Epidemiology of Unintentional
Injuries in the African Countries
“Overview and Control Challenges”
Injury Epidemiology Work...
Global Burden of Injuries
 Injuries caused 5 million deaths worldwide
>9% of all deaths (2000)
 Injuries are the leading...
Global Burden of Injuries (2)
 45 injuries need hospital admission and
1300 injuries requiring ambulatory care for
every ...
75%
50%
25%
Africa Americas
Eastern
Mediterranean
Europe
South East
Asia
Western
Pacific
Deaths, by Broad Cause Group & WH...
Global Injury Rates by Age Groups
0
50
100
150
200
250
300
0-4 5_14 15-44 45-69 70+
Per100,000Population
Age Group
WHO, 20...
Global Causes of Injury Mortality
RTI
Poisoning
Falls
Burns
Drowning
Violence
Others
Global Injury Mortality (WHO, 2002)
RTI Global Fatalities
Global Road Fatality Trends
10Source: WHO. Injury – A leading cause of the global burden of disease. . WHO, 2002
DISABILITY ADJUSTED LIFE YEARS (DALYS...
Injuries due to Unintentional Falls
Fire-related Burns
Drowning injuries
Unintentional poison-related injuries
Sources of Injury Information
“National records from various sources”
 Death certificates
 Hospital records
 Trauma reg...
Factors Affecting the
Prevalence and Pattern of Injuries
 Age.
 Gender (Male/Female Ratio [2-3/1]).
 Fatal vs. Nonfatal...
Strengths & Weaknesses of Injuries
Records in the African Countries
 Poor recording system in most of the health faciliti...
Why limited action against injuries?
 Perception of injuries as “Accidents” unpredictable
and inevitable.
 Reluctance of...
Why limited policy response to injuries?
 Relative neglect, due to Limited awareness of the
burden & little evidence of r...
Scope for the Response to Injuries
 Change thinking about injuries to scientific
approach as preventable health problem.
...
Steps of Developing Injury Control Program
1. Identify size of the injury problem.
2. Determine specific circumstances of ...
Essential Features of Successful
Injury Control Program
Data collection
& Analysis
Plan goals &
Interventions
Implement
In...
Priority Setting Criteria
 Overall impact of priority setting process on equity.
 Answerability in an ethical way.
 Lik...
Steps of Research Utilization
Problem Identification
Dissemination
Research Design
Implementation
Utilization
Elements of Effective Trauma Care System
Pre-hospital:
- Call and Care
Centers.
- Ambulances.
-Trained Staff
(PHCC &
Ambul...
Intervention Strategies for Injury Control
 Education.
 Legislation, regulations and enforcement
 Product modification....
Global Response to the Injury Problem
 Increasing recognition of injuries as priority health
problem, especially RTI.
 A...
Recommendations
for Injury Control Strategies
 Based on local evidence and research.
 Taking into account existing socia...
Recommendations (Cont.)
for Injury Control
 Training of medical staff and the public
on injury care:
 Train all hospital...
Recommendations (Cont.)
for RTI control strategies
 Address special factors:
 Urban development.
 Vulnerable road users...
WHO/CNISTeach Injury Epidemiology
Workshop (Kampala-Uganda 2009)
Injury Control Activities
in Egypt
Egypt Activities for Injury Control
 Establishing MOHP Injury Registry Program.
 Training medical professionals and heal...
Egyptian Activities for RTI Control
 New more stringent traffic law.
 National campaign on RTI by MOHP (1997).
 Decree ...
Efforts for Injury Control in the EMRO Region
“The Golden Hour inTrauma Care”
Injury Control Program
in Ismailia Schools, Egypt
RoadTraffic Injury Control Seminar Cairo,
Egypt (May 18, 2007)
Epidemiology of Unintentional Injuries in the African Countries ...
Epidemiology of Unintentional Injuries in the African Countries ...
Epidemiology of Unintentional Injuries in the African Countries ...
Epidemiology of Unintentional Injuries in the African Countries ...
Epidemiology of Unintentional Injuries in the African Countries ...
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Epidemiology of Unintentional Injuries in the African Countries ...

  1. 1. Epidemiology of Unintentional Injuries in the African Countries “Overview and Control Challenges” Injury Epidemiology Workshop PEERCORPSTrust Fund in collaboration withThe IPIFA/WHO Dar Es Salaam ,Tanzania July 3-5, 2009 Hesham El-Sayed Faculty of Medicine Suez Canal University, Egypt
  2. 2. Global Burden of Injuries  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.
