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Oleg O. Bilukha, MD, PhD; Muireann Brennan, MD, MPH; Bradley A. Woodruff, MD, MPH

JAMA. 2003;290:650-653.

Context  Afghanistan is one of the countries most affected by injuries due to landmines and unexploded ordnance.

Objective  To understand the epidemiological patterns and risk factors for injury due to landmines and unexploded ordnance.

Design and Setting  Analysis of surveillance data on landmine and unexploded ordnance injuries in Afghanistan collected by the International Committee of the Red Cross in 390 health facilities in Afghanistan. Surveillance data were used to describe injury trends, injury types, demographics, and risk behaviors of those injured and explosive types related to landmine and unexploded ordnance incidents.

Participants  A total of 1636 individuals injured by landmines and unexploded ordnance, March 2001 through June 2002.

Results  Eighty-one percent of those injured were civilians, 91.6% were men and boys, and 45.9% were younger than 16 years. Children were more likely to be injured by unexploded ordnance (which includes grenades, bombs, mortar shells, and cluster munitions), whereas adults were injured mostly by landmines. The most common risk behaviors for children were playing and tending animals; for adults, these risk behaviors were military activity and activities of economic necessity (eg, farming, traveling). The case-fatality rate of 9.4% is probably underestimated because surveillance predominantly detects those who survive long enough to receive medical care.

Conclusions  Landmine risk education should focus on hazards due to unexploded ordnance for children and on landmine hazards for adults and should address age-specific risk behaviors. Expanding community-based and clinic-based reporting will improve the sensitivity and representativeness of surveillance.

Author Affiliations: Epidemic Intelligence Service, Epidemiology Program Office (Dr Bilukha) and International Emergency and Refugee Health Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health (Drs Bilukha, Brennan, and Woodruff), Centers for Disease Control and Prevention, Atlanta, Ga.

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