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Strategic approaches for injury prevention and control in the South-East Asia Region

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iiiStrategic Approaches for Injury Prevention and Control in the South-East Asia Region

Contents

Preface ........................................................................................................................v

Executive summary ................................................................................................... vii

Acknowledgements .................................................................................................... xi

Introduction ..................................................................................................................1

WHO strategy for injury prevention .............................................................................3

Purpose and importance .............................................................................................4

Methodology ................................................................................................................5

Burden of injury and violence in the South-East Asia Region .....................................6

Pattern and profile of injuries by causes....................................................................16

Road traffic injuries ......................................................................................................... 16

Drowning ........................................................................................................................ 17

Suicide ............................................................................................................................ 17

Burns .............................................................................................................................. 18

Poisoning ........................................................................................................................ 18

Assaults .......................................................................................................................... 19

Barriers to injury prevention and control ....................................................................21

Response to the problem ..........................................................................................22

Bangladesh ..................................................................................................................... 22

Bhutan ............................................................................................................................ 22

India ................................................................................................................................ 23

Indonesia ........................................................................................................................ 24

Maldives ......................................................................................................................... 24

Myanmar ......................................................................................................................... 24

Nepal .............................................................................................................................. 24


Strategic Approaches for Injury Prevention and Control in the South-East Asia Regioniv

Sri Lanka ........................................................................................................................ 25

Thailand .......................................................................................................................... 25

Timor-Leste ..................................................................................................................... 26

Strategic approaches for injury prevention and control .............................................29

Advocacy ........................................................................................................................ 29

Better information for injury prevention and control ........................................................ 30

Policy formulation and strengthening ............................................................................. 30

Capacity strengthening for injury prevention and control ............................................... 31

Implementation of interventions ...................................................................................... 31

Resource mobilization .................................................................................................... 32

Towards an intersectoral approach ................................................................................. 32

Empowering civil society ................................................................................................ 33

Strengthening pre-hospital and emergency care ............................................................ 33

Rehabilitation of the injured ............................................................................................ 33

Monitoring and evaluation .............................................................................................. 33

Conclusions ...............................................................................................................35

Recommendations.....................................................................................................36

References ................................................................................................................37

Annexes

1. Recommendations of the Regional Meeting of the National Programme Managers on Injury Prevention and Care ...........................................................39

2. Interventions to implement ..................................................................................41

3. WHO resource materials .....................................................................................47

4. WHO collaborating centres for injuries in the South-East Asia Region ...............49

5. Summary of activities to fulfil regional strategy for injury prevention & control....50


vStrategic Approaches for Injury Prevention and Control in the South-East Asia Region

Preface

Injuries are a leading cause of death, hospitalization and disability in the South-East Asia (SEA) Region. The available data indicate that nearly 1.5 million deaths, 20-30 million hospitalizations and more than 50 million emergency room registrations are due to injuries in the Region. Among those killed, injured and disabled significant numbers are men in younger age groups. Road traffic injuries (RTIs), suicides, burns and work-related injuries are the major causes contributing significantly to death and disability. The socio-economic losses are huge and phenomenal though unmeasured.

Despite the huge increase in injuries in South-East Asia, global experiences from high-income countries reveal that injuries are predictable and preventable. A systems approach to injury prevention and control by implementing feasible and cost-effective measures through intersectoral and coordinated mechanisms can reduce the injury burden in the SEA Region. Scientific evidence is crucial to document ongoing changes and to examine the efficacy and effectiveness of interventions.

Strategic approaches for injury prevention and control along with policies and programmes form the backbone and the foundation for injury prevention and control programmes. Strong advocacy activities, better information systems through surveillance, policy formulation and programme development, capacity strengthening at different levels are crucial for implementation of interventions. To achieve desired goals and objectives, greater allocation of resources, an intersectoral approach, empowering civil society and measures for trauma care and rehabilitation services form the corner stones of present as well as future programmes. Undoubtedly, monitoring and evaluation are crucial to measure the progress over a period of time. I believe that this strategic document will be most useful for policy planners to make the SEA Region a safer place for future generations.

Dr Samlee Plianbangchang Regional Director


viiStrategic Approaches for Injury Prevention and Control in the South-East Asia Region

Executive summary

Title

Strategic Approaches for Injury Prevention and Control in the South-East Asia Region.

Rationale

Injury and violence are the leading causes of death, hospitalization and disability throughout the world, and a major unrecognized problem in the South-East Asia (SEA) Region also. The burden is more in developing societies of the Region and accounts for significant socioeconomic losses. Young males are affected mostly. However, injuries are predictable and preventable. The far-reaching implications of injury and violence warrant an urgent need to highlight the magnitude and severity of the problem and develop preventive strategies based on strategic approaches.

General objective

To assess the burden of injury and violence and explore ongoing efforts for prevention and control in the SEA Region.

Methodology

Phase I: A questionnaire was developed and mailed to investigators in Member States of the SEA Region. The available data related to injury burden, impact and ongoing activities was gathered by the national representatives from various sources. Published and unpublished literature was included for pooling relevant information from the Region. The compilation of information was undertaken by the lead investigator and circulated among the national representatives for their further input.

Phase II: An intercountry consultation of national programme managers was held during September, 2007 and the draft document was discussed. More information was obtained from country delegates and the report was circulated to focal persons in the ministries of health in the Member States for supplementing data as well as reviewing and endorsing the document.


Strategic Approaches for Injury Prevention and Control in the South-East Asia Regionviii

ResultsInjuries account for 10% – 15% of deaths from all causes, 20% – 25% of �

hospitalization, one third of disabilities and significant, unmeasured socioeconomic losses in the Region. Injuries account for 17% of deaths in Thailand and 10% of deaths in India with variations across countries. All countries are registering an increase in the number of injury deaths and hospitalization.

Among various injuries, road traffic injuries (RTIs) account for nearly half, followed �

by burns. Among intentional injuries, suicides are on the increase in the SEA Region. Drowning is also an important cause of injury, though it does not get a high rank in data obtained from hospitals, but can be found as the leading cause of deaths from community-based data such as death registry.

When injuries are categorized by activities, it is found that occupation-related �

injury is also important.

A national policy for injury prevention and control exists in a few countries like �

Thailand, Sri Lanka and Maldives. Other countries are formulating relevant strategies. Road traffic injuries receive high priority compared with other injuries especially drowning and falls.

National designated injury prevention and control units have been recently �

established in Indonesia, Sri Lanka and Thailand with a few staff as well as a defined budget and mechanism of implementation.

In most Member States, designated divisions with integrated and coordinated �

policies for road safety are available with ministries of transport in spite of the multidisciplinary nature and diversity of stakeholders. Even though legislation on helmet usage, drink-driving, speed control and others are stipulated in Member States, implementation needs further strengthening.

RecommendationsIt is strongly recommended that national policy and programme on Injury prevention �

and care should be developed and strengthened including monitoring for progress in all Member States. Member States which do not have a national injury prevention and control policy should develop the same.

The WHO Regional Office for South-East Asia, (WHO-SEARO), through the country �

representative and respective ministries of health, should monitor and evaluate country commitment for injury prevention and control and help in implementation of policy.


ixStrategic Approaches for Injury Prevention and Control in the South-East Asia Region

The national health authority should initiate development of national policy and �

programmes for injury prevention and control with clearly defined goals, objectives, resources and prioritization.

Member States should support the programme with clear political and administrative �

commitment, budget and human resources to reduce the burden of death and disability due to injuries.


xiStrategic Approaches for Injury Prevention and Control in the South-East Asia Region

Acknowledgements

The process of compilation of this report based on information from various sources from the South-East Asia Region was undertaken by Dr. G. Gururaj, Professor and Head, Department of Epidemiology, WHO Collaborating Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health & Neurosciences, Bangalore, India. We are grateful to the following professionals for supporting this activity by providing information on injury burden and ongoing activities in their respective countries:

Prof Md. Siraj-ul-Islam, Bangladesh1.

The Directorate of NCDC, DG DC & EH, Jakarta, Indonesia2.

Ms. Mariyam Waseela, Maldives3.

Prof Thit Lwin, Myanmar4.

Dr B R Marasani, Nepal5.

Dr Vindya Kumarapeli, Sri Lanka6.

Dr Witaya Chadbunchachai, Thailand7.

Dr Tairjing Siripanich, Thailand8.

Mr. Tiofilo Julio Kehic Tilman, Timor-Leste, and9.

Mr. Mario Serekai, Timor-Leste10.

Our sincere thanks to Dr Mathew Varghese and Dr George Tharion from India, Dr Anil Jasinghe from Sri Lanka, Dr Moe Aung from Myanmar, Dr Daranee Suvapan, Dr Chaisri Supornsilaphachai and Dr Prawate Tantipiwatanaskul from Thailand, for supporting this activity as Temporary Advisers for the national programme managers’ meeting. Thanks to all the participants of the “Regional Meeting of National Programme Managers on Injury Prevention and Care, September 26 – 28, 2007” for their specific inputs.

This document has also benefited from the contribution of several WHO staff at WHO-SEARO, in particular, Dr Chamaiparn Santikarn and Dr Salim Mahmud Chowdhury. Dr Sunil Senanayake and Ms Anchalee Chamchuklin reviewed this document and provided valuable suggestions for improving its technical quality.


1Strategic Approaches for Injury Prevention and Control in the South-East Asia Region

The countries of the WHO South-East Asia (SEA) Region have been passing through a major and significant social, economic, epidemiological and technological transition during the last two decades. Globalization, urbanization, industrialization and media expansion have been noticeable phenomena in the Region. The health profile of the Member States is also changing significantly. Children are surviving better today from vaccine preventable diseases and many infectious conditions. In the course of this epidemiological transition, injuries are emerging as an established public health problem in all Member States.

Injuries are a leading contributor to death, hospitalization and disability all over the world and more so in the SEA Region (Gururaj et al 2004, Mohan D 2002, WHO-SEARO). As per WHO estimates, worldwide nearly 5 million people die due to injuries annually, with nearly 10 to 20 times that number being hospitalized. Road traffic injuries (RTIs) alone result in deaths of 1.2 million people and about 50 million hospitalizations all over the world with nearly one fourth

Introduction

estimated to occur in the SEA Region (WHO 2004a). Several million people visit hospital emergency rooms and local practitioners for timely management of injuries. It is also estimated that injuries contribute directly to one third of all disabilities. Injuries result in significant socio-economic losses in all countries, more so in low- and middle-income countries.

