Background: Timely vaccination is key to prevent unnecessary childhood mortality from vaccine-pre... more Background: Timely vaccination is key to prevent unnecessary childhood mortality from vaccine-preventable diseases. Despite the substantial efforts to improve vaccination completeness, the effort towards timeliness of vaccination is limited with non-attendance and delays to vaccination appointments remaining a big challenge in developing countries. There is also a limited evidence on timeliness of vaccination. Therefore, this study aimed to determine the magnitude and associated factors for timely completion of vaccination among children in Gondar city administration, north-west, Ethiopia.Method: This study employed a community-based cross sectional study design. A sample size of 821 children aged 12 to 23 months were considered. Two stages random sampling technique was used to select study subjects. To account the effect of clustering, bivariable and multivariable multilevel logistic regression analysis were applied. The measures of association estimates were expressed as adjusted ...
BACKGROUND Unique patient identification remains a challenge in many healthcare settings within l... more BACKGROUND Unique patient identification remains a challenge in many healthcare settings within low- and middle-income countries (LMICs). Without national-level unique identifiers for whole populations, countries rely on deterministic and probabilistic patient matching approaches that have proven suboptimal in LMICs. Affordable bio-metric-based approaches, implemented with consideration of contextual ethical, legal and social implications (ELSI), have a potential to address patient identification challenges and to improve care quality, patient safety and reporting accuracy. However, limited studies exist to evaluate actual performance of biometric approaches and perceptions towards these systems within LMIC contexts. OBJECTIVE To evaluate performance and acceptability of fingerprint technology (FPT) for unique patient matching and identification in the LMIC setting of Kenya METHODS This cross-sectional study was conducted at a HIV care and treatment facility in Western Kenya. An ope...
Background: The District Health Information Software-2 (DHIS2) is widely used by countries for na... more Background: The District Health Information Software-2 (DHIS2) is widely used by countries for national-level aggregate reporting of health-data. To best leverage DHIS2 data for decision-making, countries need to ensure that data within their systems are of the highest quality. Comprehensive, systematic, and transparent data cleaning approaches form a core component of preparing DHIS2 data for analyses. Unfortunately, there is paucity of exhaustive and systematic descriptions of data cleaning processes employed on DHIS2-based data. The aim of this study was to report on methods and results of a systematic and replicable data cleaning approach applied on HIV-data gathered within DHIS2 from 2011 to 2018 in Kenya, for secondary analyses. Methods: Six programmatic area reports containing HIV-indicators were extracted from DHIS2 for all care facilities in all counties in Kenya from 2011 to 2018. Data variables extracted included reporting rate, reporting timeliness, and HIV-indicator dat...
Background The District Health Information Software 2 (DHIS2) is widely used by countries for nat... more Background The District Health Information Software 2 (DHIS2) is widely used by countries for national-level aggregate reporting of health data. To best leverage DHIS2 data for decision-making, countries need to ensure that data within their systems are of the highest quality. Comprehensive, systematic and transparent data cleaning approaches form a core component of preparing DHIS2 data for use. Unfortunately, there is paucity of exhaustive and systematic descriptions of data cleaning processes employed on DHIS2-based data. In this paper, we describe results of systematic data cleaning approach applied on a national-level DHIS2 instance, using Kenya as the case example. Methods Broeck et al’s framework, involving repeated cycles of a three-phase process (data screening, data diagnosis and data treatment), was employed on six HIV indicator reports collected monthly from all care facilities in Kenya from 2011 to 2018. This resulted to repeated facility reporting instances. Quality di...
IntroductionNon-attendance and delay in vaccination schedules remain a big challenge to healthcar... more IntroductionNon-attendance and delay in vaccination schedules remain a big challenge to healthcare workers. With the continuous growth of mobile network coverage and exponential penetration of mobile devices in the developing world, adoption of short message service has been shown to increase attendance for health services by targeting participant characteristics such as forgetfulness. Therefore, the aim of this trial is to determine the effect of mobile text message reminders on completeness and timeliness of childhood vaccination in North-West, Ethiopia.Methods and analysisA two-arm, parallel, superiority, randomised controlled trial study will be employed. The study arms are the intervention group (text message reminders plus routine care) and the control group (routine care only). Mother–infant pairs will be randomised to one of the groups during enrolment. The trial will consider a sample size of 434 mother–infant pairs with 1:1 allocation ratio. Mothers assigned to the interve...
