The case for improving road safety in Pacific Islands: a population‐based study from Fiji (TRIP 6)

Objective : To estimate the incidence and demographic characteristics associated with road traffic injuries (RTIs) resulting in deaths or hospital admission for 12 hours or more in Viti Levu, Fiji. Methods : Analysis of the prospective population‐based Fiji Injury Surveillance in Hospitals database (October 2005 – September 2006). Results: Of the 374 RTI cases identified (17% of all injuries), 72% were males and one third were aged 15–29 years. RTI fatalities (10.3 per 100,000 per year) were higher among Indians compared to Fijians. Two‐thirds of deaths (largely ascribed to head, chest and abdominal trauma) occurred before hospital admission. Conclusion and implications: While the RTI fatality rate was comparable to the global average for high‐income countries, the level of motorisation in Fiji is considerably lower. To avert rising RTI rates with increasing motorisation, Fiji requires a robust road safety strategy alongside effective trauma‐care services and a reliable population‐based RTI surveillance system.     

Human resources for the control of road traffic injury

The definition of the ideal numbers and distribution of human resources required for control of road traffic injury (RTI) is not as advanced as for other health problems. We can nonetheless identify functions that need to be addressed across the spectrum of injury control: surveillance; road safety (including infrastructure, vehicle design, and behaviour); and trauma care. Many low-cost strategies to improve these functions in low- or middle-income countries can be identified. For all these strategies, there is need for adequate institutional capacity, including funding, legal authority, and human resources. Several categories of human resources need to be developed: epidemiologists who can handle injury data, design surveillance systems, and undertake research; engineers and planners versed in safety aspects of road design, traffic flow, urban planning, and vehicle design; police and lawyers who understand the health impact of traffic law; clinicians who can develop cost-effective improvements in the entire system of trauma treatment; media experts to undertake effective behaviour change and social marketing; and economists to assist with cost-effectiveness evaluations. RTI control can be strengthened by enhancing such training in these disciplines, as well as encouraging retention of those who have the needed skills. Mechanisms to enhance collaboration between these different fields need to be promoted. Finally, the burden of RTI is borne disproportionately by the poor; in addition to technical issues, more profound equity issues must be addressed. This mandates that people from all professional backgrounds who work for RTI control should develop skills in advocacy and politics.     

Capacity for a global vaccine safety system: the perspective of national regulatory authorities

Confidence in vaccine safety is critical to national immunization strategies and to global public health. To meet the Millenium Development Goals, and buoyed by the success of new vaccines produced in developing countries, the World Health Organization has been developing a strategy to establish a global system for effective vaccine pharmacovigilance in all countries. This paper reports the findings of a qualitative survey, conducted for the WHO Global Vaccine Safety Blueprint project, on the perspectives of national regulatory authorities responsible for vaccine safety in manufacturing and procuring countries. Capacity and capabilities of detecting, reporting and responding to adverse events following immunization (AEFI), and expectations of minimum capacity necessary for vaccine pharmacovigilance were explored. Key barriers to establishing a functional national vaccine safety system in developing countries were identified. The lack of infrastructure, information technology for stable communications and data exchange, and human resources affect vaccine safety monitoring in developing countries. A persistent "fear of reporting" in several low and middle income countries due to insufficient training and insecure employment underlies a perceived lack of political will in many governments for vaccine pharmacovigilance. Regulators recommended standardized and internationally harmonized safety reporting forms, improved surveillance mechanisms, and a global network for access and exchange of safety data independent of industry.     

Exploring the relationship between development and road traffic injuries: a case study from India

BACKGROUND: Road traffic injuries (RTI) are a major cause of mortality and disability in the world. Only after significant losses have communities in developed nations taken necessary steps to prevent crashes and their consequences. Increase in road safety is related to increasing socio-economic development. We aim to study the trends in injury and death rates in a developing country, India, define sub-national variations, and analyse these trends in relation to economic and population growth. METHODS: Public sector data from India were used to develop a standardized database on traffic injuries and indicator of economic development. The data were analysed using linear regression models to test the a priori hypothesis of a positive relationship between net domestic product (NDP), and injury and death rates from road crashes across states. RESULTS: The absolute burden of RTI in India has been consistently rising over the past three decades. The reported rates are lower than those estimated by global health agencies and may reflect under-reporting. Population-based rates provide a better assessment of the public health burden of RTI than vehicle-based rates. There is an inverted U-shaped relationship between NDP and injury and death rates. Even with the limited data, Kuznets phenomenon is evident for within-country level comparisons. CONCLUSIONS: India and other developing countries could learn from the experience of highly motorized nations to avoid the expected rise in RTI and deaths with economic development, by currently investing in road safety and prevention measures.     

