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medRxiv PreprintsInternational11 November 2026

Routine health information system data quality in a hill and mountain district of Nepal: a cross-sectional desk review of four years of DHIS2 data from Sankhuwasabha, 2021-2025

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Introduction. Nepal's routine health information system runs on DHIS2, but no published data-quality assessment covers its mountainous districts. The method raises a second issue: the WHO Data Quality Review (DQR) tests internal consistency partly through related-indicator pairs, assuming each indicator is recorded independently. DHIS2 validation rules act on paired values at entry, so a rule-governed pair may agree for reasons unrelated to recording quality. Methods. In this study, a WHO DQR Module 1 desk review was conducted on aggregated DHIS2 data from all 132 facilities in Sankhuwasabha d
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