multinational injury surveillance pilot project in africa mispp

Multinational Injury Surveillance Multinational Injury Surveillance Pilot Project in AfricaPilot Project in Africa

MISPPMISPP

Diego E Zavala, M.Sc., Ph.D.Diego E Zavala, M.Sc., Ph.D.Associate ProfessorAssociate Professor

Public Health ProgramPublic Health ProgramPonce School of MedicinePonce School of Medicine

Ponce, Puerto RicoPonce, Puerto Rico

Multinational Injury Surveillance ProjectMultinational Injury Surveillance Project

Project team:Project team:

P.I.: Diego E Zavala, MSc, PhD, Ponce Medical School, P.I.: Diego E Zavala, MSc, PhD, Ponce Medical School, Puerto RicoPuerto Rico

Co- PI (all IPPNW members):Co- PI (all IPPNW members): DRC: Simon Bokongo, MDDRC: Simon Bokongo, MD Kenya: Walter Odhiambo, MDKenya: Walter Odhiambo, MD Nigeria: Ime John, MD, Nigeria: Ime John, MD,

Aminu Zakari Mohammed , MDAminu Zakari Mohammed , MD Uganda: Peter Olupot Olupot, MPH, MDUganda: Peter Olupot Olupot, MPH, MD

Mpanga Senoga Ismail, MDMpanga Senoga Ismail, MD Zambia: Robert Mtonga, MDZambia: Robert Mtonga, MD

Project Administrator: Maria Valenti (IPPNW)Project Administrator: Maria Valenti (IPPNW)


With advise from:With advise from:Alberto Concha, MD, MPH - Alberto Concha, MD, MPH - Regional Advisor on Injury Regional Advisor on Injury Prevention. Prevention. Pan American Health Organization/ WHOPan American Health Organization/ WHO

Carmé Clavel-Arcas, MD, MPH – formerly at the Carmé Clavel-Arcas, MD, MPH – formerly at the National National Center for Injury Prevention and Control Center for Injury Prevention and Control Centers of Centers of Disease Prevention and Control, U.S.Disease Prevention and Control, U.S.

Institute for Peace Promotion and Injury/Violence Institute for Peace Promotion and Injury/Violence Prevention- CISALVA. University del Valle, Cali, ColombiaPrevention- CISALVA. University del Valle, Cali, Colombia

And financial support from:And financial support from:Government of CanadaGovernment of CanadaSmall Arms Survey- GenevaSmall Arms Survey- Geneva


BackgroundBackground Initiative emerged out Initiative emerged out

of the 6of the 6thth (2002) and (2002) and 7th World Conferences 7th World Conferences on Injury Prevention on Injury Prevention and Control (2004)and Control (2004)

And pre-conferences And pre-conferences on war related on war related injuries… injuries…

Multinational Injury Surveillance StudyMultinational Injury Surveillance Study

OpportunitiesOpportunities Response to WHO Response to WHO

recommendations/observationsrecommendations/observations in in that:that:

Many countries, specially in Many countries, specially in underdeveloped regions lack underdeveloped regions lack injury surveillance systems that injury surveillance systems that would provide reliable data on would provide reliable data on injury.injury.

Call for enhancing capacity for Call for enhancing capacity for collecting data on violence at the collecting data on violence at the national level in developing national level in developing countriescountries

Lack of data has made Lack of data has made multinational comparisons difficult. multinational comparisons difficult.

Participating Countries in AfricaParticipating Countries in AfricaDRC Kenya Nigeria

Uganda Zambia

Kisangani Univ. Teaching Hospital

Nairobi Kenyatta National Hospital

Dala Na.Orthopedic Hospital

AKT Hospital

Mbale Regional Hospital Lusaka University Hosp.


MethodologyMethodology::Phase IPhase I

Formative evaluationFormative evaluation

Development of QuestionnaireDevelopment of QuestionnairePAHO/CDC formPAHO/CDC formElectronic format – Epi InfoElectronic format – Epi InfoManualManual

Regional training –TOT (2006)Regional training –TOT (2006)Test PAHO/CDC formTest PAHO/CDC formTest data entry in Epi InfoTest data entry in Epi Info

Phase IIPhase II Data collection- 12 months Data collection- 12 months

prospective data collection in all prospective data collection in all sites.sites.


