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Haizel-Cobbina J, Thakkar R, Still M, Shlobin NA, Izah J, Du L, Shamim MS, Bonfield CM, Gepp R, Dewan MC. Global Epidemiology of Pediatric Traumatic Spine Injury: A Systematic Review and Meta-Analysis. World Neurosurg 2023; 178:172-180.e3. [PMID: 37473863 DOI: 10.1016/j.wneu.2023.07.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/10/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE Traumatic spine injury (TSI) leads to significant morbidity and mortality in children. However, the global epidemiology of pediatric TSI is currently unknown. We conducted a systematic review and meta-analysis to estimate the global incidence of pediatric TSI and the burden of cases. METHODS PubMed, Embase, and Scopus were searched for reports in June 2021 and updated in March 2023 with no restrictions on language or year of publication. A meta-analysis was conducted to estimate the global incidence of pediatric TSI and, subsequently, the number of cases of pediatric TSI worldwide and the proportion requiring spine surgery. RESULTS Of 6557 studies, 25 met the inclusion criteria. Road traffic accidents (64%) were responsible for most cases reported in the literature, followed by falls (18%). The global incidence of TSI in children aged ≤20 years was estimated to be 14.24 of 100,000 children, or 375,734 children, with an estimated 114,975 requiring spine surgery. Across the World Bank income classification groups, lower middle-income countries had the highest pediatric TSI case burden (186,886 cases, with 57,187 requiring spine surgery). Across the World Health Organization regions, countries in the Southeast Asia region had the largest number of projected cases at 88,566, with 27,101 requiring surgical management, followed closely by the African region, with 87,235 projected cases and 26,694 requiring surgical management. CONCLUSIONS Pediatric TSI represents a large healthcare burden globally. Interventions targeting both injury prevention and strengthening of neurosurgical capacity, especially in low resource settings, are needed to address this global health challenge.
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Affiliation(s)
- Joseline Haizel-Cobbina
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rut Thakkar
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Megan Still
- Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, Florida, USA
| | - Nathan A Shlobin
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Justine Izah
- Meharry Medical College, Nashville, Tennessee, USA
| | - Liping Du
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - M Shahzad Shamim
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Christopher M Bonfield
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ricardo Gepp
- Department of Neurosurgery, SARAH Network of Rehabilitation Hospitals, Brasília, Brazil
| | - Michael C Dewan
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
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Rashidi MM, Saeedi Moghaddam S, Azadnajafabad S, Heidari-Foroozan M, Hashemi SM, Mohammadi E, Esfahani Z, Ebrahimi N, Shobeiri P, Malekpour MR, Abbasi-Kangevari M, Rashedi S, Mohammadi Fateh S, Larijani B, Farzadfar F. Low bone mineral density, a neglected condition in North Africa and Middle East: estimates from the Global Burden of Disease Study, 1990-2019. Osteoporos Int 2023; 34:1577-1589. [PMID: 37217657 DOI: 10.1007/s00198-023-06778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 04/25/2023] [Indexed: 05/24/2023]
Abstract
Due to the high prevalence of low bone mineral density in North Africa and Middle East region, estimating its attributable burden would help to a better understanding of this neglected condition for policymakers and health researchers. This study presented the number of attributable deaths has doubled from 1990 to 2019. PURPOSE This study provides the latest estimates of the burden of low bone mineral density (BMD) from 1990 to 2019 in North Africa and Middle East (NAME) region. METHODS The data were extracted from the global burden of disease (GBD) 2019 study to estimate epidemiological indices such as deaths, disability-adjusted life years (DALYs), and summary exposure value (SEV). SEV is a measure of the exposure of the population to a risk factor that considers the amount of exposure by the level of risk. RESULTS Our findings showed that in 1990-2019, the number of deaths and DALYs attributable to low BMD had almost doubled in the region and caused 20,371 (95% uncertainty intervals: 14,848-24,374) deaths and 805,959 (630,238-959,581) DALYs in 2019. However, DALYs and death rates showed a decreasing trend after age standardization. Saudi Arabia had the highest, and Lebanon had the lowest age-standardized DALYs rates in 2019, with rates of 434.2 (329.6-534.3) and 90.3 (70.6-112.1) per 100,000, respectively. The highest burden attributable to low BMD was in the 90-94 and over 95 age groups. Also, there was a decreasing trend in age-standardized SEV to low BMD for both sexes. CONCLUSION Despite the decreasing trend of age-standardized burden indices, considerable amounts of deaths and DALYs were attributable to low BMD, especially in the elderly population, in the region in 2019. As the positive effects of proper interventions will be detectable in the long term, robust strategies and comprehensive stable policies are the ultimate solutions to achieving desired goals.
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Affiliation(s)
- Mohammad-Mahdi Rashidi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Saeedi Moghaddam
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Kiel Institute for the World Economy, Kiel, Germany
| | - Sina Azadnajafabad
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Heidari-Foroozan
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Student Research Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedeh Melika Hashemi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurological Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Zahra Esfahani
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Narges Ebrahimi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Parnian Shobeiri
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Reza Malekpour
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Abbasi-Kangevari
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Rashedi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Rajai Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Mohammadi Fateh
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Farshad Farzadfar
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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3
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Jang SW, Kim HR, Jung PY, Chung JS. Multifaceted Analysis of the Environmental Factors in Severely Injured Trauma: A 30-Day Survival Analysis. Healthcare (Basel) 2023; 11:healthcare11091333. [PMID: 37174875 PMCID: PMC10177835 DOI: 10.3390/healthcare11091333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: Most factors that predict the in-hospital survival rate in patients with severe trauma are patient-related factors; environmental factors are not currently considered important. Predicting the severity of trauma using environmental factors could be a reliable and easy-to-use method. Therefore, the purpose of this study was to determine whether environmental factors affect the survival in patients with severe trauma. (2) Methods: Medical records of patients who activated trauma team in the single regional trauma center, from 2016 to 2020, were retrospectively analyzed. After exclusion of young patients (<19 years old), cases of mild trauma (ISS < 16), and non-preventable deaths (trauma and injury severity score <25%), a total of 1706 patients were included in the study. (3) Results: In the Cox proportional hazard regression analysis, older age, night compared with day, and high rainfall were identified as statistically significant environmental predictors of mortality due to severe trauma. The relationship between mortality and precipitation showed a linear relationship, while that between mortality and temperature showed an inverted U-shaped relationship. (4) Conclusions: Various environmental factors of trauma affect mortality in patients with severe trauma. In predicting the survival of patients with severe trauma, environmental factors are considered relatively less important, though they can be used effectively.
