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Hospital-based Injury Surveillance System (HBISS) in Nicaragua Julio Rocha Francisco Tercero.

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Presentation on theme: "Hospital-based Injury Surveillance System (HBISS) in Nicaragua Julio Rocha Francisco Tercero."— Presentation transcript:

1 Hospital-based Injury Surveillance System (HBISS) in Nicaragua Julio Rocha Francisco Tercero

2 CONTENT 1.Background 2.Process 3.Results 4.Evidence-based decision making 5.Next steps and challenges

3 Epidemiology Transition in Nicaragua Before the Revolution:Infectious diseases (Before 1979) During the Revolution: War-related injuries (1979-1990) After the Revolution: Noncommunicable and (1990-Present) Injuries BACKGROUND

4 Technical Support on Injury Surveillance: During 1990-1995 (only in Leon): Social Medicine, KI (SAREC) Academic but not institutional support. During 2000-2005 (National level): CDC, PAHO, with SAREM support. Aimed to strengthen the Ministry of Health capacity buildings. BACKGROUND

5 APPROACHESSCOPEYEAR Exploratory analysis of injury data All injuries1998 Hospital-BasedAll injuries Self-inflicted Work-related injuries 1999 2004 2005 Population-BasedDomestic Violence All injuries 2000 2005 Capture-RecaptureTraffic-related injuries2004 Injury surveillance approaches in Leon, Nicaragua BACKGROUND

6 PROCESS Advocacy for interdisciplinary support for Injury Prevention and Control Minister and vice-Minister of Health Forensic Institute Mayors NGOs: Networking with woman and young people. University Police

7 PROCESS The Training Program included: A user’s manual on HBISS. Series of workshops on injury registration and data analysis (External trainers). Epi Info training to data entry and Epidemiologist.

8 PROCESS Monitoring included: Capture of cases. Quality of data. Completeness and timeliness of case reports.

9 RESULTS Dissemination of injury data: National and International publications. International Conferences. Training. Feedback with local autorities.

10 HospitalsProportion of Injuries Hospitalization rate (%) Case fatality ratio (%) Managua (Adults)2381.4 Managua (Children)1970.07 Carazo (General)15170.2 Leon (General)1840.4 Jinotega (General)4702.2 TOTAL18120.8 Results from the Hospital-based Injury Surveillance System, Nicaragua, 2003-2004

11 IntentFemaleMaleTotal (n=37,134) Self-inflicted2.10.91.3 Intentional6.817.513.9 Unintentional89.979.983.3 Total33.766.3100.0 Proportion of injuries by intent and sex. Nicaragua, 2003-2004.

12 Intent< 1515-2930-4445-64≥ 65Total (n=38,034) Self-inflicted0.32.71.30.60.31.3 Intentional2.626.021.810.23.513.9 Unintentional96.369.374.887.594.683.3 Total38.132.315.89.54.4100.0 Proportion of injuries by intent and age. Nicaragua, 2003-2004.

13 MechanismFemaleMaleTotal (n=38,343) Falls43.431.135.2 Struck by, against18.426.312.5 Cuts/stabs7.215.212.4 Traffic10.613.312.4 Foreign body8.95.56.7 Poisoning4.21.92.7 Burns2.81.92.2 Bites2.21.71.9 Firearms0.21.20.9 Strangulation0.00.1 Total33.766.3100.0 Proportion of injuries by mechanism and sex. Nicaragua, 2003-2004.

14 Mechanism< 1515-2930-4445-64≥ 65Total (n=38,239) Falls48.120.324.539.661.435.2 Struck by, against16.031.229.923.013.212.5 Cuts/stabs6.919.414.610.56.912.4 Traffic9.814.116.112.68.112.4 Foreign body9.94.25.65.73.56.7 Poisoning2.63.62.11.71.32.7 Burns3.41.51.61.41.02.2 Bites2.21.51.72.1 1.9 Firearm0.21.81.20.60.10.9 Suffocation0.00.10.0 0.1 Total38.232.315.79.44.4100.0 Proportion of injuries by mechanism and age. Nicaragua, 2003-2004.

15 MechanismSelf- inflicted IntentionalUnintentionalTotal (n=38,335) Falls0.399.535.2 Struck by,against0.136.262.512.5 Cuts/stabs0.735.662.512.4 Traffic100.012.4 Foreign body99.96.7 Poisoning40.60.657.72.7 Burns2.097.42.2 Bites4.785.71.9 Firearm2.372.919.50.9 Suffocation72.79.118.20.1 Total1.314.183.1100.0 Proportion of injuries by mechanism and intent. Nicaragua, 2003-2004.

16 IntentMinorModerateSevereTotal (n=37,106) Self-inflicted15.356.428.21.3 Intentional44.151.44.614.4 Unintentional52.945.21.982.7 Total51.246.22.6100.0 Proportion of injuries by intent and severity. Nicaragua, 2003-2004.

17 MechanismMinorModerateSevereTotal (n=37,014) Falls44.751.51.135.2 Struck by, against57.141.51.412.5 Cuts/stabs45.052.22.812.4 Traffic46.148.65.312.4 Foreign body85.014.70.36.7 Poisoning40.147.212.82.7 Burns30.459.410.22.2 Bites56.342.61.01.9 Firearm20.357.422.40.9 Suffocation18.268.213.60.1 Total51.246.22.6100.0 Proportion of injuries by mechanism and severity. Nicaragua, 2003-2004.

18 ATTRIBUTESSCORE Simplicity+++ Flexibility+++ Acceptability+++ Reliability+ Usefulness+++ Sustainability++ Timeliness+++ A broad evaluation of the HBISS in Nicaragua, 2003-2004.

19 Evidence-Based Decision Making Injuries were included in the National Plan of Health (2004-2015) The notification of injuries are compulsory (2005). Injury prevention in the agenda of three municipalities: Violence Suicide Traffic To calculate injury cost to measure the burden of injuries (2003).

20 Next steps and challenges To improve the quality of the HBISS. To standardize injury severity indicators to monitor properly the impact of intervention measures. To guarantee the sustainability of the HBISS. The needs to institutionalize within the Ministry of Health a National Injury Prevention Program.

21 Acknowledgements To all members of the hospitals that are involved in the hospital-based injury surveillance systems.

22 CONTACT US: Julio Rocha Email: injury12003@yahoo.cominjury12003@yahoo.com Web site http://www.minsa.gob.ni Francisco Tercero Email: cidsft@yahoo.escidsft@yahoo.es Web site http:// www.cids.edu.ni

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