Evaluation - Evaluation - Three types of evaluation were incorporated in Three types of evaluation were incorporated in this project: this project:

Formative evaluationFormative evaluation in the planning or Phase I; in the planning or Phase I;

Process evaluationProcess evaluation during the implementation of Phase during the implementation of Phase II (control of data quality was carried out mainly in this II (control of data quality was carried out mainly in this phase); and phase); and

Impact/Outcome evaluationImpact/Outcome evaluation, after the completion of all , after the completion of all objectives in Phase II. Ongoing.objectives in Phase II. Ongoing.


ResultsResults::

Country DRC Kenya Nigeria Uganda Zambia TotalRTI 42 400 271 389 1,352 2,454% 42.4 68.3 80.4 82.6 49.8 58.3Self-inflicted 9 1 6 7 26 49% 9.1 0.2 1.8 1.5 1.0 1.2IPV 48 179 57 67 1,332 1,683% 48.5 30.6 16.9 14.2 49.1 40.0Other 0 3 2 7 4 16% 0.0 0.5 0.6 1.5 0.2 0.4Unknown 0 3 0 1 0 4% 0.0 0.5 0.0 0.2 0.0 0.1Missing 0 0 1 0 0 1% 0.0 0.0 0.3 0.0 0.0 0.0Total 99 586 337 471 2,714 4,207% 100 100 100 100 100 100

64.5%

Outcome Evaluation: CompletenessOutcome Evaluation: Completeness

Begun data collection on Jan. 1, 2007 Begun data collection on Jan. 1, 2007 Data collection mainly in first two weeks of each month.Data collection mainly in first two weeks of each month.Unable to send rest of collected data due to technical limitationsUnable to send rest of collected data due to technical limitationsNo data received for the month of June.No data received for the month of June.

0

5

10

15

20

25

30

35

n o

f ca

ses

January February March April May June

Democratic Republic of the Congo, n=99

Evaluation: CompletenessEvaluation: Completeness

Begun June 1, 2007Begun June 1, 2007Retrospective data collection to Jan. 1, 2007Retrospective data collection to Jan. 1, 2007Great variation in the number of cases collected monthlyGreat variation in the number of cases collected monthlyOne case registered for month of April and four in MayOne case registered for month of April and four in May

0

50

100

150

200

250

300

n o

f ca

ses


Kenya, n=586


Begun data collection on Jan. 1, 2007 Begun data collection on Jan. 1, 2007 First three months approx. same number of cases.First three months approx. same number of cases.Least number of cases in May.Least number of cases in May.

0

20

40

60

80

100

n o

f ca

ses


Nigeria, n=337


Begun data collection on Jan. 1, 2007 Begun data collection on Jan. 1, 2007 Gradual increase of cases from Jan. to March. Gradual increase of cases from Jan. to March. Least number of cases in JuneLeast number of cases in June

0

20

40

60

80

100

120

n o

f ca

ses


Uganda, n=471


Begun March 1, 2007Begun March 1, 2007Retrospective data collection to Jan. 1, 2007 Retrospective data collection to Jan. 1, 2007 Gradual increase per monthGradual increase per month

0

100

200

300

400

500

600

700

800

n o

f ca

ses


Zambia, n=2,714


ImplementationImplementation: Completeness Summary: Completeness Summary

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

50.0

DRC Kenya Nigeria Uganda Zambia

Per

cen

t



Interpersonal violence (IPV)Interpersonal violence (IPV) Road Traffic Injury (RTI)Road Traffic Injury (RTI)

