Establishing Data Collection and Monitoring Systems in Africa, Latin America, and Eastern Europe
In collaboration with WHO, PAHO and other international partners, CDC has established emergency department injury surveillance systems in several countries. These systems track both fatal and nonfatal injuries, including unintentional, environmental, and work-related injuries, and those resulting from interpersonal and self-directed violence. Data from these systems are being used to help quantify the burden of injury seen in emergency departments, identify groups at risk for injury, and to inform the development of injury and violence prevention programs.  Next steps include the development of a resource that highlights best practices in injury surveillance.

Special Issue of Pan American Journal of Public Health on Injuries and Violence
In December 2008, La Revista Panamericana Salud Publica published a special issue on injuries and violence.  CDC contributed to this journal  highlighting  the development of emergency department injury surveillance systems in Colombia, El Salvador, and Nicaragua.  The article includes success stories and lessons learned from the various countries.  

Guidelines for Conducting Community Surveys on Injuries and Violence
CDC collaborated with WHO to develop the Guidelines for Conducting Community Surveys on Injuries and Violence. The Guidelines, published in 2004, provide a methodology for collecting robust, reproducible, and relatively easy-to-obtain injury data in the community.

Injury Surveillance Training Manual
CDC has developed the Injury Surveillance Training Manual.  The Manual is designed primarily for professionals who develop or operate injury surveillance systems and conduct prevention activities in less-resourced countries. It describes the steps needed to establish and maintain an injury surveillance system; provides information on designing and monitoring prevention activities; and offers guidance for making informed decisions about injury prevention. The curriculum emphasizes basic epidemiological skills needed to conduct surveillance and prevention activities; participation by different sectors and institutions in injury prevention efforts; and injury surveillance and prevention activities at the local level.  The manual and its related course has been taught in El Salvador and Nicaragua, Argentina, Brazil, Costa Rica, El Salvador, Honduras, Nicaragua, Peru, and a variety of other countries.  

Injury Surveillance Guidelines
CDC, WHO, and other partners published accepted standards for data collection in 2001, including the Injury Surveillance Guidelines [PDF 792 KB] and the International Classification for External Causes of Injuries.

Preventing Violence against Children
In 2007, CDC, in collaboration with the United Nations Children's Fund (UNICEF) office in Swaziland, conducted a national survey on violence against children with a focus on sexual violence against females between 13 and 24 years of age. The purpose of the survey was to assess the patterns of sexual and other forms of violence; identify potential risk and protective factors for sexual violence; and assess knowledge and use of health services available for female victims of violence in Swaziland. Findings from the survey are being used to identify further areas for research and to guide strategies to prevent sexual violence against children. Findings from the study are featured in the June 6, 2009 issue of The Lancet. More information about the study can also be found in the final report [PDF 380 KB].

Efforts are underway to implement similar surveys in other low- and middle-income countries, including Tanzania/Zanzibar and Kenya, focusing on the extent of violence against children, with an emphasis on sexual violence against girls and boys.  The results of this work will allow DVP and UNICEF to inform policy and program development in both countries on the prevention of violence against children. 

The Economic Dimensions of Interpersonal Violence
In 2004, CDC provided technical assistance and funding to WHO to publish a comprehensive literature review titled The Economic Dimensions of Interpersonal Violence [PDF 398 KB] [PDF 398 KB]. The report focuses on three themes:  the economic effects of interpersonal violence in a variety of socioeconomic and cultural settings; the economic effects of interventions intended to reduce interpersonal violence; and the effects of economic conditions and policies on interpersonal violence, with particular emphasis on poverty, structural adjustment, income inequality, and social investment.  Given the extensive gaps across many countries and the methodological differences in the existing literature, the report recommended the development of a standardized methodology for calculating the economic impact of violence.

