1. Surveillance Systems: Their Role in Identifying Risk and Resilience Factors Diego E Zavala, M.Sc., Ph.D. Associate Professor Public Health Program, Ponce School of Medicine Ponce, Puerto Rico IANSA Public Health Network 3 rd Biennial Meeting of States of the UN Programme of Action On Small Arms and Light Weapons July 14-18, 2008

2. Public Health Approach: ProblemResponse 1. Surveillance: What is the problem? 2. Risk Factor Identification: What is the cause? 3. Intervention Evaluation: What works? 4. Implementation: How do you do it? Source: WHO Teach VIP

4. 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 Source: WHO Teach VIP

5. Injury Pyramid 145,655 Deaths 2,701,000 Hospitalizations 33,950,000 Emergency Department Visits 65,555,000 Visits to Office-based Physicians 59,550,000 Injuries Requiring Medical Attention or Time Off Work Source: National Center for Health Statistics 1:408 1:450 1:233 1:18

6. Multinational Injury Surveillance System Pilot Project 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.

7. Public Health Approach ProblemResponse 1. Surveillance: What is the problem? 2. Risk Factor Identification: What is the cause? 3. Intervention Evaluation: What works? 4. Implementation: How do you do it? Source: WHO Teach VIP

8. Public Health Surveillance: ProblemResponse 1. Surveillance: What is the problem? Source: WHO Teach VIP Systematic ongoing Collection Analysis Interpretation Dissemination Public Health PracticeSystematic ongoing Collection Analysis Interpretation Dissemination Public Health Practice

9. Public Health Surveillance: ProblemResponse 1. Surveillance: What is the problem? Source: WHO Teach VIP Estimate magnitude of the problem Determine geographic distribution of injuries Describe context of injuries, define the problem Detect epidemics Generate hypothesis and stimulate research Evaluate control programs Monitor changes Detect changes in health practice Facilitate planningEstimate magnitude of the problem Determine geographic distribution of injuries Describe context of injuries, define the problem Detect epidemics Generate hypothesis and stimulate research Evaluate control programs Monitor changes Detect changes in health practice Facilitate planning

10. Multinational Injury Surveillance Pilot Project in Africa 2006-2007

11. Participating Countries in Africa DRC Kenya Nigeria Uganda Zambia Kisangani Univ. Teaching Hospital Nairobi Kenyatta National Hospital Dala Na.Orthopedic Hospital AKT Hospital Mbale Regional Hospital Lusaka University Hosp.

12. Multinational Injury Surveillance Project Results : Results : 64.5%

13. Multinational Injury Surveillance Study Implementation : Completeness Summary

14. Multinational Injury Surveillance Study Begun March 1, 2007 Retrospective data collection to Jan. 1, 2007 Gradual increase per month

15. Multinational Injury Surveillance Project Interpersonal violence (IPV) context: Sex 4 cases with missing information

16. Multinational Injury Surveillance Project Interpersonal Violence: Age

17. Multinational Injury Surveillance Project Interpersonal Violence: Place

18. Multinational Injury Surveillance Project Interpersonal Violence - Mechanism

19. Multinational Injury Surveillance Project IPV: CONTEXT

20. Multinational Injury Surveillance Project IPV: Relationship

21. Multinational Injury Surveillance Project CLINICAL DATA: Anatomic site

22. Public Health Surveillance ProblemResponse Source: CDC Summaries Interpretations Recommendations Reports Analysis Health Agencies Health care providers and Policy makers Public

23. Policy Development for Prevention Strategies Opportunities reliable information on cervical cancer (injury) 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 (injury) 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 (injury) prevention initiatives in developing countries this information together with provision of technical assistance is needed to develop sustainable cervical cancer (injury) 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 (injury) prevention; lack of reliable data of cancer (injury) incidence; and limited understanding by health officials about the disease (injury) itself and of its impact, specially in older women (youth). 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.