INJURY STATISTICS AND CONTROL PROGRAM IN EGYPT Strengths

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INJURY STATISTICS AND CONTROL PROGRAM IN
EGYPTStrengths Weaknesses

• Dr. Hesham Fathey El-Sayed
• Faculty of Medicine
• Suez Canal University, Egypt

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Steps of developing injury control program

• Identify size of the injury problem.
• Determine specific circumstances of injury (risk
  factors).
• Identify possible preventive measures.
• Prioritize intervention programs
• (size of the problems, likelihood of success,
  constraints, additional benefits).
• Implement interventions.
• Evaluate intervention effects.

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Essential features of successful injury control
program
Data collection Analysis
Monitoring Evaluation
Plan goals Interventions
Implement Interventions
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Sources of Injury Information National records
from various sources

• Death certificates
• Hospital records
• Trauma registries
• Case reports (Media)
• Epidemiological studies
• Police data
• Industrial reports
• Bureau of crime records
• NGOs reports

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Size of Injury Problem in Egypt (Death
certificates, CAPMAS)

• Fifth leading cause of death
• (4 of deaths).
• 16,000 deaths from injuries in 2002
  (25/100,000).
• 15 Disability adjusted life years lost (DALYs).

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Causes of Injury Mortality in Egypt (CAPMAS 1997)
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AGE DESTRIBUTION DEATH RATE OF INJURY DEATHS
Death Rate / 100,000 Population
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Distribution of Road Traffic Fatalities by Mode
of Transport
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Weaknesses of the Egyptian Injuries Death Records

• 25 of the reported injury deaths had
  unidentified cause (CAPMAS, 1997).
• (Verbal Autopsy Study- Hamam Elsayed 1999)
• Injury deaths were misclassified as other causes
  than injuries in 26 of injury deaths
• Under-registration of RTA is 46 in vital
  statistics of Ministry of Health, and 57 in
  traffic police records (Capture Recapture
  Method).
• Estimated injury death rate in Egypt estimated as
  43/100,000 instead of the reported rate of
  32/100,000.

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Size of Injury Problem in Egypt (Cont.) (Hospital
Records)

• 45 injuries need hospital admission and 1300
  injuries requiring ambulatory care for every
  injury death.
• 15-24 of all hospital admissions.
• Third cause of disease burden after ARI and GIT
  diseases.

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Strengths Weaknesses of the Health Facilities
Injuries Records in Egypt

• The Newly developed Injury Registry Program in
  the MOHP (2002).
• Injury surveys conducted in different parts of
  the country (Universities MOHP).
• Registry program did not include all health
  facilities, and even University Hospitals.
• Poor recording system in most of the health
  facilities, even university hospitals (40
  unidentified cause of trauma) (El-Sayed et,al,
  2001).

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Why limited action against injuries?

• Perception of injuries as Accidents
  unpredictable and inevitable.
• Reluctance of health professionals to accept that
  injury prevention is science (work with other
  sectors).
• Lack of ownership (multi-sectoral complexity).
• Media focus on key events rather than on
  relentless daily loss prefer high technology
  medicine.

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Why limited action against injuries? (Cont.)

• Lack of acknowledgement of what can be done by
  society.
• Challenges to powerful vested interests (motor
  vehicle industry, firearms, big industries).
• Social choices (transport, profits, work
  safety).
• Advocacy and civil society organizations.

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Why limited policy response to injuries?

• Relative neglect, due to Limited awareness of the
  burden little evidence of response.
• Limited awareness of what can be done.
• Limited availability of data necessary for making
  decisions cost, sequences, perception.
• Limited public health capacity to highlight the
  problem.
• Limited resources.
• Minimal links between society organizations and
  public health community.

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Scope for the Response to Injuries

• Change thinking about injuries to scientific
  approach as preventable health problem.
• Scientific bases for injury prevention
• Structural framework of time and vector, host and
  environment (Haddons matrix).
• Risk response
• Health education works with legislation.
• Public Health Approach
• Surveillance, risk factors, interventions
  implementation.

