In December 2008, the World Health Organization (WHO) and
UNICEF released the World Report on Child Injury Prevention1
in Hanoi, Vietnam. This long-awaited report, which has
benefited from the contributions of over 180 participants
from 56 countries, appeals to governments, practitioners, and
parents alike to ‘Keep Kids Safe’ by implementing known
good practices. It suggests that if a handful of these effective
interventions were optimally employed around the world,
‘more than 1 000 children’s lives could be saved every day’.
The report highlights the plight of children and teenagers
in Africa, who have the unenviable distinction of having the
highest unintentional injury death rates in the world (53.1 per
100 000 population, versus the global rate of 38.8 per 100 000)
(Table I). Children and teenagers under the age of 20 accounted
for almost one-third (32.8%) of the 769 226 deaths from injuries
and violence in Africa in 2004. Unintentional injuries or so-
called ‘accidents’, many of which could have been prevented,
were responsible for nearly 85% of these deaths. Specifically,
Africa has the highest rates in the world for child road traffic
fatalities (19.9 per 100 000 population – mainly pedestrians)
and poisoning (4.0 per 100 000), and the second highest rate
for drowning (7.2 per 100 000). Systematic reviews of road
traffic injuries to urban children and adolescents (<19 years)
estimate incidence rates of over 100 per 100 000 population,
mean mortality rates of over 13 per 100 000 children, and a loss
of healthy life of nearly 20 healthy life-years per 1 000 children
In South Africa, the recent burden of disease study revealed
that the road traffic fatality rate among 0 - 4-year-olds was 26.7
per 100 000 and that for 5 - 14-year-olds it was 21.9 per 100 000,
approximately twice the global rate.3 Furthermore, Childsafe
reports that the majority of childhood injury-related deaths are
due to pedestrian road traffic injuries, followed by drowning
and burns, while falls are the leading cause of hospitalisation.4
While clearly social determinants and poverty are some of
the most important factors underlying unintentional injuries,
age and development also play an important role.1,5 The injury
rate for infants under 1 year in Africa is the highest of all
age categories, but most of these injuries are poorly defined
and aggregated into a category called ‘other unintentional’.
While many of the injuries under 1 year of age could be due
to suffocation, asphyxia or natural disasters, others may be
misclassified intentional injuries, something that requires
further investigation in Africa. Children between the ages of
1 and 9 years appear to be most vulnerable to unintentional
injuries. It would indeed be unfortunate if some of the progress
towards attainment of the Millennium Development Goals in
Africa were to be undermined by loss of life after the age of 1
year to a largely preventable cause – injuries.
But all is not doom and gloom in Africa. Already many
practitioners, researchers and advocates have begun
implementing and evaluating child injuries programmes across
the continent. These include the evaluation of child-resistant
closures for paraffin in South Africa, road safety around
schools in Malawi and Mozambique, improved visibility of
schoolchildren in Ghana, Uganda and South Africa, improved
burns management in Nigeria, and the foundation of Africa’s
first burns charity ‘Children of Fire’. What is needed now is to
sustain these efforts and share the results of evaluation studies
so that good practices may be replicated in neighbouring
The World Report on Child Injury Prevention can help in
this aspect, as it offers countries a set of seven over-arching
recommendations that they should consider, as well as
twenty-four proven interventions for specific types of injuries.
From a health systems perspective, the report suggests that
instead of developing yet another vertical programme, child
injuries be integrated into other child health and development
strategies, with ministries of health playing a pivotal role.
These child injury strategies should be both multipronged and
multidisciplinary in order to achieve the best results.
In 2009 we need to focus on creating and maintaining
awareness about the magnitude, risk factors and preventability
of child injuries among policy-makers, donors, practitioners
Time to keep African kids safer
Table I. Child unintentional injuries by age, the world, 20041
<1 year years
1 - 4 5 - 9
10 - 14
15 - 19
Region of the Americas
South-East Asia region
Eastern Mediterranean region 112.7
Western Pacific region
January 2009, Vol. 99, No. 1 SAMJ
and parents in Africa. In most countries lack of awareness has
meant that the resources required for child injury prevention
have not been allocated, nor have the correct political and
organisational structures been put in place. Sustained evidence-
based campaigning is therefore required to raise awareness
about the public health, social and economic impacts of child
injuries, and how these may be prevented at the highest
policy levels. At the same time, it is critical for researchers
and academics to continue to generate the highest quality
evidence about the cost, effectiveness and cost-effectiveness of
interventions for child injury prevention and control to inform
appropriate allocation of resources. Finally, the development
of human capacity for the implementation of interventions and
programmes for child injury prevention must be addressed to
sustain positive health outcomes over time.
We join WHO and UNICEF in encouraging readers of the
SAMJ to use the report to stimulate action in their own country
in an attempt to ‘Keep Kids Safe’. To obtain your own copy of
the World Report on Child Injury Prevention please send an email
to email@example.com or download it from www.who.int/
Disclaimer: Dr Peden is a staff member of the World Health
Organization and Executive Editor of the World Report on Child
Injury Prevention. She alone is responsible for the views expressed
in this publication, and they do not necessarily represent the
decisions or policies of the World Health Organization. Dr Hyder
is an Editor of the World Report and President of the International
Society for Child and Adolescent Injury Prevention.
Competing interests: None declared.
Coordinator, Unintentional Injury Prevention
Department of Violence and Injury Prevention and Disability
20 Avenue Appia
A A Hyder
Director, International Injury Research Unit, and
Associate Professor, Department of International Health
Johns Hopkins University Bloomberg School of Public Health
Corresponding author: M Peden (firstname.lastname@example.org)
1. Peden M, Oyegbite K, Ozanne-Smith J, et al., eds. World Report on Child Injury Prevention.
Geneva: WHO and UNICEF, 2008. http://www.who.int/violence_injury_prevention/child/
en/ (available as from 10 December 2008).
2. Hyder AA, Labinjo M, Muzaffar S. A new challenge for child and adolescent survival in urban
Africa: an increasing burden of road traffic injuries. Traffic Injury Prevention 2006; 7: 381-388.
3. Norman R, Matzopoulos R, Groenwald P, et al. The high burden of injuries in South Africa.
Bull World Health Organ 2007; 85: 695-702.
4. Childsafe. Ten key facts about child injury in South Africa [Fact sheet]. http://www.childsafe.
org.za/downloads/10_key_facts.pdf (accessed 28 October 2008).
5. The Commission for Social Determinants of Health. Closing the Gap in a Generation. Health
Equity Through Action on the Social Determinants of Health. Geneva: World Health Organization,
2008. http://www.who.int/social_determinants/en/ (accessed 28 October 2008).