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Organizing a pilot projectOrganizing a pilot project on on injury surveillance.injury surveillance.
Opportunities and ObstaclesOpportunities and Obstacles
Diego E Zavala, M.Sc., Ph.D.Diego E Zavala, M.Sc., Ph.D.Director- Epidemiology and Biostatistics Core ProgramDirector- Epidemiology and Biostatistics Core Program
Public Health ProgramPublic Health ProgramPonce School of MedicinePonce School of Medicine
Ponce, Puerto RicoPonce, Puerto Rico
Multinational Injury Surveillance StudyMultinational Injury Surveillance Study
BackgroundBackground Initiative emerged out Initiative emerged out
of the last two World of the last two World Conferences on Injury Conferences on Injury Prevention and ControlPrevention and Control
And pre-conferences And pre-conferences on war related on war related injuries… injuries…
Multinational Injury Surveillance StudyMultinational Injury Surveillance Study
In collaboration with:In collaboration with:
Pan American Health Organization/ WHOPan American Health Organization/ WHOAlberto Concha, MD, MPHAlberto Concha, MD, MPH
Regional Advisor on Injury PreventionRegional Advisor on Injury Prevention
Centers of Disease Prevention and ControlCenters of Disease Prevention and ControlCarme Clavel-Arcas, MD, MPHCarme Clavel-Arcas, MD, MPH
National Center for Injury Prevention and ControlNational Center for Injury Prevention and Control CDC, U.S.CDC, U.S.
Multinational Injury Surveillance StudyMultinational Injury Surveillance Study
El Salvador
Colombia
BoliviaBrazil
Puerto Rico
DRC
Kenya
Uganda
Nigeria
Zambia
•PI: Diego E Zavala, MSc, PhD, Ponce Medical School, Puerto Rico
•Project Administrator: Maria Valenti,
International Physicians for the Prevention of Nuclear War (IPPNW)
Participating CountriesParticipating CountriesLATIN AMERICA & CARIBBEAN
Bolivia•Population: 8,724,156 (2004)
•Area:
•La Paz: Hospital de Clínicas
•Co-PI: Eduardo Dominguez- Qhana (NGO)
•Population: 184,101,109 (2004)
•Area:
•Sao Paulo: Hospital do Grajaú
•Co-Pi: Maria Fernanda Tourinho Peres, PhD
Vilma Pinheiro Gawryszewski, MD
Nucleo de Estudos da Violencia
Brazil
Participating CountriesParticipating CountriesLATIN AMERICA & CARIBBEAN
Puerto Rico
El Salvador •Population: 6,587,541 (2004)
•Area:
•Ilopango: Hospital Bartolo
•Co-PI: Emperatriz Crespín, MD -IPPNW
•Population: 3,897,960 (2004)
•Area:
•Ponce: Hospital San Lucas II
•Co-PI: Carlos García, MD
Participating CountriesParticipating CountriesLATIN AMERICA & CARIBBEAN
Colombia •Population: 42,310,775 (2004)
•Area:
•Bucaramanga: two public hospitals
•Co-PI: Marta H León Franco, MD
Participating CountriesParticipating Countries
DRC
Kenya
AFRICA •Population: 58,317,930 (2004)
•Area: •Kisangani: K.U.T. Hospital•Bukavu: Bukavu General Hospital•Panzi: Panzi General Hospital•Goma/Katwa: Goma & Katwa Gen. Hosp•Bunia: Bunia General Hospital•Kindu: Kindu General Hospital
•Co-PI: Simon Bokongo, MD (IPPNW)
•Population: 32,021,856 (2004)
•Area: •Nairobi: Kenyatta Nacional Hospital•Rift Valley: Naivasha District Hospital•Eastern Prov: Machakos Provincial Hospital
•Co-PI: Walter Odhiambo, MD (IPPNW)
Participating CountriesParticipating CountriesAFRICA
Uganda
Zambia
•Population: 26,404,543 (2004)
•Area:
•Mbale: Mbale Regional Hospital
•Kumi: Kumi Hospital
•Toroto: Toroto Hospital
•Co-PI: Peter Olupot, MD (IPPNW)
•Population: 10,462,436 (2004)
•Area:
•Lusaka: Univ. Hospital
•Kafue: Nangonwe Hospital
•Kalomo:Kalomo District Hospital
•Co-PI: Robert Mtonga, MD (IPPNW)
Participating CountriesParticipating Countries
Nigeria
AFRICA
•Population: 137,253,133
•Area:
•Dala: Nacional Orthopedic Hosp
•Kano:Aminu Kano Hospital
•Co-PI: Ime John, MD (IPPNW)
Multinational Injury Surveillance StudyMultinational Injury Surveillance Study
Phase I:Phase I:
Development of Development of QuestionnaireQuestionnaire
Retrospective review of 30 Retrospective review of 30 cases in last six monthscases in last six months
Presentation of results to Presentation of results to ED medical professionals.ED medical professionals.
