title: Mortuary based injury surveillance for low-mid income countries: process evaluation of pilot studies.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Melbourne, Victoria, Australia. Electronic address: chebi.kipsaina@monash.edu.
authors.forename: Chebiwot
authors.initials: C
authors.lastname: Kipsaina
authors.affiliation: Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Melbourne, Victoria, Australia.
authors.forename: Joan
authors.initials: J
authors.lastname: Ozanne-Smith
authors.affiliation: Department for Management of Non-communicable Diseases, Disability, Violence and Injury Prevention, World Health Organization Geneva, Switzerland.
authors.forename: Kidist
authors.initials: K
authors.lastname: Bartolomeos
authors.affiliation: Department of Forensic Medicine, Monash University, 65 Kavanagh Street, Southbank, Melbourne, Victoria, Australia.
authors.forename: Virginia
authors.initials: V
authors.lastname: Routley
mesh_terms: D000056:Accident Prevention / Q000191:economics / Q000379:methods*; D002423:Cause of Death; D003625:Data Collection; D003906:Developing Countries; D004534:Egypt / Q000453:epidemiology; D006801:Humans; D007194:India / Q000453:epidemiology; D009027:Mortuary Practice / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011159:Population Surveillance / Q000379:methods*; D012307:Risk Factors; D013188:Sri Lanka / Q000453:epidemiology; D013636:Tanzania / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000517:prevention & control*
keywords: Evaluation; Fatal injury; Injury prevention; Low-mid income countries; Mortality; Mortuary; Surveillance