Injury in the developing world.

Abstract

Injury is the commonest cause of death for children and young adults in developed and middle-income countries. In low-income countries, deaths in this age group are most often due to infectious disease, but there is a rising rate of deaths from injury.1 The Global Burden of Disease Study highlighted the overall toll from injury in the developing world.2 The table shows the major causes of death for the 2 main age groups affected by injury.3 Injury-related causes account for 3 of the top 6 killers of older children and 4 of the top 6 killers of young adults. Road traffic accidents alone are second only to AIDS as a killer of young adults. Other major causes include nonintentional or accidental causes (such as drowning, fires and burns, poisoning, falls, and home injuries) and intentional causes (such as violence and suicide). In addition to mortality, disability is often due to injury, especially with the success of the global efforts to control polio. Injury is also a leading contributor to health-related economic losses. Despite the toll from injury, scarce attention has been paid to the problem. Although a tremendous amount of resources are consumed caring for injured patients at hospitals throughout the developing world, minimal attention has been directed toward better understanding of injury, prevention efforts, or organized efforts to improve trauma treatment systems. The amount of funding devoted to such efforts is a small percentage of that devoted to other health problems in developing countries.4 Table 1 Major causes of death in developing countries (both low and middle-income) in 1998* Rank 5-14 yr Rate† 15-44 yr Rate† 1 Respiratory infections 19.7 HIV/AIDS 67.0 2 Malaria 19.4 Road traffic injuries‡ 21.9 3 Road traffic injuries‡ 14.5 Interpersonal violence‡ 20.2 4 Drowning‡ 14.5 Self-inflicted injuries‡ 19.0 5 Diarrheal diseases 12.4 Tuberculosis 17.8 6 War injuries‡ 5.3 War injuries‡ 15.5 View it in a separate window *Source: Krug et al.3 †Rates of death expressed as deaths per 100,000 per year. ‡Injury-related causes. Part of the reason for such neglect may be that many of the solutions to the problem lay outside the usual domain of health professionals. For example, possible solutions include road engineering and road use legislation. Another reason for the neglect may be a sense of futility. Injuries are conceptualized by much of the public around the world as due to bad luck or to carelessness, with little that can be done to prevent them.