The burden of fatal and non-fatal injury in rural India

Background: Little is known about the burden or causes of injury in rural villages in India. Objective: To examine injury-related mortality and morbidity in villages in the state of Andhra Pradesh, India. Methods: A verbal-autopsy-based mortality surveillance study was used to collect mortality data on all ages from residents in 45 villages in 2003-2004. In early 2005, a morbidity survey in adults was carried out using stratified random sampling in 20 villages. Participants were asked about injuries sustained in the preceding 12 months. Both fatal and non-fatal injuries were coded using classification methods derived from ICD-10. Results: Response rates for the mortality surveillance and morbidity survey were 98% and 81%, respectively. Injury was the second leading cause of death for all ages, responsible for 13% (95% Cl 11% to 15%) of all deaths. The leading causes of fatal injury were self-harm (36%), falls (20%), and road traffic crashes (13%). Non-fatal injury was reported by 6.7% of survey participants, with the leading causes of injury being falls (38%), road traffic crashes (25%), and mechanical forces (16.1%). Falls were more common in women, with most (72.3%) attributable to slipping and tripping. Road traffic injuries were sustained mainly by men and were primarily the result of motorcycle crashes (48.8%). Discussion: Injury is an important contributor to disease burden in rural India. The leading causes of injury - falls, road traffic crashes, and suicides - are all preventable. It is important that effective interventions are developed and implemented to minimize the impact of injury in this region.