Design a web based maternal death surveillance and response system for addis ababa city administration health bureau, ethiopia

Design a Web-based Maternal Death Surveillance 2017 and Response System Addis Ababa University School of Information Science And School of Public Health Design a Web-Based Maternal Death Surveillance and Response System for Addis Ababa City Administration Health Bureau, Ethiopia By SELAMAWIT GOSAYE A Project Submitted to the School of Graduate Studies of Addis Ababa University in the Partial Fulfillment of the Requirement for the Degree of Master of Science in Health Informatics June 2017 Design a Web-based Maternal Death Surveillance 2017 and Response System ADDIS ABABA UNIVERSITY SCHOOL OF PUBLIC HEALTH AND SCHOOL OF INFORMATION SCIENCES M.SC IN HEALTH INFORMATICS Design a Web-based Maternal Death Surveillance and Response System for Addis Ababa City Administration Health Bureau By SELAMAWIT GOSAYE Advisors Ato Getachew Jemaneh Signature Ato Wondmu Ayele Date Signature Date Signature Date Approved by Examining Board Dr Wondessen Mulugeta Dr Ababi Zergaw _ Signature _ Date Design a Web-based Maternal Death Surveillance 2017 and Response System Dedication This project is dedicated to my two daughters remaining my ignorance and the patience’s they showed during my project study Design a Web-based Maternal Death Surveillance 2017 and Response System Acknowledgement First of all I would like to thank the almighty God When I found myself at the feeling of fulfillment, I realized though only my name appears on the cover of this dissertation, a great many people including my family members, well-wishers, my friends and colleagues at various level contributed to accomplish this huge task At this moment of accomplishment I am greatly indebted to my research adviser Mr Getachew Jmaneh and Mr Wendmu Ayele, who accepted me This work would not have been possible without your guidance and involvement, your support and encouragement on daily from the start of the project till date I sincerely thank you from bottom of my heart and will be truly indebted to you throughout my life time I greatly appreciate and acknowledge the support received from participant institutions Most of the results described in this project would not have been obtained without their support I am equally thankful to Ethiopian federal ministry of health, EPHI , Addis Ababa Health Bureau specially Mr Mesfin Wosen and Mr.Guluma Alemayew ,Gulele Sub-City, Addis Ketema SubCity, Kolfe Keraniyo Sub-City, Gandi Memorial Hospital, Woreda 11 Health Administration and Woereda11( Pilipos) health center staffs My earnest thanks to Addis Ababa University for supporting and sponsoring this project I am grateful thanks for free fee female sponsorship of this master’s program No research project is possible without infrastructure and requisite materials and resource For this I extend thanks to Addis Ababa University Faculty of Business Library, Post Graduate Library and Digital Library I would like to express my deepest appreciation for Meseret Ayano coordinator of Health Informatics program, for her support, facilitation and encouragement throughout the study period I am extremely thankful to Dr Workshet Lamenew for his help and suggestions during this project studies My deep gratitude also goes to Ermiyas T , Atkelt Michael , for my friends for their help at various level and ever growing kindness for me, and for my families specially for Shneh Mersha and Raheal Mersha God bless you Last but not least my special thanks go to a very special person, my husband, Ermiyas Mersha for his continued and unfailing love, support and understanding during my project You were always around at times I thought that it is impossible to continue, you helped me to keep things in perspective My lovely