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Neki K, Gutierrez H, Mitra S, Temesgen AM, Mbugua LW, Balasubramaniyan R, Winer M, Roberts J, Vos T, Hamilton E, Naghavi M, Harrison JE, Job S, Bhalla K. Addressing discrepancies in estimates of road traffic deaths and injuries in Ethiopia. Inj Prev 2022; 29:234-240. [PMID: 36600523 DOI: 10.1136/ip-2022-044704] [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: 07/14/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are large discrepancies between official statistics of traffic injuries in African countries and estimates from the Global Burden of Disease (GBD) study and WHO's Global Status Reports on Road Safety (GSRRS). We sought to assess the magnitude of the discrepancy in Ethiopia, its implications and how it can be addressed. METHODS We systematically searched for nationally representative epidemiological data sources for road traffic injuries and vehicle ownership in Ethiopia and compared estimates with those from GBD and GSRRS. FINDINGS GBD and GSRRS estimates vary substantially across revisions and across projects. GSRRS-2018 estimates of deaths (27 326 in 2016) are more than three times GBD-2019 estimates (8718), and these estimates have non-overlapping uncertainty ranges. GSRRS estimates align well with the 2016 Demographic and Health Survey (DHS-2016; 27 838 deaths, 95th CI: 15 938 to 39 738). Official statistics are much lower (5118 deaths in 2018) than all estimates. GBD-2019 estimates of serious non-fatal injuries are consistent with DHS-2016 estimates (106 050 injuries, 95th CI: 81 728 to 130 372) and older estimates from the 2003 World Health Survey. Data from five surveys confirm that vehicle ownership levels in Ethiopia are much lower than in other countries in the region. INTERPRETATION Inclusion of data from national health surveys in GBD and GSRRS can help reduce discrepancies in estimates of deaths and support their use in highlighting under-reporting in official statistics and advocating for better prioritisation of road safety in the national policy agenda. GBD methods for estimating serious non-fatal injuries should be strengthened to allow monitoring progress towards Sustainable Development Goal target 3.6.
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Affiliation(s)
- Kazuyuki Neki
- World Bank Global Road Safety Facility, Washington, DC, USA
| | - Hialy Gutierrez
- Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Sudeshna Mitra
- World Bank Global Road Safety Facility, Washington, DC, USA
| | - Awoke M Temesgen
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | | | | | - Mercer Winer
- Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Jaeda Roberts
- Public Health Sciences, University of Chicago, Chicago, Illinois, USA
| | - Theo Vos
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Erin Hamilton
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - James E Harrison
- Research Center for Injury Studies, Flinders University, Bedford Park, South Australia, Australia
| | - Soames Job
- World Bank Global Road Safety Facility, Washington, DC, USA
| | - Kavi Bhalla
- Public Health Sciences, University of Chicago, Chicago, Illinois, USA
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Mortality Rates and Years of Life Lost Due to Cancer in Iran: Analysis of Data from the National Death Registration System, 2016. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2022. [DOI: 10.5812/ijcm-123633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Cancer incidence is a major public health concern and one of the leading causes of premature death worldwide. Therefore, this study was conducted to determine the death rate and years of life lost (YLL) due to cancer in Iran. Methods: In this study, death registration system (DRS) data in Iran was used. The Global Health Estimates (GHE-2016) cause categories and ICD-10 codes (C00-C97 and D00-D48) were assigned for deaths due to cancer. The crude, age-standardized mortality rates (ASMR) via world standard population was measured, and also YLL due to cancer were calculated using standard life expectancy. Results: The DRS recorded 53,492 deaths due to cancer (58.82% males and 41.18% females). The cancer mortality rate was 66.92 per 100,000 population (77.7 and 55.87 per 100,000 population in men and women, respectively) and ASMR was 96.4 per 100,000 population (115.7 and 77 per 100,000 population for males and females, respectively). The total YLL due to premature death was 736,564 in males, 580,254 in females, and 1,316,818 in both sexes. Death due to stomach cancer, tracheal, bronchus, and lung, leukemia, brain, and nervous system cancer, and breast cancer comprised the largest YLL category among different cancer sites. Conclusions: Accounting for more than 1,300,000 YLL attributed to cancer, it is a major public health problem in Iran. Therefore, promoting the prevention and control programs and policies are necessary to improve health indicators and since some cancers are preventable, the burden can be reduced by controlling tobacco use, dietary interventions, and promoting physical activity.
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Azadi T, Sadoughi F, Khorasani-Zavareh D. Using modified Delphi method to propose and validate the components of a child injury surveillance system for Iran. Chin J Traumatol 2020; 23:274-279. [PMID: 32921558 PMCID: PMC7567898 DOI: 10.1016/j.cjtee.2020.08.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 07/15/2020] [Accepted: 08/01/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Child injuries are a public health concern globally. Injury surveillance systems (ISSs) have beneficial impact on child injury prevention. There is a need for evidence-based consensus on frameworks to establish child ISSs. This research aims to investigate the key components of a child ISS for Iran and to propose a framework for implementation. METHODS Data were gathered through interview with experts using unstructured questions from January 2017 to December 2018 to identify child ISS functional components. Qualitative data were analyzed using content analysis method. Then, modified Delphi method was used to validate the functional components. Based on the outcomes of the content analysis, a questionnaire with closed questions was developed and presented to a group of experts. Consensus was achieved in two rounds. RESULTS In round I, 117 items reached consensus. In round II, 5 items reached consensus and were incorporated into final framework. Consensus was reached for 122 items comprising the final framework and representing 7 key components: goals of the system, data sources, data set, coalition of stakeholders, data collection, data analysis and data distribution. Each component consisted of several sub-components and respective elements. CONCLUSION This agreed framework will assist in standardizing data collection, analysis and distribution, which help to detect child injury problems and provide evidence for preventive measures.
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Affiliation(s)
- Tania Azadi
- Health Information Management Department, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran,Corresponding author.
| | - Davoud Khorasani-Zavareh
- Safety Promotion and Injury Prevention Research Center, Health in Disaster and Emergency Department, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Azadi T, Khorasani-Zavareh D, Sadoughi F. Barriers and facilitators of implementing child injury surveillance system. Chin J Traumatol 2019; 22:228-232. [PMID: 31208791 PMCID: PMC6667769 DOI: 10.1016/j.cjtee.2018.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 09/18/2018] [Accepted: 04/28/2019] [Indexed: 02/04/2023] Open
Abstract
PURPOSE Child injuries are a global public health problem and injury surveillance systems (ISS) can be beneficial by providing timely data. However, ISS implementation has challenges. Opinions of stakeholders of ISS implementation barriers and facilitators are a good source to understand this phenomenon. The aim of this study is to investigate barriers and facilitators of implementing ISS in Iran. METHODS This is a qualitative study. Data were gathered through interviews with 14 experts in the field of child injury and prevention from Iranian Ministry of Health and Medical Education (MOHME), medical universities, pediatrics hospitals, general hospitals and health houses during January 2017 to September 2017. Data collection and analysis continued until data saturation. Data were analyzed using content analysis through identifying meaning units. RESULTS Barriers were classified in three main categories and nine subcategories including management barriers (including performance, coordination and cooperation, supervision and attitude), weakness in data capture and usage (including data collection, data recording and data dissemination) and resource limitation (including human and financial resources). Facilitators identified in three areas of policy making (including empowerment and attitude), management (including organization, function and cooperation and coordination) and data recording and usage (including data collection/distribution and data recording). CONCLUSION The most important barrier is lack of national policy in child injury prevention. The most important facilitator is improving MOHME function through passing supportive regulations. Effective data usage and dissemination of information to those requiring data for policy making can help reduce child injuries. Coalition of stakeholders helps overcome existing barriers.
