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The Global Burden 

Globally, road traffic accidents are the leading cause of death among children and young people aged 5 to 29. Every day, more than 600 children and adolescents die as a result of road traffic injuries. Strikingly, 92 percent of these deaths occur in low- and middle-income countries, even though these nations have only about 60 percent of the world’s vehicles. Children in low-income countries are estimated to be eight times more likely to die from unintentional injuries, including head trauma, compared to those in wealthier countries. 

When looking specifically at traumatic brain injury (TBI), which includes head injuries, the incidence worldwide ranges between 47 and 280 per 100,000 children. In low-resource settings, road traffic accidents account for nearly 40 percent of all paediatric TBIs, and the mortality rate remains around 7 percent. In Tanzania, for example, studies show that road traffic injuries contribute to almost two-thirds of paediatric head trauma cases. 

Why Children Are at Risk 

Children’s unique anatomy makes them particularly vulnerable to head injury. Their heads are proportionally larger compared to their bodies, their skulls are thinner, and their brains are still developing. As a result, even what may appear to be a minor fall, or collision can result in serious neurological damage. In developing countries, the risk is amplified by unsafe road conditions, limited use of helmets, seatbelts and airbags, and less stringent enforcement of safety laws. 

Gaps in Care 

The difference in outcomes between high- and low-income regions is not only due to the causes of injury but also to the systems of care. In wealthier countries, children with severe head injuries are rapidly assessed with CT scans, treated by neurosurgeons, and supported in intensive care units. In many low- and middle-income countries, these services are scarce. Imaging facilities are often unavailable outside major cities, neurosurgeons are few and concentrated in urban centres, and critical care units are limited. While the World Health Organization recommends at least one neurosurgeon per 200,000 people, but many African countries have only a handful serving millions. 

Prevention 

Because treatment capacity is limited in much of the world and treatment only halts further brain damage rather than reversing existing damage prevention is the most effective strategy. Road traffic injuries alone claim more than 186,000 children’s lives each year, with sub-Saharan Africa accounting for more than one-third of these deaths. Measures such as enforcing helmet and seatbelt laws, reducing speeding, and improving road infrastructure have proven to save lives. Yet implementation remains weak in many low-resource regions, leaving children unprotected against entirely preventable injuries. 

Moving Forward 

Paediatric head injury is not just a medical problem; it is also a social, political and economic issue. Families in underprivileged populations often face devastating financial and emotional consequences when a child is injured. Reducing these injuries requires global commitment, which includes investment in trauma care, expansion of imaging and neurosurgical services, training of local healthcare workers, and better rehabilitation support. Equally important is empowering and educating communities to recognise the signs of dangerous head injuries and seek timely help. 

Conclusion 

The tragedy of paediatric head injury is not only that it occurs, but that outcomes vary so greatly depending on where a child is born. With early recognition, prevention, and access to care, most children can recover and lead fulfilling lives. The solutions are already known and, in many cases, cost-effective. What is needed now is global willpower to close the gap. Every child should be given the chance to survive after a head injury irrespective of the where they live or the circumstances. 

Written by Likhith Alakandy