Declaration

We INFO28-09 do hereby declare that this Project Report is original and has not been published
and/or submitted for any other degree award to any other University before.

# Names Registration Number Signature

1 Ikuna Ruth 06/U/11169/PS
2 Kalyesubula Vicent 06/U/11179/PS
3 Katongole Paul 06/U/1561
4 Kiwanuka Patrick Ivan 06/U/11213/PS
5 Muma Wycliff 06/K/4382/PS
6 Mwase Maria 06/U/1574
7 Nguru John Githiaka 06/K/4390/PS
8 Waithera Mohammad Kariuki 06/K/4889/EVE

Date: …………………………………………………….

Approval
This Project Report has been submitted for Examination with the approval of the following
supervisor.

Signed: ………………………………………………………..

Date: ……………………………………..

Mr. Paul Ssemaluulu,

FTC (UPK), BBA (MUK), MSc CS (MUK)

Department of Information Technology,

Faculty of Computing and Information Technology,

i
Makerere University

ii
Dedication

This report is dedicated to our dear parents and guardians who have cared for, facilitated and
supported us for the duration of our stay in Makerere University.

iii
Acknowledgement

We take this opportunity to thank God who was always with us and also provided the
knowledge, wisdom and skills that have enabled us to complete this project.

We would like to extend our gratitude to our group supervisor, Mr. Paul Ssemaluulu for sparing
time and effort to offer technical assistance, advice and support through this great undertaking.

Special thanks are also extended to our research contacts in their different capacities and
disciplines for their cooperation and help during data collection process. Special mention goes to
Dr. Olive Sentubwe for taking time out her busy schedule to help us with significant information
in the field of infant and maternal health.

iv
Table of Contents

Declaration....................................................................................................................................i
Approval........................................................................................................................................i
Acknowledgement.......................................................................................................................iv
Table of Contents.........................................................................................................................v
List of Tables...............................................................................................................................ix
Appendix A : Sample Questionnaires 56.............................................................................xi
List of Abbreviations.................................................................................................................xii
Abstract.....................................................................................................................................xiii
Chapter 1......................................................................................................................................1
Introduction..................................................................................................................................1
1.1 Background ...........................................................................................................................1
1.2 Problem Statement.................................................................................................................2
1.3 Main Objective.......................................................................................................................2
1.4 Specific Objectives.................................................................................................................2
1.5 Scope ....................................................................................................................................2
1.6 Significance of the Infant and Maternal Monitoring System.................................................3
Chapter 2......................................................................................................................................4
Literature Review.........................................................................................................................4
2.1 Introduction............................................................................................................................4
2.2 Information System................................................................................................................5
2.3 Databases................................................................................................................................5
2.4 Web-based Discussion Forums..............................................................................................6
2.5 Short Message Service Functionality ....................................................................................6
2.6 Case Studies...........................................................................................................................7
2.6.1 Case Study 1..................................................................................................................7

v
 Health Canada (2005) described a Hospital Information System, NShIS that linked health
information within and between hospitals across the province (Nova Scotia, Canada). It
enabled fast, secure access to patient and administrative information by appropriate
healthcare providers...............................................................................................................7
2.6.2 Case Study 2..................................................................................................................7
2.6.3 Case Study 3..................................................................................................................8
2.6.4 Case Study 4..................................................................................................................8
Chapter 3......................................................................................................................................9
Methodology................................................................................................................................9
3.1 Introduction............................................................................................................................9
3.2 Study Population....................................................................................................................9
3.3 Sampling ................................................................................................................................9
3.3.1 Sampling Technique ...................................................................................................10
3.3.2 Sampling Size .............................................................................................................10
3.4 Data Collection Techniques.................................................................................................11
3.4.1 Reading Documentations............................................................................................11
3.4.2 Questionnaires..........................................................................................................11
3.4.3 Interviews.................................................................................................................11
3.4.4 Observation..............................................................................................................12

3.5 Analysis of Collected Data...................................................................................................12

3.6 Design...............................................................................................................................17
3.7 Implementation.................................................................................................................18
3.8 Testing and Validation.....................................................................................................18
Chapter 4....................................................................................................................................19
System Design and Implementation...........................................................................................19
This chapter describes the design and implementation stages of the Infant and Maternal
Monitoring System.....................................................................................................................19
4.1 The Current System..............................................................................................................19
4.1.1 Data Inputs..................................................................................................................19

vi
 4.1.2 Data Outputs................................................................................................................20

4.1.3 System Stakeholders...................................................................................................20

4.2 System Analysis...................................................................................................................21

4.2.1 User Requirements......................................................................................................21

4.2.2 Functional Requirements.............................................................................................21

4.2.3 Non-Functional Requirements....................................................................................22

4.2.4 System Specification...................................................................................................22

4.2.5 System Constraints......................................................................................................23

4.3 System Design......................................................................................................................23

4.3.1 Data Flow Diagrams....................................................................................................23

4.3.1.1 Context Diagram/ Level 0 Diagram.........................................................................24

4.3.1.2 Level 1 Diagram.......................................................................................................26

4.3.1.3 Level 2 Diagram.......................................................................................................28

.............................................................................................................................................30

4.3.2 Entity Relationship Modeling.....................................................................................33

4.3.2.1 Entities and their Attributes......................................................................................33

4.3.2.2 Relationships between Entities.................................................................................37

4.3.2.3 Enhanced Entity Relationship Modeling Concepts..................................................37

4.3.2.4 Mapping Entity Relationship Model to Tables (Relations).....................................42

4.3.2.5 Normalization of Tables...........................................................................................44

4.4 System Implementation........................................................................................................46

4.4.1 Technologies...............................................................................................................46
4.5 Testing and Validation.........................................................................................................48

vii
 4.5.1 Testing.........................................................................................................................48
4.5.2 Validation....................................................................................................................49
Chapter 5....................................................................................................................................50
Introduction ...............................................................................................................................50
5.1 Discussion............................................................................................................................50
5.2 Results/Findings...................................................................................................................51
Chapter 6....................................................................................................................................55
Conclusion and Recommendations............................................................................................55
Conclusion................................................................................................................................55
Areas for Further Research......................................................................................................55
6.3 Recommendations................................................................................................................55
References..................................................................................................................................57
Appendices.................................................................................................................................60
Appendix A: Sample Questionnaires.........................................................................................60
Appendix B: Interview Guide....................................................................................................69
Appendix C: User Acceptance Test ..........................................................................................70

viii
List of Tables

Table 1: Sample Size

10

Table 2: The relevance of health care services 12

Table 3: Factors that contribute to such high infant mortality rates 15

Table 4: Activities of Existing System Users 19

Table 5: Hardware Requirements 21

Table 6: Software Requirements 22

Table 7: DFD Elements 23

Table 8: Entities and their Attributes 31

ix
 List of Figures

Figure 3.1: A pie chart showing ranking reasons for missing antenatal checkups 14
Figure 3.2: A bar chart showing disease contraction in infants 15
Figure 4.1: Context Diagram / Level 0 Diagram 24
Figure 4.2: Level 1 DFD Diagram 26
Figure 4.3: Level 2 DFD Diagram for Process 1- Registration 29
Figure 4.4: Level 2 DFD Diagram for Process 2- Authentication 29
Figure 4.5: Level 2 DFD Diagram for Process 3- Monitoring 30
Figure 4.6: The relationships between Entities in the System 35
Figure 4.7: A relationship between Superclass (Patient) and subclasses 36
Figure 4.8: A relationship between Superclass (MRecord) and its subclasses 37
Figure 4.9: An Enhanced Entity Relationship Diagram of the System 38
Figure 4.10: Ozeki Message Server connecting to a database server 45
Figure 5.1: User Login Page 49
Figure 5.2: Error page 49
Figure 5.3: Registration form 50
Figure 5.4: Child Immunization report 50
Figure 5.5: Discussion Forum 51

x
List of Appendices

Appendix A : Sample Questionnaires 56

Appendix B : Sample Interview Guide 63

Appendix C : Sample User Acceptance Test 64

Appendix D : Sample Code to Authenticate Users 66

xi
List of Abbreviations

ASP.NET Active Server Pages. NET

CSS Cascading Style Sheets

DBMS Database Management System

DFDs Dataflow Diagrams

EERDs Enhanced Entity Relationship Diagrams

GSM Global System for Mobile Communication

HTML Hypertext Markup Language

IIS Internet Information Server version

IS Information System

IT Information Technology

MDGs Millennium Development Goals

MS SQL Server Microsoft Structured Query Language Server

NShIS Nova Scotia Hospital Information System

SMS Short Message Service

SQL Structured Query Language

UNDP United Nations Development Programme

VB.NET Visual Basic.NET

WbIS: Web-based Information System

WHO World Health Organization

xii
Abstract

Lowering child mortality is one of the 8 Millennium Development Goals set to be achieved by Less
Developed Countries by 2015. However, child deaths are still unacceptably high with statistics in
Uganda showing that for every 1000 births; over 137 infants do not get to celebrate their 5 th
birthday.

UNDP attributes 70% of infant deaths in Less Developed Countries to the contraction of diseases
such as tuberculosis and measles. Other notable causes include malnutrition, parental ignorance,
inadequate basic health care, absence of enough medical attention to pregnant women and children.

Despite the fact that Uganda has employed a number of practical measures in the recent past to
decrease infant mortality, there hasn’t been much decrease in these unfortunate statistics. This has
been attributed to a number of factors such as, the inadequacy of basic health care especially in
rural areas, and the lack of popularity for the National Immunization Programme to mention but a
few.

The Infant and Maternal Monitoring System seeks to lower infant mortality rates by encouraging
pregnant women, as well as mothers to take their new born babies and infants to visit the nearest
health centers for required healthcare checkups, vaccinations or immunizations . This has been
achieved through the creation and use of SMS functionality on the created system.

This system improves communication and collaboration between medical practitioners through
discussion forums, thus increasing the rapidity and quality of patient care. Consequently, the
system also automates record keeping procedures for both patients and medical practitioners.

xiii
Chapter 1
Introduction
1.1 Background
The United Nations ranks “Reducing Infant Mortality” as the fourth goal in the Millennium
Development Goals to be achieved by 2015. In Uganda this is far from fruition

Every year, four million infants die within their first month of life, representing nearly 40 percent
of all deaths of children under age of five years. Almost all newborn deaths are in developing
countries with the highest number in South Asia and the highest rates in sub-Saharan Africa,
according to Sines et al. (2007).