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Affiliation(s)
- Tania Azadi
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Davoud Khorasani-Zavareh
- Safety Promotion and Injury Prevention Research Center, Health in Disaster and Emergency Department, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farahnaz Sadoughi
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran,Corresponding author.
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Safi Keykaleh M, Sohrabizadeh S. The Emergency Medical System (EMS) response to Iraqi pilgrims' bus crash in Iran: a case report. BMC Emerg Med 2019; 19:38. [PMID: 31311494 PMCID: PMC6636055 DOI: 10.1186/s12873-019-0253-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 07/10/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Iran, Road Traffic Injuries (RTIs) with mass casualties occur repeatedly. Since Road Traffic Accidents (RTAs) occur far from health facilities, EMSs play an important role in reducing the disability and mortality resulting from RTIs. Thus, the study aimed to report Iraqi pilgrims' bus which rolled over in the Malayer town. CASE PRESENTATION A mass casualty event occurred on 7 September 2017 when a bus full of Iraqi pilgrims rolled over on a road 4-km outside of Malayer, Iran. A large team of responders were dispatched including 5 ambulances with 10 EMTs along with 6 police officers serving in the area. The accident resulted in 35 injured patients (21 female and 14 male) as well as 11 deaths ranging in age from 2 to 65 years. Twenty-one of the injured were transported to the hospital and 14 patients refused transport and 12 patients sustained multiple trauma. The case has been described four phases of dispatch, on-scene, hospital and post-mission. Frequent calls made by laypeople were considered as the main challenge of dispatch phase. The response on scene was hampered by large numbers of lay bystanders. The over-crowding around the emergency units disrupted the medical care procedures in hospital phase. CONCLUSION This case highlights over-crowding and laypeople interference at the scene disrupts the relief and rescue. To solve these challenges, the public education and police monitoring and control is recommended. Establishing a unified command post at the scene can facilitate effective coordination among relief and rescue organizations.
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Affiliation(s)
- Meysam Safi Keykaleh
- Department of of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sanaz Sohrabizadeh
- Safety Promotion and Injury Prevention Research Center, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Balikuddembe JK, Ardalan A, Khorasani-Zavareh D, Nejati A, Raza O. Weaknesses and capacities affecting the Prehospital emergency care for victims of road traffic incidents in the greater Kampala metropolitan area: a cross-sectional study. BMC Emerg Med 2017; 17:29. [PMID: 28974202 PMCID: PMC5627469 DOI: 10.1186/s12873-017-0137-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 08/07/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Pre-hospital emergency care is a vital and integral component of health systems particularly in the resource constrained countries like Uganda. It can help to minimize deaths, injuries, morbidities, disabilities and trauma caused by the road traffic incidents (RTIs). This study identifies the weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTIs in the Greater Kampala Metropolitan Area (GKMA). METHODS A cross-sectional study was conducted in the GKMA using a three-part structured questionnaire. Data related to the demographics, nature of RTIs and victims' pre-hospital experience and existing Emergency Medical Services (EMS) were collected from victims and EMS specialists in 3 hospitals and 5 EMS institutions respectively. Data was descriptively analyzed, and after the principal component analysis was employed to identify the most influential weaknesses and capacities affecting the pre-hospital emergency care for the victims of RTI in the GKMA. RESULTS From 459 RTI victims (74.7% males and 25.3% females) and 23 EMS specialists (91.3% males and 8.7% females) who participated in the study between May and June 2016, 4 and 5 key weaknesses and capacities respectively were identified to affect the pre-hospital emergency care for RTI victims in the GKMA. Although some strengths exist like ambulance facilitation, EMS structuring, coordination and others), the key weaknesses affecting the pre-hospital care for victims were noted to relate to absence of predefined EMS systems particularly in the GKMA and Uganda as a whole. They were identified to involve poor quality first aid treatment; insufficient skills/training of the first responders; inadequate EMS resources; and avoidable delays to respond and transport RTI victims to medical facilities. CONCLUSIONS Though some strengths exist, the weaknesses affecting prehospital care for RTI victims primarily emanate from the absence of predefined and well-organized EMS systems in the GKMA and Uganda as a whole.
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Affiliation(s)
- Joseph Kimuli Balikuddembe
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Tehran University of Medical Sciences–International Campus, Tehran, Iran
- East African Center for Disaster Health and Humanitarian Research, Kampala, Uganda
| | - Ali Ardalan
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
- Harvard Humanitarian Initiative, Harvard University, Cambridge, USA
| | - Davoud Khorasani-Zavareh
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Health in Disaster and Emergency, School of Health, Safety and Environment, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Post-Doc Research Fellowship, Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Amir Nejati
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Emergency Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Owais Raza
- Tehran University of Medical Sciences–International Campus, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Bazeli J, Aryankhesal A, Khorasani-Zavareh D. Epidemiology of special incidents: Results from national mortality and morbidity registry and the associated factors in Iran in 2014. Electron Physician 2017; 9:5113-5121. [PMID: 28979750 PMCID: PMC5614300 DOI: 10.19082/5113] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 06/20/2017] [Indexed: 11/25/2022] Open
Abstract
Background Special incidents are harmful events that can result in people’s death or injury. Despite registering special incidents’ data in Iran, no study has yet been conducted to identify the types, rates, mortality and morbidity of such incidents and their associated factors. The present study was conducted to assess the epidemiology of incidents and their associated factors during 2014 in Iran. Methods In this cross-sectional study, all special incidents of 2014 were examined. Data were initially collected by universities of medical sciences nationwide and then sent to the Disaster and Emergency Management Center in the Ministry of Health and Medical Education. The collected data were analyzed in this study using statistical tests of Chi-square and Pearson’s correlation coefficient using SPSS ver. 14.5. Results Out of 6,892 special incidents that occurred during 2014 in Iran, 6,781 cases were included, of which, the most prevalent were traffic crashes (71%), carbon monoxide poisoning (14%), drowning (3.5%), and other cases (11.5%) (which included suspicious deaths, explosions, group poisoning, quarrels, fires, falls from height, and building collapses). The incidents led to 37,313 injuries and 3,259 deaths, of which 78% of injuries and 75% of deaths were due to road traffic incidents. Conclusion Given to relationship between occurrence of the incidents and special holidays; such incidents can be reduced through preventive planning and education. We recommend annual monitoring of special incidents and further studies on the associated factors.
