Open Access Protocol BMJ Open: first published as 10.1136/bmjopen-2017-016485 on 22 December 2017. Downloaded from Rationale and design of the violence, injury and trauma observatory (VITO): the Cape Town VITO pilot studies protocol Ardil Jabar,1 Tolu Oni,1 Mark E Engel,2 Nemanja Cvetkovic,3 Richard Matzopoulos1 To cite: Jabar A, Oni T, ABSTRACT Engel ME, et al. Rationale Strengths and limitations of this study and design of the violence, INTRODUCTION injury and trauma observatory The establishment of violence and injury observatories ► The observatories model is an internationally (VITO): the Cape Town VITO pilot elsewhere has been found to reduce the burden within accepted tool that can provide a focused studies protocol. BMJ Open a relatively short period. Currently no integrated system understanding of a particular issue or subtheme of 2017;7:e016485. doi:10.1136/ exists in South Africa to provide collated data on violence, violence. bmjopen-2017-016485 to allow for targeted interventions and routine monitoring ► The integration of violence and injury data may ► Prepublication history for and evaluation.This research seeks to identify if bringing allow a comprehensive view of the existing burden this paper is available online. multiple data sources, including but not limited to data of violence and injury within a community. To view these files please visit from the South African Police Service (SAPS), Forensic ► A potential limitation of certain datasets, for example, the journal online (http:// dx. doi. Pathology Services (FPS), Emergency Medical Services Health Systems Trust (HST), are their periodical org/ 10. 1136/ bmjopen- 2017- (EMS) and local hospital clinical databases, together are (1) survey collection, that is, biannual, not continuous, 016485). feasible; (2) able to generate data for action, that is valid, collection and the financial sustainability of these reliable and robust and (3) able to lead to interventions. rapid assessments beyond 2015. Received 23 February 2017 Concerning prospective surveillance, given the Revised 21 July 2017 METHODS AND ANALYSIS ► financial constraints facing many research bodies, Accepted 18 August 2017 The violence, injury and trauma observatory (VITO) is a it is conceivable that survey-based research will be planned collaborative, multicentre study of clinical, police limited and not sustainable in the long term. and forensic data for violence and injury in the City of Cape Town, where a local context exists of access to multiple source of health and non-health data. The VITO will http://bmjopen.bmj.com/ province’s largest city and home to almost initially be piloted in Khayelitsha, a periurban community characterised by increased rates of violence, where fatal two-thirds of the provincial population, the and non-fatal injury data will be sourced from within the highest homicide counts for the reporting community for the period 2012–2015 and subjected to period April 2015–April 2016 were recorded descriptive statistics and time-trend analyses. Analysed in the relatively impoverished subdistricts data will be visualised using story maps, data clocks, web of Nyanga (279 homicides) and Khayelitsha maps and other geographical information systems-related (161 homicides).1 products. Since 1994, efforts to improve cause of death on September 30, 2021 by guest. Protected copyright. ETHICS AND DISSEMINATION statistics in South Africa have been under way This study has been approved by the University of and have resulted in better coverage of death 2 Cape Town’s Human Research Ethics Committee (HREC registration. The Initial Burden of Disease 861/2016). We intend to disseminate our findings among Study that applied the burden of disease stakeholders within the local government safety cluster, 1Faculty of Health Sciences, approach developed by WHO, used available non-governmental organisations working within the School of Public Health and information, presenting it in a format that Family Medicine, University of violence prevention sector and the afflicted communities is relevant for planning health and other Cape Town, Cape Town, South through the SAPS and violence prevention through urban services.3 The District Health Information upgrading community forums. Findings from this work will Africa System has been employed in Kwa-Zulu Natal 2Department of Medicine, serve to identify important issues and trends, influence to track the hospital burden of trauma, with Faculty of Health Sciences, public policy and develop evidence-based interventions. University of Cape Town, Cape indicators collected governed by the District Town, South Africa Health Management Information Systems 3IT Business Intelligence & policy.4 A series of studies were undertaken in Systems Analyst, London, UK