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Affiliation(s)
- Sung Woo Jang
- Trauma Center, National Medical Center, Seoul 04564, Republic of Korea
| | - Hae Rim Kim
- College of Natural Science, School of Statistics, University of Seoul, Seoul 02504, Republic of Korea
| | - Pil Young Jung
- Department of Traumatology, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
| | - Jae Sik Chung
- Department of Traumatology, Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea
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Carroll Á, Sukumar P, O’Keeffe A. The impact of road safety strategy and policy on admissions to a national rehabilitation hospital; a 5-year retrospective review and reflection on trauma data. BMC Health Serv Res 2023; 23:175. [PMID: 36810087 PMCID: PMC9942335 DOI: 10.1186/s12913-023-09177-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023] Open
Abstract
BACKGROUND Globally, road traffic collisions (RTCs) are a common cause of death and disability. Although many countries, including Ireland, have road safety and trauma strategies, the impact on rehabilitation services is unclear. This study explores how admissions with RTC related injuries to a rehabilitation facility has changed over 5 years and how they contrast to major trauma audit (MTA) serious injury data from the same timeframe. METHODS A retrospective review of healthcare records with data abstraction in accordance with best practice was performed. Fisher's exact test and binary logistic regression were used to determine associations and statistical process control was used to analyse variation. All patients discharged with an International Classification of Diseases (ICD) 10 coded diagnosis of Transport accidents from 2014 to 2018 were included. In addition, serious injury data was abstracted from MTA reports. RESULTS 338 cases were identified. Of these, 173 did not meet the inclusion criteria (readmissions) and were excluded. The total number analyzed was 165. Of these, 121 (73%) were male and 44 (27%) were female and 115 (72%) were under 40 years of age. The majority [128 (78%)] had traumatic brain injuries (TBI), 33 (20%) had traumatic spinal cord injuries and 4 (2.4%) had traumatic amputation The numbers varied over the time period of the study but showed normal variation and not special cause variation which suggests no significant impact of policy in the time frame. There was a large discrepancy between the number of severe TBIs reported in the MTA reports and the numbers admitted with RTC related TBI to the National Rehabilitation University Hospital (NRH). This suggests there may be many people not accessing the specialist rehabilitation services they require. CONCLUSION Data linkage between administrative and health datasets does not currently exist but offers huge potential for understanding the trauma and rehabilitation ecosystem in detail. This is required to better understand the impact of strategy and policy.
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Affiliation(s)
- Áine Carroll
- School of Medicine, University College Dublin, D04 V1W8, Belfield, Dublin, Ireland. .,National Rehabilitation University Hospital, Rochestown Avenue, Dun Laoghaire, A96 E2H2, Dublin, Ireland.
| | - Prasanth Sukumar
- grid.7886.10000 0001 0768 2743School of Medicine, University College Dublin, D04 V1W8 Belfield, Dublin, Ireland
| | - Aisling O’Keeffe
- grid.7886.10000 0001 0768 2743School of Medicine, University College Dublin, D04 V1W8 Belfield, Dublin, Ireland
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Rezapur-Shahkolai F, Afshari M, Doosti-Irani A, Bashirian S, Maleki S. Interventions to prevent road traffic injuries among pedestrians: a systematic review. Int J Inj Contr Saf Promot 2022; 29:533-549. [PMID: 35776527 DOI: 10.1080/17457300.2022.2089685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Road traffic injuries (RTIs) are a serious public health problem and are an important cause of disability and death worldwide. A significant proportion of traffic injuries and fatalities are among pedestrians. Reviewing and evaluating related interventions can be a practical step to implementing appropriate methods to prevent RTIs among pedestrians, a highly vulnerable group of road users. The search of articles was conducted in the electronic databases of Scopus, PubMed, ISI, Safety Lit, and CDC. Other papers were also reviewed using forward citation and backward citation. The search strategy was for studies examined from the first years of database creation until January 10, 2021, in all languages in journals with matched judgment according to the type of population, type of interventions, comparators, and results. Joanna Briggs Institute (JBI) checklists were used to determine articles' quality and assess possible biases depending on the type of study. The initial search resulted in finding 16,272 abstracts. Finally, 25 studies, including 17 randomized clinical trials (RCTs) studies, seven studies pretest/post-test interventions (PPI), and one study controlled pretest/post-test interventions (cPPI) met the inclusion criteria. Among these preventive interventional studies, 20 studies were conducted in high-income countries, three were in lower middle-income countries, one study was in upper middle-income country, and only one study was conducted in a low-income country. Most interventional studies in the field of prevention of RTIs (15 studies) had an educational/behavioral approach, designed to change pedestrian behavior and the use of this approach was also effective in improving pedestrian behavior. The legislation/law enforcement approach was used in one study and two studies used an engineering/technology approach. In studies with an engineering approach after engineering reforms, pedestrian injuries in children decreased by 37.5%. In seven studies, multifaceted interventions were used. The interventional studies that used this approach were able to improve pedestrian safe behavior. The majority of studies were based on educational/behavioral approaches and pedestrians' behavior improved notably. In addition, the majority of interventional studies were conducted in countries with high income levels. Therefore, programming for preventive interventions to attenuate RTIs is highly important in low/middle-income countries to reduce the risk of injury to vulnerable road users. These findings can be applied by policy-makers to develop educational, engineering, environmental, and law enforcement interventions and attenuate injuries sustained by pedestrians.
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Affiliation(s)
- Forouzan Rezapur-Shahkolai
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran.,Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Afshari
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amin Doosti-Irani
- Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.,Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Saeed Bashirian
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.,Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shahnaz Maleki
- Department of Public Health, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
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Atreya A, Kc A, Nepal S, Menezes RG, Khadka A, Shah P, Kandel RA. Road Traffic Injuries among Patients Visiting the Emergency Department in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA J Nepal Med Assoc 2022; 60:922-926. [PMID: 36705172 PMCID: PMC9795097 DOI: 10.31729/jnma.7895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Road traffic injuries are preventable yet one of the most neglected public health issues. Road traffic injuries not only impact the health of the victim but also cause financial burden to the entire family. This study aimed to find out the prevalence of road traffic injuries in patients visiting the Emergency Department in a tertiary care centre. Methods A descriptive study was conducted among patients visiting the Emergency Department in a tertiary care centre from 1 January 2021 to 30 June 2021 after receiving ethical approval from the Institutional Review Committee (Reference number: IRC-LMC 07-J/020). Demographic information of the patients, accident profile and type of intervention at the hospital, and outcome were studied. Point estimate and 95% Confidence Interval were calculated. Results Among 8,765 patients visiting the emergency department, road traffic injuries were seen in 112 (1.28%) (1.04-1.52, 95% Confidence Interval). Conclusions The prevalence of road traffic injuries was found to be similar to other studies conducted in a similar setting. Keywords automobiles; demography; Nepal; soft tissue injuries; traffic accidents.
