Evaluation of the five-year Bloomberg Philanthropies Global Road Safety Program in the Russian Federation

The incidence of brain trauma caused by road injuries: Results from the Global Burden of Disease Study 2019

BACKGROUND

Road collisions are a significant source of traumatic brain injury (TBI). We aimed to determine the pattern of road injury related TBI (RI-TBI) incidence, as well as its temporal trends.

METHODS

We collected detailed information on RI-TBI between 1990 and 2019, derived from the Global Burden of Disease Study 2019. Estimated annual percentage changes (EAPCs) of RI-TBI age standardized incidence rate (ASIR), by sex, region, and cause of road injuries, were assessed to quantify the temporal trends of RI-TBI burden.

RESULTS

Globally, incident cases of RI-TBI increased 68.1% from 6,900,000 in 1990 to 11,600,000 in 2019. The overall ASIR increased by an average of 0.43% (95% CI 0.30%-0.56%) per year during this period. The ASIR of RI-TBI due to cyclist, motorcyclist and other road injuries increased between 1990 and 2019; the corresponding EAPCs were 0.56 (95% CI 0.37-0.75), 1.60 (95% CI 1.35-1.86), and 0.75 (95% CI 0.59-0.91), respectively. In contrast, the ASIR of RI-TBI due to motor vehicle and pedestrian decreased with an EAPC of -0.12 and -0.14 respectively. The changing pattern for RI-TBI was heterogeneous across countries and regions. The most pronounced increases were observed in Mexico (EAPC = 3.74), followed by China (EAPC = 2.45) and Lesotho (EAPC = 1.91).

CONCLUSIONS

RI-TBI remains a major public health concern worldwide, although road safety legislations have contributed to the decreasing incidence in some countries. We found an unfavorable trend in several countries with a relatively low socio-demographic index, suggesting that much more targeted and specific approaches should be adopted in these areas to forestall the increase in RI-TBI.

Impact of the program life in traffic and new zero-tolerance drinking and driving law on the prevalence of driving after alcohol abuse in Brazilian capitals: An interrupted time series analysis

INTRODUCTION

Driving under the influence of alcohol is one of the main factors for morbidity and mortality from traffic accidents. In 2010 and 2013, the Program Life in Traffic was implemented in Brazil, including the international initiative "Road Safety in Ten Countries", which established actions to reduce one of the main risk factors for road traffic injuries, the driving under the influence of alcohol. In 2012, a new zero-tolerance drinking and driving law (new dry law) was implemented, establishing a zero-tolerance limit for the drivers' blood alcohol concentration, and increasing punitive measures. This study aimed at analyzing the impact of these measures on the prevalence of driving under the influence of alcohol abuse in Brazilian capitals.

METHODS

An interrupted time series study was conducted using the models of autoregressive integrated moving average or seasonal autoregressive integrated moving average. The main outcome was the prevalence of driving after alcohol abuse in the adult population (≥ 18 years). The model's predictors were the interventions "Program Life in Traffic" and "New Dry Law". The former was implemented in the first quarter of 2011, initially in five capitals: Belo Horizonte, Campo Grande, Palmas, Teresina, and Curitiba, being expanded to the other capitals in the first quarter of 2013. The latter was implemented in the country on the first quarter of 2013. Data source for the study was the records of the surveillance system for risk and protection factors of chronic diseases through telephone survey (Vigitel) from 2007 to 2016.

RESULTS

The time intervals considered in the study were the quarters. Thirty-eight units were considered in the analysis, corresponding to time series points. It was found that after the implementation of the Program Life in Traffic, in the first quarter of 2011, there was a reduction in the prevalence in Belo Horizonte and Curitiba. Because the introduction of the New Dry Law and the Program Life in Traffic took place in similar periods in the other cities, there was a significant reduction in the outcome prevalence in the cities of Aracaju, Belo Horizonte, Boa Vista, Fortaleza, João Pessoa, Maceió, Manaus, Palmas, Porto Alegre, Recife, Teresina, Rio Branco, and Vitória following the law application.

CONCLUSION

The present study identified an immediate impact of the Program Life in Traffic in two capitals (Belo Horizonte and Curitiba) and a joint impact of the New Dry Law in 13 capitals. The results of this study have implications for strengthening interventions aimed at reducing the burden of morbidity and mortality from traffic accidents in Brazil.

