RT Journal
A1 Spiegel, David A.
A1 Gosselin, Richard A.
A1 Coughlin, R. Richard
A1 Joshipura, Manjul
A1 Browner, Bruce D.
A1 Dormans, John P.
T1 The Burden of Musculoskeletal Injury in Low and Middle-Income Countries: Challenges and Opportunities
JF The Journal of Bone & Joint Surgery
JO The Journal of Bone & Joint Surgery
YR 2008
FD April 1
VO 90
IS 4
SP 915
OP 923
DO 10.2106/JBJS.G.00637
UL http://dx.doi.org/10.2106/JBJS.G.00637
AB 
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.