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Affiliation(s)
- Alok Atreya
- Department of Forensic Medicine, Lumbini Medical College and Teaching Hospital, Tansen, Palpa, Nepal,Correspondence: Dr Alok Atreya, Department of Forensic Medicine, Lumbini Medical College and Teaching Hospital, Tansen, Palpa, Nepal. , Phone: +977-9857052193
| | - Arjun Kc
- Department of Orthopedics and Trauma, Lumbini Medical College and Teaching Hospital, Tansen, Palpa, Nepal
| | - Samata Nepal
- Department of Community Medicine, Lumbini Medical College and Teaching Hospital, Tansen, Palpa, Nepal
| | - Ritesh George Menezes
- Forensic Medicine Division, Department of Pathology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Province, Saudi Arabia
| | - Anuska Khadka
- Lumbini Medical College and Teaching Hospital, Tansen, Palpa, Nepal
| | - Palak Shah
- Department of Internal Medicine, Sumeru Hospital, Pulchowk, Lalitpur, Nepal
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Hounkpe Dos Santos B, Kpozehouen A, Glele Ahanhanzo Y, Daddah D, Lagarde E, Coppieters Y. Implementation of a model of awareness-raising for taxi motorcyclists in Benin in relation to helmet use: a quasi-experimental study. BMC Public Health 2022; 22:1424. [PMID: 35883078 PMCID: PMC9327388 DOI: 10.1186/s12889-022-13857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 07/21/2022] [Indexed: 11/21/2022] Open
Abstract
Background This study aims to test the effectiveness of an awareness-raising model designed based on the theory of planned behaviour regarding helmet use for motorcycle taxi drivers. Methods This quasi-experimental study took place in the cities of Parakou (intervention group) and Porto Novo (control group). Over a three-month period, a package of awareness-raising activities, based on the theory of planned behaviour, have been implemented in the intervention area. Data relate to knowledge, attitudes and practices regarding helmet use was collected prospectively before the intervention, at the end, and 6 months later. Stata 15 was used for data analysis. Chi-square or Fisher, Student’s or Kruskal-Wallis tests was carried out. The difference-in-difference method was used to determine the specific effect of the awareness activities. Results After the intervention, there was an improvement in the total score in both groups compared to baseline. The total score increased by 0.2 (0.06–0.3) in the experimental group when the number of sessions attended increased by one (p = 0.005). The difference-in-difference estimator measured among subjects who attended at least one awareness session, controlling for socio-demographic variables, showed a significantly higher difference in the total score of subjects in the experimental group compared to those in the control group both at the end of the interactive sessions and 6 months later. Conclusion This model improves the helmet-wearing behaviour of motorbike taxi drivers in the experimental area. It could be adapted and applied to other socio-professional groups and other types of users.
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Affiliation(s)
- Bella Hounkpe Dos Santos
- Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium. .,Institut Régional de Santé Publique, Université d'Abomey-Calavi, Ouidah, Benin.
| | - Alphonse Kpozehouen
- Institut Régional de Santé Publique, Université d'Abomey-Calavi, Ouidah, Benin
| | | | - Donatien Daddah
- Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium.,Institut Régional de Santé Publique, Université d'Abomey-Calavi, Ouidah, Benin
| | | | - Yves Coppieters
- Ecole de Santé Publique, Université libre de Bruxelles, Brussels, Belgium
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Hounkpe Dos Santos B, Aïna A, Kpozehouen A, Glele Ahanhanzo Y, Daddah D, Coppieters Y, Paul É. [Assessment of road safety intervention implementation in Benin in 2019]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2022; Vol. 33:763-778. [PMID: 35485133 DOI: 10.3917/spub.215.0763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The study aims to assess the level of implementation of road safety interventions in Benin. METHOD The research is based on an evaluative study of road safety aimed to analyze the implementation and logic of road safety interventions, conducted in Benin in 2019. It combined a review of the gray literature and a qualitative component. The data were collected through documents and interviews in structures involved in road safety management. RESULTS Road safety was a national priority with one lead institution and several structures involved. There was a lack of consensus among stakeholders, insufficient framework documents, resources, legislative texts, and study data. Few roads were in good condition and very few allowed the separation of two-wheeled vehicles. The vehicle fleet was outdated. Various activities were carried out to raise awareness, to educate the population and to enforce the texts but they were insufficient and poorly coordinated. Reference hospitals had the minimum service to deal with trauma cases. The interventions had not yet resulted in a reduction in the number of injuries and fatalities by accidents, which was increasing. CONCLUSION Benin has made great efforts in the area of road safety. However, there are still some shortcomings to take into account.
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Tavakkoli M, Torkashvand-Khah Z, Fink G, Takian A, Kuenzli N, de Savigny D, Cobos Muñoz D. Evidence From the Decade of Action for Road Safety: A Systematic Review of the Effectiveness of Interventions in Low and Middle-Income Countries. Public Health Rev 2022; 43:1604499. [PMID: 35296113 PMCID: PMC8900064 DOI: 10.3389/phrs.2022.1604499] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 01/07/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives: To evaluate the effectiveness of road safety interventions in low and middle-income countries (LMICs), considering the principles of systems theory presented in the Global Plan for the Decade of Action for Road Safety. Methods: We conducted a systematic review according to PRISMA guidelines. We searched for original research studies published during 2011–2019 in the following databases: Medline, Embase, PsycInfo, Scopus, Web of Science, Cochrane library, Global Health Library, ProQuest and TRID. We included studies conducted in LMICs, evaluating the effects of road traffic safety interventions and reporting health-related outcomes. Results: Of 12,353 non-duplicate records, we included a total of 33 studies. Most interventions were related to legislation and enforcement (n = 18), leadership (n = 5) and speed management (n = 4). Overall, legislation and enforcement interventions appear to have the largest impact. Few studies were found for road infrastructure, vehicle safety standard and post crash response interventions. Conclusion: Based on the currently available evidence, legislation and enforcement interventions appear most impactful in LMICs. However, many interventions remain understudied and more holistic approaches capturing the complexity of road transport systems seem desirable. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=197267, identifier CRD42020197267.