The Cost of Interpersonal and Self-Directed Violence
In 2008, WHO and CDC jointly published The Manual for estimating the economic costs of injuries due to interpersonal and self-directed violence.  It provides guidance on how to measure: (1) direct medical costs arising from violence-related injuries and deaths, such as the costs of hospitalization, of outpatient visits and of transport to hospital; and (2) indirect costs, including productivity losses, arising because of violence-related injuries and deaths. The manual provides a framework for computing estimates of these costs, while taking into account the constraints, particularly data limitations, which may be confronted in low-resource settings.  The manual included pilot case studies in Brazil, Jamaica, and Thailand.  Cost Studies are currently being implemented in Kenya, Tanzania, and Uganda.

Developing National Policies to Prevent Violence and Injuries: a Guideline for Policy-Makers and Planners
In 2006, CDC provided technical assistance and funding to WHO to publish Developing National Policies to Prevent Violence and Injuries: a Guideline for Policy-Makers and Planners. This document provides the rationale for such policies; the importance of the health sector in their development; and the link between national policies and legislation. The Guideline presents a step-by-step process for developing national policies to prevent violence and injuries. Lessons learned from many countries are used throughout the document to highlight specific issues related to policy development.

Handbook for the Documentation of Interpersonal Violence Prevention Programs
CDC worked with WHO to develop the Handbook for the Documentation of Interpersonal Violence Prevention Programs [PDF 253 KB] . The Handbook, which documents proven and promising prevention strategies, was pilot tested in Brazil, India, Jamaica, Jordan, Macedonia, Mozambique, the Russian Federation, and South Africa. A database has been developed and narratives for violence prevention activities have been completed in seven of the eight countries. The final Handbook will include country summaries and an aggregate report. A screening tool to examine evidence-based programs and outcome evaluations will be created in the future. Documents will be developed to assist countries with limited experience in evaluation.

Preventing Child Maltreatment: A Guide to Taking Action and Generating Evidence
CDC provided technical assistance and funding to WHO to develop Preventing Child Maltreatment: a Guide to Taking Action and Generating Evidence [PDF 253 KB] , which was launched in October 2006. The Guide provides technical assistance around the development of policies and programs for child maltreatment prevention that uses a scientific, evidence-based approach and public health principles. It is currently being piloted in Brazil, Jordan, and the Philippines, where three-year, child maltreatment prevention project assessments are nearing completion.

CDC is providing specific technical assistance to Brazil in their pilot efforts.  “Primeira Infância Melhor” (PIM) is a home visitation program to promote health and child development and to prevent violence in Brazil. It is being implemented in over 200 municipalities in the State. During 2008-2009, much of the focus of the project has been on finalizing the content of a home visitation and centre-based parent training program for the prevention of child maltreatment by teenage mothers. Using funds from the Brazilian National Council for Scientific and Technical Development, the project team has completed a draft of the project evaluation methodology and evaluation instruments. CDC funding and technical assistance has been devoted to refining the program strategy and the content of training manuals for intervention staff.

Preventing Intimate Partner and Sexual Violence
WHO began to increase its prevention efforts in domestic violence following the publication of its multi-country study on the topic. With technical assistance and funding from CDC, WHO is developing a framework for preventing intimate partner and sexual violence, similar to that created for child maltreatment. The first consultation meeting with experts in the field was held in May 2007. Current plans include publishing the framework based on feedback from experts, introducing the framework at two regional workshops, and piloting three demonstration projects built around the framework.

Violence against Women: the Health Sector Responds
CDC participated in the evaluation of PAHO's Integrated Response to Intimate Partner Violence in Central America. PAHO published the findings in Violence against Women: the Health Sector Responds in 2003. The report included lessons learned from Belize, Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua, and Panama.

Violence Prevention Evidence Base
This database, developed by The Centre for Public Health at Liverpool John Moores University, provides access to abstracts from published studies that have measured the effectiveness of interventions to prevent violence. To be included in the database, studies must have measured the impact of interventions directly on violence. Studies have been selected through a systematic review of published academic literature. The abstracts can be searched by violence type, keywords, and geographical area of implementation.