Injuries are defined as “body lesions due to an external cause, either intentional or unintentional, resulting from a sudden exposure to energy (mechanical, electrical, thermal, chemical or radiant) generated by agent–host interaction” (WHO, 2004b). Within this broad group they are classified as unintentional and intentional depending on the intent. Transport accidents, falls, accidental drowning and submersion, contact with heat and hot substances, accidental poisoning by and exposure to noxious substances, exposure to inanimate mechanical forces and exposure to animate mechanical forces are commonly referred to as unintentional injuries, while intentional self-harm and assault (against


Strategic Approaches for Injury Prevention and Control in the South-East Asia Region2

women, children and elderly, and youth) are intentional injuries. The International classification of Diseases (ICD 10) provides a comprehensive framework for classification of injuries and is the recommended method for classifying injuries.

Injuries are predictable and prevent-able. Experience from many countries over the last three decades has shown that injuries can be substantially reduced with appropriate policies, programmes and interventions (OECD, 2006; WHO, 2002; WHO, 2004a; Racioppi et al, 2004).

Several strategies are known to decrease the burden of injuries and violence. Im-mediate efforts at appropriate levels are required in all Member States of the SEA Region, as the burden of injury and violence is expected to increase during the coming decades. Road traffic injuries alone are expected to increase by 147% by 2020 in India (Kopits et al, 2005). As the ongoing efforts are minimal, strategic approaches and sustainable policies and programmes are required in the Region to reduce the burden of violence and injuries.



The overall goal of WHO’s injury and vio-lence prevention and control programme is to incorporate injury prevention in the health and development agenda of the Member States and strengthen policies and programmes by:

Advocating and supporting Member 1. States to establish/strengthen injury unit(s) in the ministry of health for implementing and coordinating national programmes for prevention and control of injuries and violence.

Supporting and extending guidance 2. to Member States to develop and implement national policies and plans to deal with road traffic injuries and other major Injuries and disabilities.

Supporting Member States in im-3. proving surveillance and related information systems including pop-

ulation-based surveys for planning, monitoring and assessing impact of national programmes for prevention and control of injuries, violence and disabilities.

Supporting Member States in imple-4. menting evidence-based, cost-ef-fective interventions to tackle injury, violence and disabilities.

Assisting Member States in imple-5. menting, documenting and dissemi-nating multisectoral, population-wide programmes to prevent and/or al-leviate the consequences of injuries, violence and disabilities.

Supporting Member States in strength-6. ening national health and social sys-tems to prevent and manage injuries, violence and disabilities.

WHO strategy for injury prevention



This document is based on secondary sources of data (primarily from reports and presentations by national delegates from the ministries of health of Member States) aimed at providing an overview

of injury burden and impact, identifying barriers to injury prevention and control, delineating available interventions, and outlining strategies for injury prevention, care and control in the SEA Region.

Purpose and importance



Data are based on information provided by the national focal points within the ministries of health in all Member States of the Region. These focal points completed a questionnaire incorporating brief information on the burden of injuries and existing policies, programmes and interventions. In addition, information from a few published and unpublished reports was incorporated in various places.

The findings were discussed at the Regional Meeting of the National

Programme Managers on In jury Prevention and Care held in Nonthaburi, Thailand, 26-28 September 2007. The outlined strategies were discussed and agreed upon in the meetings and are outlined for further action by the Regional Office for South-East Asia, (WHO-SEARO) and Member States of the Region. The document was re-circulated to all Member States to provide required information and update it with the current data and situation in 2008.

Methodology



As per WHO, globally every year 5 million people or every day nearly 16,000 people die from injuries accounting for 9% of the total deaths and 13% of DALYs. The South-East Asia Region accounts for 28% of global injury deaths and 30% of DALYs with unintentional and intentional injuries contributing 69% and 31% of deaths respectively (WHO 2003). RTIs alone account for 20% of all injury-related deaths and 23% of injury-related disease burden in the Region. Suicides (17%)

and fires (burns) (7%) are the other major injury causes (Sharma S et al, 2004).

During the last two decades injuries have shown an increasing trend in all Member States with significant variations. The South-East Asia Region accounts for 1.5 million deaths annually with injury and violence being among the top five leading causes of death and hospitalization (Figure 1, Tables 1 and 2). They are also a leading contributor to

Burden of injury and violence in the South-East Asia Region

Figure 1: Injury pyramid of the South-East Asia Region

Based on 2002 estimates



socioeconomic losses in the Member States (Aeron Thomas, 2004; Mohan D, 2006). Due to the absence of good quality data, injuries have been a hidden, unrecognized epidemic in the Region. It is well acknowledged that injuries are underreported events undermining the burden of the problem (Aeron Thomas et al, 2000).

Recent large-scale population-based surveys on children in the South-East Asia and Western Pacific Regions by The Alliance for Safe Children (TASC) and UNICEF using uniform methodology and based on verbal autopsy has revealed a huge burden of injuries among children. Among the total deaths, children account for one fourth of deaths (UNICEF and TASC, 2004) (www.tasc.org).

The Bangladesh Health and Injury �

Survey (BHIS) funded by UNICEF and conducted by the Institute of Child and Mother Health amongst a population of 820,347 less than 19 years old indicated that the annual injury death rate in children was 52/100000 population, with injuries accounting for 9.7% of the total deaths. A community-based study (Rahman et al, 2005) established that major causes of injury were drowning, RTIs and suicide. However, reports (2005) of the Director-General of Health Services (DGHS) in Bangladesh revealed that poisoning and RTIs were the leading causes of death

and hospitalization contributing to 11.3% of all deaths and 20% of all hospitalizations.

In Bhutan, injuries and poisoning are �

the 10th leading cause of death and 4th leading cause of hospitalization (The Royal Government of Bhutan: Annual Health Bulletin, 2007).

It is estimated that a million deaths �

are due to injuries in India. The recent report by the Commission on Macroeconomics and Health estimates that RTIs and other injuries will result in 850 000 deaths and hospitalization of 20 million persons every year (Gururaj G, 2006). As per National Crime Records Bureau, a total of 574,850 episodes of unnatural accidents were reported with 470,923 injuries and 271,760 deaths. Among various injuries, deaths due to suicides (n=113,914), and RTIs (n=98,254) were the major ones followed by homicides (n=43,084), animal bites (n=20,700), burns (n=19,093) and poisoning. Males showed three times higher predilection for injuries in comparison to females. The injuries and deaths were most common in the 15 – 44-years age group.

According to the National Household �

Health Survey of Indonesia in 2001, it was estimated that injury death rates among men and women are 71 and 18 per 100 000 population respectively. RTIs emerge as the



most common problem from the standpoint of fatality, disability and economic loss. Drowning and violence are also major causes of injury. Occupation-related injuries are also important.

In Myanmar, injury and poisoning �

were the 3rd leading cause of morbidity (14% of all illnesses) and the 4th leading cause of death (9% of all deaths). According to the injury surveillance report, through its Sentinel Injury Survey in 25 townships across Myanmar, the most affected are persons between the ages of 21 to 30 years, with a male predilection of 65%.

In 2004, injuries were the leading �

cause of death and the 3rd leading cause of hospitalization in Nepal (Gururaj G, 2004). Notably, suicides, poisoning and road traffic Injuries were the significant contributors to mortality and morbidity. It has been estimated that injuries and accidents contributed 7% of all deaths and were responsible for 9% of DALYs. Further, it is estimated that about 10% of the population is disabled; half of them due to injuries. Information from the health sector reveals that 1,316 persons died, 3,447 were hospitalized and 19,347 were treated in emergency rooms (ER) with a ratio of 1:3:15 during 2001 (Annual report 2000/01).

In Sri Lanka, the leading causes �

of injuries are road traffic injuries and poisoning. Most injuries occur on the road and at home. Over the years there has been an increase in hospitalization due to traumatic injuries and poisoning from 1,732 cases per 100 000 population in 1980 to 4 090 in 2007. Traumatic injuries continue to be the leading cause of hospitalization since 1995. In 2007, 14.5% of admissions and 3.6% of deaths in government hospitals were due to traumatic injuries while poisoning led to 4.0% of deaths. Injury and poisoning are the leading cause of death in all ages except in infancy and above 50 yrs of age. In 2005, injuries accounted for 23.1% of all registered deaths in Sri Lanka (Gururaj G et al, 2004).

In Thailand (2006), accidents and �

poisonings were the second leading cause of deaths (57/100,000). RTIs (10,421 – 17%), drowning (4,666 – 7.5%), suicides (3,612 – 5.6%) and assaults (3,359 – 5.4%) were the leading causes of death (data based on country death statistics) (Figure 2).

Timor-Leste’s Health Management �

Information System is in its early stages of development. According to the Off ice of the HMIS & Epidemiological Survei l lance, Ministry of Health, there were 1 686 non-fatal road traffic injuries in the



country during 2007 with information being unavailable for other injuries.

The real magnitude and impact of the problem in the Region is revealed by a few hospital- and population-based studies.

A one-month rapid epidemiological su rvey in 2002 us ing common methodologies in Indonesia, India, Nepal,

Myanmar, Sri Lanka and Thailand revealed that injuries accounted for 23% - 52% of ER registrations, varying from institution to institution. Road traffic Injuries, falls and burns were the three leading injury causes. Different published reports and articles reveal that drowning was a major problem in countries like Bangladesh, Maldives, Indonesia and Thailand, and was more common among young people.

Figure 2: Trend of deaths from Injuries in Thailand 1996-2006 (rate / 100,000 population)

40

30

20

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01996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Num

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ths

Source: Death Registry, Bureau of Health Statistics, Ministry of Public Health



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mpt

oms,

signs

an

d ab

norm

al cli

nica

l and

lab

orat

ory

findi

ngs,

not

elsew

here

cla

ssifi

ed

Pneu

mon

iaUn

know

nTr

aum

atic

inju

ries

Tube

rcul

osis

Acut

e asp

hyxia

Sou

rce:

Dat

a pr

ovid

ed b

y th

e in

jury

exp

erts

from

the

Mem

ber

Sta

tes.

