Road traffic injuries in India: a review of the literature

Factors Associated With the Complexity of Facial Trauma

INTRODUCTION

Facial fractures have their incidence, etiology, clinical presentation, and features influenced by variables such as economic, cultural, and demographic factors. A large number of these fractures require simple or more complex approaches, and it becomes important to understand their clinical and epidemiological profile and factors associated with the fracture event and surgical indication.

OBJECTIVE

The objective of this research is to analyze the clinical and epidemiological profile of surgical fractures and their associations with causal factors such as alcohol consumption, day of the incident, and nonuse of helmet for motorcycle accidents.

METHOD

A retrospective study was conducted with collection of data from medical records of patients operated for facial fractures at the Hospital Regional of Cariri, state of Ceara, the Northeast of Brazil. Records from 2012 to 2014 were acquired highlighting sex, age, occupation, etiology, anatomical sites of fractures, and surgeries of varying complexities for single or multiple fractures. The day of the event, report or signs of alcohol consumption, and the use of helmets in motorcycle accidents were named associated factors.

RESULTS

As a result the authors had a total of 624 cases of surgical facial fractures. Out of these, 546 (87.5%) were male and the majority of them presented between 20 and 30 years of age (40.5%). It was also observed that as an etiological factor motorcycle accidents led to more cases of surgical facial fractures, with 357 cases (62.1%), followed by physical aggression with 72 cases (12.5%).

CONCLUSIONS

It can be concluded that there is a high prevalence of surgical facial fractures in male patients between 20 and 30 years of age, caused by motorcycle accidents, and that there was a strong association between the consumption of alcohol, failure to wear a helmet, and the presence of surgical facial multiple fractures.

Changing pattern and etiology of maxillofacial fractures during the civil uprising in Western Libya

Background

The purpose of the present study was to evaluate changing pattern in characteristics of maxillofacial fractures and concomitant injuries in Western Libya During revolution and to assess the association between mechanism of injury and fracture patterns.

Material and Methods

A retrospective review of medical records and radiographs of 187 patients treated for maxillofacial fractures from January 2010 to December 2012 was performed, there were 326 fractures in 187 patients.

Results

The male: female ratio was 6:1. Most fractures occurred in patients aged 11 to 40 years, and few injuries occurred in patients aged > 50 years. Most fractures occurred from motor vehicle accidents, and other most frequent causes included assault, gunshot, and fall injuries. Most maxillofacial fractures involved the mandible, zygomatic complex, or maxilla. Most mandibular fractures occurred at the parasymphysis, angle, or condyle. Associated injuries most frequently involved the head, chest, and extremities. Most patients were treated with open reduction (132 patients [71%]), and 26 patients (14%) were treated nonoperatively. There were 21 complications (11%).

Conclusions

In summary, motor vehicle accidents were the most frequent cause of maxillofacial fracture in western Libya, possibly because of the lack of seat belt legislation. Interpersonal violence was a less frequent cause of maxillofacial fracture, possibly because of the religious restriction on alcohol consumption.

Key words:Tauma, mandible, zygomatic complex, maxilla, treatment, complications.

Correlates of fatality risk of vulnerable road users in Delhi

Pedestrians, cyclists, and users of motorised two-wheelers account for more than 85% of all the road fatality victims in Delhi. The three categories are often referred to as vulnerable road users (VRUs). Using Bayesian hierarchical approach with a Poisson-lognormal regression model, we present spatial analysis of road fatalities of VRUs with wards as areal units. The model accounts for spatially uncorrelated as well as correlated error. The explanatory variables include demographic factors, traffic characteristics, as well as built environment features. We found that fatality risk has a negative association with socio-economic status (literacy rate), population density, and number of roundabouts, and has a positive association with percentage of population as workers, number of bus stops, number of flyovers (grade separators), and vehicle kilometers travelled. The negative effect of roundabouts, though statistically insignificant, is in accordance with their speed calming effects for which they have been used to replace signalised junctions in various parts of the world. Fatality risk is 80% higher at the density of 50 persons per hectare (pph) than at overall city-wide density of 250 pph. The presence of a flyover increases the relative risk by 15% compared to no flyover. Future studies should investigate the causal mechanism through which denser neighborhoods become safer. Given the risk posed by flyovers, their use as congestion mitigation measure should be discontinued within urban areas.