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Affiliation(s)
- Maryam Tavakkoli
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
- *Correspondence: Maryam Tavakkoli,
| | | | - Günther Fink
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Amirhossein Takian
- School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nino Kuenzli
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Don de Savigny
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Daniel Cobos Muñoz
- Epidemiology and Public Health Department, Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland
- University of Basel, Basel, Switzerland
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Malhotra SK, White H, Dela Cruz NAO, Saran A, Eyers J, John D, Beveridge E, Blöndal N. Studies of the effectiveness of transport sector interventions in low- and middle-income countries: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1203. [PMID: 36951810 PMCID: PMC8724647 DOI: 10.1002/cl2.1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND There are great disparities in the quantity and quality of infrastructure. European countries such as Denmark, Germany, Switzerland, and the UK have close to 200 km of road per 100 km2, and the Netherlands over 300 km per 100 km2. By contrast, Kenya and Indonesia have <30, Laos and Morocco <20, Tanzania and Bolivia <10, and Mauritania only 1 km per 100 km2. As these figures show, there is a significant backlog of transport infrastructure investment in both rural and urban areas, especially in sub-Saharan Africa. This situation is often exacerbated by weak governance and an inadequate regulatory framework with poor enforcement which lead to high costs and defective construction.The wellbeing of many poor people is constrained by lack of transport, which is called "transport poverty". Lucas et al. suggest that up to 90% of the world's population are transport poor when defined as meeting at least one of the following criteria: (1) lack of available suitable transport, (2) lack of transport to necessary destinations, (3) cost of necessary transport puts household below the income poverty line, (4) excessive travel time, or (5) unsafe or unhealthy travel conditions. OBJECTIVES The aim of this evidence and gap map (EGM) is to identify, map, and describe existing evidence from studies reporting the quantitative effects of transport sector interventions related to all means of transport (roads, rail, trams and monorail, ports, shipping, and inland waterways, and air transport). METHODS The intervention framework of this EGM reframes Berg et al's three categories (infrastructure, prices, and regulations) broadly as infrastructure, incentives, and institutions as subcategories for each intervention category which are each mode of transport (road, rail trams and monorail, ports, shipping, and inlands waterways, and air transport). This EGM identifies the area where intervention studies have been conducted as well as the current gaps in the evidence base.This EGM includes ongoing and completed impact evaluations and systematic reviews (SRs) of the effectiveness of transport sector interventions. This is a map of effectiveness studies (impact evaluations). The impact evaluations include experimental designs, nonexperimental designs, and regression designs. We have not included the before versus after studies and qualitative studies in this map. The search strategies included both academic and grey literature search on organisational websites, bibliographic searches and hand search of journals.An EGM is a table or matrix which provides a visual presentation of the evidence in a particular sector or a subsector. The map is presented as a matrix in which rows are intervention categories (e.g., roads) and subcategories (e.g., infrastructure) and the column outcome domains (e.g., environment) and subcategories as (e.g., air quality). Each cell contains studies of the corresponding intervention for the relevant outcome, with links to the available studies. Included studies were coded according to the intervention and outcomes assessed and additional filters as region, population, and study design. Critical appraisal of included SR was done using A Measurement Tool to Assess Systematic Reviews (AMSTAR -2) rating scale. SELECTION CRITERIA The search included both academic and grey literature available online. We included impact evaluations and SRs that assessed the effectiveness of transport sector interventions in low- and middle-income countries. RESULTS This EGM on the transport sector includes 466 studies from low- and middle-income countries, of which 34 are SRs and 432 impact evaluations. There are many studies of the effects of roads intervention in all three subcategories-infrastructure, incentives, and institutions, with the most studies in the infrastructure subcategories. There are no or fewer studies on the interventions category ports, shipping, and waterways and for civil aviation (Air Transport).In the outcomes, the evidence is most concentrated on transport infrastructure, services, and use, with the greatest concentration of evidence on transport time and cost (193 studies) and transport modality (160 studies). There is also a concentration of evidence on economic development and health and education outcomes. There are 139 studies on economic development, 90 studies on household income and poverty, and 101 studies on health outcomes.The major gaps in evidence are from all sectors except roads in the intervention. And there is a lack of evidence on outcome categories such as cultural heritage and cultural diversity and very little evidence on displacement (three studies), noise pollution (four studies), and transport equity (2). There is a moderate amount of evidence on infrastructure quantity (32 studies), location, land use and prices (49 studies), market access (29 studies), access to education facilities (23 studies), air quality (50 studies), and cost analysis including ex post CBA (21 studies).The evidence is mostly from East Asia and the Pacific Region (223 studies (40%), then the evidence is from the sub-Saharan Africa (108 studies), South Asia (96 studies), Latin America & Caribbean (79 studies). The least evidence is from Middle East & North Africa (30 studies) and Europe & Central Asia (20 studies). The most used study design is other regression design in all regions, with largest number from East Asia and Pacific (274). There is total 33 completed SRs identified and one ongoing, around 85% of the SR are rated low confidence, and 12% rated as medium confidence. Only one review was rated as high confidence. This EGM contains the available evidence in English. CONCLUSION This map shows the available evidence and gaps on the effectiveness of transport sector intervention in low- and middle-income countries. The evidence is highly concentrated on the outcome of transport infrastructure (especially roads), service, and use (351 studies). It is also concentrated in a specific region-East Asia and Pacific (223 studies)-and more urban populations (261 studies). Sectors with great development potential, such as waterways, are under-examined reflecting also under-investment.The available evidence can guide the policymakers, and government-related to transport sector intervention and its effects on many outcomes across sectors. There is a need to conduct experimental studies and quality SRs in this area. Environment, gender equity, culture, and education in low- and middle-income countries are under-researched areas in the transport sector.
