Cost-effectiveness analyses for injury prevention initiatives in low- and middle-income countries

Eighty-five percent of the worlds’ population live in low- and middle-income countries (LMICs).1 An LMIC is defined as a country with a gross national income per capita of ≤US$11 115 in 2006.2 Although less than 40% of the world’s vehicles are found in LMICs, more than 85% of all deaths due to traffic crashes occur in LMICs.3 Fatality rates per 100 000 population in LMICs are substantially higher than those in high-income countries (HICs). For example, traffic crash fatality rates in the LMICs of Africa and Central/South America are 28.2 and 25.3 per 100 000 population, respectively, compared with 16.1 and 16.8 per 100 000 population in the HICs of North America and Europe, respectively.4 The high numbers of crashes, multiple deaths per crash, and the high mortality from traffic injuries all contribute to the high fatality rates in LMICs.5

Deaths due to traffic crashes in LMICs affect children and those of working age (15–44 years) the most (table 1). In the 15–44 year age group, traffic crashes are the leading cause of death in men, accounting for about three-quarters of deaths in this age group.4 6 7 There are also distinct differences in fatality rates between types of road users and between rural and urban settings within countries. For example, traffic fatalities and injuries mostly occur to pedestrians, passengers and cyclists in LMICs, whereas in the developed world, drivers are most likely to be killed or injured.1 4

Fatality rates due to traffic crashes have increased dramatically in some countries; for example, from 1975 to 1998, rates increased 237% in Colombia, 243% in China, and 384% in Botswana.8 These increases are partly due to economic growth and a corresponding growth in the numbers of motor vehicles.1 5 8 9

What is being done about …