INJURY SURVEILLANCE TRAINING MANUAL 

ANSWERS TO EXERCISES 

SESSION II

ASSESS INJURY DATA SOURCES AND 

DESCRIBE THE INJURY PROBLEM 

Developed with the support of the 

National Center for Injury Prevention and Control 

Division of International Health, Epidemiology Program Office 

Centers for Disease Control and Prevention 

Atlanta, GA 
Page 8: 

Exercise 1. 

Data sources existing in the region (strengths and weaknesses):

Possible Data Sources in the Region 

Injury Data Sources in the Region Possible Injury Data Sources Strengths Weaknesses 

Police/Law Enforcement 

Public Health 

Forensic Medicine 

Coroner/Medical Examiner 

District Attorney 

Transportation Office 

Emergency Departments 

Vital Statistics Office 

Nongovernmental Offices (NGO) 

Newspapers 

Possible Answers: 

Strengths: a. They have available information 

 b. Data collected are reliable 

 c. The coverage area is the city 

 Weaknesses: a. The information is not systematized 

 b. The codes used are different than the health codes 

 c. The information is available each three months 

Page 10: 

Discussion: 

 Initiate discussion by asking the following questions: 

1. If one person is hospitalized because of an injury and later dies in another 

another hospital in another city or state : 

 a. Where must the death certificate be filed? 

b. Where should the investigation about the perpetrator 

 and circumstances be conducted? 

 c. Where the case must be counted? 
Possible Answers: 

a. The death certificate would be filed in the last hospital, 

 where the person died. 

b. The investigation would be conducted in the city where 

 the event occurred. The police or forensic medicine 

 department should report the case in the city where the 

 event occurred. 

c. The case would be counted for vital statistics purposes 

 in the place of residence of the victim and for prevention 

 purposes in the place where the event occurred. 

Page 12: 

Discussion: 

 Select one participant to draw on the board the process that is 

 followed when an injury death occurs in the city: 

a. What do the police do? 

b. What does the forensic office do? 

c. What does the health sector do? 

d. What does the district attorney do? 

e. What does the coroner/medical examiner do? 

 f. What do the relatives do? 
Possible Answer: Victim at Scene 

 

Victim at forensic office 

Vital statistics office receives the 

death certificate 

Victim is buried 

Forensic medicine/coroner/medical 

examiner performs the necropsy, 

determines the cause and nature of 

death, and prepares the death certificate 

District attorney 

investigates circumstances, 

cause of death, and victim 

Police arrive on the scene first, 

collect preliminary data, and 

notify relevant officials 

Public health department 

receives a copy of the death 

certificate 

Page 14:

Discussion: 

Divide the class into two groups and ask them which data source they will select for 

each one of the events in the Table 2. 

a. Fatal injuries 

b. Nonfatal injuries 

Possible Answers: 

a. Fatal injuries: police, forensic medicine, health statistics 

b. Nonfatal injuries: data from emergency department, police, 

forensic medicine, nongovernmental organizations (NGOs), etc. 

Which data source is more appropriate to provide information for the injury 

surveillance system? 

a. Fatal injuries: forensic medicine 

b. Nonfatal injuries: emergency department 
Page 16: 

Exercise: 

Prepare a table with the frequency of the 10 or 15 leading causes of death in the 

region (similar to Table 3). If local data are not available, use the data provided on 

the CD-ROM . 

Possible Answer: 

Leading Causes of Death in Colombia — 1999 

Rank Cause of Death Number 

 1 Homicide and Sequelae 25,855 

 2 Ischemic Heart Disease 21,908 

 3 Cerebrovascular Diseases 13,393 

 4 Chronic Lower Respiratory Diseases 9,452 

 5 Accidents (Unintentional Injuries) and Sequelae 7,624 

 6 Diabetes Mellitus 6,801 

 7 Hypertensive Diseases 5,490 

 8 Acute Respiratory Diseases 5,277 

 9 Perinatal Diseases 4,790 

10 Malignant Neoplasm 4,487 

11 Digestive System Disease 4,483 

12 Stomach Tumor 4,112 

13 Cardiac Insufficient 3,902 

14 Undetermined Cause 3,632 

15 All Other Causes 62,357 

Total 183,563 

Source: National Department of Statistics – DANE - Colombia 

Page 17: 

Discussion: 

Initiate the discussion by showing injury deaths in the United States and Cali, 

Colombia. Ask the following questions: 

a. Are there differences in injury mortality characteristics? 

b. Are the data comparable? 

c. Which indicator (s) will you use to compare these data? 

Possible Answers: 

a. Yes, there are differences. Violence-related deaths 

accounted for more than 20,000 deaths in Cali. In 

the United States, unintentional deaths accounted 

for almost 100,000 cases. 
 b. The data are not comparable, because the first data set 

corresponds to a country, and the second to a city. The 

denominators are also very different: 350 million for the 

United States and around 2 million for Cali. 

c. It would be better to compare the United States with all 

of Colombia and use adjusted rates. Another approach 

could be to compare Cali with a city in the United States 

that has a similar population, and use crude or adjusted 

rates. 

