EXTERNAL CAUSES MORTALITY SURVEILLANCE SYSTEM IN COLOMBIA A

“EXTERNAL CAUSES MORTALITY SURVEILLANCE SYSTEM IN COLOMBIA: A Successful Model” Maria Isabel Gutiérrez. M. MD. , MSc. , Ph. D Rafael Espinosa del Vallin. MD. , MSc. Andrés Fandiño L. MD. Edgar Muñoz St.

Violence is the leading cause of death in Colombia 1 HOMICIDES BY CITY 2004 Total number of homicides: 20, 167 3. 000 2. 402 2. 500 1. 846 2. 000 1. 571 1. 500 1. 049 1. 000 500 900 768 730 462 315 380 436 373 581 541 232 0 Source: Central Judicial Police Directive Office Criminology Research Center 443 535 672 491 842 623 249 289 230 466 416 142 1. 517

2 Inadequate data for defining interventions Standardization and Validation of Primary Information Sources External Causes of Deaths Surveillance System Committee in Cali Number of cases 2500 2000 1500 1000 500 Forensic Medicine 0 . 1990 Police 1991 Public Prosecution office 1992 1993 Health Secretariat 1994 .

50 0 Ene-00 Feb-00 Mar-00 Abr-00 May-00 Jun-00 Jul-00 Ago-00 Sep-00 Oct-00 Nov-00 Dic-00 Ene-01 Feb-01 Mar-01 Abr-01 May-01 Jun-01 Jul-01 Ago-01 Sep-01 Oct-01 Nov-01 Dic-01 Ene-02 Feb-02 Mar-02 Abr-02 May-02 Jun-02 Jul-02 Ago-02 Sep-02 Oct-02 Nov-02 Dic-02 Ene-03 Feb-03 Mar-03 Abr-03 May-03 Jun-03 Jul-03 Ago-03 Sep-03 Oct-03 Nov -03 Dic-03 2 Inadequate data for defining interventions HOMICIDE TREND PER MONTH OF OCCURRENCE ACCORDING TO SOURCE 2000 -2003 Ibagué Casos 40 30 20 10 Forensic Medicine Surveillance System Source: Forensic Medicine and Police

Public Policies to Injury Prevention 3 Motorcyclist deaths by traffic injuries in Cali 1993 - 2004 200 Cases Motorcycle driver 179 helmet law 163 150 Reduction on enforcement personnel 142 145 135 112 110 Repeal of day time reflective vests Mandatory driving school after infraction National transit code 107 100 90 71 68 Motorcycle drivers and passengers helmet law 50 71 Reflective vest law Weekend motorcycle ban Years Source: Fatal injury surveillance system, Cali Prepared by Alvaro Sanchez O. CISALVA Institute- Universidad del Valle, Colombia. Anterior Siguiente 20 04 20 03 2 20 01 20 00 99 19 19 98 19 97 19 96 19 95 19 94 19 9 3 0

To develop an instrument that enables local and state governments to deal with causes of urban violence and criminality, as well as with intentional and unintentional injuries, making possible the design and implementation of effective public policies and programs aimed to contribute to safety and citizen coexistence.

Political will from governments and local authorities for using information about violence in decision making. Coordination of information source institutions (Police, Forensic Medicine, Public Prosecution Offfice, Public Health, others) contributing with data and integrating in interinstitutional operative and analysis committees Capacity Building and Follow-up with Local Developments (Software, information analysis, intervention strategies, strategy evaluations, Technological transfer, etc. ).

