For the complete DHIS2 documentation index, see llms.txt.

AEFI - Data Entry Trainer's Guide¶

DHIS2 Immunization Toolkit

Adverse Events Following Immunization (AEFI)

Preparation Notes¶

To modify this guide, you will have to review the local SOPs that are in place and modify any workflow or features discussed in the order the user will interact with them

Create an account with the same level of access as the users you are demonstrating to (ie. if they can only search and enter within one facility, have your user have the same authority)

Please refer to the system design document and installation guide for more details on the users and user groups. Create 3 users for the demo as follows:

The person entering the initial AEFI data into DHIS2 (either a facility staff or district staff entering data for all facilities in their district depending on local workflow). We will refer to them as the “facility user” in this document
First decision making level user (district / province). (note : this user may be the same as the person entering the initial AEFI data into DHIS2)
National level user

Ensure to assign these users to the respective user groups. This will give them the access to data entry as required and notifications.

Note

Demonstrating multiple users

When working with multiple users it can be difficult for those watching the demo to follow along if each user is not clearly identified. Additionally, switching between users without clearing cache can result in a previous user’s settings being displayed within the window of the new user that you log in with (ex. org units, dashboards, program stages, etc.). Please consider the following when working with multiple users:

Open separate browsers (for example, regular chrome, chrome in incognito and one firefox window -- add more modes/windows (firefox in private mode, edge, edge in private mode, etc.) depending on the amount of users you are showing).

Log in to each user you will be testing before starting your demo. Since each browser is its own window, create a duplicate tab within each browser.

Your session may time out causing you to log out from DHIS2 within one of the windows for a user you had previously logged in with, reload your duplicate tab to check this and log in to carry forward from wherever your user was logged in previously if needed.

Consider using a note of some kind that overlays itself on top of the windows you are using to perform the demo. Enter the name/type of user you are showing as you move between the different users so each user is visible to those reviewing the demo. An example app is simple sticky notes (https://www.simplestickynotes.com/). When working with these apps have them set to appear “Always on top.” Here is an example of such an overlay:

If it is the procedure to enter this data from a paper form, it will be useful to have a copy of the form they would normally use as reference filled in. This can just be a form that you have filled in yourself for example or can be a copy of a form from the actual implementation that you have received from the Ministry of Health. It will be useful to reference the AEFI storyline’s and reporting forms included in the training package when either finding or filling in example forms from your country implementation.
If they are entering data in real-time, then having forms is not necessarily required but you should prepare the details of an example case that you can follow in your examples. Referencing the AEFI storyline’s will be helpful in developing case studies for real time data entry.
For the exercises and small activities during the demo, ensure there are copies of forms or case-studies that the participants can use to register their own cases.
Your training DB should have some existing cases filled in to help support demonstrating search, filter and dashboard functionality
If demonstrating the working lists functionality, you will need to have a subset of the events you have created and assigned to a user where you can show this functionality
There are notifications tied to this program. You can use the DHIS2 messaging to demonstrate this; however, if you want to demonstrate this via e-mail or SMS instead make sure that you configure and test this in the instance both the trainer and participant’s will be using.

Background¶

This program is aimed at capturing data for any adverse event following immunization
The trainer is expected to provide the specific background information on AEFI to the audience based on the background of the individuals they are instructing. WHO offers materials on AEFI here: http://gvsi-aefi-tools.org/aefidata/training/resources_didactic_sessions.html. The explanation of this workflow should occur before practical sessions on entering the data into DHIS2 if needed.

Step by Step Guide¶

Log in to the DHIS2 system using the Username and password
Navigate to tracker capture
Review the org unit and program selection and select a facility to work in
Briefly describe the first page list if this appears, but note that we will get back to this later on.

