Acta Pædiatrica ISSN 0803–5253 REVIEW ARTICLE Falls among children in the developing world: a gap in child health burden estimations? Adnan A. Hyder (ahyder@jhsph.edu) 1 , David Sugerman 2 , Shanthi Ameratunga 3 , Jennifer A. Callaghan 4 1.Department of International Health, and Center for Injury Research and Policy, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA 2.Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, USA 3.Section of Epidemiology & Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand 4.Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA Keywords Child health, Developing countries, Falls, Injury, Paediatric injury Correspondence Adnan A. Hyder, MD, MPH, PhD, Department of International Health, and Center for Injury Research and Policy, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Suite E-8132, Baltimore, MD 21205, USA. Tel: +410-955-3928 | Fax: +410-614-1419 | Email: ahyder@jhsph.edu Received 18 March 2007; revised 7 May 2007; accepted 1 June 2007. DOI:10.1111/j.1651-2227.2007.00419.x Abstract Aim: To estimate the incidence and mortality rates for unintentional fall injuries in children under 5 years of age in three developing regions of the world. Methods: This is a systematic review of literature on unintentional childhood fall injuries. A computerized PUBMED search of literature published between 1980 and 2006 was conducted and a manual search of journals was also completed. Results: Over 140000 injuries to children under 19 years were reported in 56 studies (21 from Asia, 20 from Africa and 15 from South America); on an average 36% of injuries (52 575) were due to falls. The median incidence is estimated at 137.5 fall injuries per 100000 children. The incidence of falls specific to the under-5 age group was reported in 16 studies with a median incidence of 40.6 falls per 100 000. The overall average incidence rate for childhood falls is highest in South America at 1315 followed by Asia at 1036 and Africa at 786 per 100000, respectively. Average mortality rates were highest for Asia at 27 followed by Africa at 13.2 per 100000, respectively. Conclusion: This review demonstrates that the burden of falls on children has not been well documented, and is most likely under-reported. With the large and growing population of children in developing countries, the public health implications of the observed results are tremendous. Appropriate prevention relies on accurate statistics. INTRODUCTION Unintentional injuries have been recognized as one of the leading causes of death among children and young adults (1). Over 700 000 children die every year as a result of in- juries, especially in developing countries where 13% of the total burden of disease among children less than 15 years old has been attributed to injuries (2). Environmental, social and developmental factors make children highly vulnerable to injuries (3). Among children under 5 years of age the impact of injury is often obscured by the substantial burden of peri- natal and infectious diseases; injuries are the leading cause of death for children after their first birthday. There is also high morbidity associated with childhood injuries: for every injured child who dies, there are several thousand children who live with varying degrees of disability. A large propor- tion of these injuries occur in either the home or in leisure environments. The vast majority of child injuries are unintentional in- juries, which encompass a wide range of conditions such as road traffic injuries, falls, burns, drowning and poisoning. Globally, an estimated 391 000 people of all ages died due to falls in 2002, making it the second leading cause of un- intentional injury death globally after road traffic injuries. In contrast to high-income countries (HIC), the burden and pattern of child injuries in developing countries is poorly known and not well studied. The problem of child injuries is further compounded by the population distribution in these countries. According to data for 2005, 141 million children 1394 C 2007 The Author(s)/Journal Compilation C 2007 Foundation Acta Pædiatrica/Acta Pædiatrica 2007 96, pp. 1394–1398