malawi_hiv_program_reports 1.0.1 → 1.0.2

data/app/services/malawi_hiv_program_reports/moh/cohort_disaggregated.rb

@@ -0,0 +1,608 @@
+# frozen_string_literal: true
+
+module MalawiHivProgramReports
+  module Moh
+    # This class is used to add additional cohort disaggregated data
+    # rubocop:disable Metrics/ClassLength
+    class CohortDisaggregated
+      include MalawiHivProgramReports::Utils::ModelUtils
+      include MalawiHivProgramReports::Adapters::Moh::Custom
+
+      def initialize(name:, type:, start_date:, end_date:, rebuild:, **kwargs)
+        @name = name
+        @type = type
+        @start_date = start_date
+        @end_date = end_date
+        @rebuild = rebuild
+        @occupation = kwargs[:occupation]
+        @location = kwargs[:location]
+        @adapter = ActiveRecord::Base.connection.adapter_name.downcase
+      end
+
+      def find_report
+        build_report
+      end
+
+      def build_report
+        builder = CohortDisaggregatedBuilder.new(outcomes_definition: 'moh', location: @location,
+                                                 occupation: @occupation)
+        builder.build(nil, @start_date, @end_date)
+      end
+
+      def initialize_disaggregated
+        ActiveRecord::Base.connection.execute('DROP TABLE IF EXISTS temp_disaggregated')
+
+        ActiveRecord::Base.connection.execute(
+          'CREATE TABLE IF NOT EXISTS temp_disaggregated (
+             patient_id INTEGER NOT NULL,
+             age_group VARCHAR(20),
+             initial_maternal_status VARCHAR(10),
+             maternal_status VARCHAR(10),
+             given_ipt INT(1),
+             screened_for_tb INT(1),
+             site_id INT NOT NULL DEFAULT 1,
+             PRIMARY KEY(patient_id, site_id)
+          );'
+        )
+
+        { temp_disaggregated: 'created' }
+      end
+
+      def disaggregated(quarter, age_group)
+        if quarter == 'pepfar'
+          start_date = @start_date
+          end_date = @end_date
+
+          begin
+            records = ActiveRecord::Base.connection.select_one("SELECT count(*) rec_count FROM temp_patient_outcomes #{site_manager(
+              operator: 'AND', column: 'site_id', location: @location
+            )}")
+            @rebuild = true if records['rec_count'].to_i < 1
+          rescue StandardError => e
+            Rails.logger.error "Error: #{e.message}"
+            initialize_disaggregated
+            rebuild_outcomes 'pepfar'
+          end
+
+          if @rebuild
+            initialize_disaggregated
+            rebuild_outcomes 'pepfar'
+          end
+
+        else
+          start_date, end_date = generate_start_date_and_end_date(quarter)
+
+          if @rebuild
+            initialize_disaggregated
+            art_service = CohortBuilder.new
+            art_service.init_temporary_tables(@start_date, @end_date, @occupation)
+            art_service.update_tb_status(end_date)
+          end
+        end
+
+        tmp = get_age_groups(age_group, start_date, end_date)
+
+        # A hack to get female that were pregnant / breastfeeding at the beginning of the reporting period + those are currently the same state
+        if age_group == 'Pregnant'
+          tmp_arr = []
+          (tmp || []).each do |data|
+            begin
+              date_enrolled = data['date_enrolled'].to_date
+            rescue StandardError => e
+              Rails.logger.error "Error: #{e.message}"
+              raise data.inspect
+            end
+            earliest_start_date = begin
+              data['earliest_start_date']
+            rescue StandardError
+              date_enrolled
+            end
+