Page 19: 

Exercise: 

Calculate frequencies with injury data from sources such as: Police, Forensic 

Medicine and Public Health. Summarize the data for major injury categories: 

homicide, suicide, motor vehicle-related, and other unintentional deaths. 

Compare the results. 

Answer the following questions: 

a. Are there some differences among the data from 

different sources? 

b. Which events have more discrepancies? 

c. If discrepancies are found, explain why there may be 

differences? 

Possible Answer Using hypothetical Data from “Alarca City:” 

Tables similar to Table 5 from Session II: 

a. Injury Mortality Reported by the Police Department 

Alarca City — 2000 

Intent Cause of Injury Frequency 

Motor Vehicle-Related 1,229 

Other Unintentional Deaths

Drowning 149 

Falls 169 

Poisoning 158 

Electric Shock 10 

Burns 15 

Firearms 35 

Unintentional Deaths 

Blunt Trauma 26 

Homicides 2,696 Violence-Related 

Deaths Suicides 415 

Total 4,902 
b. Injury Mortality Reported by the National Statistics Office 

Alarca City — 2000 

Intent Cause of Injury Frequency 

Motor Vehicle-Related 1,347 

Other Unintentional Deaths

Drowning 318 

Falls 271 

Poisoning 154 

Burns 25 

Unintentional Deaths 

Firearms 26 

Violence-Related Homicides 2,430 

Deaths Suicides 655 

Legal Intervention 2 

Undetermined 20 

Total 5,248 

Compare the Data Among Data Sources: 

Intent Cause of Injury Police Department National Statistics Office 

Motor-Vehicle Related 1,229 1,347 

Other Unintentional Deaths

Drowning 149 318 

Falls 169 271 

Poisoning 158 154 

Electric Shock 10 

Burns 15 25 

Firearms 35 26 

Unintentional 

Deaths 

Blunt Trauma 26 

Homicides 2,696 2,430 

Suicides 415 635 Violence-Related 

Deaths 

Legal Intervention 2 

Undetermined 20 

Total 4,902 5,248 
Answers: 

a. Yes, there are differences in almost all causes—and especially 

in cases of homicide and motor vehicle-related injuries. 

b. The statistical office receives the death certificates from the 

forensic office and the physician, and it may not immediately 

send all death certificates. Another explanation is that not all 

deaths have death certificates. The police department may not 

report undetermined deaths and those caused by legal 

intervention. 

 
INJURY SURVEILLANCE TRAINING MANUAL 

ANSWERS TO EXERCISES 

SESSION III 

BUILD A COALITION TO SUPPORT THE 

INJURY SURVEILLANCE SYSTEM AND 

PREVENTION ACTIVITIES 

Developed with the support of the 

National Center for Injury Prevention and Control 

Division of International Health, Epidemiology Program Office 

Centers for Disease Control and Prevention 

Atlanta, GA 
Page 4: 

Questions for Discussion: 

1. What does “coalition” mean to you? 

2. What are some other names for a coalition? 

3. Do you think it’s important to have a coalition to support the injury 

surveillance system and prevention activities? 

Possible Answers: 

1. People meet to agree on goals. 

2. Group, meeting, committee, council, stakeholders. 

3. A coalition can help to get resources or staff for the injury surveillance 

system and prevention activities. 

Conclusions: 

When the injury surveillance system begins to get data and results, the coalition will 

be very important for defining prevention strategies. 

Page 9: 

Questions for Discussion: 

1. What institutions in your region are working in injury prevention 

and control? 

2. What kinds of programs or projects do they have? 

Possible Answers: 

1. NGOs, international organizations, local groups, community groups, etc. 

2. They work with women, families, youth, neighborhood residents, etc. 

Conclusions: 

Summarize the information about the institutions or organizations working in injury 

control and prevention and the area of interest. 
Page 10: 

Questions for Exercise in Your City or Country: 

1. Is it socially acceptable for a husband to hit his wife? 

2. What is the relationship between the mayor and the health authorities, 

security authorities, and communities? 

3. Are motorcyclists required to wear helmets? 

4. How is drunk driving viewed? 

5. Is there a regulation that applies to gun ownership? 

6. Are the authorities interested in establishing an injury surveillance 

system in their jurisdiction? 

7. In which category would you include this photo? Why would someone 

display this bumper sticker? 

Possible Answers: 

Social Framework: 

Is it socially acceptable for a husband to hit his wife? 

1. Yes, is acceptable; it is considered a private issue for the couple. 

2. Yes, but the situation has been changing in recent years. 

3. No, it is not acceptable. There are laws to protect the woman. 

How is drunk driving viewed? 

1. It is acceptable to drive when drunk. 

2. It is not acceptable. There is a higher fine for drunk driving. 

In which category would you include this photo? Why would someone display this 

bumper sticker? 

1. It could be included in the social framework, because it reflects behaviors 

acceptable by the culture 

2. Some people displaying this bumper sticker may want to show that they are 

dangerous; perhaps, the message is “stay way from me,” or “don’t 

 bother me.” 
Political Framework: 

What is the relationship between the mayor and the health authorities, security 

authorities, and communities? 

1. The mayor has a good relationship with these institutions and 

has information about the injury problems in the city. 

