Richard Matzopoulos CRIME, VIOLENCE AND INJURY LEAD PROGRAMME Medical Research Council

1. An overview of fatal injury surveillance in South Africa Cuernavaca, Mexico, 1-2 June 2005 Richard Matzopoulos CRIME, VIOLENCE AND INJURY LEAD PROGRAMME Medical Research Council University of South Africa Institute for Social and Health Sciences Centre for Peace Action

2. National Injury Mortality Surveillance System (NIMSS) • strengths and weaknesses • strategic challenges • future plans for the NIMSS

3. history • 1993 –1995 Cape Town • 1998 – 2 years of DACST funding • national pilot – Gauteng, Durban, CT • 1999 – 1st annual report – Kimberley, PE, EL • 10 mortuaries, 5 provinces • 2000 – 2nd report – Gauteng, PE • 15 mortuaries, 5 provinces • 2001 – 3rd report – Durban, EL, Mpumalanga • 32 mortuaries, 6 provinces

4. Coverage Non-natural mortality 68 930 (MRC Burden of Disease, 2000) 12 to 15 %of all mortality NIMSS 24 600 / 68930 = 36% Rural: 5-6%, Urban: 55-64%

5. Coverage • Mainly urban • Metros - Johannesburg, Durban, Cape Town, Pretoria, Port Elizabeth, Erkhuruleni • Cities – East London/KWT/Bisho, Kimberley • Rural towns • Mpumalanga, Stellenbosch, Potchefstroom, Kroonstad, Nelspruit • 7 out of 9 provinces represented • Warehoused at MRC • Report- generating software

6. External cause Firearm Sharp force Hanging Drowning Demographics Age Population group Sex Forensic info Event Place Blood alcohol

7. External cause of death (N = 22 248)

8. External cause of death among males (N = 17 932)

9. External cause of death among females (N = 4076)

10. Overall apparent manner of death (N = 22 248) Source: National Injury Mortality Surveillance System, 2003

11. Fatal injury rates / 100 000 population

12. Transport User by BAC (n=2953) Transport User by BAC, NIMSS, 2003

13. National Injury Mortality Surveillance System (NIMSS) • strengths and weaknesses • strategic challenges • future plans for the NIMSS

14. strengths and weaknesses • Data quality and coverage  Detailed info on who, what, when, where  Mortuary catchment and population data questionable  (minimised by city coverage)  No gold std for apparent manner of death  Resource for specialised studies Mainly urban - complete datasets for major cities Rural sites difficult to establish and maintain  Representivity  Comparability (correlates with ICD coding) • Sustainability  Standardised (manuals, procedures, storage, reporting)  Cost < $80 000 p.a. (incl staff, reports, media, etc)  widely used / generates considerable publicity – protective factors

15. National Injury Mortality Surveillance System (NIMSS) • strengths and weaknesses • strategic challenges • future plans for the NIMSS

16. strategic challenges • Competing data and interests • StatsSA – national (90%), 16+ yrs, no manner / external CoD • police – national, underreporting, criminal justice, form-based • transport – national, reliant on police, detailed info, substantial underreporting • Sensationalism vs rationalism • Media focus on high rates and not public health utility • DoH and other govt depts feel threatened • Sustainability • Limited funding prevents expansion • Relocation of mortuaries from police to health (turf ?) • Data to action • 3 tiers of government • City focus for 2010 world cup

17. National Injury Mortality Surveillance System (NIMSS) • strengths and weaknesses • strategic challenges • future plans for the NIMSS

18. Focus on cities • city infrastructure • accessible • responsive • well established and centralised documentation of strategies and challenges • coordinated information systems • amenable to personal and consultative interaction • 2003 annual report initial commitment to city focus • National injury profile • City specific rates (Jhb, Durb, CT, Pret) • Separate city-reports (chapters 3-6) • transfer to DoH?

19. Health Facility Regional Home Affairs Office National Home Affairs Office Statistics South Africa Doctor NIMSS data set NIMSS (MRC/UNISA and DoH) DoH Regional co-ordinator Data entry at site / regional? NIMSS resp. in job description MRC/UNISA Data warehouse Report-generation Analytic research City-level prevention Headman NIMSS collection at all mortuaries sites Mortuary Mortuary-specific reports sites City reports National violence and injury prevention NIMSS annual report Safe city initiatives Proposed future location of NIMSS

20. Thank You

21. 8th World Conference onInjury Prevention &Safety Promotion Data to Action - Securing Safety as a right ICC, Durban, South Africa 2 - 5 April 2006 www.safety2006.info

22. Conference Profile:2000 Participants from 131 Countries350 Oral presentations1500 Posters100 Exhibitors Sponsor Co-hosts WorldHealthOrganization Data to Action - Securing Safety as a right

23. Conference Objectives:Translate injury data into prevention actions- Critical review of approachesFoster exchanges in all fields of injury prevention and safety promotionExamine critical applications of injury prevention and safety promotion practices for different regions of the worldStimulate/strengthen injury prevention and safety promotion as central to national, continental & international public health policies and programmesCreate opportunities for multidisciplinary and cross-sectoral dialogue Highlight international injury prevention milestones and possibilities for innovation Data to Action - Securing Safety as a right

24. Data to Action - Securing Safety as a right For more information visit www.safety2006.info See you at ICC, Durban, South Africa from 2 - 5 April 2006