DATA COLLECTION,

ANALYSIS AND
PRESENTATION

9 FEBRUARY 2010
Introduction
Definition
 A health Information System (HIS) can be defined as a
combination of people, equipment and procedures organized to
provide health information to health workers and others in a
way that enables them to make informed decisions.

 This is the data that is routinely provided by health facilities. It is

collected by health workers on a day to day basis.

2
…introduction
A Health Information System is made up of
three elements:
 An input data

A processing component in which input data

are transformed into output information

 An output (information for the user

3
…introduction
 Sources of data in put for the HIS are the
health units at the district and the lowest
levels of the Local government structures and
the community as well.

4
…introduction
Principles underlying a good HIS;
 Data collection should conform with data requirements
(relevant) and with processing capabilities.

 The information collected should be simple to obtain

 Feedback of information to the providers of the health

data is very important. This is backbone to a sound
HIS.

5
….introduction
 One way upward flow of information to the
central (district, national) level is very
dangerous.

 Lack of feedback to the providers of the data

will lead to low morale and they will not put in
any effort into their work leading to poor
quality of the data.

6
….introduction
 Providers of health information or data collectors
(health workers in the health facilities) should not
only feed information into the district and national
HIS, but should also be users of their own data.

 Analysis should be done at the local level as well to

include coverage estimation and use of targets at
all levels.

7
FEEDBACK AND LOCAL
ANALYSIS IN HIS DATA
Central
Feedback

Regional

District

Health Facilities Local Analysis

8
DATA COLLECTION (INPUT)
Purpose and tools
For effective planning and wise use of resources, health
planners need to know the scope of the problems they are
dealing with. Examples;

 How many people use the services offered?

 What are the most common ailments affecting people in the

health service area?

9
…data collection
 Which ones would it be most effective to
tackle?

Without having a basis of sound information,

health planners run risk of ad hoc
management, with no clear strategy or
informed reasoning for the decisions they
take.

10
…data collection
 Datacollection can be quite simple, requiring a
pen or pencil.

 May require several people

 Useof pre-printed forms, calculators, computers

and all the accessories that come with
computers

11
…data collection
Methods
 Routine data collection

 Periodic data collection

 Choice of method depends upon the frequency of

the occurrence of the event being studied and on
the costs involved.

12
….data collection
Periodic data
 Survey, one-time costs, can appear expensive but
may be less expensive than routine data collection.

 Allow for filling in gaps in basic knowledge about the

community

 May combine data from both sources so as to obtain

more data at the community level.

13
…data collection
Forms used for data collection should be simple and
always in supply.

Kinds of data and Common forms

Morbidity forms
 Outpatient tally sheets and summary forms

 Disease notification forms

 Outpatient register (details by patient, including

treatment)

14
…data collection
Inpatient care forms
 Inpatient cards
 Maternity/delivery register
 Admission and discharge forms

Preventive activity forms

 Antenatal attendance registers
 Family planning
 Growth monitoring attendance, weight and children at
risk
 Immunization forms

15
…data collection
Supply and stock forms
 Essential drugs

 Vaccines

 Other supplies (needles, syringes, gloves

Others
 Laboratory forms

 Temperature charts

 Environmental health forms

16
…data collection
Recording and reporting
 Data collection should be standardized to ease
analysis and for comparison purpose.

 Sets of forms designed for data collection as

outlined. Other forms include monthly report forms,
annual summary sheets for outpatients,
immunization, family planning, maternal and child
health and growth monitoring data.

17
….data collection
 In each health facility, activities should be
instantly recorded by tallying and summed up
at the end of the day. The sum of totals make
a weekly or monthly total for each activity.

18
…data collection
Sources of error
 Forgetting to tally E.g.; During immunization before or
after

 Misclassification; recording in the wrong category

 Miscalculations

 Figure cooking; Forgets to fill in forms or forms get lost

19
…data collection
Due to the ease with which errors can be made,
there is need to check on all the instruments used
for data collection on a periodic basis

 Are the forms used to collect data being filled in

correctly?

 Are the reagents used for laboratory tests still active?

 Have the scales been properly adjusted?

20
…data collection
Quality of diagnosis
 In Outpatients use of clinical picture, history or physical
examination.

 Diagnosis more difficult if multiple diseases occur at the same

time.

 Chronic and acute conditions may appear at the same time

 In areas with stable malaria, the symptoms may be vague due to

frequent attacks.

21
…data collection
 Inareas where malaria is endemic, there is a
tendency to record every patient with fever as
malaria which leads to over reporting.

 Many patients with malaria treat themselves

(drug shops, shops)

 Laboratories, X-ray facilities and others aid

diagnosis

22
…data collection
 Cause of death may not be established.

 Signs and symptoms before death as observed

in health care facility or reported by relatives
may be used to establish cause of death.