Adapting the emergency first aid responder course for Zambia through curriculum mapping and blueprinting

OBJECTIVES

Community members are often the first to witness and respond to medical and traumatic emergencies, making them an essential first link to emergency care systems. The Emergency First Aid Responder (EFAR) programme is short course originally developed to help South Africans manage emergencies at the community level, pending arrival of formal care providers. EFAR was implemented in two rural regions of Zambia in 2015, but no changes were originally made to tailor the course to the new setting. We undertook this study to identify potential refinements in the original EFAR curriculum, and to adapt it to the local context in Zambia.

DESIGN

The EFAR curriculum was mapped against available chief complaint data. An expert group used information from the map, in tandem with personal knowledge, to rank each course topic for potential impact on patient outcomes and frequency of use in practice. Individual blueprints were compiled to generate a refined EFAR curriculum, the time breakdown of which reflects the relative weight of each topic.

SETTING

This study was conducted based on data collected in Kasama, a rural region of Zambia's Northern Province.

PARTICIPANTS

An expert group of five physicians practising emergency medicine was selected; all reviewers have expertise in the Zambian context, EFAR programme and/or curriculum development.

RESULTS

The range of emergencies that Zambian EFARs encounter indicates that the course must be broad in scope. The refined curriculum covers 54 topics (seven new) and 25 practical skills (five new). Practical and didactic time devoted to general patient care and scene management increased significantly, while time devoted to most other clinical, presentation-based categories (eg, trauma care) decreased.

CONCLUSIONS

Discrepancies between original and refined curricula highlight a mismatch between the external curriculum and local context. Even with limited data and resources, curriculum mapping and blueprinting are possible means of resolving these contextual issues.

Prevalence and regional correlates of road traffic injury among Chinese urban residents: A 21-city population-based study

OBJECTIVE

This study estimated the prevalence of road traffic injury among Chinese urban residents and examined individual and regional-level correlates.

METHOD

A cross-sectional multistage process was used to sample residents from 21 selected cities in China. Survey respondents reported their history of road traffic injury in the past 12 months through a community survey. Multilevel, multivariable logistic regression analysis was used to identify injury correlates.

RESULTS

Based on a retrospective 12-month reporting window, road traffic injury prevalence among urban residents was 13.2%. Prevalence of road traffic injury, by type, was 8.7, 8.7, 8.5, and 7.7% in the automobile, bicycle, motorcycle, and pedestrian categories, respectively. Multilevel analysis showed that prevalence of road traffic injury was positively associated with minority status, income, and mental health disorder score at the individual level. Regionally, road traffic injury was associated with geographic location of residence and prevalence of mental health disorders.

CONCLUSIONS

Both individual and regional-level variables were associated with road traffic injury among Chinese urban residents, a finding whose implications transcend wholesale imported generic solutions. This descriptive research demonstrates an urgent need for longitudinal studies across China on risk and protective factors, in order to inform injury etiology, surveillance, prevention, treatment, and evaluation.

The impact of road traffic injury in North India: a mixed-methods study protocol

BACKGROUND

Road traffic injuries are a large and growing public health burden, especially in low and middle income countries where 90% of the world's deaths due to road traffic injuries are estimated to occur. India is one of the fastest growing economies, with rapid motorisation and increasing road traffic burden. However, there are limited data addressing the problem of non-fatal road traffic injuries, with existing data being of poor quality, non-representative and difficult to access, and encompassing a limited number of relevant variables. This study aims to determine the outcomes of road traffic injuries on function and health-related quality of life, to assess their social impact and to weigh the economic cost of road traffic crashes in an urban setting in India.