Background: The World Health Organization estimates that 29% of under-five mortality could be pre... more Background: The World Health Organization estimates that 29% of under-five mortality could be prevented with existing vaccines. However, non-consistent attendance for immunization appointments remains a global challenge to healthcare providers. Thus, innovative strategies are required to reach the last mile where technology could be effectively utilized to achieve better compliance with children immunization schedules. Therefore, the aim of the review was to systematically collect and summarize the available evidence on the effectiveness of text message reminders on childhood vaccination. Methods: This review was conducted according to a priori published protocol on PROSPERO. A systematic literature search of databases (PubMed/MEDLINE, EMBASE, Cochrane/Wiley library, and Science direct) was conducted. Eligibility and risk of bias assessments were performed independently by two reviewers. PRISMA flow diagrams were used to summarize the study selection process. Taking into account the level of heterogeneity, a random effects model was used and risk ratios with their 95% CI were used to present the pooled estimates. To investigate the sources of heterogeneity, subgroup analysis and meta-regression analysis were also considered. In this review, publication bias was assessed statistically using Harbord test. Results: A total of 1771 articles were searched. Out of those 1771 articles, 558 duplicated articles were removed. About 1213 articles were further screened, and finally, ten articles met the inclusion criteria. The meta-analysis showed that there is a significant effect of text message reminders on childhood vaccination coverage (RR = 1.11; 95% CI 1.05-1.17) with a moderate level of heterogeneity (I 2 = 64.3%, P = 0.003). The results from the Harbord test suggested that there is no evidence for publication bias (P = 0.340). Conclusion: This review highlights the potential benefits of incorporating mobile text message reminders into the standard management of childhood immunizations, especially in low-and middle-income countries. The frequency and timing of the text message reminders are also crucial in determining the effectiveness of text message reminders. Hence, mHealth interventions deserve more attention as a potential innovation to improve healthcare programs. Systematic review registration: PROSPERO CRD42017074230
Journal of the American Medical Informatics Association : JAMIA, 2018
The introduction of mobile communication technologies in health care in low- and middle-income co... more The introduction of mobile communication technologies in health care in low- and middle-income countries offers an opportunity for increased efficiencies in provision of care, improved utilization of scarce resources, reductions in workload, and increased reach of services to a larger target population. Short message service (SMS) technologies offer promise, with several large-scale SMS-based implementations already under way. Still largely lacking in the research literature are evaluations of specific ethical issues that arise when SMS programs are implemented and studied in resource-limited settings. In this paper, we examine the ethical issues raised by the deployment of SMS messaging to support patient retention in HIV care and treatment and in the research conducted to evaluate that deployment. We use case studies that are based in Mozambique and ground our discussion in the ethical framework for international research proposed by Emanuel et al., highlighting ethical considerat...
Studies in health technology and informatics, 2017
National Health Data Warehouses (NHDWHs) promise to improve individual and population health. The... more National Health Data Warehouses (NHDWHs) promise to improve individual and population health. These systems are now increasingly being deployed in low- and middle-income countries (LMICs), given increased recognition of the value of data analytics in informing decision-making. However, ethical issues relevant to implementation of NHDWHs in LMICs remain largely ignored or, at best, inadequately addressed. In this paper, we highlight and critically analyze several of the key ethical issues, including privacy, informed consent and trust, confidentiality and security, secondary data use, sustainability and implementation validity, risk-benefit ratio, governance and conflict of interest, justice, equity, access, and collaborative partnerships. We then provide a set of guiding principles and points to consider for countries and implementers to guide further decision-making around ethics of implementing NHDWHs within LMICs.
Studies in health technology and informatics, 2017
As healthcare organizations strive to improve quality of care and patient safety, it becomes para... more As healthcare organizations strive to improve quality of care and patient safety, it becomes paramount that they identify patients correctly and match records accurately both within and across institutions. Continuous care and population health benefits can be optimized when providers can have a comprehensive view of a patient's health record through seamless health information exchange. Various patient matching techniques have emerged to facilitate accurate patient identification. In this paper, we present a review of existing patient matching techniques, analyzed based on accuracy, cost and execution time.
