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Public Health and Geographic Information Systems (GIS):  The application and analysis of disease-specific public health data from Ciudad Sandino, Nicaragua

A research project undertaken as a part of the Roger Thayer Stone Center for Latin American Studies Summer Research Grant Program

Investigator:  John M. Miller
Advisors: Nancy Mock, DrPH, Alex Coles, PhD

The need for research

Understanding patterns of disease and epidemiologic surveillance data is best done with effectively designed information systems. With the explosion of information and information management tools during the past decade, a rich literature is developing that links the importance of indicators such as global and local climatic parameters, other environmental factors, and socio-demographic characteristics of populations with infectious/parasitic disease patterns. Geographic Information System (GIS) technology currently enables the integration of various data layers, representing physical and social data, on a spatial analysis platform. Information systems based on GIS technology can serve many purposes ranging from assisting public health departments with disease control efforts to modeling and forecasting for early warning systems. Applied to Latin America, these techniques can be examined at a macro-level (national or regional) and micro-level (municipio or local health center) of analysis for understanding disease transmission and for controlling disease spread. Successful attempts at this have been realized in the US and European public health systems as well as in Singapore. Yet for Latin American countries, numerous gaps in knowledge, training and resources available for technology limit the application of these approaches within the public health community.  The primary objective of this project will be to assist a local Nicaraguan health community with understanding and developing means to employ a technologically sound information system. 

      Second, to assist the efforts of the Center for Disaster Management and Humanitarian Assistance’s research agenda in epidemic forecasting in Latin America, this project will serve as a micro-level approach to data collection and applied analysis using available spatial analytic methods.  Geo-referencing of health center and puestos de salud (health points) will be done using GPS hand-held device and will be linked to a digitized map of the community and outlying areas. Disease case data will be collected over a five-year period (time permitting) for dengue and malaria (time-permitting, both will be attempted).  This information will be linked to spatial reference points from patient data and stored for analysis upon return to New Orleans.  Patient data including age and gender will be recorded.

Overall, this project will serve the research interests of Tulane and the developing technology interests of the health community in Ciudad Sandino, Nicaragua.  Data collected will serve both as an introduction to electronic storage of health information and for research analysis and potential validation studies at Tulane.   In addition, this will enhance my abilities in translating my database and ArcView GIS skills into a functional, applied development project, utilizing my epidemiologic and Spanish skills.   I am very interested in furthering my career in the direction of technology and information systems applied to health and epidemic decision-making.  This project and working with this community would be a crucial step in that direction and would allow me the opportunity to combine a great deal of my skills. 

The proposed methodology

 The methodology involved in this research project involves both the acquisition of data and the data analysis.  Using GPS recordings and digitized area maps, geographic information will be entered into ArcView GIS 3.1.  (This software is currently available and being used at the Payson Center.)  See attached sample map.  Health data will be recorded using MS Access-based entry form developed through coursework for BIOS 622 database management class and performed by myself during my stay in Ciudad Sandino.   Analysis of data will be conducted to determine clustering effects and spatial representation of disease within the community.  I will be working with Dr. Alex Coles and Dr. Nancy Mock to facilitate appropriate methods for data analysis using SPSS and ArcView GIS 3.1.

In addition, the Pan American Health Organization (PAHO) is scheduled to release the first version of a proprietary GIS record collection and health analysis software called SIG Epi in April/May.  This tool is available as freeware and in Spanish.  PAHO is working with collaborative groups to facilitate distribution and training of this tool for local and national health facilities in Latin America.  The development of this tool coincided with the development of standards for GIS data collection methodology.   This methodology is published on the PAHO web site and will be followed during the collection of data in Ciudad Sandino.   In addition, this tool, if released in time, this tool will be used as the basis for the introduction and training of GIS. 

The contribution of field research

 The fieldwork involved in this project proposal is designed to:

 1)      Aid in collecting health outcome indicator data in relation to malaria and dengue in Ciudad Sandino, Nicaragua;

 2)      Assist with geo-locating health centers and health facilities within a local community; and

 3)      Introduce through informal training sessions the concept of GIS and available tools that are used to geographically represent disease case data and assist in surveillance and control efforts.

Fieldwork is essential in continuing the relationship with the local health officials and in acquiring health data.  A micro-level analysis of health outcome data and examination of the data in relation to current population and geo-referenced markers requires field placement and retrieval of information.  Further it is necessary to introduce the notion of GIS and how available technological tools assist in epidemiologic surveillance and disease control.  Fieldwork is essential in realizing the benefits within the local community and with acquisition and analysis of health information. Without field research this data would not be available otherwise.

Further, this project should be viewed as an initial phase of a long-term relationship with the community of Ciudad Sandino to develop the community-based GIS capabilities of the local health sector.  It is my long-term goal to work with this community to integrate technology and health information systems to assist both the development of local health resources and integration of their existing active surveillance system into improved decision-making.  However, this initial phase will provide valuable information and is achievable in the allotted timeframe.  I have very good relations with the Director of this community health system and with the Director of the surveillance program as well as with the statistics and epidemiologic control officers.  I worked with them very closely last year and have discussed my intentions and current plan with them.  They are very open and responsive to my needs and are excited about both assisting with research data and in working towards a more technologically integrated approach to epidemic surveillance

The Location  (click to view map of the region)

The fieldwork will take place from the middle of May to the end of June 2000 in Ciudad Sandino, Nicaragua.  Ciudad Sandino is a community of about 100,000 people located about 10 miles outside of Managua, the capital. There are 5 health clinics, one main hospital and a series of puestos de salud (health posts) in the community. Each clinic is staffed with 3 or 4 physicians and a range of health workers and educators. The newest clinic, in a section of town called Nueva Vida, opened in August 1999 in a new resettlement community established after Hurricane Mitch.

This project will be conducted primarily at the Centro de Salud in Zone 7 in Ciudad Sandino.  This Health Center houses the epidemiological surveillance data for the 15 zones of Ciudad Sandino as well as information linking the health data to patient location. The Director of the epidemic surveillance for Ciudad Sandino is Dr. William Gutierrez (tel: 5-05-269-6520).  During the summer of 1999, I organized and sent a series of children’s relief items for this community and participated in a general heath education/Mitch relief effort.  Details of this project, participating organizations, pictures and further description of the health facilities is located here.  I will have accommodation with the same family I stayed with last year. 

The content of the page is produced by John M. Miller and any and all comments, question, or suggestions should be addressed to me. 

Last Updated October 25, 2000