The Rise Of Hand Injuries In Low- And Middle-Income Countries

The hand is the visible part of the brain.
– Immanuel Kant

The hands are an essential part of human function, enabling us to not only perform everyday activities, but also to communicate and express our emotions. Research and education on global health issues generally tend to focus on life-threatening conditions, such as HIV and cancer; rather than disabling but non-life-threatening injuries. This trend has resulted in hand injuries to be treated as a low priority public health issue. However, hand injuries pose a significant challenge in developed nations, and even more so in developing nations. Hand injuries cause a financial burden and are associated with decreased physical and mental health, as well as a decreased quality of life.

With rapid industrialization, the incidence of hand injuries is expected to continuously rise in low- and middle-income countries (LMICs). In response to this prediction, there is a growing need to investigate the risk factors, occupational hazards and most cost-effective interventions for the prevention of hand injuries in LMICs. We recently reviewed the existing research on hand injuries in LMICs to determine how the global burden of hand injuries can be reduced.

Barriers to Occupational Health

Research shows that the majority of hand injuries occur in the workplace, commonly involving machinery. Understanding this common cause of injury suggests that behavioral and environmental modifications, as well as work-related public awareness may be the most effective initiative to decrease the burden of hand injuries in LMICs. Research on occupational hazards in developing countries has suggested that there is a financial barrier preventing the implementation of proper safety devices in the workplace. Protective equipment is known to reduce the risk of occupational injuries in a number of occupational settings and while it may require a substantial overhead, has the ability to decrease the burden these injuries have on individuals and society.

Barriers to Effective Treatment

LMICs often lack the emergency medical systems required for proper management of hand injuries. Many trauma centers in LMICs either do not have a properly trained hand surgeon or are not equipped to treat hand trauma (e.g. metal pins or screws). In a study assessing hand injuries in Ethiopia, as many as 78% of patients were treated non-operatively because there was “no operative facility.” Patients who do not have access to proper treatment have an increased risk of poor functional outcomes and a decreased probability of returning to previous employment.

The absence of a worker’s compensation system in LMICs may lead to delayed treatment and a lack of employer responsibility for workplace injuries. Prompt treatment for complex hand injuries provides better outcomes. Delays in time from injury to treatment due to cost, access, etc., can potentially increase the disability caused by hand injuries.

Burden of Hand Injuries

Unlike many other types of injuries, the majority of economic burden from hand injuries results from disability rather than mortality. Hand injuries can lead to a significant decline in physical activity, negatively impacting activities of daily living and work capacity. Hand injuries in LMICs have been associated with prolonged absence and inability to work, ranging from 30 days to 4.4 months. Some workers may be unable to return to work altogether, or may need to secure a new job with modified physical requirements. The direct and indirect costs associated with hand injuries pose a significant financial burden to LMICs on a nationwide and individual level. Further research is needed at this time to determine the total long term indirect cost of hand injuries.

Future Directions

Economic development is likely to result in increased rates of hand injuries in LMICs, posing a financial burden, functional limitations and decreased quality of life. Additional research is needed to estimate the burden of hand injuries in LMICs, identify risk factors, and evaluate cost-effective solutions. Therefore, we recommend greater attention and funds allocated to research, prevention and treatment of hand injuries in LMICs.

Our findings and recommendations for future research are described in detail in the article entitled, Hand injuries in low- and middle-income countries: systematic review of existing literature and call for greater attention, recently published in the journal Public Health. This work was led by Dr. Zuhaib Ibrahim from The Institute for Advanced Reconstruction, Drs. Charalampos Siotos and Lifchez from the Department of Plastic and Reconstructive Surgery at Johns Hopkins Hospital and Dr. Hyder from Johns Hopkins Bloomberg School of Public Health.