Chapter Thirteen Unintentional Injuries

The Importance of Unintentional Injuries Among the single leading causes of death and DALYs lost worldwide 6% of deaths worldwide, 8% of DALYs lost

Key Definitions Injury - “the result of an act that damages, harms, or hurts; unintentional or intentional damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of sch essentials as heat or oxygen” Unintentional injuries - “that subset of injuries for which there is no evidence of predetermined intent”

The Burden of Unintentional Injuries More than 90% of deaths from unintentional injuries in 2001 were in low- and middle-income countries Percentage of deaths from unintentional injuries was twice as high in low- and middle-income countries as in high-income countries Deaths only represent part of the burden Significant differences between rates in males and females Variation among different regions

Table 13.1: Deaths from Unintentional Injuries, 2001

Table 13.2: Percentage Distribution of Deaths and DALYs from Unintentional Injuries

Table 13.3: Death Rates from Unintentional Injuries Source: Adapted with permission from Norton R, Hyder AA, Bishai D, Peden M. Unintentional injuries. In: Jamison DT, Breman JG, Measham AR, et al., eds. Disease Control Priorities in Developing Countries. 2nd ed. Washington, DC and New York: The World Bank and Oxford University Press; 2006:738.

Table 13.5: Percentage of Total Deaths from Unintentional Injuries Source: Adapted with permission from Lopez AD, Mathers CD, Murray CJL. The burden of disease and mortality by condition: data, methods, and results for In: Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL, eds. Global Burden of Disease and Risk Factors. Washington, DC and New York: The World Bank and Oxford University Press; 2006:

Childhood Injury 98% of childhood injury deaths are in low- and middle-income countries Represent 2.7% of total deaths for children ages 0-4 and 3.5% of total deaths for children ages 5-14 in low- and middle-income countries Children ages years comprise 30% of the population but account for about 50% of total injury-related DALYs

Risk Factors for Unintentional Injuries Developmental immaturity relative to dangers present in environment Inability to provide adult supervision and child care Exposure to unsafe workplaces Poor motor safety practices

The Costs and Consequences of Injuries Direct costs including medical care, hospitalization, rehabilitation and funeral services Indirect costs including lost wages, sick leave, disability payments, and insurance payouts Rapidly increasing economic burden due to road traffic injuries in some countries Psychosocial consequences such as pain, fatigue, memory loss, changes in work status, altered family dynamics

Addressing Key Injury Issues Formal surveillance systems to provide information on numbers and patterns Interventions designed for individual communities Haddon’s Matrix to demonstrate interaction of environment, vector, and host Education, enforcement, and engineering efforts

Emergency Medical Services Low-cost, but effective ways of improving EMS: Special vehicles for low-income or rural communities Advance arrangements with owners of available transport Training truck drivers to provide first aid and transport Training healthcare personnel who work in emergency situations

Future Challenges Focusing additional attention on unintentional injuries in low- and middle-income countries Integrating lessons learned in high-income countries Engineering safety into newer roads Increasing knowledge of injury prevention