Police Others (Firemen) Police Inspectors OPERATIVE Traffic Secretariat COMMITTEE (GOVERNMENT - HEALTH) Public Prosecution Office (URI & CTI)* *Immediate Reaction Unit Forensic Medicine Health Secretariat Health Institutions (URI) & the Technical Investigation Body (CTI) Monthly meeting with primary information sources to validate and complete data

CRIME SURVEILLANCE SYSTEM DEPARTAMENT OF NARIÑO – MUNICIPALITY OF IPIALES GEORGETOWN UNIVERSITY – CISALVA INSTITUTE - UNIVERSIDAD DEL VALLE 1. MUNICIPALITY OF THE EVENT: HOMICIDIES FORM 3. DATE OF EVENTS 2. CODE: DAY MONTH 5. PLACE OF OCURRANCE 5. 1. ADDRESS 7. TYPE OF PLACE OF THE EVENTS 2. PUBLIC ROAD OR SPACE 1. HOME 3. FARM OR COUNTRYSIDE 4. BAR O RELATED FACILITY 5. RIVER / LAGOON (Monday, Tuesday, etc. ) ) 8. OTHER PLACE 9. UNKNOWN 10. NAME OF THE VICTIM 1. Male 2. Months 4. Unspecified 16. MUNICIPALITY OF RESIDENCE 20. TYPE OF WEAPON 1. Firearm 2. 3. 4. 5. Sharp object Firearm/sharp object Blunt object Strangling/Suffocating 6. Explosives 7. Other arm 8. Under study 99. NO DATA 11. LAST NAMES OF THE VICTIM 2. Female 13. AGE MEASURED IN : 1. Years 3. Days 6. PRISON 7. PLACE OF WORK 9. NUMBER OF FATAL VICTIMS IN THE SAME 12. SEX MILITARY TIME 5. 2. NEIGHBORHOOD – SMALL VILLAGE – SMALL TOWN 6. AREA OF EVENT 1 Urban zone 2 Rural zone 3 Rural town 8 DAY OF THE MONTH EVENT( 4. TIME OF EVENT YEAR 3. Unspecified 14. AGE 15. OCCUPATION 17. NEIGHBORHOOD OF RESIDENCE 18. TIPO DE DOCUMENTO DE IDENTIDAD 1. Cedula de Ciudadanía 5. Id card 2. Cedula de Extranjería 6. Adult without Id 3. Passport 7. Minor without id 4. Birth certificate 19. ID # 8. No data 21. CONTEXT OF ASSAULT 1. Unknown or to be established (the context is unknown) 2. War conflict (conflict with military forces and illegal armed groups) 3. Interpersonal violence (dispute) 4. Domestic violence (dispute between relatives; against women, minors, elderly; due to passion issues) 5. Organized crime (drug trafficking; by assassins; kidnapping; collection of debts, car jacking, motorcycle jacking, bank robberies; common robbery, social intolerance) 6. Confrontation with law enforcement (by official authorities) 7. Other type of violence (eg. a lost bullet) 22. SHORT NARRATION OF EVENTS (write down whether if it is a special day in the Municipality, the sector, or the neighborhood where the event occurred; if the victim presents involvement of alcohol use) Elaborated by the “Crime Surveillance” Project Technical Group

Systematization of information Statistical Analysis Geo-reference Bulletin production Epi data Epi Info Map Maker Homicides Suicides Traffic deaths Non-intentional deaths

MAYOR GOVERNOR Consulting room (Government, Health Traffic) POLICE COMMANDER ANALYSIS COMMITTEE DIRECTORS (Public Prosecution Office, CTI, Forensic med. ) OTHERS: (COUNCILS, LEADERS, ETC. ) Universities Decision making and strategy definitions for Violence and Non-intentional Deaths Prevention and Control

Homicides according to day of the week January - October 2004 25 Cases Crime Surveillance of Apartadó - Antioquia N = 62 20 34% 15 10 15% 5 11% 13% 8% 6% 0 MON TUE WED THU FRI Day of occurrence SAT Source: Crime Surveillance, Police, Technical Investigation Body (CTI), Forensic Medicine, Judicial Police and Investigation Section (SIJIN) SUN

Homicides according to time of occurrence January - October 2004 Crime Surveillance in Apartadó - Antioquia Casos N = 62 16 14 24% 23% 12 19% 10 8 6 10% 4 2 8% 8% 5% 3% Time of occurrence Source: Crime Surveillance, Police, Technical Investigation Body (CTI), Forensic Medicine, Judicial Police and Investigation Section (SIJIN) 03 : 0 005 : 59 9 00 : 0 0 - 02 : 5 59 21 : 0 023 : 59 020 : : 0 18 15 : 0 017 : 59 59 014 : 12 : 0 59 011 : : 0 09 06 : 0 008 : 59 0