ObjectivesOnly half of consultants' medical recommendations are implemented. We created a... more ObjectivesOnly half of consultants' medical recommendations are implemented. We created a tool that lets referring providers review and implement electronic recommendations made by consultants, with the hypothesis that facilitation with our tool could improve implementation.MeasurementsThe tool was piloted among geriatrics consultants and hospitalists. Pre-post evaluation was done with control (before pilot; N = 20) and intervention (after pilot; N =
Randomized trials are difficult to perform in resource-limited settings. We developed a Randomiza... more Randomized trials are difficult to perform in resource-limited settings. We developed a Randomization and Enrollment Tool (RET) within a live EHRs which automated enrollment, randomization, and data-collection in support of robust EHRs-based randomized interventions. We describe an observational assessment of RET which we piloted at three Kenyan HIV clinics for a decision support trial. We manually evaluated RET’s adequacy and accuracy in its core functions. RET enrolled 327/6626 patients, 100% meeting criteria based on EHRs data. Human reviews reveal that only 250 patients (76.5%) should have been enrolled as the EHRs contained inaccurate data for the other 77 (23.4%). 23 eligible patients were also missed through sole reliance on EHRs data. 18 (5.5%) RET-enrolled patients never received the intervention because of missed appointments. An automated randomization tool has potential to reduce human and financial costs of conducting EHRs-based randomized trials, but remains vulnerable to data quality and workflow limitations.
Studies in health technology and informatics, 2015
Current approaches for capacity building in Health Informatics (HI) in developing countries mostl... more Current approaches for capacity building in Health Informatics (HI) in developing countries mostly focus on training, and often rely on support from foreign entities. In this paper, we describe a comprehensive and multidimensional capacity-building framework by Lansang & Dennis, and its application for HI capacity building as implemented in a higher-education institution in Kenya. This framework incorporates training, learning-by-doing, partnerships, and centers of excellence. At Moi University (Kenya), the training dimensions include an accredited Masters in HI Program, PhD in HI, and HI short courses. Learning-by-doing occurs through work within MOH facilities at the AMPATH care and treatment program serving 3 million people. Moi University has formed strategic HI partnerships with Regenstrief Institute, Inc. (USA), University of Bergen (Norway), and Makerere University (Uganda), among others. The University has also created an Institute of Biomedical Informatics to serve as an HI...
Journal of the American Medical Informatics Association : JAMIA, May 9, 2015
Efficient, effective health care requires rapid availability of patient information. We designed,... more Efficient, effective health care requires rapid availability of patient information. We designed, implemented, and assessed the impact of a primary care electronic medical record (EMR) in three rural Kenyan health centers. Local clinicians identified data required for primary care and public health reporting. We designed paper encounter forms to capture these data in adult medicine, pediatric, and antenatal clinics. Encounter form data were hand-entered into a new primary care module in an existing EMR serving onsite clinics serving patients infected with the human immunodeficiency virus (HIV). Before subsequent visits, Summary Reports were printed containing selected patient data with reminders for needed HIV care. We assessed effects on patient flow and provider work with time-motion studies before implementation and two years later, and we surveyed providers' satisfaction with the EMR. Between September 2008 and December 2011, 72 635 primary care patients were registered and ...
Studies in health technology and informatics, 2015
The increasing adoption of Electronic Health Records (EHR) by developing countries comes with the... more The increasing adoption of Electronic Health Records (EHR) by developing countries comes with the need to develop common terminology standards to assure semantic interoperability. In Kenya, where the Ministry of Health has rolled out an EHR at 646 sites, several challenges have emerged including variable dictionaries across implementations, inability to easily share data across systems, lack of expertise in dictionary management, lack of central coordination and custody of a terminology service, inadequately defined policies and processes, insufficient infrastructure, among others. A Concept Working Group was constituted to address these challenges. The country settled on a common Kenya data dictionary, initially derived as a subset of the Columbia International eHealth Laboratory (CIEL) / Millennium Villages Project (MVP) dictionary. The initial dictionary scope largely focuses on clinical needs. Processes and policies around dictionary management are being guided by the framework ...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2015
Shortages of health workers and large number of HIV-infected persons in Africa mean that time to ... more Shortages of health workers and large number of HIV-infected persons in Africa mean that time to provide antiretroviral therapy (ART) adherence and other messages to patients is limited. Using time-motion methodology we documented the intensity and nature of counseling delivered to patients. The study was conducted at a rural and an urban HIV clinic in western Kenya. We recorded all activities of 190 adult patients on ART during their return clinic visits to assess type, frequency, and duration of counseling messages. Mean visit length for patients at the rural clinic was 44.5 (SD=27.9) minutes and at urban clinic was 78.2 (SD=42.1) minutes. Median time spent receiving any counseling during a visit was 4.07 minutes (IQR 1.57-7.33) at rural and 3.99 (IQR 2.87-6.25) minutes at urban, representing 11% and 8% of total mean visit time respectively. Median time patients received ART adherence counseling was 1.29 (IQR 0.77-2.83) minutes at rural and 1.76 (IQR 1.23-2.83) minutes at urban (p=0.001 for difference). Patients received a median of 0.18 (0-0.72) minutes at rural and 0.28 (IQR 0-0.67) minutes at urban clinic of counseling regarding contraception and pregnancy. Most patients in the study did not receive any counseling regarding alcohol/substance use, emerging risks for ongoing HIV transmission. Though ART adherence was discussed with most patients, time was limited. Reproductive counseling was provided to only half of patients, and 'positive prevention' messaging was minimal. There are strategic opportunities to enhance counseling and information received by clients within HIV programs in resource-limited settings.
