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The Burden of Musculoskeletal Injury in Low and Middle-Income Countries: Challenges and Opportunities
David A. Spiegel, MD1; Richard A. Gosselin, MD2; R. Richard Coughlin, MD3; Manjul Joshipura, MD4; Bruce D. Browner, MD5; John P. Dormans, MD1
1 Division of Orthopaedic Surgery, Children's Hospital of Philadelphia, 2nd Floor Wood Building, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104. E-mail address: spiegeld@email.chop.edu
2 The University of California at Berkeley School of Public Health, 506 Warren Hall, Berkeley, CA 94720-7360
3 Department of Orthopaedic Surgery, University of California at San Francisco, 1001 Potrero Avenue, #3A36, San Francisco, CA 94110
4 Academy of Traumatology, A/35, Someshvara II, Satellite Road, Ahmedabad 380015 India
5 Department of Orthopaedic Surgery, University of Connecticut Health Center, 10 Talcott Notch Road Farmington, CT 06034-4037
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at Children's Hospital of Philadelphia, the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; the University of California at Berkeley School of Public Health, Berkeley, California; San Francisco General Hospital, the University of California at San Francisco School of Medicine, San Francisco, California; Academy of Traumatology, Ahmedabad, Gujarat, India; and the University of Connecticut Health Center, University of Connecticut School of Medicine, Farmington, Connecticut

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Apr 01;90(4):915-923. doi: 10.2106/JBJS.G.00637
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The global burden of injury is substantial, and injuries are predicted to be a leading cause of death and disability over the next few decades1-6. The majority of this burden will be borne by low and middle-income countries, where preventive strategies are often nonexistent and barriers to the timely and appropriate care of the injured include absent or inefficient systems for the delivery of trauma care, inadequacies in the number and the distribution of health-care facilities and workers, a lack of infrastructure and/or physical resources, and a lack of education and training. Addressing the burden of injury in low and middle-income countries has become a public health priority. So-called essential services, which are low-cost, high-yield, and target major health problems, should be made available to every person in the world7-10. While surgery has been traditionally viewed as a high-cost treatment lying outside the realm of the traditional public health model, evidence is emerging that the burden of surgical diseases such as trauma is substantial, and that essential surgery may be a cost-effective addition to the health system in low and middle-income countries11,12. The goals for this review were (1) to provide a public health perspective on the burden of injury in low and middle-income countries, (2) to discuss the delivery of musculoskeletal trauma care in resource-challenged environments, (3) to highlight deficiencies in physical resources and human resources for health care, (4) to outline approaches to teaching and training, and (5) to describe the information flow between economically developed and underdeveloped regions.
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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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