The application of a biometric identification technique for linking community and hospital data in rural Ghana
TL;DR: Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings and can be enhanced in communities with some basic Demographic Surveillance System or census information.
Abstract: Background : The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Objective : Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. Design : A combination of biometrics and other personal identification techniques were used to identify individual’s resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. Results : A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Conclusions : Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information. Keywords: biometrics; fingerprint; identification; techniques; electronic; database; data-linkage (Published: 17 March 2016) Citation: Glob Health Action 2016, 9 : 29854 - http://dx.doi.org/10.3402/gha.v9.29854
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TL;DR: In this article, a mixed-methods study involved surveying 625 migrants using respondent-driven sampling and conducting in-depth interviews with a sub-sample of 48 migrants, exploring health status and health seeking behaviours for recent illness/injury.
Abstract: People working in Ghana's informal sector have low rates of enrolment in the publicly funded National Health Insurance Scheme. Informal sector workers, including migrant girls and women from northern Ghana working as head porters (kayayei), report challenges obtaining insurance and seeking formal health care. This article analyses how health insurance status affects kayayei migrants' care-seeking behaviours. This mixed-methods study involved surveying 625 migrants using respondent-driven sampling and conducting in-depth interviews with a sub-sample of 48 migrants. Analyses explore health status and health seeking behaviours for recent illness/injury. Binary logistic regression modelled the effects of selected independent variables on whether or not a recently ill/injured participant (n = 239) sought health care. Although recently ill/injured participants (38.4%) desired health care, less than half (43.5%) sought care. Financial barriers overwhelmingly limit kayayei migrants from seeking health care, preventing them from registering with the National Health Insurance Scheme, renewing their expired health insurance policies, or taking time away from work. Both insured and uninsured migrants did not seek formal health services due to the unpredictable nature of out-of-pocket expenses. Catastrophic and impoverishing medical expenses also drove participants' migration in search of work to repay loans and hospital bills. Health insurance can help minimize these expenditures, but only 17.4% of currently insured participants (58.2%) reported holding a valid health insurance card in Accra. The others lost their cards or forgot them when migrating. Access to formal health care in Accra remains largely inaccessible to kayayei migrants who suffer from greater illness/injury than the general female population in Accra and who are hindered in their ability to receive insurance exemptions. With internal migration on the rise in many settings, health systems must recognize the varied needs of populations in multi-ethnic and multilingual countries to ensure that internal migrants can access affordable, quality health services across domestic borders.
40 citations
TL;DR: Investigation of changes in L loa microfilarial densities during TaNT campaigns run 18 months apart for elimination of onchocerciasis in areas that are co-endemic for loiasis found that individuals treated with ivermectin do not need to be retested for L loA microFilaraemia before the next treatment, provided that they can be re-identified.
Abstract: Summary Background A test-and-not-treat (TaNT) strategy has been developed to prevent people with high concentrations of circulating Loa loa microfilariae (>20 000 microfilariae per mL) developing serious adverse events after ivermectin treatment during mass drug administration to eliminate onchocerciasis. An important question related to cost and programmatic issues is whether annual retesting is required for everyone. We therefore aimed to investigate changes in L loa microfilarial densities during TaNT campaigns run 18 months apart. Methods In this observational cohort study, we assessed the participants of two TaNT campaigns for onchocerciasis. These campaigns, which were run by a research team, together with personnel from the Ministry of Health and community health workers, were done in six health areas (in 89 communities) in Okola health district (Cameroon); the first campaign was run between Aug 10, and Oct 29, 2015, and the second was run between March 7, and May 26, 2017. All individuals aged 5 years and older were invited to be screened for Loa loa microfilaraemia before being offered ivermectin (unless contraindicated). L loa microfilarial density was measured at the point of care using the LoaScope. All those with a L loa microfilarial density of 20 000 microfilariae per mL or less were offered treatment; in the first 2 weeks of the 2015 campaign, a higher exclusion threshold of 26 000 microfilariae per mL or less was used. At both rounds of the