List of Reviewers 2013

Motor vehicle accidents are the leading cause of death in adolescents and young adults worldwide. Nearly three-quarters of road deaths occur in developing countries and men comprise a mean 80% of casualties. The rate of road traffic accidents caused by four-wheeled vehicles is the highest globally reported road traffic accidents statistic. In Saudi Arabia, the motor vehicle is the main means of transportation with one person killed and four injured every hour. Over 65% of accidents occur because of vehicles travelling at excess speed and/or drivers disobeying traffic signals. Road traffic injuries cause considerable economic losses to victims, their families, and to nations as a whole. Strategic prevention plans should be implemented soon by various sectors (health, police, transport, and education) to decrease the mortality and morbidity among adolescent and young age group. Strong and effective coordination between ministry of health and other ministries together with World Health Organization and other related organisations will be an important step towards implementing the international Decade of Action for Road Safety (2011–2020). The aim of this review article is to highlight some aspects of the health impacts of road traffic accidents.     

Road traffic crash injuries and fatalities in the city of Kerman,Iran

The objective of this study was to investigate road traffic crash injuries and fatalities. Cases of 3902 road traffic injuries (1709 drivers, 891 passengers, 376 pedestrians and 926 motorcyclists) and 1564 road traffic fatalities (RTFs; 1222 males and 342 females) were collected from 2005 to 2008 using the database of the police forces and Department of Forensic Medicine in Kerman, respectively. Results showed that 66% of the injuries were related to car occupants (drivers and passengers) and men/women ratio was 5:1. The highest men/women ratio was (12.2:1) for drivers, while the lowest ratio (1.8:1) was for pedestrians. Most of the injuries had taken place at 16:01–20:00 h followed by 08:01–12:00 h. Highest numbers of injuries were found in male with the age groups of 18–24 years. The highest fatality rate of 79 per 100,000 population occurred in 2007–2008. Fatality ratio indicated higher male ratio, four times higher than females. The victims were 39% male between 30 and 55 years of age. Head injuries were present in 69% of the cases. In our series of forensic autopsy cases, head injuries were more frequent in motor vehicle occupants, pedestrians and motorcyclists. On average, two people died per day in RTFs in Kerman.     

Patterns of injuries and motor-vehicle traffic accidents in Athens

The extremely high cost of motor-vehicle accidents in public health leads to the necessity of a better injury data collection in the Accident and Emergency Hospital Departments. The ‘Asclepeion’ of Voula Hospital covers the southeastern suburban areas of the greater Athens area (1 000 000 population). The aim of this study is to present information on the pattern of injuries in Athens, in order to understand the magnitude of the problem and develop rational prevention programmes. Specially trained health visitors of the Emergency Department Injury Surveillance System (EDISS) interviewed in person every injured victim who was brought into the Emergency Service of the ‘Asclepeion’ of Voula Hospital. The study was performed during a 3-year period, from 1996 to 1998; 4564 persons were interviewed. Traffic accidents were more frequent on weekdays with a seasonal peak in July and among young Greeks (aged 25 – 34 years). The usual type of injuries seen in vehicle-accident victims were cerebral contusion and concussion, while in motorcycle-accident victims, head contusion and fractures. The most common reasons for the accident were excessive speed, poor condition of road, inattention, abstraction or drowsiness and drug effects. A total of 29.8% of motorcycle drivers and 5.7% of motorcycle passengers wore a helmet and 26.3% of car drivers and 14.1% of car passengers were using seatbelts. The identification of road traffic injury patterns can contribute to the development of injury prevention measures and guide rational preventive interventions that can reduce the incidence of these injuries. The EDISS system established at ‘Asclepeion’ of Voula Emergency Service can provide useful and accurate information about this serious and multidimensional problem of Greek Public Health.     

