WHO supported Injury Surveillance in Africa

1
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

2
AFRO at a glance

• 46 countries
• Wide variation in size, level of development,
  resources, population structure
• 3 official languages French, English, Portuguese

3
Countries with WHO supported surveillance

• Advanced implementation
• Ethiopia
• Uganda
• Mozambique
• Planning stages
• Ghana
• Kenya
• Expressed interest
• Senegal, Guinea, Rwanda

4
Results (prelim) of capacity survey

• 46 countries surveyed, 35 responded (76)
• Most countries collect fatal nonfatal injury
• Dissemination is by hard copy reports

5
Mozambique

• Injury Surveillance started in 2000
• Surveillance sites ( City of Maputo - all
  Provincial and Central hospitals n4)
• 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

6
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 a list with
  definitions of terms used for mechanism of
  Injury)

7
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.

8
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.

9
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

10
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.

11
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

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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.

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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 shouldnt 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?