Homicide according to day and time January - October 2. 004 Apartadó - Antioquia Cases 25 N = 62 18: 00 -23: 59 20 21 12: 00 -17: 59 06: 00 -11: 59 15 00: 00 -05: 59 Hora 9 10 7 8 8 5 5 4 0 MON TUE WED THU Source: Crime Surveillance, Police, Technical Investigation Body (CTI), Forensic Medicine, Judicial Police and Investigation Section (SIJIN) FRI SAT SUN

HOMICIDE DEATHS IN APARTADO JANUARY – OCTOBER 2004 URBAN ZONE MAP

Homicides according to sex and age groups Number of cases 25 Social Surveillance for Citizen Coexistence Ibagué Tolima 2003 N= 121 Women=7. 4% Men=92. 6% 21 20 17 15 11 10 5 0 3 0 -4 5 -9 10 -14 15 -19 20 -24 25 -29 30 -34 35 -39 40 -44 45 -49 50 -54 55 -59 60 -64 >65 Age groups Source: Inter-institutional Committee (Police, SIJIN, CTI, Forensic Medicine, Health, Government, Traffic) 41% of the cases represents youth between 15 – 29 years (50 cases) and an important percentage (39%) represents adults between 35 – 49 years (47 cases). under 14 years 3 cases were registered.

Characterization of homicides according to the comuna* of occurrence Social Surveillance for Citizen Coexistence Ibagué 2003 Number of cases 20 (17) N= 121 15 20% (12) 10 14% (5) 5 0 (4) (3) (4) 6% 1 5% 4% 3 4 5 (8) 8% 9% 5% 2 (7) (8) (4) (3) 5% 6 7 8 Comuna 10 8% (3) 4% 4% 9 9% (7) 11 12 13 unas are delimited regions in municipalities represented by neighborhoods grouped togeth Source: Inter-institutional Committee (Police, SIJIN, CTI, Forensic Medicine, Health, Government, Traffic)

TRAFFIC RELATED DEATHS ACCORDING TO TYPE OF ACCIDENT Social Surveillance for Citizen Coexistence January - December 2003 44% Pedestrian 33 8 22% Automobile driver 11% Motorcyclist driver 16% 12 Automobile passenger 5% 4 Motorcycle passenger Cyclist 3% 2 no data n= 75 5% 4 0 5 10 15 20 25 30 35 Cases Source: Inter-institutional Committee (Police, SIJIN, CTI, Forensic Medicine, Health, Government, Traffic) 40

TRAFFIC RELATED DEATHS ACCORDING TO CHARACTERISTIC OF THE VICTIM AND AGE January - December 2003 25 n=75 22 20 7% 14 15 7% 14% 10 86% 6 4 14% 25% 15 -19 Autom. Driver 26% 4 50% <14 0 8 21% 7 5 90% 50% 21% 20 -24 Autom. passenger 25% 38% 25 -29 30 -34 Motorcycle driver 35 -39 5 3 1 100% 33% 40 -44 45 -49 Mot. passenger 20% 40% 5% 50 -54 60 y más Pedestrian Cyclist No Data Source: Inter-institutional Committee (Police, SIJIN, CTI, Forensic Medicine, Health, Government, Traffic)

TRAFFIC DEATHS MUNICIPALITY OF IBAGUE

HOMICIDE DISTRIBUTIONS ACCORDING TO PLACE OF OCCURREN Departmental Crime Surveillance in Antioquia - 2004 100% n= 70 n= 49 n= 24 n= 20 80% N= 157 60% Other Place of work Bar/Related Farm/Countryside House Public road 40% 20% 0% APARTADO TURBO CHIGORODO CAREPA Source: Crime Surveillances of Apartadó, Chigorodó, Carepa, Turbo

