Background Injuries remain a significant public health challenge, particularly in low- and middle-income countries where more than 90% of injury-related morbidity and mortality occur. Global trends show a general decline in injury burden in response to robust surveillance, evidence-based injury prevention policies and programs and investment in national and regional trauma systems of care; however, in many low- and middle-income countries, the decline is much less pronounced and is increasing in some countries. Zimbabwe is one such example with limited to no trauma surveillance, a conspicuously rising incidence of injury-related morbidity and mortality, a strained and fragmented emergency response system and minimal injury prevention activity. There is a gap in understanding of the true burden of disease of injury, the state of and opportunities for surveillance and the specific barriers and facilitators for implementing a trauma registry in Zimbabwe that has proven challenging elsewhere in Africa. Furthermore, there is also a lack of knowledge on contextual risk factors that contribute to injuries in children for use in designing targeted preventive interventions. Lastly, there is limited data on how patients, particularly children, navigate the healthcare system in search of care for injuries. Methods The public health response to injury prevention entails accurately quantifying the scale of the problem, understanding the contextual and systemic risk factors contributing to injuries, developing evidence-based interventions, and implementing sustainable, data-driven strategies that can be tested, refined, and scaled up. This mixed-methods work follows the initial steps of this approach in Zimbabwe. I established the current evidence on the burden of injuries in Zimbabwe through a systematic review of published and grey literature and a narrative review of the Global Burden of Disease estimates. I then conducted a scoping review of trauma registries from the African continent since 2000 to understand trends in variables used and describe operational and design attributes to use in design of a bespoke registry instrument. This was followed by a qualitative study among stakeholders to identify barriers to implementing trauma registries in Zimbabwe. I then conducted a qualitative study among admitted injured patients, their families and healthcare workers from central hospitals to identify contextual risk factors for common injuries and potential mitigating interventions. In the next chapter, we investigated the typology of health system patient journeys through a journey mapping methodology and the reasons for the delay along that journey. Lastly, we piloted a new instrument based on the scoping review and qualitative studies using a prospective observational study design to understand routes through the health system and delays for patients at central hospitals with injury. Results There were 11,603 deaths from all injuries in Zimbabwe in 2021, constituting 6.01% of all-cause deaths that year. The age-standardised death rate from injury in the country rose 28.3% from 76.19 to 97.76 per 100,000 population from 1990 to 2021. The top five causes of injury in 2021 were road injuries, self-harm, interpersonal violence, drowning and fire, and heat and hot substances. A systematic review of available data sources found significant gaps in trauma surveillance literature in the country. Available data shows significant discrepancies between different sources for the same injuries and substantial uncertainty with wide confidence intervals. I found that trauma registries in Africa are fragmented and have inconsistent definitions of variables. Registries from 22 countries were identified. A long list of 189 discreet variables was extracted, and a “core” set of commonly occurring variables from the existing literature emerged , with 45 variables occurring in at least 30% of registries. I also identified several barriers to implementing a trauma registry in Zimbabwe, including resources (consumables and operational resources, financial, human resources, technology infrastructure), operational, regulatory, data and utility barriers. Patient journey mapping revealed four distinct typologies of patient care pathways and prolonged delays in accessing care for injuries. We identified contextual risk factors for burns and road traffic crashes, including systemic, environmental and individual. Finally, I piloted a bespoke trauma surveillance tool in three central hospitals in Zimbabwe, which successfully captured critical data on patient flow and delays in the injury journey. However, data completeness for vital signs (2%-12%) and events in the emergency department (32%-56%) were poorly documented. Median care-seeking interval, health-system interval and treatment interval were 1 hr 40, 2 hr 30 and 3.1 days, respectively, for all injuries. The care-seeking interval for burns was significantly higher than for fractures and visceral injuries. Conclusion This study highlighted the urgent need for accurate, granular data on paediatric injuries in Zimbabwe. Through a systematic review, a scoping review, qualitative studies and the development of a bespoke hospital-based trauma surveillance tool, we have shown that despite the limitations of existing data sources, the burden of disease in Zimbabwe is substantial and appears to be increasing. Multiple barriers plague implementation of a trauma registry however there are opportunities for obtaining buy-in, ensuring sustainability and ensuring quality data collection. This trauma registry has demonstrable utility for mapping health system delays and movements of patients through different levels of care. It could potentially help inform policy for better allocative efficiency and delivering accessible, affordable and effective trauma care in Zimbabwe.