1. Richard Matzopoulos CRIME, VIOLENCE AND INJURY LEAD PROGRAMME Medical Research Council University of South Africa Institute for Social and Health Sciences Centre for Peace Action An overview of fatal injury surveillance in South Africa Cuernavaca, Mexico, 1-2 June 2005

2. National Injury Mortality Surveillance System (NIMSS) National Injury Mortality Surveillance System (NIMSS) strengths and weaknesses strengths and weaknesses strategic challenges strategic challenges future plans for the NIMSS future plans for the NIMSS

3. history  1993 –1995 Cape Town  1998 – 2 years of DACST funding national pilot – Gauteng, Durban, CT  1999 – 1 st annual report – Kimberley, PE, EL 10 mortuaries, 5 provinces  2000 – 2 nd report – Gauteng, PE 15 mortuaries, 5 provinces  2001 – 3 rd report – Durban, EL, Mpumalanga 32 mortuaries, 6 provinces

4. Coverage Non-natural mortality 68 930 (MRC Burden of Disease, 2000) 12 to 15 %of all mortality NIMSS 24 600 / 68930 = 36% Rural: 5-6%, Urban: 55-64%

5. Mainly urban  Metros - Johannesburg, Durban, Cape Town, Pretoria, Port Elizabeth, Erkhuruleni  Cities – East London/KWT/Bisho, Kimberley Rural towns  Mpumalanga, Stellenbosch, Potchefstroom, Kroonstad, Nelspruit 7 out of 9 provinces represented Warehoused at MRC Report- generating software Coverage

6. External cause Firearm Sharp force Hanging Drowning Demographics Age Population group Sex Event Place Blood alcohol Forensic info

7. External cause of death (N = 22 248)

8. External cause of death among males (N = 17 932)

9. External cause of death among females (N = 4076)

10. Overall apparent manner of death (N = 22 248) Source: National Injury Mortality Surveillance System, 2003

11. Fatal injury rates / 100 000 population

12. Transport User by BAC (n=2953) Transport User by BAC, NIMSS, 2003

13. National Injury Mortality Surveillance System (NIMSS) National Injury Mortality Surveillance System (NIMSS) strengths and weaknesses strengths and weaknesses strategic challenges strategic challenges future plans for the NIMSS future plans for the NIMSS

14. Data quality and coverage  Detailed info on who, what, when, where  Mortuary catchment and population data questionable  (minimised by city coverage)  No gold std for apparent manner of death  Resource for specialised studies  Mainly urban - complete datasets for major cities  Rural sites difficult to establish and maintain   Representivity  Comparability (correlates with ICD coding) Sustainability  Standardised (manuals, procedures, storage, reporting)  Cost < $80 000 p.a. (incl staff, reports, media, etc)  widely used / generates considerable publicity – protective factors strengths and weaknesses

15. National Injury Mortality Surveillance System (NIMSS) National Injury Mortality Surveillance System (NIMSS) strengths and weaknesses strengths and weaknesses strategic challenges strategic challenges future plans for the NIMSS future plans for the NIMSS

16. Competing data and interests  StatsSA – national (90%), 16+ yrs, no manner / external CoD  police – national, underreporting, criminal justice, form-based  transport – national, reliant on police, detailed info, substantial underreporting Sensationalism vs rationalism  Media focus on high rates and not public health utility  DoH and other govt depts feel threatened Sustainability  Limited funding prevents expansion  Relocation of mortuaries from police to health (turf ?) Data to action  3 tiers of government  City focus for 2010 world cup strategic challenges

17. National Injury Mortality Surveillance System (NIMSS) National Injury Mortality Surveillance System (NIMSS) strengths and weaknesses strengths and weaknesses strategic challenges strategic challenges future plans for the NIMSS future plans for the NIMSS

18. city infrastructure  accessible  responsive  well established and centralised documentation of strategies and challenges  coordinated information systems amenable to personal and consultative interaction 2003 annual report initial commitment to city focus  National injury profile  City specific rates (Jhb, Durb, CT, Pret)  Separate city-reports (chapters 3-6) transfer to DoH? Focus on cities

19. Doctor Health Facility Headman Mortuary National Home Affairs Office Regional Home Affairs Office Statistics South Africa NIMSS (MRC/UNISA and DoH) DoH Regional co-ordinator Data entry at site / regional? NIMSS resp. in job description MRC/UNISA Data warehouse Report-generation Analytic research City-level prevention NIMSS collection at all mortuaries sites Mortuary-specific reports sites City reports Safe city initiatives NIMSS data set National violence and injury prevention NIMSS annual report Proposed future location of NIMSS

20. Thank You

21. 8th World Conference on Injury Prevention & Safety Promotion ICC, Durban, South Africa 2 - 5 April 2006 www.safety2006.info Data to Action - Securing Safety as a right

22. Co-hosts Sponsor World Health Organization Conference Profile: 2000 Participants from 131 Countries 350 Oral presentations 1500 Posters 100Exhibitors Data to Action - Securing Safety as a right

23. Conference Objectives: Translate injury data into prevention actions - Critical review of approaches Foster exchanges in all fields of injury prevention and safety promotion Examine critical applications of injury prevention and safety promotion practices for different regions of the world Stimulate/strengthen injury prevention and safety promotion as central to national, continental & international public health policies and programmes Create opportunities for multidisciplinary and cross-sectoral dialogue Highlight international injury prevention milestones and possibilities for innovation Data to Action - Securing Safety as a right

24. See you at ICC, Durban, South Africa from 2 - 5 April 2006 For more information visit www.safety2006.info Data to Action - Securing Safety as a right