International Collaborative Effort on Injury June 1-3, 2005 Cuernevaca, Mexico Yvette Holder, Consultant Biostatistician/Epidemiologist

An Overview of ICE-related work  ICECI (Violence Module)  WHO’s Injury Surveillance Guidelines  Violence Indicators

Intent Variable Classification scheme 1Unintentional Includes ‘accidental’ injuries Includes ‘accidental’ injuries 2Intentional self-harm Any deliberate or intentional injury to self Any deliberate or intentional injury to self Includes suicides, para-suicides, self-mutilation Includes suicides, para-suicides, self-mutilation 3Assault Includes injuries inflicted by other person(s) with intent to injure or kill someone Includes injuries inflicted by other person(s) with intent to injure or kill someone Excludes Excludes legal interventions (4.1) and operations of war civil conflict (4.2) civil conflict (4.2) 4Other violence 4.1Legal intervention Includes injuries inflicted by law-enforcing agents during legal action or inflicted by state agencies during attempts to enforce the law, execution or injury performed at the behest of judiciary or ruling authority Includes injuries inflicted by law-enforcing agents during legal action or inflicted by state agencies during attempts to enforce the law, execution or injury performed at the behest of judiciary or ruling authority 4.2 Operations of war and civil conflict 5Undetermined intent 6Adverse effects or complication of medical or surgical care

Violence Module - ICECI Adverse Effects Unintentional INTENT War/ Civil Conflict Undetermined InterpersonalContext of Assault Perpetrator/Victim Relationship Interpersonal Violence Sub-module Type of conflict No. of previous attempts Proximal Risk Factors Intentional Self-harm Self-directed Violence Sub-module War/Civil Conflict Sub-Module INTENTIONALINTENTIONAL

WHO Injury Surveillance Guidelines

Purpose of Guidelines  Provide surveillance officers/researchers with the basic tools for collecting information on injury  Facilitate capture of injury data in a standardised but flexible format  Hence, contribute to the building of an internationally comparable body of injury data

Layout of the Guidelines - Introduction  Injury - definition; types; epidemiology  Surveillance - definition; purpose  Need for injury surveillance  Steps of the surveillance process  Attributes of a good surveillance system

Designing an Injury Surveillance System Identify StakeholdersDefine/ Redefine Objectives Identify Data Sources & Systems Assess available resources Sensitise/Orient Stakeholders State Data Needs Draft Form & Formulate Data Collection System Process Data Design Output for Dissemination Implement & Train Monitor & Evaluate

International Classification of External Cause of Injury (ICECI  Intent  Mechanism  Object  Place  Activity  Alcohol Use  Other Psychoactive Drug Use  Mode of Transport  Type  Counterpart  Perpetrator/Victim Rel.  Circumstances of Assault  Proximal Risk Factor

Injury Surveillance Information System Overview Occupation AssaultsTransport Sport Suicides MDS CORE

Core Data Set - for All Injuries Minimum Data Set (MDS) Age, Sex, Intent, Place Activity, Nature of Injury, Mechanism/External Cause Text Summary Optional Data Set Date, Time, Residence, Alcohol Use, Drug Use, Object, Severity, Disposition

CORE INJURY SURVEILLANCE INSTRUMENT- MDS

Expanded Data Set – All Injuries

Modules for Specific Injury Types e.g. Assaults Minimum Data Set Circumstances, Perpetrator/Victim Relationship Optional Data Set Object

Place Of Occurrence (First Two Levels of Detail

Place of Occurrence (Third Level of Detail)

Building a Data Set Core Minimum Data Set with basic categories + modules + modules + data elements + detailed categories + detailed categories = ICECI

Way Forward  Application Surveillance Guidelines Surveillance Guidelines  Validation Comparison with Injury Matrix (60% of specifically defined cells) Comparison with Injury Matrix (60% of specifically defined cells) excludes non-traffic, machinery, overexertion and natural/environmentexcludes non-traffic, machinery, overexertion and natural/environment includes sexual assaultincludes sexual assault % of unspecified injuries according to the ICECI MDS % of unspecified injuries according to the ICECI MDS  ?Further editing

Evaluation  Retrospective review of surveillance system data  Prospective System Evaluation  System Environment Evaluation

Indicators for Monitoring Violence  Purpose: To monitor violence in the Americas in a standardised way  Types: Basic: minimal, readily available Basic: minimal, readily available Developmental: desirable but collection would require a system to be put in place Developmental: desirable but collection would require a system to be put in place Research: best collected via surveys Research: best collected via surveys Note: All rates are per 100,000 population

Basic Indicators  Age-adjusted suicide rate  Age-adjusted homicide rate in males aged yrs  Age-adjusted homicide rate in females aged yrs  Homicide rate in children aged 0-4 yrs.  Reports of assault per 1000 pop.  Reports of robbery per 1000 pop.  Reports of kidnappings per 100,000 pop.

Developmental Indicators – I  Age-adjusted death rate due to intimate partner violence (IPV)  Death rate due to child abuse  Death rate due to elder abuse  Age-adjusted robbery-related homicide rate  Age-adjusted hospital discharge rate due to suicide attempts  Age-adjusted hospital discharge rate due to assault in males aged yrs

Developmental Indicators – I ct’d  Age-adjusted hospital discharge rate due to assault in females aged yrs  Hospital discharge rate due to assault in children aged less than 5 yrs  Hospital discharge rate for assault in elderly  Reported civil rights violations per 1,000 pop.  Reported cases of child maltreatment per 1,000 pop  Reported cases of school fights per 100,000 pop of school-aged children per yr

Developmental Indicators – II  Age-adjusted hospital discharge rate for assault resulting from IPV  Hospital discharge rate resulting from child abuse  Hospital discharge rate for assault due to elder abuse

Developmental Indicators – III  Age-adjusted Emergency Room (ER) visit rate due to suicide attempts  Age-adjusted ER visit rate in males aged yrs. due to assaults  Age-adjusted ER visit rate due to assaults resulting from IPV  ER visit rate due to assaults resulting from child abuse  ER visit rate due to assaults resulting from elder abuse

Research Indicators  Rate of suicide ideation  Rate of suicide attempts in past 12 months  Self-reported weapon carrying among youth at school, per 100 school children  Self-reported fighting rate among youth at school per 100 school children  Self-reported rate of IPV per 1,000 respondents