intervention, participants were registered with a paper form, in which personal information were collected. In 2017, we also recorded whether each individual reported participation in the 2015 campaign. The primary outcome, assessed in all participants, was whether L loa microfilarial density was above or below the exclusion threshold (ie, the criteria that guided the decision to treat). Findings In the 2015 TaNT campaign, 26 415 people were censused versus 29 587 people in the 2017 TaNT campaign. All individuals aged 5 years and older without other contraindications to treatment (22 842 people in 2015 and 25 421 people in 2017) were invited to be screened for L loa microfilaraemia before being offered ivermectin. In 2015, 16 182 individuals were examined with the LoaScope, versus 18 697 individuals in the same communities in 2017. 344 (2·1%) individuals were excluded from ivermectin treatment because of a high L loa microfilarial density in 2015, versus 283 (1·5%) individuals in 2017 (p 99·9%) of 6983 individuals treated with ivermectin in 2015 had L loa microfilariae density below the level associated with neurological serious adverse events. Interpretation Individuals treated with ivermectin do not need to be retested for L loa microfilaraemia before the next treatment, provided that they can be re-identified. This adjusted approach will enable substantial cost savings and facilitate reaching programmatic goals for elimination of onchocerciasis in areas that are co-endemic for loiasis. Funding Bill & Melinda Gates Foundation, Division of Intramural Research (National Institute of Allergy and Infectious Diseases, US National Institutes of Health).
23 citations
TL;DR: Implementation of an iris recognition system in routine health information systems is feasible and highly acceptable as part of routine care in Kenya and scale-up could improve unique patient identification and tracking, enhancing disease surveillance activities.
Abstract: Background Use of routine HIV programme data for surveillance is often limited due to inaccuracies associated with patient misclassification which can be addressed by unique patient identification.We assessed the feasibility and acceptability of integrating an iris recognition biometric identification system into routine HIV care services at 4 sites in Kenya. Methods Patients who had recently tested HIV-positive or were engaged in care were enrolled. Images of the iris were captured using a dual-iris camera connected to a laptop. A prototype iris biometric identification system networked across the sites, analysed the iris patterns; created a template from those patterns; and generated a 12-digit ID number based on the template. During subsequent visits, the patients’ irises were re-scanned, and the pattern was matched to stored templates to retrieve the ID number. Results Over 55 weeks 8,614 (98%) of 8,794 new patients were assigned a unique ID on their first visit. Among 6,078 return visits, the system correctly re-identified patients’ IDs 5,234 times (86%). The false match rate (a new patient given the ID of another patient) was 0·5% while the generalized false reject rate (re-scans assigned a new ID) was 4·7%. Overall, 9 (0·1%) agreed to enrol but declined to have an iris scan. The most common reasons cited for declining an iris scan were concerns about privacy and confidentiality. Conclusion Implementation of an iris recognition system in routine health information systems is feasible and highly acceptable as part of routine care in Kenya. Scale-up could improve unique patient identification and tracking, enhancing disease surveillance activities.
16 citations
TL;DR: In this paper, the authors describe the historical process of institutional and infrastructural harmonisation in the production of biometric population registers in Ghana and trace the difficulties and institutional negotiations that accompany this integration into a centralised population data infrastructure.
Abstract: In the global effort to strengthen national identification systems (SDG 16.9), biometric identification technologies and civil registration systems have been associated with different motives and applications, thus fuelling their competition for public attention and resources. The case of Ghana illustrates how these alternative systems, along with further sources of personal data, have recently been integrated into the larger political vision of a centralised, national population data system. Based on ethnographic fieldwork, the paper traces the difficulties and institutional negotiations that accompany this integration into a centralised population data infrastructure. Acknowledging how sets of actors, infrastructures and power relations are layered onto each other to unintended effects, the article describes the historical process of institutional and infrastructural harmonisation in the production of biometric population registers in Ghana.
10 citations
TL;DR: Fingerprint technology performed very well in identifying adult patients in an LMIC setting and serious considerations need to be given to the use of fingerprint technology for patient identification in LMICs, but this has to be done with strong consideration of ethical, legal, and social implications as well as security issues.
