surveillance systems: their role in identifying risk and resilience factors
TRANSCRIPT
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
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
Source: WHO Teach VIP
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
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
Public Health Public Health Surveillance:Surveillance:
Problem Response
1. Surveillance:What is the
problem?
Source: WHO Teach VIP
Systematic ongoingSystematic ongoingCollectionCollectionAnalysisAnalysisInterpretationInterpretationDisseminationDisseminationPublic Health PracticePublic Health Practice
Public Health Public Health Surveillance:Surveillance:
Problem Response
1. Surveillance:What is the
problem?
Source: WHO Teach VIP
•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
Multinational Injury Surveillance ProjectMultinational Injury Surveillance Project
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
Multinational Injury Surveillance ProjectMultinational Injury Surveillance Project
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+
Multinational Injury Surveillance ProjectMultinational Injury Surveillance Project
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
Multinational Injury Surveillance ProjectMultinational Injury Surveillance Project
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.
Multinational Injury Surveillance ProjectMultinational Injury Surveillance Project
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
Multinational Injury Surveillance ProjectMultinational Injury Surveillance Project
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
Multinational Injury Surveillance ProjectMultinational Injury Surveillance Project
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.