# Presentation: 441582

**Hospital-based Injury Surveillance System (HBISS) **
**in Nicaragua**** **
***Julio Rocha***
***Francisco Tercero***

**Notes:**
Buenas tardes, señores y señoras ministros de Salud de la Región centroamericana, Haiti, y Dominicana.es un honor poder compartir este tiempo con uds.
Gracias por la oportunidad que nos brindo EPO- Division de Salud International y 
El equipo :
 Mark Anderson, jefe de proyecto
Sandra Berrios 
Carme Clavel Arcas, nica española, becaria internacional CDC Division de Prevención y Control de las Lesiones. Profesores míos escuela 

## 			CONTENT

**Background**
**Process**
**Results**
**Evidence-based decision making**
**Next steps and challenges**

## Epidemiology Transition in Nicaragua

**Epidemiology Transition in Nicaragua**
- Before the Revolution:		**Infectious diseases**
**  ****(Before 1979)**
- During the Revolution: 	**War-related injuries**
**  ****(1979-1990)**
- After the Revolution: 		**Noncommunicable and                **
**  ****(1990-Present)****	****	****	****Injuries**

***BACKGROUND***

## Technical Support on Injury Surveillance:

**Technical Support on Injury Surveillance:**
**During 1990-1995 (only in Leon):**
**Social Medicine, KI (SAREC)**
**  ****Academic but not institutional support.**
**During 2000-2005 (National level):**
**CDC, PAHO, with SAREM support.**
**  ****Aimed to strengthen the Ministry of Health capacity **
**  ****buildings.**

***BACKGROUND***

## Injury surveillance approaches in Leon, Nicaragua 

| APPROACHES | SCOPE | YEAR |
| --- | --- | --- |
| Exploratory analysis
of  injury data
 | All injuries | 1998 |
| Hospital-Based    | All injuries
Self-inflicted
Work-related injuries | 1999
2004
2005
 |
| Population-Based | Domestic Violence
All injuries | 2000
2005
 |
| Capture-Recapture  | Traffic-related injuries | 2004 |

**Injury surveillance approaches in Leon, Nicaragua**

***BACKGROUND***

## 			PROCESS

**	****	****	*****PROCESS***
**Advocacy for interdisciplinary support **
**for Injury Prevention and Control**
**Minister and vice-Minister of Health**
**Forensic Institute**
**Mayors**
**NGOs: Networking with woman and young people.**
**University**
**Police**

## 			PROCESS

**The Training Program included:**
**A user’s manual on HBISS.**
**Series of workshops on injury registration and **
**  ****data analysis (External trainers).**
**Epi Info training to data entry and Epidemiologist.**

## 		PROCESS

**Monitoring included:**
**Capture of cases.**
**Quality of data.**
**Completeness and timeliness of case reports.**

## 		RESULTS

**Dissemination of injury data:**
**National and International publications.**
**International Conferences.**
**Training.**
**Feedback with local autorities.**

## Results from the Hospital-based 

| Hospitals | Proportion of Injuries | Hospitalization rate (%) | Case fatality ratio (%) |
| --- | --- | --- | --- |
| Managua (Adults) | 23 | 8 | 1.4 |
| Managua (Children) | 19 | 7 | 0.07 |
| Carazo (General) | 15 | 17 | 0.2 |
| Leon (General) | 18 | 4 | 0.4 |
| Jinotega (General) | 4 | 70 | 2.2 |
| TOTAL | 18 | 12 | 0.8 |

**Results from the Hospital-based **
**Injury Surveillance System, Nicaragua, 2003-2004**

## Proportion of injuries by intent and sex.

| Intent | Female | Male | Total
(n=37,134) |
| --- | --- | --- | --- |
| Self-inflicted | 2.1 | 0.9 | 1.3 |
| Intentional | 6.8 | 17.5 | 13.9 |
| Unintentional | 89.9 | 79.9 | 83.3 |
| Total | 33.7 | 66.3 | 100.0  |

**Proportion of injuries by intent and sex.**
**Nicaragua, 2003-2004.**

## Proportion of injuries by intent and age.

| Intent | < 15 | 15-29 | 30-44 | 45-64 | ≥ 65 | Total
(n=38,034) |
| --- | --- | --- | --- | --- | --- | --- |
| Self-inflicted | 0.3 | 2.7 | 1.3 | 0.6 | 0.3 | 1.3 |
| Intentional | 2.6 | 26.0 | 21.8 | 10.2 | 3.5 | 13.9 |
| Unintentional | 96.3 | 69.3 | 74.8 | 87.5 | 94.6 | 83.3 |
| Total | 38.1 | 32.3 | 15.8 | 9.5 | 4.4 | 100.0 |

**Proportion of injuries by intent and age.**
**Nicaragua, 2003-2004.**

## Proportion of injuries by mechanism and sex.

| Mechanism | Female | Male | Total
(n=38,343) |
| --- | --- | --- | --- |
| Falls | 43.4 | 31.1 | 35.2 |
| Struck by, against | 18.4 | 26.3 | 12.5 |
| Cuts/stabs | 7.2 | 15.2 | 12.4 |
| Traffic | 10.6 | 13.3 | 12.4 |
| Foreign body | 8.9 | 5.5 | 6.7 |
| Poisoning | 4.2 | 1.9 | 2.7 |
| Burns | 2.8 | 1.9 | 2.2 |
| Bites | 2.2 | 1.7 | 1.9 |
| Firearms | 0.2 | 1.2 | 0.9 |
| Strangulation | 0.0 | 0.1 | 0.1 |
| Total | 33.7 | 66.3 | 100.0  |