Mukasa (2008) directly quoted Diana Sekaggya, an official of the UNDP in Uganda. She said
that over 137 children out of every 1,000 born in Uganda die before their fifth birthday while 76
infants out of every 1,000 die before their first birthday.

Definition of Key Terms:

• Infant is a baby or young child of 5 years old and below, Hornby (1974).

• Maternal is a word that describes a woman having feelings of a typical mother towards a
child in terms of love and care, Hornby (1974).

• Monitoring is a means through which progress and development is Observed, Watched or

inspected to ascertain whether there are any notable deviations or irregularities, Hornby
(1974).

• System is a group of structured and coordinated elements working together for a unified
purpose, Hornby (1974).

• Patient Monitoring is the process of observing patient historical records collected over time
by a medical practitioner to allow for medical decisions on the patients health.

• The Infant and Maternal Monitoring System is an Information System that will serve to
capture, store, retrieve and disseminate information about both mothers and infants (patients),
which will be used by Medical practitioners to efficiently provide quality healthcare to these
patients with the overall aim of curbing high infant mortality rates in Uganda.

1
1.2 Problem Statement

Sub-Saharan Africa accounts for about half the deaths of infants in the developing world. In
Uganda, over 137 children out of every 1,000 born in the country die before their fifth birthday,
as estimated by UNDP (2008). While statistics show that the maternal and infant mortality rates
have improved between 2000 and 2008, the latest data points toward stagnation. There is urgent
need for Uganda to examine viable measures to try to halve infant mortality by 2015. The Infant
and Maternal Monitoring System endorses the use of IT to encourage and remind pregnant
women to attend antenatal check-ups and guardians of infants to bring them for basic health care
with the overall aim of curbing high infant mortality rates in Uganda.

1.3 Main Objective

To develop an Infant and Maternal Monitoring System with the intention of curbing high infant
mortality rates in Uganda, so aiding in its attempt to halve infant mortality rates by 2015.

1.4 Specific Objectives

i. To investigate factors that have bearing on infant mortality in Uganda.

ii. To design an Infant and Maternal Monitoring System

iii. To implement the Infant and Maternal Monitoring System

iv. To test and validate the system

1.5 Scope

This project focused on the development of an Infant and Maternal Monitoring System with the
sole purpose of maintaining pregnant women’s records and infants immunization and
vaccination records. The system promotes information sharing among medical practitioners,
improves record management and sends reminders to registered patients. It thus makes
information available to medical practitioners in health care facilities within Kampala, Uganda

2
with the purpose of promoting efficiency, quality and improving health care particularly towards
pregnant women and infants.

1.6 Significance of the Infant and Maternal Monitoring System

High quality prenatal and post natal care improves the survival and health of infants, while
providing an entry point for health contacts with the pregnant women and mothers at a key point
in the continuum of care, Lincetto, et al (2006). If provided, promoted, monitored, researched,
and further tested, health care services such as: antenatal care and vaccinations will create lasting
improvements in health systems and constitute major progress in meeting the MDGs. More
importantly, it will save the lives of thousands of mothers and children every year, Sines, et al
(2007).

The Infant and Maternal Monitoring System is one such feasible solution, the practical uses of
the system are discussed below:

Pinto (2006) notes that an automated electronic health records system, such as the Infant and
Maternal Monitoring System, creates efficiencies and dramatically streamlines processes such as
patient registration and records management. It also improves communication by offering an
intellectual knowledge base for medical practitioners over discussion forums which eases the
rapidity of patient care.

In addition to the above, Poissant and Kawasumi (2005) noted that an electronic health record
system offers more comprehensive security measures than previously used methods such as
locked cupboards or room storage. Password protection limits access to patient information to
authorized users: Doctors, Nurses, Midwives.

It solves the archived-records dilemma where pre-existing health records are in paper form. An
electronic record stores both archived and active patient records in a centralized database, Pinto
(2006). The system is a cost-effective and technologically-viable alternative to manually paper-
based patient record keeping and ensures that medical practitioners have access to the right
patient data at the right time.

3
According to Poissant and Kawasumi (2005), an electronic records system efficiently reduces
documentation time, and leads to better patient care with an increase in patient-interaction time
with the implementation of the Infant and Maternal Monitoring System.

Chapter 2
Literature Review
2.1 Introduction
According to Sines, et al (2007), there are four million infants that die within their first month of
life every year representing nearly 40 percent of all deaths. Almost all newborn deaths are in
developing countries, the highest rates in sub-Saharan Africa. Newborn survival is undoubtedly
linked to the health of the mother, and nowhere is this more evident than with those newborns
and infants whose mothers die during childbirth.

Lincetto, et al (2006) considers pregnancy as a crucial time to promote healthy behaviours and
parenting skills. Good antenatal-care links the woman and her family with the formal health
system, hence contributing to good health through the life cycle. Inadequate care during this time
breaks a critical link in the continuum of care, and affects both women and their babies.

One proposed explanation hindering the progress in lowering infant mortality in Uganda has
been a decline in vaccinations, especially in the late 1990s. Moller (2002) states that the overall
share of fully immunized children fell from 47% in 1995 to 37% in 2000 yet vaccinations are
directly relevant to lowering infant mortality. Also, the share of pregnant women receiving at
least one tetanus toxoid injection has fallen during this period, to the detriment of progress on
infant mortality. Nevertheless, the recent substantial increases in public health expenditures
should help to reverse these trends.

In the past 20 years IT has revolutionized virtually every facet of people’s everyday lives.
Organizations of all types have long seen that IT when viewed comprehensively and deployed
effectively can replace old challenges with new possibilities. However, one of the areas of slow
evolution is the healthcare system.

Information Technology is defined by Laudon and Laudon (2002), as any form of technology
comprising of mainly hardware and software used by people to handle information. Roos (2007)

4
defines IT as any technology that powers or enables storage, processing, and information flow
within an organization. Anything involved with computers, software, networks, intranets, web
sites, servers, databases and telecommunications falls under the IT umbrella. The use of I T in the
provision of healthcare has advantages: leading to error reduction, improving communication
between health care practitioners, and better access to medical information.

Uganda needs I T to encourage and remind pregnant women to attend antenatal check-ups and
guardians of infants to bring them in for basic health care services as well as automating Hospital
Information Systems with the electronic patient health records and a score of other technologies
that support information sharing, quality as well as efficiency of record keeping, and health care
provision. The Infant and Maternal Monitoring System demonstrate this.

2.2 Information System

An Information System is a collection of integrated components that capture, process, store,
retrieve and disseminate information in an organisation to enable decision making or
interdisciplinary study of systems that provide information to users within organisations, Laudon
and Laudon (2002). It may also be defined as a collection of methods, practices, algorithms, and
methodologies that transform data into information, and provide knowledge desired by and
useful for individuals and group users in organizations and other entities. This system can
involve a combination of work practices, information, people, and technologies organized to
accomplish goals in that organization. Information Systems can either be online (web-based) or
offline.

Vassiliadis and Stavrakas (2002) argued that WbIS for example online discussion forums can be
considered as the synthesis of information from several sources in the operational environment
of an Intranet.

2.3 Databases
A database is a shared collection of logically related data, and the description of this data is
designed to meet the information needs, Connolly and Begg, (2004). Computer-based databases
have reduced data storage requirements and improved the efficiency of data retrieval. As a result,

5
raw data from many users and organizations can be retrieved very quickly and accurately. They
can be online (web-based) or offline.

According to Ramakrishnan and Gehrke, (2002), Databases have several components which
include a Data dictionary or Metadata – which provides a description of data to enable program–
data independence. Database systems are managed using DBMS which is a software system that
enables users to define, create, maintain, and control access to the database. Databases are built
on architectures, which address the system design issues that make the DBMS work. It is an
invaluable reference for database researchers, practitioners and for those in other areas
computing interested in the system design techniques for scalability and reliability. Key uses of
databases include; helping in the storage, management and retrieval of vast amounts of
information.

2.4 Web-based Discussion Forums

These are designed to support shared threaded discussions that occur in a precise context and
offer tools that support asynchronous collaboration, Baskin (2001). Discussions are structured
into forums and threads.

Medical practitioners are therefore given an environment where they can share their knowledge
and work collaboratively in building new knowledge notes. It is seen as an opportunity to
encourage more collaboration and interaction between medical practitioners.

In order to contribute a comment or question, users must manually reconstruct the context of
their remark before making it. As such, the resulting discussion will be seen by other users who
may freely contribute to a given discussion.

2.5 Short Message Service Functionality

Karthikayan (2000) considers SMS as a revolution in the field of wireless world, involving
sending and receiving text based messages using a mobile telephone. The system has its
messages in form of reminders sent by an SMS Messaging Server to the respective patients. The
patients or receivers receive the SMS through a mobile telephone. The most important advantage
of the SMS service is its low cost nature.

6
A Short Message Service is a communication service standardized in the GSM mobile
communication system that uses standardized communications protocols so allowing for the
interchange of short text messages between mobile telephone devices. SMS technology has
facilitated the development and growth of text messaging.

2.6 Case Studies

The following case studies show that employment of IT in the field of medicine has had a
positive outcome.

2.6.1 Case Study 1

Health Canada (2005) described a Hospital Information System, NShIS that linked health
information within and between hospitals across the province (Nova Scotia, Canada). It
enabled fast, secure access to patient and administrative information by appropriate
healthcare providers.
The NShIS system, put in place by March 2006, allowed doctors, nurses, and other healthcare
staff in hospitals to have the up-to-date patient information they needed to provide timely and
safe quality health care.

Its benefits included decreasing wait times for test results and x-rays, reducing the chance of
clinical error due to transmission and interpretation errors through electronic prescription entry.
Electronic scheduling that eliminated the chance of duplicate bookings, and allowed for
cancellations to be quickly filled, helping to reduce wait times and allow for remote access to
patient hospital information by physicians in their offices.

