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Epidemiology of Unintentional Injuries in the African Countries ...

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  • 1. 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
  • 2. Global Burden of Injuries
    • Injuries caused 5 million deaths worldwide >9% of all deaths (2000)
    • 3. Injuries are the leading causes of death in children <18 years of age.
    • 4. Injuries caused 875,000 deaths among children (<18 years) in the year 2000 (40/100,000).
    • 5. 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.
    • 6. Injuries represent 15-24% of all hospital admissions.
    • 7. 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
  • 8.
  • 9. Global Injury Rates by Age Groups
    WHO, 2002
  • 10. Global Causes of Injury Mortality
    Global Injury Mortality (WHO, 2002)
  • 11. RTI Global Fatalities
  • 12. Global Road Fatality Trends
  • 13. 10
    DISABILITY ADJUSTED LIFE YEARS (DALYS) LOST DUE TO ROAD TRAFFIC INJURIES, MALES, 2000
    Source: WHO. Injury – A leading cause of the global burden of disease. . WHO, 2002
  • 14. Injuries due to Unintentional Falls
  • 15. Fire-related Burns
  • 16. Drowning injuries
  • 17. Unintentional poison-related injuries
  • 18. Sources of Injury Information“National records from various sources”
    • Death certificates
    • 19. Hospital records
    • 20. Trauma registries
    • 21. Case reports (Media)
    • 22. Epidemiological studies
    • 23. Police data
    • 24. Industrial reports
    • 25. Bureau of crime records
    • 26. NGO’s reports
  • 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.
  • 27. 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.
  • 28. Whylimited action against injuries?
    • Perception of injuries as “Accidents” unpredictable and inevitable.
    • 29. Reluctance of health professionals to accept that injury prevention is science (work with other sectors).
    • 30. Lack of ownership (multi-sectoral complexity).
    • 31. Media focus on key events rather than on relentless daily loss & prefer high technology medicine.
    • 32. Challenges to powerful vested interests (motor vehicle industry, firearms, big industries).
  • Whylimited policy response to injuries?
    • Relative neglect, due to Limited awareness of the burden & little evidence of response.
    • 33. Limited awareness of what can be done.
    • 34. Limited availability of data necessary for making decisions. (cost, sequences, perception).
    • 35. Limited public health capacity to highlight the problem, and media focus on key events rather than on relentless daily loss .
    • 36. Limited resources.
    • 37. 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.
  • 38. 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.
  • 39. Essential Features of Successful Injury Control Program
    Data collection
    & Analysis
    Monitoring &
    Evaluation
    Plan goals & Interventions
    Implement
    Interventions
  • 40. 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
  • 41. Utilization
    Dissemination
    Implementation
    Research Design
    Problem Identification
    Steps of Research Utilization
  • 42. Elements of Effective Trauma Care System
    Pre-hospital:
    • Call and Care
    Centers.
    • Ambulances.
    • 43. Trained Staff
    (PHCC &
    Ambulances)
    - Sensitized &
    Trained public
    & Police or
    Teachers)
    Referral
    Systems:
    Diagnostics.
    • Specialized
    care
    Rehabilitation
    System:
    • Appropriate
    appliances.
    • Occupational
    Therapy.
    • Physiotherapy.
    • 47. Work and
    Home support
    Hospitals:
    • Equipments.
    • 48. Evidence-based
    Guidelines.
    OUTCOMES
  • 51. Intervention Strategies for Injury Control
    Education.
    Legislation, regulations and enforcement
    Product modification.
    Environmental modification.
    Supportive home visiting.
    Community-based studies.
  • 52. 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.
  • 53. 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.
  • 54. 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).
  • 55. 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).
  • 56. African Activities for Injury Control
  • 57.
  • 58.
  • 59. WHO/CNIS Teach Injury Epidemiology Workshop (Kampala-Uganda 2009)
  • 60. Injury Control Activitiesin Egypt
  • 61. 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.
  • 62. 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.
  • 63. Efforts for Injury Control in the EMRO Region“The Golden Hour in Trauma Care”
  • 64. Injury Control Program in Ismailia Schools, Egypt
  • 65. Road Traffic Injury Control Seminar Cairo, Egypt (May 18, 2007)
  • 66. THANK YOU