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.