The association between beverage-specific alcohol consumption and mortality among road users in Russia, 1965-2019

A vast body of literature suggests a relationship between alcohol consumption and road traffic fatalities. Despite an impressive downward trend in road traffic fatalities in Russia, the death rate is still unacceptably high. Far fewer studies have differentiated the association by road users and types of alcoholic beverages. This population-based study aims to estimate the associations of total and beverage-specific alcohol per capita (15+) consumption (APC) based on official alcohol sales statistics and road traffic mortality using police data on the number of deaths by road users. The study covers the period 1965-2019. We employed a first-order difference linear regression model with robust and autocorrelation consistent standard errors, controlling for a level of motorisation. To examine the possible evolution of the phenomenon, we repeated models separately for three consecutive periods (1965-1984, 1985-2002, 2003-2019). The findings suggest that an annual 1-litre increase in APC (in litres of pure alcohol) associated with a corresponding increase in the death rates (per 100,000 inhabitants) of both unprotected road users and motor vehicle occupants by about 0.3 (p < 0.01) and 0.4 (p < 0.05), respectively. A beverage-specific analysis for 1965-2019 revealed a positive and significant association between mortality of pedestrians and cyclists and the consumption of strong alcoholic beverages (p < 0.05) as well as mortality of drivers and passengers and the consumption of weaker alcoholic beverages, primarily beer (p < 0.01). Various road safety strategies should be applied to prevent road traffic fatalities of road users.

Lives Saved in Low- and Middle-Income Countries by Road Safety Initiatives Funded by Bloomberg Philanthropies and Implemented by Their Partners between 2007-2018

Over the past 12 years, Bloomberg Philanthropies (BP) and its partner organisations have implemented a global road safety program in low- and middle-income countries. The program was implemented to address the historically increasing number of road fatalities and the inadequate funding to reduce them. This study evaluates the performance of the program by estimating lives saved from road safety interventions implemented during the program period (2007–2018) through to 2030. We estimated that 311,758 lives will have been saved by 2030, with 97,148 lives saved up until 2018 when the evaluation was conducted and a further 214,608 lives projected to be saved if these changes are sustained until 2030. Legislative changes alone accounted for 75% of lives saved. Concurrent activities related to reducing drink driving, implementing legislative changes, and social marketing campaigns run in conjunction with police enforcement and other road safety activities accounted for 57% of the total estimated lives saved. Saving 311,758 lives with funding of USD $259 million indicates a cost-effectiveness ratio of USD $831 per life saved. The potential health gains achieved through the number of lives saved from the road safety initiatives funded by Bloomberg Philanthropies represent a considerable return on investment. This study demonstrates the extent to which successful, cost-effective road safety initiatives can reduce road fatalities in low- and middle-income countries.

Affordability and Availability of Child Restraints in an Under-Served Population in South Africa

Background: Child road traffic injuries are a major global public health problem and the issue is particularly burdensome in middle-income countries such as South Africa where injury death rates are 41 per 100,000 for under 5′s and 24.5 per 100,000 for 5–14-year-old. Despite their known effectiveness in reducing injuries amongst children, the rates of use of child restraint systems (CRS) remains low in South Africa. Little is known about barriers to child restraint use especially in low- and middle-income countries. Methods: We carried out observation studies and parent/carer surveys in 7 suburbs of Cape Town over a three month period to assess usage rates and explore the knowledge and perceptions of parents towards child restraint legislation, ownership and cost; Results: Only 7.8% of child passengers were observed to be properly restrained in a CRS with driver seatbelt use and single child occupancy being associated with higher child restraint use. 92% of survey respondents claimed to have knowledge of current child restraint legislation, however, only 32% of those parents/carers were able to correctly identify the age requirements and penalty. Reasons given for not owning a child seat included high cost and the belief that seatbelts were a suitable alternative. Conclusions: These findings indicate the need for a tighter legislation with an increased fine paired with enhanced enforcement of both adult seatbelt and child restraint use. The provision of low-cost/subsidised CRS or borrowing schemes and targeted social marketing through online fora, well baby clinics, early learning centres would be beneficial in increasing ownership and use of CRS.