The Global Burden of Unintentional Injuries and an Agenda for Progress

Abstract

According to the World Health Organization, unintentional injuries were responsible for over 3.9 million deaths and over 138 million disability-adjusted life-years in 2004, with over 90% of those occurring in low- and middle-income countries (LMIC). This paper utilizes the year 2004 World Health Organization Global Burden of Disease Study estimates to illustrate the global and regional burden of unintentional injuries and injury rates, stratified by cause, region, age, and gender. The worldwide rate of unintentional injuries is 61 per 100,000 population per year. Overall, road traffic injuries make up the largest proportion of unintentional injury deaths (33%). When standardized per 100,000 population, the death rate is nearly double in LMIC versus high-income countries (65 vs. 35 per 100,000), and the rate of disability-adjusted life-years is more than triple in LMIC (2,398 vs. 774 per 100,000). This paper calls for more action around 5 core areas that need research investments and capacity development, particularly in LMIC: 1) improving injury data collection, 2) defining the epidemiology of unintentional injuries, 3) estimating the costs of injuries, 4) understanding public perceptions about injury causation, and 5) engaging with policy makers to improve injury prevention and control.

Knowledge and training in paediatric medical traumatic stress and trauma-informed care among emergency medical professionals in low- and middle-income countries

“…trauma-informed care). Consistent with observations from past research, greater knowledge was associated with higher country income (Alisic et al, 2016; Chandran et al, 2010; Fodor et al, 2014; Schnyder et al, 2016). LMIC emergency staff had somewhat greater gaps in knowledge than their high-income country counterparts and in particular were less likely to identify that toddlers can be at risk of developing paediatric medical traumatic stress and recognize behaviours that indicate risk (Alisic et al, 2016; Hoysted et al, 2017).…”

“…Internationally, millions of children suffer acute injuries each year, with the global burden of childhood injuries being disproportionately higher in low- and middle-income countries (LMIC) than in high-income countries (Ameratunga, Hijar, & Norton, 2006; Chandran, Hyder, & Peek-Asa, 2010; Peden et al, 2008; World Health Organization, 2016). Childhood injuries can have profound and lifelong psychological effects, with approximately one in six injured children experiencing psychological sequelae, including paediatric medical traumatic stress (Kassam-Adams, Marsac, Hildenbrand, & Winston, 2013; Price, Kassam-Adams, Alderfer, Christofferson, & Kazak, 2015).…”

“…Further, there is cumulating evidence demonstrating that risk factors for the development of posttraumatic stress symptoms in children, adolescents and adults are consistent across cultures (Dyregrov et al, 2002; Ehntholt & Yule, 2006; Sack et al, 1997; Schnyder et al, 2016; Smith et al, 2002). Despite evidence that traumatic stress impacts children in LMICs (which are burdened with high rates of injuries and childhood trauma exposure) there is limited systematic research conducted in LMIC settings examining the efficacy of treatment approaches (Chandran et al, 2010; Foa et al, 2008; Fodor et al, 2014). Furthermore, many LMICs have limited access to resources, training and education and poor health infrastructure, which impacts implementation of evidence-based treatments and preventative measures (Chandran et al, 2010; Schnyder et al, 2016).…”

“…Despite evidence that traumatic stress impacts children in LMICs (which are burdened with high rates of injuries and childhood trauma exposure) there is limited systematic research conducted in LMIC settings examining the efficacy of treatment approaches (Chandran et al, 2010; Foa et al, 2008; Fodor et al, 2014). Furthermore, many LMICs have limited access to resources, training and education and poor health infrastructure, which impacts implementation of evidence-based treatments and preventative measures (Chandran et al, 2010; Schnyder et al, 2016). …”

“…However, research has consistently demonstrated that emergency staff are lacking knowledge of psychological difficulties, such as paediatric medical traumatic stress and skills in promoting psychological recovery utilizing a trauma informed care approach (Banh, Saxe, Mangione, & Horton, 2008; Hoysted et al, 2017; Kassam-Adams et al, 2015; Ziegler, Greenwald, DeGuzman, & Simon, 2005). Further, research has found a greater need for training in LMICs (Alisic et al, 2016) potentially explained by the lack of available resources, including professional training and education, in many LMICs (Chandran et al, 2010; Hsia, Thind, Zakariah, Hicks, & Mock, 2015; Obermeyer et al, 2015). Therefore, the development of targeted training programmes is required to address these limitations in emergency staff knowledge in these economic regions.…”