The findings in this report are subject to at least four limitations.
First, because surveillance for landmine- and UXO-related injuries is predominantly
clinic-based, it probably undercounts victims who die before reaching the
clinic, whose injuries are too minor to seek medical care, or who do not have
access to medical facilities. The overall sensitivity of the system is unknown
but is thought to be <50%.5,7 Second,
the reported case-fatality rate probably is underestimated because surveillance
detects predominantly victims who survive long enough to receive medical care.
Survey data from Afghanistan and other countries have shown case-fatality
rates as high as 50%-55%.8,9 Third,
the time trends in recorded injuries should be interpreted with caution because
of the low sensitivity of the system and variability in system coverage over
time depending on the availability of resources, the security situation, and
other factors. However, sensitivity of the system to landmine-related injuries
versus sensitivity to UXO-related injuries probably has not changed substantially
over time, suggesting that the data reflect a true increase in the proportion
of UXO-related injuries among all recorded injuries. Finally, although this
surveillance system identifies acute injuries, it does not monitor long-term
disability or psychological impact on victims and their families, which can
add substantially to the public health burden.