Data collection was carried out by the author and 4 research assistants. A semi-structured questionnaire was used to interview health care providers and facility administrators to assess their level of knowledge, attitudes and practices concerning HMIS and factors for change (Additional file
1). After the interview the research team requested to see the 2007 HMIS booklets (number 6, 7 & 12) in order to review the completeness of records. The parameters recorded in booklet 6 (antenatal services register) included: 1) booking visit: date, registration number, name, age, gravidity, gestation age, height, danger signs; 2) re-attendance visits: presence of anaemia, oedema, proteinuria, lie of the foetus, vaginal bleeding, syphilis test, date of TT vaccine for the index pregnancy, last childbirth (year, live or died) and referral information. The parameters for book 7 (underfive services register) were: date, registration number, date of birth, weight, date for BCG, DPT, polio, measles vaccinations and vitamin A, mother's information (name and TT vaccination status); and those for book 12 (delivery services register) were: date, registration number, name of the mother, age, gravidity, parity, date of admission, date of delivery, mode of delivery, birth before arrival (BBA), complication of labour, status at birth (live birth or stillbirth), condition of the mother at discharge and name of the health provider. The parameters which were mostly not recorded were documented. In the cases of frequent incomplete records, the research team inquired about reasons for the incompleteness. The research team also interviewed the district HMIS coordinator for the factors that affected health information system. The data were entered in the Statistical Package for Social Science (SPSS) version 10 and analyzed by generating frequencies. Exact binomial confidence intervals at 95% were used to compare the proportions of clinicians and nurses with regards to the training, knowledge, attitude and utilization of HMIS data in their health facilities. The permission to carry out this study was obtained from district medical authority and verbal consent was obtained from the interviewees.