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Delaney PG, Eisner ZJ, Bustos A, Hancock CJ, Thullah AH, Jayaraman S, Raghavendran K. Cost-Effectiveness of Lay First Responders Addressing Road Traffic Injury in Sub-Saharan Africa. J Surg Res 2021; 270:104-112. [PMID: 34649070 DOI: 10.1016/j.jss.2021.08.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/29/2021] [Accepted: 08/27/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND To investigate the cost-effectiveness of training lay first responders (LFRs) to address road traffic injury (RTI) in sub-Saharan Africa (SSA) as the first step toward formal emergency medical services (EMS) development. MATERIALS/METHODS Cost data from five LFR programs launched between 2008 and 2019 in SSA was collected for LFR cost estimation, including three prospective collections from our group. We systematically reviewed literature and projected aggregate disability-adjusted life years (DALYs) from RTI in SSA that are addressable by LFRs to inform cost-effectiveness ratios ($USD cost per DALY averted). Cost-effectiveness ratios were then compared against African per capita gross domestic product (GDP) to determine the cost-effectiveness of LFRs addressing RTIs in SSA, following WHO-CHOICE guidelines, which state cost-effectiveness ratios less than GDP per capita are considered "very cost-effective." RESULTS Average annual cost per LFR trained across five programs was calculated to be 16.32USD (training=4.04USD, supplies=12.28USD). Following WHO and Disease Control Priorities recommendations for adequate emergency catchment, initial training of 750 LFRs per 100,000 people would cost 12,239.47USD with projected total annual DALYs averted equal to 227.7 per 100,000. Cost per DALY averted would therefore be 53.75USD with appropriate LFR availability, less than sub-Saharan African GDP per capita (1,585.40USD) and the lowest sub-Saharan African GDP per capita (Burundi, 261.20USD). CONCLUSION Following WHO-CHOICE guidelines, training LFRs can be a highly cost-effective means to address RTI morbidity and mortality across sub-Saharan Africa. With EMS unavailable for 91.3% of the African population, training LFRs can be an affordable first step toward formal EMS development.
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Affiliation(s)
- Peter G Delaney
- University of Michigan Medical School,Ann Arbor, Michigan; LFR International, Los Angeles, California; Michigan Center for Global Surgery, Ann Arbor, Michigan.
| | - Zachary J Eisner
- LFR International, Los Angeles, California; Washington University in St. Louis, St. Louis, Missouri
| | - Aiza Bustos
- LFR International, Los Angeles, California; Washington University in St. Louis, St. Louis, Missouri
| | - Canaan J Hancock
- LFR International, Los Angeles, California; Washington University in St. Louis, St. Louis, Missouri
| | | | - Sudha Jayaraman
- Department of Surgery, University of Utah, Salt Lake City, Utah
| | - Krishnan Raghavendran
- Michigan Center for Global Surgery, Ann Arbor, Michigan; Department of Surgery, University of Michigan, Ann Arbor, Michigan
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12
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Are Traffic Announcements Really Effective? A Systematic Review of Evaluations of Crash-Prevention Communication Campaigns. SAFETY 2021. [DOI: 10.3390/safety7040066] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Communication campaigns are commonly used in the traffic and road safety sector to raise public awareness of the importance of avoiding risky road user attitudes and behaviors. Surprisingly few of these communication campaigns evaluate their effectiveness in a formal and comprehensive manner. The core aim of the present systematic review is to identify the type of studies that evaluate the effectiveness of campaigns in this sector, in order to identify and contrast their main findings. This systematic review followed the PRISMA methodology, by means of which the relevant articles based on the search term were identified. A total of 613 indexed articles were filtered, and a final set of 27 articles directly addressing the issue was analyzed. Search strategies were developed and conducted in WOS, Scopus, NCBI, Google Scholar and APA databases. The selected articles point out that, although advertisements alone have a certain positive effect, their effectiveness is substantially increased if they are accompanied by other preventive measures such as legislation or road safety education. In any case, more evaluations of traffic campaigns are needed to identify which techniques are effective and which are not, and which should therefore be replaced by new methods of behavior modification in future communication campaigns.
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Lepard JR, Spagiari R, Corley J, Barthélemy EJ, Kim E, Patterson R, Venturini S, Still MEH, Lo YT, Rosseau G, Mekary RA, Park KB. Differences in outcomes of mandatory motorcycle helmet legislation by country income level: A systematic review and meta-analysis. PLoS Med 2021; 18:e1003795. [PMID: 34534215 PMCID: PMC8486090 DOI: 10.1371/journal.pmed.1003795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 10/01/2021] [Accepted: 09/03/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. Even though over 90% of fatal road traffic injuries occur in low- and middle-income countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels. METHODS AND FINDINGS A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle-Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg's and Egger's tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case-control study, and 5 pre-post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p-value comparing both strata < 0.0001. There were significantly lower odds of motorcycle fatalities after enactment of helmet legislation (OR: 0.71; 95% CI: 0.61; 0.83) with no significant difference by income classification, p-value: 0.27. Odds of TBI were statistically significantly lower in HICs (OR: 0.61, 95% CI 0.54 to 0.69) than in LMICs (0.79, 95% CI 0.72 to 0.86) after enactment of law (p-value: 0.0001). Limitations of this study include variability in the methodologies and data sources in the studies included in the meta-analysis as well as the lack of available literature from the lowest income countries or from the African WHO region, in which helmet laws are least commonly present. CONCLUSIONS In this study, we observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in LMIC settings where additional measures such as public education and law enforcement might play critical roles.