Patterns of injuries and motor-vehicle traffic accidents in Athens

The extremely high cost of motor-vehicle accidents in public health leads to the necessity of a better injury data collection in the Accident and Emergency Hospital Departments. The 'Asclepeion' of Voula Hospital covers the southeastern suburban areas of the greater Athens area (1,000,000 population). The aim of this study is to present information on the pattern of injuries in Athens, in order to understand the magnitude of the problem and develop rational prevention programmes. Specially trained health visitors of the Emergency Department Injury Surveillance System (EDISS) interviewed in person every injured victim who was brought into the Emergency Service of the 'Asclepeion' of Voula Hospital. The study was performed during a 3-year period, from 1996 to 1998; 4564 persons were interviewed. Traffic accidents were more frequent on weekdays with a seasonal peak in July and among young Greeks (aged 25 - 34 years). The usual type of injuries seen in vehicle-accident victims were cerebral contusion and concussion, while in motorcycle-accident victims, head contusion and fractures. The most common reasons for the accident were excessive speed, poor condition of road, inattention, abstraction or drowsiness and drug effects. A total of 29.8% of motorcycle drivers and 5.7% of motorcycle passengers wore a helmet and 26.3% of car drivers and 14.1% of car passengers were using seatbelts. The identification of road traffic injury patterns can contribute to the development of injury prevention measures and guide rational preventive interventions that can reduce the incidence of these injuries. The EDISS system established at 'Asclepeion' of Voula Emergency Service can provide useful and accurate information about this serious and multidimensional problem of Greek Public Health.     

Road traffic injury among child motorcyclists in Vientiane Capital,Laos: a cross-sectional study using a hospital-based injury surveillance database

This study investigated the distribution of motorcyclists, including drivers and passengers, who were involved in road traffic crashes and admitted to hospital in Vientiane Capital, Laos. The focus was on child motorcycle drivers and passengers under 15 years. A hospital-based injury surveillance database in Vientiane Capital was used. The surveillance was performed in two hospitals. From 1 September to 31 December 2009, 3968 patients were admitted to the participating hospitals with road traffic injuries. Patients under 15 years accounted for 10.8% (427/3968). The majority of patients under 15 years were motorcycle drivers or passengers (71.7%, 306/427). Child motorcyclists including drivers and passengers were less likely to wear a helmet than adults (adjusted odds ratio [OR], 0.3, 95% confidence interval [CI], 0.2–0.5, for children 10–14 years; adjusted OR: 0.1, 95% CI, 0.05–0.4, for children under 10 years). It is suggested that stricter regulation enforcement for child motorcycle drivers and passengers may be needed. In addition, barriers against wearing helmets for motorcycle drivers and passengers in Laos should also be examined in further studies.     

Determinants of severe injury and mortality from road traffic accidents among motorcycle and car users in Southern Thailand

Abstract

This study aimed to identify factors associated with severe injury and mortality from road traffic accidents (RTA) among motorcycle and car users in southern Thailand. The data were obtained from the Office of Disease Prevention and Control, Thailand, for years 2008–2013. Chi-squared tests were used to assess associations between determinants and outcomes and these associations were then estimated after adjusting for possible confounding with other factors using logistic regression. Severe injury and mortality contributed 11.6% and 5% to RTA of motorcycle users, and 14.3% and 7.5% for car users. Among motorcycle users, male gender, older age, and not wearing a helmet increased severe injury and mortality rates, whereas drivers had more severe injuries than passengers. Older car users had higher severe injury and mortality rates, whereas not fastening seat belts had higher mortality. Safety device use should be made mandatory for both drivers and passengers. Male motorcycle users and the elderly should be focused on.     

Hotspots of road traffic crashes in a redeveloping area of Shanghai

To identify high-risk locations (hotspots) of road traffic crashes (RTC) in a redeveloping area of Shanghai, for formulating relevant countermeasures in similar areas. After geocoding the crash locations on electronic map, assessment of spatial clustering of accidents and hotspots spatial densities was conducted following Moran's I method, the kernel density estimation, the Ripley's K-function and the network-based kernel density estimation (NKDE). A total of 21,679 RTC incidents resulting in 24,147 victims were recorded from 2010 to 2012. RTCs tended to occur among male (81.8%) aged 20–49 years old (84.9%) riding buses (60.1%) or electric bikes (16.1%) in working time (15%). The network spatial analysis pinpointed the hotspots of RTC at the street level in the Songjiang new urban area, and more RTCs occurred at road intersections than on road segments. Findings from this research may help the authorities develop efficient programmes to target high-risk locations and specific vulnerable populations.     

