Road safety in less-motorized environments: future concerns

Effective factors of severity of traffic accident traumas based on the Haddon matrix: a systematic review and meta-analysis

Objective

This study aims to investigate the factors affecting the severity of trauma caused by traffic accidents based on martrix Haddon; a systematic review and meta-analysis.

Methods

In this study searched five international databases in this study, including Medline/PubMed, ProQuest, Scopus, Web of Knowledge, and Google Scholar, for published articles by the end of 2022. Data were entered into the statistical program and analyses were performed using STATA 17.0 software. Odds ratio (OR) values were computed for severity accidents.

Results

Results of study showed that among the risk factors related to the host, not using helmet increased the risk of injury severity by 3.44 times compared to people who have used helmets (OR Not using helmet/Using helmet = 3.44, 95% CI: 2.27-5.00, P=0.001, I2=0.00%). Also, crossing over a centre divider has a protective role for the risk of injury severity compared to undertaking (OR crossing over a centre divider/undertaking=0.39, 95% CI: 0.20-0.75, P=0.01, I2=25.79%). in terms of the type of accident, accident of car-car reduces the risk of injury severity by 23% compared to accident of car-pedestrian (OR accident of car-car/accident of car-pedestrian=0.77, 95% CI: 0.61-0.96, P=0.02, I2=0.00%).

Conclusions

It is necessary to pay attention to the intersection of human, vehicle and environmental risks and their contribution and how they interact. Based on the Haddon matrix approach, special strategies can be designed to prevent road damage. Safety standards for vehicles should also be addressed through stricter legal requirements and inspections.

A matched case-control approach to identify the risk factors of fatal pedestrian crashes on a six-lane rural highway in India

Globally, the increase in pedestrian fatalities due to road traffic crashes (RTCs) on transport networks has been a major concern. In low- and middle-income countries (LMICs), pedestrians face a high risk due to RTCs on the rural highway network. The safety evaluation methods, such as observational before-after, empirical Bayes, full Bayes, and cross-sectional methods have been used to identify risk factors of RTCs. However, these methods are data-intensive and have associated limitations. Thus, this study employed a matched case-control method to identify the risk factors of fatal pedestrian crashes. This study utilized crash, traffic volume, speed, geometric, and roadside environment data of a 175 km six-lane rural highway in India. The identified major risk factors, such as clear zone width, the presence of habitation, service roads, and horizontal curve sections, increase the likelihood of a fatal pedestrian crash. This study provides specific insights for modifying the speed limit of highway sections passing through habitation. On such highway sections, designers should shift focus to pedestrian safety. It also suggests that the service road design needs to be reconsidered from a pedestrian safety viewpoint. The proposed method can be used in any other setting having similar traffic and socio-economic conditions.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Trauma and sexual abuse in children-Epidemiology, challenges, management strategies and prevention in lower- and middle-income countries

Trauma is rising as a cause of morbidity and mortality in lower- and middle-income countries (LMIC). This article describes the Epidemiology, Challenges, Management strategies and prevention of pediatric trauma in lower- and middle-income countries. The top five etiologies for non-intentional injuries leading to death are falls, road traffic injuries, burns, drowning and poisoning. The mortality rate in LMICs is twice that of High-Income Countries (HICs) irrespective of injury severity adjustment. The reasons for inadequate care include lack of facilities, transportation problems, lack of prehospital care, lack of resources and trained manpower to handle pediatric trauma. To overcome these challenges, attention to protocolized care and treatment adaptation based on resource availability is critical. Training in management of trauma helps to reduce the mortality and morbidity in pediatric polytrauma cases. There is also a need for more collaborative research to develop preventative measures to childhood trauma.

