Equity dimensions of road traffic injuries in low- and middle-income countries

Globally, poorer population groups bear a disproportionate burden of avoidable morbidity and mortality from road traffic injuries. The distribution of road traffic injuries is generally influenced by socioeconomic factors. Poor countries bear a disproportionate burden of injuries and fatalities, and within countries, poor people account for a disproportionate portion of the ill health due to road traffic injuries. The main source of data for this paper was the road traffic injury database of the WHO World Health Report for 1999 supplemented by the WHO Global Burden of Disease Study 2000 report, and published and unpublished works. Fatality rates for 0-4 and 5-14 year olds in low- and middle-income regions, measured as deaths per 100,000 population, were six times the rates for high-income regions, while within low- and middle-income regions the rates varied widely. Within poor countries, poor people – represented by pedestrians, passengers in buses and trucks, and cyclists – suffer a higher burden of morbidity and mortality from traffic injuries. In rich countries, children from poor socioeconomic classes suffer more injuries and deaths from road crashes than their counterparts from highincome groups. The disproportionate burden of morbidity and mortality in low- and middle-income countries, and among low socioeconomic groups in those countries, illustrates problems of global inequities in health. The problems can be addressed through policies that focus on the road safety of vulnerable groups.     

ICoRSI’s comments on WHO’s draft global targets for road safety risk factors

Abstract

A recent United Nations General Assembly resolution has asked the World Health Organization (WHO) to develop voluntary global performance targets on key road safety risk factors. These targets will be used to track how well countries are doing in reducing deaths and injuries from traffic crashes. WHO has produced a draft set of country-level targets and invited feedback from state and nonstate actors. This document provides feedback from ICoRSI about the targets proposed by WHO.     

Road traffic injuries in Mozambique

Road traffic injuries affect the economy, health and quality of life of the people of Mozambique. Current road safety programmes are inadequate and inefficient given the magnitude of the problem. Data reported on road traffic crashes in the period 1990 to 2000 from the National Institute for Road Safety, the traffic police and the Central Hospital of Maputo were reviewed. The burden of road traffic injuries in Mozambique is rising, with at least three people killed daily. The age group most affected is 25-38 (39.35%), followed by 16-24 (20.79%). The main causes of crashes include reckless driving, drunken driving, roads with potholes, inadequate signs, lack of protection for pedestrians, and inadequate traffic law enforcement. However, the data are not adequate to reveal the true magnitude of the problem. Data collected by different sources are incomplete and not coordinated with other sources and databases. In urban areas, however, better response to crashes, treatment of the injured, reporting and data collection is attributable to a greater concentration of police and medical facilities. Road traffic safety programmes in Mozambique are inadequate and inefficient, starting with the data collection system. Improvement of injury surveillance systems is needed to help make road traffic safety a national development agenda priority and for developing and implementing road safety policies. For road safety programmes to be effective, government must facilitate stakeholders’ involvement, and the clear definition of government activities, civil society activities and public-private partnerships need to be established.     

Road traffic injuries in Thailand: Trends,selected underlying determinants and status of intervention

Injuries and deaths from traffic crashes have become a major public health and socio-economic problem in Thailand. Injuries, fatalities and economic losses due to traffic crashes have increased with the rising level of motorization. This study analyzes hospital-based data compiled by the Ministry of Public Health, data compiled by the National Police Office and data compiled by the traffic engineering division of the Department of Highways, Ministry of Transport and Communications. Analysis reveals that 70% of the people injured or killed in traffic crashes are aged 10-39. Men are at four to five times higher risk of death and injury due to traffic crashes than women. The number and rate of traffic injury in Thailand swung from a record low during the economic recovery in the 1980’s to record a high during the bubble economy, then declined with the economic crisis in 1997. The economic costs were estimated at U.S.$1.6 billion in 1995. An urban-rural difference in traffic injuries has been recorded with a higher rural case-fatality rate. A number of known behavioral risk factors have been identified, i.e., drunk driving, speeding, substance abuse and failure to use helmets and seat belts. However, determinants of behavior need further investigation. Hazardous road locations have also been mapped. Trends of traffic injuries seem to follow trends of economic growth. Without effective policy and implementation programs to control the determinants, it is expected that traffic injuries will increase as the country recovers from economic crisis. A major pitfall to many current government programs is that they incorporate no systematic evaluation. The fragmented structure of road safety authorities further complicates collaboration and coordination. A broad coalition of stakeholders is needed to catalyze policy action.     