Under-reporting of road traffic crash data in Ghana

Having reliable estimates of the shortfalls in road traffic crash data is an important prerequisite for setting more realistic targets for crash/casualty reduction programmes and for a better appreciation of the socio-economic significance of road traffic crashes. This study was carried out to establish realistic estimates of the overall shortfall (under-reporting) in the official crash statistics in Ghana over an eight-year period (1997–2004). Surveys were conducted at hospitals and among drivers to generate relevant alternative data which were then matched against records in police crash data files and the official database. Overall shortfalls came from two sources, namely, ‘non-reporting’ and ‘under-recording’. The results show that the level of non-reporting varied significantly with the severity of the crash from about 57% for property damage crashes through 8% for serious injury crashes to 0% for fatal crashes. Crashes involving cyclists and motorcyclists were also substantially non-reported. Under-recording on the other hand declined significantly over the period from an average of 37% in 1997–1998 to 27% in 2003–2004. Thus, the official statistics of road traffic crashes in Ghana are subject to significant shortfalls that need to be accounted for. Correction factors have therefore been suggested for adjusting the official data.     

Associations of traffic safety attitudes and ticket fixing behaviours with the crash history of Pakistani drivers

The study assessed whether traffic safety attitudes and ticket fixing behaviours were associated with the crash history. A total of 4018 male drivers from Lahore city participated in this cross sectional study. Most were aged 18–30 years (58.7%, n = 2362), 71.9% (n = 2887) received a traffic ticket, 66.5% (n = 2672) reported previous traffic ticket fixing and 71.3% (n = 2865) considered crashes as being the will of God. Crash history was reported by 95.4% (n = 3821) of drivers, and 58.2% of them reported being involved in a road traffic crash. The likelihood of reporting a previous crash was higher in those who had received a traffic sign violation ticket [adjusted odds ratio (aOR) = 1.40; 95% confidence interval (95%CI) = 1.15–1.72], were involved in traffic ticket fixing (aOR = 1.28; 95%CI = 1.07–1.53), and considered crashes as will of God (aOR = 1.86; 95% CI = 1.57–2.22). These results suggested the need for improving traffic enforcement monitoring and safety education in Pakistan.     

The impact of traffic sign deficit on road traffic accidents in Nigeria

This study assesses the impact of traffic sign deficit on road traffic accidents in Nigeria. The participants were 720 commercial vehicle drivers. While simple random sampling was used to select 6 out of 137 federal highways, stratified random sampling was used to select six categories of commercial vehicle drivers. The study used qual-dominant mixed methods approach comprising key informant interviews; group interviews; field observation; policy appraisal and secondary literature on traffic signs. Result shows that the failure of government to provide and maintain traffic signs in order to guide road users through the numerous accident black spots on the highways is the major cause of road accidents in Nigeria. The study argues that provision and maintenance of traffic signs present opportunity to promoting safety on the highways and achieving the sustainable development goals.     

Seatbelt use amongst taxi drivers in Beijing, China

Associated with explosive growth in motorization, China has the world's highest road toll with more than 100,000 deaths and 400,000 injuries annually. In response, the Chinese Government introduced the first road traffic safety law in 2003, which included mandatory use of seatbelts by drivers and front seat passengers. Noting frequent non-compliance to this seatbelt regulation by Beijing taxi drivers, the authors studied seatbelt use patterns as onboard observers in a convenience sample of 235 taxi trips. Findings indicated a low seatbelt-wearing rate among taxi drivers of 7.7%, an overt non-wearing rate of 57%, covert non-wearing of 35.3% and total non-compliance of 92.3%. As in high-income countries, adoption of proven safety strategies, including wearing safety restraints, could contribute to reducing the Chinese road toll, particularly as vehicle occupant numbers and the availability of restraints increases. Further investigation of reasons for non-compliance and pretense of wearing seatbelts is required to inform future seatbelt-wearing promotions, including attitudinal studies of taxi drivers. Seatbelt wearing rates should continue to be monitored.     

Pattern of deaths and injuries in road crashes on three main entrance roads in Kerman,Iran

Road traffic injuries and fatalities are increasing in Kerman, Iran. The study included all road traffic crashes recorded by traffic police forces located in west, northwest and south rural roads between 2005 and 2007 in Kerman city. According to the data, road traffic crashes were the main causes of injuries and deaths in Kerman. The results of this study indicated that significant differences were found between male and the female drivers. Results obtained on the driver's age indicated that higher male crashes were in age groups 26–34 years. Statistical testing of the results at the 5% significant level reveals that rate differences are significant under sunny, foggy, rainy, storm and lighting conditions of driving. The analysis results indicated that a majority of male drivers and only 0.23% of female drivers travelled unbelted while driving on rural roads in Kerman.     