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Intervention Strategies for Injury Control

• Education.
• Legislation.
• Product design.
• Environmental Modification.
• Taxation.

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Egyptian Response to the Injury Problem

• Increasing recognition of injuries as priority
  health problem in Egypt.
• Acknowledgement of injury targets in MOHP and
  Universities programs.
• Recognition of injuries as manifestation of
  inequalities (political pressure).
• Working with International Organizations
• MOHP/WHO/EMRO RTI Health Day 2004, Injury
  Surveillance Program, International Injury
  Control Meetings, IPIFA, Safe Community project,
  NGOs.)
• But limited action Few additional resources.

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Egyptian Efforts for Injury Control (Cont.)

• Road traffic injuries
• Legislations New more stringent traffic law
  (Speed control, Mandatory use of car seat belts
  and helmets).
• Passive or poor enforcement.
• Road design and traffic calming measures.
• Limited application.
• Poor designs in parts of the country.
• Unsafe roads and hostile environment (no
  cross-road sites for pedestrians, high or engaged
  pavements).

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Elements of Effective Trauma Care System

• Pre-hospital
• Call and Care
• Centers.
• Ambulances.
• Trained Staff
• (PHCC
• Ambulances)
• - Sensitized
• Trained public
• Police or
• Teachers)

• Referral
• Systems
• Transport.
• Guidelines.
• Training.
• Specialized
• Diagnostics.
• Specialized
• care

• Rehabilitation
• System
• Appropriate
• appliances.
• Occupational
• Therapy.
• Physiotherapy.
• Work and
• Home support

• Hospitals
• Equipments.
• Evidence-based
• Guidelines.
• Triage.
• Trained staff.
• Audit

OUTCOMES
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Egyptian Activities for RTI Control

• National campaign on RTI by MOHP (1997).
• Decree for free emergency care by private and
  investment hospitals.
• Establishing emergency medical centers along
  highways.
• Forming the National Council for Traffic Safety.
• Universities and MOH programs and courses for
  Emergency and Injury care (ATLS, ACLS).

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Injury Control Program of MOHP

• 1- Standardization of registration
• 2- Training medical professionals and health
  workers on registration and data management.
• 3- Training primary health care workers on Injury
  control and prevention programs

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Injury Control Program of MOHP (2)

• 4- Training health workers at emergency
  departments and ambulance services (life saving
  centers) on secondary and tertiary prevention
  programs.
• 5- Development of emergency and curative care
  facilities.
• 6- National road injury control campaign in 1997
  with other concerned ministries.

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Injury Control Program of MOHP (3)

• 7- Implementation of injury surveillance system
  at the national level.
• 8- MOHP collaboration with WHO on the development
  of program for safety promotion and injury
  surveillance.
• 9- Printing safety awareness posters and
  guidelines for kids and families
• 10- Safety awareness signs on high ways in
  collaboration with Ministry of Transport.

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Egyptian Efforts for RTI Control Golden hour
in trauma care for PHC physicians
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Injury Control Program in Ismailia Schools, Egypt
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Recommendations for RTI control strategies

• Based on local evidence and research.
• Taking into account existing social, political,
  and economic considerations.
• Legislations that should
• Convince the public.
• Enforcement, swiftness and severity..
• Attitude of law enforcement personnel.

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Recommendations (Cont.) for RTI control
strategies

• Address special factors
• Urban development.
• Vulnerable road users
• Pedestrians especially children and older people.
• Two wheelers users (bicycles, motorcycles, etc.).
• Public transport.
• Poor communities (equity challenges).

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Recommendations (Cont.) for Injury Control

• Training of medical staff and the public on
  injury care
• Train all hospitals medical staff including
  physicians, nurses, and paramedics.
• Train PHC physicians, nurses, and paramedics.
• Training of the public and first respondents
  (i.e., Policemen, teachers, drivers).