daughter’s MELONI ERMIAS AND AVILA ERMIAS thank you for your understanding i Design a Web-based Maternal Death Surveillance 2017 and Response System Acronyms A.A H.B Addis Ababa Health Bureau BPMN Business Process Model and Notation CBD Community Based Death CRVS Civil Registration and Vital Statistics DB Data Base EDHS Ethiopia Demographic and Health Surveys EFMoH Ethiopia Federal Ministry of Health EPHI Ethiopian Public Health Institution EUC Essential Use Case EUI Essential User Interface FBD Facility Based Death FMoH Federal Ministry of Health GC Gregorian calendar GTP Growth and Transformation Plan HC Health Center HSTP Health Sector Transformation Plan HTML Hyper Text Markup Language ICT Information Communication Technology IDSR Integrated Disease Surveillance and Response ISO International Organization for Standardization K.K Kolfe Keraniyo LB Live Birth LMICs Low- and Middle-Income Countries MDR Maternal Death Response ii Design a Web-based Maternal Death Surveillance 2017 and Response System MDSR Maternal Death Surveillance and Response MDSS Maternal Death Surveillance System MMR Maternal Mortality Ret MySQL Structured Query Language NGO None Governmental Organization OO Object Oriented PHP Hypertext Processer UI UML UP WHO User Interface Unified Modeling Language Unified Process World Health Organization iii Design a Web-based Maternal Death Surveillance 2017 and Response System Abstract Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy Each maternal death has a story to tell and can provide indications on practical ways of addressing its causes and determinants Most of these deaths could have been prevented with quality care Accurate information on how many women died, where they died and why they died is essential, however currently the information is not containing all the necessary data The Maternal Death Surveillance and Response done with clear standards provide information that can be used in the development of programs and interventions to improve maternal health The existing paper based MDSR (Maternal Death Surveillance and Response) system has a problem of delaying of data and information flow from each level, lack of data quality, storage and retrieval of data as needed is difficult Information Communication Technologies (ICTs) can play in improving information and accountability The aim of the designed project is to automate the current paper based MDSR system in order to access adequate and timely information on the website from local to national level for Addis Ababa City Administration Health Bauer (health extension worker, Woreda Health Administration, health facilities, Sub-City, Addis Ababa Health Bauer and FMoH) The designed project was conducted in Addis Ababa and conceptually designing of the webbased Maternal Death Surveillance System for Addis Ababa City Administration Health Bureau The project used Unified Process methodology with object oriented approach In order to collect requirements, used a data collection tools (i.e interview and relevant document review) Analysis and design of the proposed system was performed by using the unified modeling language tools and Microsoft Visio 2013 software The system prototype is also developed in order to understand the design system System usability test was done to assess effectiveness, efficiency and satisfaction of the users on the developed prototype The newly design web-based Maternal Death Surveillance System can improve business process of the existing system i.e death recording , death notification, combine data ,record action plan about modifiable factors contributing to deaths and use the information to prevent similar deaths in the future It solve the challenges of obtaining accurate data, timely report, incompleteness of data, retrieving and storing data based on the need of stakeholders iv Design a Web-based Maternal Death Surveillance 2017 and Response System Table of Contents Acknowledgement ……………………………………………………………………………… i Acronyms ………………………………………………………………………………… …….ii Abstract ………………………………………………………………………………………… iv List of table ………………………………………………………… …………………………viii List of figure ……………………………………………………………………………….