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Research Report

The Value of Hospital Data: Understanding and Preventing Intentional Injury in Liberia

Lucie Collinson
Andrew Winnington
Mary Vriniotis
Copyright Date: Jan. 1, 2016
Published by: Small Arms Survey
Pages: 84

Table of Contents

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  1. (pp. 1-6)
  2. (pp. 7-7)
  3. (pp. 11-11)
  4. (pp. 12-13)
  5. (pp. 14-14)
  6. (pp. 15-16)

    Studying the evidence related to the burden of injury of a population is a critical component of developing strategies to prevent and reduce violence. In many countries around the world, national observatories have been established to collect data to measure and monitor armed violence in an effort to inform and strengthen evidence-based armed violence reduction initiatives. These observatories collect data on violent incidents to enhance awareness of the extent and distribution of armed violence in varying geographic and socio-economic settings. An observatory’s ability to inform effective violence prevention strategies depends in large part on the efficient collection and timely sharing...

  7. (pp. 17-19)

    From December 1989 to August 2003, Liberia’s civil conflict claimed a total of 150,000–250,000 lives and displaced nearly one and a half million people (AOAV, n.d.). The conflict left the country in economic ruin and with high availability of weapons (BBC, 2015). The Accra Peace Agreement, signed in 2003, marked the end of hostilities; thereafter, a transitional government made up of the Economic Community of West African States and the United Nations Mission in Liberia steered the country towards elections in 2005. The disarmament, demobilization, rehabilitation, and reintegration programme initiated in 2004 officially disarmed more than 100,000 people (ACCD...

  8. (pp. 20-20)

    Armed violence is a preventable cause of widespread injury and suffering and thus a fundamental public health issue, one recognized by the World Health Organization (WHO) as a leading worldwide public health problem whose prevention requires a multi-sectoral approach (WHO, 2007).

    Armed violence has devastating effects on health, security, and sustainable social and economic development. The WHO’s publication Small Arms and Global Health assesses its impact on families, communities, and societies, including in terms of long-term physical and mental disabilities, the disruption of livelihoods and education, and the erosion of social networks within communities (WHO, 2001).

    The World Health Assembly—...

  9. (pp. 21-22)

    Established in March 2011, the independent Liberian Armed Violence Observatory informs 25 government and non-government stakeholders in Liberia, including the Ministry of Health and Social Welfare (see Table 1). It collects and analyses data to generate reports on armed violence in the country, which it distributes to the stakeholders and makes publicly available online. To date, LAVO has produced two reports on armed violence in Liberia, in December 2011 and July 2012 (AOAV, n.d.). The British non-governmental organization Action on Armed Violence (previously known as Landmine Action), which is based in Monrovia, administered the establishment of LAVO.

    The Observatory works...

  10. (pp. 23-25)

    Research conducted for this Working Paper indicates that LAVO is not receiving all of the available hospital injury data. This section considers not only the benefits of and challenges inherent in gathering such hospital data, but also their implications for LAVO’s ability to collate and provide comprehensive assessments.

    International evidence reveals inconsistencies between assault-related injury data from emergency departments and from the police (Sutherland, Sivarajasingam, and Shepherd, 2002). For example, a study conducted in Wales finds that 65.6 per cent of assault-related injuries during a six-month period were recorded only by emergency departments, whereas 23.6 per cent were recorded only...

  11. (pp. 26-27)

    In order to quantify the levels of violent injuries presenting to hospitals in Liberia, the authors conducted a retrospective audit of records from the two major hospitals that supply data to LAVO: Redemption and St. Joseph’s. The hospitals maintain a range of patient records, including attendance registers, admissions registers, patient files, and monthly attendance records (see Glossary). Neither hospital systematically records the causes of injuries, thus limiting the availability of data for collection (Dziewanski, 2011).

    The quality and comprehensiveness of the different hospital records varies dramatically. Because different hospitals employ different types of records, at times different names are used...

  12. (pp. 28-30)

    Redemption is located in the borough of New Kru Town and is the second-largest public hospital in Monrovia, with a capacity of 85 beds and providing 24-hour care for hundreds of patients on a daily basis (Johnson, 2012). It has both adult and paediatric wards, including neonatal care, obstetrics, and gynaecology. As the largest free hospital in Monrovia, Redemption has taken on roles as the city’s safety net and a source for health education (see Photos 1A–C). It is the second-largest referral hospital in the country, after the John F. Kennedy Memorial Medical Centre. Redemption offers free health care...

