Commentary: Time for a re-assessment of the incidence of intentional and unintentional injury in India and South East Asia

Eddleston, Michael, and Flemming Konradsen. "Commentary: Time for a re-assessment of the incidence of intentional and unintentional injury in India and South East Asia." International journal of epidemiology 36, no. 1 (2007): 208-211.


In this issue of International Journal of Epidemiology, Gajalakshmi and Peto publish their results from a community study of deaths from injury in a rural district of Tamil Nadu, south India. The results reported are just one component of a large verbal autopsy study in which families were interviewed about the cause of death of 38 836 people. The study adds greatly to our knowledge of the epidemiology of injury in rural South Asia.

The authors found that 7167 (18.5%) of 38 836 deaths in Villupuram district (population 2.5 million) were due to injury—an incidence of 130/100 000 per year, with incidences in men and women of 160 and 98/100 000, respectively. Intentional self-harm was responsible for 3429 (47.8%) of these deaths—an incidence of 62/100 000 per year (men 71, female 53). The most common method was self-poisoning (nearly always with pesticides), responsible for 53% of deaths. Hanging caused 34% and burning 13% of self-harm deaths. Three-quarters occurred in the 15–44 age group. This rate of fatal self-harm is dreadful—it is more than five times the rate in western countries and almost three times the rate in China.1,,2

Gajalakshmi’s and Peto’s results are very similar to those of the excellent prospective community study being run by the Christian Medical College, Vellore, in the Kaniyambadi Block of Tamil Nadu (Figure 1).3–5 In these 85 villages (population 108 000), injury causes 18.9% of deaths with an incidence of 137/100 000 per year. Self-harm is responsible for a higher proportion compared with Villupuram—60% vs 48%—but hanging and poisoning are, again, the most common means, causing more than 85% of self-harm deaths.3,,5 It is possible that the rates of self-harm are higher due to a reporting bias in Villupuram. Since suicide is still illegal in India,6the fact that the …

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