Road traffic injuries are a major cause of death and disability globally, with a disproportionate number occurring in developing countries. In 1998, developing countries accounted for over 85% of all road traffic crash deaths and 96% of children killed. About 90% of global disability-adjusted life years lost due to road traffic injuries occur in developing countries. The problem is increasing rapidly due to rapid motorization and other factors. However, public policy responses have been inadequate. Road traffic injuries disproportionately affect the productive age group (15-44 years) and children in developing countries. In 1998, 51% of fatalities and 59% of disability-adjusted life years lost occurred in the productive age group. Children in developing countries have high fatality rates, with rates six times higher than in high-income countries. The highest burden of injuries and fatalities is borne by poor people, who are often pedestrians, passengers, and cyclists. In developing countries, pedestrians, passengers, and cyclists account for around 90% of road traffic injury deaths. Urban pedestrians account for 55-70% of deaths. The choice of transport is often influenced by socioeconomic factors, especially income. In Kenya, people with little education are more likely to use unsafe transport modes. The growth in motor vehicle numbers is a major factor in the rising toll of road traffic injuries. In India, the number of four-wheel motor vehicles increased significantly between 1990 and 1993, and is projected to rise further. In Vietnam, deaths and injuries from road traffic crashes increased significantly between 2000 and 2001. Poor enforcement of traffic safety regulations is another reason for the high burden of road traffic injuries in developing countries. Corruption and inadequate resources contribute to this problem. Inadequate public health infrastructure also contributes, as many hospitals lack the necessary resources to treat trauma cases. Poor access to health services is another factor, as vulnerable groups cannot afford out-of-pocket payments for health care. In Ghana, only 27% of people injured in road crashes used hospital services. Policies to reduce road traffic injuries in developing countries must be based on local evidence and research, and designed for the particular social, political, and economic circumstances found in developing countries. International efforts should be made to promote learning among developing countries about policies that can successfully reduce the injury burden from road traffic crashes.Road traffic injuries are a major cause of death and disability globally, with a disproportionate number occurring in developing countries. In 1998, developing countries accounted for over 85% of all road traffic crash deaths and 96% of children killed. About 90% of global disability-adjusted life years lost due to road traffic injuries occur in developing countries. The problem is increasing rapidly due to rapid motorization and other factors. However, public policy responses have been inadequate. Road traffic injuries disproportionately affect the productive age group (15-44 years) and children in developing countries. In 1998, 51% of fatalities and 59% of disability-adjusted life years lost occurred in the productive age group. Children in developing countries have high fatality rates, with rates six times higher than in high-income countries. The highest burden of injuries and fatalities is borne by poor people, who are often pedestrians, passengers, and cyclists. In developing countries, pedestrians, passengers, and cyclists account for around 90% of road traffic injury deaths. Urban pedestrians account for 55-70% of deaths. The choice of transport is often influenced by socioeconomic factors, especially income. In Kenya, people with little education are more likely to use unsafe transport modes. The growth in motor vehicle numbers is a major factor in the rising toll of road traffic injuries. In India, the number of four-wheel motor vehicles increased significantly between 1990 and 1993, and is projected to rise further. In Vietnam, deaths and injuries from road traffic crashes increased significantly between 2000 and 2001. Poor enforcement of traffic safety regulations is another reason for the high burden of road traffic injuries in developing countries. Corruption and inadequate resources contribute to this problem. Inadequate public health infrastructure also contributes, as many hospitals lack the necessary resources to treat trauma cases. Poor access to health services is another factor, as vulnerable groups cannot afford out-of-pocket payments for health care. In Ghana, only 27% of people injured in road crashes used hospital services. Policies to reduce road traffic injuries in developing countries must be based on local evidence and research, and designed for the particular social, political, and economic circumstances found in developing countries. International efforts should be made to promote learning among developing countries about policies that can successfully reduce the injury burden from road traffic crashes.