+            imstaus = data['initial_maternal_status']
+            mstatus = data['mstatus']
+
+            if (date_enrolled >= start_date && date_enrolled <= end_date) && imstaus == 'FP' && (date_enrolled == earliest_start_date)
+              tmp_arr << data
+            elsif mstatus == 'FP'
+              tmp_arr << data
+            end
+          end
+
+          tmp = tmp_arr
+        end
+
+        if age_group == 'Breastfeeding'
+          tmp_arr = []
+          (tmp || []).each do |data|
+            begin
+              date_enrolled = data['date_enrolled'].to_date
+            rescue StandardError
+              raise data.inspect
+            end
+            earliest_start_date = begin
+              data['earliest_start_date']
+            rescue StandardError
+              date_enrolled
+            end
+
+            imstaus = data['initial_maternal_status']
+            mstatus = data['mstatus']
+
+            if (date_enrolled >= start_date && date_enrolled <= end_date) && imstaus == 'FBf' && (date_enrolled == earliest_start_date)
+              tmp_arr << data
+            elsif mstatus == 'FBf'
+              tmp_arr << data
+            end
+          end
+
+          tmp = tmp_arr
+        end
+        # ........................... Hack ends .......... Will clean up later
+
+        on_art = []
+        all_clients = []
+        all_clients_outcomes = {}
+
+        (tmp || []).each do |pat|
+          patient_id = pat['patient_id'].to_i
+          outcome = pat['outcome']
+
+          on_art << patient_id if outcome == 'On antiretrovirals'
+          all_clients << patient_id
+          all_clients_outcomes[patient_id] = outcome
+        end
+
+        list = {}
+
+        if all_clients.blank? && %w[Breastfeeding Pregnant].include?(age_group)
+          list[age_group] = {}
+          list[age_group]['F'] = {
+            tx_new: [], tx_curr: [],
+            tx_screened_for_tb: [],
+            tx_given_ipt: []
+          }
+          return list
+        elsif all_clients.blank?
+          return {}
+        end
+
+        big_insert tmp, age_group if /year|month/i.match?(age_group)
+
+        (tmp || []).each do |r|
+          gender = r['gender']&.first || 'Unknown'
+          patient_id = r['patient_id'].to_i
+          tx_new, tx_curr, tx_given_ipt, tx_screened_for_tb = get_numbers(r, age_group, start_date, end_date,
+                                                                          all_clients_outcomes)
+
+          list[age_group] = {} if list[age_group].blank?
+
+          if list[age_group][gender].blank?
+            list[age_group][gender] = {
+              tx_new: [], tx_curr: [],
+              tx_screened_for_tb: [],
+              tx_given_ipt: []
+            }
+          end
+
+          list[age_group][gender][:tx_new] << r['patient_id'] if tx_new
+          list[age_group][gender][:tx_curr] << r['patient_id'] if tx_curr
+          list[age_group][gender][:tx_given_ipt] << r['patient_id'] if tx_given_ipt
+          list[age_group][gender][:tx_screened_for_tb] << r['patient_id'] if tx_screened_for_tb
+
+          date_enrolled = r['date_enrolled'].to_date
+
+          if gender == 'F' && all_clients_outcomes[patient_id] == 'On antiretrovirals'
+            insert_female_maternal_status(patient_id, age_group, end_date)
+          elsif gender == 'F' && (date_enrolled >= start_date && date_enrolled <= end_date)
+            insert_female_maternal_status(patient_id, age_group, end_date)
+          end
+        end
+
+        list
+      end
+
+      def generate_start_date_and_end_date(quarter)
+        return [@start_date, @end_date] if quarter == 'Custom'