Multinational Injury Surveillance StudyMultinational Injury Surveillance Study
Phase II:Phase II: Secure fundingSecure funding
Regional training (TOT)Regional training (TOT)
Begin 12 month Begin 12 month prospective data collection prospective data collection in all sites.in all sites.
Multinational Injury Surveillance StudyMultinational Injury Surveillance Study
OpportunitiesOpportunities
Response to WHO Response to WHO recommendations.recommendations.
Interest & enthusiasm.Interest & enthusiasm.
Develop experience in Develop experience in international international collaboration efforts.collaboration efforts.
Foundation for further Foundation for further research efforts.research efforts.
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.
Multinational Injury Surveillance StudyMultinational Injury Surveillance Study
OpportunitiesOpportunities
Response to WHO Response to WHO recommendations.recommendations.
Interest & commitment.Interest & commitment.
Develop experience in Develop experience in international international collaboration efforts.collaboration efforts.
Foundation for further Foundation for further research efforts.research efforts.
ObstaclesObstacles
CommunicationCommunication
FundingFunding
Coordination via Coordination via internet?internet?
Local socio-political Local socio-political realitiesrealities
Multinational Injury Surveillance StudyMultinational Injury Surveillance Study
OpportunitiesOpportunities
reliable information on reliable information on cervical cancercervical cancer incidence incidence and mortality data that and mortality data that demonstrates the extent of demonstrates the extent of the problem and the the problem and the financial implications of the financial implications of the disease for the country.disease for the country.
this information together this information together with provision of technical with provision of technical assistance is needed to assistance is needed to develop sustainable develop sustainable cervical cancercervical cancer prevention prevention initiatives in developing initiatives in developing countriescountries
for which donors may be for which donors may be more willing to support more willing to support
BarriersBarriers limited availability of funds, limited availability of funds,
particularly from donor particularly from donor organizations;organizations;
absence or deficient absence or deficient infrastructure for infrastructure for cervical cervical cancercancer prevention; prevention;
lack of reliable data of lack of reliable data of cancercancer incidence; and incidence; and
limited understanding by limited understanding by health officials about the health officials about the disease itself and of its disease itself and of its impact, specially in older impact, specially in older women. women.
Herdman, C., Sherris, J., Bingham, A. Bringing about change: Policy development for cervical cancer prevention in low-resource countries. Abstract No. O-49. 19th International Papillomavirus Conference. Florianópolis, Brazil. September 1-7, 2001.
Multinational Injury Surveillance StudyMultinational Injury Surveillance Study
Funding:Funding:
FIA application 50%FIA application 50%
IPPNW: Govt. of IPPNW: Govt. of CanadaCanada
Other ?Other ?
Multinational Injury Surveillance StudyMultinational Injury Surveillance Study
Output:Output: National: National:
HospitalHospital
GovernmentGovernment
Community?Community?
International:International:ConferencesConferences
JournalsJournals