A qualitative approach to the intangible cost of road traffic injuries

The consequences of fatal and non-fatal road traffic injuries (RTI) at the personal and household levels were analysed using qualitative interviews of 12 injured and of 12 relatives of people who died for this reason. Collisions change physical and mental health both of the injured and of their relatives. This leads to changes in daily activities and even to the redefinition of future life. RTI also changes the way people see and act in life, becoming an experience that teaches them. Survivors commonly transmit a road safety message afterwards. Changes in family life were evident (in extreme cases family's composition also changed), affecting intra-familial relationships. Associated unexpected and unplanned expenditures and loss of income have consequences in the short, medium and long term that unbalance household's economies and immerse people into a constant stress. Individuals and family's future plans are occasionally condition to whether they have or not debts. Household dependence in economic terms was sometimes observed, as well as uncertainty about future life and household's sustainability. Sometimes, households change and adapt their life to what they now are able to afford, having important repercussions in vital spheres.     

The burden of road traffic injuries in Kermanshah Province,Iran, in 2010–2011: GBD 2010 method

Deaths, injuries and disabilities resulting from road traffic injuries (RTIs) are a public health major concern. This study aims to calculate the burden of RTIs in Kermanshah Province in Iran. In this study to determine the years of life lost (YLL) related to RTIs, the National Death Registration and Forensics Medicine census data were employed. We use forensic medicine data to calculate the incidence of non-fatal injuries and years lost due to disability (YLD). The cause of death and non-fatal injuries was classified using ICD-10 codes and 23 groupes of global burden of diseases (GBD) 2010. The disability-adjusted life year (DALY) estimated on the guidelines of the GBD 2010 and age and sex structure was taken from the National Statistic Center for the year 2010. Overall, 70.8% of the subjects were males. The fatal and non-fatal injury rates of RTI were 51.3 and 283.6 per 100,000 persons, respectively. YLLs and YLDs were 46613 (24.5 per 1000) and 3405 (1.8 per 1000) in both sexes, respectively. The disability adjusted life years were 40711 in males, 9306 in females and 50018 in both sexes (42.5, 9.8 and 26.3 per 1000, respectively). More than 93% of DALY was from YLL (24.5 per 1000), with a small proportion for YLD (1.8 per 1000). Accounting for more than 50,000 DALY attributed to RTIs, traffic injuries is a major public health and socioeconomic problem in Kermanshah. Designing cost-effective interventions based on comprehensive and multi-sectoral programmes at the national and provincial levels can save many lives and resources that are lost every year. Undoubtedly, establishing a surveillance system at the sub-national level and measuring the burden of injuries, as in this study, can help policy-makers and planners in lessening the burden of RTIs.     

A qualitative approach to the intangible cost of road traffic injuries

The consequences of fatal and non-fatal road traffic injuries (RTI) at the personal and household levels were analysed using qualitative interviews of 12 injured and of 12 relatives of people who died for this reason. Collisions change physical and mental health both of the injured and of their relatives. This leads to changes in daily activities and even to the redefinition of future life. RTI also changes the way people see and act in life, becoming an experience that teaches them. Survivors commonly transmit a road safety message afterwards. Changes in family life were evident (in extreme cases family's composition also changed), affecting intra-familial relationships. Associated unexpected and unplanned expenditures and loss of income have consequences in the short, medium and long term that unbalance household's economies and immerse people into a constant stress. Individuals and family's future plans are occasionally condition to whether they have or not debts. Household dependence in economic terms was sometimes observed, as well as uncertainty about future life and household's sustainability. Sometimes, households change and adapt their life to what they now are able to afford, having important repercussions in vital spheres.     

Global collaboration on road traffic injury prevention

Worldwide, nearly 1.2 million people are killed in road traffic crashes every year and 20 million to 50 million more are injured or disabled. These injuries account for 2.1% of global mortality and 2.6% of all disability-adjusted life years (DALYs) lost. Low- and middle-income countries account for about 85% of the deaths and 90% of the DALYs lost annually. Without appropriate action, by 2020, road traffic injuries are predicted to be the third leading contributor to the global burden of disease. The economic cost of road traffic crashes is enormous. Globally it is estimated that US$518 billion is spent on road traffic crashes with low- and middle-income countries accounting for US$65 billion--more than these countries receive in development assistance. But these costs are just the tip of the iceberg. For everyone killed, injured or disabled by a road traffic crash there are countless others deeply affected. Many families are driven into poverty by the expenses of prolonged medical care, loss of a family breadwinner or the added burden of caring for the disabled. There is an urgent need for global collaboration on road traffic injury prevention. Since 2000, WHO has stepped up its response to the road safety crisis by firstly developing a 5-year strategy for road traffic injury prevention and following this by dedicating World Health Day 2004 to road safety and launching the WHO/World Bank World Report on Road Traffic Injury Prevention at the global World Health Day event in Paris, France. This short article highlights the main messages from the World Report and the six recommendations for action on road safety at a national and international level. It goes on to briefly discuss other international achievements since World Health Day and calls for countries to take up the challenge of implementing the recommendations of the World Report.     