HOMICIDE DISTRIBUTIONS ACCORDING TO TYPE OF WEAPON Departmental Crime Surveillance in Antioquia - 2004 100% n= 70 n= 49 n= 24 n= 20 80% N= 157 60% 40% OTHERS 20% EXPLOSIVES BLUNT SHARP OBJECT 0% FIREARM APARTADO TURBO CHIGORODO CAREPA Source: Crime Surveillances of Apartadó, Chigorodó, Carepa, Turbo

HOMICIDE DISTRIBUTIONS ACCORDING TO TYPE OF CONTEXT Crime Observatory for Departament of Antioquia - 2004 100% n= 70 n= 49 n= 24 n= 20 N= 157 80% 60% 40% Other Legal intervention Interpersonal v. Armed conflict Organized crime Unknown 20% 0% APARTADO TURBO CHIGORODO CAREPA Source: Crime Surveillances of Apartadó, Chigorodó, Carepa, Turbo An intra-family violence case in Turbo

es 2002 Total Homicides 2003 Total Homicides 2004 POPAYAN 174 89 97 Use of surveillance data (Security Council) Team work Police, CTI, Public Prosecution Office and the army Mobile brigade controls Firearm disarmament operations Motorcycle circulation control Public facility controls (alcohol sell and consumption) SANTANDE R DE 89 59 55 Use of the surveillance (Social Policy Councils) Mobile road control brigade Firearm disarmament operations Motorcycle circulation restriction Facility controls (alcohol sell and consumption) 208* 120* 70 Use of the Surveillance (Analysis committee) Joint work between Police, Public Prosecution Office, CTI and the army Mobile road brigade Firearm disarmament operations Motorcycle circulation restriction Facility controls (alcohol sell and Total Municipali Homicid ty QUILICHA O PITALITO Implemented policies and actions

Municipio POPAYAN SANTAND ER DE QUILICHA O Total Traffic 2002* Total Traffic 2003 Total Traffic 2004 60 44 42 21 27 19 Implemented policies and actions Use of information in security council “Black stars” campaign Control of helmet and reflective wear use by motorcyclists Special brigade controls in the city Education campaigns for drivers and pedestrians Drunkenness control Control of satellite terminals in urban zones Control to transport companies Road signaling Use of information in Social Policy Council “Black stars” campaign Control of helmet and reflective wear use by motorcyclists Special brigade controls in the city Education campaigns for drivers and pedestrians Special control measures to motorcycle drivers under age of majority Drunkenness control

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DOMESTIC VIOLENCE SURVEILLANCE IN LIBANO - TOLIMA DISTRIBUTION OF DV CASES PER AGE AND SEX GROUPS YEAR 2004 Number of cases 0 er t th O nm en an do Ab ry en ta im lo ho yc Ps 10 -1 15 4 -1 9 20 -2 4 25 -2 30 9 -3 4 35 -3 9 40 -4 4 45 -4 9 50 -5 4 55 -5 9 60 -6 4 >6 5 S/ D 59 04 al 1 31 30 10 20 20 13 Al 4 l 0 ys 0 1 57 18 rb 0 11 6 ca 6 9 61 40 Ph 10 68 50 16 9 68 Ve 20 119 75 gi 30 100 2827 al 32 ic 40 150 ec t N = 298 al 50 N = 298 162 eg l Men 29. 2% xu 56 56 200 N Women 70. 8% Se 70 60 DISTRIBUTION OF DV CASES ACCORDING TO TYPE OF MALTREATMENT YEAR 2004 Age groups Sources: FHN, Hospital, Colombian Institute for Family Welfare (ICBF), Legal Medicine, Police

DOMESTIC VIOLENCE IN LIBANO TOLIMA DISTRIBUTION OF DV CASES ACCORDING TO MONTH OF OCCURENCE Number of cases 120 100 N = 298 80 32 20 8 D at a er o B ro t tn ar he rs So n ne er r 7 Sp Ex -p pa rt he er r -fa th he ep St Jan Feb Mar Apr May Jun Jul Aug Set Oct Nov Dic Fa th 0 M ot er r 0 10 5 2 or 10 40 ot 14 se 21 19 ou 15 18 -m 20 66 56 60 ep 24 St 28 13 108 97 th N = 298 39 30 20 44 N 43 O 50 40 DISTRIBUTION OF DV CASES ACCORDING TO TYPE OF PERPETRATOR Sources: FHN, Hospital, Colombian Institute for Family Welfare (ICBF), Legal Medicine, Police

