Who supported injury surveillance in africa
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Surveillance sites: ( City of Maputo - all Provincial and Central hospitals n=4) ... Data were channeled from the hospitals to the health bureau. ...

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WHO supported Injury Surveillance in Africa

Dr. Olive C. Kobusingye, WHO/AFRO

Ms. Kidist Bartolomeos, WHO Mozambique

Ms. Malin Ahrne, WHO Ethiopia

Dr. Muluken Melese, WHO Ethiopia

Mr. Milton Mutto, ICC-U Uganda

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AFRO at a glance

  • 46 countries

  • Wide variation in size, level of development, resources, population structure

  • 3 “official” languages French, English, Portuguese

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Countries with WHO supported surveillance

  • Advanced implementation:

    • Ethiopia

    • Uganda

    • Mozambique

  • Planning stages:

    • Ghana

    • Kenya

  • Expressed interest:

    • Senegal, Guinea, Rwanda

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Results (prelim) of capacity survey

  • 46 countries surveyed, 35 responded (76%)

  • Most countries collect fatal & nonfatal injury

  • Dissemination is by hard copy reports

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  • Injury Surveillance started in 2000

  • Surveillance sites: ( City of Maputo - all Provincial and Central hospitals n=4)

  • System used (ICECI based- code for mechanism adapted after evaluation)

  • Method of data capture: log books, if “reason for visit” is an injury

  • Personnel that collect data: registration clerks

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  • Data storage (on logbook and summary table into a computer)

  • Data analysis ( 2 hospitals have computerized data entry and analysis, 2 hospitals do analysis by hand and send summary table to MOH. Compilation by MOH)

  • Software (Originally was Epi-info and now looking to change to Excel )

  • Reference manual (None; staff use alist with definitions of terms used for “mechanism of Injury”)

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  • Data interpretation, reporting, dissemination

    • Until July 2004, data was collected only at 1 hospital (Maputo Central Hospital)

    • Data was compiled and used for daily and monthly hospital statistics, and was sent to hospital director and MOH as requested

    • Since July 2004, system expanded to the 3 hospitals in Maputo. All hospitals prepare their own reports and send to MoH for compilation.

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  • The pilot started in 2003. The integrated DHIS with the new free software started late 2004.

  • Data were channeled from the hospitals to the health bureau.

  • The health bureau analyzed and prepared the report.

  • Regional reports are also sent to the Federal MOH.

  • With the new free software, data are collected from health posts, health centers and hospitals. The information flow is the same as above.

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  • Surveillance sites:Government Health posts, health centers and hospitals

  • Classification system:ICD 6 with additional codes for injuries

  • Method of data capture: Log book filled by health workers and then entered into computer by data entry clerks

  • Data storage:Paper copies and software

  • Data analysis:After the trial period with the new software, each level should analyze their own data

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  • Data interpretation, reporting, dissemination:

    • It is tried only in the Addis Ababa health Bureau for the time being and after the trial it will be replicated to the other Federal States.

    • The dissemination and the frequency of reporting is not yet decided.

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  • Pilot surveillance began in 1996 at a district hospital

  • The Injury Control Center – Uganda trained staff, compiled data, analyzed it, interpreted it, and made reports

  • Reports shared with multi-sectoral group, in addition to MOH

  • Expanded to 2 hospitals late 1997

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  • Surveillance sites: now 4 regional & 1 National hospitals

  • Classification system: ICD 10 with modification

  • Method of data capture: paper copies filled by health workers. ICC-U still does entry and analysis

  • Data storage: Paper copies and computer database

  • Data analysis: computerized with Stata 8 & Epi Info 3.3

  • Since 2003, injuries also reported by all health units as part of Integrated Disease surveillance.

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General challenges

  • No budget for injury surveillance

  • Incomplete collection at health unit level.

  • Lack of trained personnel for data entry and analysis.

  • Health care system understaffed and overloaded.

  • Software problems

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Lessons learnt

  • More budget needed

  • More training the human resources before undertaking surveillance

  • More consultations from experts during software development,

  • Start small, learn from it and expand.

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Lessons learnt 2

  • For a surveillance system to be effective and useful in a setting like African hospitals it needs to be flexible.

  • Needs to be designed at the level of the staff that will be involved

  • Data collection shouldn’t be an added task, but integrated as much as possible with the daily routine of the staff

  • Needs buy in from management as well as MOH (hospital and ED directors)

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Other comments

  • Data collection VS Surveillance : sometimes leads to confusion. At what level is it considered surveillance??

  • There appears to be a catch 22: if MOH is not interested, injury surveillance could be done by interested individuals and agencies – it might get done well, but results not get used. But it may take a very long time to get MOH interested. What do you do in the meantime?