case study of university management system

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What is a university management system?

A cloud based university management system (UMS) is a digital solution that helps automate tasks. Ranging from registering students, admitting students, onboarding them, managing their fees, managing payroll for lecturers to helping students access online learning, classroom training etc. a university management system is a complete solution. Reducing manual labor and intervention, this system ensures accuracy, transparency, reliability, and integrity of records, information, intellectual property and data.

Features of a university management system

A UMS is an education ERP product that helps teachers, students, parents, external vendors, learning suppliers etc. come together via a platform and exchange information. The university administration can automate several of their processes such as attendance, announcements, results, campus updates, schedule changes etc. to all concerned persons. There is no limit on the number of features of the university management system, because every university will have its own set of processes that is different from another university. Therefore, a UMS should be able to help universities apply university-specific customizations as well as configure generalized workflows.

• A universal university management system. India, UK, US curriculum, students and international learning systems can be integrated with such a system. The system links all university departments and coordinates their activities in an automated fashion.
• Eliminates data corruption either through willful misappropriation or by manual errors.
• Data/information security with strong encryption.
• Ability for customizations and extensibilities.
• Offline and online round-the-clock support.

University Management Software Types and Purposes

Academic software

The education ERP UMS monitors student progress, reports it, suggests improvements, automatically provides learning resources, manages online submissions, executes examinations and corroborates results. The university management system India, Europe, Americas UMS can also be configured to have automated convocation processes, with automated degree and postgraduate degree delivery. The level of automation can be configured. A self-adjusting UMS will have no external or internal manual intervention. Most students prefer this type of system.

Finance and Accounting Management

This type of ERP for the University Management System should handle payments from students, suppliers, vendors. It can also provide reporting and financial statistics modules. Made for the university finance and administration department, an entire finance and accounting feature-set can be built-in. The feature-set can be specific to this type of university, and its business.

HR software

An HR education ERP UMS helps the university administration to manage their employees. This UMS will have tracking capabilities including managing working hours, logging of tasks, completion deadlines and sharing of work. A UMS ERP should provide flexibility and adaptability. It means that the modules of the UMS ERP can be customized and applied as per business-specific requirements and also in a generalized way.

Department Management

A university is a complex organization of people, processes, departments and technologies. All the departments and people have to often work cohesively. The level of cohesion and collaboration requirements differs as per many factors such as nature of task, departmental dynamics, university events and university processes. A UMS education ERP should support such complex departmental integration use-cases. Using UMS, departments should be able to work as siloes, transparently, collaboratively – all at the same time.

Inventory and Library Management 

A university will have enormous types and quantities of inventory. The university could have complex supply chain processes. Likewise, a university’s digital library system may also need good knowledge management techniques. The library system could have educational resources being supplied from external learning providers. All of this needs management and manual management is not scalable. So an inventory and library management UMS helps support stock-keeping and knowledge management in efficient and scalable ways.

Benefits of a university management system

Centralized Admissions

The UMS will help prospective students apply to the university online. The admission process can be automated with the education ERP software so that teachers don’t manually peruse the applications. The software will peruse the data and request for additional data from the student if required. Data entry, verification, validation, storage can be automated. The admission module can also assist students in paying their admission fees, receiving acknowledgments, and online onboarding.

BI-Powered Analytics & Reports

The analytics and reporting module of the education ERP software can analyze data from various sources and produce reports. The analysis types can be modeled and configured. The data can be extracted from BI systems within the university or via integrations with cloud-based BI software. Analysis can be made on productivity, improvements, processes, student activities, teaching methodologies, and learning effectiveness. In fact, there is no limit on the types of analysis that can be made.

Choice Based Education System

Each university has a standard curriculum and also study areas that are electives. Students can choose from these electives via the education ERP software. This choice based education system enables students to specialize in specific subjects. They gain expertise in those subject areas and can expand their horizons from there. A UMS should be able to provide these facilities. Online learning is one such mechanism that helps students with virtual labs, theory courses, practical based education, project work, feedback and results management.

Ease in Operation

Managing a university is a complex process. The aim of education ERP software UMS should be to reduce complexity and promote simplicity of operations. If the UMS itself is complex to operate, it defeats the purpose. Instead, a UMS should have intuitive and self-explanatory controls and UI components. Even non-technical users should be able to operate the system easily. When the system is easy to operate, more people start using it, as they find it more helpful and interesting.

Better Communication

Every department, entity, and function in the university has high levels of coordination. The UMS university ERP ensures that there is no scope for misunderstanding between any departments. All inter-departmental communication is transparent, recorded, and accessible. There could be personal and candid channels of communication as well. This aspect enables UMS administrators to leverage access based communication privileges.

Keeping Data Safe

Digital data is easy to record, access, transmit, and store. But if it is not managed properly, it can get corrupted or stolen. The UMS has to apply data redundancy technology to ensure that data is replicated. Disaster recovery mechanisms have to be put into place to ensure data resiliency. Access control lists, and strong encryption will ensure that data cannot be accessed without authentication and authorization.

Better Pricing

A university ERP can have multiple modules. A university may need only a few modules and some modules on an on-demand basis. A modular approach ensures that a UMS can be priced as per usage requirements. Being cloud-based also helps a UMS to scale only when there is increased usage, and shrink otherwise. This way, pricing can be non-rigid, and helps universities to manage their costs, usage and resources efficiently.

Why Modern Universities Can’t Do Without Management Software?

There are three primary reasons why educational establishments should build university data management software.

A UMS is a bare necessity because education is becoming digital and online. Traditional classroom-based education is being replaced by virtual classrooms. The latter provides the same level of experience as the former. Added to that, virtual classrooms are a more powerful tool that enables a university to impart education to a wider and broader student base using the university ERP.

Efficiency 

Manual entries, filling up papers, distributing pamphlets, putting announcements on physical bulletin boards are all inefficient. When all aspects of a university student administration process are online and automated, students have better leverage, control, and clarity. It saves time, cost, and confusion. Even teachers find that managing their activities, tasks, and scheduling is easier with a UMS. Teachers, faculty, and university administration personnel can focus on more creative tasks instead of wasting time on mundane repetitive tasks.

Flexibility

A UMS or university ERP provides the flexibility to define workflows as per changing university requirements. Hard-wired software-based workflows prevent the university from applying case-based workflows. Instead, a flexible and highly-configurable workflow-system can support any number of use cases. It also lets the university expand its capabilities and offerings without worrying about a technological upgrade or overhaul. 

Who needs a university management system?

Every university needs a university management system to stay competitive, in the reckoning, to win favor with students, and impart quality education. Without a UMS, a university will operate inefficiently, and will be unable to create any value for the student community and teachers.

Why the CAMU’s University Management System?

CAMU University Management System is the leading UMS with a full range of features and modules. Being the Best University Management Software in India and several other developed and developing countries, the benefits of the university management system has been brought forward in its entirety by CAMU. Covering all aspects of university management, student administration, learning management, and miscellaneous processes, CAMU university management software is a highly preferred university ERP system.

Visit the CAMU site and schedule a demo or call an advisor from CAMU to get started on the journey to make your university completely digitized, paperless, highly efficient, transparent, silo-less, student and teacher friendly, and a preferred university. Choose from a number of university management software types. CAMU’s diverse portfolio enables any type of university to start managing their processes irrespective of their complexity.

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Case Study on University Management System

University management system case study:.

University management system is the improvement of the university’s work and control over the educational process due to computer software and modern technologies. Nearly every university has got its own network system which enables students, parents and applicants get all the required information about the educational institution at a moment’s notice. With the help of the Internet one can visit the website of a university and observe all the programs and opportunities for students it offers.