Violence Prevention in Colombia
Through a partnership with the School of Public Health at the University of Antioquia, CDC provides technical assistance to the city of Medellin, Colombia and its 10 surrounding municipalities in the selection, development, and evaluation of evidence-based strategies for the prevention of violence against children ages 3-11.

Inter-American Coalition for the Prevention of Violence
As a member of the Inter-American Coalition for the Prevention of Violence, CDC is working to reduce violence in the Americas by developing and monitoring key indicators; conducting seminars and workshops; offering technical assistance in the design, implementation, and evaluation of programs; and by providing information to policy-makers.

Institute of Medicine Meeting
In June 2007, CDC played a key role in the Institute of Medicine's Workshop on Violence Prevention in Low- and Middle-Income Countries. The purpose of this workshop was to build the public health and business case for greater investment by U.S. agencies and foundations in violence prevention in such countries.

Mentor VIP
WHO, with technical assistance and funding from CDC, established  a Global Mentoring Program (Mentoring VIP) to facilitate skill development in injury and violence prevention research and programming. This mentoring program will be implemented in a low-cost, electronic format. The 12-month program began in September 2007, with a two-year pilot phase. In the first year, 15 mentor-student pairs were recruited, and each mentor-student pair developed a work plan and a communication plan.  Next steps include increasing the dissemination and uptake of this program, and greater collaboration with other capacity-building programs.

TEACH-VIP
WHO, with technical and financial assistance from CDC, developed TEACH-VIP, a training course on injury and violence prevention. The course is taught in 63 countries and is available electronically worldwide. It has been translated into Spanish and Portuguese and will soon be translated into Arabic, Mandarin, Russian, and French. WHO is updating TEACH-VIP with additional lessons on disability and rehabilitation, injury policy, and advocacy.  In addition, WHO and the Education Development Center (EDC) are currently developing a web-based version of the training that include the injury-specific lessons on disability and rehabilitation, injury policy, and advocacy.

World Report on Violence and Health
CDC staff served as editors of the World Report on Violence and Health. The Report is the first comprehensive review of violence on a global scale and shows that a science-based public health approach focused on prevention can contribute to reducing violence. It encourages governments to develop and implement a national plan of action for violence prevention; to enhance data collection and research capacity; to promote primary prevention responses; and to strengthen emergency response systems and services for victims of violence. Through the work of WHO, more than 50 countries had national launches of the Report and more than 25 countries have developed plans of action for violence prevention based on its recommendations.

Violence Prevention Alliance
CDC is a core partner in the Violence Prevention Alliance — a network of WHO member states, governments, nongovernmental and community-based organizations, private, international, and intergovernmental agencies working to prevent violence. The Alliance works to develop policies, programs, and tools to implement the recommendations of the World Report on Violence and Health in communities, regions, and countries around the world.  The core members of the Alliance recently developed a searchable online database of evidence-based programs.  This tool provides access to abstracts from published studies that have measured the effectiveness of interventions to prevent violence. To be included in the database, studies must have measured the impact of interventions directly on violence.  

Global Campaign for Violence Prevention: Milestone Meetings
The Global Campaign for Violence Prevention was launched after the release of the World Report on Violence and Health in 2002. The objectives of the campaign are to raise awareness about the problem of violence; highlight the crucial role that public health can play in addressing its causes and consequences; and encourage action at every level of society. Every other year, WHO, with financial and technical assistance from CDC, organizes Milestone Meetings that allow countries to showcase how they have implemented recommendations from the Report. The third meeting held in 2007 served as a platform for discussing scaled-up, country-level implementation and efforts to measure effectiveness, such as looking at rates for violence-related deaths, nonfatal injuries, and other violence-related health conditions over time.

Violence Prevention Atlas of WHO-related Activities
CDC is supporting the development of the Violence Prevention Atlas of WHO-Related Activities. This Atlas will allow countries to discover the violence-related activities of others. In addition, it will keep WHO abreast of violence prevention activities and of the best strategies for using limited resources.