Injury surveillance systems in low and middle income countries (LMIC) : challenges, prospects and lessons

An effective injury surveillance system (ISS) allows timely detection and proactive interventions against new injury problems, in keeping with the motto - "From Data to Action". Resource limitation is the biggest challenge to implementing an ISS, when data utility must be considered as well as resource consumption. Surveillance of fatal injuries is inexpensive, but data is untimely, incomplete, and limited for assessing burden. Surveillance of injury admissions is more expensive, but data is influenced by admission policy. Emergency Room surveillance permits surveillance of slight, to severe injuries. The latter two are influenced by institutional access, and there is the tendency to weigh all injuries equally. Another challenge is what data is to be captured. The International Classification of External Cause of Injuries (ICECI), provides for the use of data sets, with varying levels of detail, from minimum (for use where resources are severely constrained) to full, but ensuring that data is standardised and comparable. Implementation challenges are lack of capacity, resistance to a new operation, and fear of increased workload. These may be overcome by sensitisation, training, and a pilot. Demonstrated utility of the data through reports, applications to situations other than health (e.g. police GIS mapping), and interactions with other sectors, generates a demand for the data and contributes greatly to a sustainable ISS, as does integration into an existing system. Documented procedures, periodic revision and trained trainers on-site, address the problem of staff mobility, a problem in low and middle income countries. Common to successful ISSs, whatever the location, are: a coordinator / advocate, sensitization / training, succession strategies, frequent feedback, constant monitoring and periodic evaluations, and utilisation of the data.