University management system improves the organization of work of the institution and reduces the number of paperwork which is often the waste of time and resources. If one wants to enter a university, he will need to register in the system and find all the necessary data there.Students also can find a range of advantages using the system. First of all it enables them find out the information about the courses, subjects, required disciplines, the timetable, etc.Moreover, there are always data bases which contain all the information about student’s success and failures, as all the points and marks are registered in the system. The main advantage of the university management system is its convenience and speed.

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One can find all the necessary data about the university and the educational process very fast and will not have to travel much to visit the university himself and ask for consultation there. Moreover, university management system makes the educational process more open and fair, because no one can influence on the data registered in the system and alter it.University management system is the greatest innovation which managed to help with the control of the work of higher educational institutions in the effective way. Young people who are required to prepare a good case study on the problem related with university management system should find time to investigate the problem in general. One will need to find all the strong and weak sides of the system to be able to make the correct conclusions and analyze concrete problems on the topic.

A good case study should be researched in detail; one will need to investigate the case site and find out what the reason of the problem is and weigh its consequences. The result of the case study should be a list of smart ideas which explain the cause and effect sides of the case and a list of quality solutions to the problem.Students who need to write a case study always apply for the professional help in the Internet. One will surely need a free example case study on university management system in system analysis and design to improve his knowledge in paper writing. An inexperienced student will learn to compose a logical paper with the correct format and structure with the help of a good free sample case study on university management system.

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How Zoho Creator shaped SRM into a one-of-a-kind university

A top-ranked private university stepped up their automation game by digitizing all of their academic processes. Read on to find out how SRM got rid of bulky ledgers, outdated attendance systems, and wasteful circulars using Zoho Creator, in their pursuit of becoming a truly paperless university.

Processes automated using Zoho Creator

•   Course Selection
•   Communication
•   Attendance
•   Exams
•   Accreditation
•   Events
•   Counselling

Key advantages:

Instant communication.

SMS, email alerts, and push notifications are sent on time across multiple departments.

Multiplatform support

The app can be accessed on phones, tablets, and laptops by faculty and students.

Increased efficiency

Online attendance trackers, QR codes for event registrations, and calendar reports ensure streamlined processes.

"Right now, we're using six apps—six critical apps. So we can say that Zoho Creator runs our critical business processes".

Prof. Anand,

Executive Secretary

Going paperless: A university's digital transformation journey

SRM University is one of the top ranked private universities in India. Founded in 1985, it's always been a game-changer in education, with its interdisciplinary curriculum, diverse student base, and excellent placement records. With over 45,000 students, 3,000 faculty members, and dozens of departments, there's a substantial amount of data to be managed. Their biggest challenge was managing all of this data on paper. 

They were looking for a customizable solution and were open to trying something new. That's when Zoho Creator came into the picture, and since then, there's been no looking back. Within a year, they implemented a revolutionary academic system automating most of their operations, and as of today, they have six critical apps running their educational processes—all built using Zoho Creator.

Discover how SRM built a university management system using Zoho Creator

Facility Management System: A Case Study of University Campus

• First Online: 29 March 2017

Cite this chapter

• Arifa Begum 3 &
• Ashis K. Saha 3  

Part of the book series: The Urban Book Series ((UBS))

1505 Accesses

Remote Sensing and GIS play very important role in creating future smart cities. Facilities management being an important component of smart cities assimilates infrastructural functions and processes. Moreover it defines scheduled approaches toward the optimization of resources, in turn, promoting efficiency and simplifying complex decisions. This study aims at developing a better facility management system at Delhi University North campus by utilizing an integrated approach of information technology and GIS. The case study pertains to meet the objectives like collection of information on various facilities (viz., Banks and ATM, Photocopy and Printout shops, Food Joints, Health Care and Medical shops, Hostels, etc.) in the Delhi University North Campus and collating that information to develop the facility management system in a GIS framework. For this study, high resolution satellite imageries of QuickBird (60 cm resolution), EICHER Delhi City Map and Google Earth have been used. The heads-up digitization has been performed for feature extraction (e.g., road network, canteen, Railway Reservation centre, parks, shopping centres, etc.) from the very high resolution satellite imagery and ArcPAD mobile GIS has been used to perform the survey related to facilities in the campus. The mapped facilities have been brought into a GIS-based network analysis to find out basic closest facilities, optimized route identification, service area identification, origin-distance matrix etc. The mapped facilities have been then published using open-source ArcGIS Explorer toolbox for common users.

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Abbreviations

Automated mapping/facilities management

Automated teller machine

Facility information management system

Origin–destination

Geographic information system

Global positioning system

Universal transverse Mercator coordinate system

World geodetic system 1984

Alesheikh A, Helali H, Behroz HA (2002) WebGIS: Technologies & its Applications. In: Symposium on geospatial theory, processing and applications. Ottawa, Canada: vol XXXIV Part 4, 2002—ISPRS Commission IV

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DimensionI GIS: Mapping and Services Outsourcing. Utility/ AM-FM Mapping. http://www.dimensionigis.com/utility-am-fm.html . Accessed on Apr 2015

Elangovan C, Dr. Sekar ASS (2014) Utility management system for an engineering college. Asia Pacific J Market Manage Rev Apjmmr 3(6)

Geography. Facilities management. http://geography.name/facilities-mapping/ . Accessed on Apr 2015

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Management and Monitoring of Building Utility using GIS—A Preliminary Study. http://gisdevelopment.net/application/Utility/others/ma07307.htm . Accessed on Apr 2015

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Sinnakaudan S, Abu Bakar SH, Nyuin JD (2004) Development of the UiTM campus facility information management system (GeoCampus). International Symposium on Geoinformation, ISG 200421. Kuala Lumpur

Sinnakaudan S, Ahmad MS, Mohamad G (2001) Development of water utility management system using geographic information system (GIS). Annual Seminar on Geoinformation Penang, Malaysia

Srivastava A, Brad W (2009) GIS-based facility information management systems: an evolving success story. Esri Proceedings. ESRI, San Diego, CA

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Arifa Begum & Ashis K. Saha

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Begum, A., Saha, A.K. (2017). Facility Management System: A Case Study of University Campus. In: Sharma, P., Rajput, S. (eds) Sustainable Smart Cities in India. The Urban Book Series. Springer, Cham. https://doi.org/10.1007/978-3-319-47145-7_14

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University Queue Management System: A Case Study

San Diego State University Adopts Qtrac® for Virtual Queue Management and Wait Time Transparency

Every semester during the open enrollment period, San Diego State University (SDSU) had the same problem: huge crowds of students would gather outside the Office of Evaluations and Office of Registration waiting to be helped by staff members. Without an efficient university queue management system, the students were frustrated and wasting time. What’s more, in the administration’s efforts to mitigate the spread of COVID-19, the crowds posed a potential health risk.

With just three weeks before Fall 2021 open enrollment began, SDSU partnered with Lavi Industries to install and train the offices’ staff in the University’s queue management system. With signage, kiosks and Single Sign-On (SSO) implementation, SDSU’s student body and staff rapidly adopted the new system – replacing crowds and long physical waits with ease and transparency.

The Challenge

SDSU has a student body of more than 35,000. During each semester’s open enrollment period, about 2,000 students seek services from the Office of the Registrar and the Office of Evaluations to resolve issues ranging from payment and course registration, transcript requests, major declarations, resetting web portal passwords, grades and academic standing, and dozens of other critical administrative tasks. Depending on the workload, daily staffing in these offices varies from 10 to 20 employees – many of them students, too. With so many students seeking assistance from a small number of employees in a short window of time, crowd management was a major pain point.

