Background Despite evidence that injury impedes development in low-middle income countries (LMICs), injury prevention remains low priority in global agendas. Current injury prevention in LMICs is largely based on the Public Health Approach (PHA), with most strategies borrowing high income country interventions based on good injury surveillance systems (ISS).

A study was conducted to investigate the capacity and adequacy of the PHA for injury prevention in LMICs.

Methods Taking data as an indicative key element of the PHA, a systematic review was conducted to assess the utilisation, efficacy and effectiveness of the existing WHO Injury Surveillance Guidelines (2001) in LMICs. Subsequent, LMIC focused fatal injury surveillance guidelines were developed, evaluated by pilot studies conducted in six LMICs for process and case capture effectiveness.

Results The review identified limitations of the WHO 2001 guidelines in LMIC utilisation: mainly short-term studies, ISS not ongoing; single issues addressed; minimum dataset use lacked detail for injury prevention; local capacity not built.The pilot studies showed eligible external cause deaths are poorly captured and reported by the medico-legal system, apparent systemic issues, limited workforce capacity and training in ISS; lack of strong stewardship for fatal injury surveillance. Nonetheless, indicative data on injury deaths was obtained.

Conclusions Complementing the PHA, fatal injury response in LMICs must (i) continue to improve fatal injury data quality to quantify the issue and identify solutions, (ii) evidence gaps should not paralyse progress, rather the ‘policy window’ opportunity in the new Sustainable Development Goals should be seized, (iii) consider complex contextual and systemic issues in LMIC injury prevention policies. Proposed therefore is a modified model seeking to complement existing approaches by accounting for content, process, practice, policy environment and context for injury prevention in LMICs.