INTRODUCTIon KZN in 2010 to determine the trauma burden Correspondence to Homicide rates in the Western Cape were in KZN which has provided valuable estimates Dr Ardil Jabar; greater than the national average for of the burden of violence-related injury for a. jabaroo@ gmail. com both men and women. In Cape Town, the the province.5–7 Jabar A, et al. BMJ Open 2017;7:e016485. doi:10.1136/bmjopen-2017-016485 1 Open Access BMJ Open: first published as 10.1136/bmjopen-2017-016485 on 22 December 2017. Downloaded from While accurate and reliable reporting systems form a historical database.10 Textual information, databases, the foundation of a surveillance system, the observa- historical trends in data and indicators, profiles, reports tory model goes a step further in emphasising the colla- and other sources may convert the observatory into tion and integration of multiple different data sources, a powerful information and knowledge management including but not limited to the South African Police centre.10 Services (SAPS) crime data; forensic data from the Forensic Pathology Services (FPS) and violence-related Observatory function 2: data analysis injury data from the Emergency Medical Services (EMS), A range of multisectoral, multidisciplinary sources of to allow for a comprehensive picture of the burden of information may be analysed, using quantitative and violence-related injury. qualitative analysis methods for the purposes of (1) iden- This has been demonstrated by data sharing in the tifying patterns and trends over time in the incidence of UK between hospital emergency departments sharing violence, (2) monitoring and evaluating interventions information about violence locations, weapons and times and policies, (3) understanding the causes and determi- with local Police services, which has come to be known nants of violence and (4) developing a set of common as the Cardiff model. The Cardiff model, which is consis- indicators and standardised definitions.11 tent with the data sharing principles of violence and injury observatories among stakeholders, has reported Observatory function 3: reporting on and disseminating decreases of up to 40% in hospital admissions in Cardiff, information and knowledge where the approach was developed, compared with The objectives of the dissemination of information are to control cities.8 The data sharing has revealed ‘invisible’ (1) inform stakeholders of important issues and trends, (2) crime hotspots and gang crime activity and the targeting influence public policy, (3) develop evidence-based inter- of these hotspots at the right times has improved police ventions and policy recommendations and (4) assist collab- intelligence and the allocation of resources.8 orating agencies and other stakeholders to improve their The section below describes in detail the observatory operations and understanding of the issue through provi- 12 model and the specific value, it provides with regards to sion of an up-to-date, reliable evidence base. the reduction of violence-related injury. Rationale Observatories for violence and injury In a WHO report, injury was placed in the top 10 leading Observatories help in decision-making based on the causes of mortality worldwide, with the majority of deaths 13 principle that a better knowledge of situations affecting attributed to road injury and violence-related injury. security will make it possible to ensure more targeted Prevalence and incidence data on violence-related injury and thus more effective interventions. Although a diag- from African countries, including South Africa, are lacking when compared with industrialised nations.1 nostic tool measuring the degree of violence in a defined http://bmjopen.bmj.com/ region, over time an observatory also makes it possible to The Cape Town violence, injury and trauma observa- monitor and evaluate the impact of measures adopted. tory (VITO) study is a collaborative study that aims to The model relies on collaboration between data stake- establish the first violence and injury non-conflict registry holders, government and non-government actors within in Africa, with one of its main objectives being to collect the violence prevention and safety cluster. comprehensive clinical, police and forensic data for The observatory seeks to collate and integrate all violence and injury in the City of Cape Town. The Cape violence and injury-related data and not limit itself to Town VITO will serve as a platform for further investiga- tions including the analysis of the current context and a clinical perspective, but rather incorporates a public on September 30, 2021 by guest. Protected copyright. health approach which considers a broader contex- the evaluation of violence prevention interventions for tual understanding