*

Nat

iona

l Rep

ort -

Cau

ses

of D

eath

s in

Indi

a 20

01-0

3, G

over

nmen

t of I

ndia

, 200

9



Tabl

e 2:

Lea

ding

cau

ses

of h

ospi

taliz

atio

n in

sel

ecte

d M

embe

r St

ates

of t

he S

EA R

egio

n

Ran

kB

angl

ades

h (2

003)

Bhu

tan

(200

6)D

PR

Kor

eaIn

dia

Indo

nesi

a (2

005)

Mal

dive

s (2

005)

Mya

nmar

(2

005)

Nep

al

(200

4)Sr

i Lan

ka

(200

7)Th

aila

nd

(200

6)Ti

mor

-Les

te

(200

6)

1.In

jury

&

Poiso

ning

Othe

r di

seas

es o

f di

gest

ive

syst

em

Data

not

av

ailab

leDa

ta n

ot

avail

able

Diar

rhoe

a & G

EAr

thro

pod-

born

e vira

l fe

ver &

vira

l ha

emor

rhag

ic fe

vers

Inju

ries o

f sp

ecifi

ed o

r un

spec

ified

na

ture

Norm

al de

liver

yTr

aum

atic

Inju

ries

Com

plica

tions

of

pre

gnan

cy,

labou

r &

deliv

ery

Dise

ases

of t

he

mus

cles &

Sof

t tis

sues

2.Di

arrh

oeal

dise

ase

Othe

r re

spira

tory

&

nasa

l di

sord

ers

Data

not

av

ailab

leDa

ta n

ot

avail

able

Typh

oid

& pa

raty

phoi

d fe

ver

Mate

rnal

care

re

lated

to th

e fo

etus

and

amni

otic

cavit

y an

d po

ssib

le de

liver

y pr

oblem

s

Spon

tane

ous

deliv

ery

Unsp

ecifi

ed

type

sDi

seas

es o

f th

e res

pira

tory

sy

stem

, ex

cludi

ng

dise

ases

of

the u

pper

re

spira

tory

trac

t

Othe

r in

test

inal

infe

ctio

us

dise

ases

Othe

r dise

ases

3.Gy

neco

logi

cal

prob

lems

Othe

r kid

ney,

UTI, g

enita

l di

sord

ers

Data

not

av

ailab

leDa

ta n

ot

avail

able

DHF

Com

plica

tions

of

labo

ur an

d de

liver

y

Gast

roen

terit

isTr

aum

aSy

mpt

oms,

signs

and

abno

rmal

clini

cal a

nd

labor

ator

y fin

ding

s

Othe

r di

seas

es o

f th

e dig

estiv

e sy

stem

Resp

irato

ry

infe

ctio

ns

4.Pe

ptic

ulce

rIn

jurie

s &

poiso

ning

Data

not

av

ailab

leDa

ta n

ot

avail

able

Preg

nanc

y with

di

fficu

lties

Preg

nanc

y wi

th ab

ortiv

e ou

tcom

e

Malar

iaGa

stro

ente

ritis

Vira

l dise

ases

Othe

r en

docr

ine

diso

rder

s

Gast

roin

test

inal

dise

ases

5.Py

rexia

of

unkn

own

orig

inPn

eum

onia

Data

not

av

ailab

leDa

ta n

ot

avail

able

Intra

cran

ial

inju

ryOt

her m

ater

nal

diso

rder

s pr

edom

inan

tly

relat

ed to

pr

egna

ncy

Com

plica

tion

of

preg

nanc

yPn

eum

onia

Dise

ases

of t

he

gast

roin

test

inal

tract

Hype

rtens

ive

dise

ases

Pulm

onar

y tu

berc

ulos

is

6.Ac

ute r

espi

rato

ry

infe

ctio

nsOt

her

infe

ctio

nDa

ta n

ot

avail

able

Data

not

av

ailab

leTr

affic

accid

ents

Inte

stin

al in

fect

ious

di

seas

es

Preg

nanc

y with

ab

ortio

nEn

teric

feve

rDi

rect

and

indi

rect

obst

etric

ca

uses

Diab

etes

m

ellitu

sUr

inar

y tra

ct

Infe

ctio

ns

7.As

thm

aOt

her

circu

lator

y di

seas

es

Data

not

av

ailab

leDa

ta n

ot

avail

able

FUO

Non-

infla

mm

ator

y di

sord

ers o

f fe

male

gen

ital

tract

Arth

ropo

d-bo

rne v

iral

feve

rs

Chro

nic

obst

ruct

ive

pulm

onar

y di

seas

e

Dise

ases

of t

he

urin

ary s

yste

mOt

her

infe

ctio

us

& pa

rasit

ic di

seas

es

Malar

ia



Ran

kB

angl

ades

h (2

003)

Bhu

tan

(200

6)D

PR

Kor

eaIn

dia

Indo

nesi

a (2

005)

Mal

dive

s (2

005)

Mya

nmar

(2

005)

Nep

al

(200

4)Sr

i Lan

ka

(200

7)Th

aila

nd

(200

6)Ti

mor

-Les

te

(200

6)

8.Ma

laria

Alco

holic

liv

er d

iseas

eDa

ta n

ot

avail

able

Data

not

av

ailab

leIn

jury

& m

ultip

le in

jury

Othe

r dise

ases

of

urin

ary

syst

em

Othe

r dise

ase

of re

spira

tory

sy

stem

Deliv

ery b

y Ce

sare

an

sect

ion

Dise

ases

of

the s

kin an

d su

bcut

aneo

us

tissu

e

Acut

e upp

er

resp

irato

ry

infe

ctio

ns

Dise

ases

of

phar

ynx,

laryn

x an

d sa

livar

y gl

ands

9.An

aem

iaOt

her c

ance

rDa

ta n

ot

avail

able

Data

not

av

ailab

leMa

laria

Chro

nic l

ower

re

spira

tory

di

seas

es

Resp

irato

ry

tube

rcul

osis

Pyre

xia o

f un

know

n or

igin

Inte

stin

al in

fect

ious

di

seas

es

Dise

ases

of

bloo

d an

d bl

ood

form

ing

orga

ns

Urin

ary t

ract

in

fect

ion

10.

Hype

rtens

ion

Neon

atal

deat

hsDa

ta n

ot

avail

able

Data

not

av

ailab

lePn

eum

onia

Ischa

emic

hear

t di

seas

esTo

xic ef

fect

of

subs

tanc

e ch

iefly n

on-

med

icina

l as t

o so

urce

Urin

ary

infe

ctio

nDi

seas

es o

f the

m

uscu

losk

eleta

l sy

stem

and

conn

ectiv

e tis

sue

Pneu

mon

iaSt

roke



Tabl

e 3:

Dea

th d

ue to

var

ious

inju

ry c

ause

s in

Mem

ber

Stat

es o

f the

SEA

Reg

ion

Ban

glad

esh

(200

3)B

huta

n (2

006)

DPR

K

orea

Indi

a (2

005)

Indo

nesi

a (2

005)

Mal

dive

sM

yanm

ar

(200

5)N

epal

(2

004)

Sri

Lank

a(2

005)

Thai

land

(2

006)

Tim

or-

Lest

e

Roa

d Tr

affic

In

jurie

s16

027

12–

9825

421

86–

975

568

2236

-10

421

(16.

6)–

Acc

iden

tal

Bur

ns26

9815

–19

093

42–

136

7331

324

4–

Acc

iden

tal

Pois

onin

gN

A24

–20

800

18–

238

685

181

51–

Dro

wni

ng17

931

NA

–23

571

23–

1257

2384

446

66 (7

.5)

–

Suic

ides

9680

NA

–11

3914

12–

485

2096

4349

3612

(5.8

)–

Ass

aults

4126

NA

–32

719

11–

345

399

692

3359

(5.4

)–

* S

ourc

e: R

epor

ts r

ecei

ved

from

the

Nat

iona

l Pro

gram

me

Man

ager

s –

Mem

ber

Sta

te d

id n

ot p

rovi

de d

ata



Tabl

e 4:

Num

ber

of a

nnua

l hos

pita

lizat

ions

due

to v

ario

us in

jury

cau

ses

in M

embe

r St

ates

of t

he S

EA R

egio

n

Ban

glad

esh

(200

3)B

huta

n (2

005)

DPR

K

orea

Indi

a (2

005)

Indo

nesi

a (2

005)

Mal

dive

sM

yanm

ar

(200

5)N

epal

(2

004)

Sri

Lank

aTh

aila

nd

(200

6)

Tim

or-

Lest

e (2

006)

Roa

d tr

affic

in

jurie

s87

117

470

–44

7900

5446

3–

–16

43–

9731

04–

Acc

iden

tal

burn

s16

344

253

–22

1461

8–

–14

81–

3216

0–

Acc

iden

tal

pois

onin

gN

A17

83–

3410

1033

––

2020

–16

633

–

Dro

wni

ng41

26–

–52

422

4–

––

–71

43–

Suic

ides

9204

––

–91

5–

––

–35

156

–

Ass

aults

5760

2–

––

219

––

––

2160

37–

* S

ourc

e: r

epor

ts r

ecei

ved

from

the

Nat

iona

l Pro

gram

me

Man

ager

s –

Mem

ber

Sta

te d

id n

ot p

rovi

de d

ata



Pattern and profile of injuries by causes

Available data from the SEA Region indicate that RTI (18%), self-inflicted injuries (15%) and fires (burns) (11%) are the leading causes of injury deaths. A brief description of the profile and pattern of injuries is given in Figure 3, and Tables 3 & 4.

Road traffic injuries

Motorization without accompanying safety on roads has been a major phenomenon in the South-East Asia Region. In India, the total number of registered vehicles increased from 21 374 000 in 1991 to 72

Figure 3: Injury-related mortality in the South-East Asia Region, 2004

Poisonings, 6%(96110) War, 19 799, 1%

Drowning, 6%(99 935)

Violence, 7%(114 548)

Falls, 7%(125 839)

Fires, 11%(185 734)

Self-inflictedinjuries, 15%(251 879)

Road trafficaccidents, 18%(305 805)

Other unintentionalinjuries, 29%(517 430)

Source: WHO, Geneva, Global Burden of Disease Study, 2004 (update)



718 000 by 2004 (a four-fold increase). Of the total registered, 71% of total vehicles are motorized two-wheelers (MTWs), 12% are cars/jeeps/taxis, 1% buses with the remaining 15% constituted by other vehicles (Ministry of Road Transport and Highways, Government of India) (www.morth.nic.in). A rapid increase in vehicles is seen in other Member States as well.