Developing machine-learning-based models to diminish the severity of injuries sustained by pedestrians in road traffic incidents

An essential step in devising measures to improve road safety is road accident prediction. In particular, it is important to identify the risk factors that increase the likelihood of severe injuries in the event of an accident. There are two distinct ways of analyzing data in order to produce predictions: machine learning and statistical methods. This study explores the severity of road traffic injuries sustained by pedestrians through the use of machine-learning methodology. In general, the goal of the statistician is to model and understand the connections between variables, whereas machine learning focuses on more intricate and expansive datasets, with the aim of creating algorithms that can recognize patterns and make predictions without being explicitly programmed. The ability to handle very large datasets constitutes a distinct advantage of machine learning over statistical techniques. In addition, machine-learning models can be adapted to a wide range of data sources and problem domains, and can be utilized for numerous tasks, from image identification to natural language processing. Machine-learning models may be taught to recognize patterns and make predictions automatically, minimizing the need for manual involvement and enabling rapid data processing of enormous quantities of data. The use of new data to retrain or fine-tune a machine-learning model allows the model to adapt to changing conditions and enhances its accuracy over time. Finally, while non-linear interactions between variables can be difficult to predict using conventional statistical techniques, they can be recognized by machine-learning models. The study begins by compiling an inventory of features linked to both the accident and the environment, focusing on those that exert the greatest influence on the severity of pedestrian injuries. The "optimal" algorithm is then chosen based on its superior levels of accuracy, precision, recall, and F1 score. The developed model should not be regarded as fixed; it should be updated and retrained on a regular basis using new traffic accident data that mirror the evolving interplay between the road environment, driver characteristics, and pedestrian conduct. Having been constructed using Israeli data, the current model is predictive of injury outcomes within Israel. For broader applicability, the model should undergo retraining and reassessment using traffic accident data from the pertinent country or region.

A meta-analysis to evaluate the prevalence of maxillofacial trauma caused by various etiologies among children and adolescents

AIMS

Children and adolescents who are affected by trauma may have complications that are more serious and dangerous. Herein, a meta-analysis to evaluate the prevalence of maxillofacial trauma caused by various etiologies according to the geographic regions of the world among children and adolescents was conducted.

MATERIALS AND METHODS

A comprehensive search was performed in four databases of PubMed/MEDLINE, Web of Science, Cochrane Library, and Scopus from January 1, 2006 until July 7, 2021. To evaluate the quality of included articles, an adapted version of the Newcastle-Ottawa scale was used. The prevalence of maxillofacial trauma was estimated by event rates and 95% confidence intervals in relation to etiology and geographic region of study population.

RESULTS

Through search in the databases and the electronic sources, 3071 records were identified, and 58 studies were eligible for inclusion in the meta-analysis. A total of 264,433 maxillofacial trauma cases were reported by all included studies. Globally, the overall prevalence of maxillofacial trauma was highest due to Road Traffic Crashes (RTC) (33.8%) followed by falls (20.7%), violence (9.9%), and sports (8.1%) in children/adolescents. The highest prevalence of maxillofacial trauma were observed in African population (48.3%) while trauma due to falls was most prevalent in Asian population (44.1%). Maxillofacial trauma due to violence (27.6%) and sports (13.3%) were highest in North Americans.

CONCLUSION

The findings demonstrate that RTC was the most prevalent etiology of maxillofacial trauma in the world. The prevalent causes of maxillofacial trauma differed between the regions of study population.

Burden of Childhood Injuries in India and Possible Public Health Interventions: A Systematic Review

Childhood injuries are a major public health challenge in India and globally. This systematic review was conducted to understand the burden and spectrum of childhood injuries, with a focus on unintentional injuries, among children 5-14 years of age and to suggest approaches to prevention that can be adopted in the Indian context. This systematic review was conducted with the standard approach and use of keywords. A total of 33 studies which were found to be relevant were analyzed. Road traffic accidents (RTAs) contribute to nearly 85% of all unintentional injuries and related deaths and 90% of disability-adjusted life years (DALYs) lost in developing countries. Poor traffic regulation, heavy traffic load, and poor skill of identifying the dangerous road crossing sites make the children's age group vulnerable and prone to RTA. Children with poor skill of identification and response to dangerous road crossing sites, along with heavy unregulated traffic were found to be the major reasons for such accidents and make this age group more vulnerable. Public health-based prevention approaches need to be based upon legislation, regulation, and enforcement, as well as environmental modification, education and skill development, emergency medical care using levels of prevention, and principles of targeted prevention to effectively address child health challenges. Addressing child injuries should be a key component of all endeavors aimed at enhancing child mortality and morbidity rates, as well as the overall welfare of children, both at the national and global levels. It is imperative to prioritize policies focused on preventing unintentional injuries across all age groups, with particular attention to children.