Trends in road traffic crashes and associated injury and fatality in the People’s Republic of China, 1951–1999

The burden of road traffic injuries in the People’s Republic of China is increasing as evidenced by trends since 1951. Data from the National Statistical Office, Ministry of Communications and the Traffic Administration Bureau were analyzed. Absolute numbers of crashes, fatalities, and injuries, as well as fatalities per 100,000 population and motorization (number of vehicles per 1000 population) were used as indices to measure trends. Regional variations in trends and the characteristics of people injured or killed were also analyzed. Road traffic crashes increased 68- fold, from around 6000 in 1951 to 413,000 in 1999. Excessive speed was the main reported cause of the crashes. The injuries increased 56-fold – from around 5000 to 286,000 – and fatalities 97-fold – from 852 to around 84,000 – over the same period. The crash, fatality and injury rates also increased after 1985, due to increased motorization spurred by rapid economic growth. The number of four-wheel motor vehicles increased from 60,000 in 1951 to just under a million four-wheel motor vehicles in 1975 and to 10 million in 1987. The number of four-wheel motor vehicles then rose to 50 million in 1999, with an additional 30 million motorcycles. The increase in motorization and fatalities affected all the provinces. Road traffic injuries are the leading cause of death for populations up to the age of 45 years and the leading cause of working-life years lost in China.     

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.     

An analysis of risk factors associated with road crash severities in Namibia

Abstract

Road crash is a leading cause of death and disabilities in Namibia and other developing countries. Based on recent trends, the World Health Organization indicated that progress to realize Sustainable Development Goal (SDG) target 3.6 – which calls for a 50% reduction in the number of road traffic deaths by 2020 – remains far from sufficient. To contribute to efforts in reducing road fatalities in Namibia, this study examined risk factors associated with the severity of crashes recorded in the country. Mixed logit modelling methodology was adopted to address the problem of unobserved heterogeneity in injury severity analysis. Model estimation results reveal that collision with pedestrians, head-on collisions, ran-off road collisions and crashes involving high occupancy passenger vehicles were more likely to result in fatalities and severe injuries. The findings and recommendations of this study are expected to enhance countermeasure implementation to reduce road crashes in Namibia.     

National burden of road traffic injuries in Argentina

More than 1.2 million people die and as many as 50 million people are injured or disabled due to road traffic injuries (RTIs) every year worldwide. The lack of reliable data hinders efforts to describe the characteristics of the issue and prioritise prevention activities. The objective was to provide a snapshot of fatal and non-fatal RTI in Argentina. We used the methodology proposed by the Global Burden of Disease Injury Expert group. External causes of deaths with unknown codes were proportionately redistributed over the known categories. In 2007 in Argentina, we estimated 5915 RTI deaths, compared with 3983 RTI deaths reported previously by the Ministry of Health, accounting for 1931 additional cases. The highest number of deaths occurred in young men (15-29 years old), although the highest RTI death rates were in the age group of 55 years and older. Four-wheeled vehicle occupants were the most common road user type killed (59.1%); vulnerable road users represented one third (29.5%) of deaths and 64% of non-fatal RTI. The national and regional estimates of RTI in Argentina should help policy makers and public-health researchers to understand the importance of RTI prevention and design specific interventions to further reduce these preventable deaths and injuries.     

The epidemiology of drowning worldwide

The purpose of this analysis was to quantify the magnitude of death and disability from drowning and near-drowning worldwide and to provide epidemiological data on which to base prevention efforts. All data are from the Global Burden of Disease 2000 (Version 1) estimates in which deaths and disabilities are based on the WHO International Classification of Diseases. Extrapolations were made by age, sex, and WHO region. The six WHO regions of the world were further divided into high-income, and low- and middle-income based on the 1998 World Development indicators. According to the GBD 2000 data, an estimated 449,000 people drowned worldwide (7.4 per 100,000 population) and a further 1.3 million Disability Adjusted Life Years (DALYs) were lost as a result of premature death or disability from drowning. 97% of drownings occurred in low- and middle-income countries. Although 38% of drownings occurred in the Western Pacific Region, Africa had the highest drowning mortality rate (13.1 per 100,000 population). Males had higher drowning mortality rates than females for all ages and in all regions. Children under the age of 5 years had the highest drowning mortality rate for both sexes in all of the WHO regions except for Africa, where children aged 5 to 14 years had the highest mortality rate. World-wide, for children under the age of 15 years, drowning accounted for a higher mortality rate than any other cause of injury. Drowning is a significant problem worldwide particularly for children under the age of 15 years. Low- and middle-income countries have the highest rates of drowning and account for more than 90% of such fatalities. Primary prevention efforts should thus be focused on these countries where many children who cannot swim drown in large bodies of water.     