2. The mayor does not have a relationship with these institutions and 

 does not know the situation of injuries in the city. 

Are authorities interested in establishing an injury surveillance system in their 

jurisdiction? 

1. The government authorities are not interested in knowing about 

the injury problem. It is considered politically inappropriate. 

2. Some authorities, especially the police, transportation office, and 

health department, are interested in participating in an injury 

surveillance system. 

Legal Framework: 

Are motorcyclists required to wear helmets? 

1. No, there is no helmet law in the city. 

2. Yes, a helmet law exists, but the motorcyclists do not wear helmets. 

3. Yes, a helmet law exists. The fine is high for not wearing a helmet. 

 

 Is there a regulation that applies to gun ownership? 

1. No, a regulation does not exist. Every person who wants to 

buy a gun can buy one. 

2. Yes, a regulation exists; the military issued guns are legally acceptable. 

3. Yes, a regulation exists, but guns can still be purchased in 

some places (e.g., on the black market). 

Conclusions: 

Knowing the context within which the injury surveillance system is to be located 

helps to understand the obstacles or difficulties that may be encountered when 

implementing the system. 
INJURY SURVEILLANCE TRAINING MANUAL 

ANSWERS TO EXERCISES 

SESSION IV

DETERMINE THE APPROPRIATE METHODOLOGY FOR 

THE SURVEILLANCE SYSTEM 

Developed with the support of the 

National Center for Injury Prevention and Control 

Division of International Health, Epidemiology Program Office 

Centers for Disease Control and Prevention 

Atlanta, GA 
Page 12: 

Exercise: How would you classify and code the following examples? 

If a person falls down the stairs and strikes his head on a metal door: 

1. What is the principal diagnosis and the reason for admission at the 

hospital? 

2. If a person falls, as in the previous example, but dies as a result of the fall, 

what are the immediate cause of the injury and the underlying cause of 

death? 

Possible Answers: 

1. The resulting head injury would be the principal diagnosis and the 

reason for admission. 

2. The immediate cause of the injury is “struck against an object.” It would 

be listed as an additional code. The “fall” would be the underlying 

cause of death. 

Page 18: 

After discussion about two different emergency room-based data collection 

instruments used in injury surveillance systems in Central America and Argentina, 

ask participants the following questions: 

1. Are the variables included in these forms sufficient for an 

injury surveillance system? 

2. Are there any questions that interviewees may be reluctant 

to answer? 

3. Is it possible to fill out these forms in emergency rooms? 

Possible Answers: 

1. a. The variables are sufficient for an injury surveillance system that 

collects data from hospitals or emergency rooms. 

 b. The variables are too much for an injury surveillance system in 

emergency rooms. 

2. In the questionnaire used in Argentina, it could be that some variables 

are hard to collect, such as those related to traffic injuries and injuries 

in the mouth. Also, there are other variables that could be omitted, like 

the specific place where the injury occurred. 

 The questionnaire used in Central America has some variables about 

precipitating factors in self-inflicted injuries, but this information is often 

difficult to get. 
3. Personnel in emergency rooms often have many activities to do while 

assisting patients. If they have to fill out forms, the forms must be as 

short as possible. The personnel must also be trained on how to fill out 

the forms. 

Page 23: 

Exercise: Define the Criteria to Establish a Fatal Injury Surveillance System:

Group 1: Variables 

 Codes and case definition 

Group 2 Data collection instruments and frequency 

 Type of surveillance system 

 Personnel necessary to operate the system 

Posible Answers: 

 

 Group 1:

Variables: Demographic variables, characteristics 

and context of the event. 

Codes and Case Definition: ICD-10 and definitions include in 

this clasification. 

 

 Group 2:

Data Collection Instruments: Similar to form in WHO Guidelines, 

in order to collect the information every month. 

Type of Surveillance: Sentinel, including only the trauma hospitals. 

Personnel: The personnel in the epidemiology office will be in charge 

of developing the system. 

 
INJURY SURVEILLANCE TRAINING MANUAL 

ANSWERS TO EXERCISES 

SESSION V

DEFINE THE ANALYSIS PLAN OF THE 

SURVEILLANCE DATA 

 

Developed with the support of the 

National Center for Injury Prevention and Control 

Division of International Health, Epidemiology Program Office 

Centers for Disease Control and Prevention (CDC) 

Atlanta, GA 
Page 6: 

Exercise: Calculate frequency and percentage of injuries using local data.

Possible Answer from Group 1: 

Violence-Related Deaths in Cali — 2001 

Cause of Death Frequency Percentage 

Homicides 2,055 95.6% 

Suicides 94 4.4% 

Total 2,149 100.0% 

Source: Fatal Injury Surveillance System, Cali, Colombia. Data from: Police, Forensic Medicine, District 

Attorney, Transportation Office. 

Unintentional Deaths in Cali — 2001 

 Cause of Death Frequency Percentage 

Motor Vehicle-Related Deaths 355 75.3% 

Other Unintentional Deaths 116 24.7% 

Total 471 100.0% 

Source: Fatal Injury Surveillance System, Cali, Colombia. Data from: Police, Forensic Medicine, District 

Attorney, Transportation Office. 

