Challenges in information systems and research in global health. The case of Manhiça Health Research Center in Mozambique. Aponte J. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)

1. 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

2. Centro de Investigação em Saúde da
Manhiça
Moçambique
Fighting disease
Promoting development
Collaborative programme
Ministerio da Saude - Faculdade de Medicina (UEM)
Fundacio Clinic de Barcelona - Spanish Agency for International
Cooperation

3. Study area
MOZAMB IQU E
MOZAMB IQU E
Manhica District
Manhica District
DSS Site
DSS Site


Mozambique
Mozambique
Maputo Province
Maputo Province
0 100200
100200
0 100200
0 100 200
0
0 50
50 100
100
Kilometers
Kilometers
Kilometers
Kilometers
Kilometers
LOCATION OF MANHICA DSS SITE, MOZAMBIQUE, 36,000

4. Research
Paediatric deaths in communitty
Rank Age Group
based on
Tackling the main causes of proportion
0–27 28 d – 11 12–59 6-14
morbidity and mortality in children days1 months2 months3 years4
under the age of 5 years and
pregnant women in sub saharan 1 Premat
(31%)
Malaria
(22.6%)
Malaria
(31.4%)
Malaria
(18.2%)
Africa: the most vulnerable
population groups 2 Neonatal
asphyxia
Pneumoni
(19.1%)
Malnutriti
(20.1%)
Open
wounds,
(16.3%) burns, etc.
(10.4%)
Total Fertility Rate 5,1 3 Septicaeia Malnutritin Pneumon Trauma
(14.6%) (10.0%) (10.4%) (10.4%)
IMR 88,9
Neonatal MR 41,8 4 Pneumoni Diarrhoea Diarrhoea Pneumoa
5q0 172,7 (10.6%) (8.0%) (6.0%) (9.1%)
Life Expectancy 55 y No Meningitis No Meningitis
5
consensus (7.5%) consensus (9.1%)
(7.3%) (5.7%)
4

5. 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
80-84
- Key informants weekly 70-74
60-64
- Daily maternal services (3)
50-54
40-44
30-34
20-24
10-14
0-4
10 5 0 5 10
S. Masculino S.femenino
6

7. Geographical Platform
- Well defined study area
Manhiça (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
7

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
8

9. Interactions
Morbidity Surveillance
Geographical
Permanent
ID
Number
Demographical Research Specific
Activities
Modular system that allows to measure the incidence/prevalence of
several diseases as well as risk factors which allows to evaluate the
effect of specific health interventions

11. 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

15. 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