2.6.2 Case Study 2

Chute (2000) saw that the work of hospitals as caring for patients (the everyday women and men
of America). As such hospitals are to strive to improve the safety and quality of that care.
Research showed that certain kinds of IT – such as Computerized Physician Order Entry
(CPOE), computerized decision support systems, and bar-coding for medication administration –
limited errors, improved care, and also improved efficiency. While American hospitals have
been pioneers in harnessing IT to improve patient care, quality and efficiency, the challenge now

7
is to extend its use and integrate it into the routine care processes in all hospitals, big and small,
in both rural and urban areas.

2.6.3 Case Study 3

Accenture (2006) is committed to achieving high performance in the health care industry by
working with their clients to improve the quality, accessibility and affordability of health care
around the world. Patient-centered health care is at the heart of this commitment.

In South Africa, there was a pressing need to bring individual patients into the heart of the health
care ecosystem. Electronic health records that were accessible to patients and healthcare
professionals in any hospital or health care centre in South Africa gave promise of a consolidated
view of health information that make patient centricity and healthcare integration possible.

In order to gauge patient receptiveness towards the introduction of electronic health records,
Accenture conducted extensive research countrywide with more than 2,000 respondents,
representing 92 percent of South Africa's urban population. The results were compelling and
revealed opportunities to leverage technology for high performance in the health care industry.

2.6.4 Case Study 4

According to Jareethum and Titapant (2008), a study was conducted on 68 healthy pregnant
women who attended the antenatal clinic and delivered at Siriraj Hospital .Those who met the
inclusion criterion between May 2007 and October 2007 were enrolled and randomly allocated
into two random groups. The study group received two SMS messages per week from 28 weeks
of gestation until giving birth. The other group was pregnant women who did not receive SMS.
Both groups had the same antenatal and perinatal care.
The satisfaction, confidence and anxiety scores were evaluated using a questionnaire at the
postpartum ward. The pregnancy outcomes were also compared in these two groups. The
registered results showed that the pregnant women, who received prenatal support in SMS

8
messages, had higher confidence levels and lower anxiety levels than the control group in the
antenatal period. However, no difference in pregnancy outcomes was found.

Chapter 3
Methodology
3.1 Introduction
This section presents the study area, methods and techniques that were used in data collection,
analysis and processing. It also includes the design of the research, the sizes of the samples and
how these samples were be selected and the procedures that were used.

3.2 Study Population

The study was conducted by group members that questioned medical professionals within
random health care units within Kampala city, Uganda. The survey involved the critical study,
investigation and communication with doctors, nurses and midwives all of reputable healthcare
centers and having over 3 years experience in the fields of antenatal and infant health care.

3.3 Sampling
Sampling is a practice of selecting and inquiring from a fraction of the total population for
purposes of making conclusions about that population as a whole. It was carried out based on the
following justifications:

i. It was time saving because studies are carried out over a few sample areas, and allowed
for checks and counter checks for accuracy.

ii. A proven practical and realistic means of population representation

iii. It eliminated the need for a large number of interviewers and research assistants who are
expensive and difficult to control.

iv. The project time scope was short, approximately four months.

9
 3.3.1 Sampling Technique

Purposive sampling was the preferred sampling technique. It is a non–probabilistic technique of

sampling that has researchers selecting a sample based on their own judgement towards a
specific purpose. Selected health care units in the Kampala city region were chosen to represent
the Ugandan population as a whole.

The main justification behind the selection of the above mentioned technique is that health care
units in Kampala were countless and geographically dispersed. Health care practitioners that
were approached were reputable and easily accessible.

In addition, the respondents were highly experienced individuals in the fields of antenatal and
infant health care, thus were credible sources of information.

3.3.2 Sampling Size

The study used a sample size of 16 respondents from 4 different healthcare centers, this sample
was manageable enough for the researchers to question and analyze the findings. The sample
consisted of medical practitioners with over 3 years experience in antenatal and child care. As
such, they were able to provide accurate, credible and consistent information regarding health
care for pregnant women and infants.

Table 1: Sample Size

CATEGORY SAMPLE SIZE

Doctors 5

Nurses 6

Midwives 5

TOTAL 16

10
3.4 Data Collection Techniques
3.4.1 Reading Documentations

This involved carrying out research and extensive reading of existing materials and
documentation regarding prenatal, antenatal, and infant health care; requirements, design and
implementation of Information Systems and all the already mentioned technologies.

Resources such as libraries and the internet were exploited. This method was easy to use and
provided a lot of background information.

3.4.2 Questionnaires

In this method a number of related questions were used basing on the study objectives. Both
open ended and closed questions were administered. Questions were supplied to the respective
respondents who were required to fill in the questions accordingly. See Appendix A

The questionnaires were then analysed to determine the accuracy and consistency according to
the objectives of the topic.

Even after system development questionnaires were passed out to respondents to test user
friendliness and gain system acceptance. Questionnaires were employed mostly in instances
where researchers had no chance to physically interview the respondents.

3.4.3 Interviews

In this method the researchers came up with questions beginning with what, why how when and
where. It was a one on one discussion with the respondents and oral guided questions were
administered between the informer and the informant. These interviews helped in validating the
already gathered information. The responses were captured or noted down, analyzed and
processed for use during the design and implementation of the project.

The interview guide is provided in Appendix B.

11
 3.4.4 Observation
The observation method involved the careful study of existing health care systems in place for
pregnant women and infants. The existing Information System was observed in order to
understand information flow and how this data was being utilized in specified health care
centers.

This method helped the researchers to learn about the problems related to health care for
pregnant women and infants as well as any pressing concerns with the existing Information
System. This method was cheap, easy to use and readily available to the researcher.

3.5 Analysis of Collected Data

Noting that in a standard health center, slightly over 350 pregnant women are registered
annually, while considering the fact that approximately 200 of them complete the recommended
minimum of 4 antenatal care visits. Each antenatal checkup over the course of the pregnancy (9
months or 3 trimesters) is of great importance in terms of effectively monitoring the health,
progress and development of both the mother-to-be and her child.

Table 2: The relevance of health care services

PREGNANCY HEALTH CARE SERVICES RELEVANCE

STAGE

First Early trimester: To confirm the pregnancy

Trimester(1-3
months) • Health history is noted

• Physical examination

• Blood and urine tests carried out.

12
 Late trimester:
• Foetal ultrasound is performed
• Listen for a foetal heart beat using a Doppler
• Pelvic Exam
• Pap Smear
• Breast Exam
• Blood Screening for Rubella, Hepatitis, HIV,
syphilis and spinal bifida amongst others
• Blood pressure is checked
• Mother’s weight is recorded
• Urine screening for protein and sugar
• The fundal height is measured to check baby's
growth
• Additional prenatal testing as needed
Second • Foetal ultrasound
Trimester (4- • Record mother’s weight
6 months) • Fundal height is measured to check baby's
growth
• Blood pressure is checked
• Urine sample is screened
• Blood screening for Rubella, Hepatitis, HIV,
syphilis and spinal bifida amongst others.
13
The ultrasound provides an image of the
foetus and placenta.
Screening tests uses your blood or urine
sample to check perform a battery of tests
especially where infections or
discrepancies are suspected so that the
correct precautions are taken
All the performed examinations serve to
check the developmental progress of both
mother and child
Ultrasounds are used to monitor fetal heart
beat and to identify any foetal problems in
growth
Screening tests uses blood or urine
samples to check perform a battery of tests
especially where infections or
discrepancies are suspected so that the
correct precautions are taken.
Third • Foetal ultrasound Ultrasounds are used to monitor fetal heart
Trimester (7- beat and to identify any foetal problems
9 months) • Blood screening for Rubella, Hepatitis, HIV, that may bring about high risk factor in
syphilis and spinal bifida amongst others delivery
• Ultrasound scan Screening tests uses blood or urine
samples to check perform a battery of
• Clinical examination
tests especially where infections or
• Foetal & placental check discrepancies are suspected so that the
correct precautions are taken
• Urine sample to screen for sugar and protein
• Mother’s weight is recorded
• Listen for baby's heart beat
• Palpate to check baby's position (vertex,
breech, posterior, etc.)
• Fundal height is measured to check baby's
growth
• Reviewing of delivery plan
• Mother’s blood pressure is checked

• Prenatal Testing Basics

NOTE: All pregnant women should be screened for Human Immuno-deficiency Virus (HIV)
infection to help prevent newborn HIV infection.

Many pregnant women that fail to go for their antenatal checkups give their health care providers
for a number of reasons. These range from ignorance and/or forgetfulness, inadequate finances to
pay off medical bills, and long distances from health centers.

14
 Others
Longdistances
Inadequate finances
Ignorance and/or forgetfulness

Figure 3.1: A pie chart showing ranking reasons women give for missing antenatal checkups

As noted in the above chart, ignorance of these women on how important these antenatal
checkups are. Others attribute it to mere forgetfulness, however these expectant women assume
that since they feel fine or healthy it is okay to dismiss these checkups.

The above only goes to show that the Infant and Maternal Monitoring System may remedy this
using its SMS functionality which will constantly remind these women to go for these much
needed medical checkups.

Out of the approximate 150 births recorded monthly in an average health center, it is estimated
that 50 to 90 mothers out of the annually recorded 2000 start and finish the immunization
process. Many of these mothers also believe in the use of traditional remedies or self medication
on their children for a number of treatable illnesses such as Malaria. These activities have
influenced on the numbers of recorded infection rates of both immunizable diseases and treatable
illnesses in comparison to other ailments such as this is illustrated in Figure 3.2 below

15
 Immunizable
diseases

Treatable
diseases Infection rates per 100
children

Others

0 10 20 30 40 50 60

Figure 3.2: A bar chart showing disease contraction of infants in an average health center

Most infant deaths result from a combination of preventable or treatable diseases such as acute
respiratory infections like Pneumonia, Diarrhoea, and Malaria and immunizable diseases such as
Tuberculosis and Measles. Some of these diseases can easily be prevented through simple
improvements in basic health services and proven interventions, such as oral rehydration therapy,
insecticide-treated mosquito nets and vaccinations.

