Kidist Bartolomeos

Injury prevention and the attainment of child and adolescent health

Urgent attention is required to tackle the problem of child and adolescent injury across the world. There have been considerable shifts in the epidemiological patterns of child deaths; while great progress has been made in preventing infectious diseases, the exposure of children and adolescents to the risks of injury appear to be increasing and will continue to do so in the future. The issue of injuries is too often absent from child and adolescent health agendas. In December 2008, WHO and the United Nations Childrens Fund published the World report on child injury prevention, calling global attention to the problem of child injuries. This article expands on the reports arguments that child injuries must be integrated into child health initiatives and proposes initial steps for achieving this integration.

Data sharing in public health emergencies: a call to researchers.

Data are the basis for public health action, and rapid data sharing is critical during an unfolding health emergency.1,2 The information disseminated through peer-reviewed journals and accompanying online data sets is vital for decision-makers.1 The deficiencies with existing data-sharing mechanisms, which were highlighted during the 2013–16 Ebola epidemic in west Africa, have brought the question of data access to the forefront of the global health agenda.2 In September 2015, agreement was reached on the need for open sharing of data and results, especially in public health emergencies.3 Subsequently, following published expressions of support by its members, the International Committee of Medical Journal Editors (ICMJE) have explicitly confirmed that pre-publication dissemination of information critical to public health will not prejudice journal publication in the context of a public health emergency declared by WHO.4 While efforts so far have focused on results from clinical trials, and on making full accompanying data sets available at the time of publication, there are further opportunities to expand access to information from observational studies, operational research, routine surveillance and the monitoring of disease control programmes. To improve timely access to data in the context of a public health emergency, the Bulletin of the World Health Organization will implement a new data sharing and reporting protocol. The protocol is established specifically to address the data gap that exists in responding to the current Zika virus epidemic, and will apply in the first instance only to articles submitted in the context of this outbreak. On submission to the Bulletin, all research manuscripts relevant to the Zika epidemic will be assigned a digital object identifier and posted online in the “Zika Open” collection within 24 hours while undergoing peer review. The data in these papers will thus be attributed to the authors while being freely available for reader scrutiny and unrestricted use, distribution and reproduction in any medium, provided that the original work is properly cited as indicated by the Creative Commons Attribution 3.0 Intergovernmental Organizations license (CC BY IGO 3.0)5. Should a paper be accepted by the Bulletin following peer review, this open access review period will be reported in the final publication. In the event that a paper does not survive peer review, and given the rapidly evolving knowledge basis on this disease, authors will be free to seek publication elsewhere. If the authors of any paper posted with the Bulletin in this context are unable to obtain acceptance with a suitable journal, WHO undertakes to publish these papers in its institutional repository as citable working papers, independently of the Bulletin. This early access to research manuscripts at WHO builds on examples of other rapid information access platforms such as PROMED and F1000Research.6,7 Given the number and complexity of unanswered questions on the mechanisms and consequences of Zika infection and associated disease, our goal is to encourage all researchers to share their data as quickly and widely as possible. With this protocol for immediate online posting, we are providing another means to achieve immediate global access to relevant data. Researchers can thus share their data while meeting their need to retain authorship, achieve precedence, and to put their research on public record. We are pleased to announce that the first paper to which this protocol applies is now available online.8

Core Competencies for Scientific Editors of Biomedical Journals: Consensus Statement

BackgroundScientific editors are responsible for deciding which articles to publish in their journals. However, we have not found documentation of their required knowledge, skills, and characteristics, or the existence of any formal core competencies for this role.MethodsWe describe the development of a minimum set of core competencies for scientific editors of biomedical journals.ResultsThe 14 key core competencies are divided into three major areas, and each competency has a list of associated elements or descriptions of more specific knowledge, skills, and characteristics that contribute to its fulfillment.ConclusionsWe believe that these core competencies are a baseline of the knowledge, skills, and characteristics needed to perform competently the duties of a scientific editor at a biomedical journal.

