Injuries among children: An unrecognized threat in low- and middle-income countries

BACKGROUND: Reducing under-5 mortality is a major global health and development initiative. High under-5 mortality rates are driven by under-1 mortality due to neonatal complications and diseases. However, emerging evidence from China, India, and South Africa suggests that injuries are a leading cause of death among 1-4 year olds in low- and middle-income countries (LMICs). This study investigates the relative importance of injury mortality among children that survive beyond the first year of life using data from countries across the world.

METHODS: We obtained national cause-of-death statistics from the WHO Mortality Database, and supplemented this with data from six African countries. In all, we analyzed data from 38 high-income countries (HICs) and 48 LMICs. We computed injury fraction ‘(injury deaths)/(all deaths)' for all countries for 0-4 and 1-4 year olds. We calculated age-specific injury death rates for 62 countries (33 HICs and 29 LMICs) with relatively complete death registration data.

RESULTS: On average, in both HICs and LMICs, injuries constituted 7% (SD: 3.4%) of deaths among 0-4 year olds. However, the proportion of injuries among 1-4 year olds was much larger at 24% (SD: 10.0%) of deaths (HICs, 26%; LMICs 22%). The average injury death rate among 1-4 year olds in LMICs (17.5 per 100,000) was 2.8 times the average rate among HICs (6.2 per 100,000).

CONCLUSIONS: The substantial threat of injuries to child health is evident when under-5 mortality is disaggregated into under-1 and 1-4 years. Ongoing global child survival initiatives need to include sustained efforts in injury prevention.