Epidemiology of Unintentional Injuries in the African Countries ...
Epidemiology of Unintentional
Injuries in the African Countries
“Overview and Control Challenges”
Injury Epidemiology Workshop
in collaboration withThe IPIFA/WHO
Dar Es Salaam ,Tanzania
July 3-5, 2009
Faculty of Medicine
Suez Canal University, Egypt
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
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
Injuries responsible for >12% of global
burden of disease (DALYs).
Deaths, by Broad Cause Group & WHO Region, 2001
maternal and perinatal conditions
and nutritional deficiencies
Source: WHR 2002
Global Injury Rates by Age Groups
0-4 5_14 15-44 45-69 70+
Global Causes of Injury Mortality
Global Injury Mortality (WHO, 2002)
Sources of Injury Information
“National records from various sources”
Case reports (Media)
Bureau of crime records
Factors Affecting the
Prevalence and Pattern of Injuries
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
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
Newly developed injury surveillance programs that
started in the some countries (Egypt).
Injury surveys conducted in some countries.
Why limited action against injuries?
Perception of injuries as “Accidents” unpredictable
Reluctance of health professionals to accept that
injury prevention is science (work with other
Lack of ownership (multi-sectoral complexity).
Media focus on key events rather than on
relentless daily loss & prefer high technology
Challenges to powerful vested interests (motor
vehicle industry, firearms, big industries).
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 .
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).
Health education & works with legislation.
Public Health Approach:
Surveillance, risk factors, interventions & implementation.
Steps of Developing Injury Control Program
1. Identify size of the injury problem.
2. Determine specific circumstances of injury (risk
3. Identify possible preventive measures.
4. Based on local evidence and research.
5. Taking into account existing social, political, and
6. Prioritize intervention programs:
(size of the problems, likelihood of success, constraints, additional benefits).
7. Implement interventions.
8. Evaluate intervention effects.
Essential Features of Successful
Injury Control Program
Plan goals &
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
Maximum potential of reduction of existing disease
* Child Health and Nutrition Research Initiative
Steps of Research Utilization
Elements of Effective Trauma Care System
- Call and Care
- Sensitized &
& Police or
Intervention Strategies for Injury Control
Legislation, regulations and enforcement
Supportive home visiting.
Global Response to the Injury Problem
Increasing recognition of injuries as priority health
problem, especially RTI.
Acknowledgement of injury targets in MOHP and
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.
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.
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).
for RTI control strategies
Address special factors:
Vulnerable road users:
Pedestrians especially children and older people.
Two wheelers users (bicycles, motorcycles, etc.).
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 inTrauma
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
Establishing emergency medical centers along
Establishing the National Council forTraffic Safety.
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)