Implications for research

We aimed to study the anatomical distribution, severity, and outcome of hospitalised trauma pedestrian patients in Al Ain, United Arab Emirates (UAE), so as to improve preventive measures. All pedestrian trauma patients who were involved with a road traffic collision and admitted to Al Ain Hospital for more than 24 hours or who died in the hospital were included in the study. Data were prospectively collected during March 2003–October 2007. Three hundred and eighteen patients were studied, 279 (87.7%) were males. Median (range) age was 31 (1–75) years. UAE nationals were significantly younger than non-nationals (median (range) age of 14 (2–75) years compared with 33 (1–75) years, p = 0.001, Mann–Whitney U-test). The lower limb (57.2%) was the most common injured region followed by the head (46.9%). The median (range) Injury Severity Score of patients was 5 (1–45). The median (range) total hospital stay was 11.3 (1–130) days. Thirty patients died (overall mortality 9.4%). In conclusion, mortality of pedestrian injured patients in the UAE is high. Severe head injury was the main cause of death. Measures to improve pedestrian safety should be adopted so as to reduce morbidity and mortality. These include educating drivers and pedestrians on road safety and enforcement of traffic safety laws.     

A contemporary analysis of road traffic crashes,fatalities and injuries in Trinidad and Tobago

Road safety, in particular pedestrian safety, is a problem in Trinidad and Tobago. Data were derived from the database of the Traffic and Highway Patrol Unit of the Trinidad and Tobago Police Service. Road traffic crashes in Trinidad and Tobago are largely an urban problem. Four urban areas accounted for nearly three-quarters of reported road traffic crashes, fatalities and injuries. Pedestrians, passengers and drivers accounted for 93% of fatalities and 95% of injuries due to road traffic crashes in 2000. Pedestrians alone accounted for 42% of fatalities and 34% of injuries in 2000. Trends over time show that there has been a decline in fatality rates from 17 deaths per 100,000 population in 1960 to 10 deaths per 100,000 population in 2000, despite rapid motorization. Motorization increased four-fold from 63 registered vehicles per 1000 population in 1960 to 250 vehicles per 1000 population in 2000. In conclusion, effort should be intensified to ensure safety for all road users and, in particular, pedestrians, passengers and drivers. Improved data collection and operational research would improve monitoring and evaluation of policy interventions.     

The key risk indicators of road traffic crashes in Serbia,Niš region

Traffic crashes are a serious public health and socio-economic problem, and they are one of leading causes of death of males in Serbia. In order to determine the main causes of road traffic crashes in Ni? region, Republic of Serbia, nine key risk indicators of road traffic crashes are identified, organized into four groups (number and structure of crashes, consequences of traffic crashes, temporal and spatial location of traffic crashes, causes and sanctions), and described in detail. The indicators are ranked based on group fuzzy analytic hierarchy process (AHP), where experts from insurance companies, professionally engaged in the process of risk assessment, with different previous experience present different impact on the final ranking. In relation to the most influential factors in the assessment of traffic crashes, improper and unadjusted vehicle speed, overtaking and passing, as well as the physical condition of the driver have the highest effect.     

Effectiveness of interventions to prevent motorcycle injuries: systematic review of the literature

Globally, 49% of deaths from traffic crashes occur among vulnerable road users, including pedestrians, bicyclists, and motorcyclists. Approximately, a quarter of those killed are motorcyclists. The authors carried out a systematic review of the literature to evaluate the effectiveness of interventions to prevent motorcycle crashes and the associated morbidity and mortality. The studies included in this review provide evidence for the effectiveness of helmet use, protective clothing, training, and penalties for alcohol consumption and speeding in preventing injury and death to motorcyclists. The use of helmets is effective, especially if it is universally required by law for drivers and passengers. Training to obtain a license also has positive effects but not when it is totally voluntary. There is limited but consistent evidence that strengthening laws for penalties related to alcohol consumption or speeding has an impact on risk. Traffic calming interventions could help reduce crashes in urban areas. In jurisdictions where there is limited regulation or adherence to effective measures, such as the use of helmets, efforts should be directed primarily at expanding such practices. In other areas, efforts can focus on approaches based on alternative effective measures or on more innovative interventions adapted to local conditions.