The mortuary as a source of injury data: Progress towards a mortuary data guideline for fatal injury surveillance

To help bridge the obstacle of inadequate injury fatality data in low and medium income countries (LMICs) a simple cost effective system for mortuary surveillance of fatal injuries is being developed in consultation with the WHO. This will inform, direct and monitor injury prevention (IP) interventions and policies in LMICs. This article uses CDCs ‘attributes of a successful surveillance system’ to describe the process, the barriers and solutions in development of this mortuary data guideline. The consultative process utilised generated feedback from key stakeholders including forensic pathologists, Ministry of Health officials and injury prevention experts. An International Advisory Group was also convened to guide the guideline development. These assisted the adjustment of the proposed guideline to maximise flexibility, acceptability and stability; whilst minimising resource implications. Representativeness and the securing of government support perhaps remain the most significant challenges. Consultation with the advisory group and the wider stakeholders has been effective in developing a widely acceptable, user-friendly, low resource data form to gather useful data. Further strategies to overcome barriers need to be developed over the course of the pilot study and this should be done in consultation with the advisory group and stakeholders.

WHO to develop guide to promote standardised documentation of deaths due to injuries and violence

Effective injury prevention decision-making and priority-setting require consistent and comparable data on the burden of, and circumstances leading to, injuries and violence. In many high-income and some middle-income countries, vital registration (eg, death certificates) are the usual source of mortality data. However, in many low-income countries, mortality data are missing altogether. Even in countries where vital registration data exist, they are fragmented and in many cases incomplete. Death registration data containing usable information on the cause of death are lacking from 82 (43%) countries—most …

The case for investing in public health surveillance in low- and middle-income countries

Surveillance is central to public health. In the absence of comparable data from most low-income and middle-income countries, national and international agencies use estimates to monitor health targets. Although morbidity and mortality estimations generated by statistical modelling can fulfill national and global reporting requirements, locally generated data are needed to guide evidence-based local action. The focus on measurement around the sustainable development goals provides an opportunity for WHO and the global health community to make a case for increased investment by governments to strengthen local surveillance systems.

903 Implementation of road safety interventions in low and middle income countries – a case of Kenya

Background Kenya was one of 10 countries, and the only one in sub-Saharan Africa that participated in a 5-year road traffic injury prevention demonstration project, which was part of the Bloomberg Philanthropies Global Road Safety Programme (BPGRSP). The global programme focused on implementation of evidence based road safety interventions. In Kenya, the focus of the Project was to increase helmet wearing among motorcycle riders and to reduce speed on the main highways which pass through two implementation sites (sub-counties). Methods Project was implemented between 2010–2014. Implementation of intervention was led by a consortium of six organisations. WHO as one of the organisations that took the role of coordination between national government and consortium partners. The local work was led by a local multi-agency working group of stakeholders (under the leadership of MOH) which were responsible for developing, implementing and monitoring of national and/or local work plan. A core package of road safety interventions (social marketing, legislative review, training of journalists, trauma care improvement, data system strengthening, child pedestrian safety) targeting the identified risk factors, were developed and implemented. Interventions were adapted for the local setting. Monitoring and evaluation, capacity development on enforcement and engagement with NGOS was led by the other consortium partners. Results In the 5 years of the project, several achievements in most of the intervention areas were observed. Speed compliance at both intervention sites reached above 90%. Helmet wearing improved slightly (by 26%), but only at one site. There was a significant decline (over 85%) in the number of child pedestrian injuries and deaths at pilot sites. The national helmet standard was revised. Efforts to integrate some of the activities into the National Transportation Safety Authority and MOH’s work is ongoing. Conclusions Targeted multi-sectoral action using a combination of evidence-based interventions implemented as a package, with adaptation to the local setting and capacity can lead to positive outcome. The sustainability of the positive results at intervention sites and scale up of the proven interventions to national level is a challenge in Low and middle income countries.

