Organizing a pilot projecton injury surveillance. Opportunities and Obstacles Diego E Zavala, M.Sc., Ph.D. Director- Epidemiology and Biostatistics Core

Organizing a pilot projectOrganizing a pilot project on on injury surveillance.injury surveillance.

Opportunities and ObstaclesOpportunities and Obstacles

Diego E Zavala, M.Sc., Ph.D.Diego E Zavala, M.Sc., Ph.D.Director- Epidemiology and Biostatistics Core ProgramDirector- Epidemiology and Biostatistics Core Program

Public Health ProgramPublic Health ProgramPonce School of MedicinePonce School of Medicine

Ponce, Puerto RicoPonce, Puerto Rico

Multinational Injury Surveillance StudyMultinational Injury Surveillance Study

BackgroundBackground Initiative emerged out Initiative emerged out

of the last two World of the last two World Conferences on Injury Conferences on Injury Prevention and ControlPrevention and Control

And pre-conferences And pre-conferences on war related on war related injuries… injuries…


In collaboration with:In collaboration with:

Pan American Health Organization/ WHOPan American Health Organization/ WHOAlberto Concha, MD, MPHAlberto Concha, MD, MPH

Regional Advisor on Injury PreventionRegional Advisor on Injury Prevention

Centers of Disease Prevention and ControlCenters of Disease Prevention and ControlCarme Clavel-Arcas, MD, MPHCarme Clavel-Arcas, MD, MPH

National Center for Injury Prevention and ControlNational Center for Injury Prevention and Control CDC, U.S.CDC, U.S.


El Salvador

Colombia

BoliviaBrazil

Puerto Rico

DRC

Kenya

Uganda

Nigeria

Zambia

•PI: Diego E Zavala, MSc, PhD, Ponce Medical School, Puerto Rico

•Project Administrator: Maria Valenti,

International Physicians for the Prevention of Nuclear War (IPPNW)

Participating CountriesParticipating CountriesLATIN AMERICA & CARIBBEAN

Bolivia•Population: 8,724,156 (2004)

•Area:

•La Paz: Hospital de Clínicas

•Co-PI: Eduardo Dominguez- Qhana (NGO)

•Population: 184,101,109 (2004)

•Area:

•Sao Paulo: Hospital do Grajaú

•Co-Pi: Maria Fernanda Tourinho Peres, PhD

Vilma Pinheiro Gawryszewski, MD

Nucleo de Estudos da Violencia

Brazil


Puerto Rico

El Salvador •Population: 6,587,541 (2004)

•Area:

•Ilopango: Hospital Bartolo

•Co-PI: Emperatriz Crespín, MD -IPPNW

•Population: 3,897,960 (2004)

•Area:

•Ponce: Hospital San Lucas II

•Co-PI: Carlos García, MD


Colombia •Population: 42,310,775 (2004)

•Area:

•Bucaramanga: two public hospitals

•Co-PI: Marta H León Franco, MD

Participating CountriesParticipating Countries

DRC

Kenya

AFRICA •Population: 58,317,930 (2004)

•Area: •Kisangani: K.U.T. Hospital•Bukavu: Bukavu General Hospital•Panzi: Panzi General Hospital•Goma/Katwa: Goma & Katwa Gen. Hosp•Bunia: Bunia General Hospital•Kindu: Kindu General Hospital

•Co-PI: Simon Bokongo, MD (IPPNW)

•Population: 32,021,856 (2004)

•Area: •Nairobi: Kenyatta Nacional Hospital•Rift Valley: Naivasha District Hospital•Eastern Prov: Machakos Provincial Hospital

•Co-PI: Walter Odhiambo, MD (IPPNW)

Participating CountriesParticipating CountriesAFRICA

Uganda

Zambia

•Population: 26,404,543 (2004)

•Area:

•Mbale: Mbale Regional Hospital

•Kumi: Kumi Hospital

•Toroto: Toroto Hospital

•Co-PI: Peter Olupot, MD (IPPNW)