RTIs have increased significantly in the last two decades in the Region (Gururaj et al 2004). RTIs in Bangladesh increased from 3 904 deaths in 1997 to 16 027 in 2003. As per WHO, RTIs were the sixth leading cause of death in India with a greater share of hospitalization, death, disability and socio-economic losses in the young and middle-aged population (IDSP 2005). RTI deaths increased from 58 000 in 1991 to 98 254 by 2005 (Figure 4), while injuries escalated from 250 000 to 447 900 (NCRB 2005). In Nepal, RTI resulted in 1 643 injuries and 568 deaths in 2004, while in Thailand there were 10 421 deaths in 2006 (Figure 2). The increased trend is also observed in Myanmar and Indonesia (Figures 5 & 6).

Nearly three fourths of those killed and injured are young people in the 5 – 44-year age group with a male preponderance. Pedestrians, two-wheeler riders, pillion-riders and bicyclists account for 70% - 80% of total RTI deaths and injuries. Hospital-based studies in Bangalore, India during 1993, 1998, and 2004 and from other centres have shown

that pedestrians, motorized two-wheeler occupants and bicyclists are injured and killed to the extent of 25%-35%, 30%-40% and 7%-10% respectively with minor variations across studies. Similar findings have been observed in other population-based surveys (Gururaj G, 2004 & 2006; Mohan D, 2004). This pattern is also similar in other countries of the Region. The economic losses in India alone are to the tune of Rs.55,000 crores (Mohan D, 2004) and a recent study has shown that the cost of a fatality is approximately Rs. 1.3 million (Bhattacharya et al. 2007).

Drowning

Drowning is a major public health problem in Bangladesh, Thailand, Maldives and Indonesia. In Bangladesh with an annual rate of 11.5/ 100000 population, drowning is most common among children below the age of 5 years having the highest rates of drowning to the extent of 75/100,000 population. It is estimated that almost 17,000 children die every year in Bangladesh due to drowning (Rahman et al, 2005). Nearly 3,600 persons lost their lives due to drowning in Thailand during 2006, contributing 7.5% of total injury deaths.

Suicide

Suicide is an important cause of death in the Region. In 2005, nearly 9 000 people ended their lives in Bangladesh, while in India 113 914 ended their lives (NCRB). The number of suicides in India during the decade (1995 - 2005) recorded an



increase of 27.7% i.e. from 89 178 in 1995 to 113 914 in 2005. At the national level, male to female ratio was 2:1 with 63% suicides occurring among men. Among total suicides, 35% involved those in the 15-29 years age group and 34% in the 30-44 years age group with a higher number of males in both the age groups (NCRB, 2005). In Nepal, 11 460 deaths were reported as a result of suicide during a five-year span from 1999-2004. The most common method of suicide was hanging (60%) followed by poison ingestion, burns, falls from a height etc. In Sri Lanka, suicide deaths increased from 7 411 in 1991 to 8 519 in 1995. However, since 1995, suicides have been declining and 5 412 deaths were recorded in 2000. In Thailand, suicides resulted in 3 612 deaths and hospitalization of 35 156 persons with self-inflicted injuries in 2006.

Burns

In Bangladesh there were 2 698 deaths and 16 344 hospitalizations due to burns in 2005 (Rahman et al, 2005). Persons in the 15 - 44 years age group contributed to more than half of these cases. In 2005, 20 016 persons were injured due to burns in India. Of these, 2 214 were non-fatal, whereas 19 093 persons were fatally injured. Women were twice as likely to be affected by burn injury, either fatal or non-fatal. The various causes of burns were electrocution, explosion and fires. The consistently low figures recorded for non-fatal burns indicate that probably such injuries are under-reported.

Poisoning

Data on poisoning at individual country levels are limited as they are included under intentional and unintentional (accidental) injuries and the practice varies from country to country. Among those admitted to Dhaka Medical College Hospital in 2002 in Bangladesh, 317 deaths and 2 260 injured were recorded due to poisoning. Cases were most likely to occur in the age group of 5 – 29 years, with the male to female ratio being almost equal (Gururaj G, 2004). In India, in 2005, there were 23 280 cases of poisoning resulting in 3 410 injuries and 20 800 deaths. The ratio of 2:1 continued to be unfavourable to men. Accidental intake of insecticides, poisonous liquor, leakage of poisonous gases and snake/scorpion bite were the common causes of poisoning. Poisoning is also a major problem in Sri Lanka, with the majority of cases being intentional with suicidal intent. Pesticide consumption is the major cause and organophosphorus and carbamite group of chemicals are most commonly incriminated. In 2007, there were 62 721 (1.4%) admissions due to poisoning. These included 17 723 (28.3%) cases of pesticide consumption and 44 998 (71.7%) cases involving other substances such as drugs, medicaments, biological substances and non-medicinal substances. Poisoning accounted for 4.0% (1561) of deaths reported in the government hospitals in Sri Lanka.



Assaults

Assaults are important indicators of violence in society. However, due to lack of information and socio-cultural issues, the problem of violence against women, children and the elderly and even interpersonal violence is unrecognized.

Assaults/homicides resulted in deaths of 400; 32 719; 4 126 and 3 359 persons

in Nepal; India; Bangladesh and Thailand respectively as per recent official reports. Nearly 20–30 times of this number would have been hospitalized. Even though the health sector provides care for all injured persons, systematic information gathering is lacking in the Region. Studies in the Region have indicated significant under reporting of deaths and hospitalization due to violence/assaults.

Figure 4: Trend of road traffic injuries death in India, 1980 – 2005

0102030405060708090

100

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

Num

ber o

f dea

ths



Figure 6: Comparison of registered vehicles with total population in Indonesia (1996-2006)

0

50

100

150

200

250

1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Registered vehicles Road length (km) No. of accidents

DEATH PER 10000 vehicles per 100000 populationPopulation

(num

bers

in00

0,00

0)Figure 5: Changing trends of road traffic injuries in Myanmar (1999-2005)

1000

2000

3000

4000

5000

6000

01999 2000 2001 2002 2003 2004 2005

Years

3886

3459

5830

3658

4583

5154

5708

Num

ber o

f roa

dtra

ffic

inju

ries



Barriers to injury prevention and control

Despite the enormity of the problem, injury and violence prevention and control has not received adequate attention from policymakers, professionals and from society at large. Programmes for injury prevention and control are minimal in many of the Member States. Some reasons for this scenario are given below:

The emerging problem of rapid ur-1. banization, industrialization, motor-ization with less emphasis on injury prevention and safety promotion.

Lack of good information systems on 2. injury burden, pattern and impact.

Although three countries (Indonesia, 3. Sri Lanka and Thailand) in the Region have a specific unit in the respective ministries of health for injury prevention, this is not a priority area within the health sector and in any other sector. Communicable diseases are at the top of the priority list. In most Member States no ministry is taking the lead in formulating, developing or influencing implementation, monitoring and evaluating prevention programmes in this area.

There is insufficient epidemiological 4. approach to injury prevention and control.

Injuries are perceived as a common 5. event in the day-to-day life of individuals, thereby leading to a sense of apathy.

The concept of victim blaming, mainly 6. on human errors, has been in focus, without understanding fully the complexities of injury occurrence and the resulting effects.

Community participation has been 7. missing in the area of injury prevention and control.

Prevalent fatalistic attitudes in the 8. community have relegated injury prevention to the periphery.

Lack of financial and human resources 9. for injury prevention and control.

Lack of intersectoral collaboration, 10. especially in the budget system of collaborative projects/programmes.



Response to the problem

The response at policy, professional and civil society levels to the growing problem has been found in a few Member States. Most Member States are mainly making significant inputs for trauma care both in physical and manpower terms. Since injury interventions are to be addressed by different sectors i.e. police, transport, welfare, urban development and others, common and specific strategies and approaches at national, regional, state/ provincial levels are yet to be developed.

Bangladesh

There is no centralized agency/policy to monitor, control and mitigate injuries; however, the country has made progress in recent years by establishing a National Road Safety Council under the Ministry of Communication, thereby enabling compilation of RTI statistics. This agency has been instrumental in the development of a road safety policy and functions as the lead agency for co-ordination, implementation and monitoring of road safety activities under the Chairman, Bangladesh Road Transport Authority.

Helmet laws, speed control laws, road user education and human resource development activities have been initiated and implemented. However, legislation for car safety belts and prevention of drink–driving are yet to be implemented. A health and injury survey based on cluster sampling has been conducted jointly by UNICEF, the Government of Bangladesh and The Alliance for Safe Children (TASC) to collect data, even though comprehensive injury surveillance is missing. The country has also allocated a small amount towards research on injury prevention in the annual operational plan of DGHS. Since 2005, UNICEF, Bangladesh, is providing technical and financial support to a nongovernmental organization in developing a feasible and cost effective child injury prevention programme.

Bhutan

The country has a national nodal officer in the department of public health who is responsible for injury prevention activities (who is also responsible for NCD, mental health and drug abuse). However, there



is no national coordinating agency for injury. The country also lacks a national policy on injury prevention and control. In spite of this, the disability prevention and rehabilitation programme in the department of public health carried out some injury prevention activities. The department planned to initiate the first phase of an injury surveillance system in 29 hospitals as a pilot programme from October 2007. Although injury prevention and control has not been included as part of undergraduate or post-graduate courses, the country conducts regular training programmes. For the purpose of road safety, various laws and regulations are being enforced.

India

The recognition of injury and violence as a public health problem has been a recent phenomenon. Injury prevention and control activities are carried out by a number of independent ministries, NGOs and others without greater intersectoral collaboration. There is no central coordinating nodal agency at the national or state levels. In recent years, the National Transport Policy (section 8.7 focuses on road safety), National Road Safety Policy (a draft National Road Safety Policy has been submitted by an expert group and is awaiting approval of the Government of India) and National Urban Development Policy have been developed. The urban development policy aims at providing a transport system that would save lives, time and

money for city residents. The Indian Motor Vehicles Act of 1988 with amendments in 2002 and 2003 has several chapters and sections aimed at road safety. However, the implementation of these laws is left to individual states and there are deficiencies in implementation and monitoring. Specifications/designs for roads and vehicles are being improved and are under review by the Roads Wing of the Transport Ministry.