+
+        quarter, quarter_year = quarter.humanize.split
+
+        quarter_start_dates = [
+          "#{quarter_year}-01-01".to_date,
+          "#{quarter_year}-04-01".to_date,
+          "#{quarter_year}-07-01".to_date,
+          "#{quarter_year}-10-01".to_date
+        ]
+
+        quarter_end_dates = [
+          "#{quarter_year}-03-31".to_date,
+          "#{quarter_year}-06-30".to_date,
+          "#{quarter_year}-09-30".to_date,
+          "#{quarter_year}-12-31".to_date
+        ]
+
+        current_quarter   = (quarter.match(/\d+/).to_s.to_i - 1)
+        quarter_beginning = quarter_start_dates[current_quarter]
+        quarter_ending    = quarter_end_dates[current_quarter]
+
+        [quarter_beginning, quarter_ending]
+      end
+
+      def screened_for_tb(my_patient_id, age_group, start_date, end_date)
+        data = ActiveRecord::Base.connection.select_one <<~SQL
+          SELECT patient_screened_for_tb(#{my_patient_id},
+            '#{start_date.to_date}', '#{end_date.to_date}', #{@location}) AS screened;
+        SQL
+
+        screened = data['screened'].to_i
+
+        ActiveRecord::Base.connection.execute <<~SQL
+          UPDATE temp_disaggregated SET screened_for_tb =  #{screened},
+          age_group = '#{age_group}'
+          WHERE patient_id = #{my_patient_id} AND site_id = #{@location};
+        SQL
+
+        screened
+      end
+
+      def given_ipt(my_patient_id, age_group, start_date, end_date)
+        data = ActiveRecord::Base.connection.select_one <<~SQL
+          SELECT patient_given_ipt(#{my_patient_id},
+            '#{start_date.to_date}', '#{end_date.to_date}', #{@location}) AS given;
+        SQL
+
+        given = data['given'].to_i
+
+        ActiveRecord::Base.connection.execute <<~SQL
+          UPDATE temp_disaggregated SET given_ipt =  #{given} ,
+          age_group = '#{age_group}'
+          WHERE patient_id = #{my_patient_id} AND site_id = #{@location};
+        SQL
+
+        given
+      end
+
+      def get_numbers(data, age_group, start_date, end_date, outcomes)
+        patient_id = data['patient_id'].to_i
+        tx_new = false
+        tx_curr = false
+        tx_screened_for_tb = false
+        tx_given_ipt = false
+        outcome = outcomes[patient_id]
+
+        begin
+          date_enrolled = data['date_enrolled'].to_date
+        rescue StandardError
+          raise data.inspect
+        end
+        earliest_start_date = begin
+          data['earliest_start_date'].to_date
+        rescue StandardError
+          nil
+        end
+
+        if date_enrolled >= start_date && date_enrolled <= end_date
+          tx_new = true if !earliest_start_date.blank? && (date_enrolled == earliest_start_date)
+
+          tx_curr = true if outcome == 'On antiretrovirals'
+        elsif outcome == 'On antiretrovirals'
+          tx_curr = true
+        end
+
+        if age_group == 'Pregnant'
+          tx_new = false if data['initial_maternal_status'] != 'FP' && tx_new
+
+          tx_curr = false if data['mstatus'] != 'FP'
+        end
+
+        if age_group == 'Breastfeeding'
+          tx_new = false if data['initial_maternal_status'] != 'FBf' && tx_new
+
+          tx_curr = false if data['mstatus'] != 'FBf'
+        end
+
+        [tx_new, tx_curr, tx_given_ipt, tx_screened_for_tb]
+      end
+
+      def get_age_groups(age_group, _start_date, _end_date)
+        if age_group != 'Pregnant' && age_group != 'FNP' && age_group != 'Not pregnant' && age_group != 'Breastfeeding'
+
+          age_group_patients = ActiveRecord::Base.connection.select_all <<~SQL
+            SELECT