…… ix CHAPTER ONE 1 Introduction 1.1 Background 1.2 Statement of the Problem 1.3 Objective 1.3.1 General Objective 1.3.2 Specific Objective 1.4 Significance of the Project 1.5 Scope and Limitation 1.6 Organization of the Report CHAPTER TWO Literature Review 2.1 Health Information System 2.2 Health Information and Communication Technologies 2.2.1 World Wide Web 2.3 System Development Methodology Iterative and Incremental v Design a Web-based Maternal Death Surveillance 2017 and Response System Unified Modeling Language Use Case Modeling 10 Class Diagram Modeling 11 Sequence Diagram 11 Deployment Diagram 11 2.4 Maternal Death Surveillance and Response 12 2.4.1 Maternal Death 12 2.4.2 Surveillance 12 2.4.3 MDSR 12 2.5 Ethiopia Health Information Systems and MDSR 13 2.5.1 Ethiopia Health Information Systems 13 2.5.2 MDSR in Ethiopia 13 2.6 Related Work 14 CHAPER THREE 15 Methodology 15 3.1 Study Area and Period 15 3.2 Study Design 15 3.3 Source Population 15 3.4 Data Collection Tool 17 3.5 Method of Data Analysis 17 3.6 System Development 18 3.7 Prototype Usability Testing Method 18 3.8 Requirement Data Collection Quality Assurance 18 vi Design a Web-based Maternal Death Surveillance 2017 and Response System 3.9 Dissemination of Results 18 3.10 Operational Definitions 19 3.11 Ethical Consideration 20 Chapter four 21 Analysis and Design 21 Analysis 21 4.1 Analysis of the system 21 4.1.1 Overview of the Existing MDSR System 21 4.1.2 Findings of the Current MDSR System 22 4.1.2.1 Data Collection and Use of Information in the Current System 22 4.1.2.2 Report /Communication in the Current System 23 4.1.2.3 People in the Current System 23 4.1.2.4 Procedure (process) in the Current System 24 4.1.2.5 Technology (Software, Hardware and Network) in the Current System 25 Modeling 26 4.2 Business Process Modeling 26 4.2.1 The Existing MDSR System Business Process Modeling 26 4.3 Requirement Modelling 29 4.3.1 Functional Requirement 29 4.3.2 Non-functional Requirement 31 4.3.3 Business Model Use Case / Essential Use Case of MDSR 32 4.3.4 Essential User Interface Prototyping 34 4.4 System Analysis Modeling 39 vii Design a Web-basedAlphabetical Maternal Death Surveillance 2017 List of Zonal codes and Response System Addis Ababa Addis Ababa Addis Ababa Addis Ababa Addis Ababa Addis Ababa Addis Ababa Addis Ababa Addis Ababa 10 11 12 13 14 15 16 17 18 19 20 21 Addis Ababa Afar Afar Afar Afar Afar Amhara Amhara Amhara Amhara Amhara Amhara ADDIS KETEMA AKAKI/KALITI ARADA BOLE KIRKOS GULELE KOLFE KERANIO LIDETA NEFAS-SILK LAFTO YEKA AFAR AFAR AFAR AFAR AFAR AWI BAHIR DAR E GOJJAM N GONDAR N SHEWA N WOLLO 22 23 24 25 Amhara Amhara Amhara Amhara OROMIA S GONDAR S WELLO WAG HIMRA 26 27 Amhara BenshangulGumuz BenshangulGumuz BenshangulGumuz BenshangulGumuz Benshangul- W GOJJAM ASOSA ADD-YEK AFA-AF1 AFA-AF2 AFA-AF3 AFA-AF4 AFA-AF5 AMH-AWI AMH-BAH AMH-EGJ AMH-NGN AMH-NSA AMHNWO AMH-ORO AMH-SGN AMH-SWO AMHWAG AMH-WGJ BEN-ASO KEMASHI BEN-KEM 75 SNNPR SILTI SOU-SIL MAO-KOMO BEN-MAK 76 SNNPR S Omo SOU-SOU METEKEL BEN-MET 77 SNNPR WOLAYTA SOU-WOL PAWE BEN-PAW 78 SNNPR YEM SOU-YEM 28 29 30 31 ADD-ADK ADD-AKK ADD-ARA ADD-BOL ADD-KIR ADD-GUL ADD-KOK ADD-LID ADD-NSL 48 49 50 51 52 53 54 55 56 Oromia Oromia Oromia Oromia Oromia Oromia Oromia Oromia Oromia HORO GUDURU ILLUABABORA JIMA Jima Town KELEM Nekempt Town N SHOA SHASHEMENE Town SW SHEWA ORO-HOR ORO-ILB ORO-JIM ORO-JMT ORO-KEL ORO-NEK ORO-NSH ORO-SHA ORO-SWS 57 58 59 60 61 62 