Though occupational health was one of the components of the National Health Policy, 1983, and was also included in the National Health Policy 2002, very little attention has been paid to mitigate the effect of occupational diseases through a proper programme. The Ministry of Health & Family Welfare launched a scheme entitled “National Programme for Control & Treatment of Occupational Diseases” in 1998-99.

Several laws have been enacted in recent years to address domestic violence, child labour, women’s empowerment and protection, rights of workers and all these have had an impact on injury prevention and control, directly or indirectly. There is also an attempt to develop a national suicide prevention programme with defined objectives and programmes to reduce suicides. The Loss Prevention Association of India Ltd is engaged in promoting safety and loss control through education, training and consultancy.

The National Programme for Re-habilitation of Persons with Disabilities



by the Department of Social Welfare, Government of India provides services to persons with disability. The programme addresses disabilities through preven-tion, early detection and rehabilitation. Scholarship for deserving people, awards for meritorious disabled students, or-ganizing programmes on 3 December (International Day of Persons with Disability), vocational training, income generation programmes, setting up of special schools, and vocational centres are some of the activities.

Indonesia

While injury prevention and control is felt to be a low priority area with no national framework, there are multiple institutions in different sectors involved in injury prevention and control, necessitating the formation of a formal coordinating body at the national and local levels. However, in 2004, Indonesia developed the National Road Safety Action Plan supported by all sectors related to injury prevention and safety promotion. Each concerned ministry also has its own strategies and action plan. A number of laws on health issues, traffic, manpower insurance, disability and child protection have been enacted but need translation into action through government regulations, guidelines and enforcement. Ongoing initiatives comprise national periodic service, health and work safety programmes, workplace health promotion for non-organized labour, establishment of public safety centres and a brigade for disaster mitigation.

Maldives

The Ministry of Public Health coordinates a number of injury prevention and control activities and has a nodal officer for this area. A road safety council has been established recently to coordinate and implement activities. A sentinel injury surveillance system was started at the Indira Gandhi Memorial Hospital and was expanded to one regional hospital in 2005. Advocacy activities are carried out regularly. Various laws are yet to be implemented for prevention and control activities.

Myanmar

The country is setting up a National Policy Framework for injury prevention and control with a 10-year perspective from 2005 - 2015 with the objectives of developing a network between the government agencies and community stakeholders, setting up of an injury-free safety environment in the community with the ultimate objective of preventing and reducing deaths and disabilities from injuries. A workshop in this regard was conducted in 2004.

Nepal

Nepal has made progress in the field of injury prevention and control through the establishment of a National Coordinating Agency for Injury Prevention in the Ministry of Health with a National Nodal Officer in charge. A National Health Information System for collation and



compilation of injury-related data has been established. Regular advocacy programmes are in progress to focus upon injuries as a major public health problem. Helmet laws, legislation for car safety belts, measures to reduce drink–driving, speed control laws and education of road users are being implemented. There is need for a national policy for injury prevention and control. Budgetary allocation for injury prevention, pre-hospital care and research is lacking.

Sri Lanka

There is recognition that the health sector alone cannot provide solutions for comprehensive injury prevention, which requires a multisectoral approach.

An analysis of the current injury prevention efforts reveals the following: lack of collaborative action; poor enforcement of laws and regulations; lack of proper injury surveillance and poor community awareness and active participation in prevention of injuries. Although there is a well distributed network of health institutions throughout the country injury management is currently being done mainly by secondary and tertiary care level institutions with less emphasis placed on primary care level.

The government acknowledges that the prevention and management of injuries is a priority issue in the national health agenda. The country has developed a national policy and a strategic framework on injury prevention,

which was accepted at the national level in June 2003. The national policy was revised in 2009, and the strategic plan is awaiting Cabinet approval.

The emphasis of the national policy is on promoting the health and well being of the population by reducing exposure to risk and prevention of injuries, reduction of severity of an injury and its impact and provision of acute and long-term, post-event care.

It is planned to establish a lead agency to strengthen coordination for injury prevention and management within the health sector and with other agencies, to strengthen advocacy and multi-sectoral involvement, to review, update and introduce legislative and regulatory mechanisms, to empower community and healthcare providers for prevention of injuries and disabilities, to strengthen organizational capacity for improving pre-hospital and institutional care for emergency and rehabilitation at all levels of care and to strengthen the injury information system.

Thailand

Thailand has made rapid strides in injury prevention. Notable efforts include the creation of a National Accident Prevention Committee Nodal Office acting as a focal organization for unintentional injury prevention before 1993. The committee acts as a national coordinating mechanism, chaired by the Prime Minister and with secretarial



support from a Division in the Prime Minister’s Office (recently recognized by the Department of Disaster Prevention and Mitigation, Ministry of Interior). In 1993, the Ministry of Public Health (MoPH) set up the Medical Institute for Accident and Disaster (MIAD) in the Department of Medical Service to take care of the pre-hospital services and injury prevention. Also, the Epidemiology Division was given responsibility for NCD epidemiology including establishing an injury surveillance system for the country. The basic health information on causes of death and admission and the individual data collection from sentinel hospitals have facilitated policy makers to decide an appropriate policy. The sentinel hospitals, with the data they collected and used, have become important partners in developing the trauma registry-cum-injury surveillance system, pre-hospital service system, and prevention in other major health promoting hospitals for road safety injuries, assaults and drowning.

With regard to RTI, a Road Safety Directing Centre has been created under the Department of Disaster Prevention and Mitigation of the Ministry of Interior. A national policy for RTI prevention has also been in place since 2003. Data

regarding prevalence of injuries and their prioritization for mitigation and control are collected from national injury surveillance, routine data of various ministries and vital statistics generating agencies. National task forces for RTI, suicide, poisoning and drowning are in place. Regular training programmes for injury prevention and care are being conducted for quasi- and para-medical workers. Strong advocacy programmes, budgetary allocations and legislation/ implementation of road safety laws are some of the recent developments.

Timor-Leste

The Department of Noncommunicable Diseases in the Directorate of Health Services is responsible for injury prevention and control activities. The health management and information system is in early stages of development and campaigns are being developed on helmets and seat belt laws. Two training programmes in 2005 and 2007 were conducted as part of WHO activities to strengthen trauma care. Some of the laws are in the early stages of implementation.



Tabl

e 5:

Sta

tus

of in

jury

pre

vent

ion

and

cont

rol a

ctiv

ities

in th

e So

uth-

East

Asi

a, 2

007

SlNo

men

clat

ure

BAN

BHU

DPRK

IND

INO

MAL

MM

RNE

PSR

LTH

ATL

S

1.Na

tiona

l Pol

icy

for I

njur

y Pr

even

tion

& Co

ntro

lYe

sNo

Data

not

av

aila

ble

NoYe

sYe

sIn

pr

ogre

ssNo

Yes

Yes

No

2.Na

tiona

l coo

rdin

atin

g Ag

ency

for I

PC

Yes

NoDa

ta n

ot

avai

labl

eNo

Yes

Yes

Yes

NoYe

sNo

3.Na

tiona

l co-

ord

agen

cy/u

nit w

ithin

Min

. of

Heal

thNo

Yes

Data

not

av

aila

ble

NoYe

sYe

sYe

sYe

sYe

s-Ye

sYe

s

4Na

tiona

l Nod

al O

ffice

r for

Inju

ry P

reve

ntio

n Ac

tiviti

es

Yes

Yes

Data

not

av

aila

ble

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

5.Bu

dget

allo

catio

n in

MOH

for I

PCNo

Yes

Data

not

av

aila

ble

NoYe

sYe

sNo

Yes

Yes

No

6.Na

tiona

l hea

lth In

form

atio

n ag

ency

for i

njur

y in

form

atio

nNo

Yes

Data

not

av

aila

ble

NoYe

sNo

Yes

Yes

NoYe

sYe

s

7.Na

tiona

l/Reg

iona

l Sur

veill

ance

Pro

gram

me

for I

PC*

Yes

NoDa

ta n

ot

avai

labl

ePi

lot

Pilo

tNo

Yes

NoYe

sYe

sNo

8.Na

tiona

l Tas

k Fo

rce

for P

rev.

& Co

ntro

l of

RTI,

burn

s, s

uici

des,

poi

soni

ng &

oth

er

prio

ritize

d in

jurie

sYe

sNo

Data

not

av

aila

ble

NoNo

Yes

Yes

NoNo

Yes

No

9.In

clus

ion

of IP

C in

und

ergr

adua

te, p

ost-

grad

uate

and

alli

ed c

ours

esNo

NoDa

ta n

ot

avai

labl

ePi

lot

Yes

NoYe

sYe

sYe

sNo

No

10.

Regu

lar t

rain

ing

prog

ram

mes

for I

P Ca

re

and

cont

rol

NoYe

sDa

ta n

ot

avai

labl

eNo

Yes

NoYe

sYe

sYe

sYe

sNo

11.

Hum

an re

sour

ce d

evel

opm

ent p

rogr

amm

es

in h

ealth

, pol

ice

and

road

sec

tors

Yes

-Da

ta n

ot

avai

labl

eAd

hoc

Yes

No-

Yes

-No

No

12.

Advo

cacy

act

iviti

es fo

r evi

denc

e-ba

sed

mat

eria

l to

brin

g In

jury

as

an im

porta

nt P

ub.

Heal

th p

robl

em (l

ast 1

2 m

)Ye

sYe

sDa

ta n

ot

avai

labl

eYe

sYe

sYe

sYe

sYe

sYe

s-Ye

sYe

s

13.

Prov

isio

n of

bud

get f

or IP

C re

sear

ch in

go

vern

men

t bud

geta

ry a

lloca

tion

/ util

izatio

nYe

sNo

Data

not

av

aila

ble

NoYe

sNo

Yes

NoNo

Yes

No



SlNo

men

clat

ure

BAN

BHU

DPRK

IND

INO

MAL

MM

RNE

PSR

LTH

ATL

S

14Sp

ecifi

c po

licie

s, p

lans

& p

rogr

amm

es fo

r de

velo

ping

/ st

reng

then

ing

emer

genc

y - p

re-

hosp

ital c

are

serv

ices

NoNo

Data

not

av

aila

ble

NoYe

sYe

s-

-Ye

sNo

15.