 Itis useful to record not only cause of death but

the associated causes and complications

23
DATA ANALYSIS
 Health statistics may be presented as
absolute numbers but often they are
represented as rates (number of events are
related to the population involved)

 In order to simplify comparisons, rates are

usually expressed in relation to an arbitrary
total (e.g. 1000, 100,000 or 1,000,000)

24
…data analysis
No. of persons affected or
number of events
Rate = __________________ x 1000
Population at risk

25
….analysis
Crude Rates
 Rates which are calculated with the total population in
an area as the denominator

 Crude rates from different populations cannot be easily

compared because of the striking differences in the age
and sex structure of the population

 E.g.; The crude death rate may be relatively high in a

population with a high proportion of elderly persons
compared with the rate in a younger population.

26
…analysis
 If the death rate is to be used as an indicator of the
health status of a population, adjustment of the
crude rate must be done.

 Standardization of the crude rate for age, sex or

other parameter of the population is necessary.

 The adjustment is made to a standard population

27
…analysis
Crude rates

Crude birth rate = No. of live births in a year x 1000

Mid-year population

Crude death rate= No. of deaths in a year x 1000

Mid year population

Natural Increase rate = No. of live births – No. of

deaths in a year
____________________ x 1000
Mid-year population

28
…analysis
Specific rates
 Rates that are calculated using data from specific
segments of the population.

 They use the particular population at risk as the

denominator

 E.g.; the age specific death rate in a total population

may be analyzed separately for each sex in 1-year
age groups or in 5-year or 10-year age groups

29
…analysis

No of deaths in people of a
specific age/sex
Age/sex specific death rate =________________ x 1000

No of people in the specified

age/sex group

30
…analysis
Specific rates

Fertility rate = Total no. of births in a year

No. of women aged 15-49 years

Annual no. of deaths due to pregnancy,

Maternal Mortality = childbirth and puerperal conditions x 100,000
Ratio (MMR)
Total no. of births in a year

31
…analysis
Vital Statistics
 Rates calculated from vital statistics are used to reflect the health
status of a community as a whole or to study the health problems
and needs of specific groups. E.g. the rates of maternal deaths,
stillbirth and perinatal mortality are of value in the analysis of
obstetric problems and obstetric services.

 The overall health of the community may be assessed using

standardized death rates.

 The mortality rates of the most susceptible age groups are more
sensitive indicators

32
…analysis
Infant Mortality Rate (IMR)

IMR = Annual no. of deaths in the first year

_______________________ X 1000
No. of live births in a year

 The IMR is widely accepted as one of the most useful

single measure of the health status of the community.

 The IMR is usually very high in communities where health

and social services are poorly developed.

33
…analysis
IMR
 Responds dramatically to simple measures like
establishment of maternal and child health (MCH) services

 MCH services can bring down the rate from 200-300/1000

live births to 50-100/1000 live births

 Developed countries range 10-40/1000 live births

34
…analysis
The IMR is usually subdivided into two, the neonatal and
post neonatal death rates.

Annual no. of deaths in the first 28 days

Neonatal mortality rate = ______________________________ x 1000
No. of live births in a year

Annual no. of deaths between 28 days

and 1 yr
Post neonatal mortality rate = ____________________________ x 1000
No. of live births in a year

35
…analysis
The neonatal death rate is a result of problems related to maternal
and obstetric factors.

 Pregnancy (Congenital abnormalities, low birth weight)

 Delivery (birth injuries, suffocation)

 After delivery (tetanus, other infections)

Post neonatal mortality rate is related to a variety of environmental

factors and more so to child care
 Improvements in MCH bring a fall in both rates

36
…analysis
Under 5 Mortality Rate (U5MR)
 The IMR taken by itself underestimates the loss of child life.

Annual no. of deaths under 5 years

 U5MR = _____________________________ x 1000
No. of live births in a year

 UNICEF advocates the use of U5MR as the single most

important indicator of the state of the world’s children.

37
…analysis
U5MR reflects the following;
 Nutritional health and the health knowledge of the mothers

 The level of immunization and Oral Rehydration Therapy (ORT) use

 The availability of MCH services (including prenatal care)

 Income and food availability in the family

 The availability of clean water and safe sanitation

 The overall safety of the child’s environment.

38
…analysis
Morbidity Statistics (data about occurrence of sickness within the
community)
 It provides more detailed assessment of the health of the
community

 It is more difficult to collect and interpret than records of births

and deaths

 Anybody can easily recognize and record births and deaths

 Collection of morbidity data depends on the extent to which

individuals recognize departures from health and also on the
availability of facilities for the diagnosis of illness.

39
…analysis
 The quality of morbidity statistics depends on the extent of
coverage and the degree of sophistication of the medical
services

 Unlike vital events (birth, death) occur only on one

occasion in the lifetime of any person, sickness may occur
repeatedly in the same person.

 Also one person may suffer from several diseases at the

same time.

40
…analysis
Morbidity rates are used to describe the pattern of
sickness in a community.

 Incident rates; describe the frequency of occurrence of

new cases of a disease or spells of illness.

 Incident rates; defined in terms of numbers of persons

who start an episode of sickness in a particular period or
alternatively in terms of the number of episodes during
that period.