63 64 65 66 67 68 Oromia Oromia Oromia Oromia SNNPR SNNPR SNNPR SNNPR SNNPR SNNPR SNNPR SNNPR W ARSI W HARERGHE W SHEWA W WELLEGA ALABA BENCH MAJI DAWRO GAMO GOFA GEDEO GURAGHE HADIYA HAWASSA CA ORO-WAR ORO-WHA ORO-WSH ORO-WWE SOU-ALA SOU-BEN SOU-DAW SOU-GAM SOU-GED SOU-GUR SOU-HAD SOU-HWA 69 70 71 72 SNNPR SNNPR SNNPR SNNPR KEFA KEMBATA/TEMBARO KONTA Segen SOU-KEF SOU-KET SOU-KOT SOU-SEG 73 74 SNNPR SNNPR SHEKA SIDAMA SOU-SHK SOU-SID xxv xiv Design a Web-based Maternal Death Surveillance 2017 and Response System 32 33 34 Gumuz Dire-Dawa Gambela Gambela 35 36 37 38 39 40 41 Gambela Gambela Hareri Oromia Oromia Oromia Oromia 42 43 44 45 46 47 Oromia Oromia Oromia Oromia Oromia Oromia DIRE-DAWA AGNUAK GAMBELLA MEJENGER NUER HARERI ADAMA Town ARSI BALE BISHOFTU Town BORENA E HARERGHE E SHEWA E WELLEGA Finfine Zuria GUJI DIR-DIR GAM-AGN GAMGAM GAM-MEJ GAM-NUE HAR-HAR ORO-ADA ORO-ARI ORO-BAL ORO-BIS 79 80 81 Somali Somali Somali AFDER DOLLO FAFAN SOM-AFD SOM-DOL SOM-FAN 82 83 84 85 86 87 88 Somali Somali Somali Somali Somali Somali Tigray JARAR KORAH LIBEN NOGOB SHEBELE SITI C TIGARY SOM-JAR SOM-KOR SOM-LIB SOM-NOG SOM-SHE SOM-SIT TIG-CTI ORO-BOR ORO-EHA ORO-ESH ORO-EWE ORO-FIZ ORO-GUJ 89 90 91 92 93 94 Tigray Tigray Tigray Tigray Tigray Tigray E TIGARY MEKELLE NW TIGARY SE TIGARY S TIGARY W TIGARY TIG-EST TIG-MEK TIG-NWT TIG-SET TIG-STI TIG-WTI xxvi xiv Design a Web-based Maternal Death Surveillance 2017 and Response System Facility based maternal death form Abstractor related Name of the abstractor: Qualification of the Abstractor _ Telephone number of the abstractor: Date of abstraction: Was the abstractor involved in the management of the case? Yes No II Identification/ Back ground information No Question Response Medical Record Number of the deceased Age of deceased Years Time of death and date of death Ethnicity When did the death occur? In transit While waiting for treatment Place of usual residence Following start of treatment Woreda/subcity Kebele _ Got _ House number Religion Orthodox Muslim Protestant Educational status of the deceased Others (specify) -1.Illiterate 2.No education, but can read and write 3.Grade complete Don’t know Marital status of the deceased Single 2.Married Widowed Divorced Others (specify) xxvii xiv Design a Web-based Maternal Death Surveillance 2017 and Response System 10 Level of education of the husband 1.Illiterate 2.No education, but can read and write Grade completed _ 11 Occupation of the deceased Don’t know Farmer Merchant/tradesperson Public employee Daily labourer Unemployed 12 Occupation of the husband Others (e.g housewife) Farmer Merchant/tradesperson Public employee Daily labourer Unemployed 13 Monthly income if possible Others (specify) birr xxviii xiv Design a Web-based Maternal Death Surveillance 2017 and Response System VI Obstetric characteristics No Question Gravidity Parity Number of living children Attended ANC? If yes, where is the ANC? If yes, number of visits Response 3 Yes No Not known Health post Health center Hospital Other (specify) Basic package of services provided (Tick ALL that apply) RPR Hgb, Blood group, HIV status, U/A BP measurement during the follow up Fefol supplementation TT immunization Other (Specify) xxix xiv Design a Web-based Maternal Death Surveillance 2017 and Response System Problems or risk factors in the current pregnancy: (Tick ALL that apply) I Pre existing problems Hypertension Anaemia Diabetes HIV positive Cardiac problem Malaria Tuberculosis Hepatitis Other (Specify) II Antenatal/ intranatal problems/risks (Tick ALL that apply) Preeclampsia / eclampsia Placenta previa Previous Caesarean Section Multiple gestation Abnormal lie/presentation Anemia Malaria UTI/pyelonephritis Unintended pregnancy Other (specify) State of pregnancy at the time of death 10 If delivered, what is the outcome? 