Leve

l of a

ctiv

ities

in ro

ad s

afet

y:-

-Da

ta n

ot

avai

labl

e-

--

--

--

-

a. D

evel

opm

ent o

f roa

d sa

fety

pol

icy

Yes

NoDa

ta n

ot

avai

labl

eYe

sYe

sNo

Yes

Yes

No

b. L

ead

agen

cy fo

r coo

rdin

atio

n,

impl

emen

tatio

n &

mon

itorin

g of

road

sa

fety

act

iviti

esYe

sYe

sDa

ta n

ot

avai

labl

eNo

Yes

--

NoYe

sYe

sNo

c. L

egis

latio

n an

d en

forc

emen

t of m

ajor

ro

ad s

afet

y la

ws-

-Da

ta n

ot

avai

labl

e-

--

--

--

-

i. He

lmet

legi

slat

ion

and

enfo

rcem

ent f

or

mot

orcy

cle

rider

sYe

sYe

sDa

ta n

ot

avai

labl

eYe

sYe

sNo

-Ye

sYe

sYe

sYe

s

ii. H

elm

et le

gisl

atio

n an

d en

forc

emen

t for

m

otor

cycl

e pi

llion

s-

-Da

ta n

ot

avai

labl

eNo

No-

--

Yes

--

ii. L

egis

latio

n/im

plem

enta

tion

of s

afet

y be

lts fo

r car

occ

upan

tsNo

Yes

Data

not

av

aila

ble

Yes

Yes

No-

Yes

Yes

Yes

Yes

iii. L

egis

latio

n an

d im

plem

enta

tion

for

redu

cing

drin

king

and

driv

ing

NoYe

sDa

ta n

ot

avai

labl

eYe

s-

No-

Yes

Yes

Yes

No

iv. S

peed

con

trol L

aws

Yes

Yes

Data

not

av

aila

ble

No-

Yes

-Ye

sYe

sYe

s

v. Ed

ucat

ion

of ro

ad u

sers

Yes

Yes

Data

not

av

aila

ble

Yes

Yes

Yes

-Ye

sYe

sYe

sYe

s

vi. T

raffi

c we

ekNo

-Da

ta n

ot

avai

labl

eYe

sYe

s-

--

--

-

16.

Natio

nal l

evel

mul

ti-se

ctor

al P

rev.

Prog

.Ye

sNo

Data

not

av

aila

ble

NoYe

sYe

s-

NoNo

Yes

No

Sour

ce: I

nfor

mat

ion

base

d on

cou

ntry

pre

sent

atio

ns m

ade

at th

e B

i-reg

iona

l Wor

ksho

p on

Inju

ry S

urve

illan

ce h

eld

in C

hian

g M

ai, T

haila

nd fr

om

18 to

21

Dec

embe

r 20

06 a

nd R

egio

nal M

eetin

g of

Nat

iona

l Pro

gram

me

Man

ager

s on

Inju

ry P

reve

ntio

n an

d C

are

held

in N

onth

abur

i, Th

aila

nd fr

om

26 to

28

Sep

tem

ber

2007

. The

info

rmat

ion

was

furth

er u

pdat

ed in

200

8 by

foca

l per

sons

in th

e M

inis

tries

of H

ealth

of W

HO

SE

A R

egio

n M

embe

r S

tate

s.



Strategic approaches for injury prevention and control

The strategic approaches for injury prevention and control were discussed at a meeting of the National Programme Managers in Nonthaburi, Thailand during September 26-28, 2007. The summary and recommendations of this meeting are provided in Annexure 1.

Advocacy

In the South-East Asia Region, injuries and violence are considered as accidents and fatalistic events by society and not as a public health problem by some governments. In recent decades, advocacy efforts by WHO, international organizations, national governments and civil society have helped to place injury and violence prevention on the public health agenda of the Member States. An enabling policy environment and a receptive community are required for successful injury prevention and control programmes. A sustained and strong advocacy strategy and activities aimed at policymakers, professionals, politicians, the media and the public are required through a number of important strategies. These include:

Persuading policymakers to include �

in jury prevent ion and safety promotion in the national agenda and to incorporate it in all existing programmes.

Supporting at national level to �

develop legislative, regulatory and environment changes.

Disseminating key knowledge and �

information available from WHO and other UN organizations in a broader, graded and targeted manner.

Adaptation and development of new �

advocacy materials at national and sub-national / provincial or regional levels.

Building strong partnership with civil �

society, international organizations, national governments and profes-sional organizations.

Developing a situational analysis and �

status report on injury and violence for all Member States of the South-East Asia Region.



Better information for injury prevention and control

Improved data collection mechanisms are crucial and urgently required in the Region to formulate and to strengthen existing and new programmes. Injury-related data are available in several sectors - police, transport, insurance, social welfare, NGOs and others. Hence, a centralized way of examining the problem is difficult. Even though information gathering through surveillance and research has been identified as a key area, with the recent development of injury surveillance guidelines, ICD classification methods and International Classification of External Causes of Injury (ICECI) classification system of injuries, this has become a reality in a few countries.

The proposed regional strategies for strengthening surveillance and research include:

Supporting and providing tools and �

methodologies for data collection to Member States for prioritizing injury burden and impact.

Providing technical assistance to �

Member States to initiate surveillance activities and improve data collection efforts along with the causes of injuries (ICD 10, Chapter 20 - external causes of morbidity and mortality).

Strengthening capacity of profes- �

sionals across health, police, trans-port, education and social justice sectors for compilation, analysis and dissemination of findings.

Helping Member States to build injury �

research capacity for establishing insti tut ions for injury/violence research and others, which focus on regional problems.

Providing evidence to Member �

States on cost-effectiveness and feasible solutions for implementing programmes and to use it as a tool for advocacy purposes.

Policy formulation and strengthening

Many Member States in the Region do not have scientifically sound and sustainable policies for injury prevention and control. Consequently, the plans and programmes have not evolved to address the issue. This scenario has resulted in insufficient resources, trained manpower, professional and technical inputs to policies and programmes. In the SEA Region, only Indonesia, Myanmar, Sri Lanka and Thailand have injury prevention and control policies.

Hence, regional strategies to strengthen this action include:

Supporting all Member States to �

formulate national injury prevention policies with clear objectives, plans of action and mechanisms for implementation.

Incorporating injury prevention and �

control in national-level policies and programmes for implementation.

Facilitating and setting up working �

groups and national taskforces



on specific injuries like road traffic injuries, burns, suicides and inter-personal violence in all Member States to develop national policies.

Helping Member States to develop �

a national coordinating authority with technical experts, budget and man-power to formulate programmes.

Capacity strengthening for injury prevention and control

In recent years, TEACH-VIP and Mentor VIP (www.who.int) programmes have been developed globally by WHO Headquarters, Geneva and the global experts in injury prevention and control. These programmes aim at strengthening knowledge and skills of injury prevention practitioners and provide a mechanism for advocacy efforts. In the Region, there is a framework and contents for undergraduate medical curriculum and nursing curriculum developed by WHO-SEARO in consultation with the experts from the medical councils of Member States, which have been endorsed by the concerned councils in countries.

Some strategic approaches that would be very useful in the Region include:

Greater dissemination of TEACH-VIP �

and Mentor VIP programmes across concerned authorities in respective countries.

Developing focused programmes �

for sensit ization and capacity strengthening of policymakers and senior professionals in Member States.

Integrating injury and violence �

prevention and control in the curricula of medical and nursing schools and also in academic programmes of other sectors.

Identifying institutions in the Re- �

gion and networking for capacity strengthening and human resource development.

Implementation of interventions

As indicated in the earlier sections of this report, there are a few proven and cost-effective solutions that can be readily implemented in all Member States (Annexure – 2). While the need for evaluation of these interventions does not require overemphasis, establishing mechanisms for interventions and further evaluation is urgently needed. Larger advocacy and sensitization programmes are required at different levels for implementing these interventions.

To facilitate implementation of selected and focused interventions the strategies include:

Supporting national governments and �

focal points with adequate scientific information on the importance, scope and feasibility of implementing interventions.



Facilitating greater interaction be- �

tween health and safety profession-als, industry and civil society.

Encouraging governments and civil �

society to establish mechanisms for technology development of interventions in different areas as and when required.

Resource mobilization

Several national ministries at different levels need greater resources to move forward the agenda of injury prevention and control, as there is no allocated budget for this particular activity. The budget in health is largely for acute hospital-based trauma care, and there is a small budget for injury surveillance and prevention. However, with the daily exposure to the problems of injuries, doctors, nurses and other concerned health personnel realize the seriousness of the problem and would like to help in solving it. They are considered major human resources to be mobilized for a national task force or a network for injury surveillance, prevention and safety promotion. Experience in certain Member States of the Region like Maldives, Myanmar, Sri Lanka and Thailand have shown that health personnel in general hospitals can provide good support to the above activities and progress can be seen substantially with the effort of such a network.

Towards an intersectoral approach

As the causes of injury can be found in different developmental activities and in the non-health sector, an intersectoral approach is the key for success in injury prevention and control. An intersectoral approach calls for recognition of the problem by all members and joint devel-opment of interventions to address the problem. The approach calls for recog-nition of the roles and responsibilities of different sectors and identifying a unified way to address the problem. Since the health sector bears the maximum brunt of injury and violence and has certain values to add, such as epidemiology and research capacity, the health ministry should take the lead role in strengthening this approach.

In this regard, the following ap-proaches could be considered:

Encouraging Member States to �

formulate policies based on epide-miological information and also on identification and participation of related sectors in developing policies and programmes sharing a clearly identified role of each organization.

Dissemination of good practices in �

intersectoral approaches.

Facilitating dialogue and networking �

at regional and national levels.



Empowering civil society

Translation of national policies and programmes into action at different levels is crucial for success. Local government and nongovernmental organizations at different levels, both within and outside the health sector, including those from social welfare, education and others can be involved effectively in this area as they are closer to the communities. They are also in a better position to influence interventions at different levels.

Strengthening pre-hospital and emergency care

Studies have shown that appropriate management of injured persons soon after the occurrence of injury can result in a significant decline in mortality and also reduce disabilities. WHO has recently published essential trauma care guidelines and guidelines on pre-hospital care to help Member States formulate appropriate strategies in this area.

To strengthen pre-hospital and emergency care in the South-East Asia Region, WHO would:

Help Member States to develop �

minimum guidelines and standards for management of persons suffering injury and violence.

Encourage Member States to develop �

basic first-aid courses for health and first-aid responders in the community like the police, students, commercial vehicle drivers, community health

workers/volunteers and others in a prioritized manner.

Improve the emergency service �

component in the curricula of medical and nursing schools.

