Urban and rural differences in child injury deaths in

Abstract

Injury, a major cause of morbidity and mortality for children worldwide, is concentrated in low- to middle-income countries (LMICs). Despite the growing rate of childhood injury in LMICs, effective prevention and control remain inadequate owing to the lack of comprehensive epidemiological information on the external causes and magnitude of this problem. This populationbased study examined whether the incidence and the pattern of fatal injuries among children differ in rural and urban areas of South Africa. The National Injury Mortality Surveillance System (NIMSS) was used to select cases for the period of 2007. Age- and gender-specifi c incidence rates for rural and urban children were computed for specifi c injury types. Following a cross-sectional method, we analysed all deaths among children below 15 years of age in Gauteng (urban) and Mpumalanga (rural) who died in 2007. For the year 2007, NIMSS recorded a total of 612 injury deaths among children in Mpumalanga (rural) and another 1 400 injury deaths among children in Gauteng (urban). Equally high overall injury death rates were found among children from Gauteng (31.7/100 000) and Mpumalanga (29.2/100 000). The study also revealed several differences with respect to the primary external causes of child injury-related deaths across the two provinces. In particular, passengerrelated motor vehicle deaths were more evident among children in rural areas than in urban areas, while other unintentional (non-transport-related) deaths – specifi cally those associated with burns – were more common among urban children than among rural children. Such differences may arise because of the many environmental and infrastructure-related differences that exist between rural and urban areas. Therefore, prevention and intervention efforts in South Africa should focus on the risk factors that are unique to urban and rural children respectively.