**4. Demographics of lightning injury**

Lightning was the second largest storm killer in the United States for over a century, exceeded only by floods [5]. Since data collection began in the United States, lightning deaths have roughly paralleled the percentage of the population living in rural areas ([20], **Figure 1**). Although this has been a consistent finding in countries as they become "developed" [24], urbanization is not the only factor governing lightning injury. In Africa, as people move to cities to find work, huge shantytowns often arise on the periphery of cities (**Figure 3**). These dwellings do not meet the

#### **Figure 3.**

*Typical African dwellings and work areas, particularly in rural areas [1]. (A) Mudbrick with generationsold thatch roofs or sheet metal held down by rocks. In some areas, chicken wire may be cast over the thatch to prevent monkeys and baboons from disrupting the roof. In others, car tires may be placed on the roof because it is thought that their "rubber" will protect the building from lightning. (B) Soweto shantytown. Soweto is a million-plus populated southwest township near Johannesburg, South Africa, and the birthplace of Nelson Mandela. (courtesy Derek Elsom).*

definition of "lightning-safe": a substantial, fully enclosed building with plumbing, wiring, and metal structural components running through the walls. Not only do buildings with these features tend to be less likely to collapse in a storm, but the metal and pipes act as a modified "Faraday cage" channeling lightning through the walls and around the inhabitants [5]. Lightning safety advocates avoid using the world "shelter" as almost all "shelters" are not lightning-safe (bus shelters, golf shelters, rain shelters, picnic shelters, etc.) [5].

Another "lightning-safe" area to choose in a thunderstorm is nearly any fully enclosed metal vehicle such as a school bus, automobile, truck, and most mechanized farming equipment. Open carts, including boda bodas, golf carts, and others are not lightning-safe [20, 21].

To illustrate the difference substantial, lightning-safe construction makes, **Figure 4** compares the relative frequency of locations of U.S. deaths from lightning from the 1890s, before indoor plumbing and wiring was common, with the most recent decade for which data was available [39]. In the 1890s, over half of the U.S. population lived in rural areas where few buildings had indoor plumbing, electrical wiring, or what would nowadays be considered reasonably lightning-safe construction. **Figure 4** shows that the largest percentage of deaths in the 1890s occurred indoors because when lightning hit them, they were likely to collapse on the inhabitants and any surviving inhabitant was likely to have lightning injuries.

**111**

related diagnoses [5, 6].

*Mitigating the Hazard of Lightning Injury and Death across Africa*

As housing construction became more substantial and more likely to be lightning-safe, the share of indoor lightning deaths decreased to nearly zero and has certainly been less than one per year for the past two decades in the United States. Similarly, as farming in the United States became mechanized, fewer people were "exposed" to lightning. Nowadays, the vast majority of people killed by lightning in the Unites States and other developed countries are pursuing recreational and other outdoor nonwork activities such as organized sports, gardening, fishing, boating, or

*Comparison of the percentage of locations where U.S. lightning fatalities occurred in the 1890s versus the* 

**Figure 4** shows the second most common location of U.S. deaths in the 1890s was for labor-intensive outdoor activities with farming coming a close third. **Figure 4** is useful because the U.S. 1800's data gives a reasonable approximation of where to expect lightning deaths to occur in developing countries including sub-

The fatality rate from lightning in the United States is now more than two orders of magnitude lower than a century ago ([1, 20, 40], **Figure 1**). Over the last decade, lightning deaths in the United States have averaged 27 per year or less than 1 in 12,000,000 population [39]. The fatality rate per capita has become very low in developed countries during the last century due to widespread availability of "lightning-safe" structures and metal-topped, fully enclosed vehicles, extensive public education by broadcast meteorologists and in-print and electronic media, mechanized agriculture, weather apps, good forecasting that incorporates lightning warnings, and other factors, including the fact that there is simply less lightning in most developed countries, which tend to be in temperate climates, compared to

**Table 1** shows many differences in known demographics of lightning injuries between developed and developing countries. In developed countries, it is well known that the injury to death ratio is about 9:1, so that 90% survive [6, 16, 41]. The injury/death ratio in Africa and developing countries is unknown but is expected to be lower since fewer lightning-safe locations are available, resulting in a higher proportion of deaths. More people die per lightning event in the developing world than in the United States and other developed countries, particularly in agricultural and school events [42, 43]. Injuries, in general, are less well documented as some victims may not seek medical care immediately and most countries do not require reporting of these medical visits nor of lightning-

Whereas the male-to-female fatality rate in developed countries is consistently about 3:1 [2], many developing countries have a large portion of their population involved in labor-intensive agriculture during the daytime when thunderstorms are

running and are almost always within a few feet of safety [1].

tropical and subtropical areas of the world [1, 5, 40].