Page 11: 

Exercise: Using injury data, calculate crude rates for homicide, motor vehicle‐related,

and other unintentional deaths. 

Possible Answer: 

 Number, Percentage, and Crude Rates by Injury Mortality in Cali — 2000 

Cause of Death Cali* (population in 2000: 1,945,995) 

Unintentional Deaths Number Percentage Rate per 100,000 

Population 

Motor Vehicle-Related 467 17.9 % 23.9 

Other Unintentional Deaths 104 3.9 % 5.3 

Violent Deaths 

Homicides 1,961 74.9 % 100.7 

Suicides 85 3.3 % 4.4 

Total 2,617 100.0 % 134.4 

Source: Fatal Injury Surveillance System, Cali, Colombia. Data from: Police, Forensic Medicine, District 

Attorney, Transportation Office. 
 Comparison between Injury Rates from El Salvador and the World 

In both places, the crude rate for homicides is higher than for other injuries. 

However the rate in Cali is more than twice that of El Salvador. Compared with the 

crude world rate, the Cali rate is eight times higher, and the rate in El Salvador is 

four times higher. Rates for suicides are almost three times higher in El Salvador 

than in Cali. In comparison, the world rate is lower. Motor vehicle-related crude 

rates are similar in both countries, although slightly higher in El Salvador. Both are 

higher than the world rate. 

Rates by Injury Mortality in El Salvador and Cali, 2000, and Worldwide, 1998 

Cause of Death Cali* El Salvador** World*** 

Unintentional Deaths 

Rate per 100,000 

Population 

Rate per 100,000 

Population 

Rate per 100,000 

Population 

Motor Vehicle-Related 23.9 25.9 19.9 

Other Unintentional Deaths 5.3 14.9 7.9 

(approximately) 

Violent Deaths 

Homicides 100.7 42.9 12.5 

Suicides 4.4 12.9 16.1 

Total 134.4 96.8 97.9 

Source: *Fatal Injury Surveillance System, Cali, Colombia. Data from: Police, Forensic Medicine, 

 District Attorney, Transportation Office. 

 **Injury Surveillance Workshop in El Salvador—2003. Data from: Forensic Medicine. 

 ***Krug E. Injury: A Leading Cause of the Global Burden of Disease. WHO;1999. 

Page 16: 

Calculate adjusted rates using local data, such as homicide data. 

Possible Answer: 

Adjusted Rates for Homicides in El Salvador — 2000 

Age 

Group 

(1) 

Number of 

Homicides 

(2) 

El Salvador 

Population in 

Each Group 

(3) 

Ratio 

[(2) / (3)] 

(4) 

Standard 

Population 

(U.S. 2000) 

(5) 

Expected 

Deaths 

(6) 

<5 35 797,160 0.000044 18,987,000 833.64 

05–14 34 1,436,961 0.000024 39,977,000 945.90 

15–24 990 1,333,587 0.000742 38,077,000 28,266.79 

25–34 776 1,008,257 0.000770 37,233,000 28,656.19 

Adjusted Rate 

for 

El Salvador 

[Total (6) / 

Total (5) 

multiplied by 

100,000] 

35–44 382 628,444 0.000608 44,659,000 27,146.00 

45–54 225 454,824 0.000495 37,233,000 18,419.05 

55–59 71 165,099 0.000430 23,961,000 10,304.31 

60+ 183 451,705 0.000405 34,710,000 14,062.12 

Total 2,696 6,276,037 0.000430 274,837,000 128,634.00 46.80 

Source: Injury Surveillance Workshop in El Salvador; 2003. Data from: Forensic Medicine. 

The adjusted rates for Cali and El Salvador, using this standard population, do not 

show a big difference in the crude rates. This could mean that the population 

distribution in these cities is similar to the distribution of the standard population. 
Page 17: 

Calculate years of potential life lost (YPLL) using injury local data, such as homicide 

data. 

YPLL by Homicides in El Salvador — 2000 

Age Group 

(1) 

Midpoint 

(2) 

Life Expectancy 

(65 yrs) Minus 

Midpoint 

(3) 

Homicides 

(4) 

YPLL 

[(3) x (4)] 

(5)

1–4 2.5 65 – 2.5 = 62.5 35 2,187.5 

05–14 9.5 65 – 9.5 = 55.5 34 1,887.0 

15–24 19.5 65 – 19.5 = 45.5 990 45,045.0 

25–34 29.5 65 – 29.5 = 35.5 776 27,548.0 

35–44 39.5 65 – 39.5 = 25.5 382 9,741.0 

45–54 49.5 65 – 49.5 = 15.5 225 3,487.5 

55–64 59.5 65 – 59.5 = 5.5 71 390.5 

65–74 NA NA 

75–84 NA NA 

85+ NA NA 183 

Total 2,696 90,287.0 

Source: Injury Surveillance Workshop in El Salvador, 2003. Data from: Forensic Medicine. 

