INJURY EPIDEMIOLOGY & PREVENTION

Definitions Injury “Acute exposure to physical agents such as mechanical energy, heat, electricity, chemicals, and ionising radiation interacting with the body in amounts or at rates that exceed the threshold of human tolerance. In some cases, injuries result from the sudden lack of essential agents such as oxygen or heat.” (Source: Gibson, 1961; Haddon, 1963) 2 June 20162NCD Epi

Definitions Violence “The intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community, that either results in or has a high likelihood of resulting in injury, death, psychological harm, maldevelopment or deprivation.” (Source: WHO, 1996) 2 June 20163NCD Epi

The Global Injury Problem 5 million deaths worldwide = 9% of all deaths (2000) 12% of global burden of disease Road traffic “incidents” are the leading cause of injury deaths worldwide 90% of injury deaths occur in low- and middle- income countries Highest number of deaths in S.E. Asia & Western Pacific regions 2 June 20164NCD Epi

The Epidemiological Model VectorAgent Host Environment 2 June 20165NCD Epi

The Ecological Model IndividualCommunity Relationship Society Complex Linkages Source: Krug E et al., eds., June 20166NCD Epi

VIP Temporal primary secondary tertiary Targeted universal selective indicated Approach passive active 2 June 20167NCD Epi

VIP strategies Engineering Environmental modification Enforcement Education /empower ment Evaluation 2 June 20168NCD Epi

VIP Public Health Approach Defining Characteristics  Population-based  Multidisciplinary  Evidence-based  Collective action  Prevention 2 June 20169NCD Epi

(1) Surveillance What is the problem? (2) Risk factor identification What are the causes? (4) Implementation How is it done? (3) Develop and evaluate interventions What works? The Public Health Approach 2 June NCD Epi

Severity Setting Activity Mechanism Intent Nature Categorizing Injury 2 June NCD Epi

Injury Pyramid Deaths Injuries resulting in hospitalization Injuries resulting in ambulatory and emergency treatment Injuries resulting in treatment in Primary care settings Injuries treated by paramedics only (school nurse, physiotherapist, first aid) Untreated injuries or injuries which were not reported 2 June NCD Epi

Types of data and potential sources of information Mortality Death certificates Reports from mortuaries Morbidity and Health-related Hospitals Medical records Self Reported Surveys Media 2 June NCD Epi

Community-based Demographic records Local government records Law enforcement Police records Prison records Economic-social Institutional or agency records Special studies Source: adapted from Krug et al., eds., June NCD Epi

Leading Causes of Mortality and Burden of Disease world, 2004 % 1.Ischaemic heart disease Cerebrovascular disease Lower respiratory infections COPD Diarrhoeal diseases HIV/AIDS Tuberculosis Trachea, bronchus, lung cancers Road traffic accidents Prematurity, low birth weight 2.0 % 1.Lower respiratory infections Diarrhoeal diseases Depression4.3 4.Ischaemic heart disease HIV/AIDS3.8 6.Cerebrovascular disease Prematurity, low birth weight Birth asphyxia, birth trauma Road traffic accidents Neonatal infections and other 2.7 MortalityDALYs 2 June NCD Epi

Source: WHO, June NCD Epi

Ten leading causes of burden of disease, world, 2004 and June NCD Epi

References 1 1.Last J. A dictionary of epidemiology. 5 th Edition. Oxford, New York, Toronto: Oxford University Press, Remington PL, Brownson RC, Wegner MV. Chronic disease epidemiology and control. 3 rd Edition. Washington, D.C.: American Public Health Association, WHO Action Plan for the Global Strategy for the Prevention and Control of Non-communicable Diseases. Geneva: WHO, June NCD Epi

References 2 4.Fadhil I. Diabetes and other non- communicable diseases: An Eastern Mediterranean Perspective. WHO, Kuh D, Ben Shlomo Y. A life course approach to chronic disease epidemiology. Oxford, New York, Toronto: Oxford University Press, Newcomer RJ, Benjamin AE. Indicators of chronic health conditions. Baltimore, London: The Johns Hopkins University Press, June NCD Epi