The COVID pandemic accelerated plans to institute a more effective line management solution. Keen to avoid crowds of students, many of whom would have just moved back to campus for in-person classes, SDSU sought a queue management solution that would let students stand on line virtually, and eliminate the physical crowds in front of and outside the offices.

4 Factors for Measuring Success

In selecting a solution, SDSU identified four key areas that would need to be resolved.

Campus crowd control

With students spilling out of the office building and onto the quad, crowds were always a source of frustration for students and a brand image issue for the school administration. The disorganized mass of students was not in line with the culture of a leading public research university. The 2020 pandemic, however, turned what was a persistent issue into a potential health hazard. Eliminating crowds suddenly became imperative for SDSU.

Student wait time transparency

Both offices are walk-in only – first come, first served. The wait times, and the uncertainty surrounding them, were damaging student-staff relations. Students had to find time between classes and work to come to the office, but had no idea how long they would have to wait – or even if they would be seen at all. To regain student confidence, the solution needed to provide transparency about wait times so students could choose to wait on site if they were high up on the queue or, if there were many students ahead of them, go about the campus and monitor when they should return.

Staff workflow transparency

Employees in both offices had no way to track student wait times, give estimates on how long students would have to wait for services, or gain insight into which services were most in-demand at any given time. SDSU needed a cloud-based, data-driven solution that could provide insights into the times when demand for service ebbed and flowed, as well as the reasons for student visits, to more efficiently staff these offices.

Implementation speed

SDSU approached Qtrac just three weeks before students would begin open enrollment. With equipment that needed to be installed and staff that needed software training, every minute counted. SDSU required a provider with proven assurance that the virtual queueing solution could be implemented: 1) before the massive wave of students came onto campus during the open enrollment period, and 2) staff and students could readily adopt.

What Qtrac Did:

The Virtual Queue—A Better Waiting Experience

In just 3 weeks, Lavi’s team installed the Qtrac software, a kiosk with digital tablet, and QR code signage, and also trained 20 staff members. SDSU began the Fall 2021 semester with a fully-operational virtual queue management system that was rapidly adopted by both staff and students.

The student body, so-called “digital natives,” took to the technology naturally and intuitively, and were enthusiastic in their embrace of a modern solution.

Three major elements contributed to the successful launch and adoption of the University’s queue management system:

Efficient and comprehensive training

Qtrac training experts provided remote video lessons to all staff in the Office of the Registrar and the Office of Evaluations. And to make staff adoption even more attractive and easy, Qtrac worked with SDSU to implement  Single Sign-On (SSO) capability. With SSO, SDSU staff can use one username and password across all their online systems– not just for Qtrac. This feature simplifies the process with “one less thing” for staff to remember.

Virtual Queuing Software = Real-time transparency

Office services are still provided on a first-come, first-served basis. However, by scanning the QR code on the signage at the front of the offices, students can now hold their place in line. Using Qtrac’s mobile queuing wait screen on their smartphones, they also see exactly how many other students are in front of them. With real-time updates on their place in line, the students are free to wait in the library, at the cafe or anywhere else they want, and then return to the offices as their place on line approaches.

Flexible options

SDSU wants to accommodate students wherever they are in their use of technology, and wherever they are on campus, so it’s important to them to provide options. While most students opt to scan the QR on the aforementioned signage, the Lavi team also installed a Qtrac registration kiosk with a digital pad at the entry to each office so that students had the option to type in their information there. As a third option, students can also enter the virtual line from anywhere by simply texting a phone number that’s prominently displayed on the Qtrac signage. Some students report using this feature to get on virtual lines while they’re still in class – and appreciate this flexibility given their busy schedules.

The Results

When open enrollment began, the crowds of hundreds spilling onto the quad never materialized. Students came to the offices; saw the signage with instructions about using the QR code, kiosk, or texting; and immediately began using the new virtual queue solution.

Resistance to adopting the new system was one of SDSU’s biggest worries before implementation, but it turned out virtual queue management was not only something the students wanted to use, but, in their digital-first world, was something they were already accustomed to. As digital natives, Qtrac’s functionality and user interface was as intuitive to the students as writing their name. And since many of the employees in the offices are themselves students, they quickly understood training and were able to help other employees get up to speed.

In addition to solving the crowding issues, SDSU uses the data collected by Qtrac to inform staffing decisions at both offices. Whereas prior to implementing Qtrac, both students and staff were in the dark about wait times and service availability, now the offices can see service patterns for any given day and time for any given service, and staff appropriately.

Qtrac was brought in to solve a major crowd problem at SDSU, but its insights improved operational efficiency . Students report feeling less frustrated by their experiences in the offices since they no longer have to waste time being physically present on lines and staff schedules better match the demand for services. Employees, both in the office and within SDSU administration, see noticeable improvement in staff-student relations since introducing Qtrac.

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Development of an Online Integrated Library Management Information System: Case Study “University of Gitwe”

Abstract— Automated Information System is a software application which often provides a major impact on the universities’ social and economic satisfaction as it consists of various aspects of the educational process, automates administrative and business activities and financial management, assists in decision-making by supporting information flow within the university. UG-LMIS (University of Gitwe Library Management Information System) is a library automation web application, a sub-module of the University of Gitwe’s Integrated Management Information System (UGIMIS), a web-based and an online application automating the whole university’s management. UG-LMIS was designed for the University of Gitwe to replace its existing manual record-keeping system. The new system controls the following information; student information, the catalog of books, track of issues and return of books, book searching and tracking, e-mail services, notice about book issue status, reporting capabilities, etc. These services are provided in an efficient and cost-effective manner with the goal of reducing the time and resources currently required for such tasks. UG- LMIS is a UMIS with great user interface designs, more performance enhancements, and many of enriched modules. It works for a big deal to bring value to the words ‘care’ and ‘comfort’ in this higher learning scenario. Besides, UG-LIMS is endowed with an advanced feature as it is a part of the university website, it can be accessed online anywhere at any time.

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Data modeling, relational data model, normalization, transaction processing, concurrency control, file organization, indexing and b+ tree, sql introduction.

Interview Questions

What is University Management System?

A University management system is a web-based solution that covers all the functions of a university and college. It is developed for analyzing, conducting, and monitoring the complex activity of the university and affiliated colleges like admission, examination, and many more.

Importance of University Management System

When we compare the manual process with the university management system, the university management system makes easier the overall process of the university management system. The university management system creates a platform that collaborates with all students, administrators, faculty, and stakeholders. Some key benefits of the university management system are as follows.

• It is very easy for the student to access information and educational service.
• It provides transparency in all the processes.
• It provides better communication between all the stakeholders of the university.
• All the tasks are executed in a very simplifying matter.
• The pre and post-examination works have the management of the time-critical activity.

What is an ER Diagram?

We can also call ER diagram the database design for the university management system project. The ER diagram is like a picture that contains how all the entities are related to each other. The most important part of the ER diagram is Relationships, Attributes, and Entities.

Importance of ER Diagram

The ER diagram for the project is the foundation for the building of the database of the project. The properties, datatypes, and attributes are defined by the ER diagram.

ER Diagram for University Management System

The ER diagram for the university management system, the system data, and their attributes. The data and the attributes are represented by the table, and the table shows how they are related to each other.

Database Design for the University Management System

The above diagram shows the database design for the university management system. This database design shows all the system data, and the output for the user is stored in the database. In DBMS, a good ER diagram is needed for the creation of a university management system.

University Management System ER Diagram Tables

The below table shows all about the field name of the table, description, datatype, and character length. Each table of the ER diagram defines and explains the data storage.

