A study in Managua, Nicaragua, has suggested that using a hospital emergency department based surveillance system overcomes a key problem for estimating work related deaths and injuries in developing countries—capturing data on informal workers. It offers a better prospect for assessing the true size and scope of work related injury, which is generally unknown in the developing world, say its authors.

Work related injuries accounted for about one in five of all injuries seen in the department and work related deaths for about one in 10 of all deaths, according to one year’s data for 2001–2 covering >20 000 patients. The 27 work related deaths outstripped the International Labor Organisation’s total for Nicaragua in 1998. Two thirds of all work related injuries occurred outside a formal workplace—almost half at home and a fifth on the street. Falls were a leading cause of all injuries and deaths, and a sure candidate for investigation and drawing up safety measures. Despite its drawbacks the study has a better chance of its data being more realistic than existing statistics as it analysed all patients seen in the department, without exception.

The world’s workforce is concentrated in developing countries, and here the burden of work related deaths and injury is highest. But current data, based exclusively on the formal sector, only 10% of which gets health coverage in developing countries, grossly underestimates this. With so much work done outside the formal sector, increasingly so with globalisation, better data coverage is essential.