Problematic Khat use: Case Definition and Impact among Khat Users in Addis Ababa

151 Pages·2014·2.16 MB·English

ADDIS ABABA UNIVERSITY SCHOOL
OF INFORMATION SCIENCE
AND
SCHOOL OF PUBLIC HEALTH

MSc in HEALTH INFORMATICS PROGRAM

Automating an Integrated Management of Newborn and
Childhood Illness (e-IMNCI): Optimize real-time clinical
decision support system

By:

TUHA MUSTEFA AHMED

JUNE 2014

ADDIS ABABA, ETHIOPIA
ADDIS ABABA UNIVERSITY SCHOOL
OF INFORMATION SCIENCE AND
SCHOOL OF PUBLIC HEALTH

Automating an Integrated Management of Newborn and Childhood
Illness (e-IMNCI): Optimize real-time clinical decision support
system

A Project Submitted to the School of Information Science and Public Health
of Addis Ababa University in Partial Fulfillment of the Requirements for
Degree of Master of Science in Health Informatics

By:
TUHA MUSTEFA AHMED

JUNE 2014

ADDIS ABABA, ETHIOPIA
ADDIS ABABA UNIVERSITY SCHOOL
OF INFORMATION SCIENCE AND
SCHOOL OF PUBLIC HEALTH

Automating an Integrated Management of Newborn and Childhood
Illness (e-IMNCI): Optimize real-time clinical decision support
system

By:
TUHA MUSTEFA AHMED

Names and Signature of Members of the Examining Board

1.
Examiner Signature Date

2.
Examiner Signature Date

3.
Advisor Signature Date

4.
Advisor Signature Date
DEDICATION

To my beloved brother Rufael Gebeyehu (Babi)
I
ACKNOWLEDGEMENTS

My special thanks goes to my advisors Dr. Martha Yifru and Dr. Ayele Belachew for their commitment,
encouragement, valuable comments, stimulating advice, and constructive suggestions who helped me to pass
the difficulties I faced in the course of conducting the project and finish my project. My grateful thanks
go to all staff members of Addis Ababa University, School of Public health and Information science for
their coordination and facilitation efforts toward my achievement.

I would like to extend my thanks to Dr. Aderajew Sendek (MD in Hiwot-Fana Hospital, Harar), who freely
gave his time and valuable information necessary for the project work. My special thanks are also due to all
my friends for their all rounded contribution and support in the course of conducting this project work. To
all others who helped me in completing this project, I am really grateful.

I would like also to extend my thanks and appreciation to health workers in Janmed and Yeka Worda 4
for providing me with necessary valuable information

Last but not least, I owe my sincere gratitude to my family members. Especially, to my beloved brother
Babi for your inspiration to join this department.

.
II
Table of Contents
DEDICATION ........................................................................................................................................... I
ACKNOWLEDGEMENTS ......................................................................................................................II
Table of Contents.......................................................................................................................................III
List of Figures ......................................................................................................................................... VI
List of Tables ..........................................................................................................................................VII
List of Acronyms .................................................................................................................................. VIII
ABSTRACT ............................................................................................................................................ IX
CHAPTER ONE
INTRODUCTION..................................................................................................................................... 1

1.1 Background...................................................................................................................................... 1

1.1.1 Electronic Integrated Management of Newborn and Childhood Illness (e-IMNCI) ................ 2

1.1.2 Clinical Decision Support System (CDSS)............................................................................... 3

1.2 Statement of the Problem................................................................................................................. 4

1.3 Objectives of the Project.................................................................................................................. 5

1.3.1 General Objective ..................................................................................................................... 5

1.3.2 Specific Objectives ................................................................................................................... 5

1.4 Scope and Limitations of the Project ............................................................................................... 6
1.4.1 Scope of the Project.................................................................................................................... 6
1.4.2 Limitations of the Project........................................................................................................... 6
1.5 Significance of the Project ............................................................................................................... 7

CHAPTER TWO

LITERATURE REVIEW.......................................................................................................................... 8

2.1 GENERAL LITERATURE ............................................................................................................. 8

2.1.1 Integrated Management of Newborn and Childhood Illness .................................................... 9

2.1.2 Clinical Decision Support System. ......................................................................................... 10

2.2 RELATED WORKS...................................................................................................................... 17

CHAPTER THREE

METHODOLOGY .................................................................................................................................. 20

3.1 Target Population…....................................................................................................................... 20

3.2 System Development ..................................................................................................................... 22
III
3.2.1 Spiral Methodology................................................................................................................. 22

3.2.2 Knowledge Representation Method........................................................................................ 23
3.2.3 Development Tools ................................................................................................................. 24

3.4 System Testing and Evaluation ..................................................................................................... 24

3.4.1 Expert-Based Evaluation ........................................................................................................ 24

3.4.2 User-Based Evaluation ........................................................................................................... 25

3.4 Method of Dissemination of Results ............................................................................................. 25

3.5 Operational Definition ................................................................................................................... 26

3.6 Ethical Clearance ........................................................................................................................... 26

CHAPTER FOUR

DISCUSSION OF RESULTS ................................................................................................................. 27

