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Use of Gis for Analysis of Community Health Worker Patient

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Use of Gis for Analysis of Community Health Worker Patient USE OF GIS FOR ANALYSIS OF COMMUNITY HEALTH WORKER PATIENT REGISTRIES FROM CHONGWE DISTRICT, A RURAL LOW-RESOURCE SETTING, IN LUSAKA PROVINCE, ZAMBIA by Mine Metitiri, MPH, CPH A Thesis Presented to the FACULTY OF THE USC GRADUATE SCHOOL UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree MASTER OF SCIENCE (GEOGRAPHIC INFORMATION SCIENCE AND TECHNOLOGY) December 2014 Copyright 2014 Mine Metitiri TABLE OF CONTENTS DEDICATION........................................................................................................................... v ACKNOWLEDGEMENTS .................................................................................................... vi LIST OF TABLES .................................................................................................................. vii LIST OF FIGURES ............................................................................................................... viii LIST OF ABBREVIATIONS ................................................................................................. ix ABSTRACT .............................................................................................................................. xi CHAPTER ONE: INTRODUCTION ..................................................................................... 1 Motivation .......................................................................................................................... 3 CHAPTER TWO: BACKGROUND....................................................................................... 8 2.1 Geography .................................................................................................................... 8 2.1.1 Physical .................................................................................................................. 8 2.1.2 Climate ................................................................................................................... 9 2.2 Population ................................................................................................................... 10 2.3 Disease Burdens ......................................................................................................... 12 2.3.1 Malaria ................................................................................................................. 13 2.3.2 Pneumonia Infections........................................................................................... 19 2.3.3 Diarrheal Diseases ............................................................................................... 20 2.4 Mobile Health (mHealth) Applications .................................................................... 21 2.5 GCC mHealth Study in Chongwe District, Zambia ............................................... 28 2.5.1 Overview .............................................................................................................. 28 2.5.2 Study Area ........................................................................................................... 29 2.5.3 Population ............................................................................................................ 30 2.5.4 Community Health Volunteers ............................................................................ 30 2.5.5 Data Collection .................................................................................................... 31 2.5.6 Outcomes ............................................................................................................. 32 CHAPTER THREE: METHODOLOGY ............................................................................ 33 3.1 Datasets ....................................................................................................................... 33 3.1.1 GCC Dataset ........................................................................................................ 33 3.1.2 CSO Administrative Area Shapefiles .................................................................. 39 3.1.3 CSO Population Datasets ..................................................................................... 41 3.1.4 District Health Facility Dataset ............................................................................ 42 3.2 Variables ..................................................................................................................... 42 3.3 Analysis ....................................................................................................................... 49 3.3.1 ArcGIS Data Preparation ..................................................................................... 49 3.3.2 Population Density Distributions ......................................................................... 50 3.3.3 Illness Case Count Distributions .......................................................................... 50 3.3.4 Incidence Rates .................................................................................................... 51 3.3.5 SaTScan v9.3 Cluster Analysis ............................................................................ 51 CHAPTER FOUR: RESULTS .............................................................................................. 55 4.1 Spatial Epidemiologic Maps ..................................................................................... 55 4.1.1 Population Density Maps (Ward and SEA) ......................................................... 55 4.1.2 Illness Case Count Distributions .......................................................................... 57 4.1.3 Incidence Rates .................................................................................................... 58 4.2 Cluster Analysis Results ............................................................................................ 61 4.2.1 Fever .................................................................................................................... 61 4.2.2 Malaria ................................................................................................................. 62 4.2.3 Diarrheal Illnesses ................................................................................................ 65 4.2.4 Pneumonia............................................................................................................ 68 4.3 Limitations.................................................................................................................. 71 CHAPTER FIVE: DISCUSSION .......................................................................................... 73 CHAPTER SIX: CONCLUSIONS ........................................................................................ 84 6. 1 Policy Implications.................................................................................................... 84 6.2 Future Research ......................................................................................................... 86 REFERENCES ........................................................................................................................ 88 APPENDICES ......................................................................................................................... 94 Appendix A: Population Density Maps ......................................................................... 95 Appendix B: Disease/Illness Count Proportional Symbols Maps ............................... 98 Appendix C: Disease/Illness Incidence Maps .............................................................. 108 Appendix D: SaTScan v9.3 Cluster Analysis Maps .................................................... 118 DEDICATION This is dedicated to the Community Health Workers and Volunteers serving on the frontlines of healthcare delivery in Zambia and developing regions globally. "Everybody can be great, because anybody can serve. You don't have to have a college degree to serve. You don't have to make your subject and verb agree to serve. You only need a heart full of grace. A soul generated by love." - Dr. Martin Luther King Jr. v ACKNOWLEDGEMENTS I would like to acknowledge my committee members Dr. Darren Ruddell and Dr. Daniel Warshawsky. Many thanks to my mentors Dr. Travis Longcore for his support and guidance on this project and Dr. Pascalina Chanda-Kapata for her guidance also and whose work in Chongwe district served as the inspiration for this thesis. Thank you to my family and friends for their constant support and encouragement throughout this process, without whom I would not have gotten this far, most especially William Ngosa, Jessie Pinchoff, and Colin Mattison for sharing their data analysis and GIS expertise when answering my questions and Dr. Dela Kusi-Appouh for reading all of my drafts. I am forever grateful. Thank you also to the Zambian Ministry of Health staff at all government levels, the staff at the Central Statistical Office in Lusaka, the Surveyor General’s Office in Lusaka, and PATH’s Lusaka offices for sharing their datasets and providing information. vi LIST OF TABLES Table 2.1 Leading Causes of Death in Zambia for Non-communicable and Communicable Diseases..................................................................................................................................... 13 Table 2.2 Epidemiology of prevalent malaria species in Zambia .......................................... 14 Table 3.1 GCC Health facilities included in GCC geospatial dataset .................................... 38 Table
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