+              patient_id, `disaggregated_age_group`(date(birthdate), date('#{@end_date}')) AS age_group
+            FROM temp_earliest_start_date e #{site_manager(operator: 'WHERE', column: 'e.site_id', location: @location)}
+            GROUP BY e.patient_id
+            HAVING #{@adapter == 'mysql2' ? 'age_group' : "`disaggregated_age_group`(date(birthdate), date('#{@end_date}'))"} = '#{age_group}';
+          SQL
+          age_group_patient_ids = [0]
+          (age_group_patients || []).each do |patient|
+            age_group_patient_ids << patient['patient_id'].to_i
+          end
+
+          results = ActiveRecord::Base.connection.select_all <<~SQL
+            SELECT o.cum_outcome AS outcome, e.*
+            FROM temp_earliest_start_date e
+            LEFT JOIN temp_patient_outcomes o ON o.patient_id = e.patient_id #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+            WHERE date_enrolled <= '#{@end_date}' #{site_manager(operator: 'AND', column: 'e.site_id', location: @location)}
+            AND e.patient_id IN(#{age_group_patient_ids.join(',')})
+            GROUP BY #{@adapter == 'mysql2' ? 'e.patient_id' : 'o.cum_outcome, e.*'};
+          SQL
+        elsif age_group == 'Pregnant'
+          create_mysql_female_maternal_status
+          results = ActiveRecord::Base.connection.select_all <<~SQL
+            SELECT
+              e.*, maternal_status AS mstatus,
+              t2.initial_maternal_status,
+              t3.cum_outcome AS outcome
+            FROM temp_earliest_start_date e
+            INNER JOIN temp_disaggregated t2 ON t2.patient_id = e.patient_id #{site_manager(operator: 'AND', column: 't2.site_id', location: @location)}
+            INNER JOIN temp_patient_outcomes t3 ON t3.patient_id = e.patient_id #{site_manager(operator: 'AND', column: 't3.site_id', location: @location)}
+            WHERE maternal_status = 'FP' OR initial_maternal_status = 'FP' #{site_manager(operator: 'AND', column: 'e.site_id', location: @location)}
+            GROUP BY #{@adapter == 'mysql2' ? 'e.patient_id' : 't3.cum_outcome, maternal_status, t2.initial_maternal_status, e.*'};
+          SQL
+
+        elsif age_group == 'Breastfeeding'
+          create_mysql_female_maternal_status
+          results = ActiveRecord::Base.connection.select_all <<~SQL
+            SELECT
+              e.*, maternal_status AS mstatus,
+              initial_maternal_status,
+              t3.cum_outcome AS outcome
+            FROM temp_earliest_start_date e
+            INNER JOIN temp_disaggregated t2 ON t2.patient_id = e.patient_id #{site_manager(operator: 'AND', column: 't2.site_id', location: @location)}
+            INNER JOIN temp_patient_outcomes t3 ON t3.patient_id = e.patient_id #{site_manager(operator: 'AND', column: 't3.site_id', location: @location)}
+            WHERE maternal_status = 'FBf' OR initial_maternal_status = 'FBf' #{site_manager(operator: 'AND', column: 'e.site_id', location: @location)}
+            GROUP BY #{@adapter == 'mysql2' ? 'e.patient_id' : 't3.cum_outcome, maternal_status, initial_maternal_status, e.*'};
+          SQL
+
+        elsif age_group == 'FNP'
+          create_mysql_female_maternal_status
+          results = ActiveRecord::Base.connection.select_all <<~SQL
+            SELECT
+              e.*, maternal_status AS mstatus,
+              initial_maternal_status,
+              t3.cum_outcome AS outcome
+            FROM temp_earliest_start_date e
+            INNER JOIN temp_disaggregated t2 ON t2.patient_id = e.patient_id #{site_manager(operator: 'AND', column: 't2.site_id', location: @location)}
+            INNER JOIN temp_patient_outcomes t3 ON t3.patient_id = e.patient_id #{site_manager(operator: 'AND', column: 't3.site_id', location: @location)}