The field column lists all the attributes of the database that describes each column. The types table of the database shows what kind of data each attribute is, and the length shows how many characters it has.

Table Name: Student

Table name: course, table name: college:-, table name: registration:-, table name: permission, table name: roles, table name: log-in, table name: users.

With the help of the above tables, we can set up the database for the university management system. It provides the full description of the database with its table names. They will enter all the values and attributes for the database in the table.

How to create ER Diagram

We can create the ER diagram for the table just in 5 minutes. There are some steps, and with the help of these steps, we can build the ER diagram for the university management system project. The steps are as below.

Step 1: We must familiarize ourselves with the entity relationship diagram cardinality and symbols. Then we have to show the data structure for the project in the entity relationship diagram. The symbol of the entity relationship diagram shows how they fit together. Before making the ER diagram, we should properly know the meaning of all the symbols and how to use all of them symbols.

Symbol of entity relationship diagram:-

• Fields: This entity shows how the different types of data are used together for a project. The symbol is used to show how the part of the project is working.
• Primary key: It is a set of unique properties that are used for finding the specific entity.
• A foreign key: It is a type of key made up of a piece of data with too many links to other things.

Step 2: Finalize the entities included

Start making your ER Diagram by deciding on all the parts your university management system must have. You'll need to leave the area in your design for these rectangles to be included later.

Step 3: Add the attributes of each entity

After you've decided on the entities, think about the traits you'll need for each one. In a conceptual ER diagram, the details of the different entities are given as attributes. Attributes are things like a thing's traits, a many-to-many relationship, or a one-to-one relationship. Attributes with multiple values can be given more than one value.

Step 4: Describe the relationships (cardinality) between entities and attributes

You will need the entities, their attributes, and the relationships between them to plot the relationships between the ERD. To get the right entity relationship diagram, you will use the information you gathered to build the data structure.

You need to know how the University Management System was designed and built using diagrams. With the help of an ER diagram will help you make a system that works well. Making it will help you understand how the software works behind the scenes. This is where all the data that goes in and out of the system will be stored.

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Top 40 Most Popular Case Studies of 2021

Two cases about Hertz claimed top spots in 2021's Top 40 Most Popular Case Studies

Two cases on the uses of debt and equity at Hertz claimed top spots in the CRDT’s (Case Research and Development Team) 2021 top 40 review of cases.

Hertz (A) took the top spot. The case details the financial structure of the rental car company through the end of 2019. Hertz (B), which ranked third in CRDT’s list, describes the company’s struggles during the early part of the COVID pandemic and its eventual need to enter Chapter 11 bankruptcy. 

The success of the Hertz cases was unprecedented for the top 40 list. Usually, cases take a number of years to gain popularity, but the Hertz cases claimed top spots in their first year of release. Hertz (A) also became the first ‘cooked’ case to top the annual review, as all of the other winners had been web-based ‘raw’ cases.

Besides introducing students to the complicated financing required to maintain an enormous fleet of cars, the Hertz cases also expanded the diversity of case protagonists. Kathyrn Marinello was the CEO of Hertz during this period and the CFO, Jamere Jackson is black.

Sandwiched between the two Hertz cases, Coffee 2016, a perennial best seller, finished second. “Glory, Glory, Man United!” a case about an English football team’s IPO made a surprise move to number four.  Cases on search fund boards, the future of malls,  Norway’s Sovereign Wealth fund, Prodigy Finance, the Mayo Clinic, and Cadbury rounded out the top ten.

Other year-end data for 2021 showed:

• Online “raw” case usage remained steady as compared to 2020 with over 35K users from 170 countries and all 50 U.S. states interacting with 196 cases.
• Fifty four percent of raw case users came from outside the U.S..
• The Yale School of Management (SOM) case study directory pages received over 160K page views from 177 countries with approximately a third originating in India followed by the U.S. and the Philippines.
• Twenty-six of the cases in the list are raw cases.
• A third of the cases feature a woman protagonist.
• Orders for Yale SOM case studies increased by almost 50% compared to 2020.
• The top 40 cases were supervised by 19 different Yale SOM faculty members, several supervising multiple cases.

CRDT compiled the Top 40 list by combining data from its case store, Google Analytics, and other measures of interest and adoption.

All of this year’s Top 40 cases are available for purchase from the Yale Management Media store .

And the Top 40 cases studies of 2021 are:

1.   Hertz Global Holdings (A): Uses of Debt and Equity

2.   Coffee 2016

3.   Hertz Global Holdings (B): Uses of Debt and Equity 2020

4.   Glory, Glory Man United!

5.   Search Fund Company Boards: How CEOs Can Build Boards to Help Them Thrive

6.   The Future of Malls: Was Decline Inevitable?

7.   Strategy for Norway's Pension Fund Global

8.   Prodigy Finance

9.   Design at Mayo

10. Cadbury

11. City Hospital Emergency Room

13. Volkswagen

14. Marina Bay Sands

15. Shake Shack IPO

16. Mastercard

17. Netflix

18. Ant Financial

19. AXA: Creating the New CR Metrics

20. IBM Corporate Service Corps

21. Business Leadership in South Africa's 1994 Reforms

22. Alternative Meat Industry

23. Children's Premier

24. Khalil Tawil and Umi (A)

25. Palm Oil 2016

26. Teach For All: Designing a Global Network

27. What's Next? Search Fund Entrepreneurs Reflect on Life After Exit

28. Searching for a Search Fund Structure: A Student Takes a Tour of Various Options

30. Project Sammaan

31. Commonfund ESG

32. Polaroid

33. Connecticut Green Bank 2018: After the Raid

34. FieldFresh Foods

35. The Alibaba Group

36. 360 State Street: Real Options

37. Herman Miller

38. AgBiome

39. Nathan Cummings Foundation

40. Toyota 2010

Scope & Importance of University Management System

• Examination Processing , Learning Spiral , Online Assessment , Online Exam Solution , Online Examination System | Online Exam Solution , Post-Examination Processing , Pre-Examination Processing , Question Bank Management , University Examination System , University Management system

MEANING: University Management System

Online systems have made it possible for universities to manage all their processes from student enrollment, admissions, payments, verification, communication, pre-examination works, and post-examination activities effectively & efficiently. A modern University Management System such as UCanManage helps students  & universities to manage their tasks smoothly. Learning Spiral’s University Management System powers numerous Universities and is well known for its cloud-based, AWS-hosted, effective and efficient features.

An effective university management system helps in the following areas of administration: Online Student Management, Online Examination Management

SCOPE OF UNIVERSITY MANAGEMENT SYSTEM 

Our University Examination Systems help manage the entire spectrum of examination activities. This includes activities: Online Examination System , secured question bank management, question item creation, test venue audit reports, filling of examination forms, the release of admit cards, a compilation of results, generation of mark sheets, digital evaluation, on-screen marking, question paper distribution etc. The examination system is also tightly integrated with what is popularly called the Student life cycle i.e. the process of management of the various stages of the student starting from Enrollment to filling of exam forms, declaration of results and final convocation or award of degrees.

Our combination of products i.e. SmartExam & UCanAssess helps us to perfectly manage the university examination system. Our modern university examination system conduct exams for large universities where students are million in number. 

The examination system is also tightly integrated with what is popularly called the Student life cycle i.e. the process of management of the various stages of the student starting from Enrollment to filling of exam forms, declaration of results and final convocation or award of degrees.

Overall, when compared to the manual process, an effective University Management System makes managing university operations easier and more reliable. The university management system aids in the creation of a platform for all stakeholders including Admin, faculty, and students to collaborate.