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Affiliation(s)
- Javad Bazeli
- Ph.D. Student of Health in Disasters and Emergencies, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Aryankhesal
- Ph.D. in Health Policy and Management, Associate Professor, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.,Ph.D. in Health Policy and Management, Associate Professor, Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Davoud Khorasani-Zavareh
- Ph.D. in Safety Promotion and Injury Prevention, Associate Professor, Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ph.D. in Safety Promotion and Injury Prevention, Associate Professor, Department of Health in Disaster and Emergency, School of Health, Safety and Engineering, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Ph.D. in Safety Promotion and Injury Prevention, Associate Professor, Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
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Pattern of Injuries from Road Traffic Accidents Presented at a Rural Teaching Institution of Karachi. Indian J Surg 2017; 79:332-337. [PMID: 28827908 DOI: 10.1007/s12262-017-1605-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 02/23/2017] [Indexed: 12/16/2022] Open
Abstract
The aim of the study is to study the pattern of injuries from road traffic accidents presented at the emergency department of a rural teaching institution in Karachi. This descriptive case series was conducted prospectively in the Emergency Department of Fatima Hospital and Baqai Medical University from 1 January 2012 to 21 March 2013. There were 385 patients in the series. All of the patients with recent injuries from road traffic accidents were included. Cases with injuries more than 72 h old were excluded. The majority of patients had lower limb injuries 172 (44.7%), followed by head and neck injuries 107 (27.8%), multiple injuries 62 (16.1%), upper limb injuries 22 (5.7%), abdominoperineal injuries 19 (5%), and chest injuries 3 (0.8%). Majority (229, 59.5%) of patients were given first aid treatment and discharged, while 151 (39.3%) patients were either admitted or referred to better equipped hospitals. Three patients were brought dead, and two patients left against medical advice. The lower limb injuries were the commonest road traffic accidental injuries, followed by head and neck injuries, multiple injuries, upper limb injuries, abdominoperineal injuries, and chest injuries.
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Balikuddembe JK, Ardalan A, Zavareh DK, Nejati A, Kasiima S. Factors affecting the exposure, vulnerability and emergency medical service capacity for victims of road traffic incidents in Kampala Metropolitan Area: a Delphi study. BMC Emerg Med 2017; 17:1. [PMID: 28061754 PMCID: PMC5219676 DOI: 10.1186/s12873-016-0112-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 12/06/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Kampala Metropolitan Area (KMA) is the fastest developing region in Uganda. Over recent years, this has placed exponential demand on the road sector, which consequently has contributed to rapid growth in motorized vehicles which, predisposes the region to a high risk of road traffic incidents (RTIs). A number of concerted road safety and post-crash management measures to respond to RTIs in the KMA in particular and Uganda as a whole have been undertaken. However, there is a need to greatly improve the measures by better identifying the factors influencing the exposure, vulnerability and emergency medical service (EMS) capacity for RTI victims. The present study seeks to investigate and reveal these factors. METHODS A Delphi technique employing a questionnaire and involving a multidisciplinary panel of experts was used in three rounds. RESULTS The ten (10) most important factors affecting the exposure, vulnerability and EMS capacity for victims of RTIs in the KMA were identified. Socio-cultural, infrastructure and road safety aspects were the factors most identified as affecting the exposure and vulnerability. The absence of a national EMS policy and post-crash care system, as well as the fact that many victims lack health insurance, were noted to be the factors adversely affecting the EMS capacity. CONCLUSIONS There exists is a real need to substantially reduce the burden of RTIs in KMA, with ultimate goal of saving lives that are being lost needlessly and reducing the impact of injuries and trauma and the economic losses associated with it. This study offers insights into the causes of RTIs and the most appropriate ways of responding to them especially with the establishment and empowerment of predefined and structured EMS systems.
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Affiliation(s)
- Joseph Kimuli Balikuddembe
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Tehran University of Medical Sciences – International Campus, Tehran, Iran
| | - Ali Ardalan
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
- Harvard Humanitarian Initiative, Harvard University, Cambridge, USA
| | - Davoud Khorasani Zavareh
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Health in Disaster and Emergency, School of Health, Safety and Engineering, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Amir Nejati
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Department of Emergency Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Stephen Kasiima
- Directorate of Road Traffic and Road Safety, Uganda Police Force, Kampala, Uganda
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Balikuddembe JK, Ardalan A, Khorasani-Zavareh D, Nejati A, Munanura KS. Road traffic incidents in Uganda: a systematic review study of a five-year trend. J Inj Violence Res 2017; 9:796. [PMID: 28039687 PMCID: PMC5279989 DOI: 10.5249/jivr.v9i1.796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 06/02/2016] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Over the years, Uganda has been one of the low and middle-income countries bearing the heaviest burden of road traffic incidents (RTI). Since the proclamation of the United Nations Decade of Action for Road Safety 2011 - 2020, a number of measures have been taken to reduce the burden. However, they ought to be premised on existing evidence-based research; therefore, the present review ventures to report the most recent five-year trend of RTI in Uganda. METHODS Based on Preferred Reporting Items for Systematic Reviews and Meta-Data Analysis (PRISMA) guidelines, a systematic review was employed. Using a thematic analysis, the articles were grouped into: trauma etiology, trauma care, mortality, cost, trauma registry and communication, intervention and treatment for final analysis. RESULTS Of the nineteen articles that were identified to be relevant to the study, the etiology of RTI was inevitably observed to be an important cause of injuries in Uganda. The risk factors cut across: the crash type, injury physiology, cause, victims, setting, age, economic status, and gender. All studies that were reviewed have advanced varying recommendations aimed at responding to the trend of RTIs in Uganda, of which some are in tandem with the five pillars of the United Nations Decade of Action for Road Safety 2011 - 2020. CONCLUSIONS Peripheral measures of the burden of RTIs in Uganda were undertaken within afive-year timeframe (2011-2015) of implementing the United Nations Decade of Action for Road Safety. The measures however, ought to be scaled-up on robust evidence based research available from all the concerned stakeholders beyond Kampala or central region to other parts of Uganda.
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Affiliation(s)
| | - Ali Ardalan
- Department of Disaster Public Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Patel A, Krebs E, Andrade L, Rulisa S, Vissoci JRN, Staton CA. The epidemiology of road traffic injury hotspots in Kigali, Rwanda from police data. BMC Public Health 2016; 16:697. [PMID: 27485433 PMCID: PMC4971670 DOI: 10.1186/s12889-016-3359-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 07/22/2016] [Indexed: 11/26/2022] Open
Abstract
Background Road traffic injuries (RTIs) are the eighth-leading cause of death worldwide, with low- and middle-income countries sharing a disproportionate number of fatalities. African countries, like Rwanda, carry a higher burden of these fatalities and with increased economic growth, these numbers are expected to rise. We aim to describe the epidemiology of RTIs in Kigali Province, Rwanda and create a hotspot map of crashes from police data. Methods Road traffic crash (RTC) report data from January 1, 2013 to December 31, 2013 was collected from Kigali Traffic Police. In addition to analysis of descriptive data, locations of RTCs were mapped and analyzed through exploratory spatial data analysis to determine hotspots. Results A total of 2589 of RTCs were reported with 4689 total victims. The majority of victims were male (94.7 %) with an average age of 35.9 years. Cars were the most frequent vehicle involved (43.8 %), followed by motorcycles (14.5 %). Motorcycles had an increased risk of involvement in grievous crashes and pedestrians and cyclists were more likely to have grievous injuries. The hotspots identified were primarily located along the major roads crossing Kigali and the two busiest downtown areas. Conclusions Despite significant headway by the government in RTC prevention, there continue to be high rates of RTIs in Rwanda, specifically with young males and a vulnerable road user population, such as pedestrians and motorcycle users. Improvements in police data and reporting by laypersons could prove valuable for further geographic information system analysis and efforts towards crash prevention and targeting education to motorcycle taxis could help reduce RTIs in a severely affected population.
