To better elucidate the incidence, nature, and consequences of transportation related injuries in a developing urban area, we undertook an epidemiologic survey in Kumasi, Ghana. 656 (5.6%) of 11,663 persons surveyed had sustained an injury in the preceding year. Transportation related mechanisms accounted for 16% of these injuries, but were more severe than other mechanisms in terms of length of disability and cost of treatment. The majority of injuries were either to passengers involved in crashes of mini-buses or taxis (29%) or to pedestrians struck by these vehicles (21%). Prevention strategies may need to be fundamentally different from those of developed nations and need to target professional drivers more than private road users.