Some of the key benefits one can derive are

• Easy Access to information and educational services for Students 
• Transparency in processes
• Better Communication between all stakeholders
• Simplifying & Streamlining all Tasks and their execution 
• Management of time-critical activities like Pre and post Examination works 

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• Published: 25 April 2024

Assessing intersectional gender analysis in Nepal’s health management information system: a case study on tuberculosis for inclusive health systems

• Ayuska Parajuli 1 ,
• Sampurna Kakchapati 1 ,
• Abriti Arjyal 1 ,
• Deepak Joshi 1 ,
• Chandani Kharel 1 ,
• Mariam Otmani del Barrio 2 &
• Sushil C Baral   ORCID: orcid.org/0000-0002-3425-6915 1  

Infectious Diseases of Poverty volume  13 , Article number:  31 ( 2024 ) Cite this article

Metrics details

Tuberculosis (TB) remains a major public health problem in Nepal, high in settings marked by prevalent gender and social inequities. Various social stratifiers intersect, either privileging or oppressing individuals based on their characteristics and contexts, thereby increasing risks, vulnerabilities and marganilisation associated with TB. This study aimed to assess the inclusiveness of gender and other social stratifiers in key health related national policies and the Health Management Information System (HMIS) of National Tuberculosis Programme (NTP) by conducting an intersectional analysis of TB cases recorded via HMIS.

A desk review of key policies and the NTP’s HMIS was conducted. Retrospective intersectional analysis utilized two secondary data sources: annual NTP report (2017–2021) and records of 628 TB cases via HMIS 6.5 from two TB centres (2017/18–2018/19). Chi-square test and multi-variate analysis was used to assess the association between social stratifers and types of TB, registration category and treatment outcome.

Gender, social inclusion and concept of intersectionality are incorporated into various health policies and strategies but lack effective implementation. NTP has initiated the collection of age, sex, ethnicity and location data since 2014/15 through the HMIS. However, only age and sex disaggregated data are routinely reported, leaving recorded social stratifiers of TB patients static without analysis and dissemination. Furthermore, findings from the intersectional analysis using TB secondary data, showed that male more than 25 years exhibited higher odds [adjusted odds ratio (a OR ) = 4.95, 95% confidence interval ( CI ): 1.60–19.06, P  = 0.01)] of successful outcome compared to male TB patients less than 25 years. Similarly, sex was significantly associated with types of TB ( P  < 0.05) whereas both age ( P  < 0.05) and sex ( P  < 0.05) were significantly associated with patient registration category (old/new cases).

Conclusions

The results highlight inadequacy in the availability of social stratifiers in the routine HMIS. This limitation hampers the NTP’s ability to conduct intersectional analyses, crucial for unveiling the roles of other social determinants of TB. Such limitation underscores the need for more disaggregated data in routine NTP to better inform policies and plans contributing to the development of a more responsive and equitable TB programme and effectively addressing disparities.

Nepal, in its early stage of federalisation, is a multi-ethnic, multi-lingual, multi-religious and multi-cultural state with diverse geography. The new state architecture comprises three tiers of government—one federal, seven provincial and 753 local governments. In this federal structure, health is among the most decentralized sectors, where basic health services fall under the exclusive functions of local government [ 1 , 2 ]. The local governments have the authority to plan, operate, and manage their own health systems, bringing health services closer to peoples’ home. This approach aims to narrow gaps in health service access and utilization caused by synergistic interaction with various social stratifiers, such as gender, education, occupation and socio-economic status of the individual [ 3 , 4 ].

Intersectional gender analysis involves analyzing how gender power relations intersect with other social factors (such as age, ethnicity, religion, gender, education, occupation, geography, migration status, etc.) to affect people’s lives and create differences in needs and experiences [ 5 ]. These factors intersect, either privileging or oppressing individuals based on their characteristics and contexts, thereby increasing the risk, vulnerabilities, and marginalisation. Such evidence can better inform policies, programmes and services to ensure that no one is left behind. Tuberculosis (TB) servs as an example, as National TB compared against yearly disease estimation by WHO shows that 10,000 TB patients are beyond the reach of the National Tuberculosis Programme (NTP), Nepal [ 6 ].

TB remains a public health challenge in Nepal. As of 2021, Nepal is one of the high TB burden countries, with an increasing prevalence of cases. A total of 28,677 cases were notified and registered within the NTP in 2020/21 [ 7 ]. National data indicates that males suffer two times more from TB than females [ 7 ]. The higher prevalence of TB among males is attributed to sex and gender specific behavioral factors, such as daily activities/occupation, risk behaviors, social roles and responsibilities [ 8 , 9 ]. Males travel more frequently, leading to more social contacts; spend more time in settings conducive for TB transmission (e.g. bars) and engaged in occupations associated with a higher risk of infection, such as mining, labor work [ 8 , 9 ].

TB is high settings with common practice of gender and social inequities. Lower TB prevalence among females may suggest under reporting and underdiagnosis [ 10 , 11 ]. Women in Nepal experience a longer total delay before TB diagnosis (median 3.3 months) compared to men (2.3 months) [ 12 ]. Limited household decision‐making power to females, particularly regarding healthcare, may contribute to this delay. In 2016, over 40% of women could not make decisions about their own healthcare due to reasons such as treatment cost, distance to health facilities, and lack of permission to seek treatment [ 13 ]. Apart from gender disparities, patients from rural areas experience longer delays in seeking care compared to the urban population [ 14 ]. Social barriers to the healthcare access include fear of stigma and discrimination, linked to poverty, lower caste and TB [ 15 ]. Moreover, treatment outcomes of TB are also associated with sex, gender, age, education, race/ethnicity and residential area of TB patients [ 16 ]. Although TB drugs are provided free of cost, several disabling factors such as poor socioeconomic conditions, family liabilities, and the burden of losing income contribute to loss to follow up during TB treatment [ 17 ].

Taking TB as a case example, these literature findings provide evidence that various social stratifiers such as age, sex, education, occupation, gendered roles and responsibilities, largely influence the disease and treatment outcomes [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Additionally, traditionally inherited caste-based discrimination is one of the major barriers to accessing healthcare services in Nepal, often interacting synergistically with gender, education, occupation and socio-economic status of individuals [ 3 , 4 ]. Therefore, the application of an intersectional gender lens is critical to improving the health status of people, including those with TB. A toolkit for conducting intersectional gender analysis for infectious diseases of poverty has been established to comprehend concerns via an intersectional gender lens. This pilot study aimed to inform the toolkit "Incorporating Intersectional Gender Analysis into Research on Poverty-Related Infectious Diseases" [ 27 ]. The study objective was to explore inclusiveness of gender and social stratifiers in key health-related policy documents and Health Management Information System (HMIS) through a desk review. Using TB as a case example, this study also aimed to assess the feasibility of conducting disaggregated and intersectional analysis of TB patient data recorded via HMIS within the NTP in Nepal.

Study design

A retrospective study was conducted through desk review and secondary data analysis. A web-based search was performed on key health-related policy documents of relevant government ministries. The reviewed policy documents included the Constitution of Nepal (2015), Urban Health Policy (2015), National Population Policy (2014), National Health Policy (2019), National Strategy for Reaching the Unreached (2016), Gender Equality and Social Inclusion Strategy of the Health Sector (2018), and Health Sector Information System National Strategy (2006). The review was focused to explore inclusiveness of gender, equity and social stratifiers within the policies and strategies [ 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. Additionally, National strategy related to TB, namely National Strategic Plan for Tuberculosis Prevention, Care and Control 2016–2021 and the National Strategic Plan to End TB 2021/22–2025/26 was reviewed, considering TB as a case example in this study [ 6 , 25 ].