 
Page 19: 

Exercise: Ask the participants to identify the type of map and the information

necessary to prepare it.  

a. Traffic Injury Deaths in Nicaragua — 2000 

(state rates per 100,000 population) 

Traffic Injury Deaths in Nicaragua, 2000. State rates 

per 100,000 population

Source: Injury Surveillance Workshop; Nicaragua; November 2003; CDC and Ministry of Health

Rates

High

Medium

Low

Pacific Ocean

Atlantic Ocean

Costa Rica

10.4-13.1

8.6-10.3

0.98-8.5

10.4-13.1

Honduras

Lake

Lake

Traffic Injury Deaths in Nicaragua, 2000. State rates 

per 100,000 population

Source: Injury Surveillance Workshop; Nicaragua; November 2003; CDC and Ministry of Health

Rates

High

Medium

Low

Pacific Ocean

Atlantic Ocean

Costa Rica

10.4-13.1

8.6-10.3

0.98-8.5

10.4-13.1

Honduras

Lake

Lake

Possible Answer: 

This is an area map showing motor vehicle-related deaths in Nicaragua, 2000. The 

data was provided by the ministry of health and the rates were classified as high, 

medium, and low. (In the original presentation, these rates were depicted by the 

colors of a traffic light; in a single-color presentation, shades of grey are used.) 

The information necessary to prepare this map is the number of traffic injury deaths 

by state and each state’s population. 
b. Map of Suicide Rates 

(per 100,000 population; most recent data available: March 2002) 

Map of suicide rates per 100000 population; 

most recent year available as of March 2002

Source: WHO

Possible Answer: 

This is an area map depicting suicide rates worldwide. This map was provided by 

the Pan American Health Organization (PAHO). The rates have been classified into 

four categories. 

The information necessary for this map is the number of suicides by country and 

each country’s population. 
Source: Fatal Injury Surveillance System, Cali. Data from: Police, Forensic Medicine, District Attorney, Transportation 

Office. 

c. Pedestrian Deaths in Cali in 2001 – Place of Occurrence 

Possible Answer: 

This is a “black spots” map, used to visualize the areas most critically affected by 

one event. In this case, the map depicts pedestrian deaths in Cali in 2001. The 

clusters show where the need for research and prevention strategies is greatest. 

The information necessary for this map is the number of pedestrian deaths, the 

address where the event occurred, and a map of the city showing its roads. 

Page 23: 

Discussion Questions: 

1. Which information is most important to present to stakeholders? 

2. Which indicators would best show the size of the problem? 

3. Do you think cost data is important to stakeholders? 

4. Should you include recommendations about prevention strategies 

in your surveillance reports? 
Possible Answers: 

1. It is important to let stakeholders know how many injuries have occurred 

in the region over time—such as last week, one month, three months, one 

semester, one year, or the last five years. 

2. The number and percentage of injuries among the total and a breakdown 

by injury type would best show the size of the problem. 

3. It is very important to demonstrate the cost of injuries and how much 

could be saved both in economic cost and in lives saved by using 

prevention strategies (and what the comparative cost of prevention 

strategies would be). 

4. Yes. It is important to provide such recommendations because most of the 

time stakeholders need ideas about possible strategies to apply in their 

region and want to know which strategies have been applied successfully 

in other places. 
INJURY SURVEILLANCE TRAINING MANUAL 

ANSWERS TO EXERCISES 

 

SESSION VI

USE SURVEILLANCE DATA TO INFORM INJURY PREVENTION 

Developed with the support of the 

National Center for Injury Prevention and Control 

Division of International Health, Epidemiology Program Office 

Centers for Disease Control and Prevention (CDC) 

Atlanta, Georgia, USA 
Page 7 

Exercise: Prepare a table with indicators for unintentional and violence-related 

injuries: 

1. General information 

a. Leading causes of death (frequency and crude rates), as prepared in Session II, 

 Item 4. 

b. Frequency, proportion, and crude rates of injury deaths by intention 

 (i.e., homicide, suicide, motor vehicle-related, and other unintentional deaths). 

 These were calculated in Session V, Item 1. 

 c. Trend of injury crude rates, with information for a minimum of 5 years. 

Possible Answer: 

a. Leading causes of death: 

 

Leading Causes of Death in Colombia — 1999 

Rank Cause of Death Frequency Rate per 100,000 

Inhabitants 

 1 Homicide and Sequelae 25,855 78.08 

 2 Ischemic Heart Disease 21,908 66.16 

 3 Cerebrovascular Diseases 13,393 40.45 

 4 Chronic Lower Respiratory Diseases 9,452 28.54 

 5 Accidents (Unintentional Injuries) and Sequelae 7,624 23.02 

 6 Diabetes Mellitus 6,801 20.05 

 7 Hypertensive Diseases 5,490 16.58 

 8 Acute Respiratory Diseases 5,277 15.93 

 9 Perinatal Diseases 4,790 14.46 

10 Malignant Neoplasm 4,487 13.55 

11 Digestive System Disease 4,483 13.53 

12 Stomach Tumor 4,112 12.41 

13 Other Heart Diseases 3,902 11.78 

14 Undetermined Cause 3,632 10.96 

15 All Other Causes 62,357 188.33 

Total 183,563 554.40 

Source: National Department of Statistics. 

