Injury Research in LMICs Requires a Fundamental Directional Change

I want to make the point that an essential shift in injury research from burden assessment to hypothesis testing is still lagging in Low- and Middle-Income Countries (LMICs)

Every month hundreds of injury research publications originating from Low- and Middle-Income Countries find a place in scientific journals. Recent bibliographic analysis has revealed that the numbers of LMIC publications have surged enormously in the last decade ( This is a welcome change.

Nonetheless, my perception is that most LMICs manuscripts still focus on injury burden assessment. Even if some of those manuscripts adopt a critical approach to the injury problem, in my opinion they still use descriptive analyses without making headway towards a deep understanding of injury risks by testing specific hypothesis. Some argue that lack of basic injury statistics is the main reason to focus on burden assessments, to which I agree partially. Nevertheless, I think that analytical studies using inferential statistics to test specific hypothesis are not being conducted to the same extent as is the case in developed countries in North America, Western Europe and the Pacific. The greatest benefit of specific hypothesis testing is a clear recommendation for stakeholders.

Let me give you a simple example with our work on the Karachi-Hala highway (Pakistan). We started with a descriptive analysis of road traffic injuries (RTI) occurring on the selected highway sections (, and expectedly confirmed that the RTI burden on these selected sections was significantly higher than on similar roads in a Western European Country. Our preliminary analyses showed that work zones accounted for a third of fatalities. To understand this problem in depth, we shifted from burden assessment to testing a specific hypothesis i.e., that for the same number of vehicle km travelled, more RTIs occurred in work zones than on other sections of the same highway ( We also showed that oncoming traffic contributed to increased fatality risks in work zones. This clearly meant that road injuries in work zones are preventable if traffic in these zones is separated. This is a clear recommendation for road safety stakeholders compared to just stating that the said highway has a “very high” RTC risk. We followed our work by testing more complex hypotheses regarding interactions of drivers’ hazard perceptions at high- and low-risk road traffic crash sites (

The bottom-line here is that it is time that injury researchers in LMIC go beyond survey analysis to conduct studies with specific hypothesis based on their descriptive data. This will make their preliminary burden assessments more meaningful for stakeholders.