Cluster analysis of the spatial distribution of pedestrian deaths and injuries by parishes in Kampala city, Uganda

Studies on pedestrian deaths and injuries at the urban level in Africa mostly provide overall aggregated figures and do not examine variation in the sub-urban units. Using cluster analysis, this study sought to determine if the observed pattern in the distribution of pedestrian injuries and deaths among parishes in Kampala city is significant. Pedestrian crash data from 2015 to 2019 were collected from the Uganda Traffic Police database. Serious and fatal pedestrian injury rates were mapped by parish using ArcMap and cluster analyses conducted. Results from spatial autocorrelation (Moran's Index of 0.18 and 0.17 for fatal and serious injury rates respectively) showed that the distributions were clustered within parishes crossed by highways and located in the inner city respectively. Z-scores of 3.32 (p < 0.01) for serious injury rates and 3.71 (p < 0.01) for fatal injury rates indicated that the clustering was not random. This study's main contribution was providing a detailed spatial distribution of pedestrian fatal and serious injury rates for Kampala; a city in a low developing country in Africa at the micro-scale of a parish. This foundational exploratory paper formed the first step of a broader study examining built environment factors explaining this pattern.

Epidemiological characteristics of deaths from road traffic accidents in Addis Ababa, Ethiopia: a study based on traffic police records (2018-2020)

INTRODUCTION

Road traffic accidents are a major cause of fatal and nonfatal injuries, causing permanent disabilities, and other indirect health complications. Each year, road traffic accidents (RTA) cause a lot of fatalities and injuries in Ethiopia, putting the country among the list of the most affected countries by RTA in the world. Despite the high rates of road traffic collisions in Ethiopia, very little is known about the factors that contribute to fatal RTA in the country.

OBJECTIVES

the objective of this study is to assess the epidemiological characteristics of deaths from road traffic accidents in Addis Ababa, Ethiopia: A study based on traffic police records (2018-2020).

METHOD

A retrospective observational study design was conducted used in this study. All road traffic accident victims reported to Addis Ababa police station between 2018 and 2020 were study population and the collected data was evaluated with Statistical Package for the Social Sciences (SPSS) version 26 software. Binary logistic regression model was used to indicate the association between dependent and independent variables. Statistically, significant associations were declared at P < 0.05.

RESULT

There were 8458 recorded road traffic accidents in Addis Ababa during 2018-2020. Among these accidents, 1274 (15.1%) caused death while 7184 (84.1%) caused an injury. Males accounted for 77.1% of the decedents (sex ratio of almost 3.36:1). The majority 1020 (80%) of the fatality occurred on a straight road and 1106 (86.8%) of the fatality occurred in dry weather. Weekday 1.243 (AOR, 1.234, 95 CI, 1.071-1.443), driver educational status below grade twelve 0.326(AOR 0.326, CI, 0.285-0.374), and commercial truck vehicle 1.682 (OR, 1.696, CI, 1.410-2.040) were statistically associated with fatality after adjusting for potential confounding variables.

CONCLUSION

The prevalence of RTA fatality in Addis Ababa is high. The accidents that occurred during the weekdays were more fatal. Driver's educational status, weekdays, and vehicle type were factors associated with mortality. There is a need to introduce road safety interventions that targeted identified factors in this study to reduce fatalities attributed to RTIs.

The importance of pediatric trauma prevention: The work of Criança Segura - Safe Kids Brazil

Trauma is the leading cause of death in children and adolescents less than 14 years of age worldwide. Although there have been advances regarding treatment in the last decades, it is still complex to assemble well-trained teams and proper hospitals to care for traumatized children. The most effective vaccine and the less expensive tool to deal with such a burden is prevention. The aim of the Non-Governmental Organization (NGO) Criança Segura - Safe Kids Brazil is to work with child and adolescent trauma prevention through three pillars: mobilization, communication, and public policy. Nationwide actions, campaigns, education material, events, research, and proposing laws resulted in a 53% decrease of trauma deaths in Brazil in a 20-year period. The strategy contributes to build the culture of prevention in Brazil with the involvement of every sector of society. Childhood trauma prevention is effective in decreasing trauma deaths. Criança Segura is now part of Children's Villages, an international organization that will be able to multiply the model through different countries. LEVELS OF EVIDENCE: Review article.

