Development and Evaluation of a Community Surveillance Method for Estimating Deaths Due to Injuries in Rural Nepal

Abstract

Almost 10% of global deaths are secondary to injuries, yet in the absence of routine injury surveillance and with few studies of injury mortality, the number and cause of injury deaths in many countries are not well understood. This study aimed to develop and evaluate the feasibility of a method to identify injury deaths in rural Nepal. Working with local government authorities, health post staff and female community health volunteers (FCHVs), we developed a two-stage community fatal injury surveillance approach. In stage one, all deaths from any cause were identified. In stage two, an interview with a relative or friend gathered information about the deceased and the injury event. The feasibility of the method was evaluated prospectively between February 2019 and January 2020 in two rural communities in Makwanpur district. The data collection tools were developed and evaluated with 108 FCHVs, 23 health post staff and two data collectors. Of 457 deaths notified over one year, 67 (14.7%) fatal injury events were identified, and interviews completed. Our method suggests that it is feasible to collect data on trauma-related deaths from rural areas in Nepal. These data may allow the development of injury prevention interventions and policy.

Public health surveillance through community health workers: a scoping review of evidence from 25 low-income and middle-income countries

“…The studies adopted quantitative, qualitative and mixed methodologies with some studies specifically describing interventions to train CHWs. 11 12 Studies were from 25 LMICs across the world including Africa, [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Asia, [27][28][29][30][31][32][33][34][35][36] Latin America 37 38 and the Caribbean. 39 Although most studies focused on specific infectious diseases including HIV/AIDS, 20 malaria, 15 18 37-39 tuberculosis (TB), 16 19 Ebola, 12 neglected tropical diseases (NTDs) 13 24 26 and COVID-19, 34 others focused on maternal and child health, 14 25 29-32 35 general health/overall mortality 17 21 23 33 and specific outcomes such a suicide.…”

“…In Zimbabwe, Kambarami et al 25 highlighted that as part of pregnancy surveillance, CHWs collected data on women’s menstrual health, while in Pakistan, Khalid et al 32 described CHWs as playing a critical role in collecting data on pregnancies, births, and maternal and child deaths during household visits. In rural Nepal, Bhatta et al 33 also highlight the role of CHWs in improving surveillance by collecting data on fatal injuries and other demographic data. In some cases, the data collected are not restricted to mortality and morbidity data but may also include samples in the case of surveillance for patients with TB in South Africa.…”

“… 24 In cases where CHWs have the capacity to test and treat, they have effectively not only provided information to aid surveillance but successfully ended outbreaks as in the case of malaria outbreaks in Santo Domingo. 39 For data that are often extremely hard to find in LMIC contexts such as suicide data 28 and data on injuries, 33 the use of CHWs has played a role in providing such critical information for health systems while ensuring that those in rural and remote communities are included in such surveillance. 29 31 CHWs’ community engagement skills also help to facilitate cooperation from community members leading to effective surveillance and the sustainability of public health surveillance efforts.…”

Road traffic death coding quality in the WHO Mortality Database

“… 18 Our findings suggest that the availability of mortality data in the WHO Mortality Database has not improved over the period from 2015 to 2020, as we only observed 52 countries and territories reporting complete data for all 6 years. Possible reasons for poor data availability include: (i) some countries and territories have not established reliable vital statistics systems to collect mortality data; 26 (ii) vital registration systems in some countries and territories are disrupted by war or political unrest; 27 , 28 (iii) several countries and territories do not use standard ICD codes to record mortality data; 29 (iv) some countries and territories lack adequate resources and qualified coders to reliably complete death certificates and gather mortality data; 30 , 31 and (v) some countries and territories refuse to submit their data to WHO, perhaps due to concerns about data misinterpretation or misuse, intentional or unintentional privacy disclosure, or loss of data ownership. 32 , 33 …”

Identification of research priorities for suicide prevention in Nepal: a Delphi study

“…In contrast, a five- year study of Nepal police records of suicidal deaths between 2015 and 2019 showed an increase of 33% in suicidal deaths over five years [ 9 ]. According to a recent community-based study, self-harm and assault accounted for 44 of the 67 total injury deaths (66%) in two wards in Makwanpur, Nepal [ 10 ], despite in contrast to a study using global burden of disease which suggest that only a small proportion (1.6%) of deaths are intentional [ 11 ].…”