METHODS AND ANALYSIS

This prospective observational study will recruit approximately 1500 participants injured in road traffic crashes, who are admitted to hospital for >24 h at any of three participating hospitals in Chandigarh, India. Face-to-face baseline interviews will be conducted by telephone at 1, 2, 4 and 12 months postinjury. Standardised tools will be used to collect data on health and social outcomes, and on the economic impact of road traffic crashes. Descriptive analysis and multivariate models will be used to report outcome data and associations. The qualitative in-depth interviews will be analysed thematically using content analysis. This study will provide the first comprehensive estimates on outcomes of serious road traffic injury in India, including economic and social costs, and the impact on individuals and families.

ETHICS AND DISSEMINATION

Primary ethics approval was received from the Postgraduate Institute for Medical Education and Research, institute's ethics committee, Chandigarh, India. Results will be disseminated via the usual scientific forums including peer-reviewed publications and presentations at international conferences.

Risk factors for fatal and nonfatal road crashes in iran

Background:

Road traffic injuries are among the leading causes of death in the world and Iran.

Objectives:

The aim of this study was to assess the role of age, sex, education, and time of accident on human casualties and mortalities of road crashes in Iran.

Materials and Methods:

This study was based on data gathered by Iranian Police Department from the records of road crashes from April 4, 2008 through April 4, 2009. Road crashes are categorized into three types: with no human casualties, with injuries, and with human mortalities.

Results:

The largest rate of human causalities was observed in people aged between 25 to 34 years (P < 0.001). Illiterate people had 81% smaller odds of causality in road crashes (P < 0.001) in comparison with those with a kind of academic education. Overall, 73.4% of crashes had happened during the last ten days of a month were with human casualties (P < 0.001) and human casualties rate was slightly higher in crashes happened between 1 AM to 5 AM Fatality rate was slightly higher in the females (OR = 2.6, P = 0.068). The smallest odds of fatality were found in the people aged between 18 to 24 years and the highest odds were seen in people ≥ 55 years of age (P < 0.001). In people with a university education, 61.9% of crashes were with fatality (P = 0.026). In addition, 82.8% of crashes during winter, 60.2% of crashes during autumn, and 35.8% of crashes during summer were with mortalities. Overall, 78.3% of crashes with human casualties that had happened during 1 AM to 5 AM led to mortalities. There was also a significant association between injury and its intensity with fastening seatbelts.

Conclusions:

Older age, university degrees, female sex, wintertime, and the time of accident seem to be the most important risk factors in road crashes that lead to fatalities in Iran. Drivers in Iran should be informed and trained regarding these risk factors, which have direct effect on casualties and mortalities in road crashes.

Use of kangri (a traditional firepot) as a weapon

Kangri an earthenware firepot has been traditionally used by people of Kashmir for protecting themselves for harsh winter weather. This study done on patients admitted in the burns ward and general emergency ward of a tertiary care hospital, is perhaps the first of its kind. It analyses the use of this very traditional and useful art form as a weapon that can cause significant damage during interpersonal conflicts. As is clear from the study its use as weapon can inflict considerable damage and can lead to lifelong disabilities. Out of the 20 cases studied over a period of one year 2 cases received grievous injuries over head and face region in form of permanent disfigurement. Almost half of the injuries i.e. 7 cases were mechanical in nature whereas rest 13 cases belong to thermal category. Most of the injuries were simple and healed with preliminary medical attention but in 2 cases there was permanent disfigurement and both were because of deep burns.

The quality of police data on RTC fatalities in India

BACKGROUND

Police records are the major source of data on road traffic collision (RTC) deaths in India.

OBJECTIVE

To examine the utility and quality of police data on RTC deaths available from two sources.

METHODS

Police data on RTC deaths available from National Crime Records Bureau (NCRB) and Ministry of Road Transport and Highways (MoRTH) were accessed. The utility of these data for surveillance and consistency of data reported by the two organisations was examined. Data completeness was assessed for India, its six geographic regions and for the mode of travel using cause of death estimates from the Sample Registration System (SRS) and Global Burden of Disease (GBD) as a reference.