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Affiliation(s)
- Anjni Patel
- Department of Surgery, Division of Emergency Medicine, Duke University, Durham, NC, USA.,Department of Emergency Medicine, Section of Prehospital and Disaster Medicine, Emory University, Atlanta, GA, USA
| | - Elizabeth Krebs
- Department of Surgery, Division of Emergency Medicine, Duke University, Durham, NC, USA
| | | | - Stephen Rulisa
- Department of Obstetrics & Gynecology, University of Rwanda School of Medicine, Kigali, Rwanda
| | - João Ricardo N Vissoci
- Department of Medicine, Faculdade Ingá, Maringá, Paraná, Brazil.,Duke University Medical Center, DUMC Box 3096 2301 Erwin Road, Duke North, Suite 2600, Durham, NC, 27710, USA.,Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Durham, USA
| | - Catherine A Staton
- Department of Surgery, Division of Emergency Medicine, Duke University, Durham, NC, USA. .,Duke University Medical Center, DUMC Box 3096 2301 Erwin Road, Duke North, Suite 2600, Durham, NC, 27710, USA. .,Division of Global Neurosurgery and Neurosciences, Department of Neurosurgery, Duke University Medical Center, Durham, USA.
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Izadi N, Najafi F, Khosravi A. The burden of road traffic injuries in Kermanshah Province, Iran, in 2010-2011: GBD 2010 method. Int J Inj Contr Saf Promot 2016; 24:435-443. [PMID: 27264333 DOI: 10.1080/17457300.2016.1178300] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Deaths, injuries and disabilities resulting from road traffic injuries (RTIs) are a public health major concern. This study aims to calculate the burden of RTIs in Kermanshah Province in Iran. In this study to determine the years of life lost (YLL) related to RTIs, the National Death Registration and Forensics Medicine census data were employed. We use forensic medicine data to calculate the incidence of non-fatal injuries and years lost due to disability (YLD). The cause of death and non-fatal injuries was classified using ICD-10 codes and 23 groupes of global burden of diseases (GBD) 2010. The disability-adjusted life year (DALY) estimated on the guidelines of the GBD 2010 and age and sex structure was taken from the National Statistic Center for the year 2010. Overall, 70.8% of the subjects were males. The fatal and non-fatal injury rates of RTI were 51.3 and 283.6 per 100,000 persons, respectively. YLLs and YLDs were 46613 (24.5 per 1000) and 3405 (1.8 per 1000) in both sexes, respectively. The disability adjusted life years were 40711 in males, 9306 in females and 50018 in both sexes (42.5, 9.8 and 26.3 per 1000, respectively). More than 93% of DALY was from YLL (24.5 per 1000), with a small proportion for YLD (1.8 per 1000). Accounting for more than 50,000 DALY attributed to RTIs, traffic injuries is a major public health and socioeconomic problem in Kermanshah. Designing cost-effective interventions based on comprehensive and multi-sectoral programmes at the national and provincial levels can save many lives and resources that are lost every year. Undoubtedly, establishing a surveillance system at the sub-national level and measuring the burden of injuries, as in this study, can help policy-makers and planners in lessening the burden of RTIs.
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Affiliation(s)
- Neda Izadi
- a Department of Epidemiology , Kermanshah University of Medical Sciences , Kermanshah , Iran
| | - Farid Najafi
- b Department of Epidemiology, Research Center for Environmental Determinants of Health (RCEDH) , Kermanshah University of Medical Sciences , Kermanshah , Iran
| | - Ardeshir Khosravi
- c Iranian Ministry of Health and Medical Education, Non-communicable Diseases Research Center , Tehran University of Medical Sciences , Tehran , Iran
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Sango HA, Testa J, Meda N, Contrand B, Traoré MS, Staccini P, Lagarde E. Mortality and Morbidity of Urban Road Traffic Crashes in Africa: Capture-Recapture Estimates in Bamako, Mali, 2012. PLoS One 2016; 11:e0149070. [PMID: 26871569 PMCID: PMC4752233 DOI: 10.1371/journal.pone.0149070] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 12/28/2015] [Indexed: 12/05/2022] Open
Abstract
Background Low- and middle-income countries are currently facing the massive public health challenge of road traffic injuries. The lack of effective surveillance systems hinders proper assessment of epidemiologic status and intervention priorities. The objective of our study was to estimate the mortality and morbidity attributable to road crashes in Bamako, Mali using the capture-recapture method. Methods During the 1 January, 2012–31 April, 2012 period, we collected data on road traffic crashes from the road accident registers of the police forces of Bamako, Mali on the one hand, and from a register kept by health facilities in the same area. An automatic, then manual matching procedure was performed to find pairs of records related to the same crash victims. The number of victims and the number of fatalities were estimated by the capture-recapture method using the Chapman estimator. Results The health facility and the police registries included 3587 and 1432 records, respectively. The matching procedure identified 603 common records, 31 of which were fatalities. The annual incidence estimate for road victims was 1038 in 100 000 and the annual incidence estimate for road fatalities was 12 in 100 000. Victims from both sources were more likely to be male, in the 15–34 age group, and almost half of all injured road users and two in three fatalities were using motorized two-wheelers. One victim out of five was a pedestrian. Conclusion Our estimates are in line with available literature data from low-income countries. While more cases were reported by health facilities than by police forces, we believe that an effective surveillance system should not be based solely on medical reports as much would be missing as regards the crash circumstances and characteristics.
