Haddon Matrix

Presented by
Dr Sasmita Bisoyi
 Contents
• Introduction
• Public health approach to injury prevention
• Steps of Haddon matrix
• Modified Haddon matrix
• Three dimensional Haddon matrix
• Case study
• Summary

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 Introduction
• The Haddon Matrix was developed by William Haddon in
1970.

• It was originally derived to reduce morbidity and mortality

from injuries.

• It took into account the epidemiological triad and also

incorporated a time dimension.

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• The time dimension was divided into three intervals
– Pre-event
– event
– post-event.

• This gave rise to a 3 × 3 table, with time on the left side of the
table and the agent–host–environment triad across the top of
the table.

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• The “environment” part of the Haddon Matrix was
subsequently expanded into
– physical environment
– social environment

• The Haddon Matrix is a useful tool for brainstorming a broad

list of risk factors - and opportunities for intervention - for any
injury issue.


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Fig-1:The epidemiological triangle applied to
injury

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Public health approach to injury prevention

2) Risk factor
1) Surveillance identification
What is the What are the
problem? causes?

4) Implementation 3) Develop and

evaluate
How is it done? interventions
What works?

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 Four interrelated steps of public health
approach

• What is the problem?

• What are the causes?

• What works?

• How is it done?

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 What is the problem?
Determine the

• magnitude,

• scope and

• Characteristics of the problem.

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 What are the causes?

• Identify factors that increase the risk of disease,

injury or disability.

• Determine factors that are potentially modifiable.

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 What works?

• Assess measures that can be taken to prevent the

problem

• Pilot test and

• evaluate interventions.

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 How is it done?

• Implement proven and effective interventions.

• Evaluate effectiveness of interventions.

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• The goal is to fill in the 12 empty boxes where the two
elements intersect with a risk factor or potential intervention
strategy.

• Then we can see that there are multiple points one could
intervene in preventing (pre-event) or reducing (event or post)
injuries from a injury event.

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 Steps in Using the Haddon Matrix
• Use community data to determine injury problem that requires
an intervention.

• Assess the contributing factors or characteristics from the

perspective of:
1. Host or Human Factors
2. Agent of Energy or Vehicle
3. Physical Environment
4. Social Environment

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• Combine with time phases

1. Pre-Event: What factors affect the host before the event

occurs?
2. Event: What are Factors related to the crash phase?
3. Post-Event: What are Factors related to the Post-Event Crash
Phase?

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• By identifying interventions that fit within each cell of the
matrix one can generate a list of strategies for addressing a
variety of injury or other public health problems.

• Interventions that address multiple levels and/or different

boxes of the Haddon’s matrix are most effective for injury
prevention.

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• A road traffic collision is the outcome of the interaction among
a number of factors, some of which may not appear to be
directly related to road traffic injuries.

• The Haddon matrix helps to identify human, vehicle and

environmental factors during pre-, crash- and post-crash
phases.

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 Influencing exposure Influencing crash
to risk involvement
(Rapid motorization, (speed, alcohol,
socioeconomic handheld use of mobile
changes, increase in phone, young riders,
need for travel) driver fatigue)

Road
traffic
injuries
Influencing severity
Influencing crash
of post crash injuries
severity
(absence of first aid or
(Non use of helmets
quality care in hospital
and seatbelts, no
or trained expertise in
protection like airbags)
trauma care)

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 Factors

Phase Human Vehicles and equipment Environment

Pre-crash Crash Information Roadworthiness Road design and

prevention Lighting road layout
Attitudes
Braking Speed limits
Impairment
Handling Pedestrian facilities
Police enforcement
Speed management

Crash Injury Use of restraints Occupant restraints Crash-protective

prevention roadside objects
during the Impairment Other safety devices
crash Crash protective design

Post-crash Life First-aid skill Ease of access Rescue facilities

sustaining Fire risk
Access to medics Congestion

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 Modified haddons matrix
• Modifications of the Haddons Matrix have been introduced
and used in the analysis of other health challenges such as
natural disasters and infectious disease outbreaks.

• It incorporates an analysis of socioeconomic and cultural

factors linked to EVD outbreaks in Africa, that is, the columns
“Health Policy and Funding Environment” and “Social and
Cultural Environment” have been added.