**Proportion of injuries by mechanism and sex.**
**Nicaragua, 2003-2004.**

## Proportion of injuries by mechanism and age.

| Mechanism | < 15 | 15-29 | 30-44 | 45-64 | ≥ 65 | Total
(n=38,239) |
| --- | --- | --- | --- | --- | --- | --- |
| Falls | 48.1 | 20.3 | 24.5 | 39.6 | 61.4 | 35.2 |
| Struck by, against | 16.0 | 31.2 | 29.9 | 23.0 | 13.2 | 12.5 |
| Cuts/stabs | 6.9 | 19.4 | 14.6 | 10.5 | 6.9 | 12.4 |
| Traffic | 9.8 | 14.1 | 16.1 | 12.6 | 8.1 | 12.4 |
| Foreign body | 9.9 | 4.2 | 5.6 | 5.7 | 3.5 | 6.7 |
| Poisoning | 2.6 | 3.6 | 2.1 | 1.7 | 1.3 | 2.7 |
| Burns | 3.4 | 1.5 | 1.6 | 1.4 | 1.0 | 2.2 |
| Bites | 2.2 | 1.5 | 1.7 | 2.1 | 2.1 | 1.9 |
| Firearm | 0.2 | 1.8 | 1.2 | 0.6 | 0.1 | 0.9 |
| Suffocation | 0.0 | 0.1 | 0.0 | 0.0 | 0.0 | 0.1 |
| Total | 38.2 | 32.3 | 15.7 | 9.4 | 4.4 | 100.0 |

**Proportion of injuries by mechanism and age.**
**Nicaragua, 2003-2004.**

## Proportion of injuries by mechanism and intent.

| Mechanism | Self-inflicted | Intentional | Unintentional | Total
(n=38,335) |
| --- | --- | --- | --- | --- |
| Falls |  | 0.3 | 99.5 | 35.2 |
| Struck by,against | 0.1 | 36.2 | 62.5 | 12.5 |
| Cuts/stabs | 0.7 | 35.6 | 62.5 | 12.4 |
| Traffic |  |  | 100.0 | 12.4 |
| Foreign body |  |  | 99.9 | 6.7 |
| Poisoning | 40.6 | 0.6 | 57.7 | 2.7 |
| Burns |  | 2.0 | 97.4 | 2.2 |
| Bites |  | 4.7 | 85.7 | 1.9 |
| Firearm | 2.3 | 72.9 | 19.5 | 0.9 |
| Suffocation | 72.7 | 9.1 | 18.2 | 0.1 |
| Total | 1.3 | 14.1 | 83.1 | 100.0 |

**Proportion of injuries by mechanism and intent.**
**Nicaragua, 2003-2004.**

## Proportion of injuries by intent and severity.

| Intent | Minor | Moderate | Severe | Total
(n=37,106) |
| --- | --- | --- | --- | --- |
| Self-inflicted | 15.3 | 56.4 | 28.2 | 1.3 |
| Intentional | 44.1 | 51.4 | 4.6 | 14.4 |
| Unintentional | 52.9 | 45.2 | 1.9 | 82.7 |
| Total | 51.2 | 46.2 | 2.6 | 100.0  |

**Proportion of injuries by intent and severity.**
**Nicaragua, 2003-2004.**

## Proportion of injuries by mechanism and severity.

| Mechanism | Minor | Moderate | Severe | Total
(n=37,014) |
| --- | --- | --- | --- | --- |
| Falls | 44.7 | 51.5 | 1.1 | 35.2 |
| Struck by, against | 57.1 | 41.5 | 1.4 | 12.5 |
| Cuts/stabs | 45.0 | 52.2 | 2.8 | 12.4 |
| Traffic | 46.1 | 48.6 | 5.3 | 12.4 |
| Foreign body | 85.0 | 14.7 | 0.3 | 6.7 |
| Poisoning | 40.1 | 47.2 | 12.8 | 2.7 |
| Burns | 30.4 | 59.4 | 10.2 | 2.2 |
| Bites | 56.3 | 42.6 | 1.0 | 1.9 |
| Firearm | 20.3 | 57.4 | 22.4 | 0.9 |
| Suffocation | 18.2 | 68.2 | 13.6 | 0.1 |
| Total | 51.2 | 46.2 | 2.6 | 100.0  |

**Proportion of injuries by mechanism and severity.**
**Nicaragua, 2003-2004.**

## A broad evaluation of the HBISS in Nicaragua, 2003-2004.

| ATTRIBUTES | SCORE |
| --- | --- |
| Simplicity | +++ |
| Flexibility | +++ |
| Acceptability | +++ |
| Reliability | + |
| Usefulness | +++ |
| Sustainability | ++ |
| Timeliness | +++ |

**A broad evaluation of the HBISS in Nicaragua, 2003-2004.**

## 	Evidence-Based Decision Making

**Injuries were included in the National Plan of Health (2004-2015)**
**The notification of injuries are compulsory (2005).**
**Injury prevention in the agenda of three municipalities:**
**Violence**
**Suicide**
**Traffic**
**To calculate injury cost to measure the burden of injuries (2003).**

## 	Next steps and challenges

- To improve the quality of the HBISS.
- To standardize injury severity indicators to monitor
-   properly the impact of intervention measures.
- To guarantee the sustainability of the HBISS.
- The needs to institutionalize within the Ministry of
-   Health a National Injury Prevention Program.

## 	Acknowledgements

**To all members of the hospitals that are involved in the**
**hospital-based injury surveillance systems. **

## Julio Rocha

***Julio Rocha***
**Email: **_[injury12003@yahoo.com](mailto:injury12003@yahoo.com)_
**Web site http://www.minsa.gob.ni**
***Francisco Tercero***
**Email: **_[cidsft@yahoo.es](mailto:cidsft@yahoo.es)_
**Web site http:// www.cids.edu.ni**