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Affiliation(s)
- Jacob R. Lepard
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- * E-mail:
| | | | - Jacquelyn Corley
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Ernest J. Barthélemy
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Neurosurgery, Mount Sinai Health System, New York, New York, United States of America
| | - Eliana Kim
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- University of California-San Francisco School of Medicine, San Francisco, California, United States of America
| | - Rolvix Patterson
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Tufts University School of Medicine, Boston, Massachusetts, United States of America
| | - Sara Venturini
- Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | - Megan E. H. Still
- Department of Neurosurgery, University of Florida, Gainesville, Florida, United States of America
| | - Yu Tung Lo
- Department of Neurosurgery, National Neuroscience Institute, Singapore
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Gail Rosseau
- Department of Neurosurgery, George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Rania A. Mekary
- Computational Neuroscience Outcomes Center, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- School of Pharmacy, MCPHS University, Boston, Massachusetts, United States of America
| | - Kee B. Park
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
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Dos Santos BH, Kpozehouen A, Ahanhanzo YG, Daddah D, Ouendo EM, Leveque A, Coppieters Y. Implementation of a model of awareness-raising for taxi motorcyclists in Benin in relation to helmet use: protocol for a quasi-experimental study. BMC Public Health 2021; 21:241. [PMID: 33509139 PMCID: PMC7842175 DOI: 10.1186/s12889-021-10298-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the large cities of Benin, motorcycle taxi drivers, mainly between the ages of 20 and 40, are particularly exposed to accidents due to their profession. User awareness, along with legislative reforms and enforcement measures, would reduce the incidence of crashes and injuries. This study aims to test the effectiveness of an awareness-raising model regarding helmet use for motorcycle taxi drivers. METHODS This is a quasi-experimental study that will take place in the cities of Parakou (intervention group) and Porto Novo (control group). Over a three-month period, a package of awareness-raising activities will be implemented in the intervention area, targeting a group of motorcycle taxi drivers. The messages to be developed for awareness-raising will focus on the most frequently influencing factors, as identified by the baseline collection. These key messages will be disseminated through various tools and communication channels (banners, motorcycle stickers and motorcycle taxi uniforms, interactive sessions). Data will be collected prospectively via a self-reported questionnaire and observation, carried out before the intervention, at the end, and 6 months later. The data will relate to knowledge, attitudes and practices regarding helmet use. The analysis will compare the indicators between the groups, as well as between the pre- and post-intervention phase. The KoboCollect software will be used for data entry and processing, and Stata 15 will be used for data analysis. Chi-square or Fisher, Student's or Kruskal-Wallis tests will be used for the comparisons. The difference-in-difference method will be used to determine the specific effect of the awareness activities. DISCUSSION This study will assess the contribution of awareness messages to changing the behaviour of motorcycle taxi drivers by determining the specific effect of the intervention.
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Affiliation(s)
- Bella Hounkpe Dos Santos
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium. .,Institut Régional de Santé Publique, Ouidah, Benin.
| | | | | | - Donatien Daddah
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.,Institut Régional de Santé Publique, Ouidah, Benin
| | | | - Alain Leveque
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
| | - Yves Coppieters
- Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium
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Banstola A, Kigozi J, Barton P, Mytton J. Economic Burden of Road Traffic Injuries in Nepal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17124571. [PMID: 32630384 PMCID: PMC7345187 DOI: 10.3390/ijerph17124571] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 12/26/2022]
Abstract
The evidence of the economic burden of road traffic injuries (RTIs) in Nepal is limited. The most recent study, conducted in 2008, is now considered outdated because there has been a rapid increase in vehicle numbers and extensive road building over the last decade. This study estimated the current economic costs of RTIs in Nepal, including the direct costs, productivity costs, and valuation of pain, grief, and suffering. An incidence-based cost-of-illness analysis was conducted from a societal perspective, employing a bottom-up approach using secondary data. All costs incurred by the patients, their family members, and costs to society were estimated, with sensitivity analyses to consider uncertainty around the data estimates available. Productivity loss was valued using the human capital approach. The total costs of RTIs in 2017 were estimated at USD 122.88 million. Of these, the costs of productivity loss were USD 91.57 million (74.52%) and the pain, grief, and suffering costs were USD 18.31 million (14.90%). The direct non-medical costs were USD 11.50 million (9.36%) whereas the direct medical costs were USD 1.50 million (1.22%). The economic costs of RTIs increased by threefold since 2007 and are equivalent to 1.52% of the gross national product, indicating the growing national financial burden associated with preventable RTIs.
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Affiliation(s)
- Amrit Banstola
- Faculty of Health and Applied Sciences, University of the West of England, Bristol BS16 1QY, UK;
- Health Economics Unit, University of Birmingham, Birmingham B15 2TT, UK; (J.K.); (P.B.)
- Correspondence:
| | - Jesse Kigozi
- Health Economics Unit, University of Birmingham, Birmingham B15 2TT, UK; (J.K.); (P.B.)
| | - Pelham Barton
- Health Economics Unit, University of Birmingham, Birmingham B15 2TT, UK; (J.K.); (P.B.)
| | - Julie Mytton
- Faculty of Health and Applied Sciences, University of the West of England, Bristol BS16 1QY, UK;
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16
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Bonnet E, Nikiéma A, Adoléhoume A, Ridde V. Better data for better action: rethinking road injury data in francophone West Africa. BMJ Glob Health 2020; 5:bmjgh-2020-002521. [PMID: 32371569 PMCID: PMC7223014 DOI: 10.1136/bmjgh-2020-002521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/08/2020] [Accepted: 04/08/2020] [Indexed: 01/23/2023] Open
Affiliation(s)
- Emmanuel Bonnet
- Résiliences, Institut de recherche pour le developpement, Bondy, Seine Saint Denis, France
| | | | | | - Valery Ridde
- CEPED, Institut de Recherche pour le Développement, Paris, France
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Ospina-Mateus H, Quintana Jiménez LA, Lopez-Valdes FJ. Understanding motorcyclist-related accidents in Colombia. Int J Inj Contr Saf Promot 2020; 27:215-231. [PMID: 32046587 DOI: 10.1080/17457300.2020.1725895] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In 2016, Colombia's position regarding motorcyclist fatalities per 100,000 inhabitants was tenth worldwide and second in South America. In the seven years from 2012-2018, the proportion of deceased and injured motorcyclists among all road users was 50%. To analyse the significant aspects of the accident rate of motorcyclists in Colombia from 2016 to 2018 and estimate cost social value of motorcycle-related deaths. The global numbers of fatalities and injuries were compared to the Colombian context. Descriptive and inferential statistics were conducted to explore the association of fatal trauma and motorcycle accidents. P values and odds ratios were calculated. Bogotá, Cali, and Medellín were the cities with the most accidents. The month, day, time, age of the victims, and climatic conditions had a statistically significant association with the fatal trauma. Most victims were between the ages of 20-29 years. Motorcycles were involved in more than 60% of accidents. The social cost of a life lost in a motorcycle accident was estimated at $2,418 million Colombian pesos (725,400 USD) per year. The establishment of countermeasures for the road safety of vulnerable users should focus on associated causal factors in order to develop strategies to effectively reduce the number of accidents.