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Affiliation(s)
- Hammadoum A. Sango
- Département d’Enseignement et de Recherche Santé Publique et Spécialités, Faculté de Médecine et d’Odonto-Stomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
| | - Jean Testa
- Département de Santé Publique. Centre MURAZ, Ministère de la Santé, Bobo-Dioulasso, Burkina Faso
- * E-mail:
| | - Nicolas Meda
- Département de Santé Publique. Centre MURAZ, Ministère de la Santé, Bobo-Dioulasso, Burkina Faso
- Centre de Recherche Internationale pour la santé, UFR Sciences de la santé, Université de Ouagadougou, Ouagadougou, Burkina Faso
| | - Benjamin Contrand
- Équipe Prévention et prise en charge des traumatismes. Inserm U897 ISPED—Université de Bordeaux2, Bordeaux, France
| | - Mamadou S. Traoré
- Département d’Enseignement et de Recherche Santé Publique et Spécialités, Faculté de Médecine et d’Odonto-Stomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Bamako, Mali
- Institut National de Recherche en Santé Publique (INRSP), Ministère de la Santé et de l’Hygiène Publique, Bamako, Mali
| | - Pascal Staccini
- Département « Ingénierie du Risque et Informatique de Santé », UMR 912 SESSTIM INSERM, Université de Nice Sophia Antipolis, Nice, France
| | - Emmanuel Lagarde
- Équipe Prévention et prise en charge des traumatismes. Inserm U897 ISPED—Université de Bordeaux2, Bordeaux, France
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Hailemichael F, Suleiman M, Pauolos W. Magnitude and outcomes of road traffic accidents at Hospitals in Wolaita Zone, SNNPR, Ethiopia. BMC Res Notes 2015; 8:135. [PMID: 25886357 PMCID: PMC4404595 DOI: 10.1186/s13104-015-1094-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 03/24/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A Road traffic accident is an incident on a way or street open to public traffic, resulting in one or more persons being killed or injured, and involving at least one moving vehicle. METHODS The aim of this study is to assess magnitude and outcome of road traffic accidents among trauma victims at hospitals in Wolaita zone. A cross sectional hospital based study design using retrospective chart review was conducted from March 5th to March 25th, 2014. Simple random sampling technique was applied to identify sample population. The data was entered in to Epi info version 3.5.1 and transferred to SPSS version 16 for further analysis. RESULTS A total of 384 trauma victims were incorporated in the study of which 240 (62.5%) were due to road traffic accidents. The majority of patients were male 298 (77.6%) and most commonly aged between 20-29 (35.42%). The principal outcome of injury was more commonly lower extremity (182 patients, 47.4%), compared to upper extremity (126 patients, 32.8%). CONCLUSION Of all trauma patient presenting to hospitals (62.5%) are the result of road traffic accident. Hence, the provision of tailored messages to all members of the community regarding knowledge and practices of road safety measures like appropriate use of pavements by pedestrians and avoiding risky driving behaviors. Besides this make use of compulsory motorcycle helmets would appear to be a very important intervention.
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Affiliation(s)
- Feleke Hailemichael
- Wolaita Sodo University School of Public Health, P.O. Box, 138, Wolaita Sodo, Ethiopia.
| | - Mohammed Suleiman
- Wolaita Sodo University Department of Anesthesia, Wolaita, Ethiopia.
| | - Wondimagegn Pauolos
- Wolaita Sodo University School of Public Health, P.O. Box, 138, Wolaita Sodo, Ethiopia.
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Road traffic deaths and injuries are under-reported in Ethiopia: a capture-recapture method. PLoS One 2014; 9:e103001. [PMID: 25054440 PMCID: PMC4108419 DOI: 10.1371/journal.pone.0103001] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 06/25/2014] [Indexed: 11/22/2022] Open
Abstract
In low and middle income countries road traffic injuries are commonly under-reported. This problem is significantly higher among those less severely injured road users. The objective of this study was to determine the incidence and the level of ascertainment of road traffic injuries and deaths by traffic police and hospital registry. In this study two-sample capture-recapture method was applied using data from traffic police and hospital injury surveillance, through June 2012 to May 2013. The study was conducted on one of the busiest highways in Ethiopia, the Addis Ababa – Hawassa highway. Primary data were collected by accident investigators and hospital emergency nurses using a structured checklist. Four matching variables; name of the victim, sex, place and time of the accidents was used to get the matched cases. During the study period the police independently reported 224 deaths and 446 injuries/billion vehicle kilometer while hospitals reported 123 deaths and 1,046 injuries/billion vehicle kilometer. Both sources in common captured 73 deaths and 248 injuries/billion vehicle kilometer. Taking the two data sources into consideration, the capture-recapture model estimated the incidence of deaths and injuries ranged 368–390 and 1,869–1,895 per billion vehicle kilometer, respectively. The police source captured 57.4%–60.9% of deaths and 23.5%–23.9% of injuries while the hospital sources captured 31.5%–33.4% of deaths and 55.2%–56% of injuries. Deaths and injuries among females, younger age victims, cyclists/motorcyclists and pedestrians were under-reported by traffic police. In conclusion neither of the two sources independently provided accurate coverage of road traffic incident related deaths and injuries. Strengthening both systems is necessary to obtain accurate information on road accidents and human causalities.
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Khorasani Zavareh D, Bohm K, Khankeh H, Talebian MT, Mohammadi R, Bigdeli M, Castren M. Why should being visible on the road? A challenge to prevent road traffic injuries among pedestrians in Iran. J Inj Violence Res 2014; 7:93-4. [PMID: 24879078 PMCID: PMC4522322 DOI: 10.5249/jivr.v7i2.490] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 02/21/2014] [Indexed: 12/04/2022] Open
Affiliation(s)
| | | | | | | | | | - Maryam Bigdeli
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran.
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Khorasani-Zavareh D, Bigdeli M, Hatami H, Meshkini A, Mohammadi R. Application of mark-recapture to evaluate preventive road traffic injury policy. J Inj Violence Res 2013; 6:97-8. [PMID: 24284811 PMCID: PMC4009177 DOI: 10.5249/jivr.v6i2.479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 03/17/2013] [Indexed: 11/05/2022] Open
Affiliation(s)
| | | | | | - Ali Meshkini
- School of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Bazargan-Hejazi S, Zamani-Alavijeh F, Hindman D, Mohamadi E, Bazargan M. How do motorcyclists manage mental tensions of risky riding? BMC Public Health 2013; 13:865. [PMID: 24050539 PMCID: PMC3850570 DOI: 10.1186/1471-2458-13-865] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 09/05/2013] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Road traffic injuries, especially those involving motorcycles, are a particular concern in Iran. We aimed to identify the specific cognitive dissonances and consonances associated with risky riding among Iranian motorcyclists. METHODS This was a grounded theory qualitative study of male motorcyclists who were ≥ 18 and were living in one of the three cities of Tehran, Isfahan and Ahwaz. Thirty four (n = 34) motorcyclists participated in 19 in-depth interviews and 5 focus-groups between January 2007 and February 2008. RESULTS We identified four categories of motorcycle riders each endorsing a unique risk bias they employed to justify their risky ridings. The categories included: (1) Risk Managers who justified risky riding by doubting that it would result in negative outcomes if they are competent riders. (2) Risk Utilizers who justified risky riding as functional and practical that would enable them to handle daily chores and responsibilities more efficiently. (3) Risk Calculators who justified risky riding by believing that it will help them to avoid road crashes. (4) Risk Takers who justified risky riding by arguing that risky riding is thrilling and brings them peer recognition. CONCLUSION Our findings reveal different groups of motorcyclists according to their different rationalizations for risky riding. Road safety advocates can benefit from our findings by matching relevant and appropriate interventions and incentives to these specific groups.