RESULTS

Data imperative for surveillance including deaths by age and sex for each state, the counterpart vehicle or object and use of safety equipment were not available. The total number of deaths reported by NCRB and MoRTH was similar across states but showed large differences by mode of travel categories. Compared with GBD, completeness of the number of fatalities reported by both sources in 2010 was approximately 50%. Completeness for the geographic regions ranged from 26.4% to 76.4%, using SRS data, in 2001-2003.

CONCLUSIONS

This detailed examination of police data on RTC fatalities from two sources has raised several questions about the validity of these data and has highlighted a number of gaps that limit the usefulness of these data for surveillance and informing road safety policies. Unless these are addressed, significant reductions in RTC fatalities cannot be achieved in India.

A population-based study on road traffic injuries in Pune City, India

OBJECTIVE

The annual mortality of road traffic injuries (RTIs) is estimated to be over 80,000 in India; however, there is not enough information about the magnitude, pattern, and factors associated with RTIs in a population-based scenario, where the police and hospital records suffer from severe underreporting. This study was conducted with the aim of identifying the burden, pattern, and risk factors of RTIs in the population of Pune City.

METHOD

A population-based cross-sectional study was conducted among 9014 individuals in a randomly selected and representative sample of the population from 14 administrative wards of the city from March 2008 to April 2009.

RESULTS

The annual incidence rate of RTIs was 93.2 (95% confidence interval [CI], 83.2-103.2) per 1000 individuals and after adjustment for age it was 76.4 per 1000 individuals. Injury occurrence was significantly more among the age group 15-30, males, and students and workers. Univariate analysis showed a significant association between RTIs and age, gender, occupation, mode of transport, driving a vehicle, and alcohol abuse. Multivariate analysis showed that only age, driving a vehicle, and alcohol abuse were the factors associated with RTIs.

CONCLUSION

The magnitude of RTIs in India is very high, which is not reflected in police registration reports.

Road traffic injury mortality and its mechanisms in India: nationally representative mortality survey of 1.1 million homes

OBJECTIVES

To quantify and describe the mechanism of road traffic injury (RTI) deaths in India.

DESIGN

We conducted a nationally representative mortality survey where at least two physicians coded each non-medical field staff's verbal autopsy reports. RTI mechanism data were extracted from the narrative section of these reports.

SETTING

1.1 million homes in India.

PARTICIPANTS

Over 122 000 deaths at all ages from 2001 to 2003.

PRIMARY AND SECONDARY OUTCOME MEASURES

Age-specific and sex-specific mortality rates, place and timing of death, modes of transportation and injuries sustained.

RESULTS

The 2299 RTI deaths in the survey correspond to an estimated 183 600 RTI deaths or about 2% of all deaths in 2005 nationally, of which 65% occurred in men between the ages 15 and 59 years. The age-adjusted mortality rate was greater in men than in women, in urban than in rural areas, and was notably higher than that estimated from the national police records. Pedestrians (68 000), motorcyclists (36 000) and other vulnerable road users (20 000) constituted 68% of RTI deaths (124 000) nationally. Among the study sample, the majority of all RTI deaths occurred at the scene of collision (1005/1733, 58%), within minutes of collision (883/1596, 55%), and/or involved a head injury (691/1124, 62%). Compared to non-pedestrian RTI deaths, about 55 000 (81%) of pedestrian deaths were associated with less education and living in poorer neighbourhoods.

CONCLUSIONS

In India, RTIs cause a substantial number of deaths, particularly among pedestrians and other vulnerable road users. Interventions to prevent collisions and reduce injuries might address over half of the RTI deaths. Improved prehospital transport and hospital trauma care might address just over a third of the RTI deaths.

