Implementation of a Medical Geographic Information System: Concepts and Uses

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INTRODUCTION

A medical geographic information system (MGIS) facilitates spatial data analysis and modelling of disease, environment, and healthcare systems. An MGIS is a computer system that can be used for employing the methods and theories of medical geography, which is concerned with geographic aspects of health and healthcare systems. Geographic methods have long been used as aetiological research tools to provide clues about the reasons for occurring diseases (1). According to Hunter, geography is a discipline that bridges the social and environmental sciences, and its integration and coherence derive from systems-related analysis of socioenvironmental interaction through time and over space (2). He argues that we should not focus only on the disease agent, but also on the pathogen, host, and the environment. Within the field of medical geography, these issues are considered to be dynamic, because they vary in space and time (3-11). By studying the link between characteristics of space and human health, we can gain insight into the relationships between environmental exposures and illness. This understanding may help improve the design of healthcare systems, health interventions, and community-based programmes.

Finding integrated solutions to health problems often requires an understanding of both environment and health parameters (12). Geographic information systems (GIS) can be used for studying people within their environment and a systems framework (13). A GIS can facilitate the modelling of relationships between environmental exposures and human health. Detailed spatial studies, particularly local-level studies that describe spatial variation of diseases, are rarely conducted, because appropriate GIS databases are not available. However, several studies (14-18) have shown the benefit of using detailed geo-referenced data and computer-assisted mapping for investigating spatial variation of health and disease.

Public-health professionals are increasingly recognizing the benefits of using a GIS to investigate the health and environmental issues and spatial components of health services. There is a growing awareness among health professionals about the usefulness of GIS, because most of them do not have skills in the theory and use of GIS, and the technology is not often used in the health sector (19). Implementation of a well-structured GIS requires not only collecting detailed geo-referenced data but also designing structured relationships between the entities and attributes within the GIS. A well-structured GIS design can facilitate spatial analysis of health- and environment-related data.

This paper presents concepts and uses of a well-structured MGIS that was implemented in 1994 in a rural area of Bangladesh to enhance the research capabilities of ICDDR,B: Centre for Health and Population Research in public health. The MGIS has proven useful for epidemiological investigations of diseases and for monitoring health-service systems of the research site at Matlab, Bangladesh. The following sections describe the Matlab MGIS and how it is being used.

MATERIALS AND METHODS

Matlab geographic information system

The Matlab study area presently includes 142 villages. Approximately, 213,000 people live in these villages. Since 1966, vital demographic events of the study area have been recorded in a demographic surveillance system (DSS). Specific health-related events have also been collected and are maintained in a record-keeping system (RKS). The MGIS, integrated with these databases, has widened the scope of investigating health problems. Although a multidisciplinary working team, comprising epidemiologists and social scientists, use the system, the GIS specialists are, however, its main users.

Conceptual design of Matlab MGIS

A well-structured MGIS requires the consideration of several issues, including organizational goals, data-flow mechanisms, data structures, and the way how the database will be used. …