title: Development and evaluation of a spatial decision support system for malaria elimination in Bhutan.
abstract: BACKGROUND
  Bhutan has reduced its malaria incidence significantly in the last 5 years, and is aiming for malaria elimination by 2016. To assist with the management of the Bhutanese malaria elimination programme a spatial decision support system (SDSS) was developed. The current study aims to describe SDSS development and evaluate SDSS utility and acceptability through informant interviews.
  
  
  METHODS
  The SDSS was developed based on the open-source Quantum geographical information system (QGIS) and piloted to support the distribution of long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) in the two sub-districts of Samdrup Jongkhar District. It was subsequently used to support reactive case detection (RACD) in the two sub-districts of Samdrup Jongkhar and two additional sub-districts in Sarpang District. Interviews were conducted to ascertain perceptions on utility and acceptability of 11 informants using the SDSS, including programme and district managers, and field workers.
  
  
  RESULTS
  A total of 1502 households with a population of 7165 were enumerated in the four sub-districts, and a total of 3491 LLINs were distributed with one LLIN per 1.7 persons. A total of 279 households representing 728 residents were involved with RACD. Informants considered that the SDSS was an improvement on previous methods for organizing LLIN distribution, IRS and RACD, and could be easily integrated into routine malaria and other vector-borne disease surveillance systems. Informants identified some challenges at the programme and field level, including the need for more skilled personnel to manage the SDSS, and more training to improve the effectiveness of SDSS implementation and use of hardware.
  
  
  CONCLUSIONS
  The SDSS was well accepted and informants expected its use to be extended to other malaria reporting districts and other vector-borne diseases. Challenges associated with efficient SDSS use included adequate skills and knowledge, access to training and support, and availability of hardware including computers and global positioning system receivers.
authors.affiliation: Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia. dockinley@gmail.com.|Phuentsholing General Hospital, Phuentsholing, Bhutan. dockinley@gmail.com.
authors.forename: Kinley
authors.identifier: http://orcid.org/0000-0002-8857-2665
authors.initials: K
authors.lastname: Wangdi
authors.affiliation: Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia.
authors.forename: Cathy
authors.initials: C
authors.lastname: Banwell
authors.affiliation: School of Public Health & Social Work, Queensland University of Technology, Brisbane, QLD, Australia.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Gatton
authors.affiliation: Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia.
authors.forename: Gerard C
authors.initials: GC
authors.lastname: Kelly
authors.affiliation: Vector-borne Disease Control Programme, Department of Public Health, Ministry of Health, Gelephu, Bhutan.
authors.forename: Rinzin
authors.initials: R
authors.lastname: Namgay
authors.affiliation: Research School of Population Health, College of Medicine, Biology and Environment, The Australian National University, Canberra, ACT, Australia.
authors.forename: Archie C A
authors.initials: AC
authors.lastname: Clements
mesh_terms: D001631:Bhutan; D002675:Child, Preschool; D003660:Decision Support Systems, Management; D060740:Disease Eradication / Q000458:organization & administration*; D005843:Geography; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D057148:Insecticide-Treated Bednets / Q000600:supply & distribution; D008288:Malaria / Q000517:prevention & control*
keywords: Bhutan; Key informants; Long-lasting insecticidal nets; Spatial decision support system