11 Date and place of delivery 12 Gestational Age at the time of death in antepartum and /or intra partum events (specify time period in months & weeks) Antepartum Intra partum Postpartum Post abortion Ectopic Live birth Stillbirth Date: Place of delivery: xxx xiv Design a Web-based Maternal Death Surveillance 2017 and Response System 13 No If the death was postpartum or post abortion, after how many days did the death occur? Facility Episode days Question Response Date of admission Day of admission Working days Weekends Holiday Time of admission Main reason/symptom for admission Is it a referred case? Yes No If “No” to question number go to number Referred from (Name of health facility) Reason for referral Comment on referral Working hours Nonworking hours Accompanied by HCWs Appropriate management 10 11 Summary of management at hospital Qualification of the most senior attending health professional(s) Primary cause of death 12 Is this preventable death? 13 If preventable maternal death, specify factors according to the three delay model Delay in seeking care Delay in reaching at right facility Delay within the facility (diagnostic and therapeutic) INSTRUCTIONS: This form should be stored with a copy of the relevant Verbal Autopsy Summary form (Annex 3) and Annex in a secured location (e.g locked cupboard in HC manager’s office) xxxi xiv Design a Web-based Maternal Death Surveillance 2017 and Response System Summary Form for Verbal Autopsy Number (This should be the number from the verbal autopsy) Age _ Address: Region: _ HouseNo: Zone: Woreda: _Kebele: Marital status: single: _ Married: widowed: other(specify): _ Religion: Ethnicity: _ Occupation: Level of education: Income: 10 Gravidity: 11 Parity: 12 Abortions: 13 Place of death: 14 Date of death _ 15 Death occurrence in relation to pregnancy/labour/ postpartum: 16 17 Likely cause of death: Contributory causes: xxxii xiv Design a Web-based Maternal Death Surveillance 2017 and Response System Delays Delay Contributory factors Tick if Relevant Harmful traditional practices Family poverty Failure of recognition of the problem Lack of decision to go to health facility Delayed referral from home Delayed arrival to referred facility Lack of roads Lack of transportation No facility within reasonable distance Delayed arrival to next facility from referral from another facility Delay Delay Delayed management after admission Delayed or lacking supplies and equipment(specify) Human error or mismanagement Action Plan Template (To be completed by Review Committees at Facility and Health Centre Levels) Case ID (Medical Record Number): Date of meeting: Date of Death: Death preventable yes no What actions will you take as a result of this case? Avoidable Factor Action to be taken as a result of the case Person responsible for the action to be taken Timescale Comment and Action challenges to completeddate completeness of action Remark xxxiii xiv Design a Web-based Maternal Death Surveillance 2017 and Response System Three copies of this form should be made, one is kept at the facility, one at the woreda and one at the zone Name of the reviewer: _ sign: _ date: Reporting template from Health facility to next level (fill it in duplicates) Date of reporting: 2 Name of the facility: Next level: ID No of deceased: Place of death Date of death _ Age: _ Marital status: Religion: _ 10 Ethnicity: _ 11 Address: Urban _ Rural 12 Level of education _ 13 Gravidity 14 Parity _ 15 Cause of death 16 Death in relation to pregnancy/ L& D/puerperium: xxxiv xiv Design a Web-based Maternal Death Surveillance 2017 and Response System Contributory factors/non-medical- tick all that apply Delays Delay Contributory factors Tick ALL that apply Harmful traditional practices Family poverty Failure of recognition of the