World Health Organization Injury Research Articles

Piloting a hospital-based road traffic injury surveillance system in Nairobi County, Kenya, 2018–2019

BackgroundKenya's estimated road traffic injury (RTI) death rate is 27.8/100,000 population, which is 1.5 times the global rate. Some RTI data are collected in Kenya; however, a systematic and integrated surveillance system does not exist. Therefore, we adopted and modified the World Health Organization's injury surveillance guidelines to pilot a hospital-based RTI surveillance system in Nairobi County, Kenya. MethodsWe prospectively documented all RTI cases presenting at two public trauma hospitals in Nairobi County from October 2018–April 2019. RTI cases were defined as injuries involving ≥1 moving vehicles on public roads. Demographics, injury circumstances, and outcome information were collected using standardized case report forms. The Kampala Trauma Score (KTS) was used to assess injury severity. RTI cases were characterized with descriptive statistics. ResultsOf the 1,840 RTI cases reported during the seven-month period, 73.2% were male. The median age was 29.8 years (range 1–89 years). Forty percent (n = 740) were taken to the hospital by bystanders. Median time for hospital arrival was 77 min. Pedestrians constituted 54.1% (n = 995) of cases. Of 400 motorcyclists, 48.0% lacked helmets. Similarly, 65.7% of bicyclists (23/35) lacked helmets. Among 386 motor vehicle occupants, 59.6% were not using seat belts (19.9% unknown). Seven percent of cases (n = 129) reported alcohol use (49.0% unknown), and 8.8% (n = 161) reported mobile phone use (59.7% unknown). Eleven percent of cases (n = 199) were severely injured (KTS <11), and 220 died. ConclusionWe demonstrated feasibility of a hospital-based RTI surveillance system in Nairobi County. Integrating information from crash scenes and hospitals can guide prevention.

Trauma care and capture rate of variables of World Health Organisation data set for injury at regional hospitals in Tanzania: first steps to a national trauma registry

BackgroundIn Tanzania, there is no national trauma registry. The World Health Organization (WHO) has developed a data set for injury that specifies the variables necessary for documenting the burden of injury and patient-related clinical processes. As a first step in developing and implementing a national Trauma Registry, we determined how well hospitals currently capture the variables that are specified in the WHO injury set.MethodsThis was a prospective, observational cross-sectional study of all trauma patients conducted in the Emergency Units of five regional referral hospitals in Tanzania from February 2018 to July 2018. Research assistants observed the provision of clinical care in the EU for all patients, and documented performed assessment, clinical interventions and final disposition. Research assistants used a purposefully designed case report form to audit the injury variable capture rate, and to review Ministry of Health (MoH) issued facility Register book recording the documentation of variables. We present descriptive statistics for hospital characteristics, patient volume, facility infrastructure, and capture rate of trauma variables.ResultsDuring the study period, 2891 (9.3%) patients presented with trauma-related complaints, 70.7% were male. Overall, the capture rate of all variables was 33.6%. Documentation was most complete for demographics 71.6%, while initial clinical condition, and details of injury were documented in 20.5 and 20.8% respectively. There was no documentation for the care prior to Emergency Unit arrival in all hospitals. 1430 (49.5%) of all trauma-related visits seen were documented in the facility Health Management Information System register submitted to the MoH. Among the cases reported in the register book, the date of EU care was correctly documented in 77% cases, age 43.6%, diagnosis 66.7%, and outcome in 38.9% cases. Among the observed procedures, initial clinical condition (28.7%), interventions at Emergency Unit (52.1%), investigations (49.0%), and disposition (62.9%) were documented in the clinical charts.ConclusionsIn the regional hospitals of Tanzania, there is inadequate documentation of the minimum trauma variables specified in the WHO injury data set. Reasons for this are unclear, but will need to be addressed in order to improve documentation to inform a national injury registry.

The relevance of WHO injury surveillance guidelines for evaluation: learning from the aboriginal community-centered injury surveillance system (ACCISS) and two institution-based systems

BackgroundOver the past three decades, the capacity to develop and implement injury surveillance systems (ISS) has grown worldwide and is reflected by the diversity of data gathering environments in which ISS operate. The capacity to evaluate ISS, however, is less advanced and existing evaluation guidelines are ambiguous. Furthermore, the applied relevance of these guidelines to evaluate ISS operating in various settings is unclear. The aim of this paper was to examine how the World Health Organization (WHO) injury surveillance guidelines have been applied to evaluate systems operating in three different contexts.MethodsThe attributes of a good surveillance system as well as instructions for conducting evaluations, outlined in the WHO injury surveillance guidelines, were used to develop an analytical framework. Using this framework, a comparative analysis of the application of the guidelines was conducted using; the Aboriginal Community-Centered Injury Surveillance System (ACCISS) from Canada, the Shantou-Emergency Department Injury Surveillance Project (S-EDISP) from China, and the Yorkhill-Canadian Hospitals Injury Reporting and Prevention Program (Y-CHIRPP) imported from Canada and implemented in Scotland.ResultsThe WHO guidelines provide only a basic platform for evaluation. The guidelines over emphasize epidemiologic attributes and methods and under emphasize public health and injury prevention perspectives requiring adaptation for context-based relevance. Evaluation elements related to the dissemination and use of knowledge, acceptability, and the sustainability of ISS are notably inadequate. From a public health perspective, alternative reference points are required for re-conceptualizing evaluation paradigms. This paper offers an ISS evaluation template that considers how the WHO guidelines could be adapted and applied.ConclusionsFindings suggest that attributes of a good surveillance system, when used as evaluation metrics, cannot be weighted equally across ISS. In addition, the attribute of acceptability likely holds more relevance than previously recognized and should be viewed as a critical underpinning attribute of ISS. Context-oriented evaluations sensitive to distinct operational environments are more likely to address knowledge gaps related to; understanding links between the production of injury data and its use, and the effectiveness, impact, and sustainability of ISS. Current frameworks are predisposed to disassociating epidemiologic approaches from subjective factors and social processes.