Studies in health technology and informatics, 2013
In sub-Saharan Africa (SSA), cardiovascular disease (CVD) is the leading cause of death among ind... more In sub-Saharan Africa (SSA), cardiovascular disease (CVD) is the leading cause of death among individuals over the age of 30. Hypertension, a major risk factor for CVD, contributes significantly to the CVD burden in SSA. In order to address the human resource challenge of managing hypertension in low- and middle-income countries (LMICs), task-shifting hypertension care from physicians to nurses has been proposed. To support this task-shifting strategy, the Academic Partnership Providing Access to Healthcare (AMPATH) has developed an Android tablet-based electronic Decision Support and Integrated Record-Keeping (DESIRE) tool to record patient data and assist with clinical decision-making. We investigated the usability of the DESIRE tool in the setting of nurse management of hypertension in rural western Kenya through the use of "mock patient" encounters and "think aloud" exercises. Fiftyseven critical incidents were identified and twenty-three design changes were ...
Background: Timely vaccination is key to prevent unnecessary childhood mortality from vaccine-pre... more Background: Timely vaccination is key to prevent unnecessary childhood mortality from vaccine-preventable diseases. Despite the substantial efforts to improve vaccination completeness, the effort towards timeliness of vaccination is limited with non-attendance and delays to vaccination appointments remaining a big challenge in developing countries. There is also a limited evidence on timeliness of vaccination. Therefore, this study aimed to determine the magnitude and associated factors for timely completion of vaccination among children in Gondar city administration, north-west, Ethiopia.Method: This study employed a community-based cross sectional study design. A sample size of 821 children aged 12 to 23 months were considered. Two stages random sampling technique was used to select study subjects. To account the effect of clustering, bivariable and multivariable multilevel logistic regression analysis were applied. The measures of association estimates were expressed as adjusted ...
BACKGROUND Unique patient identification remains a challenge in many healthcare settings within l... more BACKGROUND Unique patient identification remains a challenge in many healthcare settings within low- and middle-income countries (LMICs). Without national-level unique identifiers for whole populations, countries rely on deterministic and probabilistic patient matching approaches that have proven suboptimal in LMICs. Affordable bio-metric-based approaches, implemented with consideration of contextual ethical, legal and social implications (ELSI), have a potential to address patient identification challenges and to improve care quality, patient safety and reporting accuracy. However, limited studies exist to evaluate actual performance of biometric approaches and perceptions towards these systems within LMIC contexts. OBJECTIVE To evaluate performance and acceptability of fingerprint technology (FPT) for unique patient matching and identification in the LMIC setting of Kenya METHODS This cross-sectional study was conducted at a HIV care and treatment facility in Western Kenya. An ope...
