Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom; Ox-Col Collaboration, Department of Clinical Medicine, University of Colombo, Colombo, Sri Lanka; South Asian Clinical Toxicology Research Collaboration, Sri Lanka.
PLoS One. 2007 Jul 11;2(7):e599. doi: 10.1371/journal.pone.0000599.
Road traffic crashes are considered by the WHO to be the most important global cause of death from injury. However, this may not be true for large areas of rural Asia where road vehicles are uncommon. The issue is important, since emphasising the importance of road traffic crashes risks switching resources to urban areas, away from already underfunded rural regions. In this study, we compared the importance of road traffic crashes with other forms of injury in a poor rural region of South Asia.
METHODOLOGY/PRINCIPAL FINDINGS: We collected data on all deaths from injury in the North Central Province of Sri Lanka (NCP; population 1,105,198 at 2001 census) over 18 months using coronial, hospital, and police data. We calculated the incidence of death from all forms of intentional and unintentional injury in the province. The annual incidence of death from injury in the province was high: 84.2 per 100,000 population. Half of the deaths were from self-harm (41.3/100,000). Poisoning (35.7/100,000)-in particular, pesticide self-poisoning (23.7/100,000)-was the most common cause of death, being 3.9-fold more common than road traffic crashes (9.1/100,000).
CONCLUSIONS/SIGNIFICANCE: In poor rural regions of South Asia, fatal self-harm and pesticide self-poisoning in particular are significantly more important than road traffic injuries as a cause of death. It is possible that the data used by the WHO to calculate global injury estimates are biased towards urban areas with better data collection but little pesticide poisoning. More studies are required to inform a debate about the importance of different forms of injury and how avoidable deaths from any cause can be prevented. In the meantime, marked improvements in the effectiveness of therapy for pesticide poisoning, safer storage, reduced pesticide use, or reductions in pesticide toxicity are required urgently to reduce the number of deaths from self-poisoning in rural Asia.
世界卫生组织认为道路交通碰撞是全球因伤致死的最重要原因。然而，在亚洲广大农村地区，由于道路车辆罕见，这一说法可能并不正确。这是一个重要的问题，因为强调道路交通碰撞的重要性可能会将资源转移到城市地区，而不是已经资金不足的农村地区。在这项研究中，我们比较了道路交通碰撞与南亚一个贫困农村地区其他形式伤害的重要性。
方法/主要发现：我们在 18 个月的时间里，通过法医、医院和警方的数据，收集了斯里兰卡中北部省（NCP；2001 年人口普查时人口为 1105198 人）所有因伤死亡的数据。我们计算了该省所有故意和非故意伤害致死的发生率。该省的年伤害致死发生率很高：每 10 万人中有 84.2 人死亡。一半的死亡是自残造成的（41.3/10 万人）。中毒（35.7/10 万人）——特别是农药自杀（23.7/10 万人）——是最常见的死因，是道路交通碰撞（9.1/10 万人）的 3.9 倍。
结论/意义：在南亚贫困农村地区，致命的自残和特别是农药自杀是导致死亡的重要原因，明显超过道路交通伤害。世界卫生组织用于计算全球伤害估计的数据可能偏向于数据收集更好但农药中毒较少的城市地区。需要进一步研究，以了解不同形式伤害的重要性以及如何预防任何原因导致的可避免死亡。同时，迫切需要提高农药中毒治疗的有效性、更安全的储存、减少农药使用或降低农药毒性，以减少亚洲农村地区因自杀而死亡的人数。
