title: Improving imperfect data from health management information systems in Africa using space-time geostatistics.
abstract: BACKGROUND
  Reliable and timely information on disease-specific treatment burdens within a health system is critical for the planning and monitoring of service provision. Health management information systems (HMIS) exist to address this need at national scales across Africa but are failing to deliver adequate data because of widespread underreporting by health facilities. Faced with this inadequacy, vital public health decisions often rely on crudely adjusted regional and national estimates of treatment burdens.
  
  
  RESULTS
  This study has taken the example of presumed malaria in outpatients within the largely incomplete Kenyan HMIS database and has defined a geostatistical modelling framework that can predict values for all data that are missing through space and time. The resulting complete set can then be used to define treatment burdens for presumed malaria at any level of spatial and temporal aggregation. Validation of the model has shown that these burdens are quantified to an acceptable level of accuracy at the district, provincial, and national scale.
  
  
  CONCLUSIONS
  The modelling framework presented here provides, to our knowledge for the first time, reliable information from imperfect HMIS data to support evidence-based decision-making at national and sub-national levels.
authors.affiliation: School of Geography, University of Southampton, Southampton, United Kingdom. pgething@soton.ac.uk
authors.forename: Peter W
authors.initials: PW
authors.lastname: Gething
authors.forename: Abdisalan M
authors.initials: AM
authors.lastname: Noor
authors.forename: Priscilla W
authors.initials: PW
authors.lastname: Gikandi
authors.forename: Esther A A
authors.initials: EA
authors.lastname: Ogara
authors.forename: Simon I
authors.initials: SI
authors.lastname: Hay
authors.forename: Mark S
authors.initials: MS
authors.lastname: Nixon
authors.forename: Robert W
authors.initials: RW
authors.lastname: Snow
authors.forename: Peter M
authors.initials: PM
authors.lastname: Atkinson
mesh_terms: D000349:Africa; D003660:Decision Support Systems, Management; D003695:Delivery of Health Care; D018563:Disease Notification; D040362:Geographic Information Systems; D058016:Health Facility Administration; D006801:Humans; D008288:Malaria / Q000175:diagnosis* / Q000628:therapy*; D008331:Management Information Systems; D016347:Medical Records Systems, Computerized; D015233:Models, Statistical; D040442:Public Health Informatics; D012041:Regional Medical Programs; D015203:Reproducibility of Results; D013997:Time Factors