WHO基本药物概念与国家实践

本文对世界卫生组织基本药物概念的发展历程进行系统描述,并总结这一概念在典型发展中国家和发达国家的实践情况,重点介绍在保证药品质量和安全、建立高效、透明和公平的药品采购供应体系、在完善的国家药物政策框架下协调各部门目标和各方利益等方面的经验。     

Road traffic injury--a global public health scourge: a review for World Health Day 2004 (April 7)

OBJECTIVE: Globally in 2000, 1.2 million deaths resulted from road traffic injury (RTI) and about 10 times this number were injured. Because of the size of the problem, its expected growth and its preventability, World Health Day 2004 (April 7) was devoted to RTI. This review highlights attention to RTI by the ANZJPH and investigates relevance to the developing world, where 90% of all RTI deaths now occur. METHOD: All articles published by the ANZJPH over the five-year period 1999-2004, which met the World Health Organization definition of RTI, were reviewed. RESULTS: The eight studies selected and reviewed focused particularly on young drivers, alcohol use and Indigenous Australians, using a range of research and evaluation methods. Risk factors identified including widespread risky driving behaviour by young males and alcohol involvement. Intervention successes included legislative change regarding utility passengers, current vehicle inspection certificate and effects associated with the lead-up to New Zealand's 1992 Transport Act. CONCLUSIONS: The dramatic and continued reduction in Australia's road toll following peak rates in the 1960s has relied on scientific research, such as that reviewed here, for its effective evidence base. This review indicates that RTI is established on the public health agenda in Australia--a key aim of WHO's five-year strategy, for emulation by developing regions and nations. IMPLICATIONS: High-income countries such as Australia and New Zealand have the knowledge, expertise and also the responsibility to assist regional low- and middle-income countries to counter the growing scourge of RTI that accompanies rapid motorisation.     

桂林市道路交通伤害交通环境因素分析

目的探讨交通环境中道路交通伤害(RTI)的危险因素,为预防和减少RTI的发生提供科学依据。方法通过广西省桂林市交警总队收集的桂林市区2000—2009年的RTI数据,对交通环境中RTI的影响因素进行单因素和多因素Logistic回归分析,筛选出交通环境中RTI的危险因素。结果桂林市城区2000—2009年共发生RTI 3 603次,其中人为因素造成的RTI 3 278次,占90.98%,道路因素造成的RTI 250次,占6.94%,车辆因素造成的RTI 75次,占2.08%;单因素Logistic回归分析结果表明,标志标线(OR=1.363)、泥泞路面(OR=6.976)、积水路面(OR=10.057)、干燥路面(OR=8.055)、环形交叉口(OR=4.172)、四枝分叉口(OR=1.574)、桥梁(OR=2,558)、普通路段(OR=0.691)、三级公路(OR=2.321)、二级公路(OR=1.602)、一级公路(OR=3.206)、城市一般道路(OR=0.655)、夜间有路灯照明(OR=0.469)和白天(OR=2.061)是桂林市RTI发生的交通环境因素;多因素Logistic回归分析结果表明,标志标线、四枝分叉口、普通路段、一级公路、二级公路、城市一般道路和白天是桂林市交通环境中RTI发生的危险因素。结论标志标线、四枝分叉口、普通路段、一级公路、二级公路、城市一般道路和白天等交通环境是导致RTI发生的主要危险因素。     

The new International Health Regulations: considerations for global public health surveillance

