Violence & Injury Prevention(VIP)

Nurah M Alamro, MD. MPH.Lecturer – Community Medicine

College of MedicineKing Saud University

nmalamro@ksu.edu.sa

DefinitionsInjury• “Acute exposure to physical agents such as

mechanical energy, heat, electricity, chemicals, and ionising radiation interacting with the body in amounts or at rates that exceed the threshold of human tolerance. In some cases, injuries result from the sudden lack of essential agents such as oxygen or heat.”

(Source: Gibson, 1961; Haddon, 1963)

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DefinitionsViolence• “The intentional use of physical force or

power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.”

(Source: WHO, 1996)

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The Global Injury Problem

• 5 million deaths worldwide = 9% of all deaths (2000)

• 12% of global burden of disease• Road traffic “incidents” are the leading cause

of injury deaths worldwide• 90% of injury deaths occur in low- and middle-

income countries• Highest number of deaths in S.E. Asia &

Western Pacific regions

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Principles!

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The Epidemiological Model

Vector Agent

Host

Environment

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The Haddon Matrix

Factors

Phase Human Vehicles and Equipment

Environment

Pre-Crash

Crash Prevention Information Attitudes Impairment Enforcement

Road worthiness

Lighting Braking Handling Speed

management

Road design Speed limits Pedestrian

facilities

Crash Injury prevention during the crash

Use of restraints Impairment

Occupant restraints

Other safety devices

Crash protective roadside objects

Post-crash

Life - sustaining First aid skill Access to medics

Ease of access

Fire risk

Rescue facilities

Congestion

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The Ecological Model

IndividualCommunity RelationshipSociety

Complex Linkages

Source: Krug E et al., eds., 2002.20/04/23 8N.ALAMRO - COMM 311

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VIP Public Health Approach

Defining Characteristics

Population-based Multidisciplinary Evidence-based Collective action Prevention

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(1) SurveillanceWhat is the problem?

(2) Risk factoridentification

What are the causes?

(4) Implementation How is it done?

(3) Develop andevaluate

interventionsWhat works?

The Public Health Approach

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Public Health Approach in Action

DESEPAZ in Colombia

(1) SurveillanceHigh rate of violentcrime

(2) Risk factorsAlcoholHandgunsAttitudes/values

(3) InterventionsEducationLegislationCommunity involvement

Reduction in homicides

Public demand for more prevention

(4) ImplementationSpecial budgets for police, judiciary etc. Television advertisingCultural/educational Programmes /Restrictions on alcohol and handguns

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Categorizing Injury

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Data Classification Systems

• International Classification of Disease (ICD)• Occupational Injury and Illness Classification

System (OIICS) • Nordic Medico-Statistical Committee

(NOMESCO)• The International Classification of External

Causes of Injury (ICECI) • The Abbreviated Injury Severity Scale (AIS)

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Injury Pyramid

Deaths

Injuries resulting in hospitalization

Injuries resulting in ambulatory and

emergency treatment

Injuries resulting in treatment inPrimary care settings

Injuries treated by paramedics only(school nurse, physiotherapist, first aid)

Untreated injuries or injuries which werenot reported

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Types of data and potential sources of information

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Source: adapted from Krug et al., eds., 200220/04/23 18N.ALAMRO - COMM 311

Health Statistics and Informatics

Leading Causes of Mortality and Burden of Disease

world, 2004

%

1. Ischaemic heart disease 12.2

2. Cerebrovascular disease 9.7

3. Lower respiratory infections 7.1

4. COPD 5.1

5. Diarrhoeal diseases 3.7

6. HIV/AIDS 3.5

7. Tuberculosis 2.5

8. Trachea, bronchus, lung cancers 2.3

9. Road traffic accidents 2.2

10. Prematurity, low birth weight 2.0

%

1. Lower respiratory infections 6.2

2. Diarrhoeal diseases 4.8

3. Depression 4.3

4. Ischaemic heart disease 4.1

5. HIV/AIDS 3.8

6. Cerebrovascular disease 3.1

7. Prematurity, low birth weight 2.9

8. Birth asphyxia, birth trauma 2.7

9. Road traffic accidents 2.7

10. Neonatal infections and other 2.7

Mortality DALYs

Health Statistics and Informatics

Adult mortality rates by major cause group and region, 2004

0 2 4 6 8 10 12

Africa

Europe

South East Asia

Eastern Mediterranean

Americas

Western Pacific

High income

Death rate per 1000 adults aged 15–59 years

Cardiovascular diseases

Cancers

Other noncommunicable diseases

Injuries

HIVAIDS

Other infectious and parasitic diseases

Maternal and nutritional conditions

Source: WHO, 2004

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Health Statistics and Informatics

Ten leading causes of burden of disease, world, 2004 and 2030

Quiz• In epidemiological

model of road traffic incident, the host is:• Car• Driver• Energy

transferred• Wet road

• Defining VIP according to target group include except:

•Universal•Selective•Indicated•Passive

• Injury can be categorised according:• Severity• Intent• Setting• All of the above

• The apex of the injury pyramid represents:• Relatively small number

of non-fatal injury cases • Relatively small number

of fatal injury cases • More numerous injuries

of lesser severity • More numerous injuries

of greater severity

• According to WHO, RTA as a leading cause of burden of disease in 2030 will rank:• 1st • 3rd • 20th • 9th

““PreventionPrevention is the VaccineVaccine for the DiseaseDisease

of Injury”Injury”

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