Multinational Injury Surveillance Pilot Project in Africa MISPP

1. Multinational Injury Surveillance Pilot Project in AfricaMISPP Diego E Zavala, M.Sc., Ph.D. Associate Professor Public Health Program Ponce School of Medicine Ponce, Puerto Rico

2. Multinational Injury Surveillance Project • Project team: • P.I.: Diego E Zavala, MSc, PhD, Ponce Medical School, Puerto Rico • Co- PI (all IPPNW members): • DRC: Simon Bokongo, MD • Kenya: Walter Odhiambo, MD • Nigeria: Ime John, MD, Aminu Zakari Mohammed , MD • Uganda: Peter Olupot Olupot, MPH, MD Mpanga Senoga Ismail, MD • Zambia: Robert Mtonga, MD • Project Administrator: Maria Valenti (IPPNW)

3. Multinational Injury Surveillance Project With advise from: • Alberto Concha, MD, MPH - Regional Advisor on Injury Prevention. Pan American Health Organization/ WHO • Carmé Clavel-Arcas, MD, MPH – formerly at the National Center for Injury Prevention and Control Centers of Disease Prevention and Control, U.S. • Institute for Peace Promotion and Injury/Violence Prevention- CISALVA. University del Valle, Cali, Colombia And financial support from: Government of Canada Small Arms Survey- Geneva

4. Multinational Injury Surveillance Project • Background • Initiative emerged out of the 6th (2002) and 7th World Conferences on Injury Prevention and Control (2004) • And pre-conferences on war related injuries…

5. Opportunities Response to WHO recommendations/observations in that: Many countries, specially in underdeveloped regions lack injury surveillance systems that would provide reliable data on injury. Call for enhancing capacity for collecting data on violence at the national level in developing countries Lack of data has made multinational comparisons difficult. Multinational Injury Surveillance Study

6. Participating Countries in Africa Nigeria Kenya DRC Dala Na.Orthopedic Hospital AKT Hospital Kisangani Univ. Teaching Hospital Nairobi Kenyatta National Hospital Uganda Zambia Lusaka University Hosp. Mbale Regional Hospital

7. Multinational Injury Surveillance Project Methodology: • Phase I • Formative evaluation • Development of Questionnaire • PAHO/CDC form • Electronic format – Epi Info • Manual • Regional training –TOT (2006) • Test PAHO/CDC form • Test data entry in Epi Info • Phase II • Data collection- 12 months prospective data collection in all sites. 6

8. Multinational Injury Surveillance Project Evaluation - Three types of evaluation were incorporated in this project: • Formative evaluation in the planning or Phase I; • Process evaluation during the implementation of Phase II (control of data quality was carried out mainly in this phase); and • Impact/Outcome evaluation, after the completion of all objectives in Phase II. Ongoing.

9. Multinational Injury Surveillance Project Results: 64.5%

10. Outcome Evaluation: Completeness • Begun data collection on Jan. 1, 2007 • Data collection mainly in first two weeks of each month. • Unable to send rest of collected data due to technical limitations • No data received for the month of June.

11. Evaluation: Completeness • Begun June 1, 2007 • Retrospective data collection to Jan. 1, 2007 • Great variation in the number of cases collected monthly • One case registered for month of April and four in May

12. Evaluation: Completeness • Begun data collection on Jan. 1, 2007 • First three months approx. same number of cases. • Least number of cases in May.

13. Evaluation: Completeness • Begun data collection on Jan. 1, 2007 • Gradual increase of cases from Jan. to March. • Least number of cases in June

14. Multinational Injury Surveillance Study • Begun March 1, 2007 • Retrospective data collection to Jan. 1, 2007 • Gradual increase per month

15. Multinational Injury Surveillance Study • Implementation: Completeness Summary

16. Interpersonal violence (IPV) Multinational Injury Surveillance Project DEMOGRAPHICS: Sex Road Traffic Injury (RTI) 4 cases with missing information 11 cases with missing information

17. Multinational Injury Surveillance Project DEMOGRAPHICS: Age • Interpersonal violence (IPV) Road Traffic Injury (RTI)

18. Multinational Injury Surveillance Project EVENT DATA: Place • Interpersonal violence (IPV) Road Traffic Injury (RTI)

19. Multinational Injury Surveillance Project EVENT DATA: Activity • Interpersonal violence (IPV) Road Traffic Injury (RTI)

20. Multinational Injury Surveillance Project IPV: Mechanism

21. Multinational Injury Surveillance Project IPV: CONTEXT

22. Multinational Injury Surveillance Project IPV: Relationship

23. Multinational Injury Surveillance Project IPV: Sex of perpetrator

24. Multinational Injury Surveillance Project RTI: Mode of Transport

25. Multinational Injury Surveillance Project RTI: Road User

26. Multinational Injury Surveillance Project RTI: Counterpart

27. Multinational Injury Surveillance Project CLINICAL DATA: Anatomic site • Interpersonal violence (IPV) Road Traffic Injury (RTI)

28. Weaknesses Insufficient funding for 24/7 data collection for 6 months Difficulty in obtaining ethical research clearance Limited number of ED staff available/ ED staff are very busy High patient turnout Data collection process Lack of computers and weak internet connections Strengths Technical support TOT, training of ED staff Availability of extra data on injuries Involvement of medical students/ medical assistants Data collection and data entry well done Use of questionnaire/ easy to fill out Acceptance by hosp staff/ administration Multinational Injury Surveillance Project SWOT* ANALYSIS SWOT = Strengths, Weaknesses, Opportunities, Threats

29. Threats Requires accurate data entry and computer literacy. Inadequate funds and incentives for ER staff. Questionnaire is very detailed hence requires longer history-taking. Lack of full time data entry personnel. Need skilled personnel Political instability Opportunities Injury data available for research. Increased awareness of surveillance systems by hospital & health authorities. More thorough evaluation of patients Improvement of data capture by hospital personnel Can be implemented in hospital on a permanent basis and expanded to other hospitals. Findings can be used for advocacy work in favour for more surveillance, capacity building and improvement of infrastructure in local hospitals. Multinational Injury Surveillance Project SWOT* ANALYSIS SWOT = Strengths, Weaknesses, Opportunities, Threats

30. Multinational Injury Surveillance Project • Next Steps ? • Country level: • Complete final evaluation at each hospital. • Feedback to hospital administration/ health authorities. • Lobbying to government health authorities (role of WHO?). • Continue with training and capacity building. • International: • Seek assistance to transform pilot project into a self-sustainable public health strategy.