# Presentation: 529557

## 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

**Notes:**
Nigeria has more than 124 million population, with a life expectancy at birth of 45. Seychelles has 81,000, and life expectancy at birth of 72. 

## Countries with WHO supported surveillance

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

**Notes:**
Nigeria has more than 124 million population, with a life expectancy at birth of 45. Seychelles has 81,000, and life expectancy at birth of 72. 

## Results (prelim) of capacity survey

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

**Notes:**
Others: 8 = not known, 1 = no classification system in use, 1 = no response

## 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.

**Notes:**
For example for WHD there was specific request on statistics on RTIs. Special reports were prepared for the media when requested. The first report by MOH from the surveillance system was presented at MOH in October 04. A full 2004 report is currently under preparation. 

## 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?