The impact of mandatory helmet law on the outcome of maxillo facial trauma: a comparative study in kerala

INTRODUCTION

Motorcyclists comprise the majority of road-traffic victims in low and middle income countries,and consequently, the majority of the road-traffic victims globally. Simple measures can be taken to make safer on the roads, which include enforcement of safety measures like seat belt and helmets. The compulsory Helmet law was enforced in Kerala on 18/06/07. Resistance to legislation on motorcycle helmets still coexists world wide with debate on the effectiveness of helmets. In an attempt to analyze the protective effect of helmets on facial injuries a comparative study was conducted in Government Dental College, Calicut, which is a major trauma centre in northern Kerala.

METHODS

Data for the present study was obtained from the patients who have reported to the Emergency Department of Oral and Maxillofacial Surgery, Government Dental College, Calicut, for a period of 6 months immediately after the implementation of strict helmet rule in Kerala. For the study all patients with a history of nonfatal motor cycle accident sustaining facial injuries were included. The results were compared with the study conducted in the same institution in the pre law period.

RESULTS

The study demonstrates the protective effect of motorcycle helmets in decreasing the morbidity of maxillofacial trauma.There was a marked decrease in incidence of motorcycle-related injuries, remarkable increase in helmet usage and better outcome in helmeted individuals in the post law period.

CONCLUSION

Road traffic injury control is a public health problem. Health and medical professionals have an ethical responsibility to educate and arrange for the safety of individuals. Helmets are effective in preventing or reducing the severity of motorcycle-related injuries and in a developing country like India, enforced mandatory motor cycle helmet law is potentially one of the most cost effective interventions available.

Unintentional injury mortality in India, 2005: nationally representative mortality survey of 1.1 million homes

Background

Unintentional injuries are an important cause of death in India. However, no reliable nationally representative estimates of unintentional injury deaths are available. Thus, we examined unintentional injury deaths in a nationally representative mortality survey.

Methods

Trained field staff interviewed a living relative of those who had died during 2001-03. The verbal autopsy reports were sent to two of the130 trained physicians, who independently assigned an ICD-10 code to each death. Discrepancies were resolved through reconciliation and adjudication. Proportionate cause specific mortality was used to produce national unintentional injury mortality estimates based on United Nations population and death estimates.

Results

In 2005, unintentional injury caused 648 000 deaths (7% of all deaths; 58/100 000 population). Unintentional injury mortality rates were higher among males than females, and in rural versus urban areas. Road traffic injuries (185 000 deaths; 29% of all unintentional injury deaths), falls (160 000 deaths, 25%) and drowning (73 000 deaths, 11%) were the three leading causes of unintentional injury mortality, with fire-related injury causing 5% of these deaths. The highest unintentional mortality rates were in those aged 70years or older (410/100 000).

Conclusions

These direct estimates of unintentional injury deaths in India (0.6 million) are lower than WHO indirect estimates (0.8 million), but double the estimates which rely on police reports (0.3 million). Importantly, they revise upward the mortality due to falls, particularly in the elderly, and revise downward mortality due to fires. Ongoing monitoring of injury mortality will enable development of evidence based injury prevention programs.

Epidemiology of injury in rural Pondicherry, India

BACKGROUND

To find out the prevalence of "all" injuries, its nature, outcome and sources of treatment among rural population of Pondicherry.

METHODS

It was a triangulated study of quantitative (survey) and qualitative (Focus Group Discussion, FGD) methods. The trained second year medical undergraduate students paid house visits to all houses in five feasibly selected villages of our field practice area. The students interviewed the housewife and obtained information for all injuries for each family member in last one year and its sources of treatment. We could obtain information for 1,613 (96.7%) households. Post-survey, FGDs were undertaken to explore the various traditional treatments for the common injuries. The data was entered and analyzed using Epi_info 6.04d software package.

RESULTS

Overall, the prevalence of all injury among all age groups was 30.6% in last one year. Injuries were significantly more after 18 years of age and among men (p was less than 0.001). About 99.2% injuries reported were accidental and majority (58.2%) went to government doctor for treatment. Most common causes of injuries were fall on the ground from height or due to slip (7.4%), road traffic accidents (5.6%), agriculture related injuries (5%) and bites by scorpion/insects/snakes /dogs (4.1%). FGDs explored some potentially harmful traditional remedial measures at village level such as application of mud or cow dung on the injury and burning the site of thorn prick on foot sole.