Introduction.......................................................................................................................................... 27

4.1 System Analysis ............................................................................................................................ 27

4.1.1 Current System........................................................................................................................ 27

4.1.2 Proposed System ......................................................................................................................28
4.1.3 Functional and Data Requirements..........................................................................................29
4.1.3.1 Functional Requirements...................................................................................................29
4.1.3.2 Data Requirements.............................................................................................................29

4.1.4 Nonfunctional Requirements ...................................................................................................30

4.1.5 System Analysis Models .........................................................................................................30
4.1.5.1 Use case Model ....…………………………………………...…………………………...30
4.1.5.2 Class Diagram…………………………………...……………………………………….42
4.1.5.3 Sequence Diagram...……………………………………………………………………..43
4.3 System Design ................................................................................................................................ 48

4.3.1 Architecture of e-IMNCI System ................................................................................................ 48

4.3.2 Subsystem Decomposition ...................................................................................................... 49

4.3.3 Hardware/Software Mapping .................................................................................................. 50

4.3.4 Persistent Data Management................ ................................................................................... 51
.
4.4 System Implementation .................................................................................................................. 55

4.4.1 Guideline ……………… ......................................................................................................... 55

4.4.2 Electronic Medical Record of eIMNCI.................................................................................... 57

4.2.4 Clinical Decision Support ........................................................................................................ 59

4.5 Testing and Evaluation ................................................................................................................... 63

4.3.1 System Performance Test......................................................................................................... 63

IV
4.3.2.1 Experiment Result of the system’s CDS ............................................................................... 66

4.3.2 System Usability Test .............................................................................................................. 67

CHAPTER FIVE

CONCLUSIONS AND RECOMMENDATIONS.................................................................................. 70

5.1 Conclusions ................................................................................................................................... 70

5.2 Recommendations.......................................................................................................................... 71
References ............................................................................................................................................... 72

APPENDIX ............................................................................................................................................. 72

Appendix A: Requirement Collection Checklist. ................................................................................ 74

Appendix B: Usability testing tasks and survey questions .................................................................. 77

Appendix C: User interfaces of the system ......................................................................................... 81
V
List of Figures

Figure 1.1: Guideline to check and classify for malnutrition and anaemia 2
Figure 2.1: Summary of the integrated case management process 11
Figure 3.1: Architecture of CDS module of the e-IMNCI system. 24
Figure 4.1: Use case diagram for e-IMNCI system 42
Figure 4.2: Class diagram of e-IMNCI system 43
Figure 4.3: Sequence diagram for Register Patient use case 43
Figure 4.4: Sequence diagram for register diagnosis result use case 44
Figure 4.5: Sequence diagram for check guideline use case 45
Figure 4.6: Sequence diagram for diagnosis assistant use case 46
Figure 4.7: Sequence diagram for generate report use case 47
Figure 4.8: Architecture of the e-IMNCI system 48
Figure 4.9: Subsystem decomposition of e-IMNCI 49
Figure 4.10: Deployment diagram of e-IMNCI system 50
Figure 4.11: Main phases of database design 51
Figure 4.12: Entity relationship(ER) diagram for the prototype of e-IMNCI 52
Figure 4.13: Database schema of e-IMNCI system 53
Figure 4.14: Database diagram of e-IMNCI system 54
Figure 4.15: A user interface to select the guideline 55
Figure 4.16: A user interface which describes the essential newborn care actions 56
Figure 4.18: A user interface designed to register patient’s information. 57
Figure 4.19: A user interface used to update the current status of a patient. 57
Figure 4.20: A screen to select and enter the observed sign and symptoms of the patient. 58
Figure 4.21: A screen designed to register diagnosed results of a patient. 58
Figure 4.22: Relationship between attributes, conditions, rules and actions in the inference
engine. 61
Figure 4.23: Working memory and inference engine for cough and difficult 62
Figure 4.24: User interface used to display the diagnosis and treatment result of the breathing
problem of the system’s CDS. 62
Figure 4.24: User interface used to display the diagnosis and treatment result of the CDS of the
system 62
Figure 4.25: The average time taken to perform tasks by participants. 64
Figure 4.26: The average time to complete tasks by participants. 65
VI
Figure 4.27: Task success distribution by participants. 65
Figure 4.28: Average time vs. expected time taken to perform each task. 66
Figure 4.29: Compared result of the prototype system and recorded diagnosis data. 67

List of Tables

Table 1.1. Examples of CDS interventions by target area of care.
3
Table 4.1: Description of login use case.
32
Table 4.2: Description of register patient use case.
33
Table 4.3: Description of register diagnosis result use case.
34
Table 4.4: Description of update patient status use case. 35
Table 4.5: Description of Search patient history use case.
36
Table 4.6: Description of generate report use case.
37
Table 4.7: Description of check guideline use case.
38
Table 4.8: Description of diagnosis assistant use case.
39
Table 4.9: Description of logout use case.
40
Table 4.10: Description of manage account use case.
41
Table 4.11: knowledge base rules expressed in natural language.
60
Table 4.12: Summary of participant’s profile.
63
Table 4.13: User satisfaction survey result evaluated by participants.
68
VI