Pattern of road traffic injuries: one year hospital-based study in Western Nepal

Road traffic injuries and deaths caused by motor vehicles is a growing public health problem all over the world. Inter-country or regional differences in the pattern of injury by road users have significant implications in determining prevention policies. The present study was conducted to evaluate the pattern of injuries in 217 hospitalized trauma patients admitted during 1 year, 2003. The majority of the injuries (54%) involved motorcycles. The highest incidence amongst the male population was in the age group of 16 – 30 years. Head and face injuries and injuries to the lower limbs comprised 58.1% and 50.7% of all injuries respectively. The bones of the lower limbs were most commonly fractured. To conclude, the traffic casualties of motorcyclists and pedestrians are considered a major problem and the preventive measures to reduce these transport-related injuries are discussed in this study.     

Pattern of road traffic injuries: one year hospital-based study in Western Nepal

Road traffic injuries and deaths caused by motor vehicles is a growing public health problem all over the world. Inter-country or regional differences in the pattern of injury by road users have significant implications in determining prevention policies. The present study was conducted to evaluate the pattern of injuries in 217 hospitalized trauma patients admitted during 1 year, 2003. The majority of the injuries (54%) involved motorcycles. The highest incidence amongst the male population was in the age group of 16 - 30 years. Head and face injuries and injuries to the lower limbs comprised 58.1% and 50.7% of all injuries respectively. The bones of the lower limbs were most commonly fractured. To conclude, the traffic casualties of motorcyclists and pedestrians are considered a major problem and the preventive measures to reduce these transport-related injuries are discussed in this study.     

Productivity losses from road traffic deaths in Turkey

The importance of road traffic injuries in Turkey is not generally appreciated, in part due to lack of knowledge of its economic burden and in part due to major underestimation in official statistics. The total years of potential life lost and potentially productive years of life lost from mortality were calculated in order to estimate the cost of productivity losses from road traffic deaths in Turkey. More years of potentially productive life are lost due to road traffic deaths than to respiratory tract illnesses or diabetes mellitus, two other serious health problems in Turkey. Road traffic deaths cost Turkey an estimated USD 2.6 billion every year in productivity losses alone, more than the World Bank estimate of the indirect costs from the 1999 Marmara earthquake (USD 1.2-2 billion), Turkey's worst earthquake since 1939 (World Bank Turkey Country Office, 1999). This study highlights the importance of accurate information in ameliorating the burden of road traffic safety in Turkey. Turkey has great opportunities to implement cost-effective interventions to reduce the economic burden of fatal and non-fatal road traffic injuries.     

News and Events

Our aim is to report the findings of the initial three years of road traffic injuries (RTI) surveillance at Karachi and to compare it with previously published RTI-related data from Pakistan and other low-and middle-income countries. Data were collected through the RTI surveillance programme at Karachi (RTIRP) from the five biggest emergency departments of the city, which receive almost all the major emergencies of the city for the period September 2006 till September 2009. A total of 99,272 victims were enlisted by the RTIRP during the study period. Annual incidence of RTI is calculated to be 184.3 per 100,000 populations and mortality is 5.7 per 100,000 populations. Eighty nine per cent of victims are male and 73% are between 15 and 44 years of age. Commonest road user to be affected is riders of two wheelers (45%). Only 7% of affected motorcyclists were found to be wearing helmets at the time of the accident. Trends of injuries remained uniform over the years. Most frequent injuries were external wounds, followed by orthopaedic injuries. On the basis of our surveillance system, we have presented the largest RTI-related data from a metropolitan city of Pakistan to date.     

