Mortuary based injury surveillance for low-mid income countries: process evaluation of pilot studies Chebiwot Kipsaina a, *, Joan Ozanne-Smith a , Kidist Bartolomeos b , Virginia Routley a a Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Melbourne, Victoria, Australia b Department for Management of Non-communicable Diseases, Disability, Violence and Injury Prevention, World Health Organization Geneva, Switzerland Background Globally, injury is the fourth major cause of death and the third leading contributor to total Disability Adjusted Life Years (DALYs) lost due to health conditions. The World Health Organization (WHO) projects that in 2015, 5.2 million people will die from injury related causes, an increase from five million in 2011. Ninety percent of fatal injuries occur in Low-Mid Income Countries (LMICs) [1]. In 2012, approximately 888,013 people died as a result of injuries in Africa, which accounted for 9.6% of all deaths in the region [2]. Injury is a multifaceted issue. One major contributing factor to developing nations’ inefficiency in addressing particular causes of death and injury through policy and legislative responses has been the inability to collect useful, reliable and timely data to inform prevention strategies. In most high income nations (such Injury, Int. J. Care Injured 46 (2015) 1509–1514 ARTICLE INFO Article history: Received 19 February 2015 Accepted 2 June 2015 Keywords: Fatal injury Surveillance Mortality Mortuary Evaluation Low-mid income countries Injury prevention ABSTRACT Objective: Globally, injury is the fourth major cause of death and the third leading contributor to Disability Adjusted Life Years lost due to health conditions, with the greatest burden borne by low- middle income countries (LMICs) where injury data is scarce. In the absence of effective vital registration systems, mortuaries have been shown to provide an alternative source of cause of death information for practitioners and policy makers to establish strategic injury prevention policies and programs. This evaluation sought to assess the feasibility of implementing a standardised fatal injury data collection process to systematically collect relevant fatal injury data from mortuaries. The process evaluation is described. Methods: A manual including a one page data collection form, coding guide, data dictionary, data entry and analysis program was developed through World Health Organization and Monash University Australia collaboration, with technical advice from an International Advisory Group. The data collection component was piloted in multiple mortuaries, in five LMICs (Egypt, India, Sri-Lanka, Tanzania and Zambia). Process evaluation was based on a questionnaire completed by each country’s Principal Investigator. Results: Questionnaires were completed for data collections in urban and rural mortuaries between September 2010 and February 2011. Of the 1795 reported fatal injury cases registered in the participating mortuaries, road traffic injury accounted for the highest proportion of cases, ranging from 22% to 87%. Other causes included burns, poisoning, drowning and falls. Positive system attributes were feasibility, acceptability, usefulness, timeliness, and simplicity and data field completeness. Some limitations included short duration of the pilot studies, limited injury data collector training and apparent underreporting of cases to the medico-legal system or mortuaries. Conclusion: The mortuary has been shown to be a potential data source for identifying injury deaths and their circumstances and monitoring injury trends and risk factors in LMICs. However, further piloting is needed, including in rural areas and training of forensic pathologists and data-recorders to overcome some of the difficulties experienced in the pilot countries. The key to attracting ongoing funding and support from governments and donors in LMICs for fatal injury surveillance lies in further demonstrating the usefulness of collected data. ß 2015 Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: +61 3 96844127. E-mail address: chebi.kipsaina@monash.edu (C. Kipsaina). Contents lists available at ScienceDirect Injury journal homepage: www.elsevier.com/locate/injury http://dx.doi.org/10.1016/j.injury.2015.06.005 0020–1383/ß 2015 Elsevier Ltd. All rights reserved.