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 Agent Host Physical Health policy Social and
environment and funding cultural
environment environment

Before the Presence of Level of Human Adequacy of Trust of

outbreak Ebola virus health literacy settlement health people on the
of local near forest facilities and authorities
people regions resources and literacy
level

During the Virulence of Behaviour of Adequate Quick Cultural

outbreak specific strain infected communicatio identification practices
people n system and strict
isolation

After the Mutation of Re-integration Deforestation Funds to help Prejudice and

outbreak virus of recovered and recovered discrimination
Elimination of patients destruction of patients against
animal habitat of bats recovered pt
reservoir

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 Three dimensional Haddons matrix
• The matrix of four columns and three rows combines public
health concepts of host-agent-environment as targets of change
with the concepts of primary, secondary, and tertiary
prevention.

• The addition of the third dimension should facilitate its

application in decision making.

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 Case scenario
• On a visit to an old age home, you encounter Mr X , a 67 year
old resident of the home. He is on regular painkillers for left
hip pain but has not been assessed by a clinician for the same.
He has also had complaints of a ringing in his ears for which
he has not sought any medical care. You notice that he is
limping because of a fall, on a patch of wet floor. When you
assess the premises, you find that corridor is dimly lit and
there is a leakage in the wash basin area. Create a Haddons
matrix and identify potential areas of intervention.

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 Host Agent/Vehicle Physical Social
environment environment
Pre-fall • Assessment Use of good • Repair of Being alert for
of hip joint quality slippers leaking pipes hazards, fall
for • Well lit prevention and
osteoarthritic corridors and response
changes prevent dark
• Assessment zones
for tinnitus
and balance
Event(fall) • Provision of Appropriate Supportive Residential
assistive positioning and structure or thick homes must have
devices good quality hip carpeting to anti slip flooring
• Use of protector cushion the fall
protective
pads to
prevent
impact during
fall
Post-fall Assessment of Use of alarm Remove physical Funding and
bones for systems to alert barriers for coordinated
fractures or soft after fall accessing the system for post
tissue contusions injured trauma care and
rehabilitation 26
 Can the Haddon Matrix Be Used for
Infectious Disease Control?
• The Haddon Matrix forces us to think systematically about the
particular health problem we are dealing with
• Dan Burnett proposed that the Haddon Matrix be used
against SARS
• Phua modified and expanded the Haddon Matrix and
proposed its use against Nipah virus. (He also proposed its use
against natural disasters such as tsunamis).

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 Phua’s “Modified Haddon Matrix” to Study Infectious Disease
Outbreaks & Natural Disasters
Agent Intermediate host “Host” Environment
(I)Affected
individual
(II)Individual’s
family
(III)Affected
community
(IV)The larger
society
Factors leading to
the event
(before the event)
Factors affecting
severity, rate of
spread, and
extent of impact
(during the event)
Reactions to the
event (during the
event)
Short-term and
long-term effects 28
(after the event)
 Using the “Modified Haddon Matrix” to Analyze Avian Influenza :
Action to be Taken Against Factors Identified Below
Agent Intermediate host “Host” Environment
(I)Affected individual
(II) Family members
(III)Affected
community
(IV) Larger society
Factors leading to Agent can cause Avian influenza virus (I) Close contact with Close proximity of
the event disease in humans present in wild, & eating of sick birds people & birds e.g.
migratory birds (III) Raising chickens rearing backyard
(before the event)
is important economic chickens
activity
Factors affecting Agent does not spread Can spread from wild (I) Mobility of infected Sale and smuggling of
severity, easily between humans to domestic birds; wild individual infected birds is not
bird migration patterns (II) Close contact stopped quickly
rate of spread,
in Europe and Asia (III) Community
and extent of
impact (during the dependent on raising
chickens
event)
(IV) Chicken exports
to foreign countries
Reactions to the (III) Fear (IV) Mass Tourist arrivals
event culling; active affected
monitoring by WHO &
(during the event)
Ministry of Health

Short-term and Evidence that H5N1 (I) High mortality Boon for drug
long-term can also affect non- (II) Deaths affect companies; fear of
human animals family members more virulent strains
effects (after the
(III) & (IV) Economic appearing
event)
losses 29
THANK YOU

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