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Affiliation(s)
- Holman Ospina-Mateus
- Departamento de Ingenieria Industrial, Universidad Tecnológica de Bolívar, Cartagena, Colombia.,Departamento de Ingenieria Industrial, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Francisco J Lopez-Valdes
- Instituto de Investigacion Tecnológica (IIT), ICAI Engineering School, Universidad Pontificia de Comillas, Madrid, Spain
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18
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Road Safety in Low-Income Countries: State of Knowledge and Future Directions. SUSTAINABILITY 2019. [DOI: 10.3390/su11226249] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Road safety in low-income countries (LICs) remains a major concern. Given the expected increase in traffic exposure due to the relatively rapid motorisation of transport in LICs, it is imperative to better understand the underlying mechanisms of road safety. This in turn will allow for planning cost-effective road safety improvement programs in a timely manner. With the general aim of improving road safety in LICs, this paper discusses the state of knowledge and proposes a number of future research directions developed from literature reviews and expert elicitation. Our study takes a holistic approach based on the Safe Systems framework and the framework for the UN Decade of Action for Road Safety. We focused mostly on examining the problem from traffic engineering and safety policy standpoints, but also touched upon other sectors, including public health and social sciences. We identified ten focus areas relating to (i) under-reporting; (ii) global best practices; (iii) vulnerable groups; (iv) disabilities; (v) road crash costing; (vi) vehicle safety; (vii) proactive approaches; (viii) data challenges; (ix) social/behavioural aspects; and (x) capacity building. Based on our findings, future research ought to focus on improvement of data systems, understanding the impact of and addressing non-fatal injuries, improving estimates on the economic burden, implementation research to scale up programs and transfer learnings, as well as capacity development. Our recommendations, which relate to both empirical and methodological frontiers, would lead to noteworthy improvements in the way road safety data collection and research is conducted in the context of LICs.
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Adeleye AO, Clark DJ, Malomo TA. Trauma demography and clinical epidemiology of motorcycle crash-related head injury in a neurosurgery practice in an African developing country. TRAFFIC INJURY PREVENTION 2019; 20:211-215. [PMID: 30946601 DOI: 10.1080/15389588.2018.1553085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 11/14/2018] [Accepted: 11/23/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Though motor vehicle crashes (MVCs) were the main cause of head trauma from road traffic injuries (RTIs), motorcycle crashes (MCCs) are now a major cause of RTI-related head injury (HI) in many developing countries. METHODS Using a prospective database of HIs from a neurosurgical practice in a sub-Saharan African developing country, a cross-sectional survey was conducted for the trauma demography and clinical epidemiology of this MCC-related HI. RESULTS Motorcycle crashes accounted for 57% (473/833) of all RTI-related HIs in this registry. The victims, with a mean age of 33.1 years (SD = 18.3), consisted mainly of males (83.1%), those of low socioeconomic status (>90%), and those aged between 20 and 40 years old (56%). MCCs involved only riders in 114 cases (114/473, 32.1%), of which 69% were motorcycle-motorcycle crashes. The HI was moderate-severe in 50.8%; clinical symptomatology of significant HI included loss of consciousness (92%), anisocoria (35%), Abbreviated Injury Scale head (AIS-head) score > 3 (28%), and CT-Rotterdam score > 3 (30%). Extracranial systemic injury involved the limbs most frequently, with an Injury Severity Score (ISS) >25 in 49%. The fatality rate was 24%. MCC-related HI among pedestrian victims involved more vulnerable age groups (the young and elderly) but have lower mean ISS compared to motorcycle passengers (mean ISS = 23.5 [11.6] vs. 27.4 [13.0]; 95% confidence interval [CI], 1.27-6.49; P = .004). In addition, compared to a contemporary cohort of MVC-related HIs in our registry, MCC victims were older (mean age 34.8 years [18.0] vs. 30.8 [18.4]; P = .002); had higher proportions of certain extracranial trauma like long bone fractures (71 vs. 29%; P = .02); and suffered fewer surgical brain lesions (25.5 vs. 17.2%; P = .004). CONCLUSIONS Motorcycle crashes are now a significant threat to the heads, limbs, and lives of vulnerable road users in developing countries.
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Affiliation(s)
- Amos O Adeleye
- a Division of Neurological Surgery, Department of Surgery, College of Medicine , University of Ibadan
- b Department of Neurological Surgery , University College Hospital , UCH, Ibadan , Nigeria
| | - David J Clark
- c Department of Academic Neurosciences , Cambridge University , Cambridge , UK
| | - Toluyemi A Malomo
- b Department of Neurological Surgery , University College Hospital , UCH, Ibadan , Nigeria
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20
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McIlroy RC, Plant KA, Hoque MS, Wu J, Kokwaro GO, Nam VH, Stanton NA. Who is responsible for global road safety? A cross-cultural comparison of Actor Maps. ACCIDENT; ANALYSIS AND PREVENTION 2019; 122:8-18. [PMID: 30300797 DOI: 10.1016/j.aap.2018.09.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 06/08/2023]
Abstract
The traditional three 'E's approach to road safety (engineering, education, enforcement) has had, and will continue to have, a significant impact on road traffic casualty rates worldwide. Nevertheless, with rising motorisation in many countries, global fatality numbers have changed little over the past decade. Following calls for the application of sociotechnical systems thinking to the problem, we widen the road safety discussion with an additional four 'E's; economics, emergency response, enablement, and, the umbrella term for the approach taken, ergonomics. The research presents an application of Rasmussen's Risk Management Framework to the road safety systems of five distinct nations; Bangladesh, China, Kenya, the UK, and Vietnam. Following site visits, reviews of literature, and interviews with subject matter experts in each of the countries, a series of Actor Map models of the countries' road safety systems were developed. These are compared and discussed in terms of the wide variety of interconnecting organisations involved, their influences on road safety outcomes, the differences between nations, and the need to look beyond road users when designing road safety interventions.