Saharan Africa where over 90% of buildings are not lightning-safe.

*DOI: http://dx.doi.org/10.5772/intechopen.90468*

*2007–2016 decade (updated from [39]). (©Ronald L. Holle).*

**Figure 4.**

*Mitigating the Hazard of Lightning Injury and Death across Africa DOI: http://dx.doi.org/10.5772/intechopen.90468*

**Figure 4.**

*Public Health in Developing Countries - Challenges and Opportunities*

definition of "lightning-safe": a substantial, fully enclosed building with plumbing, wiring, and metal structural components running through the walls. Not only do buildings with these features tend to be less likely to collapse in a storm, but the metal and pipes act as a modified "Faraday cage" channeling lightning through the walls and around the inhabitants [5]. Lightning safety advocates avoid using the world "shelter" as almost all "shelters" are not lightning-safe (bus shelters, golf

*Typical African dwellings and work areas, particularly in rural areas [1]. (A) Mudbrick with generationsold thatch roofs or sheet metal held down by rocks. In some areas, chicken wire may be cast over the thatch to prevent monkeys and baboons from disrupting the roof. In others, car tires may be placed on the roof because it is thought that their "rubber" will protect the building from lightning. (B) Soweto shantytown. Soweto is a million-plus populated southwest township near Johannesburg, South Africa, and the birthplace of Nelson* 

Another "lightning-safe" area to choose in a thunderstorm is nearly any fully enclosed metal vehicle such as a school bus, automobile, truck, and most mechanized farming equipment. Open carts, including boda bodas, golf carts, and others

To illustrate the difference substantial, lightning-safe construction makes,

**Figure 4** compares the relative frequency of locations of U.S. deaths from lightning from the 1890s, before indoor plumbing and wiring was common, with the most recent decade for which data was available [39]. In the 1890s, over half of the U.S. population lived in rural areas where few buildings had indoor plumbing, electrical wiring, or what would nowadays be considered reasonably lightning-safe construction. **Figure 4** shows that the largest percentage of deaths in the 1890s occurred indoors because when lightning hit them, they were likely to collapse on the inhabitants and any surviving inhabitant was likely to have

shelters, rain shelters, picnic shelters, etc.) [5].

are not lightning-safe [20, 21].

*Mandela. (courtesy Derek Elsom).*

**110**

**Figure 3.**

lightning injuries.

*Comparison of the percentage of locations where U.S. lightning fatalities occurred in the 1890s versus the 2007–2016 decade (updated from [39]). (©Ronald L. Holle).*

As housing construction became more substantial and more likely to be lightning-safe, the share of indoor lightning deaths decreased to nearly zero and has certainly been less than one per year for the past two decades in the United States. Similarly, as farming in the United States became mechanized, fewer people were "exposed" to lightning. Nowadays, the vast majority of people killed by lightning in the Unites States and other developed countries are pursuing recreational and other outdoor nonwork activities such as organized sports, gardening, fishing, boating, or running and are almost always within a few feet of safety [1].

**Figure 4** shows the second most common location of U.S. deaths in the 1890s was for labor-intensive outdoor activities with farming coming a close third. **Figure 4** is useful because the U.S. 1800's data gives a reasonable approximation of where to expect lightning deaths to occur in developing countries including sub-Saharan Africa where over 90% of buildings are not lightning-safe.

The fatality rate from lightning in the United States is now more than two orders of magnitude lower than a century ago ([1, 20, 40], **Figure 1**). Over the last decade, lightning deaths in the United States have averaged 27 per year or less than 1 in 12,000,000 population [39]. The fatality rate per capita has become very low in developed countries during the last century due to widespread availability of "lightning-safe" structures and metal-topped, fully enclosed vehicles, extensive public education by broadcast meteorologists and in-print and electronic media, mechanized agriculture, weather apps, good forecasting that incorporates lightning warnings, and other factors, including the fact that there is simply less lightning in most developed countries, which tend to be in temperate climates, compared to tropical and subtropical areas of the world [1, 5, 40].