+            WHERE maternal_status = 'FNP' #{site_manager(operator: 'AND', column: 'e.site_id', location: @location)}
+            GROUP BY #{@adapter == 'mysql2' ? 'e.patient_id' : 't3.cum_outcome, maternal_status, initial_maternal_status, e.*'};
+          SQL
+
+        end
+
+        results
+      end
+
+      def create_mysql_female_maternal_status
+        ActiveRecord::Base.connection.execute <<~SQL
+          DROP FUNCTION IF EXISTS female_maternal_status;
+        SQL
+
+        ActiveRecord::Base.connection.execute <<~SQL
+          CREATE FUNCTION female_maternal_status(my_patient_id int, end_datetime datetime, my_site_id int) RETURNS VARCHAR(20)
+          DETERMINISTIC
+          BEGIN
+
+          DECLARE breastfeeding_date DATETIME;
+          DECLARE pregnant_date DATETIME;
+          DECLARE maternal_status VARCHAR(20);
+          DECLARE obs_value_coded INT(11);
+
+
+          SET @reason_for_starting = (SELECT concept_id FROM concept_name WHERE LOWER(name) = LOWER('Reason for ART eligibility') LIMIT 1);
+
+          SET @pregnant_concepts := (SELECT GROUP_CONCAT(concept_id) FROM concept_name WHERE LOWER(name) IN (LOWER('Is patient pregnant?'), LOWER('Patient pregnant')));
+          SET @breastfeeding_concept := (SELECT GROUP_CONCAT(concept_id) FROM concept_name WHERE LOWER(name) = 'Breastfeeding');
+
+          SET pregnant_date = (SELECT MAX(obs_datetime) FROM obs WHERE concept_id IN (@pregnant_concepts) AND voided = 0 AND person_id = my_patient_id AND obs_datetime <= end_datetime AND site_id = my_site_id);
+          SET breastfeeding_date = (SELECT MAX(obs_datetime) FROM obs WHERE concept_id IN (@breastfeeding_concept) AND voided = 0 AND person_id = my_patient_id AND obs_datetime <= end_datetime AND site_id = my_site_id);
+
+          IF pregnant_date IS NULL THEN
+            SET pregnant_date = (SELECT MAX(obs_datetime) FROM obs WHERE concept_id = @reason_for_starting AND voided = 0 AND person_id = my_patient_id AND obs_datetime <= end_datetime AND value_coded IN(1755) AND site_id = my_site_id);
+          END IF;
+
+          IF breastfeeding_date IS NULL THEN
+            SET breastfeeding_date = (SELECT MAX(obs_datetime) FROM obs WHERE concept_id = @reason_for_starting AND voided = 0 AND person_id = my_patient_id AND obs_datetime <= end_datetime AND value_coded IN(834,5632) AND site_id = my_site_id);
+          END IF;
+
+          IF pregnant_date IS NULL AND breastfeeding_date IS NULL THEN SET maternal_status = "FNP";
+          ELSEIF pregnant_date IS NOT NULL AND breastfeeding_date IS NOT NULL THEN SET maternal_status = "Unknown";
+          ELSEIF pregnant_date IS NULL AND breastfeeding_date IS NOT NULL THEN SET maternal_status = "Check BF";
+          ELSEIF pregnant_date IS NOT NULL AND breastfeeding_date IS NULL THEN SET maternal_status = "Check FP";
+          END IF;
+
+          IF maternal_status = 'Unknown' THEN
+
+            IF breastfeeding_date <= pregnant_date THEN
+              SET obs_value_coded = (SELECT value_coded FROM obs WHERE concept_id IN(@pregnant_concepts) AND voided = 0 AND person_id = my_patient_id AND obs_datetime = pregnant_date AND site_id = my_site_id LIMIT 1);
+              IF obs_value_coded = 1065 THEN SET maternal_status = 'FP';
+              ELSEIF obs_value_coded = 1066 THEN SET maternal_status = 'FNP';
+              END IF;
+            END IF;
+
+            IF breastfeeding_date > pregnant_date THEN
+              SET obs_value_coded = (SELECT value_coded FROM obs WHERE concept_id IN(@breastfeeding_concept) AND voided = 0 AND person_id = my_patient_id AND obs_datetime = breastfeeding_date AND site_id = my_site_id LIMIT 1);