Initial results of Pakistan's first road traffic injury surveillance project

Our aim is to report the findings of the initial three years of road traffic injuries (RTI) surveillance at Karachi and to compare it with previously published RTI-related data from Pakistan and other low-and middle-income countries. Data were collected through the RTI surveillance programme at Karachi (RTIRP) from the five biggest emergency departments of the city, which receive almost all the major emergencies of the city for the period September 2006 till September 2009. A total of 99,272 victims were enlisted by the RTIRP during the study period. Annual incidence of RTI is calculated to be 184.3 per 100,000 populations and mortality is 5.7 per 100,000 populations. Eighty nine per cent of victims are male and 73% are between 15 and 44 years of age. Commonest road user to be affected is riders of two wheelers (45%). Only 7% of affected motorcyclists were found to be wearing helmets at the time of the accident. Trends of injuries remained uniform over the years. Most frequent injuries were external wounds, followed by orthopaedic injuries. On the basis of our surveillance system, we have presented the largest RTI-related data from a metropolitan city of Pakistan to date.     

Road traffic crashes with fatal and non-fatal injuries in Arkhangelsk,Russia in 2005–2010

The study investigated trends in traffic crashes with fatal and non-fatal injuries in Arkhangelsk, Russia in 2005–2010. Data were obtained from the road police. Negative binomial regression with time regressor was used to investigate trends in monthly incidence rates (IRs) of crashes, fatalities, and non-fatal injuries. During the six-year period, the police registered 4955 crashes with fatal and non-fatal injuries, which resulted in 217 fatalities and 5964 non-fatal injury cases. The IR of crashes with fatal and non-fatal injuries per total population showed no evident change, while the IR per increasing total number of motor vehicles decreased on average by 0.6% per month. Pedestrian crashes constituted 51.8% of studied crashes, and pedestrians constituted 54.6% of fatalities and 44.5% of non-fatal injuries. The IRs of pedestrian crashes and non-fatal pedestrian injuries per total population decreased on average by 0.3% per month, and these were the major trends in the data.     

Applying the capture-recapture method to estimate road traffic deaths and injuries in three non-contiguous cities in the Philippines

In establishing goals for the Philippine road safety plan, police data were used. Police reports are likely underreporting. We apply capture-recapture analysis to determine expansion factors and estimate the true incidence. Three cities were visited where data on deaths (2014) and injury (January–March 2014) from hospitals, police and civil registry were collected. Matching was done to generate a final list of injured and dead individuals. The Chapman method was used for estimating the true number of cases. Police data exhibited underreporting in all site. Expansion factors of the police data range from 5.4 to 29× for deaths and 3.2 to 47× for non-fatal injuries. Expansion factors are likely useful to estimate the true incidence of road traffic injuries in areas with weak injury surveillance systems such as the Philippines.     

Average out-of-pocket healthcare and work-loss costs of traffic injuries in Karachi, Pakistan

The objective of this study was to assess the average out-of-pocket healthcare and work-loss costs of road traffic injuries (RTI) in Karachi. In this cross-sectional study, RTI patients presenting to the five trauma centres in Karachi were contacted using stratified sampling to report their inpatient and outpatient expenses, the time spent in hospital and their average monthly income. These costs were compared among different categories of patient-related variables using analysis of variance test. Out of 341 RTI victims, two wheelers accounted for the majority of injuries (77.2%, N?=?256) followed by pedestrians (14.2%, N?=?48). Almost half of the sample patients were breadwinners (N?=?135, 45.2%), with 87.4% (N?=?118) earning less than US$ 248. Average out-of-pocket healthcare costs were US$ 271 (SD?=?440.9), which were significantly higher (P ≤ 0.026) for pedestrians (US$ 442), moderate (US$ 341.7) or severe (US$ 553.8) injury, and treatment in private hospitals (US$ 451.7). Similarly, average work loss was US$ 67.1 (SD?=?132.1), which were significantly higher (P?=?0.001) for breadwinners (US$ 99.1), moderate (US$ 130.0) or severe (US$ 157.1) injury, and treatment in private hospitals (US$ 150.0). Study results clearly showed the need to advocate RTI prevention measures in Pakistan as any such event could lead to a difficult economic situation for those involved and their family.     

Morbidity and mortality from road traffic crashes in children in Metro West,City of Cape Town – 2014

The road traffic crash injury burden significantly impacts the lives of South African children. This study aimed to assess the fatal and non-fatal pattern of road traffic crash injury of children under 13 years old from Metro West, City of Cape Town, from 1 January until 31 December 2014. The data were stratified by age, sex and mechanism of road traffic crash. The overall mortality rate was 8.7 per 100 000 population and pedestrians contributed the most to this burden (72.5%). There were more male children involved in a road traffic crash (p?=?0.0001). The greatest proportion of fatal and non-fatal road traffic crash injuries was observed in children aged 5–9 years. Fractures contributed to the greatest rate of years lived with disability (3.0 years of life lived with disability per 100 000). Our study found that the burden of road traffic crashes primarily affects male pedestrians aged 5–9 years old.     