  3. 3. 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).
  4. 4. 75% 50% 25% Africa Americas Eastern Mediterranean Europe South East Asia Western Pacific Deaths, by Broad Cause Group & WHO Region, 2001 Communicable diseases, maternal and perinatal conditions and nutritional deficiencies Noncommunicable conditions Injuries Source: WHR 2002
  5. 5. Global Injury Rates by Age Groups 0 50 100 150 200 250 300 0-4 5_14 15-44 45-69 70+ Per100,000Population Age Group WHO, 2002
  6. 6. Global Causes of Injury Mortality RTI Poisoning Falls Burns Drowning Violence Others Global Injury Mortality (WHO, 2002)
  7. 7. RTI Global Fatalities
  8. 8. Global Road Fatality Trends
  9. 9. 10Source: WHO. Injury – A leading cause of the global burden of disease. . WHO, 2002 DISABILITY ADJUSTED LIFE YEARS (DALYS) LOST DUE TO ROAD TRAFFIC INJURIES, MALES, 2000
  10. 10. Injuries due to Unintentional Falls
  11. 11. Fire-related Burns
  12. 12. Drowning injuries
  13. 13. Unintentional poison-related injuries
  14. 14. Sources of Injury Information “National records from various sources”  Death certificates  Hospital records  Trauma registries  Case reports (Media)  Epidemiological studies  Police data  Industrial reports  Bureau of crime records  NGO’s reports
  15. 15. 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.
  16. 16. 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.
  17. 17. Why limited action against injuries?  Perception of injuries as “Accidents” unpredictable and inevitable.  Reluctance of health professionals to accept that injury prevention is science (work with other sectors).  Lack of ownership (multi-sectoral complexity).  Media focus on key events rather than on relentless daily loss & prefer high technology medicine.  Challenges to powerful vested interests (motor vehicle industry, firearms, big industries).
  18. 18. Why limited policy response to injuries?  Relative neglect, due to Limited awareness of the burden & little evidence of response.  Limited awareness of what can be done.  Limited availability of data necessary for making decisions. (cost, sequences, perception).  Limited public health capacity to highlight the problem, and media focus on key events rather than on relentless daily loss .  Limited resources.  Minimal links between society organizations (e.g., NGOs) and public health community.
  19. 19. 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.
  20. 20. Steps of Developing Injury Control Program 1. Identify size of the injury problem. 2. Determine specific circumstances of injury (risk factors). 3. Identify possible preventive measures. 4. Based on local evidence and research. 5. Taking into account existing social, political, and economic considerations. 6. Prioritize intervention programs: (size of the problems, likelihood of success, constraints, additional benefits). 7. Implement interventions. 8. Evaluate intervention effects.
  21. 21. Essential Features of Successful Injury Control Program Data collection & Analysis Plan goals & Interventions Implement Interventions Monitoring & Evaluation
  22. 22. 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
  23. 23. Steps of Research Utilization Problem Identification Dissemination Research Design Implementation Utilization
  24. 24. Elements of Effective Trauma Care System Pre-hospital: - Call and Care Centers. - Ambulances. -Trained Staff (PHCC & Ambulances) - Sensitized & Trained public & Police or Teachers) Referral Systems: -Transport. -Guidelines. -Training. -Specialized Diagnostics. -Specialized care Rehabilitation System: -Appropriate appliances. -Occupational Therapy. -Physiotherapy. -Work and Home support Hospitals: - Equipments. - Evidence-based Guidelines. -Triage. -Trained staff. -Audit OUTCOMES
  25. 25. Intervention Strategies for Injury Control  Education.  Legislation, regulations and enforcement  Product modification.  Environmental modification.  Supportive home visiting.  Community-based studies.
  26. 26. 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.
  27. 27. 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.
  28. 28. 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).
  29. 29. 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).
  30. 30. WHO/CNISTeach Injury Epidemiology Workshop (Kampala-Uganda 2009)
  31. 31. Injury Control Activities in Egypt
  32. 32. 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 inTrauma 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.
  33. 33. 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 forTraffic Safety.
  34. 34. Efforts for Injury Control in the EMRO Region “The Golden Hour inTrauma Care”
  35. 35. Injury Control Program in Ismailia Schools, Egypt
  36. 36. RoadTraffic Injury Control Seminar Cairo, Egypt (May 18, 2007)

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