OpenMRS as a Key Malaria Intervention

The OpenMRS system was implemented in Ruhiira, Uganda in November, 2008. The medical record system is used for the majority of patient visits to the clinics. As of April 30, there have been 20,077 patients/26,518 patient encounters. In December and January, an average of 861 patients/mth >5 y.o. were seen at the clinic of which 473.5 were suspected malaria cases. On average, 54.8% of patients suspected were treated and 42.5% of patients who were smear negative were treated. For patients <5, an average of 253.5 patients were seen, of which 173 were suspected malaria cases. 63.3% of suspected patients were treated/51.3% of those testing negative were treated.

 In February, a training workshop was held on the diagnosis and treatment of malaria and the WHO protocol was adapted for use at Ruhiira Health center. For two months that followed, 933.5 patients 5 and over were seen of which 511.5 were suspected malaria cases. However, only 22.7% of patients were treated and 13.5% of patients with negative tests were treated. This represents a reduction of 63.1% in the # of cases treated (p<.05). The percentage of smear negative patients who were treated decreased by 73.1% (p=0.01). For patients under 5, an average of 281.5 patients were seen of which 208.5 were suspected to have malaria. On average, 34.7% of patients were treated and 24.7% of those testing negative were treated. These represent declines of 44.7% (p<.05) and 60.2% (p=0.01) respectively.

 In this setting, the ability to provide effectively real-time analysis of the data lead to a significant adherence to the WHO guideline for malaria diagnosis and treatment. The decrease in the number of courses represents a savings of $665 per month which exceeds the costs of the EMR, and a mechanism to employ graduates and keep them in the health system.