Geographic injury surveillance in low-resource settings

Injury is a leading cause of morbidity and mortality in almost every country and in almost every age group. The global societal and economic burden of injury dwarfs many other health issues, yet attention to the problem is proportionally low. Effective injury prevention relies on injury surveillance – the collection, analysis, interpretation, and dissemination of data on injury and its social and environmental determinants. Injury surveillance has been widely implemented in many well-resourced settings, yet in most low- and middle-income countries and in low-resource settings within high-income countries, surveillance is poor or non-existent, meaning it is difficult to design effective prevention programs. Given the high-cost and complexity of many conventional surveillance activities, novel, easy-to-use, and affordable strategies must be developed to enable low-resource settings to engage in injury surveillance. The objective of this dissertation was to develop theoretical and methodological knowledge that could enable community-groups, health facilities, and other organizations to engage in injury surveillance activities, especially in settings with limited resources. In particular, this dissertation explores the role of geospatial technologies in all phases of surveillance – from data collection through to dissemination. The dissertation addresses this objective through both hospital- and community-based surveillance activities in two study sites, Cape Town, South Africa, and Vancouver, Canada. In South Africa, GeoWeb technologies and citizen-generated data approaches were used to enable injury surveillance at a low-resource hospital. In Vancouver, a method was designed and demonstrated to understand the relationship between road-user behaviours and pedestrian injury. This method was developed for community-based surveillance and prevention organizations, and was utilized by a local pedestrian safety project to understand a pedestrian injury problem in an impoverished Vancouver neighbourhood. Together, these investigations comprise an integrated project informed by and contributing to global health perspectives on injury. While research at each study site provided empirical evidence pertaining to the local injury burden, the main findings of this dissertation was the broader evidence that could be used to inform geographic injury surveillance in other low-resource settings, whether in high-, medium-, or low-income countries.