Improving care for victims of violence in resource-poor settings such as Lusaka, Zambia: results of a low-budget intervention.

UNLABELLED: Health professionals from Zambia and Austria conducted a low-cost intervention in Lusaka, Zambia, intended to improve care outcomes for victims of interpersonal violence (IPEV). It was designed to build on existing health and social services infrastructures. During 1 year, 174 victims of IPEV seen at the Lusaka University Hospital emergency room were interviewed by medical students. An intervention included training for medical and social service personnel and distribution at key locations of printed materials on services available to IPEV victims. Postintervention data analysis revealed that victims of IPEV had improved understanding of available social services, and victims' confidence was increased about receiving additional help and articulating health concerns. Other benefits: improved visibility, networking among partner organisations; new descriptive data about IPEV victims; improved cross-cultural understanding among medical participants. RECOMMENDATION: low-cost interventions should continue to be explored to improve care for victims of IPEV in resource-poor settings.

The Arms Trade Treaty (ATT): a public health imperative.

The United Nations adopted an historic international Arms Trade Treaty (ATT) in April 2013. A 1997 meeting of Nobel Peace Prize laureates who called for an International Code of Conduct to address the 'destructive effects of the unregulated arms trade' initiated discussions that led to the Treaty. Public health institutions, including the World Health Organization and the International Committee of the Red Cross, and nongovernmental health groups such as International Physicians for the Prevention of Nuclear War, made adoption of the ATT a public health imperative. The poorly regulated $70 billion annual trade in conventional arms fuels conflict, with devastating effects on global health. The ATT aims to 'reduce human suffering'. It prohibits arms' sales if there is knowledge that the arms would be used in the commission of genocide, attacks against civilians, or war crimes. The health community has much to contribute to ensuring ratification and implementation of the ATT.

Implementing a hospital based injury surveillance system in Africa: lessons learned.

A multinational injury surveillance pilot project was carried out in five African countries in the first half of 2007 (Democratic Republic of the Congo, Kenya, Nigeria, Uganda and Zambia). Hospitals were selected in each country and a uniform methodology was applied in all sites, including an injury surveillance questionnaire designed by a joint programme of the Pan American Health Organization and the United States Centres for Disease Control and Prevention. A total of 4207 injury cases were registered in all hospitals. More than half of all injury cases were due to road traffic accidents (58.3%) and 40% were due to interpersonal violence. Self-inflicted injuries were minimal (1.2% of all cases). This report provides an assessment of the implementation of the project and a preliminary comparison between the five African countries on the context in which inter-personal injury cases occurred. Strengths and weaknesses of the project as well as opportunities and threats identified by medical personnel are summarized and discussed. A call is made to transform this pilot project into a sustainable public health strategy.

Implementing a hospital based injury surveillance system in Zambia: a preliminary report.

The University Teaching Hospital in Lusaka, Zambia, is the nation's premier tertiary referral hospital and a teaching centre for the University of Zambia as well as a research centre of excellence. It was one of the five sites chosen as part of a multinational injury surveillance project conceived to provide preliminary data in response to observations made by public health agencies such as the World Health Organization, and the United States Centres for Disease Control and Prevention (CDC) on the paucity of such data from third world settings. The study covering a period of 6 months from January 2007 to June 2007, used a pre-tested survey instrument crafted by the Ponce School of Medicine in Puerto Rico in close consultation with the CDC and the Pan-American Health Organization (PAHO). A 24-hour system collected a total of 2714 cases, with due care taken to ensure that all the parameters were entered as required.

Armed violence: a health problem, a public health approach.

At the World Health Assembly in 1996, the World Health Organization (WHO) declared violence "a leading worldwide public health problem" and called for public health strategies to address it. The WHO's call to action, as well as an international political movement that is gaining strength, has helped galvanize health professionals in many countries to employ the tools of public health and their medical skills to better understand the causes of violence, to use research findings to influence policy, and to animate statistics with a human face. This paper reviews the scope of the problem, with a focus on armed violence with small arms and light weapons. It presents a history of International Physicians for the Prevention of Nuclear War's (IPPNW) involvement in this issue. A case example from IPPNW/Zambia demonstrates how health community involvement can raise awareness about armed violence and its risk factors, and influence policy changes.

A multinational injury surveillance system pilot project in Africa.

This paper describes the development of a pilot project to test the implementation of an epidemiological surveillance system for intentional (violent) and non-intentional injuries, at emergency departments in selected hospitals in five African countries applying the World Health Organization's guidelines. We outline obstacles and opportunities encountered during the process. By definition, a surveillance system systematically collects, reviews, and evaluates information to understand the context in which specific injuries occur. Implementation in diverse sociocultural environments in Zambia, Uganda, Democratic Republic of the Congo, Nigeria, and Kenya has provided an opportunity to gather reliable data on injuries for comparisons between these countries. Analysis of the detailed information may permit researchers to generate evidence-based recommendations. Addressed to public authorities, and health authorities in particular, they can help address injury incidence in their communities from a public health perspective.

Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology.

OBJECTIVE: Foot ulcers and their complications are an important cause of morbidity and mortality in diabetes. The present study aims to examine the long-term outcome in terms of amputations and mortality in patients with new-onset diabetic foot ulcers in subgroups stratified by etiology. RESEARCH DESIGN AND METHODS: Patients presenting with new ulcers (duration <1 month) to a dedicated diabetic foot clinic between 1994 and 1998 were studied. Outcomes were determined until March 2000 (or death) from podiatry, hospital, and district registers. Baseline clinical examination was done to classify ulcers as neuropathic, ischemic, or neuroischemic. Five-year amputation and mortality rates were derived from Kaplan-Meier survival analysis curves. RESULTS: Of the 185 patients studied, 41% had peripheral vascular disease (PVD) and 61% had neuropathy; 45%, 16%, and 24% of patients had neuropathic, ischemic, and neuroischemic ulcers, respectively. The mean follow-up period was 34 months (range 1-65) including survivors and patients who died during the study period. Five-year amputation rates were higher for ischemic (29%) and neuroischemic (25%) than neuropathic (11%) ulcers. Five-year mortality was 45%, 18%, and 55% for neuropathic, neuroischemic, and ischemic ulcers, respectively. Mortality was higher in ischemic ulcers than neuropathic ulcers. On multivariate regression analysis, only increasing age predicted shorter survival time. CONCLUSIONS: All types of diabetic foot ulcers are associated with high morbidity and mortality. The increased mortality appears to be independent of factors increasing ulcer risk-that is, neuropathy and PVD-in patients with established foot ulcers.