How much would low- and middle-income countries benefit from addressing the key risk factors of road traffic injuries?

Abstract

Despite strong advocacy, the UN Decade of Action for Road Safety (2011–2020) is ending with most low- and middle-income countries (LMICs) no closer to the Sustainable Development Goals target of reducing traffic mortality by half. In contrast, most high-income countries (HICs) have seen large benefits in recent decades from large-scale safety interventions. We aimed to assess how much LMICs would benefit from interventions that address six key risk factors related to helmet use, seatbelt use, speed control, drink driving, and vehicle design for safety of occupants and pedestrians. We use a comparative risk assessment framework to estimate mortality and health loss (disability adjusted life years lost, DALYs) that would be averted if these risks were reduced through intervention. We estimate effects for six countries that span all developing regions: China, Colombia, Ethiopia, India, Iran, and Russia. We find relatively large benefits (27% reductions in road traffic deaths and DALYs) from speed control in all countries, and about 5%-20% reductions due to other interventions depending on who is at risk in each country. To achieve larger gains, LMICs would need to move beyond simply learning from HICs and undertake new research to address risk factors particularly relevant to their context.     

Road traffic accidents and policy interventions in Korea

The high rate of road traffic crashes, in conjunction with the absence of order on the road, has long been considered a critical social problem in Korea. The Korean public seems to agree that high priority ought to be placed on policies for improving road safety. Using data from government sources, this study describes what has happened in the area of road traffic crashes since 1970, the causes of traffic crashes, and the relative importance of traffic injuries as a cause of death in Korea. Road traffic crashes in Korea increased nearly eightfold, from 37,000 in 1970 to 290,481 in 2000. The fatalities increased three-fold and injuries ten-fold over the same period. Road traffic injuries were the leading cause of death for people under 29. However, through multiple policy interventions, partly in response to the 2002 FIFA World Cup, about two thousand road traffic deaths and nine thousand traffic-related disabilities were averted in 2001 alone. The policy interventions included enforcement of penalties for seven risky driving behaviours, including drunk driving and speeding, installation of traffic-monitoring cameras, financial rewards for citizens who reported traffic violations, introduction of a road safety evaluation system, correction of accident black spots in existing roads, and road safety education programs. Through multiple policy interventions, road traffic crashes in Korea were reduced in a relatively short time period, along with their associated injuries and fatalities. However, road traffic crashes still pose a major public health problem, threatening the quality of life of the Korean people.     

Opportunities to reduce road traffic injury: new insights from the study of urban areas

Abstract

Over the past four decades considerable efforts have been taken to mitigate the growing burden of road injury. With increasing urbanisation along with global mobility that demands not only safe but equitable, efficient and clean (reduced carbon footprint) transport, the responses to dealing with the burgeoning road traffic injury in low- and middle-income countries has become increasingly complex. In this paper, we apply unique methods to identify important strategies that could be implemented to reduce road traffic injury in the Asia-Pacific region; a region comprising large middle-income countries (China and India) that are currently in the throes of rapid motorisation. Using a convolutional neural network approach, we clustered countries containing a total of 1632 cities from around the world into groups based on urban characteristics related to road and public transport infrastructure. We then analysed 20 countries (containing 689 cities) from the Asia-Pacific region and assessed the global burden of disease attributed to road traffic injury and these various urban characteristics. This study demonstrates the utility of employing image recognition methods to discover new insights that afford urban and transport planning opportunities to mitigate road traffic injury at a regional and global scale.     

Gender and geographic differences in intentional and unintentional injury mortality among children in Illinois, 1988–1998

Road traffic crashes and injuries constitute a major health, economic and developmental challenge for many African countries. With only 4% of the world's motor vehicles, African roads witness more than 10% of the world total collision fatalities. With further motorisation, the number of road traffic crashes, injuries and fatalities are expected to grow. This study updates on the status, trends, causes, countermeasures and issues in traffic safety in African countries by reviewing studies published in the past 12 years. The study found that traffic fatalities continued its upward trend in recent years. Similar to those in motorised countries, the study identified that human behaviour and incapacitation account for more than 85% of the contributing factors reported by police in Africa. Unlike in developed countries, the victims of traffic casualties are primarily vulnerable road users. Pedestrians alone account for more than 40% of the total fatalities on African roads. Limited countermeasures were reported in the literature. The outcomes of these programmes are mixed and the research methods have inconsistent validity. Investigation in the feasibility of transferring proven programmes from motorised countries is suggested as an efficient measure for traffic safety improvement.     