Though the government through the Ministry of Health has endeavored to curb these high infant
mortality rates by carrying out malaria awareness campaigns calling for the use of insecticide-
treated mosquito nets, and recent immunization drives. The above as well as other factors
contribute to such high statistics. These are given below:

Table 3: Factors that contribute to such high infant mortality rates

FACTORS REASONS

Poor immunization A notable drop in immunization levels from 47% in 1995 to 37% in
coverage 2000 as noted by Moller (2002).

Low political support for vaccination policies.

Lack of popularity for the National Immunization Programme.

Malnutrition or under- Families especially in rural Uganda cannot afford to have a

16
nutrition balanced diet which is vital to the proper growth and development
of a child’s health.

Low socio-economic status Families usually cannot afford basic health care this is worsened by
recent economic turmoil with the “credit crunch”- where prices
seem to have sky rocketed.

Poor antenatal and post Inadequate services:

natal care
i. One midwife having over 200 pregnant women to oversee.

ii. The proportion of deliveries assisted by a trained medical

professional was essentially stagnant at 38% in 1989 and
39% in 2001

Poor attitude of health workers who are overworked and underpaid

High HIV infection rates The presence of HIV has serious implications for antenatal care and
amongst pregnant women delivery , it increases risks of maternal and infant mortality

Mothers lack of a basic This is especially because of the high number of Adolescent
education. pregnancies which contributes to the cycle of maternal deaths and
childhood mortality

All in all, the medical professionals absolutely agreed that by reminding pregnant women to have
antenatal checkups and as well as reminding mothers or guardians to bring their children for
immunization would be a positive step toward lowering infant mortality rates especially if
implemented alongside with the already existent health campaigns that the Ministry of Health
has already put in place.

3.6 Design

17
Design tools such as Data Flow diagrams (DFDs) and Enhanced entity relationship diagrams
(EERDs) were used in the development of the system. Enhanced Entity Relationship Diagrams
show the clear breakdown of entities, the relationship between them and their attributes.Both
DFDs and EERDs are easy to use and interpret

3.7 Implementation
Several technologies were used during the implementation of this project. The
technologies/programming languages will include HTML, Cascading Style Sheets (CSS)
MSSQL, Visual Basic.Net and ASP.NET.

In implementation of this system the following software were used:

i. Visual Studio 2008

ii. MSSQL Server 2008(Express Edition)

iii. Ozeki Message Server (Trial)

3.8 Testing and Validation

3.8.1 Testing

Testing done by use of Unit testing done after each module was created and integration testing
done as each of the created modules was assembled to work together and finally a system test
after all the modules were assembled to come up with the entire system.

3.8.2 Validation

The complete system was presented to end user representatives who tried out the system and
verified that the developed system addressed all the requirements and would satisfy all the
intended user needs. A questionnaire designed to capture their responses, thoughts and
impressions was availed to the user during the validation.

18
Chapter 4
System Design and Implementation
This chapter describes the design and implementation stages of the Infant and Maternal

Monitoring System.

4.1 The Current System

The existing medical information system uses paper-based records with specialized cards
designed by the Ministry of Health for healthcare units in Uganda. In a given health care facility,
a pregnant woman is presented with an antenatal card which is used to capture their background
information as well as some health related questions. This information is helpful to the midwife
or doctor that is administering pre-natal health care.

This same card serves as a progress form for the pregnant woman for the duration of her
pregnancy, with the aim of ensuring normal foetal health and development.

In the case of an infant, a child health card is given at birth indicating birth weight and
background information. It is using this form that an infant’s health progress is monitored in
terms of immunization, de-worming, weight gain and general growth to ensure normal progress.

Patients are registered once, after which with each visit their medical records (cards) are pulled
up for viewing and to check on their medical progress.

4.1.1 Data Inputs

i. Patient background information.

ii. Patient medical history.

iii. Next scheduled appointment dates.

iv. Posts by different healthcare practitioners on the discussion forum.

v. Articles Posted by registered users.

19
 4.1.2 Data Outputs
i. Reminders based on next scheduled appointment.

ii. Antenatal progress Report.

iii. Infant Progress Report.

iv. Display of posts submitted for viewing on the website

4.1.3 System Stakeholders

i. Doctors

ii. Nurses

iii. Midwives

iv. Patients

Table 4: Activities of existing system users

USECASE NAME SUMMARY DESCRIPTION

DOCTOR Individual responsible for • Query system for extreme medical cases
diagnosing, and treating • Views a infant’s or pregnant woman’s medical
extreme medical cases records and reports

NURSE Individual responsible for • Register infants

handling child ailments and
immunizations
MIDWIFE Individual responsible for
monitoring and maintaining
the health of pregnant women
• Query system for existing infants medical records
• Modify/update/delete an infant’s medical records.
• Refer extreme medical cases to the Doctor.
• Register pregnant women
• Query system for existing patient’s antenatal
medical records
• Modify/update/delete a pregnant woman’s
• Refer extreme medical cases to the Doctor.

20
4.2 System Analysis

The requirements of the system are categorized into user, functional, and non-functional
requirements and system specification.

4.2.1 User Requirements

The system has the following specified user requirements:

1. Midwives should be able to view and update information about patients

2. Doctors should be able to view information about patients

3. Nurses should be able to enter the data provided by the patients.

4.2.2 Functional Requirements

According to Sommerville (2001), functional requirements describe the functionality or services
the system is expected to provide.

The following are the system’s functional requirements:

1. The system captures processes and stores patient information.

2. The Infant and Maternal Monitoring System permit the querying of patient records by
authorized users.

3. Furthermore, the system allows users to view patient information as needed and generates
patient reports based on end users command.

4. The system sends SMS text messages to respective patients when necessary.

21
 5. The system users can post articles on the website as well as discuss topics in the
discussion forum.

6. Computing estimated date of delivery.

4.2.3 Non-Functional Requirements

These are not directly concerned with specific functions delivered by the system. They pertain to
system properties such as: reliability, accuracy to mention but a few, Sommerville (2001).

The following are the non-functional requirements:

1. The system allows access to only authorized users who are expected to have a username
and password.

2. The system is easy to learn and use by its end users.

3. The system is efficient so as not to waste system resources

4. The system is portable so that it may easily run on most operating systems

5. Reliability because the application is a standalone system relying on database stored on

a remote server hence allowing for fast system start up

6. The data output will be accurate since the input data is validated.

7. Maintainability, the system is easy to maintain since it is modular and object oriented

8. The system can be adapted to allow for system expansion in patient numbers or staff
hence scalability.

4.2.4 System Specification

In order for the system to perform as expected, theses are its specifications for hardware and
software

Table 5: Hardware Requirements

22
Hardware Minimum System Requirements

Processor Intel Pentium IV or Higher for desktops

Memory 512 MB of RAM or higher

Hard Drive space 10GB

Monitor display 1024 × 768 High color-16 bit Recommended

Table 6: Software Requirements

Software Minimum System Requirements

Operating Systems Windows 2000, Windows NT, Windows XP and Windows Server
2003 Enterprise Edition

Database MS SQL Server 2005

Server MS SQL Server 2005

Ozeki Messaging Server

4.2.5 System Constraints

i. The system will only be accessible to authorized users.

ii. A patient may only register once.

iii. Different users are limited to particular views of information.

iv. Internet connection is required.

4.3 System Design

System design is concerned with how the system functionalities are provided by different
components of the system, Sommerville (2001). System design tools such as: DFDs ,EERDs
were used in the development of the system and its database respectively.

4.3.1 Data Flow Diagrams

These are tools for structured analysis that examine inputs, outputs, and processes. They show
how data moves and changes through a specified system in a graphical top-down fashion that is a

23
 graphical representation of a system’s components, processes and the interfaces between them.
They represent a logical model that shows what a system does, not how it does it; stressing the
flow of data within a system

A DFD comprises combinations of 4 symbols:

Table 7: DFD Elements.

NAME SYMBOL DESCRIPTION

External entity It is outside the context of the system and can be any class of
people, organization or another system.

Its function is to supply or receive data. It is the originator or

receiver of information outside the scope of the system portrayed in
the data flowing.

Data flow It shows the movement of data and is a pipeline carrying data
through the system. These show the movement of data between
processes, external entities, and data stores in a DFD

Process This portrays the transformation of input data flows to output data
flows in DFDs. Incoming data flows are processed or transformed
into outgoing data flows

Data store A temporary /time delayed repository that processes can add data
to/or retrieve data from.

DFDs were used to establish system functions. It was broken down from the context diagram
onward into a Level 1 and 2 DFDs through a technique called Levelling.

Levelling is the decomposition from a Context Diagram to a much detailed representation in this
case, levels 1 and 2.

4.3.1.1 Context Diagram/ Level 0 Diagram

24
 This is the highest level DFD that defines the scope of the system and provides an “outward”
looking view from the system; shows system boundaries and interaction with external entities. It
also shows the other systems and/or groups of people that interact with the system and the main
flows of data. It is illustrated in Figure 3.

It has data flows, external entities, one process (the system in focus), and has no data stores

• External entities: Patient, Midwife, Doctor, Nurse and Director.

• Process: Infant and Maternal Monitoring System.

Director

Staff_info

User_login Doctor
Patient
User_login

Rem
ind
er
View Referral_info

Infant and
EnterPreg_info Maternal
Monitoring
User_login System

Midwife
SYSTEM
BOUNDARY
ViewPreg_info

EnterChild_info
View_ChildProgress
User_login

25
 Nurse

Figure 4.1: Context Diagram/ Level 0 Diagram

4.3.1.2 Level 1 Diagram

Figure 4 shows that the Infant and Maternal Monitoring System was decomposed into three
processes that interact with data stores and external entities

• Registration (Process 1):

This process captures information about staff at healthcare units, pregnant women and
infants accordingly; and registers them into the system. This is done by end users
(Director, Midwife, and Nurse respectively). This information is then stored in the
Records data store.

• Authentication (Process 2):

The above mentioned process accepts user login information of end users (Midwives,
Nurses, and Doctors) and verifies this information before granting these users access to
the system as a whole.

• Monitoring (Process 3):

26
 This process enables end users to access, update, edit or modify patient information. It is
especially useful in representing how the Patient information (Patient_info) is retrieved
from the Record data store to undergo transformation with every alteration made by the
end users. This information is then stored in a data store called Patient_Records from
where it can be further manipulated by end users as they see fit.