Mortality due to injuries in Maputo City, Mozambique

Records of all registered deaths due to injuries maintained by the Legal Medicine Department in Maputo City for the period 1 January to 31 December 2000 were reviewed. Among the 1135 registered deaths, road traffic injuries accounted for the most common underlying cause of death (43.7%), followed by firearm discharge (8.7%) and burns (7.8%). For all deaths, skull fracture (21.9%), organ system injury (17.2%) and brain tissue injury (9.3%) were the most important intermediate causes of death and among the immediate causes of death acute anaemia (21.9%) was the most common followed by asphyxia (14.4%) and traumatic shock (12.0%). Overall, most cases were seen in the age group 20-29 years (27.0%) and comprising mainly males (male/female ratio 3.1). The most commonly reported cause for the victims to sustain injuries leading to death were accidents (59.4%), followed by homicides (19.8%), unknown causes (16.1%) and suicides (4.2%). Prevention of road traffic injuries and improved emergency care and health facility-based treatment is needed to reduce injury-related mortality.     

Parental beliefs about supervising children when crossing roads and cycling

Pedestrian and cyclist injuries are significant public health issues, together accounting for 11-30% of road deaths in highly motorised countries. Children are particularly at risk. In Australia in 2009 11.4% of pedestrian deaths and 6.4% of cyclist deaths comprised children aged 0-16 years. Parental attitudes and level of supervision are important to children's road safety. Results from a telephone survey with parents of children 5-9 years (N?=?147) are reported. Questions addressed beliefs about preventability of injury, appropriate ages for children to cross the road or cycle independently and the frequency of holding 5-9 year old children's hands while crossing the road. Results suggest that parents believe most injuries are preventable and that they personally can act to improve their own safety in the home, on the road, at work, as well as in or on the water. Most parents (68%) indicated children should be 10 years or older before crossing the road or cycling independently. Parents were more likely to report holding younger children's hands (5-6 years) when crossing the road and less likely to do so for 7- to 9-year olds. There was a small effect of child gender, with parents more likely to hold a boy's hand than that of a girl.     

Pattern of traffic injuries in Shanghai: implications for control

In China, traffic-related injuries are often treated as transportation issues, called 'accidents'. The objectives of the research are to analyse traffic injury patterns, estimate costs of traffic injuries and provide evidence to develop effective prevention strategies. There were over 1 500 deaths due to traffic-related injuries annually in Shanghai from 1987 to 2003, and it is rising year by year with the rate of growth in motorization. The rates of annual increase are 3.59% in fatalities (from 7.78 to 14.18 per 100000 population) and 10.46% in non-fatalities (from 53.93 to 264.98 per 100000 population) respectively during the period. The analysis of the geographic information system showed that the geographic distribution of traffic injuries in the countryside regions of Shanghai had the highest rates. Labour force groups represented the majority of fatalities (70.97%) and serious traffic injuries (90.51%). The mortality rates were 18.40 per 100000 population and 10.02 per 100000 population in 45-65 year age group and 15-44 year age group respectively; the morbidity rates of serious traffic injuries were 121.60 per 100000 population and 70.46 per 100000 population in the same groups respectively. And females generally showed a lower incidence than males. In general, fatalities and injuries were higher for drivers, bicyclists and pedestrians. Among road traffic injury-related fatalities, 66.8% were attributed to head injuries. Of those with fatal head injuries, bicyclists accounted for 29.8% of the total; pedestrians accounted for 28.3%; motorcyclists accounted for 25.5%. Total traffic injury cost was estimated at least US $645989580 in Shanghai in 2003. Good injury intervention programmes need to be done as soon as possible to effectively reduce traffic injury burden in Shanghai, China.     

The use of seatbelts and child restraints in three Mexican cities

Seatbelts and child restraints can reduce deaths resulting from road traffic crashes, and are one of the risk factors being targeted by the Road Safety in 10 Countries project in Mexico. This study quantifies the prevalence of restraint use in two of the intervention sites (Guadalajara-Zapopan and León) and one comparison site (Cuernavaca). Three rounds of roadside observations were conducted between November 2010 and January 2012. The overall prevalence of seatbelt use was 45.0% (95% CI = 44.3–45.7) amongst all occupants ≥10 years of age in the three cities. Child restraint use in children <5 years of age ranged from 7.9 to 17.4%. Two rounds of surveys were administered to all road traffic injury (RTI) victims presenting at a tertiary hospital in each city; RTI victims had lower seatbelt use than the general population (31% vs 42%, p = 0.037). This study demonstrates the need for further targeted intervention to increase use of these highly efficacious safety devices in Mexico.