Abstract: Background Unique patient identification remains a challenge in many health care settings in low- and middle-income countries (LMICs). Without national-level unique identifiers for whole populations, countries rely on demographic-based approaches that have proven suboptimal. Affordable biometrics-based approaches, implemented with consideration of contextual ethical, legal, and social implications, have the potential to address this challenge and improve patient safety and reporting accuracy. However, limited studies exist to evaluate the actual performance of biometric approaches and perceptions of these systems in LMICs. Objective The aim of this study is to evaluate the performance and acceptability of fingerprint technology for unique patient matching and identification in the LMIC setting of Kenya. Methods In this cross-sectional study conducted at an HIV care and treatment facility in Western Kenya, an open source fingerprint application was integrated within an implementation of the Open Medical Record System, an open source electronic medical record system (EMRS) that is nationally endorsed and deployed for HIV care in Kenya and in more than 40 other countries; hence, it has potential to translate the findings across multiple countries. Participants aged >18 years were conveniently sampled and enrolled into the study. Participants’ left thumbprints were captured and later used to retrieve and match records. The technology’s performance was evaluated using standard measures: sensitivity, false acceptance rate, false rejection rate, and failure to enroll rate. The Wald test was used to compare the accuracy of the technology with the probabilistic patient-matching technique of the EMRS. Time to retrieval and matching of records were compared using the independent samples 2-tailed t test. A survey was administered to evaluate patient acceptance and satisfaction with use of the technology. Results In all, 300 participants were enrolled; their mean age was 36.3 (SD 12.2) years, and 58% (174/300) were women. The relevant values for the technology’s performance were sensitivity 89.3%, false acceptance rate 0%, false rejection rate 11%, and failure to enroll rate 2.3%. The technology’s mean record retrieval speed was 3.2 (SD 1.1) seconds versus 9.5 (SD 1.9) seconds with demographic-based record retrieval in the EMRS (P<.001). The survey results revealed that 96.3% (289/300) of the participants were comfortable with the technology and 90.3% (271/300) were willing to use it. Participants who had previously used fingerprint biometric systems for identification were estimated to have more than thrice increased odds of accepting the technology (odds ratio 3.57, 95% CI 1.0-11.92). Conclusions Fingerprint technology performed very well in identifying adult patients in an LMIC setting. Patients reported a high level of satisfaction and acceptance. Serious considerations need to be given to the use of fingerprint technology for patient identification in LMICs, but this has to be done with strong consideration of ethical, legal, and social implications as well as security issues.
10 citations
References
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TL;DR: A brief overview of the field of biometrics is given and some of its advantages, disadvantages, strengths, limitations, and related privacy concerns are summarized.
Abstract: A wide variety of systems requires reliable personal recognition schemes to either confirm or determine the identity of an individual requesting their services. The purpose of such schemes is to ensure that the rendered services are accessed only by a legitimate user and no one else. Examples of such applications include secure access to buildings, computer systems, laptops, cellular phones, and ATMs. In the absence of robust personal recognition schemes, these systems are vulnerable to the wiles of an impostor. Biometric recognition, or, simply, biometrics, refers to the automatic recognition of individuals based on their physiological and/or behavioral characteristics. By using biometrics, it is possible to confirm or establish an individual's identity based on "who she is", rather than by "what she possesses" (e.g., an ID card) or "what she remembers" (e.g., a password). We give a brief overview of the field of biometrics and summarize some of its advantages, disadvantages, strengths, limitations, and related privacy concerns.
4,678 citations
"The application of a biometric iden..." refers background in this paper
...Common among such include systems for fingerprint identification, face recognition, iris scan, retina scan, hand geometry, and voice scan (16, 17)....
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Book•
01 Dec 2004
TL;DR: This book provides a comprehensive assessment of the scientific evidence on prevalence and hazards, and the resulting health effects, of a range of exposures that are known to be hazardous to human health, including childhood and maternal undernutrition, nutritional and physiological risk factors for adult health, addictive substances, sexual and reproductive health, and risks in the physical environments of households and communities.
