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 • 46 countries • Wide variation in size, level of development, resources, population structure • 3 “official” languages French, English, Portuguese
Countries with WHO supported surveillance • Advanced implementation: • Ethiopia • Uganda • Mozambique • Planning stages: • Ghana • Kenya • Expressed interest: • Senegal, Guinea, Rwanda
Results (prelim) of capacity survey • 46 countries surveyed, 35 responded (76%) • Most countries collect fatal & nonfatal injury • Dissemination is by hard copy reports
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
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”)
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 • 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.
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
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 • 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
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 • 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 • 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 • 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 • 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?