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The Global Burden of Injury

The Global Burden of Injury. Rochelle A. Dicker, MD, FACS Assistant Professor of Surgery University of California, San Francisco. INJURY claims over 5 million lives worldwide every year. Calculating Burden. Cause of Death Patterns by age and gender

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The Global Burden of Injury

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  1. The Global Burden of Injury Rochelle A. Dicker, MD, FACS Assistant Professor of Surgery University of California, San Francisco

  2. INJURYclaims over 5 million lives worldwide every year

  3. Calculating Burden • Cause of Death Patterns by age and gender • Worldwide this is known only 35% of the time • Disability Impact • Incidence of disease or injury • Proportion leading to disabling outcome • Average age of disability onset and its duration • Severity of disability

  4. Disability Adjusted Life Years Major Factors • Duration of time lost due to a death • Disability weights/Degrees of incapacity: 0-1 • Age weights=Importance of healthy life at a given age

  5. DALY Disability Weights • BKA .281 • Paraplegia .671 • Quadriplegia .895

  6. DALYs 2005

  7. Bottom Line INJURY is the lead cause of death and disability worldwide in people under 60 years of age

  8. Impact of Injury by Region: Leading Causes of Injury Mortality • Low and Middle Income Countries: • Western Pacific-Interpersonal Violence and Road Traffic Crashes • Europe-Suicide and Poisonings • Americas-Interpersonal Violence 88% of road traffic crashes-$65 billion 95% of homicides

  9. Injury in Africa The third leading cause of death 7 of 15 and 5 of 15 leading causes of death in men and women, respectively; 15-44 years old

  10. Studying the Burden of Disease • Recognition of its implications: • Development of prevention strategies • The Public Health Model: Surveillance and screening Recognition of risk factors Development of prevention and intervention strategies Progressive evaluation of effects to target population • Policy Implementation and targeted resource allocation for health care

  11. Getting Started: Surveillance Measuring Injury in Uganda • 88% of population live in rural areas • 220% increase in motor vehicles 1985-1995 • Households in rural and urban areas were randomly selected for survey • Survey was qualitative and quantitative

  12. Injury Mortality • Urban: 217/100,000 • Traffic crashes and violence • Rural: 92/100,000 • Drownings are a tremendous issue in the lake regions (rural) • Burns and falls affect children Kobusingye O, Guwatudde D, Lett R, “Injury Patterns in urban and rural Uganda” Injury Prevention 2001; 7:46-50

  13. Infrastructure in Uganda • No prehospital system • The injured are brought in by bystanders, police, or relatives • One 24 hour casualty ward: Mulago Hospital; 1200 beds • Other hospitals: • Daytime injuries-seen in clinic • Nighttime-direct admit to ward

  14. The City of Kampala • Trauma registry data • 4359 injured patients from 5 hospitals • 75% went to Mulago • Mean age 24.2 years • Traffic crashes=50% of all injuries • Largest occupation of the injured-students Kobusingye OC, Guwatudde D, Owor G, Lett RR; “Citywide trauma experience in Kampala, Uganda: A call for intervention” Injury Prevention 2002:8;133-136

  15. A Call for a System and Prevention • The unaccounted injuries • People who never make it to the hospital • 2.2/1000 per year die of injuries • Minor injuries are crowding hospitals • Poor triage system • 36% of severely injured arrive >1hour after injury

  16. Steps towards Policy and Prevention • WHO’s Department of Injuries and Violence Prevention-2000 • Review of 28 existing Nation Policies regarding injury • Many provide a framework for Prevention strategies • NO Violence Prevention policy was found in Asia, Africa, Eastern Europe or Middle East

  17. Examples of National Goals • “An injury free Sri Lanka”. Integrating injury prevention into everyday life • Brazil: Contribute to the quality of life of people; reduce morbimortality

  18. How to Develop National Policy? • Tunisia: National strategy for Emergency Medical Services • Medical practitioners working group • Presentation to policymakers • Lessons learned • The 5 E’s • Education • Enforcement • Engineering • Emergency • Evaluation

  19. Key Steps for Policy • Situation analysis of epidemiology; geared towards solutions • Identify a lead agency • Prepare a strategy and plan of action • Raise awareness • Create task forces amongst the key stakeholders and community • Seek LONG-TERM commitments • Allocation of personnel and $$$$$

  20. Who are the Leaders? Ministries of Health • Catalyst • Facilitator • Advocate • Coordination • Supportive Ministries of Transport, Justice, Education, Sport, Housing, Interior

  21. Choosing Interventions • Evidence • Cost effectiveness • Acceptability • Feasibility • Time frame • Measurability

  22. International agreements can help societies demand change

  23. UCSF/Mulago Research

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