41
…analysis
No. of persons starting an episode of
illness in a defined period
Incidence rate (persons) =________________________ x 1000
Average no. of persons exposed to risk
during that period

No. of episodes of illness starting during

defined period
Incident rate (episodes) = _____________________ x 1000
Average no. of persons exposed to risk
during the period

42
…analysis
Prevalence rate; defined as the number of
persons who are currently sick at a specified
point in time
No of persons who are sick at a
given time
Prevalence rate = _________________________ x 1000
Average no. of persons exposed to risk

43
…analysis
Fatality rate; the number of deaths in relation to
the number of new cases of a particular
disease.

 Itis a measure of the severity of the disease,

efficacy of therapy (treatment) and the state of
the host immunity.
No of deaths ascribed to a specified disease
Fatality rate = _________________________________ x 1000
No. of reported cases of the specified disease

44
DATA PRESENTATION
 Data gathered from immunization, antenatal care, growth
monitoring and morbidity and others.

 Collection of data becomes more meaningful if analysis is

done regularly and locally.

 Presentation of data numerically and graphically enhances

insight into what is going on in the catchment population

 Aim is to produce a precise and accurate demonstration of

the information

45
…data presentation
 Information is summarized to simplify and highlighted to draw
attention to the most important features

Numerical presentation
 An arrangement of the figures in order of magnitude, so that the
range of the data from the smallest to the largest is clearly
displayed.

 Simple statistical calculations can be made; mean, median, mode,

range, standard deviation

46
…data presentation
Tabulation
 Data are sorted, arranged, condensed and set out in
such a way as to bring out the essential points.

 The raw data are classified, compressed and grouped

into a frequency distribution

 E.g.; data may be classified into 5 year or 10 year age

groups, with a record of the number of persons in
each group.

47
…presentation
For effective presentation the following must be observed;

 Title; should clearly describe the material contained in the text. Features of
the title (i) What is the material contained in the table? (ii) Where is the
location of the study? (iii) When was the study carried out?

 Labeling; Each row and each column should be clearly labeled and the
units of measurement stated. If a rate is used, the base of measurement and
the number of observations must be stated.

 Totals; The totals of columns and rows should be shown

 Footnotes; abbreviations and symbols should be explained in footnotes

48
…presentation
Graphic presentation
 These provide simple, visual aid such that the reader
rapidly appreciates the important features of the data.

Bar chart;
 A bar, the length of which is proportional to the absolute
or relative frequency of events
 Represents each item in the group
 Useful in representing discrete variables.

49
…presentation
Histogram
 A special type of bar chart used to display numerical
variables.

 The variable of interest is shown on one axis as a

continuous scale split into classes.
 Adjoining bars are drawn, their areas representing the
frequency of events. If the class intervals are constant,
the frequency is given on the other axis.

 A population pyramid is a histogram showing age and

sex of a population

50
…presentation
Pie Chart
 Consists of a circle which is divided into
sectors, with the area of each sector
proportional to the value of each variable

Graphs; shows two variables, one on the

horizontal axis and the other on the vertical axis

51
Report preparation
Annual report
 Summarizes and discusses all information collected in the year

 Comparisons should be made with previous years and with other areas
in the same year as this facilitates meaningful interpretation of data.

 Information which is vague or not useful should be left out

 Statistics and Data should be interpreted and conclusions drawn

 Executive summary should be provided.

52
…report
Minimum list of contents for a district HIS annual report
1. Executive summary

2. Population and Health services

- Assess quality of the HIS data (reporting rate)
- Population projected for current year
- Health facilities: number, population per facility,
service offered
- Health staff by major categories
- PHC areas covered, numbers of active Community health
care workers, trained TBAs, NGO activities
- Environmental health services
- drug supply.

53
…report
3. Inpatient statistics
- number of beds by ward, admissions, mean length of
stay, bed occupancy

- Minor and major surgery activities

- Leading inpatient diagnoses and mortality (case fatality

rates)

- Notifiable diseases, including HIV/AIDS

54
…report
4. Outpatient statistics
- Leading diagnoses (number, percentages, incidence) and
Outpatient attendances by age
- Seasonality of diseases
- Laboratory data on malaria, intestinal worms, schistosomiasis,
anaemia

5. Antenatal care and maternity

- Attendance at the ANC and mean number of visits per attendant
(and time of first visit)
- Tetanus toxoid immunization
- coverage of births by institution
- data on abnormal deliveries, still births and maternal deaths

55
…report
6. Nutritional status of children
- Birth weight from health facilities: mean, percentage low
birth weight

- Attendance at growth monitoring sessions (in clinics and

communities) and percentage underweight by age
and by month

7. Immunization
- Number of vaccinations given and estimates of coverage
- Number of cases of EPI diseases

56
…report
8. Family Planning
- Number of new visits and revisits and estimate of
coverage
- Number and types of supplied methods

Dissemination of reports
 Very important component of the HIS
 Those who provide data to the HIS should receive first
 All data users in the district should receive
 Report submitted to the national (central) last

57