Abstract: During the last quarter of the twentieth century, a number of works have addressed both the methodological and empirical aspects of population-wide impacts of major causes of diseases. This gradual establishment of "risk assessment" or "risk quantification" has been driven partly by the academic curiosity of individual researchers and partly by the demands of regulatory agencies and public policy for better quantitative evidence on the health implications of certain risk exposures. These efforts nonetheless have generally been within the disciplinary and methodological traditions of individual risk factors and in a limited number of settings. As a result, the criteria for evaluating scientific evidence have varied greatly across risk factors resulting in lack of comparability across risk factors.
This book provides a comprehensive assessment of the scientific evidence on prevalence and hazards, and the resulting health effects, of a range of exposures that are known to be hazardous to human health, including childhood and maternal undernutrition, nutritional and physiological risk factors for adult health, addictive substances, sexual and reproductive health, and risks in the physical environments of households and communities, as well as among workers. This book is the culmination of over 3 years of scientific enquiry and data collection, collectively known as the comparative risk assessment (CRA) project, involving over 100 scientists, applying a common analytical framework and methods to ensure greater consistency and comparability in using and evaluating scientific evidence across risks.
As a result, our understanding of the comparative extent of disease burden caused by various exposures worldwide has advanced, and key areas of scientific enquiry to better inform policy needs to reduce risks have been elucidated. As public health researchers and practitioners evaluate policy alternatives for improving population health, this book not only demonstrates the enormous potential for disease prevention, but also provides a fundamental reference for the scientific evidence on some of the most important global risks to health.
2,451 citations
Journal Article•
1,697 citations
"The application of a biometric iden..." refers background or methods in this paper
...Computer hardware and logistics: (1) the raincoats; (2) the mouse; (3) the biometric fingerprint devices; (4) the web cameras; (5) the mini-laptops; (6) the red calico used for the background of the photos taken; (7) the spare batteries for the mini-laptops; and (8) the field notebooks used....
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...Introduction In public health, there is increasing interest in the availability of reliable data from general community that can be linked with health facility information (1)....
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TL;DR: As people become more connected electronically, the ability to achieve a highly accurate automatic personal identification system is substantially more critical and organizations are looking to automated identity authentication systems to improve customer satisfaction and operating efficiency.
Abstract: W A LT ER S IP SE R For this reason, more and more organizations are looking to automated identity authentication systems to improve customer satisfaction and operating efficiency as well as to save critical resources (see Figure 1). Furthermore, as people become more connected electronically, the ability to achieve a highly accurate automatic personal identification system is substantially more critical [5]. Personal identification is the process of associating a particular individual with an identity. Identification can be in the form of verification (also known as authentication), which entails authenticating a claimed identity (“Am I who I claim I am?”), or recognition (also known as identification), which entails determining the identity of a given person from a database of persons known to the system (“Who am I?”). Knowledge-based and token-based automatic personal identification approaches have been the two traditional techniques widely used [8]. Token-based approaches use something you have to make a personal identification, such as a passport, driver’s license, ID card, credit card, or keys. Knowledge-based approaches use something you know to make a personal identification, such as a password or a personal identification number (PIN). Since these traditional approaches are not based on any inherent attributes of an individual to make a personal identification, they suffer from the
827 citations
"The application of a biometric iden..." refers methods in this paper
...Biometric identification Biometric identification is a method of recognizing an individual, using a physical or behavioral characteristic (15)....
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TL;DR: This work states that the FVC2000 protocol, databases, and results will be useful to all practitioners in the field not only as a benchmark for improving methods, but also for enabling an unbiased evaluation of algorithms.
Abstract: Reliable and accurate fingerprint recognition is a challenging pattern recognition problem, requiring algorithms robust in many contexts. FVC2000 competition attempted to establish the first common benchmark, allowing companies and academic institutions to unambiguously compare performance and track improvements in their fingerprint recognition algorithms. Three databases were created using different state-of-the-art sensors and a fourth database was artificially generated; 11 algorithms were extensively tested on the four data sets. We believe that FVC2000 protocol, databases, and results will be useful to all practitioners in the field not only as a benchmark for improving methods, but also for enabling an unbiased evaluation of algorithms.
815 citations
"The application of a biometric iden..." refers background in this paper
...Compared to other biometric identification systems, fingerprint identification has a very large vendor base, with different templates and algorithms (26, 27)....
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