Data sources

MEASUREMENT OF ACCESSIBILITY

3.3 Data sources

1994). In addition, vaccine-preventable diseases such as Hepatitis B and measles and perinatal and infant mortality rates were highly prevalent in the study area (Abdool Karim

et al.,

1988; Abdool Karim

et al.,

1989; Abdool Karim & Tait, 1993; Briggs- Crofton

et al.,

1992; Buchmann

et al.,

1989; Couper & Walker, 1997).

From the background provided in this section, it is evident that the study area is an under-developed rural setting in which the communities were deprived of many basic needs as evidenced by high levels of poverty, illiteracy, unemployment, poor health status and inadequate access to health services. More use of health services is anticipated in the future as access has been improved by the initiation of the restructuring of the NHS since 1994. This included introduction of the CUBP and removal of user fees for pregnant women and children under age six years. However, more information is needed that relates the increase in the number of PHC clinics to the uptake of health care, before firm conclusions can be drawn regarding the effectiveness of the NHS.

MRC, Durban. The MI5 contains data about malaria incidence of all homesteads in the northern eastern KwaZulu-Natal malarious districts. Since the Umkhanyakude District carries the highest prevalence of malaria in KwaZulu-Natal province, more than 34 000 homesteads have been mapped in this area to facilitate malaria surveillance and control activities. The MI5 database consists of eight data fields in the core dataset. Data on malaria incidence, type of wall for each homestead for purposes of insecticide house- spraying, school and health facilities data are located in different data bases linked to the core MI5 database through a unique permanent identity number or PIN (see Appendix 1). The fields in the core MI5 dataset include the PIN, the area in which the homestead is located, the section, the homestead number, the name of the health facility in which the homestead members obtain health services, the location of the homesteads (latitude and the longitude) and the number of people in each homestead.

A detailed description of the MI5 database has been previously provided (Le Sueur

et al.,

1997; Martin

et al.,

2002). Surveillance agents from the Malaria Control Programme collect data for the MI5 database by routinely visiting the homesteads to actively screen for malaria patients. In addition to providing information regarding malaria control activities, these surveillance agents have systematically collected clinic utilization data from these homesteads in 1994 and updated in 1996. This was done by asking homestead members to identify the clinic they normally use for their PHC needs. These data were entered into the MI5 database and updated during 1997 just before this study was undertaken.

3.3.1 Preparation of the analytical databases

The analytical database was developed from information contained in the MI5 database.

All eight fields contained in the core MI5 dataset were included in the preparation of the analytical database.

A second separate database file was created by extracting data on the list of names and geographical positions (latitude and longitude) of all PHC facilities in the study area from the health facility database of all PHC facilities for South Africa obtained from the Provincial Department of Health, Pietermaritzburg. Not all data fields in the analytical data bases were used for each of the three broad methodological steps referred to above.

For each step a separate database was created from the analytical data bases and modified specifically to include new data collected in each step.

The database created for the delineation and comparison of catchment areas for PHC clinics contained data on the geographic positions of the homesteads, the total population in the homesteads, names and geographic positions of the 19 pre-existing PHC clinics. These data were required to identify the locations of PHC clinics in space and to determine the number of the catchment population in these PHC clinics. The same database was used in the comparison of absolute distances between homesteads and PHC clinics before and after the CUBP but the database was modified to include the names and geographic positions of the 16 new PHC clinics that became available after the CUBP. Two fields were added to this database created for this analysis. These fields were used to store the absolute distances calculated for each period. All data bases were created within Microsoft Access and the data was imported into MapInfo® GI5 software when performing spatial analysis.

3.3.2 Limitations of the MIS data

1. During the clinic utilization survey, not all homesteads were visited as the MI5 database includes only 92% of the population of the study area estimated in the 1996 Population Census. The homesteads and population covered in the MI5 are those that are located in malaria problem areas and were under malaria surveillance. Therefore data for the town of Jozini and areas in the western parts of the region near Lebombo

Mountains were absent from the MI5 database. This is the reason why clinics located in these areas had missing homestead and population data and were therefore excluded in the delineation and comparison of catchment areas for PHC clinics based on distance and usage. Since the MI5 was designed for use as a malaria control tool, it was not necessary at the time to include all the homesteads in the area.

2. The data on clinic utilization was intended for malaria control activities since the Malaria Control Programme was being transformed from being a vertical programme to a more integrated set of activities within PHC services offered at the health facilities as part of the DHS. Before this decentralization of malaria control activities could take place, it was therefore necessary for health authorities to establish the proportion of people who were reliant on PHC facilities.

3. Although the focus of this study is on fixed PHC clinics, in the clinic utilization survey the question asked (which clinic do you normally use for your PHC needs?) did not specifically differentiate between fixed clinics, mobile clinics and hospitals. This explains why some homestead members identified mobile clinics and hospitals as their regular source of health care. While the MI5 database has its limitations, it is nonetheless currently the only source of routinely collected data available for the study area, which provides spatial and attribute information at homestead level.