Creating an Interactive R Shiny Data Visualization Application to Facilitate Global Maternal Death Surveillance and Response (MDSR) System Reporting

Project Name: Creating an Interactive R Shiny Data Visualization Application to Facilitate Global Maternal Death Surveillance and Response (MDSR) System Reporting

Project Status: Proposed

Point of Contact: Florina Serbanescu

Center: National Center for Chronic Disease Prevention and Health Promotion

Keywords: surveillance, maternal mortality, mapping, R Shiny, dashboard, visualization, MDSR

Project Description: Background:

Maternal mortality, one of the legacy Millennium Development Goals and a current Sustainability Development Goal, is a highly preventable cause of death in developing countries. To improve identification of maternal deaths and understanding of the causes of death so that appropriate interventions can be designed, countries have focused efforts on establishing Maternal Death Surveillance and Response (MDSR) systems.  

MDSR is a framework advocated for by the World Health Organization. It allows for identifying, reporting, reviewing, analyzing, and responding to maternal deaths to facilitate actions that prevent potential future maternal deaths. In each country, establishment of MDSR will be adapted to existing systems and processes, and scaled up to reach the national level.

Documentation of MDSR scale-up should be captured through national annual reports from country Ministries of Health. Mapping at the subnational level of data can help to determine the effectiveness of lower-level interventions, breaking down an aggregated indicator to account for population and administrative-level heterogeneity, thereby leading to better programmatic planning. However, explicit geographic standards do not currently exist for national MDSR reporting guidelines. Many country-level managers may not have the technical expertise to create maps for their indicator data, and reporting often occurs only on a national or regional basis.

Proposed Method:

We seek to create a user-friendly, online shaded-area (choropleth) map dashboard tool for country managers to facilitate MDSR reporting. In lieu of traditional desktop mapping platforms such as QGIS or ArcGIS, the tool can be designed in the freeware R package, Shiny (http://shiny.rstudio.com/), allowing for interactive choropleth mapping of calculated maternal mortality indicators (i.e., maternal mortality ratios, maternal mortality rates). Worldwide administrative data exists for free, but solely for noncommercial use, in the Global Administrative Areas (GADM) database (http://www.gadm.org/). R SpatialPolygonsDataFrame (.rds) files from GADM allow for easy importation of administrative-level boundary data into R. If funded, we will work with GADM to obtain a tranche of their administrative data for the pilot R Shiny application, and build the application with potential guidance from the CDC R Shiny user subgroup. We will pilot-test it with our team’s data, procured from Uganda country partners, before working with GADM data.

Using this new platform, users may upload counts of the number of maternal deaths, and projected numbers of women of reproductive age and live births, to create real-time geographic maternal health indicator maps for reporting.

Impact/significance:

Our project will significantly advance the understanding of the geographic distribution of maternal mortality, while breaking new ground in timely subnational-level mapping. It allows in-country partners to easily create novel data visualizations for free, without extraneous software or specific geographical training.

The Division for Reproductive Health currently partners with WHO, UNFPA, USAID, and other intergovernmental organizations to modify and implement current MDSR and Integrated Disease Surveillance and Response (IDSR) guidelines. Using this existing partnership, the creation of a standardized template for choropleth mapping could be implemented in MDSR guidelines, and could be used as a template for other types of online surveillance data visualization in developing countries. This project will allow us to explore new ground in country surveillance reporting.

Transition step:

A summary report may be made to document the technical conditions required to facilitate the use of the proposed system, with a portfolio of analysis and display experience, allowing for a framework for further expansion in other areas with significant country partners.

For more information about this project, please contact the CHIIC at chiic@cdc.gov or Brian Lee at Brian.Lee@cdc.gov