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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

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

afro at a glance
AFRO at a glance
  • 46 countries
  • Wide variation in size, level of development, resources, population structure
  • 3 “official” languages French, English, Portuguese
countries with who supported surveillance
Countries with WHO supported surveillance
  • Advanced implementation:
    • Ethiopia
    • Uganda
    • Mozambique
  • Planning stages:
    • Ghana
    • Kenya
  • Expressed interest:
    • Senegal, Guinea, Rwanda
results prelim of capacity survey
Results (prelim) of capacity survey
  • 46 countries surveyed, 35 responded (76%)
  • Most countries collect fatal & nonfatal injury
  • Dissemination is by hard copy reports
mozambique
Mozambique
  • 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
mozambique6
Mozambique
  • 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”)
mozambique7
Mozambique
  • 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.
ethiopia
Ethiopia
  • 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.
ethiopia9
Ethiopia
  • 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
ethiopia10
Ethiopia
  • 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.
uganda
Uganda
  • 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
uganda12
Uganda
  • 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.
general challenges
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
lessons learnt
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.
lessons learnt 2
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)
other comments
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?