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Affiliation(s)
- Shahrzad Bazargan-Hejazi
- Department of Psychiatry, Charles R. Drew University of Medicine and Science, & David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Fereshteh Zamani-Alavijeh
- Department of Public Health, Social Determinants of Health Research Center, Faculty of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - David Hindman
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
| | - Esa Mohamadi
- Department of Nursing, Tarbiat Modarres University, Tehran, Iran
| | - Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059, USA
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Rezaei S, Arab M, Karami Matin B, Akbari Sari A. Extent, consequences and economic burden of road traffic crashes in Iran. J Inj Violence Res 2013; 6:57-63. [PMID: 24045158 PMCID: PMC4009170 DOI: 10.5249/jivr.v6i2.191] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 07/09/2013] [Indexed: 11/06/2022] Open
Abstract
Background: Road Traffic Injuries (RTIs) as a result of road traffic crashes (RTCs) rank as the leading cause of death, disability and property loss worldwide, especially in low and middle-income countries. This study aims to analyze the costs of RTCs in Iran. Methods: A standard human capital approach was used to estimate the costs. Costs included medical, administrative and funeral costs, property damage, production lost and intangible costs. Data about the number of deaths and injuries resulting from RTIs between 20 March 2009 and 20 March 2010 was obtained from two national databases designed at the Center for Disaster Management and Medical Emergencies (CDMME) and the Legal Medicine Organization (LMO), respectively. The severity and medical costs of injuries were identified by reviewing 400 medical records that were selected randomly from patients who were admitted to two large trauma centers in Shariati and Sina hospitals in Tehran province. Moreover, information about production lost, property damage, rehabilitation cost, intangible costs and administration costs were collected by review of current evidence and consulting with expert opinion. Results: In total 806,922 RTIs and 22,974 deaths resulted from the RTCs in the study period. The total cost of RTCs was about 72,465 billion Rials (7.2 billion US Dollars), which amounts to 2.19% of Iran’s Gross Domestic Production (GDP). Direct costs were 3,516 billion Rials (around 48.6 % of the total costs), following by 24,785 billion Rials (around 34.2 % of the total costs) for production lost and 12,513 billion Rials (around 17.2 % of the total costs) for intangible costs. Conclusions: This study indicated that the burden of both RTCs and RTIs in Iran is substantial. Moreover, RTCs have significant economic consequences and are a large drain on healthcare resources.
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Affiliation(s)
| | | | | | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Khorasani-Zavareh D, Shoar S, Saadat S. Antilock braking system effectiveness in prevention of road traffic crashes in Iran. BMC Public Health 2013; 13:439. [PMID: 23642097 PMCID: PMC3649935 DOI: 10.1186/1471-2458-13-439] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 04/25/2013] [Indexed: 11/17/2022] Open
Abstract
Background Anti-lock Brake System (ABS) helps the equipped vehicles to stop under heavy braking, in a shorter distance and with a better control of direction. It was expected that this technology will reduce the rate of fatal road traffic crashes (RTC); however, the outcome is controversial in the real world. The aim of this study is to compare the claimed annual incidence rate and financial losses due to RTCs in ABS vs. non-ABS personal vehicles in Iran. Methods A telephone survey among drivers of two similar models of personal vehicles was arranged. The studied vehicles were of the same brand and type; but only one of them was equipped with ABS. The number of RTCs, subsequent financial loss, and drivers’ knowledge and perception about ABS were sought. The sample consisted of drivers of 1232 ABS and 3123 non-ABS vehicles. Results The annual incidence rate of RTC involving another vehicle was 145.1 (134.8-155.9) per 1000 vehicle-years and there was not a statistically significant difference between study groups. The incidence of RTC with another vehicle due to brake failure was 50.3 (42.9-58.5) for 1000 non ABS vehicle-years and 30.0 (21.2-41.2) for 1000 ABS equipped vehicle-years. The difference was statistically significant after adjustment for the driver and vehicle's age and the daily driving time. The attributable risk of RTC for non-ABS vehicles was 20/1000 vehicles and the excess fraction was 39.8%. The mean financial loss due to reported RTCs was $987.9 ± $1547.3 US Dollars and there was not a statistically significant difference between study groups. While 61.1% of ABS vehicle drivers reported situations in which they believed the ABS had prevented a crash, 44.1% of them however, they did not know how to use ABS efficiently. Conclusions Law enforcement to maintain safe distance and adhere to speed limit while driving, is needed to raise the effectiveness of ABS. This is as necessary as considering mandatory outfitting of ABS. Safety authorities should first consider the global experience and local evidence, before adopting any specific policy in this regard. The drivers need to learn the right way to use ABS for maximum effectiveness.
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Affiliation(s)
- Davoud Khorasani-Zavareh
- Social Determinants of Health Research Center, Urmia University of Medical Sciences, Urmia, Iran
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Bhatti JA, Salmi LR. Challenges in evaluating the decade of action for road safety in developing countries: a survey of traffic fatality reporting capacity in the Eastern Mediterranean region. TRAFFIC INJURY PREVENTION 2012; 13:422-426. [PMID: 22817558 DOI: 10.1080/15389588.2012.655431] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE The United Nations have proclaimed the "Decade of Action for Road Safety 2011-2020" to reduce traffic fatalities worldwide, particularly in low- and middle-income countries (LMICs). It is estimated that the LMICs in the Eastern Mediterranean Region (EMR) have the highest traffic fatality rates. This study evaluated the capacity of current traffic fatality reporting in the EMR to indicate the impact of future interventions. METHODS The World Health Organization's (WHO) SMART (specific, measurable, achievable, realistic, timely) criteria for indicators were used to assess traffic fatality reporting in the 17 LMICs in the EMR. RESULTS Official statistics accounted for less than 60 percent of estimated fatalities in 12 of the 17 EMR countries. Police data were the main source of reporting for 11 LMICs, only 3 had a specific traffic fatality surveillance system, the standard definition of fatality was used for 7 LMICs, local fatality distributions were available for 5 LMICs, multiple data sets were available for 6 LMICs, and only 7 regularly published fatality data. CONCLUSIONS These reporting problems could easily undermine the evaluation of any future preventive efforts in the EMR. International cooperation and financial assistance from experienced high-income countries, focusing on building capacity, might be useful in strengthening the current reporting systems in LMICs in the EMR.
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Affiliation(s)
- Junaid A Bhatti
- McGill University, Douglas Hospital Research Centre, Montreal, Canada.
