Antimicrobial Resistance Surveillance: WHONET and DHIS2 integration in Bangladesh

Part of the Interoperability DAC2021 Session: Wednesday 23nd June 14:00

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John Stelling and Adam Clark, Brigham and Women’s Hospital, Boston, United States
Julhas Sujan, International Vaccine Institute CAPTURA-Bangladesh, Dhaka, Bangladesh

Topic Summary: WHONET and DHIS2 interoperability for antimicrobial resistance surveillance and pilot testing in Bangladesh

Antimicrobial resistance (AMR) is an emerging public health threat causing significant morbidity, mortality, and healthcare costs especially in low- and medium-income countries, but to date few groups have explored advanced AMR data management within DHIS2. In this work, we describe a collaboration between the Bangladesh Ministry of Health and Family Welfare’s Directorate General of Health Services (DGHS), the CAPTURA Project (Capturing Data on Antimicrobial Resistance Patterns and Trends in Use in Regions of Asia) led by the International Vaccine Institute (Republic of Korea) supported by the UK Department of Health Fleming Fund, and the WHONET development team at the WHO Collaborating Centre for Surveillance of Antimicrobial Resistance (United States).

WHONET, www.whonet.org, is a free software promoted by the World Health Organization supporting local, national, regional, and international resistance surveillance activities in over 2,500 human, animal, and food microbiology laboratories in over 130 countries. WHONET supports advanced automated features for interpretation of antimicrobial susceptibility test measurements by CLSI and EUCAST standards; multidrug-resistance profiles; 190 public health, clinical, and quality control isolate alerts; and statistical detection of hospital and community outbreaks using SaTScan. WHONET supports international guidelines for the management of “repeat” isolates, e.g. “first isolate per patient per species per data stratification and data subset”, which is not supported by DHIS2 core functionality. WHONET’s import tool BacLink permits the capture and standardization (ETL-extract, transform, and load) of microbiology data from diverse laboratory information systems, test instruments, and desktop applications.

To support WHONET and DHIS2 interoperability, we have developed pre-defined and user-defined data export options of two types: 1) aggregate statistics (and associated metadata) to DHIS2 Data Sets; and 2) isolate listings (and associated metadata) to DHIS2 Event Programs. These WHONET listing and analysis exports can be visualized within DHIS2 dashboards, pivot tables, charts, and maps. Metadata exports are consistent across all WHONET installations, permitting simple data exchange between DHIS2 instances.

In Bangladesh, we have installed WHONET in 31 laboratories and trained more than 140 microbiologists, clinicians, IT staff, and national AMR policymakers. Three years of laboratory data from 41 governmental and private hospitals in eight divisions are being submitted to the DGHS AMR-dedicated DHIS2 server through the WHONET-DHIS2 interoperability features described, leveraging both WHONET’s advanced data management and alert capabilities for AMR data with existing Bangladesh DHIS2 platforms for web-based visualization for all communicable diseases supporting the development, implementation, monitoring, and impact evaluation in near real-time of national resistance containment strategies.

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Hi John

Great to know that you working on very essential area of AMR and in a process of integration with DHIS2.

You should know HISP Bangladesh are currently maintaining 6 national instances of DHIS2 with few pilots instances as well. Our implementation is one of the largest implementation in the world. You mentioned about ‘DGHS AMR-dedicated DHIS2 server’ and me, my team and our DGHS counterpart are not aware of that. Please let us know the detail of that.

We are also supporting Hospital automation with LAB System and GoB already deploying 62 hospitals and labs and another 500 hospitals will be completed in next 5 years. So it is important to know how do AMR reporting fits there. Will discuss with you soon.

Best regards

Hannan

Thank you Hannan for the message. Yes, I have been very impressed by the very significant DHIS2 accomplishments in Bangladesh! That is one of the reasons that we thought Bangladesh would be an excellent pilot country for the WHONET-DHIS2 AMR integration work. Another reason was the significant experience and expertise of Mr. Julhas Sujan, who has worked for several years with antimicrobial resistance data, antimicrobial consumption data, WHONET, and DHIS2 in collaboration with the University of Oslo, HISP-Bangladesh, HISP-India, WHO, and national authorities in Bangladesh.

Mr. Julhas has been discussing our WHONET-DHIS2 integration work with colleagues at Bangladesh CDC and IEDCR. He would be able to provide more information about these discussions and medium-term implementation plan. Our idea has been to pilot the software development work with non-confidential data (aggregate statistics) on our AWS DHIS2 instance, but then to transfer everything over to an official Bangladesh DHIS2 server when the pilot site has matured. We look forward to collaborating in Bangladesh to making this a production system!

It is also useful to highlight that the Co-Chair of the United Nations newly-established Global Leaders Group on Antimicrobial Resistance is Bangladesh Prime Minister H.E. Sheikh Hasina. So a successful implementation in Bangladesh would be a great model for emulation elsewhere.

With best regards,

       John

Recording of the session can be found here: