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: injury12003@yahoo.comWeb site http://www.minsa.gob.ni

•Francisco TerceroEmail: cidsft@yahoo.esWeb site http:// www.cids.edu.ni