Keywords: perinatal surveillance, epidemiology, clinical records, databases, internet, Latin America

Perinatal surveillance is based on accurate and timely data taken directly from the perinatal care providers of a region or country. Standardisation is a key issue to follow time trends in quality of care and to monitor different settings with the same indicators. While standardisation of variables and database formats eases the analysis process, it does not ensure alone a smooth and prompt availability of merged, consistent files.

The Perinatal Information System (SIP), produced by CLAP (PAHO/WHO), provides standard clinical record data entry and analysis. Ready-made statistical outputs address research, management and quality assessment issues within the maternity premises. This instrument is in use in all countries of Latin America and the Caribbean by an estimated 1000 maternity hospitals for a total of over one Million births a year.

To merge this large amount of data collected in the hospitals, notorious difficulties are experienced by Ministries of Health, Mother and Child Health Programs as well as at PAHO offices like CLAP. This is necessary for Perinatal Surveillance and epidemiological studies. There are communication problems in the reception of databases either by surface or e-mail. Namely, the duplication of cases is cumbersome to detect and to correct and it is difficult to guarantee the continuity of data. A considerable effort is therefore devoted to database verification which often delays the production of statistics at the regional or national level.

As part of its perinatal health fostering strategies, CLAP co-ordinates a network of Collaborating Centres, located one in each country of Latin America and the Caribbean. This network is active in the dissemination of the instruments produced by CLAP with co-ordination support from PAHO/WHO Representative Offices. This support covers technical co-operation, training of professional partners and counselling in Maternal Child policy making. A reliable and timely information system at the national and regional level is needed and felt as important by health authorities of the countries of the Region of the Americas.

Presently vital and perinatal statistics are obtained with over one year of delay; several errors must be corrected aftermath and missing information is sometimes detected.

The prompt availability of perinatal data can be greatly improved with inexpensive but specific tools and training applied to the network of Collaborating Centres of CLAP.

A special software utility will be developed which automatically sends data from the maternity hospital over the internet to a reference centre. The same software will operate in the reference centre addressing such housekeeping issues as unduplication, updating of records and tagging. A smooth, background clinical data merging of maternity hospitals in a designated repository will be thus put in place.

The Collaborating Centres and participating maternity hospitals will have their telematic capabilities strengthened to support the merging and analysis of information.

The privacy of patient data is kept in all instances outside the maternity hospital.

Basic tools for automatic transmission and merging will be developed, both to be included in the clinically widespread SIP software. The availability of these capabilities will greatly enhance the perinatal database timeliness and accuracy.

An additional tool will be developed to issue an automatic acknowledgement file to be sent from the reference centre to the maternity hospitals. This text files contains basic data quality control and a history of received data from the individual maternity. The feedback thus provided is a stimulus for continuous and accurate data capture at the maternity..

The installation of these operating features in the Collaborating Centre requires a training and a remote support with a help support line. In turn, the Collaborating Centres will support additional maternities in the same town. Training is ensured with workshops at CLAP and in the Collaborating Centres, with involvement of PAHO representatives in each country. The present project will focus training and support in four countries: two selected amongst those with better communications facilities (Chile and Uruguay) and two of relatively more difficult conditions (Bolivia and Paraguay). A total of 60 maternity hospitals will receive the new software, co-ordinated by 4 Collaborating Centres (2 in Chile, one in Bolivia and one in Paraguay) as well as CLAP.

The experience obtained with this project will result in an improvement of the merging methods to be offered as a comprehensive and tested package to all countries of the region.

The impact of the project will be monitored comparing data quality indicators of information received at CLAP from areas taking part in the project with indicators of other areas and/or at other times.

A measure of the delay observed from perinatal events to the availability of merged databases, in areas of this project compared to other areas, will allow to evaluate its usefulness.

The project will last 2 years. Software development, testing and debugging will take 6 months. Workshops and dissemination will be scheduled in the following 6 months. The second year is devoted to actual database merging from the maternity hospitals and fine tuning of software. A final evaluation and publication instance will round up the project.

The total cost of the project is U$S 150.000 for the two years, according to the following detail:

Computer servers for data merging U$S 12.000

Computers for program development U$S 12.000

System administrator (half time two years) U$S 25.000

Software packages U$S 4.000

Programmer/analysts U$S 15.000

Head of project (half time two years.) U$S 60.000

Workshops at Collaborating Centres U$S 20.000

Communications U$S 2.000

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