Fatal injuries among urban children in South Africa: risk distribution and potential for reduction

Objective To determine the leading causes of fatal injury for urban South African children aged 0-14 years, the distribution of those causes and the current potential for safety improvements. Methods We obtained injury surveillance data from the National Injury Mortality Surveillance System 2001-2003 for six major South African cities varying in size, development and sociodemographic composition. We calculated age-adjusted rates, by sex, population group and city, for death from the five leading causes of fatal injury as well as population attributable risks (PARs). Findings The leading causes of fatal injury in childhood included road traffic injuries among vehicle passengers and especially among pedestrians drowning, burns and, in some cities, firearm injuries. Large differences in PARs were observed, particularly for population groups and cities. Disparities between cities and between population groups were largest for deaths from pedestrian injuries, while differences between boys and girls were greatest for drowning deaths., Conclusion In the face of the high variability observed between cities and population groups in the rates of the most common types of fatal injuries, a safety agenda should combine safety-for-all countermeasures - i.e. lowering injury rates for all - and targeted countermeasures that help reduce the burden for those at greatest risk.