Moreover, HMIS was reviewed to explore the availability of various social stratifiers, with a specific focus on TB as a case example [ 26 ]. TB data reported over the last five years (2017–2021) were obtained from the website of National Tuberculosis Control Center (NTCC) for age-and -sex disaggregated trend analysis. Similarly, secondary analysis of recorded TB patients from two fiscal years (2017/18–2018/19) from two Directly Observed Therapy, Short-course (DOTS) centers was carried out to explore how sex, age and ethnicity interact with each other, shaping the treatment of TB patients enrolled in the NTP.

Study setting

Two selected DOTS centers were identified in the Metropolitan City of Kathmandu district in Bagmati province. This province had the highest number of notified TB patients in the year 2020/21 (6664) compared to other provinces in Nepal [ 7 ]. Among the districts within this province, Kathmandu alone accounted for around 44% (2982 TB cases), contributing approximately 10.39% to the national total (28,677) [ 7 ].

According to the 2021 National Housing and Population Census, Kathmandu district had a total population of 2,017,532, with the male population (1,025,727), slightly outnumbering the female population (991,805) [ 27 ]. This district experiences high migration from various parts of the country. There were 45 DOTS center in Kathmandu, located in various hospitals, referral centers and Urban Health Clinics (UHC) [ 28 , 29 ]. Based on the information obtained for the fiscal year 2017/18 and 2018/19, Swayambhu UHC was one of the UHCs with a high case load, handling approximately 200–250 TB cases per year. Similarly, a referral center named Nepal Anti-Tuberculosis Association (NATA), supported by the German Nepal Tuberculosis Project (GENETUP), was the largest TB referral center in Kathmandu, linked to various DOTS centres. This referral center documented approximately 400–450 cases in the last two fiscal years- 2017/18, 2018/2019. Therefore, considering feasibility with limited time and resources, we purposively selected Swayambhu UHC and NATA for this study based on their TB case load.

Data collection

All DOTS centers follow HMIS 6.5 as the TB treatment register. The same template was created in an excel sheet for data collection. Before data collection, coordination meetings with officials of the NTCC and the Epidemiology and Disease Control Division (EDCD) of the Department of Health Services, Ministry of Health and Population were conducted. During these meetings, stakeholders were oriented about the study objectives and methodology. Official letters of support were received from the respective government offices, facilitating communication with officials at DOTS centres. Similarly, clinic supervisors and DOTS focal persons from the study sites were oriented on the objectives and methodology of the study.

Supervisors, who were the data custodians at the DOTS centers, were requested to provide anonymised data during data collection. Each patient was assigned a unique identification number and no other patient identifiable information was obtained during the data collection. Data was collected and entered at the DOTS center in the presence of data custodian. Any missing information in the register was immediately discussed with the data custodian, who validated data with other records of the respective patient present in the DOTS center. Data collection took place over a period of one month in July 2020.

Data management and analysis

MS Excel was used for the data cleaning, while statistical software STATA version 14 (StataCorp LLC, College Station, Texas, USA), and the R Programme (Lucent Technologies, Jasmine Mountain, USA) were used to analyse data and create graphs, respectively. The study variables were patients’ age, sex, ethnicity, types of TB, patient registration category (new or old cases), and treatment outcome. Ethnicity of patient was categorised into two groups: ‘advantaged caste groups’ and ‘dis-advantaged caste groups’ [ 30 ]. Advantaged caste groups included the upper caste group (from both hilly and Terai region) and relatively advantaged Janajatis (Newar, Thakali, Gurung) [ 30 ]. Dis-advantaged caste group included Dalit (from both hilly and Terai region), dis-advantaged Janajati (hilly and Terai), religious minorities (Muslim) and dis-advantaged non-dalit Terai caste groups [ 30 ].

The final treatment outcome was dichotomised into ‘successful treatment outcome’ and ‘unfavorable treatment outcome’ variables [ 26 ]. Successful treatment outcome comprised patients classified as ‘cured’ and ‘completed treatment’ [ 26 , 31 ], while unfavorable treatment outcome included ‘died’, ‘treatment failure’, ‘lost to follow up’ and ‘not evaluated’ [ 26 , 27 ]. Participant age was categorised into groups according to weightage of the data i.e. ≤ 14, 15–24, 25–54 and ≥ 55 years, to facilitate comparison [ 29 ].

Data exploration involved descriptive and inferential statistics, following the process outlined in WHO toolkit ‘Incorporating intersectional gender analysis into research on infectious diseases of poverty: A toolkit for health researchers’ [ 15 ]. Sex-disaggregated data analysis was conducted in each step to identify difference between males and females across different ages and ethnic groups. Furthermore, we assessed whether any statistical difference existed between different age groups and ethnic groups within sex. Bivariate analysis employed Chi-square test to measure the association between available social stratifiers and types of TB and patient registration category. For variables with expected cell value less than five in bivariate analysis, the Fischer-exact test was applied. Multivariate logistic regression determined the most significant determinants associated with treatment outcome. Crude and adjusted odds ratios ( OR s) were calculated during the analysis, with a 95% confidence interval ( CI ) used to report the OR .

Where do we stand in terms of understanding inequalities in health system of Nepal? What is being done?

The Constitution of Nepal (2015) provides greater inclusion of female, marginalized and disadvantaged groups [ 18 , 33 ]. Subsequently, there has been notable progress in biological and the social construct of gender approaches in various policies and strategies. These initiatives mandate civil society and economic participation, as well as health service utilisation by women. Gender, social inclusion and the concept of intersectionality are well incorporated into existing National Health Policy, Nepal Health Sector Strategy, Gender Equality and Social Inclusion Strategy of the Health Sector, Urban Health Policy, Population Policy and National Strategy for Reaching the Unreached [ 19 , 20 , 21 , 23 , 24 ].

In an endeavor to reach the unreached, the Ministry of Health and Population (MoHP) established a 'Gender Equality and Social Inclusion' (GESI) section in 2013. This proactive step aimed to address disparities and promote inclusivity by mainstreaming GESI in the health sector [ 34 ]. However, despite numerous efforts, the implementation of GESI policies faces challenges due to limited operational structures and capacity at various levels within the health system. Consequently, inequities in health outcomes persist across various social stratifiers [ 3 , 35 ]. Challenges continue with the implementation of gender-sensitive and gender-responsive legislation, policies, and acts, including the intersectional recognition of factors affecting men or women based on ethnicity, caste, religion, language, indigeneity, marital status, occupation, geographical location, ability, and access to health and education [ 34 , 36 , 37 , 38 ]. These interaction occur within connected systems where social determinants and the structure of power in the society synergistically and antagonistically act, forming the privilege and oppression of individuals [ 39 ].

Furthermore, in 2014/15, the MoHP revised the HMIS to include variables such as sex, age, caste/ethnicity, and location/address. This revision enables the assessment of disaggregated health data, offering a more comprehensive understanding of 11 selected health indicators [ 34 , 40 ]. HMIS is primarily used in the public sector for recording and reporting routine health services data from public health facilities at all three levels of government (local, provincial, and federal). The private sector maintains its own information systems for recording purposes, which are not yet integrated with the government's HMIS. However, a few private health facilities report to HMIS for selected programme indicators only.