CONCLUSIONS

Considering the high prevalence of all injuries related to road traffic accidents, fall from height and agriculture work related injuries across all age groups, especially among men and some potentially harmful traditional treatments, an intervention in the form of targeted injury prevention program for different age and sex group, focusing health education efforts based on local epidemiology and behavioral practices is needed.

Crashes involving motorised rickshaws in urban India: characteristics and injury patterns

INTRODUCTION

Motorised three-wheeled vehicles (motorised rickshaw) are popular in Asian countries including India. This study aims to describe the crash characteristics and injury patterns for motorised rickshaw occupants and the road users hit-by-motorised rickshaw in urban India.

METHODS

Consecutive cases of road traffic crashes involving motorised rickshaw, irrespective of injury severity, whether alive or dead, presenting to the emergency departments of two large government hospitals and three branches of a private hospital in Hyderabad city were recruited. Crash characteristics,details of injuries, injury severity parameters and outcome were documented in detailed interviews.

RESULTS

A total of 139 (18%) of the 781 participants recruited were injured as a motorised rickshaw occupant (11%) or were hit by a motorised rickshaw (7%) in 114 crashes involving motorised rickshaw. Amongst motorised rickshaw occupants, single-vehicle collisions (54%) were more frequent than multivehicle collisions (46%), with overturning of motorised rickshaw in 73% of the single-vehicle collisions.Mortality (12%), the mean Injury Severity Score (5.8) and rate of multiple injured (60%) indicated a substantial trauma load. No significant differences in injury pattern were found between motorised rickshaw occupants and hit-by-motorised rickshaw subjects, with the pattern being similar to that of the pedestrians and two-wheeled vehicle users. With bivariate analysis for motorised rickshaw occupants,the risk of fatal outcome (odds ratio (OR) 2.60, 95% confidence interval (CI): 0.64–10.54), upper limb injury (OR 2.25, 95% CI: 0.94–5.37) and multiple injuries (OR 2.03, 95% CI 0.85–4.83) was high, although not statistically significant in multi-motorised-vehicle collisions as compared with the single-vehicle collisions or overturning. The risk of having multiple injuries (OR 4.55, 95% CI: 1.15–17.95) was significantly higher in motorised rickshaw occupants involved in front collisions. Being a front-seat motorised rickshaw passenger in a vehicle collision increased the risk of having a fatal outcome (OR 7.37,95% CI: 0.83–65.66) and a Glasgow coma score 12 (OR 2.21, 95% CI: 0.49–9.89), although not significantly when compared to the back-seat passengers.

CONCLUSION

These findings can assist with planning to deal with the consequences and prevention of road traffic injuries due to crashes involving motorised rickshaw, given the high use of these and substantial morbidity of related injuries in India. The need for improved understanding of the risk characteristics of motorised rickshaw is highlighted.

[Road traffic crashes in developing countries]

Road traffic crashes pose a major threat to individuals and national health systems. Developing countries account for 48% of motorized vehicles, but for 91% of the 1.3 million fatalities per annum. While ranked ninth among the causes of disabilities adjusted life years lost in 2004, crash injuries are projected to rise to third position by 2030. This article reviews current prognoses of deaths and disabilities, the characteristics of crashes in low and middle income countries and evidence-based road safety interventions. This article is considered a wake-up call for trauma, orthopaedic, and emergency surgeons in high-income countries to join the global community in fighting the neglected yet potentially curable epidemic named road traffic injuries.

