International journal of epidemiology
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Mid-level health managers in a developing country were studied to examine the extent to which they are able to use and analyse data they receive from a new health information system. Among 168 managers filling out a self-administered questionnaire, 52% could compute a simple cost-effectiveness ratio and 27% were able to calculate proportions. Only 43% of the managers were able to construct a cumulative graph similar to the one recommended by WHO. ⋯ Twelve out of 25 programme managers interviewed in depth did not know how well their particular programme had performed in the previous year. Similarly, only six of these managers knew their best and poorest performing districts. The results of this study suggest; 1) Training managers in data analysis and use is critical if health information systems are to actually improve health care delivery. 2) Data intended for the use of programme managers need to be presented in simple ways. 3) Further social research is required to understand how managers perceive and use data. 4) Efforts to ensure the use of data should not be seen as something to be 'added on' after information systems are in place.
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In order to determine whether firearm use was an increasing component of the general pattern of homicide in Cape Town, South Africa, hidden Markov time-series models were used to examine a week-by-week count of firearm homicides, non-firearm homicides, firearm suicides and non-firearm suicides for the 6-year period from 1986 to 1991. Of several models fitted to the proportion of homicides that involved firearms, the one which incorporated a discrete upward shift in the middle of 1991 was the most successful. ⋯ The sharp increase in 1991 in the probability that a homicide involved the use of a firearm is consistent with a reported upsurge in violence related to the so-called 'taxi wars'. Hidden Markov models, as a general methodology for the analysis of discrete-valued time series, may be a useful and flexible means of identifying time trends or points of transition related to events or interventions in a wide range of public health contexts.
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Infant feeding is a multidimensional activity that can be described and analysed in many different ways. The World Health Organization (WHO) has recently issued recommended indicators for assessing infant feeding practices. This paper presents these indicators and demonstrates their applications using the 1989 Demographic and Health Survey (DHS) data for Bolivia. ⋯ Mothers who have moved to the city since the age of 12 are most likely to be giving their infants other milks in addition to breast milk and to be bottle feeding their infants. The WHO infant feeding indicators provide a useful framework for quantifying infant feeding practices, and most of the indicators can readily be applied to DHS data. Nonetheless, improvements can be made in both the indicators themselves and the DHS questionnaire to improve reporting of internationally comparable infant feeding information.