Registration¶

Anytime we have a new adverse event we will need to register the case. Select Register to register a new adverse event
Review the enrollment page that you have configured. Describe the attributes that you are using and why they are there. Note that these attributes allow you to track this person as they go through the program, including finding them later on which will also be demonstrated. Attributes included in the standard AEFI configuration package are described within the system design document.
Describe the enrollment date which is called ‘Date patient notified the event to the health system’ in the standard configuration (note to trainer: this may be named differently based on your own configuration; use the enrollment date based on your config here) . This is the reporting date in DHIS2. AEFI onset date is represented by ‘Date AEFI Started’ and will come later in the data entry form.
Describe the generation process of AEFI Case ID and Unique System Identifier. The AEFI Case ID is locally assigned while the Unique System Identifier is system generated. Please refer to the system design document for more details.
Depending on your SOP, you may be creating new entities for a returning case or only a new enrollment. You can come back to this later when they are comfortable with the program.
Enter data for the attributes. If using a paper form, use it as reference to describe how each detail from the form gets filled in to DHIS2. After you have entered and explained the details for the enrollment, select Save and continue.

STOP

Exercise 1 - Register a new case¶

Tracker Dashboard¶

After you save the details, you will be confronted with the tracker dashboard. This is often overwhelming but hopefully a default layout is available so everyone is seeing the same thing.
The suggestion is to skip over all the other widgets initially and focus on the data entry widget. You can come back to the other widgets after some data has been entered.
Quickly recap the stages that are within the program (namely ‘AEFI’, ‘First decision making level’ and ‘National level’ stages), referring back to any background presentation(s) or demos you have already done.
Explain how different users have access to different stages and the sharing settings associated with each.
1. Facility user- AEFI data entry stage
2. District user- First Decision making level stage
3. National Level User- National level stage

You will have to describe this in some detail as you go through discussing the data entry process.

Data Entry¶

Stage 1 – Vaccine and AEFI details¶

The AEFI stage is automatically generated, and the Report compilation date (event date) will also be automatically populated based on the enrollment date. You can explain the assumption that this is the default date of report compilation but can be modified as per the actual report compilation date.
There are a number of program rules that are used to hide/show fields in the data entry page. Describe these rules to the participant. Please refer to the metadata review file for the logic within the data entry form.
Before entering the data from your example (either paper form or live case), review all the triggers for your program rules in order for the participant to understand where hidden fields they see on the paper form (or items they need to collect in real time) are located. For example, in AEFI stage there are rules triggered for:
Is the patient pregnant?
Is the patient lactating?
> 3 days (Severe local reaction)
Beyond nearest joint
Seizures
If died, date of Death:
Was an Autopsy requested?
After you have explained the location of hidden fields and the triggers for them, reset the form by deleting these values (or delete the event and create a new one). You should now see the form for the AEFI stage in its original layout. As the data entry form is a custom form, some of the text remains visible but the fields for entering data / checkboxes are hidden until they are required as per the logic defined by the rule.
Take your example case that you have prepared and enter the details into the first stage (all information up to the “first decision making level” should therefore be entered).
If you are satisfied with the details you have entered, you can complete the event.
There will be buttons to delete the event or print the form as well. There are multiple delete buttons for the event, enrollment and entity. Users may only have authority to perform certain delete actions. Only review the delete functions that are relevant to the group you are working with.
Explain the notification system in place for this program. After data entry in the AEFI stage is completed, two notifications will be sent.
One to the first decision making level user “Hello, AEFI stage has been completed for (case ID) at (facility). Please take the next steps to get the form verified by the authorized personnel.” It will look something like this (note to trainer: the message may be different depending on how it is configured in your system)

Another will be sent to any users assigned to that org unit “AEFI event reported for (child name).” It will look something like this (note to trainer: the message may be different depending on how it is configured in your system)

You can explain this notification by completing the event within the stage and then checking either your messages or e-mail depending on how you have configured the notification to send. You will have to be logged in as the user that receives this notification (perhaps in a separate window).
Ensure you are assigned to the correct org unit and user group so you can receive these notifications.