Staff_info

Midwife
Director 1.0 Patient_info

Registration
Nurse
n
_logi
User Patient_info Pa
tie
AddStaff_info
AddPatient_info nt_
User_login Doctor
Midwife Re
cor
Records ds
Retrieve_Staff_info
User_login
2.0

Nurse Authenticatio
n Retrieve_Patient_info

Doctor
Ref
er ral_ 27
i nf o
 nfo
Add_Child_i

3.0 Add_Preg_info

Monitoring

fo
reg_in
EnterP Retrie
Midwife v e_Re
fe rral_i
nfo
_ info
Preg
View
Ret
ri eve
_Pr
eg_
Reminder info
o
_ inf
ild
Ch s
es Re
Nurse ogr Patient trie
Pr ve_
hild C hil
C d_
inf
o
Figure 4.2: Level 1 Diagram

4.3.1.3 Level 2 Diagram

Some of the processes established in level 1 are decomposed into sub processes as shown in
Figure 4.3, 4.4 and 4.5. In this case:

• Registration Process was split into 3 processes namely:

i. Patient_Registration:

This process accepts patient information input by Midwives and Nurses and uses
it to create a patient account

ii. Staff_Registration:

This process accepts staff information input by the system’s director and uses it to
create a staff account

iii. Validation:

28
 The validation process ascertains whether both staff and patient details are in the
correct format before storing them in their respective data stores (PARECORDS -
Patient_Records, STFHC - Health Center and Staff_Records)

• The Authentication Process does not decompose further and still serves the same
purpose as earlier noted.

• The Monitoring Process decomposed into:

i. Medical_Examination (M_Exam):

It accepts any information pertaining to a pregnant woman’s antenatal progress

and adds any new information to the pregnant woman’s records (PRECORDS
data store). It is from this same data store that this process serves to allow a
Midwife to view a pregnant woman’s antenatal progress.

ii. Reminder:

It retrieves the next appointment date a patient may have with either a Doctor,
Nurse or Midwife; as well as that patient’s telephone number and uses them to
send a predefined reminder alert inform of an SMS message to the respective
patient.

iii. Referral:

This process retrieves severe medical cases that midwives or nurses cannot handle
and forwards them to Doctors.

Doctors are then able to view these cases and treat them accordingly. Any
information that they may want to add or alter to a patient’s records are
appropriately noted and updated in the appropriate data store as shown in Figure 5

iv. ChildCare:

The above process accepts any information a Nurse may offer with regard to a
child’s health care and updates the Child_Health Records (CRECORDS) data
store accordingly.

29
KEY:
Reg - Register CP – Child and/or pregnant woman
HC – Health Center R - Referral
Stf - Staff R_A – Referral Antenatal
A - Antenatal R_C – Referral Child
P – Pregnant Woman’s info – information
C – Child’s appt - appointment

30
 PA
Reg_ RE
Midwife P p_info C
O
1.1 R
pa DS
Patient ti en
td e
Registratio tai
ls
Nurse n

_C 1.4
Reg
Validation

S
T
1.2 stf F
_h
c_ H
inf
Director Staff ils o C
eta
Registratio ffd
Reg_Stf n sta

Figure 4.3: Level 2 DFD Diagram for Process 1- Registration

Midwife

PA
RE
C
O Get p_info
R ed
m
DS fir gin
on Lo
C Nurse
ed
firm
2.0 Con
Login
Authenticatio
n Confirmed

S
T Doctor
F
H Get stf_info Log
in
C
Confirmed

Login Director

Figure 4.4: Level 2 DFD Diagram for Process 2- Authentication

 Update A_info AR
EC
Add/Change OR
A_info DS
3.1
Midwife
M_Exam
View A_info Get A_info
Get next appt
date

Get R_A_info Update R_A_info

Send reminder
View R_info

3.4 Patient
Doctor 3.2
Reminde
Referral
r

Get R_C_info Update R_C_info

Get next appt

Get C_info CR date
Add/Change EC
C_info OR
3.3 DS
Nurse
Child
Care
Update
View C_info C_info

Figure 4.5: Level 2 DFD Diagram for Process 3- Monitoring

 4.3.2 Entity Relationship Modeling
Entity–Relationship modeling is a top-down approach to database design, where the entities and
relationships between the entities are represented in the model are identified. Additional
properties about the entities and relationships (attributes) and any constraints on the entities,
relationships, and attributes are specified.

It is an aspect under Conceptual design as seen in Database Design. Database design is a stage of
the database system development lifecycle implemented after the requirements collection and
analysis stage of that lifecycle. It is made up of 3 phases namely: Conceptual, Logical and
Physical Design phase.
Conceptual Design is the process of constructing a model of information used in an enterprise
independent of all physical considerations. It ensures a precise understanding of the nature of the
data and how the organization uses it through the use of Entity Relationship and Enhanced Entity
Relationship Diagrams
In Enterprise Modeling, there is the identification of entities, attribute and the relationships
between these entities.
4.3.2.1 Entities and their Attributes
Table 8: Entities and their Attributes

ENTITY NAME ATTRIBUTES COMMENTS

Patient pId (Patient Identification) Primary Key

pName (Patient Name)
dOb (Date of Birth)
sex
address
telNo (Telephone Number)

Child mName (Mother’s Name)

mOccupation (Mother’s Occupation)
fName(Father’s Name)
 sCare (Special Care)

Pregnant_Woman educ (Level of Education)

religion
tribe
mStat (Marital Status)
nOk (Next of Kin)
occupation
grav (Gravida – Number of Children Born)
para ( Number of Living Children)
bG (Blood Group)
rh (Rhesus Factor)

Staff sId (Staff Identification) Primary Key

sName (Staff Name)

MRecord Recorded Primary Key

Antenatal_Record medical
surgical
oBS/GYN
socialHistory
familyHistory

Mens_CHistory lMenses (Duration of Menstruation)

amount
fPlanning(Family Planning)
yDiscon (Why Family Planning was discontinued)
wDiscon(When Family Planning Discontinued)

Present_Preg fLNMP(First Day Of LNMP)

eDD(Estimated Due Date)
pGes(Period of Gestation)
 compl (Complications During Pregnancy)
other (If there has been fever, cough, diahorrea,
weight loss amongst others in the last month)

Phys_ Exam height (cm - centimeters)

bP (Blood Pressure)
temp (Temperature)
weight (kg - kilograms)
pulse (Heartbeats per minute)
other (oral thrush, anaemia, deformities, etc)
pelvicExam (vulva, cervix, moniliasis, vagina)

Investigations bloodHb (Blood Haemoglobin levels)

xRay
rPR/VDRL (test for Syphilis)
mP (MP- Malaria Checkup)
hIV (HIV - test)
pelAss(Pelvic Assessment done at 36 weeks)
dConj(Diagonal Conjugate)
sCurve(Sacral Curve)
sArch (Subpublic Arch)
iTube (Ischial Tuberosities)
pelvis (Pelvis structure which can be adequate,
borederline or contracted)
others

Antenatal_Progress ammWks(Weeks of Ammenorrhoea)

date
fHeight (Fundal Height)
presen(Presentation)
posn(Position/Lie of the foetus)
 reln(Relation considering PP /Brim)
fHeart(Foetal Heart)
wgt(Weight)
bP (Blood Pressure)
vOedem (Varicose/ Oedema)
urine
tTox (Tetanus Toxoid)
complt (Complaints and Remarks)
rDate (Reurn Dtae or date of next appointment)
eName (Name of the examiner)
tmnt (Treatment)
rFactor(Risk Factor and recommendations for
delivery)

UltraSound date
rpt (Ultrasound Report)

PrevObs_History miscarrg (Miscarriages that may have occurred

both below and above 12 weeks)

delType (Types of Deliveries – Premature, Full

term)

cHealth (To ascertain whether the born baby was

born alive, its sex, and birth weight, as well as if
immunization was completed and the general
health condition of the child)

Immunization vacc (Vaccine) Primary Key

date (Date given or administered)

VitA date (Date given or administered)

Deworming meds (Medication given)

date (Date given or administered)

Ad_Ref date (Date of visit)

 advice
ndate (Date of next visit)

4.3.2.2 Relationships between Entities

I. Patient Treats

S ta f
pId {P.K}
pName
dOb 1..* 1..*
sex
address
telNo

II. Patient
Has
s Id{P.K
M R e c o rd
pId {P.K}
pName
dOb
sex
1..1 1..* s N am
re c o rd {P.K}
Id

address
telNo

Figure 4.6: The Relationships between Entities in the System

4.3.2.3 Enhanced Entity Relationship Modeling Concepts

Concepts employed are:
• Specialization
• Generalization
This is the modeling of superclasses and subclasses that adds more information to the data
model, as well as bringing more complexity to database system development.
Specialization is the process of maximizing the differences between members of an entity by
identifying their distinguishing characteristics

Generalization is the process of minimizing the differences between entities by identifying their
common characteristics.

The models III and IV(Figure 4.7 and 4.8 respectively) that are illustrated below have a
constraint {Mandatory, Or} implying that from the superclasses: MRecord and Patient
respectively, there exist only the stated subclasses and the corresponding instances of these given
subclasses can only belong to one particular subclass.

C hild

mN ame
fN ame
III. mOccupation
fOccupation
Patient sC are
pId {P.K}
pName {Mandatory,Or}
dOb
sex
Pregnant_ W oman
address
telNo educ
religion
tribe
mStat
nOk
occupation
Figure 4.7: A relationship between Superclass (Patient) and
grav
Subclasses (Child and Pregnant_Woman) para
bG
rh
 IV.