+              IF obs_value_coded = 1065 THEN SET maternal_status = 'FBf';
+              ELSEIF obs_value_coded = 1066 THEN SET maternal_status = 'FNP';
+              END IF;
+            END IF;
+
+            IF DATE(breastfeeding_date) = DATE(pregnant_date) AND maternal_status = 'FNP' THEN
+              SET obs_value_coded = (SELECT value_coded FROM obs WHERE concept_id IN(@breastfeeding_concept) AND voided = 0 AND person_id = my_patient_id AND obs_datetime = breastfeeding_date AND site_id = my_site_id LIMIT 1);
+              IF obs_value_coded = 1065 THEN SET maternal_status = 'FBf';
+              ELSEIF obs_value_coded = 1066 THEN SET maternal_status = 'FNP';
+              END IF;
+            END IF;
+          END IF;
+
+          IF maternal_status = 'Check FP' THEN
+
+            SET obs_value_coded = (SELECT value_coded FROM obs WHERE concept_id IN(@pregnant_concepts) AND voided = 0 AND person_id = my_patient_id AND obs_datetime = pregnant_date AND site_id = my_site_id LIMIT 1);
+            IF obs_value_coded = 1065 THEN SET maternal_status = 'FP';
+            ELSEIF obs_value_coded = 1066 THEN SET maternal_status = 'FNP';
+            END IF;
+
+            IF obs_value_coded IS NULL THEN
+              SET obs_value_coded = (SELECT GROUP_CONCAT(value_coded) FROM obs WHERE concept_id IN(7563) AND voided = 0 AND person_id = my_patient_id AND obs_datetime = pregnant_date AND site_id = my_site_id);
+              IF obs_value_coded IN(1755) THEN SET maternal_status = 'FP';
+              END IF;
+            END IF;
+
+            IF maternal_status = 'Check FP' THEN SET maternal_status = 'FNP';
+            END IF;
+          END IF;
+
+          IF maternal_status = 'Check BF' THEN
+
+            SET obs_value_coded = (SELECT value_coded FROM obs WHERE concept_id IN(@breastfeeding_concept) AND voided = 0 AND person_id = my_patient_id AND obs_datetime = breastfeeding_date AND site_id = my_site_id LIMIT 1);
+            IF obs_value_coded = 1065 THEN SET maternal_status = 'FBf';
+            ELSEIF obs_value_coded = 1066 THEN SET maternal_status = 'FNP';
+            END IF;
+
+            IF obs_value_coded IS NULL THEN
+              SET obs_value_coded = (SELECT GROUP_CONCAT(value_coded) FROM obs WHERE concept_id IN(7563) AND voided = 0 AND person_id = my_patient_id AND obs_datetime = breastfeeding_date AND site_id = my_site_id);
+              IF obs_value_coded IN(834,5632) THEN SET maternal_status = 'FBf';
+              END IF;
+            END IF;
+
+            IF maternal_status = 'Check BF' THEN SET maternal_status = 'FNP';
+            END IF;
+          END IF;
+
+
+
+          RETURN maternal_status;
+          END;
+        SQL
+      end
+
+      def rebuild_outcomes(report_type)
+        MalawiHivProgramReports::Moh::CohortBuilder.new(outcomes_definition: report_type, location: @location).init_temporary_tables(@start_date,
+                                                                                                                                     @end_date, @occupation)
+      end
+
+      def insert_female_maternal_status(patient_id, age_group, end_date)
+        encounter_types = []
+        encounter_types << encounter_type('HIV CLINIC CONSULTATION').encounter_type_id
+        encounter_types << encounter_type('HIV STAGING').encounter_type_id
+
+        pregnant_concepts = []
+        pregnant_concepts << concept_name('Is patient pregnant?').concept_id
+        pregnant_concepts << concept_name('patient pregnant').concept_id
+
+        results = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT person_id, obs.value_coded value_coded
