Epidemiology of Unintentional Injuries in the African Countries“Overview and Control Challenges” Injury Epidemiology Workshop PEERCORPS Trust Fund in collaboration with The IPIFA/WHO Dar Es Salaam , Tanzania July 3-5, 2009 Hesham El-Sayed Faculty of Medicine Suez Canal University, Egypt
Injuries caused 5 million deaths worldwide >9% of all deaths (2000)
Injuries are the leading causes of death in children <18 years of age.
Injuries caused 875,000 deaths among children (<18 years) in the year 2000 (40/100,000).
More than 90% of injury deaths occur in low- and middle-income countries.
Global Burden of Injuries (2)
45 injuries need hospital admission and 1300 injuries requiring ambulatory care for every injury death.
Injuries represent 15-24% of all hospital admissions.
Injuries responsible for >12% of global burden of disease (DALYs).
Deaths, by Broad Cause Group & WHO Region, 2001 Communicable diseases, maternal and perinatal conditions and nutritional deficiencies Noncommunicable conditions Injuries 75% 50% 25% Eastern Mediterranean South East Asia Western Pacific Africa Americas Europe Source: WHR 2002
Factors Affecting the Prevalence and Pattern of Injuries Age. Gender (Male/Female Ratio [2-3/1]). Fatal vs. Nonfatal injuries. Residence: Region, Country, Urban vs. Rural. Socioeconomic conditions (poverty/equity). Community vs. health facilities and vital statistics data.
Strengths & Weaknesses of Injuries Records in the African Countries Poor recording system in most of the health facilities and even in tertiary and secondary hospitals (El-Sayed et.al., 2001). Under-registration of RTI is 46% in vital statistics of Ministry of Health, and 57% in traffic police records (Verbal Autopsy Studies, El-Sayed et.al., 1992 & Khallaf et.al, 1996). Newly developed injury surveillance programs that started in the some countries (Egypt). Injury surveys conducted in some countries.
Minimal links between society organizations (e.g., NGOs) and public health community.
Scope for the Response to Injuries Change thinking about injuries to scientific approach as preventable health problem. Scientific bases for injury prevention: Structural framework of time and vector, host and environment (Haddon’s matrix). Risk response: Health education & works with legislation. Public Health Approach: Surveillance, risk factors, interventions & implementation.
Steps of Developing Injury Control Program Identify size of the injury problem. Determine specific circumstances of injury (risk factors). Identify possible preventive measures. Based on local evidence and research. Taking into account existing social, political, and economic considerations. Prioritize intervention programs: (size of the problems, likelihood of success, constraints, additional benefits). Implement interventions. Evaluate intervention effects.
Essential Features of Successful Injury Control Program Data collection & Analysis Monitoring & Evaluation Plan goals & Interventions Implement Interventions
Priority Setting Criteria Overall impact of priority setting process on equity. Answerability in an ethical way. Likelihood of efficacy and effectiveness of interventions affected by new knowledge. Likelihood of deliverability, affordability and sustainability. Maximum potential of reduction of existing disease burden. * Child Health and Nutrition Research Initiative
Utilization Dissemination Implementation Research Design Problem Identification Steps of Research Utilization
Elements of Effective Trauma Care System Pre-hospital:
Intervention Strategies for Injury Control Education. Legislation, regulations and enforcement Product modification. Environmental modification. Supportive home visiting. Community-based studies.
Global Response to the Injury Problem Increasing recognition of injuries as priority health problem, especially RTI. Acknowledgement of injury targets in MOHP and Universities programs. Recognition of injuries as manifestation of inequalities (political pressure). Working with International Organizations: MOHP/WHO/EMRO RTI Health Days , Injury Surveillance Programs, International Injury Control Meetings, IPIFA, Safe Community projects, NGOs.) But limited action & Few additional resources.
Recommendations for Injury Control Strategies Based on local evidence and research. Taking into account existing social, political, and economic considerations. Legislations that should: Convince the public. Enforcement, swiftness and severity.. Attitude of law enforcement personnel.
Recommendations (Cont.)for Injury Control Training of medical staff and the public on injury care: Train all hospitals medical staff including physicians, nurses, and paramedics. Train PHC physicians, nurses, and paramedics. Training of the public and first respondents (i.e., Policemen, teachers, drivers).
Recommendations (Cont.)for RTI control strategies Address special factors: Urban development. Vulnerable road users: Pedestrians especially children and older people. Two wheelers users (bicycles, motorcycles, etc.). Public transport. Poor communities (equity challenges).
Egypt Activities for Injury Control Establishing MOHP Injury Registry Program. Training medical professionals and health workers on registration and data management. Training primary health care workers on Injury control and prevention programs (Golden Hour in Trauma Care, WHO/EMRO). Universities and MOH programs and courses for Emergency and Injury care (ATLS, ACLS). Childhood injury registry project (WHO ) Safe-Community Program in Port-Said city.
Egyptian Activities for RTI Control New more stringent traffic law. National campaign on RTI by MOHP (1997). Decree for free emergency care by private and investment hospitals. Establishing emergency medical centers along highways. Establishing the National Council for Traffic Safety.
Efforts for Injury Control in the EMRO Region“The Golden Hour in Trauma Care”
Injury Control Program in Ismailia Schools, Egypt