{Mandatory,Or}

A n t e n a_Rt ael c o r d
m e d ic a l
s u r g ic a l
P re s e _P

fL N M P
eD D
n t re g P hy s_E x am

h e igh t
bP
M e n_C
s H is t o ry
lM e n s e s
am ount
U ltra S o u n d

date
rp t
P re v O _H
b s is t o ry

m is c a rrg
d e lT y p e
VitA

date
MReco
D ew orm ing
m eds
date
I m m u n iz a t io n

vacc
A d_R ef
date
advic e
tem p d a te nD ate
o B /SG Y N pG es f P la n n in g c H e a lt h
com pl w e igh t y D is c o n
s o c ia lH is t o ry p u ls e
other w D is c o n
f a m ily H is t o ry o t he r
p e lv ic E x a m

A n te n a t_P
am m W k s
d a te
fH e ig h t
p re s e n
posn
a l ro g re s s

recordId {P Investigations

bloodH b
xR ay
rPr/VDR L
mP
hIV
others
pelAss
re ln dC onj
fH e a rt sC urve
w gt iSpines
bP sArch
v O edem iTube
u rin e pelvis
tT ox
c o m p lt
Figure 4.8: A relationship between Superclass (MRecord) and
rD a te
eN am e its corresponding subclasses
tm n t
rF ac to r
 Pregnant _Woman

educ Antenatal_Record
Child religion
tribe
mName mStat
nOk
fName occupation
mOccupation grav Present_Preg
para
fOccupation bG
sCare rh

Phys_Exam

{Mandatory, Or}

Patient
Mens_CHistory

pId {P.K} {Mandatory, Or}

Treats pName Has
dOb UltraSound

Staff
sex
1..* address 1..1 1..*
1..*
telNo
PrevObs_History

M R ec
1..1

sId {P.K} Antenatal_Progress

sName Investigations

rec ordId{
Immunization

Deworming
Figure 4.9: An Enhanced Entity Relationship
Diagram of the System
Ad_Ref VitA
 4.3.2.4 Mapping Entity Relationship Model to Tables (Relations)
For each 1:* binary relationship, the entity on the ‘one side’ of the relationship is designated as
the parent entity and the entity on the ‘many side’ is designated as the child entity.
To represent this relationship, a copy of the primary key of the parent entity is placed into the
table representing the child entity, to act as a foreign key.

 FIGURE 4.6, MODEL I DEFINES:

Patient (pId {P.K}, pName, dOb, sex, address, telNo)

Primary Key (P.K) pId

Staff (sId {P.K}, sName)

Primary Key (P.K) sId

Owing to the many to many relationship between Patient and Staff, as a result, the relationship
Treats combines the primary keys of both entities Patient and Staff as its primary key.
Treats (pId {P.K} {F.K}, sId {P.K} {F.K})

 FIGURE 4.6, MODEL III DEFINES:

Patient (pId {P.K}, pName, dOb, sex, address, telNo)

Primary Key (P.K)pId

So as the parent entity its primary key is then shared with the child entity MRecord

MRecord (pId {F.K}, recordId{P.K})

Primary Key (P.K) pId

Foreign Key (F.K) pId which references that in the Patient relation

For the super class- sub class relationships defined by {Mandatory, Or} implies that a table
must be created for each combined super and sub class.
  FIGURE 4.7 DEFINES:
Patient (pId {P.K}, pName, dOb, sex, address, telNo)
From the super class Patient given above, the following relations (for both child and pregnant
woman) are defined:

• ChildPatient (pId {P.K}{F.K}, pName, dOb, sex,address, telNo, mName,

mOccupation, fName, fOccupation, sCare)

• PWPatient (pId {P.K}{F.K}, pName ,dOb, address, telNo, educ, religion, tribe,
mStat, nOk, occupation, grav, para, bG, rh)

 FIGURE 4.8 DEFINES:

MRecord (pId {F.K}, recordId{P.K})
From the super class MRecord given above, the following relations are defined:

• Antenatal_Record (pId {P.K}{F.K}, recordId{P.K}{F.K}, medical, surgical,

oBS/GYN, socialHistory, familyHistory)

• MensC_History (pId {P.K}{F.K}, recordId{P.K}{F.K}, lMenses, amount,

fPlanning, yDiscon, wDiscon)

• Present_Preg(pId {P.K}{F.K}, recordId{P.K}{F.K}, fLNMP, eDD, pGes,

compl, other)

• Phys_Exam (pId {P.K}{F.K}, recordId{P.K}{F.K}, height, bP, temp, weight,

pulse, other, pelvicExam)

• Investigations (pId {P.K}{F.K}, recordId{P.K}{F.K}, bloodHb, xRay,

rPR/VDRL, mP, hIV, pelAss, dConj, sCurve, iTube, sArch, pelvis, others)

• Antenatal_Progress (pId {P.K}{F.K}, recordId{P.K}{F.K}, ammWks, date,

fHeight, presen, posn, reln, fHeart, wgt, bP, vOedem, urine, tTox, complt, rDate,
eName, tmnt, rFactor)
 • UltraSound (pId {P.K}{F.K}, recordId{P.K}{F.K}, date, rpt)

• PrevObs_History (pId {P.K}{F.K}, recordId{P.K}{F.K}, miscarrg, delType,

cHealth)

• VitA (pId {P.K}{F.K}, recordId{P.K}{F.K}, date)

• Immunization (pId {P.K}{F.K}, recordId{P.K}{F.K}, vacc, date)

• Deworming (pId {P.K}{F.K}, recordId{P.K}{F.K}, meds, date)

• Ad_Ref (pId {P.K}{F.K}, recordId{P.K}{F.K}, date, advice, ndate)

4.3.2.5 Normalization of Tables

The general goal of a relational database design is to generate a set of relations that allow for the
storage of information without unnecessary redundancy yet also allow for the easy retrieval of
information. To check that each table has an appropriate structure, using normalization examines
the groupings of columns in each table or relation created. It checks the composition of each
table and avoids unnecessary duplication of data. Bigger relations are split into smaller ones so
reducing redundancy

Using some test data, our relations were effectively normalized through all normal forms that is
to say, from: Un-normalized Form (UNF), 1st Normal Form (1NF), 2nd Normal Form (2NF), and
3rd Normal Form (3NF).

• UNF where relations are yet to be normalized

• 1NF is critical in creating appropriate tables for relational databases. Relations in first
normal form have every cell contains only one value and repeating groups are removed
• 2NF contains tables already in 1NF and in which the values in each non-primary-key
column can be worked out from the values in all the columns that make up the primary
key. Every non-primary-key column is fully functionally dependent on the primary key.
• 3NF tables that already in 1NF and 2NF, and in which the values in all non-primary-key
columns can be worked out from only the primary key column(s) and no other columns. In
 3NF no non-primary-key column is transitively dependent on the primary key. Transitive
dependency is a type of functional dependency that occurs when a particular type of
relationship holds between columns of a table.

The relations in 3rd Normal Form are listed below:

• Staff (sId {P.K}, sName)

• Treats (pId {P.K} {F.K}, sId {P.K} {F.K})

• ChildPatient (pId {P.K}{F.K}, pName, dOb, sex,address, telNo, mName, mOccupation,
fName, fOccupation, sCare)

• PWPatient (pId {P.K}{F.K}, pName ,dOb, address, telNo, educ, religion, tribe, mStat,
nOk, occupation, grav, para, bG, rh)

• Antenatal_Record (pId {P.K}{F.K}, recordId{P.K}{F.K}, medical, surgical,

oBS/GYN, socialHistory, familyHistory)

• MensC_History (pId {P.K}{F.K}, recordId{P.K}{F.K}, lMenses, amount, fPlanning,

yDiscon, wDiscon)

• Present_Preg(pId {P.K}{F.K}, recordId{P.K}{F.K}, fLNMP, eDD, pGes, compl,

other)

• Phys_Exam (pId {P.K}{F.K}, recordId{P.K}{F.K}, height, bP, temp, weight, pulse,

other, pelvicExam)

• Investigations (pId {P.K}{F.K}, recordId{P.K}{F.K}, bloodHb, xRay, rPR/VDRL,

mP, hIV, pelAss, dConj, sCurve, iTube, sArch, pelvis, others)

• Antenatal_Progress (pId {P.K}{F.K}, recordId{P.K}{F.K}, ammWks, date, fHeight,

presen, posn, reln, fHeart, wgt, bP, vOedem, urine, tTox, complt, rDate, eName, tmnt,
rFactor)

• UltraSound (pId {P.K}{F.K}, recordId{P.K}{F.K}, date, rpt)

• PrevObs_History (pId {P.K}{F.K}, recordId{P.K}{F.K}, miscarrg, delType, cHealth)

 • VitA (pId {P.K}{F.K}, recordId{P.K}{F.K}, date)

• Immunization (pId {P.K}{F.K}, recordId{P.K}{F.K}, vacc, date)

• Deworming (pId {P.K}{F.K}, recordId{P.K}{F.K}, meds, date)

• Ad_Ref (pId {P.K}{F.K}, recordId{P.K}{F.K}, date, advice, ndate)

4.4 System Implementation

Several technologies were used during the implementation of this project, these are further
explained below:

4.4.1 Technologies
Most of the software used in system implementation was chosen basing on the fact that: it was
readily available, cheap, and most importantly it supported rapid development time.

i. HTML (HyperText Markup Language): which provided a means to describe the

structure of text-based information in a document—by denoting certain text as links,
headings, paragraphs, lists, and so on—and to supplement that text with interactive
forms, embedded images, and other objects.

ii. ASP.NET: a web application framework developed and marketed by Microsoft to allow
programmers to build dynamic web sites, web applications and web services. This web
development language helped in the programming of the system to send SMS’ to the
different mothers.

It also served to help in the creation of a website that enables registered user to send
questions and receive answers from other registered users. Pregnant women with internet
access may also post their queries and learn more about healthy living.

iii. Cascading Style Sheets (CSS): a style sheet language used to describe the presentation
(that is, the look and formatting) of a document written in a markup language. It
improved content accessibility, provided more flexibility and control in the specification
of presentation characteristics, enabled multiple pages to share formatting, and reduced
complexity and repetition in the structural content.
iv. Visual Basic.Net (VB.NET): a multi-purpose computer programming language from
Microsoft that is suitable for most development needs. The language was employed with
Rapid Application Development in mind; it provided several tools to shorten
development time. VB.NET served to create the electronic medical forms and patient
records.

v. IIS (Internet Information Service): a web server application developed as a part of

Windows server 2003 OS; with the aim of hosting web applications for example websites
or other application that require web connectivity to share and access resource. It acts as
the system’s web server (for testing purposes only) and functions as a launch pad for
sending short messages to the different mothers

vi. MS SQL Server 2005(Express Edition): a new version of MS (Microsoft) SQL Server
which is a Database Management System (DBMS). MS SQL was the Database
Management System (DBMS) used to implement the system’s database. It was chosen
because it was an easy to use, highly customizable low maintenance database
management system.