**Table 1** shows many differences in known demographics of lightning injuries between developed and developing countries. In developed countries, it is well known that the injury to death ratio is about 9:1, so that 90% survive [6, 16, 41]. The injury/death ratio in Africa and developing countries is unknown but is expected to be lower since fewer lightning-safe locations are available, resulting in a higher proportion of deaths. More people die per lightning event in the developing world than in the United States and other developed countries, particularly in agricultural and school events [42, 43]. Injuries, in general, are less well documented as some victims may not seek medical care immediately and most countries do not require reporting of these medical visits nor of lightningrelated diagnoses [5, 6].

Whereas the male-to-female fatality rate in developed countries is consistently about 3:1 [2], many developing countries have a large portion of their population involved in labor-intensive agriculture during the daytime when thunderstorms are


#### **Table 1.**

*Demographics of lightning injury (©MACooper).*

most common. No lightning-safe locations are typically available to these people, and deaths and injuries are often nearly equally distributed between males and females [5, 41, 44–46]. A recent study of labor-intensive agriculture in India and Bangladesh shows that 47% of the fatalities and injuries were females as they worked during the daytime hours when thunderstorms are most frequent [39, 46]. In addition, dwellings occupied outside of working hours often are not lightning-safe due to their construction of mud brick with thatch or sheet metal roofing (**Figure 3**).

While lightning deaths in developed countries rarely involve more than one person, and injuries to groups are few, deaths in developing countries often involve more than one person, sometimes with more than ten deaths per event [35]. Sometimes this is because people, particularly students, are packed together in classrooms and churches or walking with several others [1]. This leads some experts to hypothesize that ground current, responsible for at least 50% of deaths in developed countries, may play an even larger role in these situations [20, 47].

Multiple studies done by Holle [2] have shown that the majority of those killed die during the afternoon hours when thunderstorms are more likely to occur. In more developed countries, the dominant profile of lightning casualties is the young male. Risk-taking in recreation, workplaces, and organized sports tends to be dominated by males between about 15 and 30 years old. In lesser developed countries, the distribution by ages is much more dispersed. The lack of lightning-safe dwellings, schools and workplaces means that all ages and both genders are equally vulnerable at all times [27, 34, 42, 46].

#### **5. Risk factors for lightning injury**

The factors that increase the risk of lightning injury are well known ([1], **Table 2**). Like infectious diseases, lightning injuries are related to exposure. Exposure is related to the amount of lightning that occurs in a given area over time (**Table 2**, dark orange), common socioeconomic factors (mid-orange), and cultural beliefs (light orange and **Tables 2** and **3**) about lightning that affect behavior.

The frequency of lightning in a given area is measured as strokes/km2 /year (stroke density), which can vary substantially depending on season, topography, and other factors but, in total, is reasonably unchanging from year to year [38]. Most lightning occurs in cloud (IC) than cloud-to-ground (CG), but *all* lightning is dangerous because any stroke can change direction and start toward the ground where people are located. Worldwide lightning data over decades has shown no change that can be attributed to climate change, despite speculations to the contrary [48].

Lightning stroke density is higher in tropical and subtropical areas of the world, precisely where people are less likely to have substantial, developed housing and

**113**

people at risk.

*Mitigating the Hazard of Lightning Injury and Death across Africa*

**Factors that increase risk Factors that decrease risk** High lightning stroke density Low lightning stroke density Large rural population Mostly urban population Increasing population Stable or decreasing populations

Mechanized farming and stricter laws governing

Easy availability of lightning-safe buildings and fully enclosed metal vehicles within easy reach. Widespread personal knowledge of lightning injury

High-quality lightning detection data incorporated

Weather forecasting systems with high-quality forecasts and weather apps available to the public on

Easy access to high-quality medical care

An active media; news reports of injuries; enthusiastic public education with wide access to lightning safety information; knowledge of how lightning is formed and where it is statistically more

High-quality building construction involving wiring, plumbing, and metal components in the walls and roof combine to act as a 'Faraday cage' to safely divert lightning energy around inhabitants. Codecompliant lightning protection mandated for public buildings and those frequently inhabited by large

work conditions

numbers of people

avoidance behavior

into weather forecasts

a free and real-time basis

likely to hit

where work is more often outdoors [48]. The Democratic Republic of the Congo and Lake Maracaibo in Venezuela are hotspots for the highest stroke density in the world