DEMOGRAPHICS: SexDEMOGRAPHICS: Sex

11 cases with missing information4 cases with missing information

58.3%

41.7%

81.4%

18.7%

89.5%

9.4%

73.1%

28.6%

75.9%

24.2%


Male Female

69.1%

31.0%

74.9%

25.1%

76.4%

23.6%

65.3%

34.7%

71.9%

28.1%


Male Female



DEMOGRAPHICS: AgeDEMOGRAPHICS: Age

18.8%

8.8%

14.9%

11.1%

52.1%

81.6%

66.7%

59.7%

79.6%

27.1%

11.2%

19.3%

19.4%

8.2%

6.7%

6.0%

5.3%

2.1%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

0-19 20-39 40-59 60+

16.7%

11.5%

31.4%

39.9%

21.6%

50.0%

67.8%

48.7%

36.5%

65.6%

23.8%

17.2%

10.9%

16.6%

17.3%

6.4%

3.3%

3.5%

9.5%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

0-19 20-39 40-59 60+



EVENT DATA: PlaceEVENT DATA: Place

27.1%

25.1%

35.1%

64.2%

33.3%

20.8%

22.3%

36.8%

14.9%

48.5%

27.9%

3.5%

1.5%

2.2%

2.1% 2.1%

2.2%

15.8%

7.5%

4.1%

3.0%

8.1%

16.2%

12.5%

7.5%

8.8%

3.9%

33.3%

4.0%

2.1%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

Home School Street Work Bar, similar Other Unknown

54.8%

74.8%

60.9%

55.8%

84.3%

18.5%

30.3%

4.1%

24.0%

2.5%

4.4%

1.1%

2.4%

1.5%

5.5%

5.1%

8.5%

42.9%

3.9%

2.0%

10.1%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

Home School Street Work Bar, similar Other Unknown



EVENT DATA: ActivityEVENT DATA: Activity

7.3%

17.5%

17.9%

11.3%

9.5%

10.5%

29.9%

9.6%

62.5%

7.8%

43.9%

20.9%

59.8%

58.7%

6.3%

22.8%

6.1%

25.4%

5.3%

10.4%6.3%

4.5%

11.3%

12.8%

14.6%

2.4%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

Working Studying Sports Traveling

Recreation Drinking OH Other Unknown

7.1%

17.3%

14.7%

54.8%

64.5%

50.2%

55.0%

80.3%

11.9%

14.4%

11.8%

2.2%

26.2%

14.4%

12.1%

25.3%

15.2%

3.8%

4.1%

5.0%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

Working Studying Sports TravelingRecreation Drinking OH Other Unknown


IPV: MechanismIPV: Mechanism

12.5%

57.0%

21.1%

40.3%

95.6%

14.6%

19.0%

26.3%

35.8%

11.2%

20.8%

3.5%

4.5%

2.5%

5.0%

42.1%

39.6%

7.5%

4.5%

9.0%

12.5%

3.5%

3.0%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

Sexual assault Falls Blunt Force Stab/cutGunshot All Others Others NS Unk/Miss.


IPV: CONTEXTIPV: CONTEXT

29.2%

23.5%

15.8%

32.8%

70.2%

12.5%

21.2%

12.3%

10.4%

13.8%

4.2%

6.1%

16.4%

8.8%

25.7%

13.1%

16.2%

61.4%

19.4%

3.0%

20.8%

3.9%

12.5%

14.9%3.0%

3.4%

18.8%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

Quarrel/ fight Burglary/robbery Sexual assault

Gang activity Family violence DV Other

Unknown Missing


IPV: RelationshipIPV: Relationship

22.9%

14.9%

10.9%

6.3%

7.5%

35.8%

15.8%

17.9%

53.8%

52.1%

6.0%

16.8%

61.4%

19.4%

5.0%

3.4%

29.9%

32.4%

8.3%

3.0%

8.3%

30.6%

7.8%

17.5%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

Partner or ex Parents Other relatives Known personUnknown person Other Unknown Missing