V. Ozeki: an SMS Messaging Server. It enables the system to be able to send and receive
SMS messages using a database server with the help of SQL queries.
Using Ozeki, an SMS Messaging Server the system will be able to send SMS messages
using a database server with the help of SQL queries. A database server
(MSSQL) installed, in conjunction with a database table created: ozekimessageout .

Ozeki Message Server connects to the database through a standard ActiveX Data Objects
(ADO) or Open Database Connectivity (ODBC) connection (Figure 2). Using this
connection it will periodically query the database table ozekimessageout.
 Application, SQL
ODBC statement, Database
trigger

Database
MS SQL

Figure 4.10: Ozeki Message Server [Adapted from http://www.ozeki.hu]

Some web development applications used to facilitate the implementation of the project include:
Macromedia packages like Dream weaver, Fireworks, and Flash.

4.5 Testing and Validation

4.5.1 Testing

Testing involved internally checking the implemented system to identify errors and weaknesses
and to correcting them accordingly.
Integration testing was used by looking at the code critically and

The following tests were used:

i. Unit testing: which involved testing each module or class or functions identitified in the
system.

ii. Integration testing: which consisted of the study how two (or more) units work together
within a system

iii. System testing: this testing was carried out when all modules were integrated.

4.5.2 Validation

The process of checking input data of a system to ensure that it is complete, accurate, and
reasonable, Connolly and Begg, (2004). A suitable combination of validation checks ensure that
most errors are detected.

The complete system was presented to end user representatives to verify whether the developed
system addresses all the requirements and satisfies all the intended user needs. A questionnaire
was designed to capture their responses, thoughts and impressions for consideration by system
developers. Adjustments were made accordingly to make the system more user-friendly. See
Appendix C.
Chapter 5
Introduction
This chapter contains the Discussion on how each of our objectives was met and a summary of
our results/findings of the system.

5.1 Discussion
This section is a means of ascertaining whether the system is in fulfillment of the set objectives.
i. The investigation of factors that have bearing on infant mortality in Uganda was achieved
through the use of data collection methods such as interviews, questionnaires and
observation. The main ones include diseases like Pneumonia, Diarrhoea, and Malaria
Polio, and Measles to mention a few.

More importantly, it was during the data collection process that user requirements for the
system were established

ii. In order to design an Infant and Maternal Monitoring System, Data flow Diagrams and
Entity Relationship Modeling was done. With the use of data flow diagrams to examine
data inputs, outputs, and processes while showing how data moves through the system.
Entity Relationship Diagrams to find the entities their attributes and the relationship
between those entities it is from these relations or tables that the system database were
formed.

iii. In terms of implementation of the above mentioned system, many technologies were
employed to bring the system requirements and design to life. These included Visual
Basic.NET to create the application, MS SQL 2005 to create the database and ASP.NET
to create the website. However technologies such as Ozeki Messaging Server were also
used to enable the SMS (Short Message Service) functionality.
 iv. Testing and validation of the system involved: performing tests such as: unit testing and
system testing were carried out using tools existent in Visual Studio 2008 Service Pack
one to serve the purpose of making sure the system was functional. System validation
was achieved through acceptance testing which ensured that the potential end users found
the system easy to use and in fulfillment of their specified requirements.

5.2 Results/Findings
The Infant and Maternal Monitoring System - an Information System that serves to encourage
and remind pregnant women to go to health facilities for antenatal checkups, to remind guardians
to take children under their care for regular immunizations, it offers a means of information
sharing between medical practitioners using discussion forums, as well as automating the
existing manually driven patient record keeping facility.

A patient’s medical history is collected by a set of forms by end users - Nurses. Medical records
include items such as diagnosed medical conditions, prescribed medications, vital signs,
immunizations, laboratory results, and personnel characteristics like age and weight. This so
promotes automated and secure record keeping procedures for both patients and medical
practitioners, and to provide a data source meant to aid in the monitoring a patient’s progress.

The information that is of great importance in this system is the contact information: telephone
numbers and names. With these essential details, guardians of children from the age 5 years and
below as well as pregnant women can be reminded and encouraged to bring them in for basic
health care services. This is achieved through the use of an SMS function which sends reminders
for appointments to the respective patients. This is done with the aid of Ozeki SMS Server – an
interface between the system application and the telecom company service provider which then
routes messages to the respective patient’s mobile telephones.

The system has a website that provides information to the general public regarding infant and
maternal health. This website also contains a discussion forum which allows for information
sharing between medical personnel to acquire more expansive knowledge.
This front end interface, a user has to enter his\her user name and password to Login. This is
important since it ensures that the system is only accessed by authorized users. See Figure 5.1
below:

Figure 5.1: User Login Page

The system performs user validation on inputs. Incorrect entries trigger an error message. As
shown in figure 5.2.
 Figure 5.2: Error page
Electronic medical forms are used to register patients. These help to ensure accuracy and
consistency. A sample is shown below:

Figure 5.3: Registration form

Reports are important to enable medical practitioners to monitor the progress of a patient. The
system allows for antenatal progress reports and child health reports.
 Figure 5.4: Child Immunization Report

Discussion forums allow medical practitioners to share information amongst themselves and to a
small extent the general public. The forums are located on the website.

Figure 5.5: Discussion Forum

Chapter 6

Conclusion and Recommendations

Conclusion
The challenge of lowering infant mortality rates in Uganda can be achieved using the Infant and
Maternal Monitoring System. This is through the use of the Short Message Service (SMS)
functionality to encourage pregnant women and mothers to take their infants to visit their nearest
health centers to enable them get the required healthcare checkups, vaccinations or
immunizations and basic health care. The discussion forum functionality improves
communication and collaboration between medical practitioners thus increasing the rapidity and
quality of patient care.

Most consulted health care providers were in agreement that the Infant and Maternal Monitoring
System if properly implemented will indeed lower infant mortality rates even if it is at small
percentage.

Areas for Further Research

Future works may be pursued in line with:

• The creation of three dimensional growth charting system to monitor an infant’s growth
and development.

• Added functionalities that support computerized order entry in line with integration
between pharmaceutical companies and health centers

6.3 Recommendations
There are further developments and functionalities that can be made to this system; these are:
An electronic scheduling functionality which allows for setting medical appointments, eliminates
duplicate bookings, and allows for cancellations to be quickly filled, both helping to reduce wait
times in the case of a patient wait list.

Inpatient admissions and outpatient bookings can be implemented especially in health care
centers like hospitals that handle patient admissions as well as discharging patients.

A billing functionality may be added to handle patients due payments or patient debt
management

An imaging archive, which makes it possible for diagnostic tests such as: X-rays, MRIs, CT
scans and others to be stored as digital images. That can easily be viewed by authorized
healthcare providers across a secure health network.

Finally, the Ugandan government should consider the implementation of a national health IT
system, to go beyond handling the medical information of pregnant women and infants but all
ailing patients.
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Appendices
Appendix A: Sample Questionnaires
INTRODUCTION

Halving child mortality is one of the 8 Millennium Development Goals set to be achieved by Less
Developed Countries such as – Uganda by 2015. Sadly, child deaths are still unacceptably high with
statistics in Uganda showing that for every 1000 births; over 137 infants do not get to celebrate their 5th
birthday.

As students at Makerere University, in the Faculty of Computing and Information Technology we seek to
try and resolve the above mentioned problem. We intend to exploit certain avenues of technology to
reduce infant mortality by encouraging pregnant women and new born babies to visit their nearest health
centers to enable them get the required healthcare checkups, vaccinations and basic health care. Taking
part in this survey will help us better understand the situation on the ground.

Please note that the information collected in this survey will be treated as confidential, it will not be used
or disclosed except for the purpose for which it has been sent that is to say academic purposes.

GENERAL KNOWLEDGE QUESTIONS:

1. Kindly state your name

………………………………………………………………………………………………………

2. State the name of the health care facility you are currently employed in? What is your
job position/ title, and how long have you held that post?

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

3. What qualifications do you hold in the field of medicine? How long have you been
practicing medicine?
……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

DOCTOR’S QUESTIONNAIRE:

1. How many times is an average pregnant woman supposed to go to a health facility for
prenatal check-ups? Give reasons for your answer

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

2. What health care facilities are provided to pregnant women in their first trimester? State
their relevance to both the pregnant women and unborn child.

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

3. What health care facilities are provided to pregnant women in their second trimester?
State their relevance to both the pregnant women and unborn child.

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

4. What health care facilities are provided to pregnant women in their third trimester? State
their relevance to both the pregnant women and unborn child.

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……
5. Typically, estimate the number of babies that ail from immunizable diseases (polio,
measles, whooping cough, tuberculosis, tetanus, diphtheria amongst others) in this health care
facility in a given year. Tick where applicable

• 0 – 50 • 100 – 200

• 50 – 100 • Upwards of 200

6. An Information System (I S) is a collection of components that capture, process, store,

retrieve and disseminate information in an organisation to enable decision making; to provide
information to users within organisations. Kindly explains best as you can, how the pre-existing
Information System in this health facility works

…………………………………………..…….
………………………………………………………………………………………………..…….
………………………………………………………………………………………………..…….
……………………………………………………

7. As a user of the above mentioned system, kindly explain the type of information you
handle in this health care facility

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……………………………………………………………………………………………………
………

8. Given the scale ranging from bad, fair, good and excellent, rate how effective the existent
Information System is. Give a reason for your answer

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

9. Given the scale ranging from bad, fair, good and excellent, rate how effective it would be
to remind pregnant women to come in for prenatal check-ups. Give a reason for your answer
……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

10. Given the scale ranging from bad, fair, good and excellent, rate how effective it would be
to remind mothers to bring their children in for immunization. Give a reason for your answer

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

THANK YOU FOR TAKING PART IN THIS SURVEY

NURSE’S QUESTIONNAIRE:

1. How many times is an average pregnant woman supposed to go to a health facility for
prenatal check-ups? Give reasons for your answer

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……………………………………………………………………………………………………
……………………………………………………………………………………………………
…………

2. On average, how many pregnant women come in for these check-ups in a year? (Tick
where applicable)

• 0 – 100 • 200 – 300

• 100 – 200 • Upwards of 300

3. What health care facilities are provided to pregnant women in their first trimester? State
their relevance to both the pregnant women and unborn child.
……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

4. What health care facilities are provided to pregnant women in their second trimester?
State their relevance to both the pregnant women and unborn child.