Mortuary based injury surveillance for low-mid income countries: process evaluation of pilot studies

OBJECTIVE Globally, injury is the fourth major cause of death and the third leading contributor to Disability Adjusted Life Years lost due to health conditions, with the greatest burden borne by low-middle income countries (LMICs) where injury data is scarce. In the absence of effective vital registration systems, mortuaries have been shown to provide an alternative source of cause of death information for practitioners and policy makers to establish strategic injury prevention policies and programs. This evaluation sought to assess the feasibility of implementing a standardised fatal injury data collection process to systematically collect relevant fatal injury data from mortuaries. The process evaluation is described. METHODS A manual including a one page data collection form, coding guide, data dictionary, data entry and analysis program was developed through World Health Organization and Monash University Australia collaboration, with technical advice from an International Advisory Group. The data collection component was piloted in multiple mortuaries, in five LMICs (Egypt, India, Sri-Lanka, Tanzania and Zambia). Process evaluation was based on a questionnaire completed by each countrys Principal Investigator. RESULTS Questionnaires were completed for data collections in urban and rural mortuaries between September 2010 and February 2011. Of the 1795 reported fatal injury cases registered in the participating mortuaries, road traffic injury accounted for the highest proportion of cases, ranging from 22% to 87%. Other causes included burns, poisoning, drowning and falls. Positive system attributes were feasibility, acceptability, usefulness, timeliness, and simplicity and data field completeness. Some limitations included short duration of the pilot studies, limited injury data collector training and apparent underreporting of cases to the medico-legal system or mortuaries. CONCLUSION The mortuary has been shown to be a potential data source for identifying injury deaths and their circumstances and monitoring injury trends and risk factors in LMICs. However, further piloting is needed, including in rural areas and training of forensic pathologists and data-recorders to overcome some of the difficulties experienced in the pilot countries. The key to attracting ongoing funding and support from governments and donors in LMICs for fatal injury surveillance lies in further demonstrating the usefulness of collected data.

Using mortuary data for estimating urban injury mortality incidence in Africa

National vital registration systems that record causes of death do not exist in most African countries. This makes estimating incidence of mortality from injuries in African regions particularly challenging. We discuss the viability of using retrospective and prospective data gathered from death registration sites that issue death certificates for medicolegal purposes in four African cities (Lusaka, Zambia; Maputo, Mozambique; Addis Ababa, Ethiopia; and Kampala, Uganda). We describe the flow of information in the form of administrative registers and documents maintained and issued by various institutions involved with deaths (including medical institutions, forensic, police and judicial investigation records, and funeral grounds and cemeteries). In each case, we show the implications of varying social, cultural and administrative record keeping practices and identify the most complete site for collecting cause-of-death information. Next, we discuss methods for converting such data into reliable estimates of injury incidence. This requires addressing data quality issues, and estimating completeness and coverage of these data systems. We demonstrate how cause of death attribution can be improved in retrospective data gathering by following back a stratified sample of registered cases. For prospective data gathering, we recommend the adoption of a standardised surveillance instrument (currently being developed by WHO) for prospective data gathering. Finally, we demonstrate the method of estimating completeness and coverage by comparing recorded deaths with deaths predicted in the population using alternate sources.

The Mortuary as a source of injury data: progress towards a mortuary data guideline for fatal injury surveillance

Background Injury is a substantial and preventable public health problem accounting for 10% of deaths worldwide, of which 90% are estimated to occur in low and middle income countries (LMICs). To help bridge the obstacle of inadequate data in LMICs a simple cost effective system for mortuary surveillance of fatal injuries is being developed in consultation with the WHO. This will inform, direct and monitor injury prevention interventions and policies in LMICs. There are many challenges to the establishment of an international guideline for mortuary data surveillance and this article seeks to outline the process, challenges and progress. Methodology This article uses CDCs attributes of a successful surveillance system to characterise barriers anticipated in guideline development and discuss the way forward. Conclusions The development of a mortuary data guideline has proceeded and overcome various barriers. The consultative process generated feedback from key stakeholders including forensic pathologists, Ministry of Health officials and injury prevention experts. An International Advisory Group was also convened. These steps have assisted adjustment of the proposed guideline to maximise flexibility, acceptability and stability; while minimising resource implications. Representativeness and the securing of government support perhaps remain the most significant challenges. Implications Consultation with the advisory group and the wider stakeholders has been effective in developing a widely acceptable, user-friendly, low resource data form to gather useful data. Further strategies to overcome barriers will be developed over the course of the pilot study and this needs to be done in consultation the advisory group and stakeholders.