Despite studies showing stable negative population growth in most developed

The vast majority of factors determining risk of lightning injury are socioeconomic and, therefore, could be modified given adequate resources, education, and infrastructure improvement. During the day, people are at higher risk of lightning injury when they are involved in labor-intensive outdoor work such as animal husbandry and farming, when they do not have access to "lightning-safe" buildings for habitation and work, and when they are exposed as they walk to the market, work near their homes or on fishing boats, or attend school and church either outdoors or in non-lightning-safe buildings [1, 35–37]. At night, as people sleep in lightning-unsafe dwellings, entire families are at risk. It is difficult for people who have not worked extensively in Africa to understand life there, but the fact is that nearly everyone in sub-Saharan Africa is at risk 24/7/365 regardless of the activities

countries, the population of Africa continues to increase, putting more

*Risk factors for lightning injury and death. Modified from Cooper and Tushemereirwe [1] ©MACooper.*

[48]. **Figure 5** shows stroke density map of Africa.

they are pursuing [10, 16–26, 29–37, 42, 49–51].

*DOI: http://dx.doi.org/10.5772/intechopen.90468*

Labor-intensive, outdoor work such as farming,

Inadequate building construction. No lightning protection mandated for public and frequently inhabited buildings; lack of technical knowledge about lightning protection; use of lightning protection materials that are not compliant with international lightning protection codes

Lack of lightning-safe areas for easy evacuation; lack of proven actions that individuals can take to

Lack of reliable and timely weather forecasts or forecasts that are only available to specific sectors

Delayed or nonexistent access to high-quality

Little or no valid public education on lightning safety; strongly held beliefs that injuries are inevitable, regardless of personal behavior, and that lightning is called down by witches and other

Low literacy rate; multiple languages High literacy rate

No or little lightning detection data or nonavailability to the public

of the economy, primarily aviation

fishing, and animal husbandry

decrease risk

medical care

cultural beliefs

**Table 2.**


#### **Table 2.**

*Public Health in Developing Countries - Challenges and Opportunities*

Injury/death ratio Unknown, expected to be lower due to

*Demographics of lightning injury (©MACooper).*

most common. No lightning-safe locations are typically available to these people, and deaths and injuries are often nearly equally distributed between males and females [5, 41, 44–46]. A recent study of labor-intensive agriculture in India and Bangladesh shows that 47% of the fatalities and injuries were females as they worked during the daytime hours when thunderstorms are most frequent [39, 46]. In addition, dwellings occupied outside of working hours often are not lightning-safe due to their construction of mud brick with thatch or sheet metal roofing (**Figure 3**). While lightning deaths in developed countries rarely involve more than one person, and injuries to groups are few, deaths in developing countries often involve more than one person, sometimes with more than ten deaths per event [35]. Sometimes this is because people, particularly students, are packed together in classrooms and churches or walking with several others [1]. This leads some experts to hypothesize that ground current, responsible for at least 50% of deaths in devel-

**Measure Developing countries Developed countries** Deaths/million Unknown Well documented (0.01–0.5/million)

Number of deaths per event Multiple deaths Single deaths

lack of "lightning-safe" areas

Male/female deaths Tends to be more equal 3:1 Age range Equal risk for everyone Males age 15–30

oped countries, may play an even larger role in these situations [20, 47].

vulnerable at all times [27, 34, 42, 46].

**5. Risk factors for lightning injury**

Multiple studies done by Holle [2] have shown that the majority of those killed die during the afternoon hours when thunderstorms are more likely to occur. In more developed countries, the dominant profile of lightning casualties is the young male. Risk-taking in recreation, workplaces, and organized sports tends to be dominated by males between about 15 and 30 years old. In lesser developed countries, the distribution by ages is much more dispersed. The lack of lightning-safe dwellings, schools and workplaces means that all ages and both genders are equally

The factors that increase the risk of lightning injury are well known ([1], **Table 2**). Like infectious diseases, lightning injuries are related to exposure. Exposure is related to the amount of lightning that occurs in a given area over time (**Table 2**, dark orange), common socioeconomic factors (mid-orange), and cultural beliefs (light orange and **Tables 2** and **3**) about lightning that affect behavior. The frequency of lightning in a given area is measured as strokes/km2

(stroke density), which can vary substantially depending on season, topography, and other factors but, in total, is reasonably unchanging from year to year [38]. Most lightning occurs in cloud (IC) than cloud-to-ground (CG), but *all* lightning is dangerous because any stroke can change direction and start toward the ground where people are located. Worldwide lightning data over decades has shown no change that

can be attributed to climate change, despite speculations to the contrary [48].