Road safety and heavy goods vehicle driving in LMICs: Qualitative evidence from Nepal

BACKGROUND

Heavy goods vehicle drivers are an influential driving population in Nepal, with over 90% of goods in the country are transported by road. Due to the time spent on the road, drivers have long periods of exposure to the risk of crash involvement. The study explores the perceptions and experiences of heavy goods vehicle drivers and representatives from their professional association regarding road danger.

METHODS

We conducted semi-structured interviews with fifteen heavy goods vehicle drivers regularly driving on the East-West highway of Makwanpur District, Nepal. A focus group was conducted with eleven members from a major transportation entrepreneur's association in Nepal. The focus group and interviews were audio-recorded, transcribed, translated, and analyzed using thematic analysis.

RESULTS

Four themes were developed- assumptions of blame; perceptions of safety culture in the trucking industry; influence of road infrastructure; and behaviours of road users. The road and traffic environment, enforcement, and the safety culture in the heavy vehicle industry not only influenced the attitudes of the road users towards traffic safety but also legitimized and encouraged behaviours that affect safety. General and industry-related road safety improvements suggested by participants included: making provision for heavy good vehicles parking areas, separating the highway with a median strip, improving crash investigation capacity, conducting road safety awareness and training programs, strictly enforcing the speed limit and laws about driving under the influence of alcohol/drugs, and formulating strategies to create a safe, supportive working environment in the heavy vehicle industry.

CONCLUSION

Heavy goods vehicle drivers and members of the professional association can provide rich information regarding the barriers and facilitators of road risk in Nepal. Their perceptions and opinions can contribute to devising interventions at individual, societal, organizational, and governmental levels, and inform efforts to develop a positive safety culture within the heavy vehicle transport industry.

Latent Medical Conditions of Drivers Involved in Road Traffic Collisions in Ghana: Implication from Autopsy Findings

Background:

Unlike some neighboring countries like Nigeria, few studies on actual causes, impact and the prevention of road traffic collisions have been carried out in Ghana. There is the need for further research and this study sought to link injuries that caused the death of drivers involved in vehicular collisions to the latent possible contributing diseases and medical conditions in these drivers and how these conditions predispose them to the collisions.

Methods:

This is a retrospective study that used the forensic autopsy records of driver fatalities and various injuries and medical conditions of drivers involved in road traffic collisions. Information on all drivers was retrieved from archives at the Komfo Anokye Teaching Hospital’ Pathology Unit. Demographics and cause of death were used in selecting the cases, including all driver-related road traffic collisions from 2009 to 2014.

Results:

A total of 1842 road traffic collisions were recorded with 127 of them being driver related. There were 31 cases (24.4%) in 2014; the highest cases recorded for this study, with the least recorded in 2009 with only 12 cases (9.4%). There were 121 (95.3%) male drivers and 6 female drivers (4.7%). Most of the male drivers were between the ages of 30 and 39 with 39 cases, while that of females was between 40 and 49 years with 6 cases. There was no significant statistical correlation between age and sex (P = .124). No statistical correlation also existed between sex and year (P = .331). Pathologies of all body systems were established. Cardiovascular diseases were the most prevalent systemic medical condition seen in the drivers with 44.1%.

Conclusion:

The study established that the drivers had various latent medical conditions and all these could lead to possible incapacitation, affecting driver judgment, leading to collisions on the road. The National Road Safety Commission (NRSC) should request medical screening before issuing driver licenses.

