Strengthening Violence and Strengthening Violence and Injury Surveillance: Injury Surveillance:

Challenges and Opportunities Challenges and Opportunities in the Eastern Caribbeanin the Eastern Caribbean

Meeting of International Collaborative Effort Meeting of International Collaborative Effort on Injury Statistics on Injury Statistics

Cuernavaca, Mexico, June 1-3, 2005Cuernavaca, Mexico, June 1-3, 2005Presentation- Patricia BrandonPresentation- Patricia Brandon

MAP OF THE CARIBBEANMAP OF THE CARIBBEAN

BelizeJamaica

Cayman Is.

Turks &Caicos Is.

Baham

as

Bermuda

USA

Aruba Curacao

Bonaire

Trinidad &Tobago

GrenadaBarbados

St. Lucia

Dominica

St. Vincent

EustatiusSaba

MontserratNevis

Br. VirginIs. Anguilla

St.MaartenSt. Kitts

Antigua

Gu

yan

a

Su

rin

am

e

Defining the Caribbean:Defining the Caribbean:

A Matter of History, Geography, Political A Matter of History, Geography, Political Economy:Economy:

Network of Island and Mainland CountriesNetwork of Island and Mainland Countries Varying geophysical characteristicsVarying geophysical characteristics Differing socio-economic political arrangementsDiffering socio-economic political arrangements Multilingual and multiethnic populationsMultilingual and multiethnic populations

4000 to 15, million population4000 to 15, million population

Bahamas

Barbados

Belize

Guyana

Haiti

Jamaica

Suriname

Trinidad

Turks & Caicos

Cayman Islands

Bermuda

Anguilla

The BVI

Antigua & Barbuda

Dominica

Grenada

St Kitts

Saint Lucia

St Vincent

Montserrat

OECS

CARICOM

PAHO/CPC

Martinique

Guadeloupe

French Guiana

CARIBBEAN COMPLEXITIESCARIBBEAN COMPLEXITIES

Injuries: A Growing Caribbean ConcernInjuries: A Growing Caribbean Concern Increase in interpersonal violenceIncrease in interpersonal violence Decrease in social safetyDecrease in social safety Disruption and costs of hospital servicesDisruption and costs of hospital services Financial drain on hospital servicesFinancial drain on hospital services Use and dissemination of findings of various Use and dissemination of findings of various

studies by various interest groups, studies by various interest groups, Lifelong costs of injuries for rehabilitation, Lifelong costs of injuries for rehabilitation,

incarceration, social support incarceration, social support Mortality, morbidity and social sector data of Mortality, morbidity and social sector data of

varying quality. varying quality.

Injury Surveillance: Infrastructural Injury Surveillance: Infrastructural ChallengesChallenges

Small infrastructure of public sector Small infrastructure of public sector Ministries in small countriesMinistries in small countries

Lack of specific policy and plan for Lack of specific policy and plan for national information system and national information system and coordinated sector componentscoordinated sector components

Absence of an information system plan for Absence of an information system plan for the ‘health sector’:the ‘health sector’: Articulated purpose and components Articulated purpose and components

Injury Surveillance: Infrastructural Injury Surveillance: Infrastructural ChallengesChallenges

Small epidemiological-information units: Small epidemiological-information units: A unit of one ‘epidemiologist’A unit of one ‘epidemiologist’ Staff with varying degrees of trainingStaff with varying degrees of training Responsible for coordinating production, Responsible for coordinating production,

analysis, dissemination of all national and analysis, dissemination of all national and international health sector commitmentsinternational health sector commitments

Injury Surveillance: Infrastructural Injury Surveillance: Infrastructural ChallengesChallenges

Small epidemiological-information units: Small epidemiological-information units: Roles and responsibilities at data collection at Roles and responsibilities at data collection at

various levels of sector not clearly definedvarious levels of sector not clearly defined• Communicable disease surveillanceCommunicable disease surveillance• NCD, Behavioral SurveillanceNCD, Behavioral Surveillance• Contact tracingContact tracing• All emergent diseases: SARS, etcAll emergent diseases: SARS, etc

Dedicated financial resources for information Dedicated financial resources for information management: miniscule or lackingmanagement: miniscule or lacking

Injury Surveillance: Technical Injury Surveillance: Technical ChallengesChallenges

Low perception by non health sectors of Low perception by non health sectors of relevance of their information to health.relevance of their information to health.