(Departamento Nacional de Estadisticas. DANE, Colombia)
b. Frequency, proportion, and crude rates of injury deaths by intention: 

 

Injury Deaths in Colombia — 1999 

Both Sexes, All Ages 

Manner of Death Cause of Injury Number Percentage Rates per 100,000 

Inhabitants 

Unintentional Deaths Overall Motor Vehicle 7,694 17.5 23.5 

 (97,900) 

Other Unintentional Deaths 5,443 12.4 16.4 

Homicide 25,855 58.8 78.1 

Suicide 

 

 2,167 4.9 6.5 

Violence-Related Deaths 

 (46,474) 

Legal Intervention 241 0.5 1.0 

Undetermined Intent (3,819) 2,559 5.8 7.7 

Total 43,959 100.0 132.7 

Source: National Department of Statistics. 

 (Departamento Nacional de Estadisticas. DANE, Colombia) 
2. Specific information 

a. Homicides: Specific rates by age group and sex (see Session V, Item 1.3). 

b. Motor vehicle-related deaths: Rates by type of victim (pedestrian, vehicle 

 occupant, motorcyclist, and bicyclist) and rates by age group and sex. 

c. Trend of injury specific rates, with information for a minimum of 5 years. 

 Possible Answer: 

Homicides rates by Age Group and Sex: 

Homicides in Cali — 2001 

Rates by Age Group and Sex 

Number of Cases Population 2001 Rates by 100,000 

Inhabitants Age 

Groups Female Male Female Male Total Female Male 

< 5 2 3 102,842 106,858 209,700 1.9 2.8 

5 – 9 0 0 106,200 109,435 215,635 0.0 0.0 

10 – 14 4 24 100,103 98,195 198,298 4.0 24.4 

15 – 19 20 358 120,593 92,569 213,162 16.6 386.7 

20 – 24 18 423 129,125 97,165 226,290 13.9 435.3 

25 – 29 19 338 109,954 84,411 194,365 17.3 400.4 

30 – 34 25 250 86,208 73,768 159,976 29.0 338.9 

35 – 39 10 200 71,874 62,559 134,433 13.9 319.7 

40 – 44 14 127 48,674 48,245 96,919 28.8 263.2 

45 – 49 8 80 40,638 37,044 77,682 19.7 216.0 

50 – 54 7 50 35,759 31,466 67,225 19.6 158.9 

55 – 59 4 30 27,152 24,144 51,296 14.7 124.3 

60 – 64 1 18 21,741 18,242 39,983 4.6 98.7 

65 + 8 14 41,729 31,414 73,143 19.2 44.6 

Total 140 1915 1,042,592 915,515 1,958,107 13.4 209.2 

Source: Fatal Injury Surveillance System. Cali (Colombia). Data from: Police, Forensic Medicine, District 

Attorney and Transportation Office. 

 
Motor Vehicle-Related Deaths: Type of victim (pedestrian, vehicle occupant, 

motorcyclist, and bicyclist); specific rates by age-group and sex. 

Possible Answer: 

 Frequency and rates by type of victim: 

 

Motor Vehicle-Related Deaths in El Salvador — 2000 

Means of 

Transportation Frequency Percentage 

Rates per 

100,000 

Inhabitants 

Pedestrian 1,122 68.8 17.99 

Motorcyclists 28 1.7 0.44 

Cyclists 69 4.2 1.10 

Vehicle Driver 106 6.5 1.69 

Vehicle Passenger 258 15.8 4.13 

Aviation 8 0.5 0.12 

Unspecified 38 2.3 0.60 

Total 1,629 100 26.12 

Source: Forensic Medicine. El Salvador 

Motor Vehicle-Related Deaths: Specific rates by age-group and sex. 

Possible Answer: 

 Specific rates by age group and sex: 

Pedestrian Deaths in El Salvador — 2000 

Age Group and Sex of the Victims 

Males Females Age Group Frequency Rate* Frequency Rate* 

0–4 17 4.2 13 3.3 

5–9 36 9.4 9 2.4 

10–14 30 8.6 13 3.9 

15–19 46 13.8 21 6.5 

20–24 96 28.2 20 6.0 

25–29 73 26.0 16 5.6 

30–34 93 44.9 20 8.6 

35–39 67 43.7 13 7.1 

40–44 74 55.0 6 3.8 

45–49 53 46.1 10 7.7 

50–54 47 47.1 11 10.0 

55–59 40 51.0 19 21.9 

60+ 216 130.2 63 25.2 

Total 888 29.2 234 7.3 

* Rates per 100,000 population 
3. Leading Causes of Injury Morbidity: Injuries by Age Group and Sex; 

 Nature of Injuries 

Possible Answer: 

Non fatal Injuries by age group, sex and intention. (El Salvador’s population was 

used as denominator in this example) 

Injury Surveillance System in Emergency Rooms 

El Salvador, May to November 2002 

Intention, Age and Sex of Victim 

Age Groups 

Intention < 1 year 1–4 5–9 10–19 20–59 60+ Subtotal Total

Male Female Male Female Male Female Male Female Male Female Male Female Male Female

Unintentional 408 316 929 578 904 449 810 288 1,474 533 232 238 4,757 2,402 7,159 

