Background The relationship between lower economic level and high injury rates in children is well established, but less is known about how development measures shape child injury inequalities, especially in low- and middle-income countries. The aim of this study is to assess the strength of the relationship between child injury mortality rates and existing country level development measures in Sub-Saharan Africa and South Asia, the two regions with the highest child injury mortality rates globay.

Methods This was an ecological, cross-sectional country level study in 54 countries comprising the Sub-Saharan Africa and South Asia region participating in the Global Burden of Disease (GBD) project. The outcome measure was injury mortality rates per 100,000 for the 1–14 age group calculated from the GBD 2013, 2000, 1990. Country level measures chosen to reflect the core domains of development relevant to child well-being (economy/socioeconomic status, governance and human rights) were extracted from the World Bank Open Database, the Institute for Economics and Peace and the Economist Intelligence Unit. Pearson’s correlation coefficient was used to examine the association between development measures and all injuries/unintentional/intentional child mortality rates for both regions combined in 2013. Injury mortality rates were then presented for each region in 1990, 2000 and 2013.

Results Development variables that showed significant correlation with unintentional injury mortality included: Democracy Index, improved water source for the rural population, infant mortality rate, under-5 mortality rate, maternal mortality rate, life expectancy at birth and private prepaid plans. None correlated with intentional injuries. There was a decrease in all injury and unintentional mortality rates for both regions from 1990 to 2013; intentional rates increased 1990 to 2000 and are now (2013) decreasing again.

Conclusion Injury mortality rates declined overall in both regions from 1990 to 2013 but within and between regional differences exist and must be addressed in order to reduce child injury inequality on a global scale; further research is needed to improve our understanding of how development affects these rates.