+          FROM obs obs
+          INNER JOIN encounter enc ON enc.encounter_id = obs.encounter_id AND enc.encounter_type IN(#{encounter_types.join(',')}) AND enc.voided = 0 AND enc.program_id = 1 #{site_manager(operator: 'AND', column: 'enc.site_id', location: @location)}
+          WHERE obs.person_id = #{patient_id}
+          AND obs.obs_datetime <= '#{end_date.to_date.strftime('%Y-%m-%d 23:59:59')}'
+          AND obs.concept_id IN(#{pregnant_concepts.join(',')})
+          AND obs.voided = 0 #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+          AND DATE(obs.obs_datetime) = (SELECT MAX(DATE(o.obs_datetime)) FROM obs o
+                        INNER JOIN encounter e ON e.encounter_id = o.encounter_id
+                        AND e.program_id = 1 AND e.voided = 0 #{site_manager(operator: 'AND', column: 'e.site_id', location: @location)}
+                        WHERE o.concept_id IN(#{pregnant_concepts.join(',')})
+                        AND o.voided = 0 AND o.person_id = obs.person_id #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+                        AND o.obs_datetime <= '#{end_date.to_date.strftime('%Y-%m-%d 23:59:59')}')
+          GROUP BY #{@adapter == 'mysql2' ? 'obs.person_id' : 'obs.person_id, obs.value_coded'}
+          HAVING #{@adapter == 'mysql2' ? 'value_coded' : 'obs.value_coded'} = 1065
+          ORDER BY MAX(obs.obs_datetime) DESC
+        SQL
+
+        female_maternal_status = results.blank? ? 'FNP' : 'FP'
+
+        if female_maternal_status == 'FNP'
+
+          breastfeeding_concepts = []
+          breastfeeding_concepts <<  concept_name('Breast feeding?').concept_id
+          breastfeeding_concepts <<  concept_name('Breast feeding').concept_id
+          breastfeeding_concepts <<  concept_name('Breastfeeding').concept_id
+
+          results2 = ActiveRecord::Base.connection.select_all <<~SQL
+            SELECT person_id, obs.value_coded value_coded
+            FROM obs obs
+            INNER JOIN encounter enc ON enc.encounter_id = obs.encounter_id AND enc.encounter_type IN(#{encounter_types.join(',')}) AND enc.voided = 0 AND enc.program_id = 1 #{site_manager(operator: 'AND', column: 'enc.site_id', location: @location)}
+            WHERE obs.person_id =#{patient_id}
+            AND obs.obs_datetime <= '#{end_date.to_date.strftime('%Y-%m-%d 23:59:59')}'
+            AND obs.concept_id IN(#{breastfeeding_concepts.join(',')})
+            AND obs.voided = 0 #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+            AND DATE(obs.obs_datetime) = (SELECT MAX(DATE(o.obs_datetime)) FROM obs o
+                          INNER JOIN encounter e ON e.encounter_id = o.encounter_id
+                          AND e.program_id = 1 AND e.voided = 0 #{site_manager(operator: 'AND', column: 'e.site_id', location: @location)}
+                          WHERE o.concept_id IN(#{breastfeeding_concepts.join(',')}) AND o.voided = 0
+                          AND o.person_id = obs.person_id #{site_manager(operator: 'AND', column: 'o.site_id', location: @location)}
+                          AND o.obs_datetime <='#{end_date.to_date.strftime('%Y-%m-%d 23:59:59')}')
+            GROUP BY #{@adapter == 'mysql2' ? 'obs.person_id' : 'obs.person_id, obs.value_coded'}
+            HAVING #{@adapter == 'mysql2' ? 'value_coded' : 'obs.value_coded'} = 1065
+            ORDER BY MAX(obs.obs_datetime) DESC
+          SQL
+
+          female_maternal_status = results2.blank? ? 'FNP' : 'FBf'
+        end
+
+        results = ActiveRecord::Base.connection.select_all <<~SQL
+          SELECT person_id, obs.value_coded value_coded
