Injury is the second leading cause of death in
rural India.
Image: iStockphoto

New research from a comprehensive mortality survey conducted in rural India has revealed that injury is the second leading cause of death, responsible for 13 per cent of all deaths in adults. The new data shows that self-harm was responsible for 36 per cent of all injury-related deaths including poisoning, hanging and self-immolation.

The primary causes of injuries resulting in death were suicide (36 per cent), falls (20 per cent), and road traffic crashes (13 per cent). A concurrent survey showed that falls (38 per cent) and road traffic crashes (25 per cent) were also the leading causes of injuries that did not result in death. The study examined injury-related mortality and morbidity from residents in 53 villages in East and West Godavari Districts of Andhra Pradesh, that have a population of more than 200,000.

Injury is a major contributor towards death and disability worldwide, and according to author Associate Professor Rakhi Dandona at The George Institute, India around 90 per cent of injury-related deaths occur in low- and middle-income countries such as India where very little is known about the burden or causes of injury. Previously, health systems have been designed to cope with infectious diseases and injury is not recognised as a major public health issue by the local authorities because of poor availability of robust data on the injury burden. According to Dr Dandona this new data demonstrates that we now need services that can deliver care and prevention for injury.

Previous results of this survey showed that diseases of the cardiovascular system, such as heart attacks and stroke, were the leading causes of death. Infectious diseases such as tuberculosis and HIV/AIDS caused only about 12 per cent of deaths. In line with India’s rapid economic and societal changes, the health system must include a focus on chronic diseases and injury in addition to infectious diseases.

"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 minimise the impact of injury in the region. In particular, given that mainly 15-44 year olds are affected by injuries, the economic impact is substantial and clearly highlights the need for urgent intervention," said Dr Dandona.

Researchers note the first step is to implement programs and policies aimed at addressing injury in rural India, including:

• Community-based programs to reduce suicides
• Exploring options to decrease access to poisons
• Actions to increase the use of motorcycle helmets
• Occupational health and safety measures
• A review of ways to reduce falls in the home
• A focus on preventing drowning.

This study was completed as part of the Andhra Pradesh Rural Health Initiative (APRHI). This initiative is a collaboration between The George Institute and The University of Queensland in Australia, the Byrraju Foundation, the Centre for Chronic Disease Control (CCDC) and the CARE Foundation in India. Since 2003, the APRHI group has worked to identify the main health problems in the region and to develop evidence-based methods of dealing with them.