IPV: Sex of perpetratorIPV: Sex of perpetrator

42.3%

95.0%

31.6%

100.0%

3.4%

64.9%

68.8%

53.0%

2.9%

3.5%

12.5% 8.3% 10.4%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

Male(s) Female(s) M&F Unknown Missing


RTI: Mode of TransportRTI: Mode of Transport

16.7%

24.8%

7.7%

10.8%

47.5%

23.8%

19.6%

13.4%

16.7%

14.0%

2.2%

3.3%

21.4%

3.2%

11.6%

4.9%

6.3%

11.1%

16.7%

27.6%

2.4%

22.3%

10.3%

15.7%

15.4%

4.1%

2.4%

27.5%

48.7%

43.2%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

Pedestrian Bicycle Motorcycle CarTruck/Bus Other Unknown Missing


RTI: Road UserRTI: Road User

21.4%

26.3%

8.1%

11.6%

49.4%

35.7%

6.0%

19.2%

12.9%

7.0%

40.5%

24.8%

22.9%

29.3%

36.2%

27.5%

49.4%

43.7%

2.8%

2.6%

5.5%

12.8%

2.4%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

Pedestrian Driver Passenger Other Unknown Missing


RTI: CounterpartRTI: Counterpart

6.9%

23.8%

19.5%

16.2%

14.7%

69.0%

11.9%

20.3%

15.4%

16.7%

7.3%

23.8%

7.7%

15.9%

4.8%

4.9%

16.7%

6.6%

5.9%

6.6%

7.2%

6.6% 2.2%

9.4%

23.3%

2.4%

27.5%

52.8%

43.2%

2.4%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

Pedestrian Bicycle Motorcycle Car Truck/BusFixed object Other Unknown Missing



CLINICAL DATA: Anatomic siteCLINICAL DATA: Anatomic site

37.5%

69.3%

50.9%

52.2%

67.6%

18.8%

7.8%

15.8%

13.4%

9.5%

19.3%

28.4%

14.3%

6.7%

4.2%14.6%

5.0%

10.5%

4.5%

6.7%

3.5%

6.1%

16.7% 4.2%

4.5%

4.2%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

Head Thorax & Abdomen Upper extremetiesLower extremeties Pelvis/Genitals Multiple sitesOther

50.0%

49.5%

35.4%

40.1%

41.6%

6.0%

8.1%

10.3%

13.8%

11.9%

25.8%

19.5%

19.4%

18.5%

26.9%

25.4%

22.3%

2.4%

14.0%

9.5%

7.0%

2.2%

9.5%

4.8%

16.7%

0% 20% 40% 60% 80% 100%

DRC

Kenya

Nigeria

Uganda

Zambia

Head Thorax & Abdomen Upper extremetiesLower extremeties Pelvis/Genitals Multiple sitesOther


WeaknessesWeaknesses

Insufficient funding for 24/7 Insufficient funding for 24/7 data collection for 6 monthsdata collection for 6 months

Difficulty in obtaining ethical Difficulty in obtaining ethical research clearanceresearch clearance

Limited number of ED staff Limited number of ED staff available/ ED staff are very available/ ED staff are very busybusy

High patient turnoutHigh patient turnout

Data collection processData collection process

Lack of computers and weak Lack of computers and weak internet connectionsinternet connections

StrengthsStrengths

Technical supportTechnical support

TOT, training of ED staffTOT, training of ED staff

Availability of extra data on Availability of extra data on injuriesinjuries

Involvement of medical Involvement of medical students/ medical assistantsstudents/ medical assistants

Data collection and data entry Data collection and data entry well donewell done

Use of questionnaire/ easy to Use of questionnaire/ easy to fill outfill out

Acceptance by hosp staff/ Acceptance by hosp staff/ administrationadministration

SWOT = Strengths, Weaknesses, Opportunities, Threats

SWOT* ANALYSISSWOT* ANALYSIS


ThreatsThreats

Requires accurate data entry Requires accurate data entry and computer literacy.and computer literacy.

Inadequate funds and Inadequate funds and incentives for ER staff. incentives for ER staff.

Questionnaire is very detailed Questionnaire is very detailed hence requires longer history-hence requires longer history-taking.taking.

Lack of full time data entry Lack of full time data entry personnel. Need skilled personnel. Need skilled personnelpersonnel

Political instabilityPolitical instability

OpportunitiesOpportunities

Injury data available for research.Injury data available for research.

Increased awareness of surveillance Increased awareness of surveillance systems by hospital & health systems by hospital & health authorities.authorities.

More thorough evaluation of patientsMore thorough evaluation of patients

Improvement of data capture by Improvement of data capture by hospital personnelhospital personnel

Can be implemented in hospital on a Can be implemented in hospital on a permanent basis and expanded to permanent basis and expanded to other hospitals.other hospitals.

Findings can be used for advocacy Findings can be used for advocacy work in favour for more surveillance, work in favour for more surveillance, capacity building and improvement of capacity building and improvement of infrastructure in local hospitals.infrastructure in local hospitals.

SWOT = Strengths, Weaknesses, Opportunities, Threats

SWOT* ANALYSISSWOT* ANALYSIS


Next Steps ?Next Steps ? Country level: Country level:

Complete final evaluation at each hospital.Complete final evaluation at each hospital.

Feedback to hospital administration/ health authorities.Feedback to hospital administration/ health authorities.

Lobbying to government health authorities (role of WHO?).Lobbying to government health authorities (role of WHO?).

Continue with training and capacity building.Continue with training and capacity building.

International:International:Seek assistance to transform pilot project into a self-Seek assistance to transform pilot project into a self-sustainable public health strategy. sustainable public health strategy.

multinational injury surveillance pilot project in africa mispp

Documents

injury prevention

control of data quality

reliable data

implementation of phase

process evaluation

types of evaluation

impactoutcome evaluation

national level