Lightning stroke density is higher in tropical and subtropical areas of the world, precisely where people are less likely to have substantial, developed housing and

/year

10:1

**112**

**Table 1.**

*Risk factors for lightning injury and death. Modified from Cooper and Tushemereirwe [1] ©MACooper.*

where work is more often outdoors [48]. The Democratic Republic of the Congo and Lake Maracaibo in Venezuela are hotspots for the highest stroke density in the world [48]. **Figure 5** shows stroke density map of Africa.

Despite studies showing stable negative population growth in most developed countries, the population of Africa continues to increase, putting more people at risk.

The vast majority of factors determining risk of lightning injury are socioeconomic and, therefore, could be modified given adequate resources, education, and infrastructure improvement. During the day, people are at higher risk of lightning injury when they are involved in labor-intensive outdoor work such as animal husbandry and farming, when they do not have access to "lightning-safe" buildings for habitation and work, and when they are exposed as they walk to the market, work near their homes or on fishing boats, or attend school and church either outdoors or in non-lightning-safe buildings [1, 35–37]. At night, as people sleep in lightning-unsafe dwellings, entire families are at risk. It is difficult for people who have not worked extensively in Africa to understand life there, but the fact is that nearly everyone in sub-Saharan Africa is at risk 24/7/365 regardless of the activities they are pursuing [10, 16–26, 29–37, 42, 49–51].

#### **A small sample of common beliefs about lightning in Africa**

Lightning is punishment from a god for wrongdoing.

Thunder is a warning that the god who controls lightning is walking on the earth.

Muti (folk medicine in Africa) can ward off lightning damage to a house.

Wearing red attracts lightning.

Mirrors should be covered during thunderstorms because they can attract or reflect lightning to kill someone nearby.

Individuals can call lightning down to harm others; witches can be hired to call down lightning on an enemy.

It is necessary to hire a sangoma to assure good weather for your wedding or other important event. If the weather is bad, it is because someone who wishes you harm hired a stronger sangoma.

A person who has been injured by lightning requires purification by traditional healers before it is safe to touch them (delaying resuscitation and first aid efforts) or before the person can be prepared for burial.

#### **Table 3.**

*Common cultural beliefs about lightning. (©MACooper).*

*Lightning stroke density per square km per year from the global lightning dataset GLD360 network from 2014 through 2018. The density map depicts 1,568,391,741 strokes. Scale is at lower left; grid size is 10 by 10 km [48].*

Most developing countries do not have or may not enforce building codes that require lightning protection (LP) for public buildings such as schools, churches, hospitals, and other frequently inhabited buildings. Proper LP is delineated in internationally recognized codes [52, 53]. The design and installation of LP is a very

**115**

**Figure 6.**

*strike. (used with tribal permission).*

*Mitigating the Hazard of Lightning Injury and Death across Africa*

specialized field and beyond discussion in this chapter [47]. In practice, it is seldom part of the curricula for engineers or architects and is nearly always "learned on the job" although more countries are instituting LP training and certification. Because of this complexity, it is nearly impossible for the average local official, school principal, or administrator to judge between code-compliant plans and those offered by fasttalking charlatans or by well-meaning but untrained LP purveyors. Further discussion of the unvalidated claims of those using early streamer emitters (ESE) and other fraudulent practices is beyond this text, although an overview can be accessed at [47]. Unfortunately, the infiltration of purveyors of ESE and other unproven philosophies of lightning protection has resulted in multiple countries adopting lightning protection codes that are not compliant with the international IEC standards, notably France, Spain, Turkey, and many others. All wishing to have LP installed should inquire what code will be used before accepting a contract or design [47, 52, 53]. A factor that makes lightning injuries strikingly different in the developing world is the combination of keraunoparalysis (KP) (kerauno—lightning) and building construction using dry thatch [5, 54–57]. Lightning injury often causes a temporary paralysis that lasts for at least several minutes to hours. This is particularly a problem for families working or sleeping inside their mudbrick home roofed with tinder-dry, generations-old thatch. KP can prevent even the most fit young person from escaping a home as the burning thatch starts to fall ([5, 54, 55], **Figure 6**). These are the injuries that result in the media writing "burned beyond recognition" or "charred," terms that are never seen in the United States or other

Governmentally, many developing countries have little or no access to lightning detection data sources. Most meteorological authorities, while mandated to serve a country's airports to assure international flights, commerce, and tourism, have limited resources and no mandated obligation to warn citizens of droughts, floods, lightning, or other weather hazards [40, 47, 58, 59]. There are no weather apps in most of these countries, and those that exist may access poor data sources or incorporate time lags of 20–30 minutes, making their displays useless for lightning safety and injury prevention. Near-real-time warnings (delayed by less than 30 seconds) are available on a subscription basis from several vendors but are largely unaffordable or unknown to industry, government meteorological authorities, and the public in Africa [40, 47]. ACLENet is piloting this type of warning system at a few

*Eleven tribal leaders were killed when the thatch building where they were meeting caught fire from a lightning* 

*DOI: http://dx.doi.org/10.5772/intechopen.90468*

developed countries [21, 55].

schools in Uganda.

