Hospital-based Injury Surveillance System (HBISS) in Nicaragua Julio Rocha Francisco Tercero
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Transcript of Hospital-based Injury Surveillance System (HBISS) in Nicaragua Julio Rocha Francisco Tercero
Hospital-based Injury Surveillance System (HBISS)
in Nicaragua
Julio RochaFrancisco Tercero
CONTENT
1.Background
2.Process
3.Results
4.Evidence-based decision making
5.Next steps and challenges
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
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
APPROACHES SCOPE YEAR
Exploratory analysisof injury data
All injuries 1998
Hospital-Based All injuriesSelf-inflictedWork-related injuries
199920042005
Population-Based Domestic ViolenceAll injuries
20002005
Capture-Recapture Traffic-related injuries 2004
Injury surveillance approaches in Leon, Nicaragua
BACKGROUND
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
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.
PROCESS
Monitoring included:
Capture of cases.
Quality of data.
Completeness and timeliness of case reports.
RESULTS
Dissemination of injury data:
•National and International publications.
•International Conferences.
•Training.
•Feedback with local autorities.
Hospitals Proportion of Injuries
Hospitalization rate (%)
Case fatality ratio (%)
Managua (Adults) 23 8 1.4
Managua (Children) 19 7 0.07
Carazo (General) 15 17 0.2
Leon (General) 18 4 0.4
Jinotega (General) 4 70 2.2
TOTAL 18 12 0.8
Results from the Hospital-based Injury Surveillance System, Nicaragua, 2003-2004
Intent Female Male Total(n=37,134)
Self-inflicted 2.1 0.9 1.3
Intentional 6.8 17.5 13.9
Unintentional 89.9 79.9 83.3
Total 33.7 66.3 100.0
Proportion of injuries by intent and sex.Nicaragua, 2003-2004.
Intent < 15 15-29 30-44 45-64 ≥ 65 Total(n=38,034)
Self-inflicted 0.3 2.7 1.3 0.6 0.3 1.3
Intentional 2.6 26.0 21.8 10.2 3.5 13.9
Unintentional 96.3 69.3 74.8 87.5 94.6 83.3
Total 38.1 32.3 15.8 9.5 4.4 100.0
Proportion of injuries by intent and age.Nicaragua, 2003-2004.
Mechanism Female Male Total(n=38,343)
Falls 43.4 31.1 35.2
Struck by, against 18.4 26.3 12.5
Cuts/stabs 7.2 15.2 12.4
Traffic 10.6 13.3 12.4
Foreign body 8.9 5.5 6.7
Poisoning 4.2 1.9 2.7
Burns 2.8 1.9 2.2
Bites 2.2 1.7 1.9
Firearms 0.2 1.2 0.9
Strangulation 0.0 0.1 0.1
Total 33.7 66.3 100.0
Proportion of injuries by mechanism and sex.Nicaragua, 2003-2004.
Mechanism < 15 15-29 30-44 45-64 ≥ 65 Total(n=38,239)
Falls 48.1 20.3 24.5 39.6 61.4 35.2
Struck by, against 16.0 31.2 29.9 23.0 13.2 12.5
Cuts/stabs 6.9 19.4 14.6 10.5 6.9 12.4
Traffic 9.8 14.1 16.1 12.6 8.1 12.4
Foreign body 9.9 4.2 5.6 5.7 3.5 6.7
Poisoning 2.6 3.6 2.1 1.7 1.3 2.7
Burns 3.4 1.5 1.6 1.4 1.0 2.2
Bites 2.2 1.5 1.7 2.1 2.1 1.9
Firearm 0.2 1.8 1.2 0.6 0.1 0.9
Suffocation 0.0 0.1 0.0 0.0 0.0 0.1
Total 38.2 32.3 15.7 9.4 4.4 100.0
Proportion of injuries by mechanism and age.Nicaragua, 2003-2004.
Mechanism Self-inflicted
Intentional Unintentional Total(n=38,335)
Falls 0.3 99.5 35.2
Struck by,against 0.1 36.2 62.5 12.5
Cuts/stabs 0.7 35.6 62.5 12.4
Traffic 100.0 12.4
Foreign body 99.9 6.7
Poisoning 40.6 0.6 57.7 2.7
Burns 2.0 97.4 2.2
Bites 4.7 85.7 1.9
Firearm 2.3 72.9 19.5 0.9
Suffocation 72.7 9.1 18.2 0.1
Total 1.3 14.1 83.1 100.0
Proportion of injuries by mechanism and intent.Nicaragua, 2003-2004.
Intent Minor Moderate Severe Total(n=37,106)
Self-inflicted 15.3 56.4 28.2 1.3
Intentional 44.1 51.4 4.6 14.4
Unintentional 52.9 45.2 1.9 82.7
Total 51.2 46.2 2.6 100.0
Proportion of injuries by intent and severity.Nicaragua, 2003-2004.
Mechanism Minor Moderate Severe Total(n=37,014)
Falls 44.7 51.5 1.1 35.2
Struck by, against 57.1 41.5 1.4 12.5
Cuts/stabs 45.0 52.2 2.8 12.4
Traffic 46.1 48.6 5.3 12.4
Foreign body 85.0 14.7 0.3 6.7
Poisoning 40.1 47.2 12.8 2.7
Burns 30.4 59.4 10.2 2.2
Bites 56.3 42.6 1.0 1.9
Firearm 20.3 57.4 22.4 0.9
Suffocation 18.2 68.2 13.6 0.1
Total 51.2 46.2 2.6 100.0
Proportion of injuries by mechanism and severity.Nicaragua, 2003-2004.
ATTRIBUTES SCORE
Simplicity +++
Flexibility +++
Acceptability +++
Reliability +
Usefulness +++
Sustainability ++
Timeliness +++
A broad evaluation of the HBISS in Nicaragua, 2003-2004.
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).
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.
Acknowledgements
To all members of the hospitals that are involved in the
hospital-based injury surveillance systems.
CONTACT US:
•Julio RochaEmail: [email protected] site http://www.minsa.gob.ni
•Francisco TerceroEmail: [email protected] site http:// www.cids.edu.ni