Physarum-Inspired Bicycle Lane Network Design in a Congested Megacity

Improvement of mobility, especially environment-friendly green mobility, is challenging in existing megacities due to road network complexity and space constraints. Endorsing the bicycle lane network (BLN) in congested megacities is a promising option to foster green mobility. This research presents a novel bioinspired network design method that considers various constraints and preferences related to the megacity for designing an optimal BLN. The proposed method is inspired by natural Physarum polycephalum, a brainless, multi-headed single-celled organism, which is capable of developing a reticulated network of complex foraging behaviors in pursuit of food. The mathematical model of Physarum foraging behavior is adapted to maneuver various BLN constraints in megacity contexts in designing the optimal BLN. The Physarum-inspired BLN method is applied to two case studies on the megacity Dhaka for designing BLNs: the first one covers congested central city area, and the second one covers a broader area that includes major locations of the city. The obtained BLNs were evaluated comparing their available routes between different locations with the existing vehicle routes of the city in terms of distance and required travel times in different time periods, and the BLN routes were found to be suitable alternatives for avoiding congested main roads. The expected travel time using BLNs is shorter than other transport (e.g., car and public bus); additionally, at glance, the average travel speed on BLNs is almost double that of public buses in peak hours. Finally, the designed BLNs are promising for environment-friendly and healthy mobility.

Investigation of road infrastructure and traffic density attributes at high-risk locations for motorcycle-related injuries using multiple correspondence and cluster analysis in urban Tanzania

Rapid growth in use of motorcycles combined with limited road infrastructures has increased the burden of road traffic crashes and injuries in low-and middle-income countries. The aim of this study was to assess whether high-risk locations for motorcycle-related injuries identified from police crash data registers for the period 2016 to 2017 share similar road infrastructure and traffic density attributes in Dar es Salaam city. Analysis was performed using multiple correspondence and hierarchical cluster analysis. Three distinct clusters for motorcycle injury hotspots were identified. Clusters 1 and 2 were associated with more fatal and severe injuries and were characterized by overrepresentation of trunk roads, unseparated two-way roads, mixture of road users and commercial and residential areas compared to Cluster 3. Cluster3 was associated with less severe injuries compared to clusters 1 and 2 (p < 0.001). Cluster 3 was characterized by overrepresentation of feeder/street roads, separated two-way roads and presence of traffic control measures. The clusters of hotspots differed by road infrastructure and traffic density attributes. Clusters 1 and 2 were characterized by more dangerous road environments, while cluster 3 was characterized by road environments with less severe outcomes. These findings can assist in prioritizing preventive strategies for motorcycle- related injuries.

Severity and patterns of injury in helmeted vs. non-helmeted motorcyclists in a rural state

INTRODUCTION

Under current law in our rural state, there is no universal requirement for motorcyclists to wear helmets. Roughly 500 motorcycle crashes are reported by the state each year and only a fraction of those riders wear helmets. We sought to determine the difference in injury patterns and severity in helmeted versus non-helmeted riders.

METHODS

Retrospective review (2014-2018) of a single level 1 trauma center's registry was done for subjects admitted after a motorcycle collision. Demographic, injury and patient outcome data were collected. Patients were stratified by helmet use (n = 81), no helmet use (n = 144), and unknown helmet use (n = 194). Statistical analysis used Student's t-test or Pearson's χ²p-value ≤0.05 as significant. State Department of Transportation data registry for state level mortality and collision incidence over the same time period was also obtained.

RESULTS

Of the 2,022 state-reported motorcycle collisions, 419 individuals admitted to our trauma center were analyzed (21% capture). State-reported field fatality rate regardless of helmet use was 4%. Our inpatient mortality rate was 2% with no differences between helmet uses. Helmeted riders were found to have significantly fewer head and face injuries, higher GCS, lower face, neck, thorax and abdomen AIS, fewer required mechanical ventilation, shorter ICU length of stay, and had a greater number of upper extremity injuries and higher upper extremity AIS.

CONCLUSIONS

Helmeted motorcyclists have fewer head, face, and cervical spine injuries, and lower injury severities: GCS and face, neck, thorax, abdomen AIS. Helmeted riders had significantly less mechanical ventilation requirement and shorter ICU stays. Non-helmeted riders sustained worse injuries. Practical Applications: Helmets provide safety and motorcycle riders have a 34-fold higher risk of death following a crash. Evaluating injury severities and patterns in motorcycle crash victims in a rural state with no helmet laws may provide insight into changing current legislation.

An exploratory qualitative study of the prevention of road traffic collisions and neurotrauma in India: perspectives from key informants in an Indian industrial city (Visakhapatnam)

BACKGROUND

Despite current preventative strategies, road traffic collisions (RTCs) and resultant neurotrauma remain a major problem in India. This study seeks to explore local perspectives in the context within which RTCs take place and identify potential suggestions for improving the current status.

