Case 3 MVC Public Health 2024.pdf

Case 3 – Public Health: Trauma and Motor Vehicle Crashes Haroon Moolla Center for Infectious Disease Epidemiology and Research (CIDER) School of Public Health...

Case 3 – Public Health: Trauma and Motor Vehicle Crashes Haroon Moolla Center for Infectious Disease Epidemiology and Research (CIDER) School of Public Health [email protected] August 2024 Overview LO 1: Define migration and urbanisation and describe their effects on health in South Africa Trends in urbanisation Benefits and challenges of urbanisation LO 2: Discuss the epidemiology of motor vehicle crashes in South Africa Background to trauma: definition, classification, and epidemiology Motor vehicle crashes: epidemiology and determinants Prevention and health promotion LO 14: Outline the sources of information that can be used for monitoring health Routine vs surveillance systems LO 1: Urbanisation Urbanisation: movement of people from rural areas to more urban areas (cities and towns)  Increased concentrations of people in a specific geographic areas Urbanisation Percentage of world population living in urban areas Urbanisation Percentage of the South African population living in urban areas Urbanisation & Health Benefits Better access to health care Better access to housing, water & sanitation Better access to nutrition Better access to education Better access to employment Better opportunities for rapid SES improvement Urbanisation & Health Challenges (1) Effects of social and cultural changes Breakdown of family structures Single members of family migrating Affects mental health: isolation, stress & depression, substance use disorders Riskier sex (STIs & HIV) Crime & violence Urbanisation & Health Challenges (2) Effects of increased population density Rapid motorisation and Motor Vehicle Crashes (MVCs), new technology, trauma, fires Overcrowding, contributing to an increase in certain infectious diseases (e.g. TB) Particularly in developing countries with inadequate housing Urbanisation & Health Challenges (3) Effects of changes in lifestyle and the environment Increase in non-communicable diseases (e.g. hypertension, diabetes, cardiac disease), due to: More sedentary lifestyle (less exercise) Less healthy diet (more processed foods) Increased obesity rates Pollution Asthma prevalence and symptoms are increased in urban areas Overview LO 1: Define migration and urbanisation and describe its effect on health in South Africa Trends in urbanisation Benefits and challenges of urbanisation LO 2: Discuss the epidemiology of motor vehicle crashes in South Africa Background to trauma: definition, classification, and epidemiology Motor vehicle crashes: epidemiology and determinants Prevention and health promotion LO 14: Outline the sources of information that can be used for monitoring health Routine vs surveillance systems LO 2: Trauma & Motor Vehicle Crashes Definition of physical trauma: Physical injury when human body is suddenly or briefly subjected to intolerable levels of energy (WHO) Acute exposure to intolerable amounts of damage Impairment of function resulting from lack of one or more vital elements (air water warmth) as in drowning, freezing, strangulation (WHO) Trauma excludes conditions from continual stress e.g. chronic back pain or chronic disability due to work Causes of Trauma Classification of hazards: Mechanical (moving car) Thermal (hot air or water) Electrical (lightning) Chemical (poisons, alcohol) Radiant (shock wave from explosion) Classification of Trauma Various classifications of trauma: Location of damage Severity of injury Demographic classification – age and gender Type of force Intentional or unintentional Classification of Trauma Unintentional Natural disasters – earthquakes, floods Accidents in home (e.g. burns) Motor vehicle crashes Intentional Interpersonal violence (homicide or assault) Self-harm (e.g. suicide) Epidemiology of Trauma Globally DALYs: Disability Adjusted Life Years Explained on next slide Disability Adjusted Life Years (DALYs) A person gets injured at age 55, then: lives 5 years with a disability (which has a disability weight of 20%), then dies at age 60 (when their life expectancy is 65 years). How many DALYs were lost? 55 years 60 years 65 years Lost 20% of these 5 years: Lost ALL of these 5 years: =1 DALY =5 DALYs Total DALYs = 6 years Epidemiology of Trauma in South Africa Graph showing the causes of death: Infectious diseases Non-communicable diseases Trauma Trauma accounts for over 10% of deaths in South Africa Epidemiology of Trauma in the Western Cape Graphs showing the causes of death by age group (horizontal axis), for males (top graph) and females (bottom graph) Trauma is the leading cause of death in people between the ages of 15 and 44 in the South Africa (mostly driven by males) For interest: “Ca” is cancer; “CVD” is cardiovascular disease; “NCDs” are non- communicable diseases Epidemiology of Trauma in South Africa Figure 3.1 Age and sex profile of injury deaths in the western Cape, 2016 Motor Vehicle Crashes: Terminology Previously called “Motor Vehicle Accidents (MVAs)” “Accident” implies something that can’t be prevented, which is not the current thinking Now called “Motor Vehicle Crashes (MVCs)” Motor Vehicle Crashes: Mortality Road injuries are the tenth leading cause of deaths in Lower- and Middle- Income Countries (LMICs) Of MVCs that result in deaths: Men make up most of the deaths (80%) More pedestrians (>60%) die than drivers/passengers High alcohol among drivers (>50%) / pedestrians (>60%) Increased frequency over weekends for adults Mornings & early afternoons among school-children Motor Vehicle Crashes: Morbidity For each death 30 serious injuries For each death 300 less serious injuries Huge cost to the economy Determinants of MVCs Individual factors Hearing or vision impairments Behavioural factors Speed Aggression Using cellphones Societal factors Acceptability of drinking & driving Disregard for the rules of the road Poor license control Structural factors Unroadworthy vehicles Unsafe or poorly maintained roads Severity Speed plays important role in the severity of outcomes The Natural History of Disease for Trauma Exposure to a Disability Event Injury hazard and/or Death  Prevention and Health Promotion Exposure to a Disability Event Injury hazard and/or Death Decrease use of If people are driving, If MVCs do occur, Prevent motor vehicles make it safer: reduce the complications of through: incidence and injuries: Better control of severity of Safe and drivers licences injuries: Timely efficient public and emergency transport (e.g. roadworthiness Seatbelt usage response trains) of vehicles Speed limits Appropriate Campaigns to Well-maintained care and rehab reduce drunk roads of injuries (e.g. driving Better fractures) infrastructure for pedestrians Overview LO 1: Define migration and urbanisation and describe its effect on health in South Africa Trends in urbanisation Benefits and challenges of urbanisation LO 2: Discuss the epidemiology of motor vehicle crashes in South Africa Background to trauma: definition, classification, and epidemiology Motor vehicle crashes: epidemiology and determinants Prevention and health promotion LO 14: Outline the sources of information that can be used for monitoring health Routine vs surveillance systems LO 14: Sources of Information Routine Information Systems Routine Health Information Systems Specific Surveillance Systems Routine Information Systems Government collects data to guide operational decision making in general Data is collected and processed in an ongoing way: Birth and death registers National census Other routine surveys Routine Health Information Systems Data collected routinely at clinics and hospitals: Causes of deaths Number of people admitted, etc Specific Surveillance Systems Surveillance definition: continued watch over distribution & trends of incidence of disease through systematic collection, consolidation & evaluation of morbidity & mortality reports & other relevant data Key points: Systematic Ongoing For specific conditions Looking at burden of disease May be surveys, research studies, or routinely collected data Specific Surveillance Systems Acknowledgements Prof David Coetzee Dr Mpho Tlali Disability Adjusted Life Years (DALYs) A person gets injured at age 30, then: lives 25 years with a disability (which has a disability weight of 40%), then dies at age 55 (when their life expectancy is 65 years). How many DALYs were lost? 30 years 55 years 65 years Lost 40% of these 25 years: Lost ALL of these 10 years: =10 DALYs =10 DALYs Total DALYs = 20 years