Rehabilitation of the injured

Nearly one third of disabilities in the Region are due to injuries. It is ironical and paradoxical that children saved from communicable and infectious diseases are becoming victims of injury and violence later in life.

An integrated approach for rehabili-tation requires the combined services of different sectors. Strategic approaches in the Region for rehabilitation of the injured would include:

Helping national ministr ies to �

undertake an assessment of the situation with regard to the burden of disabilities and accessibility of needed services in different countries.

Supporting governments to formulate �

policies and programmes and to set national standards for rehabilitation services at different levels of the health care system, especially the role of the health sector in community-based rehabilitation.

Monitoring and evaluation

A key limitation of the existing activities is the total absence of monitoring and evaluation at different levels. There is a need for tracking changes, identifying



emerging problems, monitoring the impact of interventions and setting guidelines for future activities. Monitoring and evaluation forms the core component of all public health programmes and the health sector is familiar with this approach.

Member States need to incorporate �

monitoring and evaluation in all in jury prevent ion and control programmes.

A framework to monitor and evaluate �

programmes should be developed by the relevant authorities.



Conclusions

Evidence from Member States of the �

South-East Asia Region shows that injuries place an enormous burden on the health system. The institutions and processes that are in place are not adequately empowered or equipped to deal with the situation.

Reliable data on the injury situation �

are not available in some countries. There is a need to generate data based on country priorities. However, reasonable data for intervention are available for road traffic injuries in most Member States.

Available data indicate that road �

traffic injuries, suicides and burns are major causes of injury in all Member States of the South-East Asia Region.

Injuries among pedestrians and �

motorcyclists are a growing concern in several Member States.

There is a need to promote and �

encourage all aspects of primary and secondary prevention of injury.



Recommendations

Major areas of activity and priority actions under the Regional Strategy for Injury Prevention and Control are:

Under the area of ‘Policy develop-1. ment, advocacy and programme development’, the priority actions are:

Ensuring government commit- �

ment

Advocating for injury preven- �

tion

Institutionalizing of injury pre- �

vention programmes

Under the area of ‘Reduce injury bur-2. den through programme implementa-tion’, the priority actions are:

Establishing injury surveillance/ �

information system

Supporting quality trauma care �

system

Reducing the burden of road- �

traffic injuries

Decreasing the excess impact �

of burn-injuries

Interpersonal violence preven- �

tion

Under the area of ‘Human Resources 3. and Infrastructure Development’, the priority actions are:

Capacity building strategies �

Strengthening regional co-ordi- �

nation and support

The short-term, intermediate and long-term activities for the above-men-tioned areas are detailed in Annex-5.



References

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Bhattacharya S, Alberini A and Cropper M 3. L. The value of mortality risk reductions in Delhi, India. Journal of Risk Uncertainity, 34, 21 - 47, 2007.

Gururaj G, Rehman FAKM, Suhardi S, Jha 4. N, Santikarn C, Saksena R, Niang K M and Somatunga L C. Injuries in south East Asia ; cause for concern and call for action. Report submitted to South east asia regional office of world Health organization, 2004 (unpublished document).

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Integrated Disease Surveillance Project, 7. India, 2005.

Koptis E and Cropper M. Traffic fatalities 8. and income growth. Accident analysis and Prevention, 37 (1), 169 - 178, 2005.

Mohan D (eds). Injuries in South-East Asia - 9. Priorities for policy and Action. World Health Organization, Regional Office for South East Asia SEA/INJURIES/AI 2002

Mohan D : Road traffic Injuries : The way 10. Forward, 2004

Mohan D, Tiwari G, Khayesi M and Nafukho 11. F M. road traffic injury prevention training manual. World Health Organization and Indian institute of Technology, Delhi, 2006.

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Sharma S, Upadhyay M and Ramaboot 16. S. The challenge of Road Traffic Injury in South East Asia: Moving beyond Rhetoric. Regional Health Forum, Vol 8, No. 1, 2004, 6 – 14.



The Royal Government of Bhutan: Annual 17. Health Bulletin, 2007

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Annex 1

Recommendations of the Regional Meeting of the National Programme Managers on Injury Prevention and Care

26-28 September 2007 at Nonthaburi, Thailand

To Member StatesMember States should urgently 1. increase investment in violence and injury prevention.

Sensitizing of policy makers and 2. capacity strengthening of programme managers would enhance violence and injury prevention (VIP).

A nodal agency at the national 3. level that is responsible for injury prevention in general or in a specific area of country priority is needed. The nodal agency should have certain mechanisms for inter-sectoral coordination and monitoring with the ministries, agencies and departments that are involved.

An injury unit in the MoH with 4. budget and human resources is also needed to advocate, coordinate and implement injury prevention and care, including safety promotion. Trauma care centres and hospitals should be included as partners of the unit in VIP and safety promotion. It is an important strategy for the Region

to cope with the present situation of limited resources within the MoH.

Minimum essential data collection 5. and reporting on the situation of injury burden from Member States to the Region were agreed upon in order to help in improving VIP information in the South-East Asia Region.

Exist ing informat ion systems 6. (hospital data and other sources like police and health sector data, vital registration, etc.) should be strengthened and information used. Standard categorization of causes of injuries according to ICD 10, Chapter 20 should be implemented in death registries and hospital admission data systems to facilitate policy and planning. Reports generated should be disseminated periodically for advocacy to all stakeholders.

Linkages between injury, disability 7. prevention and rehabilitation should be strengthened in each Member State.



Safety knowledge, training pro-8. grammes and related materials need to be developed and adapted for the Region.

To WHOWHO should continue to advocate 1. for institutionalizing VIP within the Ministry of Health and at the national level. Continuing support should be provided to the injury unit.

WHO should support Member 2. States in strengthening existing information systems and in utilizing

the information for injury surveillance and advocacy.

WHO should provide a template for 3. minimum essential data collection and reporting on the situation of injury which has been agreed upon, compile the information at the regional level and disseminate to Member States.

WHO should support Member States 4. in capacity strengthening in safety knowledge and evidence-based appropriate interventions through training programmes and materials.



Annex 2

Interventions to implement

Experience of many countries clearly indicates that injuries and violence are predictable and preventable. The primary, secondary and tertiary prevention approaches address a wide variety of issues so that injuries do not occur; the extent of damage is minimized even when it occurs, and individuals are made optimally functional even after injury. The prevention of injury and violence also shares a common understanding with other public health problems to address underlying economic, social, environmental and legal issues.

The public health approach to injury prevention and control begins

with a recognition of the problem, identification of major risk factors, development of interventions and monitoring and evaluation for continued work. Irrespective of the sectors involved in prevention activities the public health approach works on high-quality available information.

A number of interventions that are effective and promising have been proposed and recommended for implementation by WHO (2007). The role of the Ministry of Health in moving forward with implementation of the larger injury prevention and control (IPC) agenda is also elaborated in the table below.

1 Surveillance:What is theproblem?

2 Identifcation ofrisk factors

3 Developmentand evaluationof interventions

4 Implementation:How is it done?

Step 1: Collecting data on the magnitude,characteristics, extent andconsequences of the problem at thelocal, national and international levels.

Step 2: Identifying causes of the problem, aswell as factors increasing or decreasingindividual suceptibility to the problem,and examining how these factors mightbe modified.

Step 3: Designing, implementing, monitoringand evaluating interventions aimed atpreventing the problem, based on theinformation gathered in steps 1 and 2.

Step 4: Disseminating information on theeffectiveness of interventions;implementing effective interventions ona larger scale; and evaluating the cost -effectiveness of larger -scaleimplementation.



Table 7: Selected violence and injury prevention interventions, by cause, effectiveness and health sector role

Intervention Effectiveness Health sector role

Unintentional injuries

Road traffic injuries

Increasing the legal age of motorcycle drivers from 16 to 18 years

Effective Advocate, collaborate, evaluate

Introducing and enforcing laws on blood alcohol concentration limits


Graduated driver licensing systems Effective Advocate, collaborate, evaluate

Traffic-calming measures Effective Advocate, collaborate, evaluate

Daytime running lights on motorcycles


Introducing and enforcing seat-belt laws


Child-passenger restraints Effective Advocate, collaborate, evaluate

Introducing and enforcing motorcycle helmet laws


Speed-introduction measures Effective Advocate, collaborate, evaluate

Fires Electrification of housing Promising Advocate, collaborate, evaluate

Banning the manufacture and sale of fireworks

Promising Lead

Reducing storage of flammable substances in households

Promising Lead

Smoke alarms and detectors Promising Advocate, collaborate, evaluate

Improving building standards Promising Advocate, collaborate, evaluate

Modifying products - for example, kerosene stoves, cooking vessels and candle holders

Promising Advocate, collaborate, evaluate

Promoting use of cold water for first aid of burns

Effective Advocate, evaluate




Poisoning Child-resistant containers Effective Lead

Poison-control centres Effective Lead

Better methods of storage, relating both to the nature of storage vessels and where they are placed

Effective Lead

The use of warning labels Promising Lead

Restricting availability of most hazardous pesticides

Effective Advocate, evaluate

Drowning Use of personal floatation devices Effective Lead

Introduction and enforcing laws on pool fencing

Effective Lead

Teaching how to swim Effective Lead

Covering bodies of water, such as wells

Effective Lead

Safety standards for swimming pools Promising Lead

Clear and simple signage Promising Lead

Properly trained and equipped lifeguards

Promising Lead

Ensuring availability of weather reports to fishermen and others working on rivers and seas

Promising

Falls Safety mechanisms on windows, such as window bars in high-rise buildings

Effective Lead

Stair gates Effective Lead

Impact-resistant surfacing material on playgrounds

Effective Lead

Safety standards for playground equipment

Promising Lead

Muscle-strengthening exercises and balance training for older adults

Promising Lead

Checking and if necessary modifying potential hazards in the home, where there are individuals at high risk

Promising Lead

Educational programmes encouraging safety devices to prevent falls

Promising Lead

Encouragement/ evolution of safer working techniques and harnesses for construction workers and window cleaners who work at heights and tree climbers