METHODS

Ten semi-structured interviews were carried out with purposively selected key informants from the city of Visakhapatnam, Andhra Pradesh. Participants were from one of the following categories: commissioning stakeholders; service providers; community or local patient group/advocacy group representatives. Transcripts from these interviews were analysed qualitatively using the Framework Method.

RESULTS

Participants felt RTCs are a serious problem in India and a leading cause of neurotrauma. Major risk factors identified related to user behaviour such as speeding and not using personal safety equipment, and the user state, namely drink driving and underage driving. Other reported risk factors included poor infrastructure, moving obstacles on the road such as other vehicles, pedestrians and animals, overloaded vehicles and substandard safety equipment. Participants discussed how RTCs affect not only the health of the casualty, but are also a burden to the healthcare system, families, and the national economy. Although there are ongoing preventative strategies being carried out by both the government and the community, challenges to successful prevention emerged from the interviews which included resource deficiencies, inconsistent implementation, lack of appropriate action, poor governance, lack of knowledge and the mindset of the community and entities involved in prevention. Recommendations were given on how prevention of RTCs and neurotrauma might be improved, addressing the areas of education and awareness, research, the pre-hospital and trauma systems, enforcement and legislation, and road engineering, in addition to building collaborations and changing mindsets.

CONCLUSIONS

RTCs remain a major problem in India and a significant cause of neurotrauma. Addressing the identified gaps and shortfalls in current approaches and reinforcing collective responsibility towards road safety would be the way forward in improving prevention and reducing the burden.

Tocilizumab: An Effective Therapy for Severely and Critically Ill COVID-19 Patients

Background: Tocilizumab (TCZ), a monoclonal antibody against the most prevalent cytokine interleukin-6 (IL-6), is an emerging therapeutic option for COVID-19 infections. The present study was undertaken to assess the therapeutic response of TCZ therapy in severely or critically ill COVID-19 patients and its role as an effective modality of management. Methods: The present retrospective observational study included 30 admitted severely or critically ill COVID-19 patients, treated with TCZ therapy on behalf of raised IL-6 levels. The patients' data concerning medical history, clinical manifestation, arterial blood gas analysis, mode of oxygenation, radiological imaging, and outcome were extracted from their medical records and compared pre- and post-TCZ infusion. Results: All patients of the study group had symptomatic presentations with a mean PaO2/FiO2 (P/F) ratio of 205.41 before TCZ infusion. All patients had a raised IL-6 level (mean value 206.56 pg/mL) that was extremely elevated in 90% of patients. Infusion of TCZ dramatically reduced mean body temperature (100.78-99.32°F) and the requirement for supplemental oxygen (68-48%) and improved mean SpO2 (86-89%) and mean P/F ratio (208-240) within 24 hours. Three patients on noninvasive ventilation were weaned off after TCZ infusion. Serum levels of IL-6 were raised initially but declined within 3-5 days of post-TCZ infusion. Conclusion: TCZ appears to be an effective therapeutic option in severely or critically ill COVID-19 patients with raised IL-6 levels. TCZ immediately improves the clinical status of patients by a probable mechanism of inhibition of cytokine storm and reduces COVID-19-related mortalities. How to cite this article: Bhandari S, Rankawat G, Singh A. Tocilizumab: An Effective Therapy for Severely and Critically Ill COVID-19 Patients. Indian J Crit Care Med 2021;25(3):260-266.

Turn signal use among motorcyclists and car drivers: The role of environmental characteristics, perceived risk, beliefs and lifestyle behaviours

Turn signal neglect is considered to be a key contributor to crashes at intersections, yet relatively little research has been undertaken on this topic, particularly in developing countries. Using a case study of Vietnam, this research aimed to explore the role of environmental characteristics, perceived risk, beliefs and lifestyle behaviours on the frequency of turn signal use at intersections. A self-administered questionnaire was distributed to motorcyclists (n = 527) and car drivers (n = 326) using online and offline methods. Using partial least squares structural equation modelling (PLS-SEM), key findings indicate that perceived risk, beliefs and environmental characteristics play a significant role in affecting the frequency of turn signal use among motorcycle riders and car drivers at intersections. While lifestyle behaviours were not found to be a good predictor of turn signal use among car drivers, they were found to indirectly affect turn signal use among motorcycle riders through the mediation of beliefs and perceived risk. The findings can help inform the development of more targeted measures to increase turn signal use.

