2. Organizing a pilot projecton injury surveillance. Opportunities and Obstacles Diego E Zavala, M.Sc., Ph.D. Director- Epidemiology and Biostatistics Core Program Public Health Program Ponce School of Medicine Ponce, Puerto Rico

3. Multinational Injury Surveillance Study Background Initiative emerged out of the last two World Conferences on Injury Prevention and Control Initiative emerged out of the last two World Conferences on Injury Prevention and Control And pre-conferences on war related injuries… And pre-conferences on war related injuries…

4. Multinational Injury Surveillance Study In collaboration with: Pan American Health Organization/ WHO Pan American Health Organization/ WHO Alberto Concha, MD, MPH Regional Advisor on Injury Prevention Regional Advisor on Injury Prevention Centers of Disease Prevention and Control Centers of Disease Prevention and Control Carme Clavel-Arcas, MD, MPH National Center for Injury Prevention and Control National Center for Injury Prevention and Control CDC, U.S. CDC, U.S.

5. Multinational Injury Surveillance Study El Salvador Colombia Bolivia Brazil 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)

6. Participating Countries LATIN 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

7. Participating Countries LATIN AMERICA & CARIBBEAN 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

8. Participating Countries LATIN AMERICA & CARIBBEAN Colombia Population: 42,310,775 (2004) Area: Bucaramanga: two public hospitals Co-PI: Marta H León Franco, MD

9. Participating 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)

10. Participating Countries AFRICA 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)

11. Participating Countries Nigeria AFRICA Population: 137,253,133 Area: Dala: Nacional Orthopedic Hosp Kano:Aminu Kano Hospital Co-PI: Ime John, MD (IPPNW)

12. Multinational Injury Surveillance Study Phase I: Development of Questionnaire Development of Questionnaire Retrospective review of 30 cases in last six months Retrospective review of 30 cases in last six months Presentation of results to ED medical professionals. Presentation of results to ED medical professionals.

13. Multinational Injury Surveillance Study Phase II: Secure funding Secure funding Regional training (TOT) Regional training (TOT) Begin 12 month prospective data collection in all sites. Begin 12 month prospective data collection in all sites.

14. Multinational Injury Surveillance Study Opportunities Response to WHO recommendations. Response to WHO recommendations. Interest & enthusiasm. Interest & enthusiasm. Develop experience in international collaboration efforts. Develop experience in international collaboration efforts. Foundation for further research efforts. Foundation for further research efforts.

15. Multinational Injury Surveillance Study Opportunities Response to WHO recommendations/observations in that: Response to WHO recommendations/observations in that: Many countries, specially in underdeveloped regions lack injury surveillance systems that would provide reliable data on injury. Call for enhancing capacity for collecting data on violence at the national level in developing countries Lack of data has made multinational comparisons difficult.

16. Multinational Injury Surveillance Study Opportunities Response to WHO recommendations. Response to WHO recommendations. Interest & commitment. Interest & commitment. Develop experience in international collaboration efforts. Develop experience in international collaboration efforts. Foundation for further research efforts. Foundation for further research efforts.Obstacles Communication Funding Coordination via internet? Local socio-political realities

17. Multinational Injury Surveillance Study Opportunities reliable information on cervical cancer incidence and mortality data that demonstrates the extent of the problem and the financial implications of the disease for the country. reliable information on cervical cancer incidence and mortality data that demonstrates the extent of the problem and the financial implications of the disease for the country. this information together with provision of technical assistance is needed to develop sustainable cervical cancer prevention initiatives in developing countries this information together with provision of technical assistance is needed to develop sustainable cervical cancer prevention initiatives in developing countries for which donors may be more willing to support for which donors may be more willing to supportBarriers limited availability of funds, particularly from donor organizations; absence or deficient infrastructure for cervical cancer prevention; lack of reliable data of cancer incidence; and limited understanding by health officials about the disease itself and of its impact, specially in older 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.

18. Multinational Injury Surveillance Study Funding: FIA application 50% FIA application 50% IPPNW: Govt. of Canada IPPNW: Govt. of Canada Other ? Other ?

19. Multinational Injury Surveillance Study Output: National: National:HospitalGovernmentCommunity? International: International:ConferencesJournals

20. Puerto Rico