Challenges in information systems

and research in global health.

The case of Manhiça Health

Research Center in Mozambique

John Aponte, MD, MSc

CRESIB – Hospital Clinic Barcelona

CISM - Mozambique

Fighting disease

Promoting development

Collaborative programmeMinisterio da Saude - Faculdade de Medicina (UEM)

Fundacio Clinic de Barcelona - Spanish Agency for International Cooperation

Centro de Investigação em Saúde daManhiçaMoçambique

Study area

0 100 200

Kilometers

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KilometersKilometersKilometersKilometersKilometersKilometersKilometersKilometersKilometers000000000 505050505050505050

KilometersKilometersKilometersKilometersKilometersKilometersKilometersKilometersKilometers

100100100100100100100100100

LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000

M O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U EM O Z A M B I Q U E

Maputo ProvinceMaputo ProvinceMaputo ProvinceMaputo ProvinceMaputo ProvinceMaputo ProvinceMaputo ProvinceMaputo ProvinceMaputo Province

Manhica DistrictManhica DistrictManhica DistrictManhica DistrictManhica DistrictManhica DistrictManhica DistrictManhica DistrictManhica District

DSS SiteDSS SiteDSS SiteDSS SiteDSS SiteDSS SiteDSS SiteDSS SiteDSS Site

MozambiqueMozambiqueMozambiqueMozambiqueMozambiqueMozambiqueMozambiqueMozambiqueMozambique

4

Research

Tackling the main causes of

morbidity and mortality in children

under the age of 5 years and

pregnant women in sub saharan

Africa: the most vulnerable

population groups

Rank

based on

proportion

Age Group

0–27

days1

28 d – 11

months2

12–59

months3

6-14

years4

1 Premat

(31%)

Malaria

(22.6%)

Malaria

(31.4%)

Malaria

(18.2%)

2 Neonatal

asphyxia

(16.3%)

Pneumoni

(19.1%)

Malnutriti

(20.1%)

Open

wounds,

burns, etc.

(10.4%)

3 Septicaeia

(14.6%)

Malnutritin

(10.0%)

Pneumon

(10.4%)

Trauma

(10.4%)

4 Pneumoni

(10.6%)

Diarrhoea

(8.0%)

Diarrhoea

(6.0%)

Pneumoa

(9.1%)

5 No

consensus

(7.3%)

Meningitis

(7.5%)

No

consensus

(5.7%)

Meningitis

(9.1%)

Paediatric deaths in communitty

Total Fertility Rate 5,1

IMR 88,9

Neonatal MR 41,8

5q0 172,7

Life Expectancy 55 y

The Problem…

• In many places in south saharan Africa, people

can live and die without being registered ever..

• How to optimize resources?

6

Demographic Platform

- 85 000 under control by follow up (DSS)-Births-Deaths-Pregnancies-Migration

- Personal identification by an unique permanent number

- House visits 2/year

- Key informants weekly

- Daily maternal services (3)

10 5 0 5 10

0-4

10-14

20-24

30-34

40-44

50-54

60-64

70-74

80-84

S. Masculino S.femenino

7

Geographical Platform

- Well defined study areaManhiça (1996)Mantchiana, Palmeira (2002)Ilha Josina (2002)Taninga (2006)Palmeira (2009)

- Identification of Households in the study area and GPS position

- Map generation

- Geographical distrubution of risk factors and confounders

Incidence of Malaria by ACD

8

Morbidity Surveillance Platform

- Passive Case Detection Surveillance

Hospital system operating for all paediatric attendances round

the clock

Manhiça Hospital (24 hours/day)

Maragra health centre

Ilha Josina, Taninga, Palmeria and Malavene health post

- Active Case Detection Cohorts

Based on the localization of individuals in DSS

- Cross sectional studies

Random samples from targeted population from DSS

Interactions

Permanent

ID

Number

Demographical

Morbidity Surveillance

Research Specific

Activities

Modular system that allows to measure the incidence/prevalence of several diseases as well as risk factors which allows to evaluate theeffect of specific health interventions

Geographical

Tools

• In 1996 the infrastructure available in the zone

was minimum

• Unreliable electrical supply

• No phones

• No support for technology

• Paper was the only reliable tool

Challenges for the future

Paper free work –>

Now days the infrastructure has change and

make possible new alternatives

- Capture of information using mobile devices

- Electronic CRFs for clinical trials

- Lab information systems to process all information

from the labs

Tools to identify people at health facilities ->

- Identification based on finger prints