Effect of Lowering the Blood Alcohol Concentration Limit to 0.03 Among Hospitalized Trauma Patients in Southern Taiwan: A Cross-Sectional Analysis

Background

In June 2013, the legal blood alcohol concentration (BAC) limit for driving was lowered from 0.05 to 0.03 mg/mL in Taiwan. Thus, this study aimed to assess the epidemiological changes in terms of drinking among drivers in southern Taiwan before and after the law was imposed.

Methods

Only patients who had undergone the BAC test at the emergency room were included in the study. The patients during the study period before (n = 2735) and after (n = 2413) the implementation of the law were selected for comparison. Drunk patients were defined as those who had a BAC ≥0.005 and were considered as driving under the influence (DUI) of alcohol. Meanwhile, driving while intoxicated (DWI) was defined as a BAC ≥0.05, which was the level adopted in the new law.

Results

Since the BAC limit lowered to 0.03, the number of DUI patients significantly decreased from 340 (12.4%) to 171 (7.1%), and that of DWI patients significantly reduced from 273 (10.0%) to 146 (6.1%) based on the alcohol test. In addition, after the implementation of the law, the number of associated injuries did not significantly decrease from that before the law was implemented in patients involved in alcohol-related crashes.

Conclusion

After lowering the legal BAC limit from 0.05 to 0.03, responsiveness to the change in law was observed among the studied population. However, such responsiveness may not be observed in some citizens who may need special interventions to help reduce their behavior of drinking and driving.

Determinants of fatal car accident risk in Finote Selam town, Northwest Ethiopia

Background

In the globe, 1.3 million deaths and around 50 million non-fatal injuries were reported. From all deaths, 90% occur in developing countries. Ethiopia is considered as one of the worst countries in the globe where road traffic accident causes a lot of fatalities and injuries of road users every year. The main objective of the study was to identify the main predictors of fatal car accident.

Methods

The retrospective research design was applied. 255 records were taken from Finote Selam traffic police office, northwest part of Ethiopia from September 2009 to January 2018. The statistical analysis was performed by using SPSS version 23 software. Chi-square for association test and ordinal logistic regression for predictor identification were used.

Results

Age of drivers were the responsible causes of fatal road traffic accident (p-value = 0.033). The more experienced drivers decreased the occurrence of fatal traffic accidents. In addition, increasing vehicle service year reduced the occurrence of accidental death. Besides, the occurrence of fatal car accident in autumn season was 0.44 times less than that of in summer season. Additionally, drivers’ educational level was played a crucial role in a road traffic accident. For instance, drivers whose educational level was below 12th grade were the most responsible factor for car accident deaths. What is more, it was seen that drivers who drove their vehicles could minimize the occurrence of fatal traffic accident (p-value = 0.010).

Conclusion

In conclusion, fatal road traffic accidents happened due to drivers’ lack of sufficient driving experience and low educational level. In addition, driving on weekends and driving on summer season were disclosed as responsible for fatal car accident. Moreover, drivers with younger age and those who drove a new vehicle likely caused fatal car accident. However, drivers who drive their vehicles seemed to be less responsible for fatal car accident than that of employed.

Modelling risk factors for fatal pedestrian crashes in Kolkata, India

In developing countries, pedestrian safety is an issue of major concern. Although an extensive body of literature is available on the identification of elements related to the pedestrian's risk; the studies are primarily conducted in urban areas of developed countries. The findings from these studies may only be partially relevant to the cities of an emerging country such as India. The present study analyzes historical crash records obtained from the "Kolkata Police" and identifies the risk factors at the road network level for the hazardous corridors posing a high risk to the pedestrians. The study findings reveal that pedestrians' fatalities at intersections are associated with a high vehicular volume, higher pedestrian-vehicular interaction, high approach speed, overtaking tendency of vehicles, certain land-use type, encroachment of footpath, inadequate sight distance, inaccessible pedestrian crosswalk, wider minor carriageway, the absence of a pedestrian signal head, and lack of enforcement. On the other hand, the models outcomes reveal that pedestrians' fatalities at midblock road segments are associated with low pedestrian volume, high approach speed, overtaking tendency of the vehicle, encroachment of footpath, on-street parking, wider road width, certain land-use type, inadequate sight distance, insufficient lighting, and inadequate pavement markings.