#### *Mitigating the Hazard of Lightning Injury and Death across Africa DOI: http://dx.doi.org/10.5772/intechopen.90468*

*Public Health in Developing Countries - Challenges and Opportunities*

Thunder is a warning that the god who controls lightning is walking on the earth. Muti (folk medicine in Africa) can ward off lightning damage to a house.

weather is bad, it is because someone who wishes you harm hired a stronger sangoma.

Mirrors should be covered during thunderstorms because they can attract or reflect lightning to kill someone

Individuals can call lightning down to harm others; witches can be hired to call down lightning on an enemy. It is necessary to hire a sangoma to assure good weather for your wedding or other important event. If the

A person who has been injured by lightning requires purification by traditional healers before it is safe to touch them (delaying resuscitation and first aid efforts) or before the person can be prepared for burial.

**A small sample of common beliefs about lightning in Africa**

Lightning is punishment from a god for wrongdoing.

*Common cultural beliefs about lightning. (©MACooper).*

Wearing red attracts lightning.

nearby.

**Table 3.**

Most developing countries do not have or may not enforce building codes that require lightning protection (LP) for public buildings such as schools, churches, hospitals, and other frequently inhabited buildings. Proper LP is delineated in internationally recognized codes [52, 53]. The design and installation of LP is a very

*Lightning stroke density per square km per year from the global lightning dataset GLD360 network from 2014 through 2018. The density map depicts 1,568,391,741 strokes. Scale is at lower left; grid size is 10 by 10 km [48].*

**114**

**Figure 5.**

specialized field and beyond discussion in this chapter [47]. In practice, it is seldom part of the curricula for engineers or architects and is nearly always "learned on the job" although more countries are instituting LP training and certification. Because of this complexity, it is nearly impossible for the average local official, school principal, or administrator to judge between code-compliant plans and those offered by fasttalking charlatans or by well-meaning but untrained LP purveyors. Further discussion of the unvalidated claims of those using early streamer emitters (ESE) and other fraudulent practices is beyond this text, although an overview can be accessed at [47]. Unfortunately, the infiltration of purveyors of ESE and other unproven philosophies of lightning protection has resulted in multiple countries adopting lightning protection codes that are not compliant with the international IEC standards, notably France, Spain, Turkey, and many others. All wishing to have LP installed should inquire what code will be used before accepting a contract or design [47, 52, 53].

A factor that makes lightning injuries strikingly different in the developing world is the combination of keraunoparalysis (KP) (kerauno—lightning) and building construction using dry thatch [5, 54–57]. Lightning injury often causes a temporary paralysis that lasts for at least several minutes to hours. This is particularly a problem for families working or sleeping inside their mudbrick home roofed with tinder-dry, generations-old thatch. KP can prevent even the most fit young person from escaping a home as the burning thatch starts to fall ([5, 54, 55], **Figure 6**). These are the injuries that result in the media writing "burned beyond recognition" or "charred," terms that are never seen in the United States or other developed countries [21, 55].

Governmentally, many developing countries have little or no access to lightning detection data sources. Most meteorological authorities, while mandated to serve a country's airports to assure international flights, commerce, and tourism, have limited resources and no mandated obligation to warn citizens of droughts, floods, lightning, or other weather hazards [40, 47, 58, 59]. There are no weather apps in most of these countries, and those that exist may access poor data sources or incorporate time lags of 20–30 minutes, making their displays useless for lightning safety and injury prevention. Near-real-time warnings (delayed by less than 30 seconds) are available on a subscription basis from several vendors but are largely unaffordable or unknown to industry, government meteorological authorities, and the public in Africa [40, 47]. ACLENet is piloting this type of warning system at a few schools in Uganda.

#### **Figure 6.**

*Eleven tribal leaders were killed when the thatch building where they were meeting caught fire from a lightning strike. (used with tribal permission).*

Many of the most lightning injury-prone countries have inadequate or hardto-reach medical care and other supports such as trained personnel, ambulance services, first aid providers, and other first responders [47]. Besides the high exposure and risk of lightning strike, victims also have less chance of survival during the acute phase or access to specialized services such as cognitive therapy and chronic pain management for those who survive [5, 16, 55].

