Chapter Thirteen

1. Chapter Thirteen Unintentional Injuries

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

3. 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”

4. 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

5. Table 13.1: Deaths from Unintentional Injuries, 2001

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

7. 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.

8. 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 2001. 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; 2006:126-127.

9. 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 0 -14 years comprise 30% of the population but account for about 50% of total injury-related DALYs

10. 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

11. 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

12. 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

13. 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

14. 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