Document Type : Original Article

Authors

• Gayan Surendra ¹
• Irosha Perera ²
• Sumith Attanayake ³

¹ Office of Deputy Director, National Dental Hospital (Teaching) Sri Lanka, Colombo

² Preventive Oral Health Unit, National Dental Hospital (Teaching) Sri Lanka, Colombo

³ Office of Deputy Director General of Dental Services, Ministry of Health, Sri Lanka, Colombo

Abstract

Background: Oral and Maxillofacial (OMF) injuries constitute a multifaceted public health threat in Sri Lanka. Surveillance of OMF injuries has become crucial for planning and monitoring of preventive and control strategies. A pilot project was undertaken aiming at strengthening the OMF injury surveillance system at National Dental Hospital (Teaching) Sri Lanka (NDHTSL).
Methods: The current interventional study with pre- and post-evaluation was conducted from March 1, 2020 to May 31, 2020 at NDHTSL. Pre-intervention assessment was performed to identify the deficiencies in the injury surveillance system. Subsequently, a novel OMF injury surveillance system was introduced and implemented at NDHTSL. The interventions were conducted over a period of 3 months, following which a post-intervention assessment was performed to assess the success of the interventions.
Results: The previous injury surveillance system had many deficiencies, such as lack of comprehensiveness, not specific to dental trauma, lack of data flow and high respondent burden, etc. Interventions included development of a novel OMF injury surveillance form, circulating comprehensive guidelines on the new system and awareness program for relevant staff. Quality indicators of injury surveillance demonstrated improvements from pre-intervention stage to post-intervention stage, such as coverage from 2.7% to 72.2%, completeness from 95% to 100%, and accuracy from 66% to 100%. The perceptions and satisfaction of the dental surgeons on OMF injury surveillance system was significantly improved by the intervention (p≤0.001).
Conclusion:  The strengthened OMF injury surveillance system was deemed efficient and effective. Further studies are warranted at different service levels prior to island wide expansion of the present system by incorporation and integration of it into the existing National Injury Surveillance System.
Introduction
 
Oral and Maxillofacial (OMF) injuries constitute a multifaceted public health threat in Sri Lanka. The  victims of this tragedy are more often children, adolescents and young males who are in economically productive age group (1–3). Hence, OMF injuries impact the economic productivity of the country while increasing the public health expenditure. Furthermore, road traffic accidents are on the rise which result in an enormous burden of OMF injuries (3–6).
“Oral and Maxillofacial injuries” is a composite term which includes injury to the oral and facial region, teeth and related structures (7); prevalence, causes and factors related to OMF injuries across the globe have been described by many published researches (8–11).
Surveillance is defined as ongoing systematic collection, analysis, interpretation and dissemination of health-related data for evidence-based decision making (12–14). Injuries are acute non-communicable diseases which should be prevented and controlled, based on the surveillance data (15). Therefore, developing the capacity of global injury systems has attracted attention as one of the most significant opportunities in global public health (16). Hence, a strengthened OMF injury surveillance system would be a prerequisite for the development of policies, strategies, guidelines as well as for expedition of the current OMF injury prevention activities (17).
Injuries are the leading cause of hospitalization over the last two decades, accounting for about 1 million hospitalizations each year which underpins the importance of a complete, accurate and timely injury surveillance system (17). Furthermore, a study published in 2004 revealed that OMF trauma was the leading cause of  dental inpatient service utilization (18).
Dental trauma is the most common cause of  dental emergencies (19). Moreover, dental trauma is recognized as a major dental public health problem across the globe which requires regular updates of knowledge in dental traumatology for preventive and control measures (20). One of the important prerequisites for development and evaluation of such prevention strategies at local level would be the establishment of a specially designed injury surveillance system which provides  accurate, complete, and timely data (21). However, lack of timely, complete and accurate data on OMF injury surveillance has become a global issue that hampers timely action and research (22). Surveillance systems for Oral and Maxillofacial Injuries have been designed by other countries with some strengths. A study conducted in Victoria, Australia, emphasized that oro-dental trauma data can be combined with injury surveillance data that are routinely collected to improve service planning and the design of oro-dental injury prevention interventions (23). Even though epidemiological data are required for service planning related to dental and oral trauma, it is evident that epidemiological data are limited and have deficiencies in coverage, comprehensiveness, and timeliness in the field of oral and dental injuries (15).
The present injury surveillance system at NDHTSL is not efficient and the collected data are not being analyzed and utilized for decision making and planning at the central level. Therefore, health staff is demotivated and does not participate in the surveillance system (24). Moreover, the current injury surveillance system is not comprehensive with regard to collection of data pertaining to OMF injuries which could be considered as a huge deficiency in this system. Against this backdrop, a strengthened OMF injury surveillance system consisting of complete, accurate, and timely collection, analysis, interpretation, dissemination, and utilization of data for decision making has become a timely need.
NDHTSL is the premier tertiary care public dental hospital in the country where patients with OMF injuries are admitted, referred, and managed, with the mission to be the center of excellence in patient centered care, education, research, and innovation. However, all such endeavors should be evidence-based for optimal outcomes. Therefore, this project aims to strengthen the OMF injury surveillance system at NDHTSL by addressing aforementioned weaknesses of injury surveillance systems.

Keywords

• Epidemiology
• Wounds and injuries
• Public health surveillance
• Oral health
• Hospital information systems