All of the socioeconomic factors listed in **Table 2** could be addressed and improved, but the cost and time to do so would be enormous and prohibitive for most African countries which may already be economically challenged. Public education, however, does not need to cost nearly as much as revising buildings and medical infrastructure [18, 60, 61], and it is probably the easiest and fastest way to make a difference [18, 60–62]. ACLENet has worked with other agencies in Uganda to begin public education through television broadcasts and newspaper inserts which teachers often hang as classroom posters and use for lesson plans [63].

The third major set of contributors to risk are the long-held cultural beliefs about lightning (**Table 2** light orange), a small sample of which are listed in **Table 3**. These beliefs have been taught for generations and are nearly impossible to counter except by persistent public education or by community elders who have been trained [64–66]. In some countries, if a family member has been injured by lightning, communities may shun the family, believing the family to be cursed and forcing them to leave their communities, property, and friends to start over [30]. In the Democratic Republic of the Congo, a head teacher and two teachers at a private school were imprisoned after being accused of "calling down lightning" to kill students at the public school in order to induce parents to enroll their children in their private school [65]. Widows or other women with no family to protect them may be stoned as witches if someone in their village is killed by lightning [64]. Other common myths can be found in the monthly ACLENet newsletters [65].

#### **6. Mechanisms of lightning injury**

Medically, lightning injury could be investigated from a number of different approaches including cellular physiology or electrical field effects, flashover versus internal flow of energy, and others [5, 47]. However, considering the five common electrical mechanisms of injury is the most useful for prevention and lightning safety education [5, 67]. To complicate further, these can be combined, and blunt or concussive trauma/barotrauma may be overlaid on any of the five [5, 67, 68]. **Figure 7** shows the relative distribution of these mechanisms in developed countries. The distribution is not known in developing countries, but it is suspected that ground current plays an even larger role.

*Ground current (also called earth potential rise and step voltage)*: The mechanism that kills the most people is ground current, where lightning strikes the surface of the earth and spreads to nearby people. It can affect a large number of people either inside or outside an unprotected building. Children crowded together in unprotected school buildings are at particular risk [42].

*Side flash/splash*: This occurs when trees, poles, towers, and many other objects that are not necessarily tall are struck and a portion of the lightning jumps to a nearby person.

*Upward streamer (leader)*: As a thundercloud moves above the earth, opposite charges are induced on the surface of the earth and in objects on the ground under the cloud whether they are a tree, a home, a person, or a blade of grass. Upward streamers, not usually visible from these objects, will reach up and attempt to

**117**

**Figure 7.**

**Figure 8.**

metal wire fences (**Figure 8**).

*fence is less likely. (©MACooper).*

fatalities, this has not been shown in any studies.

*Mitigating the Hazard of Lightning Injury and Death across Africa*

connect with the downward-moving lightning channel. The upward leader is strong enough to cause injury even if the lightning channel is not completed [69–72]. *Contact*: This occurs when the person is in contact with conducting paths such as plumbing, corded telephones or appliances, headsets, or wiring, either outdoors or inside structures. Contact injury may also occur as animals gather next to long

*Cows killed by lightning as they gathered by an ungrounded wire fence. This is a common occurrence and can be from contact injury as lightning energy is conducted from a distance or from ground current. Sideflash from the* 

*This chart shows the frequencies of the primary lightning fatality mechanisms [67]. (©MACooper/RLHolle).*

*Direct strike*: Contrary to public belief, direct strike is the least common mechanism causing only perhaps 3–5% of deaths [5, 40, 67, 73]. A direct injury occurs when the lightning stroke attaches directly to the victim and is most likely to occur in the open. While it is intuitive that a direct strike might be the most likely to cause

*Blunt trauma (concussive/explosive trauma, barotrauma)*: Blunt trauma has long been suggested as a mechanism of lightning injury [5]. As lightning passes through the air, rapid heating and expansion of the air occurs so that those nearby may experience a concussive force as if they were near an explosion. Blumenthal investigated

*DOI: http://dx.doi.org/10.5772/intechopen.90468*

*Mitigating the Hazard of Lightning Injury and Death across Africa DOI: http://dx.doi.org/10.5772/intechopen.90468*

#### **Figure 7.**

*Public Health in Developing Countries - Challenges and Opportunities*

pain management for those who survive [5, 16, 55].

often hang as classroom posters and use for lesson plans [63].