+          FROM obs obs
+          INNER JOIN encounter enc ON enc.encounter_id = obs.encounter_id AND enc.encounter_type IN(#{encounter_types.join(',')}) AND enc.voided = 0 AND enc.program_id = 1 #{site_manager(operator: 'AND', column: 'enc.site_id', location: @location)}
+          WHERE obs.person_id = #{patient_id}
+          AND obs.obs_datetime <= '#{end_date.to_date.strftime('%Y-%m-%d 23:59:59')}'
+          AND obs.concept_id IN(#{pregnant_concepts.join(',')})
+          AND obs.voided = 0 #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+          AND DATE(obs.obs_datetime) = (SELECT DATE(es.earliest_start_date) FROM temp_earliest_start_date es
+                                        WHERE es.patient_id = obs.person_id #{site_manager(operator: 'AND', column: 'es.site_id', location: @location)})
+          GROUP BY #{@adapter == 'mysql2' ? 'obs.person_id' : 'obs.person_id, obs.value_coded'}
+          HAVING #{@adapter == 'mysql2' ? 'value_coded' : 'obs.value_coded'} = 1065
+          ORDER BY MAX(obs.obs_datetime) DESC
+        SQL
+
+        initial_female_maternal_status = results.blank? ? 'FNP' : 'FP'
+
+        if initial_female_maternal_status == 'FNP'
+
+          breastfeeding_concepts = []
+          breastfeeding_concepts <<  concept_name('Breast feeding?').concept_id
+          breastfeeding_concepts <<  concept_name('Breast feeding').concept_id
+          breastfeeding_concepts <<  concept_name('Breastfeeding').concept_id
+
+          results2 = ActiveRecord::Base.connection.select_all <<~SQL
+            SELECT person_id, obs.value_coded value_coded
+            FROM obs obs
+            INNER JOIN encounter enc ON enc.encounter_id = obs.encounter_id AND enc.encounter_type IN(#{encounter_types.join(',')}) AND enc.voided = 0 AND enc.program_id = 1 #{site_manager(operator: 'AND', column: 'enc.site_id', location: @location)}
+            WHERE obs.person_id =#{patient_id}
+            AND obs.obs_datetime <= '#{end_date.to_date.strftime('%Y-%m-%d 23:59:59')}'
+            AND obs.concept_id IN(#{breastfeeding_concepts.join(',')})
+            AND obs.voided = 0 #{site_manager(operator: 'AND', column: 'obs.site_id', location: @location)}
+            AND DATE(obs.obs_datetime) = (SELECT DATE(es.earliest_start_date) FROM temp_earliest_start_date es
+                                          WHERE es.patient_id = obs.person_id #{site_manager(operator: 'AND', column: 'es.site_id', location: @location)})
+            GROUP BY #{@adapter == 'mysql2' ? 'obs.person_id' : 'obs.person_id, obs.value_coded'}
+            HAVING #{@adapter == 'mysql2' ? 'value_coded' : 'obs.value_coded'} = 1065
+            ORDER BY MAX(obs.obs_datetime) DESC
+          SQL
+
+          initial_female_maternal_status = results2.blank? ? 'FNP' : 'FBf'
+        end
+
+        ActiveRecord::Base.connection.execute <<~SQL
+          UPDATE temp_disaggregated SET maternal_status =  '#{female_maternal_status}',
+            initial_maternal_status = '#{initial_female_maternal_status}',
+             age_group = '#{age_group}' WHERE patient_id = #{patient_id} AND site_id = #{@location};
+        SQL
+      end
+
+      def big_insert(data, age_group)
+        insert_array = []
+        (data || []).each do |r|
+          insert_array << "(#{r['patient_id']}, '#{age_group}', #{r['site_id']})"
+        end
+
+        return if insert_array.blank?
+
+        ActiveRecord::Base.connection.execute <<~SQL
+          INSERT INTO temp_disaggregated (patient_id, age_group, site_id)
+          VALUES #{insert_array.join(',')};
+        SQL
+      end
+    end
+    # rubocop:enable Metrics/ClassLength
+  end
+end