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Hassel M, Asbjørnslett BE, Hole LP. Underreporting of maritime accidents to vessel accident databases. ACCIDENT; ANALYSIS AND PREVENTION 2011; 43:2053-2063. [PMID: 21819835 DOI: 10.1016/j.aap.2011.05.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Revised: 05/20/2011] [Accepted: 05/22/2011] [Indexed: 05/31/2023]
Abstract
Underreporting of maritime accidents is a problem not only for authorities trying to improve maritime safety through legislation, but also to risk management companies and other entities using maritime casualty statistics in risk and accident analysis. This study collected and compared casualty data from 01.01.2005 to 31.12.2009, from IHS Fairplay and the maritime authorities from a set of nations. The data was compared to find common records, and estimation of the true number of occurred accidents was performed using conditional probability given positive dependency between data sources, several variations of the capture-recapture method, calculation of best case scenario assuming perfect reporting, and scaling up a subset of casualty information from a marine insurance statistics database. The estimated upper limit reporting performance for the selected flag states ranged from 14% to 74%, while the corresponding estimated coverage of IHS Fairplay ranges from 4% to 62%. On average the study results document that the number of unreported accidents makes up roughly 50% of all occurred accidents. Even in a best case scenario, only a few flag states come close to perfect reporting (94%). The considerable scope of underreporting uncovered in the study, indicates that users of statistical vessel accident data should assume a certain degree of underreporting, and adjust their analyses accordingly. Whether to use correction factors, a safety margin, or rely on expert judgment, should be decided on a case by case basis.
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Affiliation(s)
- Martin Hassel
- Norwegian University of Science and Technology, Department of Marine Technology, Trondheim, Norway.
| | - Bjørn Egil Asbjørnslett
- Norwegian University of Science and Technology, Department of Marine Technology, Trondheim, Norway.
| | - Lars Petter Hole
- Norwegian University of Science and Technology, Department of Marine Technology, Trondheim, Norway.
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Haghparast Bidgoli H, Bogg L, Hasselberg M. Pre-hospital trauma care resources for road traffic injuries in a middle-income country--a province based study on need and access in Iran. Injury 2011; 42:879-84. [PMID: 20627291 DOI: 10.1016/j.injury.2010.04.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 03/07/2010] [Accepted: 04/26/2010] [Indexed: 02/02/2023]
Abstract
BACKGROUND Access to pre-hospital trauma care can help minimize many of traffic related mortality and morbidity in low- and middle-income countries with high rate of traffic deaths such as Iran. The aim of this study was to assess if the distribution of pre-hospital trauma care facilities reflect the burden of road traffic injury and mortality in different provinces in Iran. METHODS This national cross-sectional study is based on ecological data on road traffic mortality (RTM), road traffic injuries (RTIs) and pre-hospital trauma facilities for all 30 provinces in Iran in 2006. Lorenz curves and Gini coefficients were used to describe the distributions of RTM/RTIs and pre-hospital trauma care facilities across provinces. Spearman rank-order correlation was performed to assess the relationship between RTM/RTI and pre-hospital trauma care facilities. RESULTS RTM and RTIs as well as pre-hospital trauma care facilities were distributed unequally between different provinces. There was no significant association between the rate of RTM and RTIs and the number of pre-hospital trauma care facilities across the country. CONCLUSIONS The distribution of pre-hospital trauma care facilities does not reflect the needs in terms of RTM and RTIs for different provinces. These results suggest that traffic related mortality and morbidity could be reduced if the needs in terms of RTM and RTIs were taken into consideration when distributing pre-hospital trauma care facilities between the provinces.
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van Hest R, Grant A, Abubakar I. Quality assessment of capture-recapture studies in resource-limited countries. Trop Med Int Health 2011; 16:1019-41. [PMID: 21605289 DOI: 10.1111/j.1365-3156.2011.02790.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Resource-limited countries often lack robust routine surveillance systems to accurately assess the burden of human attributes and diseases. In these settings capture-recapture analysis can be an alternative tool to obtain prevalence and incidence rates. Performance of capture-recapture analyses in resource-limited countries has not been systematically reviewed. METHODS Systematic review of the performance of capture-recapture analyses in the categories of human attributes, non-infectious and infectious diseases in resource-limited countries, assessing individual study quality criteria and a minimum quality criterion per category, using PRISMA methodology. RESULTS A total of 1671 potentially relevant PubMed citations were screened, resulting in 52 eligible publications: 36% in human attributes, i.e. hidden populations, injuries and mortality; 48% in non-infectious and 15% in infectious disease categories. Twenty-one per cent of selected studies were from low income countries, 40% from lower-middle-income countries and 38% from upper-middle-income countries. Thirteen per cent achieved good individual study quality criteria, 25% were intermediate and 19% were poor. Of the good studies, six were performed on human attributes and one on a non-infectious disease. The proportions of publications meeting the minimum quality criterion per category were 42%, 20% and 37%, respectively. CONCLUSIONS Few capture-recapture studies in resource-limited countries achieved good individual quality criteria and a minority met the minimum quality criterion per category. Capture-recapture techniques in these settings should be carefully considered and implemented rigorously and are not a panacea for strengthening of routine surveillance systems.
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Affiliation(s)
- Rob van Hest
- Tuberculosis Control Section, Rotterdam Public Health Service, Rotterdam, The Netherlands.
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Kiakalayeh AD, Mohammadi R, Stark Ekman D, Yousefzade-Chabok S, Behboudi F, Jansson B. Estimating drowning deaths in Northern Iran using capture-recapture method. Health Policy 2010; 100:290-6. [PMID: 20951461 DOI: 10.1016/j.healthpol.2010.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Revised: 09/07/2010] [Accepted: 09/13/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Descriptive epidemiological study has shown that drowning is a problem health in low and middle income countries. To analyze records of drowning deaths from two injury registry systems, to ascertain a true estimate of drowning-mortality, it can help to follow up drowning prevention policy. METHODS This study uses capture-recapture methods to arrive at a more accurate estimate of the number of drowning events occurring over a one-year period in Guilan and Mazandran Provinces, in northern Iran. Records from the Iran's Forensic Medical System and Death Registry System were compared, using five matching approaches based on various combinations of the following variables: gender, place of drowning, date of death, victim age, name, region of residence, and/or place of residence. RESULTS The results revealed that the estimated number of drowning cases in the study population is much higher than official figures, ranging from 5.26 to 8.25 per 100,000 residents compared to the national figure of 4.5 per 100,000. The completeness of Death Registry System records for drowning was 70% of corrected estimates while the completeness of records from Forensic Medicine was 54.4%. CONCLUSION We conclude that the use of capture-recapture methodology may provide better accuracy in measuring drowning events. This method may also help reduce bias in the estimate of incidence rates and comparison of different populations.
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Affiliation(s)
- Ali Davoudi Kiakalayeh
- Division of Social Medicine, Department of Public Health Science, Karolinska Institutet, Norrbacka, Stockholm, Sweden.