Many of the most lightning injury-prone countries have inadequate or hardto-reach medical care and other supports such as trained personnel, ambulance services, first aid providers, and other first responders [47]. Besides the high exposure and risk of lightning strike, victims also have less chance of survival during the acute phase or access to specialized services such as cognitive therapy and chronic

All of the socioeconomic factors listed in **Table 2** could be addressed and improved, but the cost and time to do so would be enormous and prohibitive for most African countries which may already be economically challenged. Public education, however, does not need to cost nearly as much as revising buildings and medical infrastructure [18, 60, 61], and it is probably the easiest and fastest way to make a difference [18, 60–62]. ACLENet has worked with other agencies in Uganda to begin public education through television broadcasts and newspaper inserts which teachers

The third major set of contributors to risk are the long-held cultural beliefs about lightning (**Table 2** light orange), a small sample of which are listed in **Table 3**. These beliefs have been taught for generations and are nearly impossible to counter except by persistent public education or by community elders who have been trained [64–66]. In some countries, if a family member has been injured by lightning, communities may shun the family, believing the family to be cursed and forcing them to leave their communities, property, and friends to start over [30]. In the Democratic Republic of the Congo, a head teacher and two teachers at a private school were imprisoned after being accused of "calling down lightning" to kill students at the public school in order to induce parents to enroll their children in their private school [65]. Widows or other women with no family to protect them may be stoned as witches if someone in their village is killed by lightning [64]. Other

common myths can be found in the monthly ACLENet newsletters [65].

Medically, lightning injury could be investigated from a number of different approaches including cellular physiology or electrical field effects, flashover versus internal flow of energy, and others [5, 47]. However, considering the five common electrical mechanisms of injury is the most useful for prevention and lightning safety education [5, 67]. To complicate further, these can be combined, and blunt or concussive trauma/barotrauma may be overlaid on any of the five [5, 67, 68]. **Figure 7** shows the relative distribution of these mechanisms in developed countries. The distribution is not known in developing countries, but it is suspected that

*Ground current (also called earth potential rise and step voltage)*: The mechanism that kills the most people is ground current, where lightning strikes the surface of the earth and spreads to nearby people. It can affect a large number of people either inside or outside an unprotected building. Children crowded together in unpro-

*Side flash/splash*: This occurs when trees, poles, towers, and many other objects that are not necessarily tall are struck and a portion of the lightning jumps to a

*Upward streamer (leader)*: As a thundercloud moves above the earth, opposite charges are induced on the surface of the earth and in objects on the ground under the cloud whether they are a tree, a home, a person, or a blade of grass. Upward streamers, not usually visible from these objects, will reach up and attempt to

**6. Mechanisms of lightning injury**

ground current plays an even larger role.

tected school buildings are at particular risk [42].

**116**

nearby person.

*This chart shows the frequencies of the primary lightning fatality mechanisms [67]. (©MACooper/RLHolle).*

#### **Figure 8.**

*Cows killed by lightning as they gathered by an ungrounded wire fence. This is a common occurrence and can be from contact injury as lightning energy is conducted from a distance or from ground current. Sideflash from the fence is less likely. (©MACooper).*

connect with the downward-moving lightning channel. The upward leader is strong enough to cause injury even if the lightning channel is not completed [69–72].

*Contact*: This occurs when the person is in contact with conducting paths such as plumbing, corded telephones or appliances, headsets, or wiring, either outdoors or inside structures. Contact injury may also occur as animals gather next to long metal wire fences (**Figure 8**).

*Direct strike*: Contrary to public belief, direct strike is the least common mechanism causing only perhaps 3–5% of deaths [5, 40, 67, 73]. A direct injury occurs when the lightning stroke attaches directly to the victim and is most likely to occur in the open. While it is intuitive that a direct strike might be the most likely to cause fatalities, this has not been shown in any studies.

*Blunt trauma (concussive/explosive trauma, barotrauma)*: Blunt trauma has long been suggested as a mechanism of lightning injury [5]. As lightning passes through the air, rapid heating and expansion of the air occurs so that those nearby may experience a concussive force as if they were near an explosion. Blumenthal investigated

barotrauma in his dissertation and likened it to being near a 5 kg of TNT blast [68]. Barotrauma is independent of the other electrical mechanisms of injury but may potentially overlay any of them [5, 40, 68]. People may also be thrown by opisthotonic contractions and experience musculoskeletal injuries as would be expected [5, 66].