Self-Inflicted 12 5 15 13 19 5 14 25 39 13 1 0 100 61 161 

ViolenceRelated 5 3 12 8 34 12 156 26 574 78 31 2 812 

129 941 

Other 2 2 3 1 5 1 1 4 8 1 0 1 19 

10 

 

29 

Unknown 3 0 2 1 4 1 9 1 37 2 6 0 61 

5 

 

66 

Total 430 326 961 601 966 468 990 344 2,132 627 270 241 5,749 2,607 8,356 

Source: Injury Surveillance System in Emergency Department. El Salvador 

 

Possible Answer: 

Non fatal Injuries according to nature and intention: 

Injury Nature and Intention 

Injury Surveillance System in Emergency Rooms 

El Salvador — May to November 2002 

Intention 

Nature of injury Unintentional Self-Inflicted Assaults Other Unknown Total 

Wound/Superficial Injury 2,619 41 419 5 20 3,104 

Fracture 1,955 33 123 3 10 2,124 

Penetrating Injury 370 19 291 5 17 702 

Abrasion 351 3 18 1 1 374 

Burn 349 5 8 1 1 364 

Sprain/Strain 241 5 4 0 1 251 

Bite 156 0 1 5 0 162 

Injury Internal Organs 97 12 38 2 6 155 

Cerebral Concussion 110 3 3 0 4 120 

Other 634 27 25 2 3 691 

Unknown 35 0 1 1 3 40 

Total 6,917 148 931 25 66 8,087 

Source: Injury Surveillance System in Emergency Department. El Salvador 
Page 10 

Exercise: Place the following etiological factors related to Pedestrian Injuries into the 

correct cell of the Haddon Matrix: 

• No crosswalks on the roadway 

• No laws related to alcohol and driving 

• Children crossing the street without supervision 

• Age, sex and physical condition of pedestrian 

• Size and shape of the vehicle involved 

• Speed of the vehicle involved at impact 

• Quality of emergency communications 

• Quality and availability of medical services 

• Preexisting pathologies in the injured person, such as osteoporosis, 

disabilities, diabetes, etc. 

• Brakes and tires of the vehicle 

Possible Answer: 

Factors Related to the Likelihood of Pedestrian Injury: The Haddon Matrix 

Factors Phases 

Human Vehicle Physical and Social Environment 

Pre-Event 

Children crossing the street 

without supervision Brakes and tires of the vehicle 

No laws related to alcohol and driving 

No crosswalks on the roadway 

Event Age, sex, and physical 

condition of the pedestrian 

Size and shape of the vehicle 

involved 

Speed of the vehicle involved 

at impact 

Quality of emergency communications 

Post-Event 

Preexisting pathologies in 

the injured person such as 

osteoporosis, disbilities, 

diabetes, etc. 

Quality and availability of medical 

services 
Page 13 

Exercise: Place the following etiological factors related to youth violence into the 

correct cells of the Ecological Model: 

• Inequalities of gender, economics, access to health care, or education 

• Concentration of poverty 

• Peers involved in crime 

• Psychological and personality factors 

• Impulsiveness 

• Poor parenting practices 

• Local illicit drug trade 

• Weak police/criminal justice systems 

Possible Answer: 

 Ecological Model of Factors Associated with Youth Violence 

Level Etiological Factors 

Individual Psychological and personality factors 

Impulsiveness 

Relationship 

Peers involved in crime 

Poor parenting practices 

Community 

Concentration of poverty 

Local illicit drug trade 

Society 

Inequalities of gender, economics, access to 

health care, or education 

Weak police/criminal justice systems 

Source: World Report on Violence and Health. WHO 
Page 21 

Exercise: Place these statements related to Bicycle-related Injury Prevention into the 

correct cells of the Haddon Matrix: 

 1. Separate bicyclists from other forms of traffic 

 2. Equip bike with lights, reflectors, and a horn or bell 

 3. Reduce size and weight of motor vehicles to decrease injury severity 

 4. Modify vehicle front ends to decrease injury severity 

 5. Teach safe bicycling practices, including use of a bicycle helmet 

 6. Control traffic with engineering 

 7. Enforce speed limits and limits on alcohol use while bicycling and driving 

 8. Wear bicycle helmet 

 9. Wear riding gloves 

10. Use horns or bells when unable to stop 

11. Maintain mechanical condition of bike 

12. Teach cyclist to carry identification 

13. Encourage use of reflective clothing 

14. Provide emergency care 

15. Provide adequate EMS 

16. Penalize road users who broke the law 

17. Inspect bicycle for safety problems 

Haddon Matrix Used to Identify Prevention Strategies to 

 Bicycle-related Injury Prevention 

Prevention strategies Phases 

Human Vehicle (Agent) Physical and Social Environment

Pre-Event 

Teach safe bicycling 

practices, including use 

of a bicycle helmet 

Encourage use of 

reflective clothing 

Maintain mechanical 

condition of bike 

Equip bike with lights, 

reflectors,and a horn or bell 

Separate bicyclists from other forms of 

traffic 

Control traffic with engineering 

Enforce speed limits and limits on 

alcohol use while bicycling and driving 

Event Wear bicycle helmet 

Wear riding gloves 

Use horn or bell when 

unable to stop 

Reduce size and weight of motor 

vehicles to decrease injury severity 

Modify vehicle front ends to decrease 

injury severity 

Post-Event 

Teach cyclists to carry 

identification 

Provide emergency care 

Inspect bicycle for safety 

problems 

Penalize road users who broke the law

Provide adequate EMS 

 