Global public health surveillance is critical for the identification and prevention of emerging and reemerging infectious diseases. The World Health Organization recently released revised International Health Regulations (IHR) that serve as global legislation and provide guidelines for surveillance systems. The IHR aim to identify and prevent spread of these infectious diseases; however, there are some practical challenges that limit the usability of these regulations. IHR requires Member States to build necessary infrastructure for global surveillance, which may not be possible in underdeveloped countries. A large degree of freedom is given to each individual government and therefore different levels of reporting are common, with substantial emphasis on passive reporting. The IHR need to be enforceable and enforced without impinging on government autonomy or human rights. Unstable governments and developing countries require increased assistance in setting up and maintaining surveillance systems. This article addresses some challenges and potential solutions to the ability of national governments to adhere to the global health surveillance requirements detailed in the IHR. The authors review some practical challenges such as inadequate surveillance and reporting infrastructure, and legal enforcement and maintenance of individual human rights.     

A bibliometric analysis of toxicology research productivity in Middle Eastern Arab countries during a 10-year period (2003–2012)

Background

The key to universal coverage in tuberculosis (TB) management lies in community participation and empowerment of the population. Social infrastructure development generates social capital and addresses the crucial social determinants of TB, thereby improving program performance. Recently, there has been renewed interest in the concept of social infrastructure development for TB control in developing countries. This study aims to revive this concept and highlight the fact that documentation on ways to operationalize urban TB control is required from a holistic development perspective. Further, it explains how development of social infrastructure impacts health and development outcomes, especially with respect to TB in urban settings.

Methods

A wide range of published Government records pertaining to social development parameters and TB program surveillance, between 2001 and 2011 in Delhi, were studied. Social infrastructure development parameters like human development index along with other indicators reflecting patient profile and habitation in urban settings were selected as social determinants of TB. These include adult literacy rates, per capita income, net migration rates, percentage growth in slum population, and percentage of urban population living in one-room dwelling units. The impact of the Revised National Tuberculosis Control Program on TB incidence was assessed as an annual decline in new TB cases notified under the program. Univariate linear regression was employed to examine the interrelationship between social development parameters and TB program outcomes.

Results

The decade saw a significant growth in most of the social development parameters in the State. TB program performance showed 46% increment in lives saved among all types of TB cases per 100,000 population. The 7% reduction in new TB case notifications from the year 2001 to 2011, translates to a logarithmic decline of 5.4 new TB cases per 100,000 population. Except per capita income, literacy, and net migration rates, other social determinants showed significant correlation with decline in new TB cases per 100,000 population.

Conclusions

Social infrastructure development leads to social capital generation which engenders positive growth in TB program outcomes. Strategies which promote social infrastructure development should find adequate weightage in the overall policy framework for urban TB control in developing countries.     

2006-2008年河北省6家医院急诊室道路交通伤害监测分析

目的分析河北省部分城乡居民道路交通伤害状况和危害程度,为制定有效的干预措施提供科学依据。方法资料来源于秦皇岛市、藁城市各3家不同级别伤害监测哨点医院急诊室。对2006年1月1日至2008年12月31日首次就诊于哨点医院的道路交通伤害病人资料进行分析。结果共收集61 546例伤害病例,交通伤病例21 288例,占34.59%。患者男女性别比为1.94∶1,各年龄段之间男、女性别构成差异有统计学意义（χ^2=124.224,P〈0.05）;伤害性质以擦伤或浅表伤、骨折为主;交通伤发生时活动主要为驾乘交通工具和休闲活动;伤害严重程度以轻度为主;伤害部位以头部、下肢为主;机动车车祸发生时间有一定规律性。结论道路交通伤害发生存在一定规律,应充分利用医院急诊伤害监测系统,制定有针对性的预防条例并使其成为获取道路交通伤害发生情况的重要信息来源之一。     

中国道路交通伤害的模式

目的 探讨中国道路交通伤害的模式。方法 分析中国1951～2001年的道路交通伤害资料,讨论道路交通伤害的时间趋势、发生特征和影响因素,并对中国31个省、市、自治区的道路交通伤害进行综合评价。结果 中国在1951～2001年的51年中道路交通伤害一直呈上升趋势,20世纪80年代以后这个趋势尤为明显。2001年道路交通伤害的发生数、受伤人数和死亡人数均比1951年增加了100倍以上;死亡率攀升至8.51/10万人口,比1990年翻了一番。在过去的10年中,广东、山东、浙江等省的道路交通伤害死亡人数始终占据前五位,2001年道路交通伤害的综合事故率显示,西藏、新疆、青海、宁夏和甘肃等西部诸省区是道路交通碰撞最严重的地区。道路交通伤害造成的死伤以男性青壮年为最多,65岁以上的伤亡者有逐年上升趋势。道路质量、机动化程度、交通运输量等交通环境,以及驾驶员或路人的过失等人为因素是道路交通伤害的影响因素。结论 改善道路交通条件,交通立法与执法,提高城乡居民的交通安全意识等,是预防和控制道路交通伤害的主要措施。     

