIS. SAVVY (SAmple Vital registration with Verbal autopsY) is a demographic surveillance system that provides nationally representative estimates of mortalities based on age, sex, residence and zone. SAVVY covers over 805 000 persons, or about 2% of the Tanzania mainland population, and uses repeat household census every 4-5 years, with ongoing reporting of births, deaths and causes of deaths. The FBIS (Facility-Based Information System) collects routine national health management information system data. These health service use data are collected monthly at all public and private health facilities in SPD districts, i.e. about 35% of all facilities in Mainland Tanzania. Both SAVVY and FBIS systems are capable of generating supplementary information from nested periodic surveys. Additional information about the design of the SPD is available online: access to some of SPD's aggregate data can be requested by sending an e-mail to [[email protected]]

Post-stroke case fatality within an incident population in rural Tanzania.

BACKGROUND AND PURPOSE: To establish post-stroke case fatality rates within a community based incident stroke population in rural Tanzania. METHODS: Incident stroke cases were identified by the Tanzanian Stroke Incidence Project and followed-up over the next 3-6 years. In order to provide a more complete picture, verbal autopsy (VA) was also used to identify all stroke deaths occurring within the same community and time period, and a date of stroke was identified by interview with a relative or friend. RESULTS: Over 3 years, the Tanzanian Stroke Incidence Project identified 130 cases of incident stroke, of which 31 (23.8%, 95% CI 16.5 to 31.2) died within 28 days and 78 (60.0%, 95% CI 51.6 to 68.4) within 3 years of incident stroke. Over the same time period, an additional 223 deaths from stroke were identified by VA; 64 (28.7%, 95% CI 20.9 to 36.5) had died within 28 days of stroke and 188 (84.3%, 95% CI 78.1 to 90.6) within 3 years. CONCLUSIONS: This is the first published study of post-stroke mortality in sub-Saharan Africa from an incident stroke population. The 28 day case fatality rate is at the lower end of rates reported for other low and middle income countries, even when including those identified by VA, although CIs were wide. Three year case fatality rates are notably higher than seen in most developed world studies. Improving post-stroke care may help to reduce stroke case fatality in sub-Saharan Africa