Health Management Information System (HMIS): TB as a case example

HMIS in Nepal comprises distinct registers for recording TB service data, namely HIMS 6.1 Tuberculosis Sample Collection Form, 6.2 Tuberculosis Laboratory Register, 6.3 Tuberculosis Treatment Card (Health Facility), 6.4 Tuberculosis Treatment Card (Patient), 6.5 Tuberculosis Treatment Register, 6.6 Smoking cessation Register, 6.7 drug resistant (DR) Tuberculosis Laboratory Register, and 6.8 DR Tuberculosis Treatment Register [ 26 ]. All these TB registers typically include fields for recording demographic information, including age, sex, ethnicity, address, name of the caregivers and contact number of the service recipients. The classification of sex is limited to male and female, with no provision for individuals with non-binary gender identities.

While social stratifiers such as age, sex and ethnicity are recorded at the health facility levels, there are limitations in reporting this data to higher authorities. The standard reporting format predominantly focus on sex and age-disaggregated data. Information disseminated at the national level by the government through annual reports based on HMIS findings includes disaggregation by sex, age, and province. This highlights the gap, indicating that the health information system has limitations in understanding service utilisation patterns by different population groups to make tailored decisions and interventions (Fig.  1 ).

Flowchart presenting loss of variables during recording and reporting mechanism of TB. DHIS2 District Health Information Software 2; DoHS Department of Health Services; HMIS Health management information system

Scope of conducting disaggregated and intersectional analysis from the available HMIS data: taking TB as an example

Secondary data analysis was performed to assess the current limitations in conducting intersectional gender analysis with the available TB data through the HMIS, rather than producing new findings to inform disease (TB) perspective. It is essential to note that the TB programme is taken only as an illustrative example. The insights gained from this analysis could contribute to inform HMIS recording and reporting practices for various diseases and health programmes, promoting a more inclusive system.

Trend of annually reported TB cases disaggregated by ecological region, age and sex

There were pronounced variations in TB cases across different regions of Nepal. The Terai region (the lowland plains) consistently reported the highest TB cases, followed by the Hill region (the hilly areas) and the Mountain region (the mountainous areas) for the last five years. The highest proportion of TB cases was found among the population aged 65 years and above, whereas lowest proportion was found among less than 14 years. In terms of sex-wise distribution, the proportion of TB cases is notably higher among males compared to females over the last five years. These findings provide important insights into the epidemiology of TB in Nepal, showcasing variations in regional prevalence, age-related patterns, and gender disparities (Fig.  2 ).

Tuberculosis cases by region, age, sex (Data Source-National Tuberculosis Control Center) [ 41 ]

Disaggregated analysis of the recorded TB cases

We collected information from 628 TB patients from two DOTS centers, among whom 510 (81.2%) were new TB patients, while 118 (18.8%) had received previous TB treatment. During the data collection period, 152 (24.2%) were under TB DOTS treatment and 476 (75.8%) had completed their treatment. Among the patients, 338 (54.0%) had pulmonary TB (PTB), and 290 (46.0%) had extra-pulmonary TB (EPTB). Of those who completed treatment, 399 (83.8%) were successfully treated, 71 (14.9%) had an unfavorable treatment outcome and 6 (1.3%) moved to second line treatment (data not shown).

The overall male-to-female TB patient ratio was 1.1 (333/295). The age distribution of male TB patients ranged widely from a minimum age of 9 months to a maximum age of 92 years. Similarly, the age diversity of female TB patients followed a similar pattern, ranging from a minimum age of one year to a maximum age of 93 years. However, median (md) and inter-quartile range (IQR) for the age of males (md = 34 years; IQR = 22–50) were higher than those of females (md = 27 years; IQR = 21–38). In both sexes, the highest percentage of TB patients belonged to the 25–54 years age group [male (46.6%) and female (45.4%)], while the ≤ 14 years age group had the lowest TB cases [male (5.7%) as well as female (4.4%)]. Similarly, more than half of the male (55.6%) and female (56.3%) TB patients belonged to advantaged caste group, while the remaining belonged to disadvantaged caste group (Table  1 ).

Comparison of types of TB according to age, sex and ethnicity

There was a significant association between sex of the patient and the types of TB ( P  < 0.05). Among the reported cases, the proportion of males with PTB was higher (61.3%) compared to females (45.4%), while the proportion of males with EPTB was lower (38.7%) than that of females (54.6%). Figure  3 shows the proportion of pulmonary TB patients and their 95% confidence interval among different age and ethnic groups disaggregated by sex. The red horizontal line in Fig.  3 represents the proportion of pulmonary TB among total cases, i.e., 54.0%. Within males, the proportion of PTB increased with age, with the highest proportion of TB patients observed in the ≥ 55 years age group. Males had a higher prevalence of PTB compared to females in both, advantaged and dis-advantaged caste group (Fig.  3 ).

Comparison of Pulmonary TB cases by age and ethnic groups disaggregated by sex

Patient’s registration category (old/new cases) across age, sex and ethnicity

Age and sex were significantly associated with patients’ types of TB cases during registration while enrolling into the TB regimen ( P  < 0.05). A significantly higher percentage of males (61.9%) sought retreatment compared to females (38.1%) ( P  < 0.05). Similarly, patients in the 25–54 years age group constituted a significantly higher proportion (44.1%) in the retreatment category. Although not statistically significant, a higher proportion (59.3%) of the disadvantaged caste group sought retreatment compared to the advantaged caste group (40.7%). While the difference is not statistically significant, it still underscores a noteworthy trend. (Table  2 ).

Treatment outcome across age, sex and ethnicity

Out of 628 TB patients, a treatment outcome was obtained for 470 patients and 6 patients were moved to the second line treatment, which was not considered in the two categories of treatment outcome (successful and unfavorable) [ 32 ]. Figure  4 demonstrates the successful treatment outcome and its 95% confidence interval among age groups and ethnic groups disaggregated by sex. The red horizontal line represents the proportion of treatment success of TB patients among total TB patients i.e., 84.8%. The rate of successful treatment gradually decreased with age among both male and female TB patients. Female TB patients had higher successful treatment outcome in comparison to male across both caste groups.

Comparison of treatment success rate of TB cases by age and ethnic groups disaggregated by sex

Multivariate logistic analysis was conducted to assess the relationship between combined variables i.e. ‘sex and age’ and ‘sex and ethnicity’ and treatment outcome, where age group was categorized into two groups (≤ 25 years and > 25 years) due to insufficient sample size within four category of age groups. The results reveal that male more than 25 years exhibited higher odds (a OR  = 4.95, 95% CI : 1.60–19.06, P  = 0.01) of successful outcome compared to male TB patients less than 25 years (Table  3 ).

Despite of numerous efforts to apply an intersectional gender lens in the policies, implementation has been mixed, leading to evident health inequities across various social stratifiers [ 3 , 35 ]. The literature suggests that variations exist in the availability and utilization of health services, as well as health status of individuals based on several factors, including gender, age groups (with a special focus on vulnerable age groups), geography, urban/rural locations, socio-economic status, caste, ethnicity and religions, the presence of disabilities (both physical and mental) and disaster affected areas [ 38 , 42 , 43 ]. Moreover, multiple layers of vulnerability are created when two or more of these determinants intersect, amplifying the risks faced by excluded or marganilised populations. This shows the critical need for and importance of conducting gender and intersectional analysis in policy making and health planning, ensuring that no one is left behind and to addressing the specific needs of diverse and vulnerable population groups.

