Surveillance Systems: Their Role in Identifying Risk and Resilience Factors

Surveillance Systems: Their Surveillance Systems: Their Role in Identifying Risk and Role in Identifying Risk and

Resilience FactorsResilience Factors

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

Public Health Program, Ponce School of MedicinePublic Health Program, Ponce School of MedicinePonce, Puerto RicoPonce, Puerto Rico

IANSA Public Health NetworkIANSA Public Health Network33rdrd Biennial Meeting of States of the UN Programme of Action Biennial Meeting of States of the UN Programme of Action

On Small Arms and Light WeaponsOn Small Arms and Light WeaponsJuly 14-18, 2008July 14-18, 2008

Public Health Public Health Approach:Approach:

Problem Response

1. Surveillance:What is the

problem?

2. Risk FactorIdentification:What is the

cause?

3. InterventionEvaluation:

Whatworks?

4. Implementation:How do you

do it?

Source: WHO Teach VIP


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


Injury Pyramid

145,655 Deaths

2,701,000 Hospitalizations

33,950,000 Emergency Department Visits

65,555,000 Visits to Office-based Physicians

59,550,000 Injuries Requiring Medical Attention or Time Off Work

Source: National Center for Health Statistics

1:408

1:450

1:233

1:18

Multinational Injury Surveillance Multinational Injury Surveillance System Pilot ProjectSystem Pilot Project

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 injury underdeveloped regions lack injury surveillance systems that would surveillance systems that would provide reliable data on injury.provide reliable data on 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 countriesnational level in developing countries

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

Public Health Public Health ApproachApproach

Problem Response


problem?

2. Risk FactorIdentification:What is the

cause?

3. InterventionEvaluation:

Whatworks?

4. Implementation:How do you

do it?


Public Health Public Health Surveillance:Surveillance:

Problem Response


problem?


Systematic ongoingSystematic ongoingCollectionCollectionAnalysisAnalysisInterpretationInterpretationDisseminationDisseminationPublic Health PracticePublic Health Practice

Public Health Public Health Surveillance:Surveillance:

Problem Response


problem?


•Estimate magnitude of the problemEstimate magnitude of the problemDetermine geographic distribution of injuriesDetermine geographic distribution of injuriesDescribe context of injuries, define the problemDescribe context of injuries, define the problemDetect epidemics Detect epidemics Generate hypothesis and stimulate researchGenerate hypothesis and stimulate researchEvaluate control programsEvaluate control programsMonitor changesMonitor changesDetect changes in health practiceDetect changes in health practiceFacilitate planningFacilitate planning

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

2006-20072006-2007

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.

Multinational Injury Surveillance ProjectMultinational Injury Surveillance Project

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%

Multinational Injury Surveillance StudyMultinational Injury Surveillance Study

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

January February March April May June

Multinational Injury Surveillance StudyMultinational Injury Surveillance Study

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

January February March April May June

Zambia, n=2,714


Interpersonal violence (IPV) context: SexInterpersonal violence (IPV) context: Sex

4 cases with missing information

58.3%

41.7%

81.4%

18.7%

89.5%

9.4%

73.1%

28.6%

75.9%

24.2%

DRC Kenya Nigeria Uganda Zambia

Male Female


Interpersonal Violence: AgeInterpersonal Violence: 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+


Interpersonal Violence: PlaceInterpersonal Violence: 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


Interpersonal Violence - MechanismInterpersonal Violence - 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


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

Public Health Public Health SurveillanceSurveillance

Problem ResponseSource: CDC

Summaries

Interpretations

Recommendations

Reports

Analysis

Health Agencies

Health care providers and

Policy makers

Public

Policy Development for Prevention StrategiesPolicy Development for Prevention Strategies

OpportunitiesOpportunities

reliable information on reliable information on cervical cervical cancercancer ( (injuryinjury) incidence and ) incidence and mortality data that mortality data that demonstrates the extent of the demonstrates the extent of the problem and the financial problem and the financial implications of the disease for implications of the disease for the country.the country.

this information together with this information together with provision of technical provision of technical assistance is needed to assistance is needed to develop sustainable develop sustainable cervical cervical cancercancer ( (injuryinjury) prevention ) prevention initiatives in developing initiatives in developing countriescountries

for which donors may be more for which donors may be more willing to support 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 ( (injuryinjury) prevention; ) prevention;

lack of reliable data of lack of reliable data of cancercancer ((injuryinjury) incidence; and ) incidence; and

limited understanding by limited understanding by health officials about the health officials about the disease (disease (injuryinjury) itself and of its ) itself and of its impact, specially in impact, specially in older older womenwomen ( (youthyouth). ).

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.

Economy & Finance

Surveillance Systems: Their Role in Identifying Risk and Resilience Factors