STOP

Exercise 2 - Fill in AEFI details AS THE FACILITY USER¶

Searching¶

Log in as the first decision making level (district / province) user. Navigate back to tracker capture, and select the facility in which the case you want to update resides in
There are several filters that are available when looking at the initial line list page within tracker capture. Two that will be particularly useful are completed vs active enrollments, as well as the custom working list. At this point, you will want to explain what an active vs a completed enrollment is. Active = still needs data, Completed = all case details including their outcome have been entered.
After explaining these conceptually, note that we will eventually go through and complete cases at the end of this demo. Show them how the filters work to reduce the line list in their facility, and also open up an active vs. completed case to show them how data entry and the tracker dashboard will look different between the two.
There is also a search feature that will allow us to find our cases. Select Search and enter details of an existing case. This will bring the case up and you can select them to be taken to the tracker dashboard. This is useful if you need to find a specific case for any purpose.
If the country is using or planning to use immunisation program as well, you can show searching through the immunisation program and then enrolling the case to AEFI program.
Before proceeding, find the previous case that you had just entered with your facility user

STOP

Exercise 3 - Review notifications and the search and filter functionality to find a case¶

Stage 2 – First decision making level¶

You will need to change the user to first decision making level (district / province) depending on the country’s guidelines. This will be the user who looks at the AEFI data entry form and decides whether an investigation is required or not. They should be used to find the case as described above.
The First decision making level stage is not automatically generated. As such, you will need to create a new event and select an event date. Show the participants how to create a new event and select the date. It may be the case that this date will be the same as the enrollment and AEFI stage.
Go through each of the fields that are available on this portion of data entry and explain them. Once again, go through the program rules as well as their triggers-
For example, there is a rule that if an investigation is needed, only then the planned date can be seen and needs to be entered for the investigation.
Fill in the fields
Once you have finished entering these details, complete the event.
Review the notifications associated with this stage
If there is an investigation needed, a notification will be sent to the Facility level User with the subject: AEFI Investigation needed.

If not, then a different notification is sent to the National level user with the subject: AEFI first decision making level review completed

Ensure you have a user that is assigned to the correct user group so you can receive these notifications.

Exercise 4 - Fill in first decision making level AS THE DISTRICT USER and review the investigation notification¶

Stage 3 – National level¶

You will need to change the user to the national level user who finally approves the findings of the case and does the causality assessment.

Find the case you have been working on by using search or the front page list/filters and select the national level program stage
The National level stage is not automatically generated. As such, you will need to create a new event and select an event date. Show the participants how to create a new event and select the date if required. It may be the case that this date will be the same as the enrollment and AEFI stage.
Go through each of the fields that are available on this portion of data entry and explain them. Go through the program rules for controlling fields as well as their triggers-
For example there are rules for “Final causality assessment classification and sub-classification”
Using the example you have prepared, fill in the information for the request.
Once you have finished entering these details, complete the event.
Review the notification associated with this stage
When the review is finalized, a notification will be sent out to the national level with the subject “AEFI National level review complete” (note to trainer: the subject and message may be different if it is altered within your configuration)

Ensure you have a user that is assigned to the correct user group so you can receive this notification.

Exercise 5 - Fill in the National Level AS THE NATIONAL USER and review the final national notification¶

Review the tracker dashboard¶

Staying on the dashboard of the case you have not filled in all the data for, now would be a good time to review some of the other widgets available on the tracker dashboard. Useful widgets would be the enrollment widget, the top bar widget and the profile widget in particular.
You can also show users how to modify and save the default layout of the tracker dashboard to fit their individual needs if supported in their implementation (note: the user will need access to do this and there may be a default layout that is saved by an admin that will override their changes)

Completing the program enrollment¶

In this program, when you have completed the event, this means you have also completed data entry for that stage (as none of the stages in this program are repeatable). This process should now have occurred for each of the 3 stages in this program as you have instructed the participants to select the “complete” button during the demo and their exercises at the end of each stage.
When all the events within the program have been marked as completed, this should also mean data entry for this enrollment is complete. At this point, explain what completing an enrollment means.
Based on your SOP also define what happens if this were to present again as a new case (what happens if the same person has another AEFI? would you create a new case, or just re-enroll this person into the AEFI program?). You may consider going through this in much more detail in the event it is required.
Complete the enrollment of your case and review the stages to see the effect this has ha (you can no longer edit any data within the events; you cannot longer incomplete any of the events)
Go back to your working list and update it using the filter for completed enrollments. The case you have been working on should now be at the top of the list.

STOP

Exercise 6 - Complete the enrollment¶

Exercise 7 - Perform all concepts discussed¶

Register a new case, enter data into each stage, review the notifications, use the search/filters to find a case, update a case, complete enrollments