  13. (pp. 31-34)

    The authors conducted retrospective audits of ED records, attendance registers, and inpatient records for injured patients at Redemption and St. Joseph’s. An initial audit was conducted at Redemption from 12 to 24 September 2011, and a further audit took place at both hospitals from 10 to 22 August 2012.

    In view of the incomplete nature of hospital medical records, the authors randomly selected and reviewed Redemption records dating from 2004 to 2012 and St. Joseph’s records dating from 2011 to 2012. Individual records were audited for trauma and injury-related entries, regardless of whether these were intentional or non-intentional. At St....

  14. (pp. 35-45)

    All reviewed data sources indicate that the majority of injuries presenting to Redemption were non-transport-related: 78.9 per cent according to the ED attendance registers for the period 2003–06 and 65.8 per cent based on the ED attendance registers for the period 2009–12 (see Table 2), and 71.7 per cent as indicated by the patient files and 55.2 per cent as per the ED attendance registers for the period 2011–12 (see Table 3). Of all the non-transport-related injuries, more than half (52.3 per cent) were documented as interpersonal injuries in the patient files from 2011–12, compared to...

  15. (pp. 46-52)

    At St. Joseph’s, patient files provide the most comprehensive information on each injury case, supplying more details than both ED attendance notes and admissions registers on all variables besides treatment (see Table 11). However, monthly summaries from the ED notes are the primary source of information currently provided to LAVO by St. Joseph’s, which means that the Observatory is not capturing key data that stakeholders need to make informed decisions on violence prevention strategies.

    As Table 12 shows, patient files provide more information on weapons use in interpersonal injuries than the other two data sources. While patient files (n=11) document...

  16. (pp. 53-54)

    The majority of injuries presenting to both Redemption and St. Joseph’s were non-transport-related (see Figure 3). Interpersonal injuries made up more than half of non-transport-related injuries at Redemption (see Figure 4), while lacerations and unspecified trauma accounted for most of the interpersonal injuries at both hospitals (see Figure 5)....

  17. (pp. 55-61)

    The Liberian National Police was the biggest data provider to LAVO for the period July 2011 to June 2012, supplying 70.6 per cent of all data (see Table 18).

    At the time of writing, Redemption was providing LAVO with injury data from its ED attendance registers, but not from its patient files. Table 19 compares the register-based data received by LAVO with the audit data drawn from patient files from 2011–12, highlighting demographic details of intentionally injured patients who attended Redemption and the types of weapons used to inflict their injuries.

    The Redemption audit shows that other puncture wounds...

  18. (pp. 62-65)

    LAVO receives data on interpersonal injuries drawn from the ED attendance notes at St. Joseph’s. The audit conducted for this study, which was based on data in the same attendance notes, picked up 32 interpersonal injuries than were registered by LAVO during the period 10 June–27 October 2011; of these injuries, for 31 records, no information was provided on whether a weapon was used (see Table 21). Details on the perpetrator were not recorded in any of LAVO’s data from St. Joseph’s, whereas they were provided in 10.8 per cent of the audit data.

    Moreover, as Table 21 shows,...

  19. (pp. 66-68)

    As discussed above, the analysis of audit data drawn from Redemption and St. Joseph’s, as compared to LAVO data provided by the same hospitals and other sources, including media reports and police records, reveals considerable variations—in terms of both the quantity and the quality of the data. Significantly, the study shows that LAVO is not receiving all the available hospital data on injuries from armed violence in Liberia. As a result, LAVO is limited in its ability to produce comprehensive reports to inform policy-making.

    One of the reasons why LAVO is missing data on a large number of interpersonal...

  20. (pp. 69-74)

    While stressing the need for systematized record-keeping practices in hospitals, this Working Paper calls attention to the value of quality hospital data on interpersonal injuries in the context of informing and designing violence reduction policies and interventions. Given that the LAVO injury surveillance model is likely to be replicated in other West African countries, enhancing the flow of quality data from hospitals to LAVO can also be expected to maximize the effectiveness of future observatories in the region. In that sense, this study—and the following points—can serve to support not only the Liberian government in meeting international obligations...

  21. (pp. 75-80)
  22. (pp. 81-81)
  23. (pp. 82-84)