Speed control in developing countries: issues,challenges and opportunities in reducing road traffic injuries

Speed has been determined to be one of the most common contributing factors in vehicle crashes. This study explores vehicle speed as a factor in the causation of road traffic crashes, using the example of Ghana. It examines the effectiveness of various speed control measures, based on policereported traffic crashes in Ghana and published works on speed control measures in both industrialized and developing countries. In Ghana, pedestrians were the main victims of road traffic injuries. The dominant driver error assigned by traffic police was loss of control, with the underlying factor being excessive vehicle speeds. The ‘speed factor’ alone accounted for more than 50% of all Ghanaian road traffic crashes between 1998 and 2000. While the enforcement of speed limits by traffic police may not be affordable for most developing countries, rumble strips and speed humps were found to be effective on Ghanaian roads. Rumble strips installed on the main Accra-Kumasi highway reduced crashes by about 35% and fatalities by about 55%. Reducing vehicle speeds may be one of the most effective interventions to stem traffic crashes in low-income countries. However, setting lower speed limits is not an effective intervention without the traffic law enforcement resources to ensure that limits are followed. Developing countries must also look to other speed reduction measures such as speed bumps and rumble strips, roads that segregate high- and low-speed users, and technological solutions such as speed governors, as well as greater public awareness of the problem.     

Dealing with existing theory: national fatality rates,vehicle standards and personal safety

Abstract

In this paper we discuss some of the weaknesses in exiting theories and understandings behind road safety interventions and policy making. The paper deals with four main issues: road traffic fatality rates and per capita income of countries, vehicle crashworthiness standards, role of pedestrian and powered two-wheeler share in traffic on fatalities, and safety standards for vehicles other than cars. Recent data indicate that there may not be a strong relationship between income and road safety performance and it is possible for low and middle-income countries (LMIC) to decrease death rates at present income levels. Safer cars have had a major role in reducing fatality rates, but, gains in traffic safety in high income countries may be partly due to reducing exposure of vulnerable road users. Small lightweight vehicles (like tuk-tuks, three-wheeled scooter taxis) operating in many LMIC appear to have low fatality rates though they do not follow any crashworthiness standards. Very different crashworthiness standards need to be developed for low mass vehicles incapable of operating speeds greater than 50?km/h. LMIC may not be able to reduce fatality rates below about 7 per 100,000 population unless there are innovative developments in road design and all vehicle safety standards.     

Cost analysis of road traffic crashes in China

Abstract

Fatalities and injuries resulting from road traffic crashes is always a serious problem. The overall economic losses caused by road traffic crashes are beyond imagination. Including the economic cost of property damage, productivity loss, medical cost, travel delay time cost, legal cost and insurance cost, the total economic cost of traffic crashes in China in 2017 is calculated as 490.1 billion yuan (72.6 billion USD 2017), which is equivalent to 0.60% of the GDP. The cost of productivity loss accounts for the highest proportion of total economic cost, which is 72%. The second is the travel delay cost, accounting for 12% insurance cost, property damage cost and medical cost are followed. The more serious the injury, the higher the unit economic cost. The unit cost of a crash that caused only property damage is 11,274 yuan. The unit cost of a minor injured crash is 20,223 yuan. The highest unit economic cost is the unit cost of a fatal crash, which is 3,181,394 yuan. This study provides important insights into the cost-benefit analysis of China's road safety policies.     

Evaluating performance of a Lead Road Safety Agency (LRSA) in a low-income country: a case study from Pakistan

The World Health Organization recommends identifying a Lead Road Safety Agency (LRSA) within the government to coordinate preventive interventions. As LRSAs in developing countries have rarely been evaluated, this case study describes the performance of the LRSA of Pakistan with respect to the World Bank criteria. The designated LRSA, the National Road Safety Secretariat, was put into operation in 2006 and worked for about two years with World Bank funding. The agency had a stand-alone structure headed by an experienced road safety specialist during the first year only and faced difficulty in recruiting other required experts. The LRSA drafted the first National Road Safety Plan, including strategic review of road safety and existing legislation, articulated multisectorial collaboration nationally and provincially, and collected traffic injury data in some districts. Its progress was halted by its dissolution because of funding problems. Currently, two agencies specialising in traffic enforcement and transport research respectively are fulfilling LRSA functions on an ad-hoc basis. Results suggest that sustainability and consistency of LRSAs in developing countries like Pakistan may only be ensured if they are legally protected, inter-ministerial, have permanent funding and are provided with the required expertise through international cooperation, so they can perform their required functions effectively.