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162 Implementation of a mortuary-based fatal injury surveillance(FIS) system in rural and Urban Hospitals in Tanzania (2010–2015)
  1. Ahmed Makata1,
  2. Ruge Manyere1,
  3. Charles Massambu2,
  4. Amos Mwakigonja3,
  5. Kidist Bartolomeous4
  1. 1Police Forensic Bureau, Tanzania
  2. 2MoHSW,Tanzania
  3. 3Muhimbili University of Health and Allied Science, Tanzania
  4. 4World Health Organisation, Geneva

Abstract

Background Tanzanian law states that all injury deaths should undergo a postmortem medical examination. In absence of effective vital registration (VR) systems, mortuaries provide an alternative source of cause of death information to support injury prevention policies and programs. In 2010, a mortuary-based fatal injury surveillance system was established at selected mortuaries and a pilot study commenced with financial and technical support from WHO.

Methods A data collection form was developed using the WHO/Monash Fatal Injury Surveillance in Mortuaries and Hospitals Manual and was implemented in 4 mortuaries (3 urban, 1 rural). Training for project staff, ongoing technical support and monitoring was provided by WHO. The project was led by Forensic Pathologists. Data collection started in 2010, with initial piloting (2010–2011) and implementation after the publication of the manual (2013-present). In 2015, an evaluation was conducted comparing data from the mortuary with data from traffic police, hospital mortality records and with national VR registry.

Results In the initial pilot phase (2010–2011) a total of 112 cases were recorded in the 4 mortuaries. Based on the result of the piloting, the system was revised. Formal implementation started in 2013. By June 2015, a total of 2666 cases were recorded. About two-thirds were from unintentional causes, majority being due to road traffic injuries (RTI). Of the remaining, 6% were due to suicide, 15% from assault. Most of the RTI victims were passengers, motorcyclists and pedestrians. Males were over represented in all causes. Most of the deceased were 18–29 years old. Suffocation/hanging was the main mechanism of injury for suicide cases. While guns and blunt objects were the weapons involved for majority of the homicide deaths. There is a high under reporting of RTI deaths in police and VR systems. With recognition of its limitations, the FIS data from the mortuary is being used to support local injury prevention efforts.

Conclusions Compared to other sources, such as police and VR systems, mortuaries are a better surveillance data source for injury deaths, particularly for RTI deaths. In low-mid income countries, it is feasible to implement a standardised fatal injury data collection process at both rural and urban mortuaries. Local ownership of the system is key for sustainability.

  • Surveillance
  • Fatal Injury
  • Mortuary practice
  • Tanzania

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