The global burden of unintentional injuries and an agenda for progress

According to the World Health Organization, unintentional injuries were responsible for over 3.9 million deaths and over 138 million disability-adjusted life-years in 2004, with over 90% of those occurring in low- and middle-income countries (LMIC). This paper utilizes the year 2004 World Health Organization Global Burden of Disease Study estimates to illustrate the global and regional burden of unintentional injuries and injury rates, stratified by cause, region, age, and gender. The worldwide rate of unintentional injuries is 61 per 100,000 population per year. Overall, road traffic injuries make up the largest proportion of unintentional injury deaths (33%). When standardized per 100,000 population, the death rate is nearly double in LMIC versus high-income countries (65 vs. 35 per 100,000), and the rate of disability-adjusted life-years is more than triple in LMIC (2,398 vs. 774 per 100,000). This paper calls for more action around 5 core areas that need research investments and capacity development, particularly in LMIC: 1) improving injury data collection, 2) defining the epidemiology of unintentional injuries, 3) estimating the costs of injuries, 4) understanding public perceptions about injury causation, and 5) engaging with policy makers to improve injury prevention and control.

The problems in determining international road mortality

We examined road traffic crash (RTC) fatality rate data for the year 2002 with the object of determining which data source offered the most reliable estimates for international comparison work. Data from the World Health Organisation (WHO) (supplied by national health authorities) and the International Road Federation (IRF) (supplied by national transport authorities) was compared. There were large discrepancies between the rates reported. Discrepancies may be partially explained by the under-reporting of fatalities and by different definitions of road fatality. Two methodologies to adjust for these factors in the IRF database were examined. Neither brought consensus with the WHO RTC fatality rate for all nations. While the WHO provide RTC fatality rates for a wider socio-economic and geographical range of nations than the IRF, the methodology used by the WHO to produce estimates for the least economically developed nations may lead to over-estimation of RTC fatality rate. WHO RTC fatality rates were more strongly associated with variables that are thought to explain RTC fatality rate. We suggest that WHO data may be more suitable than the IRF data for international comparison studies. However, it is advisable that data for the least developed nations be excluded from such work.

Risk factors for urban road traffic injuries in Hangzhou, China

OBJECTIVE

To investigate factors that most influence urban road traffic injuries (RTI) mortality and morbidity.

METHODS

The study used linked police and hospital records of RTI patients in the city of Hangzhou during the 3-year period 2004-2006. Three RTI outcome groups were included: (1) fatally injured; (2) severely injured; and (3) mildly injured persons.

RESULTS

High risks for fatal road traffic accidents (RTA) were found on urban links, over weekend, during night hours, in male drivers who drove old vehicles without using seat belts, and at exceeding speeds, or with night time accidents and bad weather condition. In case of higher risk for all urban road users on urban junctions, the numbers on mildly injury cases were increasing. The highest combined risk for dying or being severely injured was found in male drivers driving at excessive speed, on urban links, and with night time accidents.

CONCLUSIONS

Intensifying safety education of motor vehicle drivers, enhancing traffic management and keeping balance of "person-vehicle-road" system will greatly reduce the urban traffic accidents and casualties.

Incidence and burden of road traffic injuries in urban India

BACKGROUND

The scale of road traffic injuries (RTIs) in India is uncertain because of limitations in the availability and reliability of incidence data.

OBJECTIVE

To report these data for Hyderabad city in southern India.

METHODS

In a cross-sectional population-based survey, 10 459 participants aged 5-49 years (94.3% participation), selected using three-stage systematic cluster sampling, were interviewed. Participants recalled RTIs in the preceding 3 months and RTI-related death and disability in the household in the preceding 3 years. RTI was defined as an injury resulting from a road traffic crash irrespective of the severity.