problem Lack of decision to go to health facility Delayed referral from home Delay Delayed arrival to referred facility Lack of roads Lack of transportation No facility within reasonable distance Delay Delayed arrival to next facility from referral from another facility Delayed management after admission Delayed or lacking supplies and equipments (specify) Human error or mismanagement 17 Preventable death (yes or no): INSTRUCTION: Copy kept at facility with Annex and Annex 4; Copy sent to next level x xiv Design a Web-based Maternal Death Surveillance 2017 and Response System Reporting format from Woreda/Zone to region THIS FORM SHOULD BE SUBMITTED BY THE END OF THE FIRST WEEK OF EACH MONTH (USING DATA FROM PREVIOUS MONTH) Date of reporting: Reporting woreda: _ Parameter Death1 Death Death Death Death5 ID Number (from verbal autopsy and summary forms) Date of Death Place of Death (Home, Health Post, Health Centre, Hospital, In Transit) Age Marital status Parity Educational status Timing in relation to pregnancy (antepartum, intrapartum, postpartum) Likely cause of death Contributory factors to death Delay Harmful traditional practices Family poverty Failure of recognition of the problem Lack of decision to go to health facility Delayed referral from home Delay Delayed arrival to referred facility Lack of roads Lack of transportation No facility within reasonable distance Delay Delayed arrival to next facility from referral from another facility Delayed management after admission xi xiv Design a Web-based Maternal Death Surveillance 2017 and Response System Delayed or lacking supplies and equipment(specify) Human error or mismanagement Reported by: signature: Reporting format from Region to National Levels Date of reporting: Reporting Region: _ Parameter Quantity/Number Remark Age (number) 40 years Marital status _ Single _ Married _ Others Address _ Rural urban Educational status _ None _ Primary school _ Secondary school _ University/college _ Don’t Know _ I _ Parity xii xiv Design a Web-based Maternal Death Surveillance 2017 and Response System II-IV _ >V Location of Death (tick ONE) Home – Health post Health center Hospital In transit _ Timing of death in relation to pregnancy, delivery or puerperium Antepartum, Intrapartum, Postpartum Cause of maternal death Direct obstetric causes PPH Uterine Rupture Obstructed labour Eclampsia Sepsis Abortion Others Indirect obstetric causes Others _ _ _ _ _ _ _ _ _ Specify Indirect or Other causes: Contributory factors Delay I _ Delay II _ Delay III Preventable death: _ Yes _ No Number deaths reviewed by regional SMTWG/RH task force in last one month _ _ Reported by: signature: _ xiii xiv Design a Web-based Maternal Death Surveillance 2017 and Response System DECLARATION I, the undersigned, declare that this project work is my own original work and effort and that it has not been presented for a degree in any other university, where other sources of information have been used, they have been duly acknowledged Signature:……………………………………… This research project has been submitted for examination with my approval as university advisor Signature Date Ato Getachew Jemaneh Ato Wendmu Ayele June 2017 Addis Ababa Ethiopia xxx xiv xiv ... Maternal Death Response ii Design a Web- based Maternal Death Surveillance 2017 and Response System MDSR Maternal Death Surveillance and Response MDSS Maternal Death Surveillance System MMR Maternal. .. Woreda Health Administration, health facilities, Sub -City, Addis Ababa Health Bauer and FMoH) The designed project was conducted in Addis Ababa and conceptually designing of the webbased Maternal. .. and system analysis, Class diagrams and sequence diagrams for object-oriented analysis and design and Design a Web- based Maternal Death Surveillance 2017 and Response System deployment diagrams