Although the importance of disaggregated data is emphasised in policies, its actual use for planning and developing programmes and interventions is limited. Another challenge lies in the fact that HMIS often have limited variables to record and report health service delivery data, restricting gender and intersectional analysis. This study highlights practical constraints in using existing HMIS for inclusive gender and intersectional analysis. However, it is unclear whether, how and what extent these information management systems in public and private sector provide gender and equity-focused evidence and how they inform decisions. All these challenges impede progress towards strengthening a health system that is more responsive and leaves no-one behind in federalized context. Therefore, more social stratifiers should be added to the HMIS recording and reporting forms, followed by incorporating intersectional gender lens while analysing and reporting the HMIS data. Such context highlights the complexity of addressing gender and social inclusion issues within the health sector in Nepal. While efforts have been made to recognise and tackle these challenges, practical implementation remains a significant hurdle due to capacity gaps, resource constraints and the limitations for comprehensive data collection and analysis. Addressing these challenges is crucial for achieving more equitable health outcomes across diverse social groups.

Intersectional analysis of HMIS recorded data conducted in this study illustrated various differences across sex, age and ethnicity. The proportion of females with EPTB was higher than males, consistent with studies in the United Denmark [ 16 ], and India [ 17 ]. Several factors, such as endocrine factors, smoking, and past history of TB exposure were thought to be related to this inequality [ 36 , 38 ].

Sex was significantly associated with the treatment success rate where a greater proportion of females had favorable treatment compared to males. Analysis of gender differentials has indicated that women who begin treatment for TB are more likely to adhere to the full course of treatment compared to men, resulting in a positive treatment outcome [ 40 , 41 ]. Men, being sole breadwinners, are engaged in various informal sectors and have less chance to become aware of the disease; hence, the probability of treatment non-adherence is high [ 32 ]. This continues as a cycle of TB, where a high proportion of male TB patients came for re-treatment of TB compared to female, as evidenced in this study. Furthermore, this study identified that the treatment success rate gradually decreases with an increase in age among both sexes, aligning with other studies [ 45 , 46 ]. This could be because older TB patients interrupt adherence to treatment more often than younger persons and are challenged by several determinants of health, such as low socioeconomic status, low immunity and poor access to health facility [ 47 ]. Therefore, older persons with TB might benefit from close monitoring in order to make their treatment successful [ 48 ].

Our study did not identify significant differences in TB-related outcomes across ethnic groups. However, various studies conducted in other countries have shown that the migrant population and ethnic minorities have a higher prevalence of TB in comparison to the general population [ 49 , 50 , 51 , 52 , 53 ]. This could be because of interactions between cultural and structural barriers to accessing healthcare [ 3 , 4 , 50 , 51 , 52 , 53 ]. Behind this, social power and structures have influenced vulnerability and treatment outcome of TB among people living in slums and densely populated urban settings, people living in congregate settings like factories, prisons, camps and refugees [ 44 ]. With limitations on disaggregated population data in the routine healthcare information system and a lack of context-specific models for identification and determining numbers and distribution of high-risk groups, there is less effective coverage of priority health interventions among these groups[ 14 ]. This has resulted in difficulties in the timely diagnosis of TB and prompt initiation of treatment [ 14 ].

Apart from these, other studies shows that, even though anti-TB medicines are provided free of cost, various factors such as socio-economic conditions, fear of losing job, lack of education, ethnicity as a cross cutting factor, family responsibilities contribute to the loss to follow up during TB treatment [ 16 , 17 ]. Because of these reasons, sex, gender, age, education, occupation, race/ethnicity and residential area of TB patients also interplay with each other to influence the treatment outcome of TB [ 16 , 17 ]. Hence, if we could move towards specific approaches of recording, reporting, and analysing of TB cases according to social strata (age, sex, ethnicity, education, occupation, province, etc.) of TB patients, this would contribute to narrowing down the existing information gap and identifying the unreached population.

There are some limitations in our study. Secondary data was used for the study which limited the scope of variables of this study as social stratifiers recorded in the HMIS 6.5 register of the TB was just confined to age, sex and ethnicity of the patient. This narrowed down the opportunity to conduct intersectional gender analysis to the wider extent. Also, treatment outcome of all the TB patients from the collected data could not be analysed across social stratifiers because 152 patients were still under TB treatment regimen during the time of data collection, for which treatment outcome was awaited. This ultimately reduced our sample size while analyzing ‘treatment outcome’ for this study.

The intersectional analysis conducted with limited variables (age, sex and ethnicity) presented differences across treatment outcome and types of TB within different age group and ethnicity of male and female TB patients. Hence, this study reflected the potential of reaching the unreached or vulnerable group of population via intersectional gender analysis when range of social stratifiers are captured, analysed and evidence-based decision is taken. Similarly, the findings highlight the inadequacy in the availability of social stratifiers in routine HMIS TB data. This limitation hampers the NTP’s ability to conduct intersectional analysis, essential for unveiling the roles and impacts of various social determinants of TB. Such limitation underscores the necessity for more disaggregated and inclusive data in routine NTP HMIS, enhancing the ability to inform policies and plans for building a more responsive and equitable TB programme that can systematically address disparities in TB outcomes.

Availability of data and materials

The datasets generated during this study are not publicly available due data confidentiality policy but are available from the corresponding author on reasonable request.

Abbreviations

Adjusted odds ratio

Confidence interval

District Health Information Software 2

Department of Health Services

Drug resistant

Directly observed therapy, short-course

Epidemiology and Disease Control Division

Extra-pulmonary tuberculosis

Gender Equality and Social Inclusion

German Nepal Tuberculosis Project

• Health Management Information System

Inter-quartile range

Ministry of Health and Population

Nepal Anti-Tuberculosis Association

National Tuberculosis Control Center

• National Tuberculosis Programme

Pulmonary tuberculosis

• Tuberculosis

Urban Health Clinics

World Health Organization

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Acknowledgements

This study acknowledges support received from the study respondents, health institutions at federal, provincial, and local government of Nepal.

This research was funded by the UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland (Reference 2019/980668-1).

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Contributions

AP: design, tool development, data collection, analysis and write up. SK: quantitative data analysis and write up. AA: analysis, write up and review. DJ: analysis and review. CK: design, analysis, and review. MOB: design and review. SCB: design, supervision and quality assurance, analysis, write up, review and submission.

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Correspondence to Sushil C Baral .

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This study obtained ethical approval (Reg. No. 656/2019) from the Ethical Review Board of Nepal Health Research Council (NHRC) and the Research Ethics Review Committee of the World Health Organization. All the information collected during data collection was recorded in password-protected computer, with access granted only to the core research team. As per HERD International’s data management policy, in alignment with NHRC’s data management guideline, the data collected for this research will be disposed after 5 years. In this study, we didn’t collect the data/information from the participants. However, institutional consent was obtained from the supervisor of the DOTS center, who is also the data custodian, to collect retrospective data. During the data collection, the name and identity of the TB patients was anonymized, and the collected information was used solely for research purpose. Data was collected from the TB registers into an Excel template by our researchers under the direct observation of the data custodian of the respective DOTS center. To ensure anonymity, the data custodian completely covered the section of the register with the patients’ name and address with an opaque sheet of chart paper. As each patient’s entry was given unique identification number, we do not have any personal information of TB patient to identify them. This process of collecting anonymized data, with the help of the data custodian, ensured the maintenance of patient information anonymity and confidentiality.

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The authors declare that they have no competing interests.

The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated.

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Parajuli, A., Kakchapati, S., Arjyal, A. et al. Assessing intersectional gender analysis in Nepal’s health management information system: a case study on tuberculosis for inclusive health systems. Infect Dis Poverty 13 , 31 (2024). https://doi.org/10.1186/s40249-024-01194-4

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Received : 16 October 2023

Accepted : 06 March 2024

Published : 25 April 2024

DOI : https://doi.org/10.1186/s40249-024-01194-4

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• Intersectional gender analysis
• Gender and social inequities
• Social determinant
• Social inclusion