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 a list 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 The integrated DHIS with the new free software started late 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?