Background: The District Health Information Software-2 (DHIS2) is widely used by countries for na... more Background: The District Health Information Software-2 (DHIS2) is widely used by countries for national-level aggregate reporting of health-data. To best leverage DHIS2 data for decision-making, countries need to ensure that data within their systems are of the highest quality. Comprehensive, systematic, and transparent data cleaning approaches form a core component of preparing DHIS2 data for analyses. Unfortunately, there is paucity of exhaustive and systematic descriptions of data cleaning processes employed on DHIS2-based data. The aim of this study was to report on methods and results of a systematic and replicable data cleaning approach applied on HIV-data gathered within DHIS2 from 2011 to 2018 in Kenya, for secondary analyses. Methods: Six programmatic area reports containing HIV-indicators were extracted from DHIS2 for all care facilities in all counties in Kenya from 2011 to 2018. Data variables extracted included reporting rate, reporting timeliness, and HIV-indicator dat...
Background The District Health Information Software 2 (DHIS2) is widely used by countries for nat... more Background The District Health Information Software 2 (DHIS2) is widely used by countries for national-level aggregate reporting of health data. To best leverage DHIS2 data for decision-making, countries need to ensure that data within their systems are of the highest quality. Comprehensive, systematic and transparent data cleaning approaches form a core component of preparing DHIS2 data for use. Unfortunately, there is paucity of exhaustive and systematic descriptions of data cleaning processes employed on DHIS2-based data. In this paper, we describe results of systematic data cleaning approach applied on a national-level DHIS2 instance, using Kenya as the case example. Methods Broeck et al’s framework, involving repeated cycles of a three-phase process (data screening, data diagnosis and data treatment), was employed on six HIV indicator reports collected monthly from all care facilities in Kenya from 2011 to 2018. This resulted to repeated facility reporting instances. Quality di...
IntroductionNon-attendance and delay in vaccination schedules remain a big challenge to healthcar... more IntroductionNon-attendance and delay in vaccination schedules remain a big challenge to healthcare workers. With the continuous growth of mobile network coverage and exponential penetration of mobile devices in the developing world, adoption of short message service has been shown to increase attendance for health services by targeting participant characteristics such as forgetfulness. Therefore, the aim of this trial is to determine the effect of mobile text message reminders on completeness and timeliness of childhood vaccination in North-West, Ethiopia.Methods and analysisA two-arm, parallel, superiority, randomised controlled trial study will be employed. The study arms are the intervention group (text message reminders plus routine care) and the control group (routine care only). Mother–infant pairs will be randomised to one of the groups during enrolment. The trial will consider a sample size of 434 mother–infant pairs with 1:1 allocation ratio. Mothers assigned to the interve...
Background: The World Health Organization estimates that 29% of under-five mortality could be pre... more Background: The World Health Organization estimates that 29% of under-five mortality could be prevented with existing vaccines. However, non-consistent attendance for immunization appointments remains a global challenge to healthcare providers. Thus, innovative strategies are required to reach the last mile where technology could be effectively utilized to achieve better compliance with children immunization schedules. Therefore, the aim of the review was to systematically collect and summarize the available evidence on the effectiveness of text message reminders on childhood vaccination. Methods: This review was conducted according to a priori published protocol on PROSPERO. A systematic literature search of databases (PubMed/MEDLINE, EMBASE, Cochrane/Wiley library, and Science direct) was conducted. Eligibility and risk of bias assessments were performed independently by two reviewers. PRISMA flow diagrams were used to summarize the study selection process. Taking into account the level of heterogeneity, a random effects model was used and risk ratios with their 95% CI were used to present the pooled estimates. To investigate the sources of heterogeneity, subgroup analysis and meta-regression analysis were also considered. In this review, publication bias was assessed statistically using Harbord test. Results: A total of 1771 articles were searched. Out of those 1771 articles, 558 duplicated articles were removed. About 1213 articles were further screened, and finally, ten articles met the inclusion criteria. The meta-analysis showed that there is a significant effect of text message reminders on childhood vaccination coverage (RR = 1.11; 95% CI 1.05-1.17) with a moderate level of heterogeneity (I 2 = 64.3%, P = 0.003). The results from the Harbord test suggested that there is no evidence for publication bias (P = 0.340). Conclusion: This review highlights the potential benefits of incorporating mobile text message reminders into the standard management of childhood immunizations, especially in low-and middle-income countries. The frequency and timing of the text message reminders are also crucial in determining the effectiveness of text message reminders. Hence, mHealth interventions deserve more attention as a potential innovation to improve healthcare programs. Systematic review registration: PROSPERO CRD42017074230
Journal of the American Medical Informatics Association : JAMIA, 2018
The introduction of mobile communication technologies in health care in low- and middle-income co... more The introduction of mobile communication technologies in health care in low- and middle-income countries offers an opportunity for increased efficiencies in provision of care, improved utilization of scarce resources, reductions in workload, and increased reach of services to a larger target population. Short message service (SMS) technologies offer promise, with several large-scale SMS-based implementations already under way. Still largely lacking in the research literature are evaluations of specific ethical issues that arise when SMS programs are implemented and studied in resource-limited settings. In this paper, we examine the ethical issues raised by the deployment of SMS messaging to support patient retention in HIV care and treatment and in the research conducted to evaluate that deployment. We use case studies that are based in Mozambique and ground our discussion in the ethical framework for international research proposed by Emanuel et al., highlighting ethical considerat...