From risk-based health surveillance to health promotion: an evidence-based experience in a health care setting

In the European countries the health surveillance may be provided as a part of the national health system intervention. In Italy, the legislative Decree (626/94) makes the health surveillance compulsory for all those workers who are exposed to occupational risks. The aim of this study was to describe the introduction of preventive and protective measures, according to the new regulations, in the teaching hospital of the University of Modena. The population examined in 2000 included 1523 workers. Specific health surveillance protocols were prepared on the grounds of the risk characteristics based on the scientific evidence and on the risk perception. The intervention was oriented towards health promotion. The subjects were classified into 10 groups according to the risk characteristics. The percentage of workers ranged from 4% to 42%, depending on the exposure-related health changes. Moreover, the study explored some of the health surveillance benefits: an improvement in worker's satisfaction, an improvement in relationship between stakeholders, an early detection of health changes and a sickness absence reduction after the influenza vaccination program.     

Android and ODK based data collection framework to aid in epidemiological analysis

Periodic collection of field data, analysis and interpretation of data are key to a good healthcare service. This data is used by the subsequent decision makers to recognize preventive measures, provide timely support to the affected and to help measure the effects of their interventions. While the resources required for good disease surveillance and proactive healthcare are available more readily in developed countries, the lack of these in developing countries may compromise the quality of service provided. This combined with the critical nature of some diseases makes this an essential issue to be addressed. Taking advantage of the rapid growth of cell phone usage and related infrastructure in developed as well as developing countries, several systems have been established to address the gaps in data collection. Android, being an open sourced platform, has gained considerable popularity in this aspect. Open data kit is one such tool developed to aid in data collection. The aim of this paper is to present a prototype framework built using few such existing tools and technologies to address data collection for seasonal influenza, commonly referred to as the flu.     

Roadmap for the international collaborative epidemiologic monitoring of safety and effectiveness of new high priority vaccines

With the advent of new vaccines targeted to highly endemic diseases in low- and middle-income countries (LMIC) and with the expansion of vaccine manufacturing globally, there is an urgent need to establish an infrastructure to evaluate the benefit-risk profiles of vaccines in LMIC. Fortunately the usual decade(s)-long time gap between introduction of new vaccines in high and low income countries is being significantly reduced or eliminated due to initiatives such as the Global Alliance for Vaccines and Immunizations (GAVI) and the Decade of Vaccines for the implementation of the Global Vaccine Action Plan. While hoping for more rapid disease control, this time shift may potentially add risk, unless appropriate capacity for reliable and timely evaluation of vaccine benefit-risk profiles in some LMIC's are developed with external assistance from regional or global level. An ideal vaccine safety and effectiveness monitoring system should be flexible and sustainable, able to quickly detect possible vaccine-associated events, distinguish them from programmatic errors, reliably and quickly evaluate the suspected event and its association with vaccination and, if associated, determine the benefit-risk of vaccines to inform appropriate action. Based upon the demonstrated feasibility of active surveillance in LMIC as shown by the Burkina Faso assessment of meningococcal A conjugate vaccine or that of rotavirus vaccine in Mexico and Brazil, and upon the proof of concept international GBS study, we suggest a sustainable, flexible, affordable and timely international collaborative vaccine safety monitoring approach for vaccines being newly introduced. While this paper discusses only the vaccine component, the same system could also be eventually used for monitoring drug effectiveness (including the use of substandard drugs) and drug safety.     

