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The burden of fatal and non-fatal injury in rural India
  1. M Cardona1,
  2. R Joshi1,
  3. R Q Ivers1,
  4. S Iyengar2,
  5. C K Chow1,
  6. S Colman1,
  7. G Ramakrishna3,
  8. R Dandona1,
  9. M R Stevenson1,
  10. B C Neal1
  1. 1
    The George Institute for International Health, Sydney, Australia
  2. 2
    Byrraju Satyanarayana Raju Foundation, Secunderabad, India
  3. 3
    The Centre for Chronic Disease Control, New Delhi, India
  1. Dr R Ivers, The George Institute for International Health, PO Box M201, Missenden Road, NSW 2050, Australia; rivers{at}


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% CI 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.

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  • Funding: Funding support for the India-based component of this project was provided by the Byrraju Foundation. The George Institute’s contribution to this project was made possible by an award from the George Foundation. RJ was supported by the International Post-graduate Research Scholarship and International Post-graduate Award from the University of Sydney, RI and RD by a NHMRC Population Health Capacity Building Grant, and BN by a Fellowship from the National Heart Foundation of Australia.

  • Competing interests: None declared.