TABLE 8-1 Injuries in Sub-Saharan Africa: Gender-Related Burden


Exclusive to Females

Greater for Females than for Males

Burden for Females and Males Comparable, but of Particular Significance for Females

Domestic abuse




Household burns




Rape and sexual assault




NOTE: Significance is defined here as having an impact on health that, for any reason—biological, reproductive, sociocultural, or economic—is different in its implications for females than for males.


An injury is physical damage to the body resulting from acute exposure to thermal, mechanical, electrical, or chemical energy or from the absence of such essentials as heat or oxygen. Often the term "injury" is used interchangeably with "trauma." Injuries are grouped into three major categories, based on their intent or the context in which they occur. Although the "intent" of an injury is not always clear, classification by intent allows the identification of possible risk factors and the development of prevention strategies. Unintentional injuries are those caused by motor vehicles and other forms of transportation, drowning, poisoning, burns, or falls. Unintentional injuries are sometimes referred to as ''accidents." Intentional injuries (also called "violent injuries") are homicides, suicides, interpersonal assaults, and intergroup violence resulting from war, torture, or genocide. Certain intentional injuries, such as rape, battering, sexual abuse, and domestic violence, affect females almost exclusively. Occupational injuries are the unintentional and intentional injuries that occur at work or traveling to and from a work setting. They do not include injuries that occur in nonwage employment such as homemaking.


Injuries as a Public Health Issue

Injuries traditionally have been considered by many health professionals and policymakers as "accidents," uncontrollable events outside the domain of sound public health practice. This belief has been changing, and significant progress is being made in both policy and prevention strategies. For instance, during the past decade, reductions in motor vehicle fatality rates, decreases in unintentional poisonings, and lowering rates of home fire fatalities have been realized in countries with injury prevention programs. In some countries the term "accident" is no longer used to describe an injury-producing event because of its connotation as something uncontrollable or random. "Injury prevention and control" is the term now used to describe the health-directed, scientific approach to reducing the impact of injury—intentional, unintentional, or occupational—on a society.

There are a number of reasons why injury programs should be rapidly established in all countries. First, injuries have significant impact on morbidity and mortality. In developed countries, they account for more deaths in persons between the ages 1 and 44 than all infectious diseases combined. They also result in more premature death as measured in years of productive life lost (YPLL) than all other health conditions combined. With the decreasing rates of childhood mortality and increased longevity observed in much of the Sub-Saharan region (see the Appendix), there is reason to expect that injuries will become an ever greater contributor to morbidity and mortality in the region. The second reason to establish injury prevention programs is that injuries impact significantly on health care and societal costs. In the United States, injuries imposed a $180 billion burden on the economy in 1988 (Rice et al., 1989). The final reason for establishing injury prevention and control programs is

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