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

5. What health care facilities are provided to pregnant women in their third trimester? State
their relevance to both the pregnant women and unborn child.

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

6. Are there cases where pregnant women may miss their prenatal visits? If so what are the
common reasons these women give for missing any given appointment?

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

7. On average, how many recorded births take place in this health care facility per month?
(Tick where applicable)

• 0 – 50 • 100 – 200

• 50 – 100 • Upwards of 200

8. Typically, estimate the number of babies that ail from immunizable diseases (polio,
measles, whooping cough, tuberculosis, tetanus, diphtheria amongst others) in this health care
facility in a given year. Tick where applicable
• 0 – 50 • 100 – 200

• 50 – 100 • Upwards of 200

9. Typically, estimate the number of babies that ail from treatable diseases (malaria,
diarrhoea, pneumonia amongst others) in this health care facility in a year. Tick where
applicable

• 0 – 50 • 100 – 200

• 50 – 100 • Upwards of 200

10. Estimate the average number of mothers who start and finish the immunization process
for their infants in this health care facility after the predefined age (6 years). (Tick where
applicable)

• 0 – 50 • 100 – 200

• 50 – 100 • Upwards of 200

11. An Information System (I S) is a collection of components that capture, process, store,

retrieve and disseminate information in an organisation to enable decision making; to provide
information to users within organisations. Kindly explains best as you can, how the pre-existing
Information System in this health facility; works.

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

12. As a user of the above mentioned system, kindly explain the type of information you
handle in this health care facility
……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

13. Given the scale ranging from bad, fair, good and excellent, rate how effective the existent
Information System. Give a reason for your answer

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

14. Given the scale ranging from bad, fair, good and excellent, rate how effective it would be
to remind pregnant women to come in for prenatal check-ups. Give a reason for your answer

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

15. Given the scale ranging from bad, fair, good and excellent, rate how effective it would be
to remind mothers to bring their children in for immunization. Give a reason for your answer

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……THANK YOU FOR TAKING PART IN THIS SURVEY

MIDWIVES’ QUESTIONNAIRE:

1. How many times is an average pregnant woman supposed to go to a health facility for
prenatal check-ups? Give reasons for your answer

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

2. On average, how many pregnant women come in for these check-ups in a year? (Tick
where applicable)

• 0 – 100 • 100 – 200

• 200 – 300 • Upwards of 300

3. What health care facilities are provided to pregnant women in their first trimester? State
their relevance to both the pregnant women and unborn child.

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

4. What health care facilities are provided to pregnant women in their second trimester?
State their relevance to both the pregnant women and unborn child.

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

5. What health care facilities are provided to pregnant women in their third trimester? State
their relevance to both the pregnant women and unborn child.

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

6. Are there cases where pregnant women may miss their prenatal visits? If so what are the
common reasons these women give for missing any given appointment?

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

7. On average, how many recorded births take place in this health care facility per month?
(Tick where applicable)

• 0 – 50 • 100 – 200

• 50 – 100 • Upwards of 200

8. An Information System (I S) is a collection of components that capture, process, store,
retrieve and disseminate information in an organisation to enable decision making; to provide
information to users within organisations. Kindly explains best as you can, how the pre-existing
Information System in this health facility; works.

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

9. As a user of the above mentioned system, kindly explain the type of information you
handle in this health care facility

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

10. Given the scale ranging from bad, fair, good and excellent, rate how effective the existent
Information System. Give a reason for your answer

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

11. Given the scale ranging from bad, fair, good and excellent, rate how effective it would be
to remind pregnant women to come in for prenatal check-ups. Give a reason for your answer

……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

12. Given the scale ranging from bad, fair, good and excellent, rate how effective it would be
to remind mothers to bring their children in for immunization. Give a reason for your answer
……………………………………………………………………………………………………
……………………………………………………………………………………………………
……

THANK YOU FOR TAKING PART IN THIS SURVEY

Appendix B: Interview Guide

1. General Knowledge Questions:

“Please state your name and the name of the health care facility you are currently employed in? “

“What is your job position/ title, and how long have you held that post?”

“How do you handle patient registration and record maintenance?”

“How do you keep your patients’ records?”

2. Antenatal Healthcare questions.

“What strategies are in place to ensure that pregnant women are convinced /reminded to come
for their checkups?”

“How successful are the mentioned methods if any exist?”

“How many women usually come in for an initial check up and how many actually return for the
scheduled checkups?”

“What reasons do they give for not returning?”

“Do you think with adequate reminders they would turn up for these checkups? (Yes/No
preferred answers)”

“If a mother gave birth in your center more than once, how are her records handled?”

3. Infant Healthcare questions:

“Does antenatal care have any bearing on overall child health in the long run?”

“What percentages of infants usually clear the recommended vaccines and immunizations in
your health facility?”
 “How effective are the Ministry of Health immunization policies?”

4. Concluding remarks and expression of gratitude.

Appendix C: User Acceptance Test

INTRODUCTION

The purpose of this document is to find whether the Infant and Maternal Monitoring System
meets the user requirements. If the system doesn’t act the way you expect, or you notice
something definitely wrong, please note it in the ‘Comments’ column next to the step that’s
closest to what you were doing at the time.

Name:
Occupation:
Experience in the field of medicine:

User Activities Comments

A. User Login
A. Enter predefined user name
1.
A. Enter predefined password
2.
A. Any other comments?
3.

B. Register Expectant Mother (Pregnant Woman)

B. Try to register a new patient (Pregnant woman)
1.
B. Attempt to fill in fields of electronic medical forms
2.
B. Try leaving a field empty (should get an error)
3.
B. Try to click any subsequent buttons below the
4. “register new” (a dialog box should prompt entry of
patient’s identification number)
User Activities Comments
B. Any other comments?
5.

C. Register New Child

C. Try to register a new patient (Infant)
1.
C. Attempt to fill in fields of electronic medical forms
2.
C. Try leaving a field empty (should get an error)
3.
C. Try to save the infant’s records(should get a view of
4. the saved information)
C. Click the “Child Health Card” button (a dialog box
5. should prompt entry of patient’s identification
number)
C. Any other comments?
6.
D. Viewing Patient’s Medical History
D. Try to search for a particular patient’s records
1.
D. Any other comments?
2.

NOTE: A demonstration on how the SMS function works is given

E. Navigating the Website (Discussion Forum) as a medical practitioner

E. Click the “Members only area” button (it should
1. prompt your system login information)
E. Try to post an article
2.
E. Try to post a comment
3.
E. Any other comments?
4.
 F. Navigating the Website (Discussion Forum) as a general user
F.1 Click the “General area” button
.
F.2 Try to post a comment
.
F.3 Try to post an article (It should generate an error)
.
F.4 Any other comments?
.

1. How would you rate the overall system?

Excellent Fair
Good Poor
2. Any other comments?
……………………………………………………………………………………………………………
………………………………………………………………………………………

THANK YOU FOR TAKING PART IN THIS SURVEY

Appendix D: Sample Code to Authenticate Users

#Region "Authenticating Users"

Public Shared Function CheckUserLogin(ByVal UserName As String, ByVal Password As

String)

MyDataSet.Clear()

MyDataTable.Clear()

With MyDataAdapter

MySQL = "Select UserName, Password from UserAccounts Where UserName = '" &
UserName & "' And Password = '" & Password & "'"

MyCommand = New SqlCommand(MySQL, MyConn)

MyCommand.CommandType = CommandType.Text

.SelectCommand = MyCommand

.Fill(MyDataSet)

.Dispose()

End With
 MyDataTable = MyDataSet.Tables.Item(0)

MyDataSet.Dispose()

RowsAffected = CInt(MyDataTable.Rows.Count)

If RowsAffected > 0 Then

IsSystemUser = True

Else

IsSystemUser = False

End If

MyConn.Close()

Return IsSystemUser

End Function

Public Shared Function GetUserPosition(ByVal StaffId As String)

MyDataSet.Clear()

MyDataTable.Clear()

With MyDataAdapter

MySQL = "Select position from staff Where staffNo = " & StaffId & ""

MyCommand = New SqlCommand(MySQL, MyConn)

MyCommand.CommandType = CommandType.Text

.SelectCommand = MyCommand

.Fill(MyDataSet)

.Dispose()

End With

MyDataTable = MyDataSet.Tables.Item(0)

MyDataSet.Dispose()

For Each MyDataRow As DataRow In MyDataTable.Rows

RetunedValue = (MyDataRow("position").ToString)

Next

MyConn.Close() Return RetunedValue

End Function

Public Shared Function GetUserID(ByVal UserName As String, ByVal Password As

String)

MyDataSet.Clear()
 MyDataTable.Clear()

With MyDataAdapter

MySQL = "Select staffNo from UserAccounts Where UserName = '" & UserName &
"' And Password = '" & Password & "'"

MyCommand = New SqlCommand(MySQL, MyConn)

MyCommand.CommandType = CommandType.Text

.SelectCommand = MyCommand

.Fill(MyDataSet)

.Dispose()

End With

MyDataTable = MyDataSet.Tables.Item(0)

MyDataSet.Dispose()

For Each MyDataRow As DataRow In MyDataTable.Rows

RetunedValue = (MyDataRow("staffNo").ToString)

Next

MyConn.Close() Return RetunedValue

End Function

Public Shared Function AuthenticateUser(ByVal UserName As String, ByVal Password As

String)

MyDataSet.Clear()

MyDataTable.Clear()

If CheckUserLogin(UserName, Password) = False Then Msg(IncorrectLogin)

ElseIf CheckUserLogin(UserName, Password) = True Then

Select Case GetUserPosition(GetUserID(UserName, Password))

Case "Support Staff"

RetunedValue = "Support Staff"

Case "Doctor"

RetunedValue = "Doctor"

Case "Nurse"

RetunedValue = "Nurse"

Case "System Admin"

RetunedValue = "System Admin"

 End Select End If

Return RetunedValue

End Function #End Region