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Pre-hospital care time intervals among victims of road traffic injuries in Iran. A cross-sectional study. BMC Public Health 2010; 10:406. [PMID: 20618970 PMCID: PMC2918553 DOI: 10.1186/1471-2458-10-406] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2009] [Accepted: 07/09/2010] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Road traffic injuries (RTIs) are a major public health problem, requiring concerted efforts both for their prevention and a reduction of their consequences. Timely arrival of the Emergency Medical Service (EMS) at the crash scene followed by speedy victim transportation by trained personnel may reduce the RTIs' consequences. The first 60 minutes after injury occurrence--referred to as the "golden hour"--are vital for the saving of lives. The present study was designed to estimate the average of various time intervals occurring during the pre-hospital care process and to examine the differences between these time intervals as regards RTIs on urban and interurban roads. METHOD A retrospective cross-sectional study was designed and various time intervals in relation to pre-hospital care of RTIs identified in the ambulance dispatch centre in Urmia, Iran from 20 March 2005 to 20 March 2007. All cases which resulted in ambulance dispatches were reviewed and those that had complete data on time intervals were analyzed. RESULTS In total, the cases of 2027 RTI victims were analysed. Of these, 61.5% of the subjects were injured in city areas. The mean response time for city locations was 5.0 minutes, compared with 10.6 minutes for interurban road locations. The mean on-scene time on the interurban roads was longer than on city roads (9.2 vs. 6.1 minutes, p < 0.001). Mean transport times from the scene to the hospital were also significantly longer for interurban incidents (17.1 vs. 6.3 minutes, p < 0.001). The mean of total pre-hospital time was 37.2 (+/-17.2) minutes with a median of 32.0. Overall, 72.5% of the response interval time was less than eight minutes. CONCLUSION The response, transport and total time intervals among EMS responding to RTI incidents were longer for interurban roads, compared to the city areas. More research should take place on needs-to and access-for EMS on city and interurban roads. The notification interval seems to be a hidden part of the post-crash events and indirectly affects the "golden hour" for victim management and it needs to be measured through the establishment of the surveillance systems.
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Khorasani-Zavareh D, Haglund BJA, Mohammadi R, Naghavi M, Laflamme L. Traffic injury deaths in West Azarbaijan province of Iran: a cross-sectional interview-based study on victims' characteristics and pre-hospital care. Int J Inj Contr Saf Promot 2010; 16:119-26. [PMID: 19941209 DOI: 10.1080/17457300903023980] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study highlights the socio-demographics and death circumstances of victims of fatal road traffic injuries (RTIs) in one Iranian province. A representative sample of cases was selected from a national register and interviews were conducted with the victims' family members. The study shows that there is a strong association between victim attributes (e.g. sex, age, occupation, education or marital status) and category of road-user. Although men are over-represented in all categories, women die above all as car passengers or pedestrians. Deaths of vulnerable road-users are more frequent among the younger and older age groups. Two-thirds of all deaths occurred before arrival at the hospital and 11% of the victims received ambulance transport. The patterns of fatal RTIs observed in the province differ somewhat from the rest of Iran and other low- and middle-income countries. Not only pre- but also post-crash counter-measures could help save lives in the region.
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Affiliation(s)
- Davoud Khorasani-Zavareh
- Divison of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Norrbacka, SE-171 76 Stockholm, Sweden; National Public Health Management Centre, Tabriz, Islamic Republic of Iran; Urmia University of Medical Sciences, Oroumiyeh, Islamic Republic of Iran.
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Khorasani-Zavareh D, Mohammadi R, Khankeh HR, Laflamme L, Bikmoradi A, Haglund BJA. The requirements and challenges in preventing of road traffic injury in Iran. A qualitative study. BMC Public Health 2009; 9:486. [PMID: 20030826 PMCID: PMC2811114 DOI: 10.1186/1471-2458-9-486] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2009] [Accepted: 12/23/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Road traffic injuries (RTIs) are a major public health problem, especially in low- and middle-income countries. Among middle-income countries, Iran has one of the highest mortality rates from RTIs. Action is critical to combat this major public health problem. Stakeholders involved in RTI control are of key importance and their perceptions of barriers and facilitators are a vital source of knowledge. The aim of this study was to explore barriers to the prevention of RTIs and provide appropriate suggestions for prevention, based on the perceptions of stakeholders, victims and road-users as regards RTIs. METHODS Thirty-eight semi-structured interviews were conducted with informants in the field of RTI prevention including: police officers; public health professionals; experts from the road administrators; representatives from the General Governor, the car industry, firefighters; experts from Emergency Medical Service and the Red Crescent; and some motorcyclists and car drivers as well as victims of RTIs. A qualitative approach using grounded theory method was employed to analyze the material gathered. RESULTS The core variable was identified as "The lack of a system approach to road-user safety". The following barriers in relation to RTI prevention were identified as: human factors; transportation system; and organizational coordination. Suggestions for improvement included education (for the general public and targeted group training), more effective legislation, more rigorous law enforcement, improved engineering in road infrastructure, and an integrated organization to supervise and coordinate preventive activities. CONCLUSION The major barriers identified in this study were human factors and efforts to change human behaviour were suggested by means of public education campaigns and stricter law enforcement. However, the lack of a system approach to RTI prevention was also an important concern. There is an urgent need for both an integrated system to coordinate RTI activities and prevention and a major change in stakeholders' attitudes towards RTI prevention. The focus of all activities should take place on road users' safety.
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Affiliation(s)
- Davoud Khorasani-Zavareh
- Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Norrbacka, SE-171 76, Stockholm, Sweden
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Khorasani-Zavareh D, Khankeh HR, Mohammadi R, Laflamme L, Bikmoradi A, Haglund BJA. Post-crash management of road traffic injury victims in Iran. Stakeholders' views on current barriers and potential facilitators. BMC Emerg Med 2009; 9:8. [PMID: 19435521 PMCID: PMC2692975 DOI: 10.1186/1471-227x-9-8] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 05/12/2009] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Road traffic injuries are a major public health problem, especially in low- and middle-income countries. Post-crash management can play a significant role in minimizing crash consequences and saving lives. Iran has one of the highest mortality rates from road traffic injuries in the world. The present study attempts to fill the knowledge gap and explores stakeholders' perceptions of barriers to - and facilitators of - effective post-crash management in Iranian regions. METHODS Thirty-six semi-structured interviews were conducted with medical services personnel, police officers, members of Red Crescent, firefighters, public-health professionals, road administrators; some road users and traffic injury victims. A qualitative approach using grounded theory method was employed to analyze the material gathered. RESULTS The core variable was identified as "poor quality of post crash management". Barriers to effective post-crash management were identified as: involvement of laypeople; lack of coordination; inadequate pre-hospital services; shortcomings in infrastructure. Suggestions for laypeople included: 1) a public education campaign in first aid, the role of the emergency services, cooperation of the public at the crash site, and 2) target-group training for professional drivers, police officers and volunteers involved at the crash scene. An integrated trauma system and infrastructure improvement also is crucial to be considered for effective post-crash management. CONCLUSION To sum up, it seems that the involvement of laypeople could be a key factor in making post-crash management more effective. But system improvements are also crucial, including the integration of the trauma system and its development in terms of human resources (staffing and training) and physical resources as well as the infrastructure development.
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Affiliation(s)
- Davoud Khorasani-Zavareh
- Division of Social Medicine, Department of Public Health Sciences, Karolinska Institutet, Norrbacka,SE-171 76 Stockholm, Sweden.
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Rezapur-Shahkolai F, Naghavi M, Vaez M, Shokouhi M, Laflamme L. Injury incidence, healthcare consumption and avenues for prevention: a household survey on injury in rural Twiserkan, Iran. Public Health 2009; 123:384-9. [DOI: 10.1016/j.puhe.2009.03.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Revised: 03/05/2009] [Accepted: 03/18/2009] [Indexed: 10/20/2022]
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