RESULTS

The age/sex-adjusted annual incidence of non-fatal RTI requiring a recovery period of < or =7, 8-29, and > or =30 days was 13% (95% CI 12.6% to 13.4%), 5.8% (95% CI 5.5% to 6.0%), and 1.2% (95% CI 1.1% to 1.4%), respectively. The overall adjusted rate for non-fatal RTI was 20.7% (95% CI 20.0% to 21.3%). The relative risk of RTI requiring a recovery period of >7 days was significantly higher in the third per capita monthly income quartile (1.24 (95% CI 1.12 to 1.37); p<0.05). The incidence of non-fatal RTI was highest in pedestrians, motorized two-wheeled vehicle users, and cyclists: 6.4, 6.3, and 5.1/100 persons/year, respectively. Annual RTI mortality and disability rates were 38.2 (95% CI 17.5 to 58.8) and 35.1 (95% CI 12.4 to 57.7) per 100,000 population, respectively.

CONCLUSIONS

There is a high burden of RTI in this urban population. With the recent attention focused on RTI by the Government of India, these findings may assist in planning appropriate initiatives to reduce the RTI burden.

Pedestrian road traffic injuries in urban Peruvian children and adolescents: case control analyses of personal and environmental risk factors

Background

Child pedestrian road traffic injuries (RTIs) are an important cause of death and disability in poorer nations, however RTI prevention strategies in those countries largely draw upon studies conducted in wealthier countries. This research investigated personal and environmental risk factors for child pedestrian RTIs relevant to an urban, developing world setting.

Methods

This is a case control study of personal and environmental risk factors for child pedestrian RTIs in San Juan de Miraflores, Lima, Perú. The analysis of personal risk factors included 100 cases of serious pedestrian RTIs and 200 age and gender matched controls. Demographic, socioeconomic, and injury data were collected. The environmental risk factor study evaluated vehicle and pedestrian movement and infrastructure at the sites in which 40 of the above case RTIs occurred and 80 control sites.

Findings

After adjustment, factors associated with increased risk of child pedestrian RTIs included high vehicle volume (OR 7·88, 95%CI 1·97–31·52), absent lane demarcations (OR 6·59, 95% CI 1·65–26·26), high vehicle speed (OR 5·35, 95%CI 1·55–18·54), high street vendor density (OR 1·25, 95%CI 1·01–1·55), and more children living in the home (OR 1·25, 95%CI 1·00–1·56). Protective factors included more hours/day spent in school (OR 0·52, 95%CI 0·33–0·82) and years of family residence in the same home (OR 0·97, 95%CI 0·95–0·99).

Conclusion

Reducing traffic volumes and speeds, limiting the number of street vendors on a given stretch of road, and improving lane demarcation should be evaluated as components of child pedestrian RTI interventions in poorer countries.

Patterns of road traffic injuries in a vulnerable population in Hyderabad, India

OBJECTIVE

To describe patterns of road traffic injuries (RTI) in a vulnerable population-pedestrians and users of motorized two-wheeled vehicles (MTVs)-in Hyderabad, India.

METHODS

4019 pedestrians and 4183 MTV drivers provided information on the most recent road traffic crash (RTC) irrespective of the level of injury in the last one year for 17 454 and 17 242 household members, respectively. Crashes in which any household member was involved as a pedestrian or MTV user were analysed.

RESULTS

Involvement in an RTC as a pedestrian or MTV user was reported for 1513 (4.4%, 95% CI 4.2 to 4.6%) people in the last one year. In these crashes, the person involved was an MTV user in 1264 (83.5%), aged 21-40 years in 973 (64.3%), and male in 1202 (79.4%). Six (0.4%) people died in RTCs and the cause was collision with a vehicle/person in 1133 (75%) crashes. Among the 1306 people who were injured and survived, 174 (13.3%) were treated as inpatients, 38 (2.9%) could not return fully to routine daily activities, 630 (48.2%) took leave from their regular occupation, and 13 (1%) lost their jobs following injury. Using a three month recall period, the annual incidence per 100 000 population of RTC as a pedestrian or MTV user was 2288 and of non-fatal RTI was 1931, and that of fatal RTI using one year recall period was 17.3 in this population.

CONCLUSIONS

These findings on how RTI are caused, their type, and outcomes in pedestrians and MTV users can assist in identifying interventions to improve road safety for this vulnerable population in India, and can also be useful for monitoring the effectiveness of such interventions.