 Adapted from:  World Report on Road Traffic Injury Prevention, WHO
Page 23 

Exercise: Place the following statements related to Intimate Partner Violence 

Prevention into the correct cells of the Ecological Model: 

• Women’s crisis center and battered-women shelters 

• Criminalizing physical, sexual, and psychological 

abuse by intimate partners 

• Laws requiring mandatory arrest for domestic violence 

• Treatment programs for perpetrators of intimate partner violence 

• Training health workers to identify and respond to abuse 

• Outreach workers visiting victims of violence in their 

homes and communities 

• Efforts to reform the response of institutions 

• Family and social networks to support battered women 

• Interagency coordinating council 

 

 Ecological Model of Factors Associated with 

Intimate Partner Violence Prevention 

Level Prevention Strategies 

Individual Women’s crisis center and battered women’s shelters 

Treatment programs for perpetrators of intimate partner violence 

Relationship Family and social networks to support battered women 

Outreach workers visiting victims of violence in their homes and communities 

Community Training health workers to identify and respond to abuse 

Interagency coordinating councils 

Society Laws requiring mandatory arrest for domestic violence 

Efforts to reform the response of institutions 

Criminalizing physical, sexual, and psychological abuse by intimate partners 

Source: World Report on Violence and Health. WHO 
INJURY SURVEILLANCE TRAINING MANUAL 

ANSWERS TO EXERCISES 

SESSION VII

DEFINE AN EVALUATION PLAN FOR THE 

SURVEILLANCE SYSTEM AND 

MONITOR PREVENTION ACTIVITIES

Developed with the support of the 

National Center for Injury Prevention and Control 

Division of International Health, Epidemiology Program Office 

Centers for Disease Control and Prevention (CDC) 

Atlanta, GA 
Page 15 

Exercise: Select basic, developmental, and research indicators for intimate 

partner violence (IPV): 

Questions: 

1. Is it easy to obtain the data to build the selected indicators? 

2. Do the indicators provide information that is useful 

for monitoring the event? 

3. How can you use these indicators to monitor public health 

issues in your country? 

Possible Answer: 

Indicators Easy to obtain the 

Data? 

Useful to Monitor 

the event? 

How are 

Indicators Used? 

IPV—Basic Indicators 

1.1 Age-adjusted homicide rate among 

females aged 15–44 years, 

per 100,000 population 

IPV—Developmental Indicators 

2.1 Age-adjusted death rate due to IPV, 

per 100,000 population 

2.2 Age-adjusted hospital discharge rate 

 for assault resulting from IPV, per 

 100,000 population 

2.3 Age-adjusted emergency-room visit 

rate due to assaults resulting from 

IPV, per 100,000 population 

IPV—Research Indicators 

3.1 Self-reported rate of IPV, per 

 100,000 respondents 

 
Page 17 

Exercise: Ask the participants to give opinions about the impact of prevention 

strategies applied in Cali and Samoa. 

0

20

40

60

80

100

120

140

Year 198 198 198 198 198 198 198 199 199 199 199 199 199 199 199 199 199 200 200 200

Homicide crude rate per 100,000 population

Army bases and patrols in high risk areas 

Firearms- carrying ban 

Liquor law, earlier closing of places selling liquor 

Ban of adult males as motorcyclist passengers 

Nighttime ban on unaccompanied children in public places 

a. Multiple Policies Applied in Cali 

 Source: Fatal Injury Surveillance System; Cali, Colombia; 2003. 

 Data from: Police, Forensic Medicine, District Attorney, Transportation Office 

Possible Answer: 

Since 1987, the homicide rate in this city shows a constant increase. After 1994, when 

some strategies were applied, the rates went down. However, 

in 1997 and later, the rates begin to increase slowly, eventhough some strategies 

continue being applied. It is necessary to have more information, for example, about 

the age groups most affected and the places in the city with higher rates to better 

determine the impact of the strategies. 

 
0

1

2

3

4

5

6

1960 1965 1970 1972 1975 1980 1985 1990

Total Paraquat-related 

Adapted from: World Report on Violence and Health, WHO

Arrival of 

paraquat

1972

Control of paraquat

Year

Number of suicides

b. Number of Suicides in Samoa in Relation to the Arrival of Pesticides Exercise

 Containing Paraquat and the Control of Paraquat Sales 

 1970–1988 

Possible Answer: 

The number of suicides increased slowly after 1960. At the beginning of the 1970s, 

when paraquat was introduced to the island, the number of suicides increased 

dramatically. Around 1980, controls on the use of paraquat were established, and 

immediately the total number of suicides began to decrease. Suicides related to 

paraquat showed a trend similar to that of the total cases. Based on this information, 

it appears that this strategy has been successful. However, it would be useful to 

examine changes in rates and how they are associated with control strategies. Also, 

the data does not explain why the trend in suicides related to paraquat increased 

again after 1985.