s. N ara njo s DV CASES IN LIBANO 2004 a. A lto Lo URBAN ZONE Cafetal n a Vda . San Jua Calle 13 Calle 12 a l 9 a Escuela Blanca Saenz Cra. 10 A a la Lago Cafetal ersa Los Pinos Carrera 12 SAN VICENTE Polk sv Tran Calle 10 a San Vicente Norte LOS PINOS Carrera 8 a PABLO SEXTO Carrera 10 a Calle 11 Carrera 11 Manuel Tiberio Gallego Calle 9 a Calle 8 a Carrera 9 a Carrera 13 Calle 7ª SAN JOSE ICBF Fany Hartman Caño Calle 8 a Taller y parqueadero OO. PP Calle 7ª Colegio Claret Escuela Gabriela Mistral EL ESTADIO Calle 6 a Cafetales Calle 1 B 2 E le 1 A Cal E A Guayabal Cra. C 1 alle 1 Escuela Marsella e 2 Est . 1 A ta 11 rsal nsve Quebrada San Juan Santa Helena 2 A 1 ABi Calle ra 1 S Cra. le Cal Cra o rre ur 1 D a. T Cementerio Ca Cra. ierr ad en tr pol ra . 1 A Bis . 1 B . 1 C Cra 1 E Diag 1 B Cra. 3 E. rre 1 E basto Ca ra A Se rre Ca 1 A 2 s Cra Verbal Cra. Internado Manuel Mejía lle Ca Calle Instituto Técnico Industrial Campo de futbol Bis 1 B lle Ca le 1 A C URB. LUIS FLOREZ 2 A Calle 1 S 1 B Cal 1 alle Cra. Carrera 7ª Psychological REYES UMAÑA LA LIBERTAD Carrera 7ª A a rad eb Qu Physical Ca 1 A MARSELLA Toros Calle 1 a 2 o Plaza Matadero Nuevo Carrera 5ª A er Piscina Futura Urbanización EL TRIUNFO EL CEDRAL lle Ca Unidad Deportiva Cra. qu Calle 1 A Carrera 3 os Cafetal Carrera 3 B Types of Maltreatments M l 2 na go Dia l 3 na go 1 C Dia Carrera 1 A JARAMILLO 20 DE JULIO Carrera 3 A El Cafetal lle Ca Instituto Deptal Nuestra Señora del Carmen Carrera 5 a Carrera 6 a Carrera 8 A Sa nta LAS ACASIAS Calle 2 a Tayrona Carrera 8 a Carrera 9 a Tra Carrera 2 a A Rosa Caño Calle 2 A ISS Escuela Polideportivo Alfonso Jaramillo Cll 1 C VILLA EMMA Sede Social Hospital EL CARMEN Carrera 4 a ra 14 Cafetal Carrera 7ª A Carre Sta. LAS BRISAS Ana Preescolar Eugenia Ravasco EL PALMAR da Hospital Regional de El Líbano Cafetales ebra Carrera 1 a Hotel Los Fundadores Calle 3 a Instituto Tolima Sub-Estación Eléctrica Qu Monumento s Avenida los Fundadore SAN ANTONIO Policia Heraclio Lastra C. a San a rmos llahe a Vi Carrera 2 a Notaria Liceo Calle 2 a Planta de tratamiento de agua Nuestra Señora de Lourdes COLOYITA Instrumentos Públicos Ancianato SANTA ROSA Matorral Iglesia Calle 4 A Carrera 10 a Dia go na l 3 a Piscina Villa Arango ño Carrera 3 a Sede Unisur da LAS FERIAS 12 br a Ca San Antonio Calle 5 a Carrera 6 a Plaza de Ferias Carrera 11 Calle 3 a Centro Universitario Carrera Instituto Isidro Parra Palacio Justicia Telecom Carrera 13 an ue Colegio Comercial Bomberos Parque Isidro Parra lar nva cu Almacafe Carrera 14 Ju Q Emser Cir Carrera 5 a EL CENTRO Calle 4 a Calle 3 a Granja Alsacia Líbano Parque Infantil Ca Carrera 7 a Casa de la Cultura Escuela Juan XXIII Sa n Calle 5 A lle Estadio Ariel Gonzalez Jesus Maria Villegas Carrera 15 Carrera 16 LAS FERIAS Calle 6 a Catedral de Ntra. Señora del Carmen Alcaldia Calle 5 a Piscina Status Cruz Roja brad Colegio Alicia Velez Diag. Que Carcel Caño Casa Episcopal PRIMERO DE MAYO Iglesia Divino Niño EL PORVENIR ño Ca PIZARRO L. GOMEZ 1 Sur VILLA ESPERANZA Granja la Unión Planta de gas a. M Alimentary uri llo Sexual Neglect Abandonment Other LAS AMERICAS Rosa ISIDRO PARRA a Cafetal anta AS LA POLCA RAMON Mº ARANA es Ter