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Affiliation(s)
- R C McIlroy
- Transportation Research Group, University of Southampton, UK.
| | - K A Plant
- Transportation Research Group, University of Southampton, UK
| | - M S Hoque
- Bangladesh University of Engineering and Technology, Dhaka, Bangladesh
| | - J Wu
- Tsinghua-Cambridge-MIT Future Transport Centre, Tsinghua University, Beijing, China
| | - G O Kokwaro
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - V H Nam
- National University of Civil Engineering, Hanoi, Viet Nam
| | - N A Stanton
- Transportation Research Group, University of Southampton, UK
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21
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Wang L, Yu C, Zhang Y, Luo L, Zhang G. An analysis of the characteristics of road traffic injuries and a prediction of fatalities in China from 1996 to 2015. TRAFFIC INJURY PREVENTION 2018; 19:749-754. [PMID: 29969283 DOI: 10.1080/15389588.2018.1487061] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 05/29/2018] [Accepted: 06/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES This study analyzed the characteristics and burdens of road traffic injuries (RTIs) from the 3 perspectives of time, space, and population in China and predicted traffic fatalities using 2 models. METHODS By extracting data from the China Statistical Yearbooks and GBD 2015 (Global Health Data Exchange), we described the change in the time trend of traffic crashes and economic losses associated with the rate of motorization in China from 1996 to 2015; analyzed the geographical distribution of these events by geographic information system; and evaluated the age-, sex-, and cause-specific death rate, disability-adjusted life year (DALY) rate, years of life lost (YLL) rate, and years lost due to disability (YLD) rate lost from RTIs from 1990 to 2015. In addition, we predicted the traffic fatality (per population or vehicles) trend using the log-linear model derived from Smeed's and Borsos' models. RESULTS From 1996 to 2015, the motorization rate showed rapid growth, increasing from 0.023 to 0.188. With the growth in the motorization rate, the time trends of traffic crashes and economic losses in China changed, showing a tendency to first increase and then later decrease. The crashes and losses were closely correlated and mainly distributed in some of the economically developed provinces, including Zhejiang, Jiangsu, Anhui, Sichuan, and Guangdong provinces. The health burden of RTIs presented a time trend similar to that of the economic burden, and it was higher among males than females. The death rate among older pedestrians was higher. The DALY rate and YLL rate among young and middle-aged pedestrians were higher. The YLD rate among older motor vehicle drivers was higher. In addition, the fatalities per 10,000 vehicles continued to decline, and Borsos's model was better fitted to the reported traffic fatalities than Smeed's model. CONCLUSIONS Although the burden of RTIs in China has declined, the burden of RTIs is still heavy. Hence, RTIs remain a universal problem of great public health concern in China, and we need to work hard to reduce them.
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Affiliation(s)
- Lu Wang
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
| | - Chuanhua Yu
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
- b Global Health Institute, Wuhan University, Wuchang District , Wuhan , China
| | - Yunquan Zhang
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
| | - Lisha Luo
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
| | - Ganshen Zhang
- a Department of Epidemiology and Biostatistics, School of Health Sciences , Wuhan University , Wuhan , China
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22
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Kiragu AW, Dunlop SJ, Mwarumba N, Gidado S, Adesina A, Mwachiro M, Gbadero DA, Slusher TM. Pediatric Trauma Care in Low Resource Settings: Challenges, Opportunities, and Solutions. Front Pediatr 2018; 6:155. [PMID: 29915778 PMCID: PMC5994692 DOI: 10.3389/fped.2018.00155] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/09/2018] [Indexed: 12/15/2022] Open
Abstract
Trauma constitutes a significant cause of death and disability globally. The vast majority -about 95%, of the 5.8 million deaths each year, occur in low-and-middle-income countries (LMICs) 3-6. This includes almost 1 million children. The resource-adapted introduction of trauma care protocols, regionalized care and the growth specialized centers for trauma care within each LMIC are key to improved outcomes and the lowering of trauma-related morbidity and mortality globally. Resource limitations in LMICs make it necessary to develop injury prevention strategies and optimize the use of locally available resources when injury prevention measures fail. This will lead to the achievement of the best possible outcomes for critically ill and injured children. A commitment by the governments in LMICs working alone or in collaboration with international non-governmental organizations (NGOs) to provide adequate healthcare to their citizens is also crucial to improved survival after major trauma. The increase in global conflicts also has significantly deleterious effects on children, and governments and international organizations like the United Nations have a significant role to play in reducing these. This review details the evaluation and management of traumatic injuries in pediatric patients and gives some recommendations for improvements to trauma care in LMICs.
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Affiliation(s)
- Andrew W. Kiragu
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
| | - Stephen J. Dunlop
- Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, United States
- Division of Global Medicine, University of Minnesota, Minneapolis, MN, United States
| | - Njoki Mwarumba
- Department of Political Science, Oklahoma State University, Stillwater, OK, United States
| | - Sanusi Gidado
- Department of Surgery, Bingham University Teaching Hospital, Jos, Nigeria
| | - Adesope Adesina
- Department of Surgery, Bowen University Teaching Hospital, Ogbomosho, Nigeria
| | | | - Daniel A. Gbadero
- Department of Pediatrics, Bowen University Teaching Hospital, Ogbomosho, Nigeria
| | - Tina M. Slusher
- Department of Pediatrics, Hennepin Healthcare, Minneapolis, MN, United States
- Division of Global Pediatrics, University of Minnesota, Minneapolis, MN, United States
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Road traffic injuries: Cross-sectional cluster randomized countrywide population data from 4 low-income countries. Int J Surg 2018; 52:237-242. [PMID: 29471158 DOI: 10.1016/j.ijsu.2018.02.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/08/2018] [Accepted: 02/13/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Road traffic injuries (RTI) are a leading cause of morbidity and mortality around the world. The burden is highest in low and middle-income countries (LMICs) and is increasing. We aimed to describe the epidemiology of RTIs in 4 low-income countries using nationally representative survey data. METHODS The Surgeons Overseas Assessment of Surgical Needs (SOSAS) survey tool was administered in four countries: Sierra Leone, Rwanda, Nepal and Uganda. We performed nationally representative cross-sectional, cluster randomized surveys in each country. Information regarding demographics, injury characteristics, anatomic location of injury, healthcare seeking behavior, and disability from injury was collected. Data were reported with descriptive statistics and evaluated for differences between the four countries using statistical tests where appropriate. RESULTS A total of 13,765 respondents from 7115 households in the four countries were surveyed. RTIs occurred in 2.2% (2.0-2.5%) of the population and accounted for 12.9% (11.5-14.2%) of all injuries incurred. The mean age was 34 years (standard deviation ±1years); 74% were male. Motorcycle crashes accounted for 44.7% of all RTIs. The body regions most affected included head/face/neck (36.5%) followed by extremity fractures (32.2%). Healthcare was sought by 78% road injured; 14.8% underwent a major procedure (requiring anesthesia). Major disability resulting in limitations of work or daily activity occurred in 38.5% (33.0-43.9%). CONCLUSION RTIs account for a significant proportion of disability from injury. Younger men are most affected, raising concerns for potential detrimental consequences to local economies. Prevention initiatives are urgently needed to stem this growing burden of disease; additionally, improved access to timely emergency, trauma and surgical care may help alleviate the burden due to RTI in LMICs.
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