Multinational Injury Surveillance Pilot Project in Africa MISPP

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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

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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)

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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

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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

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Multinational Injury Surveillance Study

• 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.

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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

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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.

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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.

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Multinational Injury Surveillance Project

• Results

64.5
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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.

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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

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Evaluation Completeness

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

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Evaluation Completeness

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

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Multinational Injury Surveillance Study

• Begun March 1, 2007
• Retrospective data collection to Jan. 1, 2007
• Gradual increase per month

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Multinational Injury Surveillance Study

• Implementation Completeness Summary

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Multinational Injury Surveillance Project
DEMOGRAPHICS Sex

• Road Traffic Injury (RTI)

• Interpersonal violence (IPV)

11 cases with missing information
4 cases with missing information
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Multinational Injury Surveillance Project
DEMOGRAPHICS Age

• Interpersonal violence (IPV)

• Road Traffic Injury (RTI)

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Multinational Injury Surveillance Project
EVENT DATA Place

• Interpersonal violence (IPV)

• Road Traffic Injury (RTI)

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Multinational Injury Surveillance Project
EVENT DATA Activity

• Interpersonal violence (IPV)

• Road Traffic Injury (RTI)

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Multinational Injury Surveillance Project
IPV Mechanism
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Multinational Injury Surveillance Project
IPV CONTEXT
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Multinational Injury Surveillance Project
IPV Relationship
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Multinational Injury Surveillance Project
IPV Sex of perpetrator
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Multinational Injury Surveillance Project
RTI Mode of Transport
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Multinational Injury Surveillance Project
RTI Road User
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Multinational Injury Surveillance Project
RTI Counterpart
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Multinational Injury Surveillance Project
CLINICAL DATA Anatomic site

• Interpersonal violence (IPV)

• Road Traffic Injury (RTI)

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Multinational Injury Surveillance Project
SWOT ANALYSIS

• 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

SWOT Strengths, Weaknesses, Opportunities,
Threats
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Multinational Injury Surveillance Project
SWOT ANALYSIS

• 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.

SWOT Strengths, Weaknesses, Opportunities,
Threats
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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.