A model for injury surveillance at the local level in Bangladesh : implications for low-income countries

Injury is a major public health problem in Bangladesh as in other low income countries throughout the world, but one that has gained very little attention from policy makers or even health professionals, mainly due to the lack of valid injury information in these countries. The establishment of surveillance systems for injuries at the national and local levels for the purpose of measuring trends, detecting clusters, identifying injury related risk factors, and developing intervention strategies are now essential steps to be taken in low-income countries. Despite several advances in public health surveillance practice such as sophisticated public health methods, computers, and the development of software for statistical analysis, the development of any kind of disease surveillance is a challenging task in low-income countries. This is mainly due to the scarcity of resources, low priority given to the problem, lack of interest by the people involved in these processes, and non- initiatives for the development of such systems. A model for injury surveillance is developed to be applied as part of injury prevention programmes at the local level in Bangladesh as well as in other low-income countries. The model contains the utilization of four sources of injury information to depict the injury panorama for the area, the sources being hospital injury registry, post-mortem reports, police reports, and household surveys on injury. The development of the model is based on a series of scientific approaches. First, the medical-care seeking behaviour of injury patients in a local community in Bangladesh was studied, at the same time that injury morbidity and mortality in the same community were assessed. Then the different potential sources of injury information were evaluated in terms of validity, cost effectiveness and practical feasibility. Using this information, a model of injury surveillance was designed incorporating the establishment of a practical, effective, and affordable injury registry system. Finally, the epidemiology of injury was described by means of the new injury surveillance system. The injury surveillance model has been developed and applied in the Sherpur sadar thana of Bangladesh, a district which is situated in the northern part of the country, a out 200 km from the capital city ha a, and as a total population of 381,419. Overall research project was conducted during the period 1996 until 1999. In the thesis, five studies are presented which build upon data collected for the development as well as the application of the model. The development of injury surveillance as part of a local injury prevention programme in Bangladesh is the first attempt of its kind. This experience may be useful for designing and implementing similar systems in other low-income countries