Studies in health technology and informatics, 2017
National Health Data Warehouses (NHDWHs) promise to improve individual and population health. The... more National Health Data Warehouses (NHDWHs) promise to improve individual and population health. These systems are now increasingly being deployed in low- and middle-income countries (LMICs), given increased recognition of the value of data analytics in informing decision-making. However, ethical issues relevant to implementation of NHDWHs in LMICs remain largely ignored or, at best, inadequately addressed. In this paper, we highlight and critically analyze several of the key ethical issues, including privacy, informed consent and trust, confidentiality and security, secondary data use, sustainability and implementation validity, risk-benefit ratio, governance and conflict of interest, justice, equity, access, and collaborative partnerships. We then provide a set of guiding principles and points to consider for countries and implementers to guide further decision-making around ethics of implementing NHDWHs within LMICs.
Studies in health technology and informatics, 2017
As healthcare organizations strive to improve quality of care and patient safety, it becomes para... more As healthcare organizations strive to improve quality of care and patient safety, it becomes paramount that they identify patients correctly and match records accurately both within and across institutions. Continuous care and population health benefits can be optimized when providers can have a comprehensive view of a patient's health record through seamless health information exchange. Various patient matching techniques have emerged to facilitate accurate patient identification. In this paper, we present a review of existing patient matching techniques, analyzed based on accuracy, cost and execution time.
ObjectivesOnly half of consultants' medical recommendations are implemented. We created a... more ObjectivesOnly half of consultants' medical recommendations are implemented. We created a tool that lets referring providers review and implement electronic recommendations made by consultants, with the hypothesis that facilitation with our tool could improve implementation.MeasurementsThe tool was piloted among geriatrics consultants and hospitalists. Pre-post evaluation was done with control (before pilot; N = 20) and intervention (after pilot; N =
Randomized trials are difficult to perform in resource-limited settings. We developed a Randomiza... more Randomized trials are difficult to perform in resource-limited settings. We developed a Randomization and Enrollment Tool (RET) within a live EHRs which automated enrollment, randomization, and data-collection in support of robust EHRs-based randomized interventions. We describe an observational assessment of RET which we piloted at three Kenyan HIV clinics for a decision support trial. We manually evaluated RET’s adequacy and accuracy in its core functions. RET enrolled 327/6626 patients, 100% meeting criteria based on EHRs data. Human reviews reveal that only 250 patients (76.5%) should have been enrolled as the EHRs contained inaccurate data for the other 77 (23.4%). 23 eligible patients were also missed through sole reliance on EHRs data. 18 (5.5%) RET-enrolled patients never received the intervention because of missed appointments. An automated randomization tool has potential to reduce human and financial costs of conducting EHRs-based randomized trials, but remains vulnerable to data quality and workflow limitations.
Studies in health technology and informatics, 2015
Current approaches for capacity building in Health Informatics (HI) in developing countries mostl... more Current approaches for capacity building in Health Informatics (HI) in developing countries mostly focus on training, and often rely on support from foreign entities. In this paper, we describe a comprehensive and multidimensional capacity-building framework by Lansang & Dennis, and its application for HI capacity building as implemented in a higher-education institution in Kenya. This framework incorporates training, learning-by-doing, partnerships, and centers of excellence. At Moi University (Kenya), the training dimensions include an accredited Masters in HI Program, PhD in HI, and HI short courses. Learning-by-doing occurs through work within MOH facilities at the AMPATH care and treatment program serving 3 million people. Moi University has formed strategic HI partnerships with Regenstrief Institute, Inc. (USA), University of Bergen (Norway), and Makerere University (Uganda), among others. The University has also created an Institute of Biomedical Informatics to serve as an HI...