•Population: 10,462,436 (2004)

•Area:

•Lusaka: Univ. Hospital

•Kafue: Nangonwe Hospital

•Kalomo:Kalomo District Hospital

•Co-PI: Robert Mtonga, MD (IPPNW)

Participating CountriesParticipating Countries

Nigeria

AFRICA

•Population: 137,253,133

•Area:

•Dala: Nacional Orthopedic Hosp

•Kano:Aminu Kano Hospital

•Co-PI: Ime John, MD (IPPNW)


Phase I:Phase I:

Development of Development of QuestionnaireQuestionnaire

Retrospective review of 30 Retrospective review of 30 cases in last six monthscases in last six months

Presentation of results to Presentation of results to ED medical professionals.ED medical professionals.


Phase II:Phase II: Secure fundingSecure funding

Regional training (TOT)Regional training (TOT)

Begin 12 month Begin 12 month prospective data collection prospective data collection in all sites.in all sites.


OpportunitiesOpportunities

Response to WHO Response to WHO recommendations.recommendations.

Interest & enthusiasm.Interest & enthusiasm.

Develop experience in Develop experience in international international collaboration efforts.collaboration efforts.

Foundation for further Foundation for further research efforts.research efforts.


OpportunitiesOpportunities Response to WHO Response to WHO

recommendations/observationsrecommendations/observations in in that:that:

Many countries, specially in Many countries, specially in underdeveloped regions lack underdeveloped regions lack injury surveillance systems that injury surveillance systems that would provide reliable data on would provide reliable data on injury.injury.

Call for enhancing capacity for Call for enhancing capacity for collecting data on violence at the collecting data on violence at the national level in developing national level in developing countriescountries

Lack of data has made Lack of data has made multinational comparisons difficult. multinational comparisons difficult.



Response to WHO Response to WHO recommendations.recommendations.

Interest & commitment.Interest & commitment.

Develop experience in Develop experience in international international collaboration efforts.collaboration efforts.

Foundation for further Foundation for further research efforts.research efforts.

ObstaclesObstacles

CommunicationCommunication

FundingFunding

Coordination via Coordination via internet?internet?

Local socio-political Local socio-political realitiesrealities



reliable information on reliable information on cervical cancercervical cancer incidence incidence and mortality data that and mortality data that demonstrates the extent of demonstrates the extent of the problem and the the problem and the financial implications of the financial implications of the disease for the country.disease for the country.

this information together this information together with provision of technical with provision of technical assistance is needed to assistance is needed to develop sustainable develop sustainable cervical cancercervical cancer prevention prevention initiatives in developing initiatives in developing countriescountries

for which donors may be for which donors may be more willing to support more willing to support

BarriersBarriers limited availability of funds, limited availability of funds,

particularly from donor particularly from donor organizations;organizations;

absence or deficient absence or deficient infrastructure for infrastructure for cervical cervical cancercancer prevention; prevention;

lack of reliable data of lack of reliable data of cancercancer incidence; and incidence; and

limited understanding by limited understanding by health officials about the health officials about the disease itself and of its disease itself and of its impact, specially in older impact, specially in older women. women.

Herdman, C., Sherris, J., Bingham, A. Bringing about change: Policy development for cervical cancer prevention in low-resource countries. Abstract No. O-49. 19th International Papillomavirus Conference. Florianópolis, Brazil. September 1-7, 2001.


Funding:Funding:

FIA application 50%FIA application 50%

IPPNW: Govt. of IPPNW: Govt. of CanadaCanada

Other ?Other ?


Output:Output: National: National:

HospitalHospital

GovernmentGovernment

Community?Community?

International:International:ConferencesConferences

JournalsJournals

Puerto RicoPuerto Rico

Documents

Organizing a pilot projecton injury surveillance. Opportunities and Obstacles Diego E Zavala, M.Sc., Ph.D. Director- Epidemiology and Biostatistics Core