Non-standardization of definitions and Non-standardization of definitions and categories used by various sectors to categories used by various sectors to classify the data items: classify the data items: Definition of injury varied.Definition of injury varied. Latitude of interpretation within sectors Latitude of interpretation within sectors

(police)(police) Variation in categories between countriesVariation in categories between countries

Injury Surveillance: Technical Injury Surveillance: Technical ChallengesChallenges

Variations in grouping of the ages by Variations in grouping of the ages by sector and departments or agencies within sector and departments or agencies within a sector.a sector.

Incomplete reporting and documentationIncomplete reporting and documentation Omissions of age and sex, road userOmissions of age and sex, road user Coding difficult due to incompletionCoding difficult due to incompletion Coding to nature of injury than external cause.Coding to nature of injury than external cause. EtcEtc

Injury Surveillance: OpportunitiesInjury Surveillance: Opportunities

Identification of need to strengthen national Identification of need to strengthen national health information systems in the PAHO/WHO health information systems in the PAHO/WHO Common Country for 2006-2010Common Country for 2006-2010

PAHO/CPC Proposal for Medium Term Plan PAHO/CPC Proposal for Medium Term Plan for Strengthening National Health Information for Strengthening National Health Information SystemsSystems

Caribbean Guidelines for Coordinated Injury Caribbean Guidelines for Coordinated Injury Surveillance (adapted from the WHO Surveillance (adapted from the WHO Guidelines) Guidelines)

Injury Surveillance: OpportunitiesInjury Surveillance: Opportunities

The Region experience of Jamaica and the The Region experience of Jamaica and the nascent work of Dominica: a learning nascent work of Dominica: a learning opportunity.opportunity.

Building capacity through virtual training.Building capacity through virtual training. ICE - Meeting an opportunity for ICE - Meeting an opportunity for

partnerships: sharing information, mutual partnerships: sharing information, mutual technical support.technical support.

15 - 24 years15 - 24 years 25 – 44 years25 – 44 years

CauseCause ## RateRate CauseCause ## RateRate

HomicideHomicide

HIV/AIDSHIV/AIDS

MVIsMVIs

SuicidesSuicides

275275

189189

125125

6262

21.721.7

14.914.9

9.89.8

4.94.9

HIV/AIDSHIV/AIDS

HomicideHomicide

MVIsMVIs

Other heart diseaseOther heart disease

DiabetesDiabetes

SuicidesSuicides

Cerebro-vascular DiseaseCerebro-vascular Disease

16281628

512512

261261

202202

173173

155155

151151

78.778.7

24.824.8

12.612.6

9.89.8

8.48.4

7.57.5

7.37.3

Leading causes of death for Leading causes of death for CAREC-member countries, 2000CAREC-member countries, 2000

Leading causes of death by Leading causes of death by potential years of life lost, 2000potential years of life lost, 2000

Cause of deathCause of death PYLLPYLL % of Total PYLL% of Total PYLL

HIV/AIDSHIV/AIDS

Respiratory disorders in the perinatal periodRespiratory disorders in the perinatal period

HomicidesHomicides

Diabetes mellitusDiabetes mellitus

Ischaemic heart diseaseIschaemic heart disease

Cerebro-vascular diseaseCerebro-vascular disease

Motor Vehicle InjuriesMotor Vehicle Injuries

Congenital malformationsCongenital malformations

Other heart diseaseOther heart disease

Intestinal infectious diseaseIntestinal infectious disease

99081.599081.5

5204952049

4412544125

37373.537373.5

32096.532096.5

2602626026

2535125351

24794.524794.5

23462.523462.5

1949919499

13.2413.24

6.966.96

5.905.90

4.994.99

4.294.29

3.483.48

3.393.39

3.313.31

3.143.14

2.612.61

HomicidesHomicides

Rates vary from 6.1 (Grenada), and 6.9 Rates vary from 6.1 (Grenada), and 6.9 (Antigua) to 21.9 (St. Vincent) and 23.9 (Antigua) to 21.9 (St. Vincent) and 23.9 (Saint Lucia)(Saint Lucia)

Have increased, especially in the past e Have increased, especially in the past e years - 36% increase in Antigua, 59% years - 36% increase in Antigua, 59% increase in Saint Luciaincrease in Saint Lucia

Victims tend to be males aged 25-34 Victims tend to be males aged 25-34 years, although Saint Lucia victims now years, although Saint Lucia victims now aged 20-24 yearsaged 20-24 years