BackgroundHealth data can be useful for effective service delivery, decision making, and evaluating existing programs in order to maintain high quality of healthcare. Studies have shown variability in data quality from national health management information systems (HMISs) in sub-Saharan Africa which threatens utility of these data as a tool to improve health systems. The purpose of this study is to assess the quality of Rwanda's HMIS data over a 5-year period.MethodsThe World Health Organization (WHO) data quality report card framework was used to assess the quality of HMIS data captured from 2008 to 2012 and is a census of all 495 publicly funded health facilities in Rwanda. Factors assessed included completeness and internal consistency of 10 indicators selected based on WHO recommendations and priority areas for the Rwanda national health sector. Completeness was measured as percentage of non-missing reports. Consistency was measured as the absence of extreme outliers, internal consistency between related indicators, and consistency of indicators over time. These assessments were done at the district and national level.ResultsNationally, the average monthly district reporting completeness rate was 98% across 10 key indicators from 2008 to 2012. Completeness of indicator data increased over time: 2008, 88%; 2009, 91%; 2010, 89%; 2011, 90%; and 2012, 95% (p<0.0001). Comparing 2011 and 2012 health events to the mean of the three preceding years, service output increased from 3% (2011) to 9% (2012). Eighty-three percent of districts reported ratios between related indicators (ANC/DTP1, DTP1/DTP3) consistent with HMIS national ratios.Conclusion and policy implicationsOur findings suggest that HMIS data quality in Rwanda has been improving over time. We recommend maintaining these assessments to identify remaining gaps in data quality and that results are shared publicly to support increased use of HMIS data.

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A continuous-mixing unit for the manufacture of concentrated superphosphate was developed and is being operated successfully at a production rate of 30 to 35 tons of superphosphate per hour. Finely ground rock phosphate and phosphoric acid are fed continuously by a constantweight feeder and a rotamatic controller, respectively, into a funnel-shaped mixer in which mixing is accomplished by turbulence of the reactants, and the mixture is discharged, while it is still fluid, onto a conveyer belt. The

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Egg Shaped Digesters (ESD) have been in North America since the early 1980's. Considerable experience has been gained with the existing and new ESD systems. Early systems mirrored the German experience with some American "improvements". The question becomes; Have Egg Shaped Digesters performed as expected?American owners and engineers have made many design assumptions based on past American experience with flat pancakes, and the transfer of German technology. A number of facility design improvements and operation procedure changes have been developed in America to address "weaknesses" and to fully exploit the ESD strengths. The fundamental strengths of the ESD system, particularly the vessel shape, also create operational weaknesses when the necessary and unique design and operation procedures for ESD systems are not fully understood and carefully applied.During 2002 and 2003 all of the North American ESD facilities were visited and performance data obtained. Each site provided information about facility operation, as well as solids stabilization data. Several of the plants provided case histories and serve as design critique models. While German experience provides a long history for the development of ESD extending from 1927, American ESD facilities have proven that significant differences of operation, raw solids characteristics, and equipment application must be considered to optimize the application of ESD in North America.Several specific case histories of North American ESD facilities are presented in order to provide a comprehensive review of ESD application and performance while allowing the formulation of design and operation parameters and guidelines for the successful application of ESD design to new and expanding facilities. The specific case history facilities are: SanIn addition to the detailed data and operation analysis for the six case history systems, a full database for all of the North American facilities is provided. The case histories provide the basis for design and operation recommendations to be applied to new and expansion facilities.Textbook theory indicates that thickened WAS does not stabilize well and does not produce significant quantities of gas. Actual ESD operation experience shows that the opposite occurs. TWAS when fed in slug doses can cause tremendous increase in process activity and gas production.One of the common problems encountered in the facilities in the case studies presented below is maintaining steady raw feed (volume and composition) and discharge rates in order to minimize sudden increases in gas production and attendant ancillary process problems that result. The operational surface area of an ESD system is much smaller than that of a comparable flat pancake digester. The zone below the liquid surface area is an inverted truncated cone. Minor changes in the concentration of entrained gas in the vessel can drive substantial changes in the liquid level because the volume change is reflected in substantial depth changes. When the biological activity substantially i...

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