Promising Lead




Intentional and unintentional injuries

Reducing the availability of alcohol during high-risk periods

Promising Lead

Reducing economic inequalities Promising Advocate, collaborate, evaluate

Stand-alone education programmes focusing only on changing risky behaviours

Ineffective Discourage

Strengthening social security systems

Unclear Advocate, collaborate, evaluate

Intentional injuries

Child maltreatment

Home visitation programmes Effective Lead

Training programmes for parents Effective Lead

Improving the quality of and access to prenatal and postnatal care

Promising Lead

Preventing unintended pregnancies Promising Lead

Training health-care providers to detect child maltreatment

Unclear Lead

Youth violence

Life skills training programmes Effective Advocate, collaborate, evaluate

Pre-school enrichment, to strengthen bonds with school, raise achievement and improve self-esteem


Family therapy for children and adolescents at high risk

Effective Lead

Educational incentives for at-risk high school students


Home-school partnership programmes promoting the involvement of parents


Peer mediation and counseling Ineffective Discourage

Education on the dangers of drug use

Ineffective Discourage




Intimate partner & sexual violence

School-based programmes to prevent violence in dating relationships


Training health-care providers to detect intimate partner violence and to refer cases

Unclear Lead

Teaching women survival tactics Unclear Lead

Promoting gender and social equality both through social and educational policies

Promising Lead

Elder abuse Building social networks of older people

Promising Lead

Training older people to serve as visitors and companions to individuals at high risk of victimization

Promising Lead

Developing policies and programmes to improve the organizational, social and physical environment of residential institutions for the elderly

Promising Lead

Self-inflicted violence

Restricting access to the means of self-inflicting violence - such as to pesticides, medications and unprotected heights

Effective Lead

Preventing and treating depression, alcohol and substance abuse

Effective Lead

School-based interventions focusing on crisis management, the enhancement of self-esteem, and coping skills


Phone-in help lines or hotlines for crisis management

Effective Lead

All types of violence

Reducing demand for and the availability of firearms


Sustained, multimedia prevention campaigns aimed at changing cultural norms

Promising Lead

Source: WHO and Mohan D, 2004



Effectiveness Health sector role

1. Effective: interventions evaluated with a strong research design, showing evidence of a preventive effect.

1. Lead: The health sector has primary responsibility for carrying out the intervention and monitoring its impact on the problem.

2. Promising: interventions evaluated with a strong research design, showing some evidence of a preventive effect but requiring more testing.

2. Advocate, collaborate, evaluate: Primary responsibility for implementation lies with another sector, but health has a crucial role in calling for the intervention, collaborating with other sectors in its implementation, and monitoring the intervention's impact. .

3. Unclear: interventions that have been poorly evaluated or that remain largely untested.

3. Discourage: Continued investments in interventions that have been shown to be ineffective or counterproductive waste scarce resources and - where an intervention actually exacerbates the problem - are detrimental to public health. The role of the health ministry for such interventions is therefore to discourage their development and implementation by any sector, and to offer alternatives where they exist. While the public health sector should discourage such interventions as means of preventing violence or injury, they may well be effective in preventing other civic and health problems. The term "Discourage" should not, therefore, be understood as a statement on the absolute efficacy of these programmes, but only on their efficacy in the context of injury and violence prevention.

4. Ineffective: interventions evaluated with a strong research design, and consistently shown to have no preventive effect, or even to exacerbate the particular problem. It should be noted that the term 'ineffective' is used only in relation to the impact on injury prevention.



Annex 3

WHO resource materials

Essential resources on policy and planningDeveloping policies to prevent injuries and violence: a guideline for policy-makers and planners. Geneva, WHO, 2005. http://www. who.int/violence_injury_prevention/policy/project/en/i ndex.html

Examples of more than 200 existing plans of action can be found at: http://www.who.int/violence_injury_prevention/publications/39919_ oms_br_2.pdf

Essential resources on data collectionEllsberg M, Heise L. Researching violence against women: a practical guide for researchers and advocates. Geneva, WHO, 2005. http://www. who. int/gender/documents/en/

Holder Y et al., eds. Injury surveillance guidelines. Geneva, WHO, 2001. http://whqlibdoc.who. int/hq/2001/WHO_NMH_VIP_01.02.pdf

Conducting community-based injury and violence surveys. Geneva, WHO, 2004. http://whqlibdoc. who.int/publications/2004/9241546484.pdf

WHO-ISPCAN. Preventing child maltreatment: a guide to taking action and generating evidence. Geneva, WHO, 2006. http://whqlibdoc.who. int/publications/2006/9241594365_eng.pdf

ICECI Coordination and Maintenance Group. International Classification of External Causes of Injuries (ICECI). Consumer Safety Institute, Amsterdam; and AIHW National Injury Surveillance Unit, Adelaide, 2004. http://www.iceci.org

Essential resources on services for victimsPre-hospital trauma care systems. Geneva, WHO, 2005. http://whqlibdoc.who.int/pub!ications/2005/924159294X.pdf

Guidelines for essential trauma care. Geneva, WHO, 2004. http://whqlibdoc.who.int/publications/2004/9241546409.pdf

The section of the WHO web site dealing with services for victims contains several country reports and documents and other resources for improving trauma care. It can be found at: http://www.who.int/violence_injury_prevention/ services/traumacare/en/index.html



Essential resources on prevention and evaluationViolence and injury prevention

Krug EG et al., eds. World report on violence and health. Geneva, WHO, 2002. http://www.who. inc/violence_injury_prevention/violence/world_ report/en/index.html

Preventing violence: a guide to implementing the recommendations of the World report on violence and health. Geneva, WHO, 2004. http://whqlibdoc.who.int/publications/2004/9241 592079.pdf

Preventing child maltreatment: a guide to taking action and generating evidence. Geneva, WHO, 2006. http://whqlibdoc.who.int/publications/200 6/9241594365_eng.pdf

Peden MM et al., eds. World report on road traffic injury prevention. Geneva, WHO, 2004. http://www.who.int/violence_injury_prevention/ publications/road_traffic/world_report/en/index.html

Addressing violence against women and achieving the Millennium Development Goals. Geneva, WHO, 2004. http://www.who.int/gender/ docu ments/women_MDGs_report/en/

Helmets: a road safety manual for decision-makers and practitioners. Geneva, WHO, 2006. http://www.who.int/violence_injury_prevention/ publications/roa d_tra f fic/helmet_manua 1. pdf

Road traffic injury prevention training manual. Geneva, WHO, 2006 http://whqlibdoc.who.int/ publications/2006/9241546751_eng.pdf

Child and adolescent injury prevention. Geneva, WHO, 2005. http://whqlibdoc.who.int/ publications/2005/9241593415_eng.pdf

Evaluation

Handbook for process evaluation in non-communicable disease prevention. Copenhagen, WHO Regional Office for Europe, 1999. http://dosei.who.int/uhtbin/cgisirsi/ 60nOoia4Y2/116570044/9

Rootman I et al., eds. Evaluation in health promotion: principles and perspectives. Copenhagen, WHO Regional Office for Europe, 2001.http://www.euro.who. int/InformationSources/Publications/ Catalogue/20010911_43

Essential resources on capacity-buildingTEACH-VIP users' manual. Geneva, WHO, 2005. http://whglibdoc.who.int/publications/20 05/9241593547_eng.pdf



Annex 4

WHO collaborating centres for injuries in the South-East Asia Region

The Indian Institute of Technology (IIT), Transportation Research and Injury 1. Prevention Programme (TRIPP), New Delhi, India

The Department of Epidemiology, National Institute of Mental Health and Neuro 2. Sciences (NIMHANS), Bangalore, India

The Trauma and Critical Care Centre, Khon Kaen Regional Hospital, Khon Kaen, 3. Thailand



Annex 5

Summary of activities to fulfil regional strategy for injury prevention & control

Area of activity Priority actions Short-term activities

2010 - 2011

Intermediate activities

2012 - 2013

Long-term activities

1. Policy development, advocacy and programme development

Ensuring government commitment

National policy on •injury preventionCommitment •of resources to injury prevention programme

National injury •prevention programme

Implementation •and evaluation programme for efficacy in reducing the burden of injuries

Advocating for injury prevention

Preparation of •evidence-based advocacy kitsInvolvement of •media people for advocacyLegal provisions •for road safety and consumer safety

National •resource centres on injury preventionIncorporation •of safety as an integral component in development projects

National safety •standards

Institutionalizing of injury prevention programmes

Review of •legislation in road traffic injury preventionSeparate •department/unit for injury control at MOH

Strengthening •financial resourcesLead agency •for national / regional injury prevention and control

Regional •support group on injury

2. Reduce injury burden through programme implementation

Establishing injury surveillance/information system

Develop country •profiles on injury burden and impactPilot injury- •surveillance system with guidelines in selected hospitalsImprove basic •health information system (causes of deaths and admission)

Implementation •of national injury- surveillance and information system

Continuous •and timely report of injury surveillance at national level for actions




2010 - 2011


2012 - 2013


Support quality trauma care system

Technical support •for quality hospital based pre-hospital and emergency care

Identification of •major issues and constraints on pre-hospital and emergency care pilotsSupport •Implementation of district based pre-hospital care

Implementation •of pre-hospital and emergency care in major health care facilitiesimprovement •of facilities for trauma care

Reducing the burden of road-traffic injuries

Advocacy for •national department on road safety

Preparation •of a national multisectoral strategy on road traffic injury preventionPilot the •multisectoral approachImplementation •of national programmeEstablishment •of high-powered national safety department

Evaluation •of the programme and implementation of revised programme

Decreasing the excess impact of burn-injuries

Promotion of •safer first-aid practicesIdentification of •risk-factors of burn injuriesEducation of •public on safe house and safe productsPreparation of •fire-safe housing policies and programmes

Promote safer •products

Interpersonal violence prevention

Regional •framework for interpersonal violence preventionProgramme •for violence prevention




2010 - 2011


2012 - 2013


3. Human Resource and Infrastructure Development

Capacity building strategies

Training on injury •epidemiology, prevention and careNational training •to create a critical mass for injury prevention and controlWorkshop on injury •surveillanceHuman resource •mobilizationIncorporating injury •prevention and control in medical curriculum

Training health •workers on burn-injuries and safety infrastructure development

Dissemination •of best practice modelsIncorporating •injury prevention and control in non-health professional curriculum (e.g. engineering, social sciences, and other technical areas)

Strengthening regional co-ordination and support

Identify regional •resource institutionsCreating and •facilitating regional network of expertsCommissioning •of inter-country research

Regional •resource centres for specific injuriesRegional donor •groups for “Small grant programmes on injury research”

Establishing •national resource centres for specific injuries


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