Journal of the American Medical Informatics Association : JAMIA, May 9, 2015
Efficient, effective health care requires rapid availability of patient information. We designed,... more Efficient, effective health care requires rapid availability of patient information. We designed, implemented, and assessed the impact of a primary care electronic medical record (EMR) in three rural Kenyan health centers. Local clinicians identified data required for primary care and public health reporting. We designed paper encounter forms to capture these data in adult medicine, pediatric, and antenatal clinics. Encounter form data were hand-entered into a new primary care module in an existing EMR serving onsite clinics serving patients infected with the human immunodeficiency virus (HIV). Before subsequent visits, Summary Reports were printed containing selected patient data with reminders for needed HIV care. We assessed effects on patient flow and provider work with time-motion studies before implementation and two years later, and we surveyed providers' satisfaction with the EMR. Between September 2008 and December 2011, 72 635 primary care patients were registered and ...
Studies in health technology and informatics, 2015
The increasing adoption of Electronic Health Records (EHR) by developing countries comes with the... more The increasing adoption of Electronic Health Records (EHR) by developing countries comes with the need to develop common terminology standards to assure semantic interoperability. In Kenya, where the Ministry of Health has rolled out an EHR at 646 sites, several challenges have emerged including variable dictionaries across implementations, inability to easily share data across systems, lack of expertise in dictionary management, lack of central coordination and custody of a terminology service, inadequately defined policies and processes, insufficient infrastructure, among others. A Concept Working Group was constituted to address these challenges. The country settled on a common Kenya data dictionary, initially derived as a subset of the Columbia International eHealth Laboratory (CIEL) / Millennium Villages Project (MVP) dictionary. The initial dictionary scope largely focuses on clinical needs. Processes and policies around dictionary management are being guided by the framework ...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2015
Shortages of health workers and large number of HIV-infected persons in Africa mean that time to ... more Shortages of health workers and large number of HIV-infected persons in Africa mean that time to provide antiretroviral therapy (ART) adherence and other messages to patients is limited. Using time-motion methodology we documented the intensity and nature of counseling delivered to patients. The study was conducted at a rural and an urban HIV clinic in western Kenya. We recorded all activities of 190 adult patients on ART during their return clinic visits to assess type, frequency, and duration of counseling messages. Mean visit length for patients at the rural clinic was 44.5 (SD=27.9) minutes and at urban clinic was 78.2 (SD=42.1) minutes. Median time spent receiving any counseling during a visit was 4.07 minutes (IQR 1.57-7.33) at rural and 3.99 (IQR 2.87-6.25) minutes at urban, representing 11% and 8% of total mean visit time respectively. Median time patients received ART adherence counseling was 1.29 (IQR 0.77-2.83) minutes at rural and 1.76 (IQR 1.23-2.83) minutes at urban (p=0.001 for difference). Patients received a median of 0.18 (0-0.72) minutes at rural and 0.28 (IQR 0-0.67) minutes at urban clinic of counseling regarding contraception and pregnancy. Most patients in the study did not receive any counseling regarding alcohol/substance use, emerging risks for ongoing HIV transmission. Though ART adherence was discussed with most patients, time was limited. Reproductive counseling was provided to only half of patients, and 'positive prevention' messaging was minimal. There are strategic opportunities to enhance counseling and information received by clients within HIV programs in resource-limited settings.
Studies in health technology and informatics, 2013
In sub-Saharan Africa (SSA), cardiovascular disease (CVD) is the leading cause of death among ind... more In sub-Saharan Africa (SSA), cardiovascular disease (CVD) is the leading cause of death among individuals over the age of 30. Hypertension, a major risk factor for CVD, contributes significantly to the CVD burden in SSA. In order to address the human resource challenge of managing hypertension in low- and middle-income countries (LMICs), task-shifting hypertension care from physicians to nurses has been proposed. To support this task-shifting strategy, the Academic Partnership Providing Access to Healthcare (AMPATH) has developed an Android tablet-based electronic Decision Support and Integrated Record-Keeping (DESIRE) tool to record patient data and assist with clinical decision-making. We investigated the usability of the DESIRE tool in the setting of nurse management of hypertension in rural western Kenya through the use of "mock patient" encounters and "think aloud" exercises. Fiftyseven critical incidents were identified and twenty-three design changes were ...
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Papers by Martin Were