To better ascertain the incidence, characteristics, and consequences of transport related injuries in a developing rural area, we undertook an epidemiologic survey in Ghana. From the 9442 persons surveyed, 928 injuries were reported for the preceding year. Transport related mechanisms accounted for 10% of these but were more severe than other mechanisms in terms of mortality, length of disability, and economic consequences. Most common were bicycle crashes. Second most common were motor vehicle crashes, which were the most severe and which involved commercial (83%) rather than private vehicles. Prevention strategies need to be different from developed nations and need to target commercial drivers more than private road users.