DV SURVEILLANCE IN ESPINAL - TOLIMA DISTRIBUTION OFDV CASES ACCORDING TO TYPE OF PERPETRATOR DISTRIBUTION OF DV CASES PER AGE AND SEX GROUPS 2004 Perpetrator Cases Casos 42% MOTHER 25 Mujer 35% FATHER Hombre n=82 20 n=58 STEP-FATHER N=140 15 4% SPOUSE OR PARTNER SON 10 STEP-MOTHER EX PARTNER 5 N=179 BROTHERS 0 13% >6 5 64 0 20 40 60 - 59 54 55 - 50 - 49 44 45 - 39 40 - 34 35 - 29 30 - 25 - 24 19 20 - 14 15 - 5 -9 10 - 0 -4 OTHERS Cases Casos Age range – . Sources: ICBF and Family Police Station FUENTE: FAMILY POLICE STATION - ICBF 60 80

DV CASES IN ESPINAL 2004 LIN SEMINARIO CONCILIAR EA URBAN ZONE AR OC RR FE URBANIZACION RIL CARACOLI RDOT E ESPINAL GIRA VIA VARIANT UE AG A VI A IB U Q A AD R EB LA PI JA O Bodega BANCOLOMBIA 4 BAR RIO SAN RAF AEL Carre Parque ra 5 AL ON CI Colegio Fatima Carr era 9 Colegio TECNICO INDUSTRIAL Al o am Gu Plaza de Ferias Neglect URBANIZACION SANTA MARGARITA IO RR BA A 14 RTA era MA TIM FA Carr VIA Y CA NAL A CA Other QUEBRADA AGUA SUCIA 1 2 3 Calle 4 Calle 10 . ISAI AS OLIV AR era 11 Carr era 8 Plaza de Mercado A 1 o. de MAYO 6 Cal le 7 GOR la ITA era VILLA OLIMPICA B/IO Carr CABA LLER O Y GON GAR era 9 9 11 12 Calle 14 B/IO. IA . MAR Carr Calle 15 MAR STA era cue NA ola cac Co ega Bod al IO RR BA pin RIO Es Es BAR Calle ra 7 Carr 8 Calle 13 Calle 16 17 Calle Carre 18 21 Al Calle Colegio Carr era El Rosario 8 Calle 20 19 Calle r rtado Libe ela Escu Parque Alimentary Abandonment era Carr era 13 Calle GRACIAS Calle 22 Verbal 6 Carr CENTRO DOR era 5 Parque era 6 Catedral Car Colegio rera 7 LIBE Carr 7 Carr 5 RTA Fedearroz era 9 era VIA PUERTO PEÑON 6 Carr Escuela 10 Carr BAR RIO GRASCO era 8 Calle 12 3 Calle era C Parque arrera 4 Mitologico Molino Espinal Psychological Sexual ON Calle VI Calle 2 Carr IO ROND 14 AS 2 BARRIO BELEN Physical era Calle Types of Maltreatments Carr Calle 1 Oeste era Calle Carr 12 VIA HATO VIEJO North