2010-2018年深圳市急救中心受理的道路交通伤害流行病学特点

  目的  调查深圳市2010—2018年人群道路交通伤害(road traffic injury, RTI)的现状,为深圳市完善道路交通安全相关政策及RTI预防提供参考与建议。  方法  回顾性分析2010—2018年深圳市急救中心急救综合信息查询平台受理的RTI数据,统计深圳市RTI发生的总体情况、人群特点、时间、区域分布及伤情严重程度等。  结果  2010—2018年深圳市急救中心涉及人员伤亡的RTI共79 369例,受伤/现场死亡比为79.66∶1。深圳市急救中心RTI发病率总体呈下降趋势(χ_趋势2=8.200, P=0.004),现场死亡率总体上亦呈下降趋势(χ_趋势2=4.604, P=0.032)。男性发病率为478.90/10万人,高于女性发病率223.92/10万人(χ2=92.823, P < 0.001)。受伤者年龄多以20~＜40岁青壮年为主,占比60.16%。按月份分布,7月份呼叫率最高,占比8.98%,2月份最低,占比4.84%;10月份现场致死人数最多,占比19.91%。按呼叫时间分布,周末高于工作日,一天24 h中RTI的就诊高峰时间为19∶00—20∶00及8∶00—9∶00,而3∶00—5∶00 RTI就诊数最低。按区域分布,各行政区间分布不均衡,以研究期间各区域平均常住人口为暴露分母计算, 光明区RTI发生率为1 007.73/10万人,大鹏新区及盐田区随后,为917.72/10万人和917.62/10万人。各区域间差异有统计学意义(χ2=592.057, P < 0.001)。急救反应时间分布呈非正态分布,救护车到达现场时间为11.93(8.23, 17.38) min, 救护车到达医院时间为24.25(17.93, 32.70) min。  结论  针对深圳市急救中心2010—2018年RTI流行病学特点,预防和控制RTI的关键是完善道路交通管理体制,提高重点人群的交通安全防范意识,加强高峰时段的道路监管,合理调配急救资源,提高急救反应时间,改进急救体系和服务模式,制定科学的防范措施。     

Animal disease surveillance: prospects for development in Pakistan

Surveillance is a continuous and systematic process of collection, consolidation, analysis, interpretation and dissemination of relevant information on the occurrence of health problems. Data from surveillance can be used to calculate the incidence and prevalence of events, to categorise disease distribution by relevant characteristics, to guide investigations into the occurrence of epidemic and endemic disease, and to contribute essential information for the design and evaluation of effective disease prevention and control programmes. Disease surveillance systems should also respond to the information needs of government agencies, agribusiness, academia, producers and consumers. However, in most developing countries, including Pakistan, animal disease surveillance systems are not well developed, and do not produce a desirable quality of information on disease status and trends. In this paper, the authors describe various facets of a generic surveillance system and propose a structure for a surveillance system at district level. Such systems have been designed and implemented for public health surveillance in a number of countries, and may be developed to meet the needs of veterinary public health.     

Building on the success of the Expanded Programme on Immunization: enhancing the focus on disease prevention and control

The Expanded Programme on Immunization (EPI) has succeeded in establishing a vaccine delivery system in all low and middle income (LMI) countries. Because EPI has focused on immunization delivery, its major outcome is measured in many countries only as vaccine coverage, not as disease reduction, the real goal of EPI. Monitoring disease reduction requires real-time case-based disease surveillance and appropriate interventions, for which a functional public health infrastructure is needed. If the highest priority for assessing impact of EPI shifts to disease prevention and control from vaccine coverage, the programme may be transformed to one of control of childhood communicable diseases (CCCD), with the potential of expanding the range of diseases of children and adults for control and of integrating all other current vertical (single disease) control efforts with it. EPI provides the essential platform on which CCCD can be built to create a public health infrastructure.     

Achieving universal health insurance in Korea: a model for other developing countries?

As developing countries explore alternative methods to provide universal health insurance coverage, one potential model is South Korea. In twelve years (from 1977 to 1989), Korea was able to achieve universal health insurance coverage first by mandating employer based health insurance coverage for medium and large firms and then by establishing regional health insurance systems for small firms, farmers and the self-employed. A government medical aid insurance program was instituted for low income citizens. The specifics of the plan and some of the issues encountered in implementing the plan may be of interest to developing countries who want to achieve universal health insurance while maintaining a significant role for the private sector.