Progress in pedestrian safety research

This paper looks at the pedestrian safety issue and the research that has followed to understand and solve the problem of pedestrian safety in the last 120 years - since the time of the first reported pedestrian fatality in 1899. Researches have studied the epidemiology of pedestrian crashes, pedestrian behaviour, pedestrian movements and pedestrian flows. The suggested strategies to reduce pedestrian crashes have ranged from controlling vehicular speeds to controlling pedestrian behaviour. This study presents a summary of the progress we have made in understanding pedestrian crash patterns. Pedestrian behaviour observed in different regions of the world tend to have similarity in pedestrian behaviour: gap acceptance, preferences of route choice and location for crossing roads. High income countries(HIC) have reported reduction in pedestrian fatalities as compared to low and middle income countries(LMICs), however pedestrian trips have also reduced in these countries leading to concerns about the effectiveness of 'known' strategies. Speed control through active measures have been found to have themaximal benefit and education and training programs for altering pedestrian behaviour on the road the least benefits. Low and middle income countries face pedestrian exposure on high speed roads. New research efforts are required to address pedestrian safety in both HIC and LMICs.

Mortality due to road injuries in the states of India: the Global Burden of Disease Study 1990-2017

Background

A systematic understanding of population-level trends in deaths due to road injuries at the subnational level over time for India's 1·4 billion people, by age, sex, and type of road user is not readily available; we aimed to fill this knowledge gap.

Methods

As part of the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the rate of deaths due to road injuries in each state of India from 1990 to 2017 based on several verbal autopsy data sources. We calculated the number of deaths and death rate for road injuries by type of road user, and assessed the age and sex distribution of these deaths over time. Based on the trends of the age-standardised death rate from 1990 to 2017, we projected the age-standardised death rate to 2030 to assess if the states of India would meet the Sustainable Development Goal (SDG) target to halve the death rate for road injuries from 2015 by 2020 or 2030. We calculated 95% uncertainty intervals (UIs) for the point estimates.

Findings

In 2017, 218 876 deaths (95% UI 201 734 to 231 141) due to road injuries occurred in India, with an age-standardised death rate for road injuries of 17·2 deaths (15·7 to 18·1) per 100 000 population, which was much higher in males (25·7 deaths [23·5 to 27·4] per 100 000) than in females (8·5 deaths [7·2 to 9·1] per 100 000). The number of deaths due to road injuries in India increased by 58·7% (43·6 to 74·7) from 1990 to 2017, but the age-standardised death rate decreased slightly, by 9·2% (0·6 to 18·3). In 2017, pedestrians accounted for 76 729 (35·1%) of all deaths due to road injuries, motorcyclists accounted for 67 524 (30·9%), motor vehicle occupants accounted for 57 802 (26·4%), and cyclists accounted for 15 324 (7·0%). India had a higher age-standardised death rate for road injury among motorcyclists (4·9 deaths [3·9–5·4] per 100 000 population) and cyclists (1·2 deaths [0·9–1·4] per 100 000 population) than the global average. Road injury was the leading cause of death in males aged 15 to 39 years in India in 2017, and the second leading cause in this age group for both sexes combined. The overall age-standardised death rate for road injuries varied by up to 2·6 times between states in 2017. Wide variations were seen between the states in the percentage change in age-standardised death rate for road injuries from 1990 to 2017, ranging from a reduction of 38·2% (22·3 to 51·7) in Delhi to an increase of 17·0% (0·6 to 34·7) in Odisha. If the trends estimated up to 2017 were to continue, no state in India or India overall would achieve the SDG 2020 target in 2020 or even in 2030.

Interpretation

India's contribution to the global number of deaths due to road injuries is increasing, and the country is unlikely to meet the SDG targets if the trends up to 2017 continue. India needs to implement evidence-based road safety interventions, promote strong policies and traffic law enforcement, have better road and vehicle design, and improve care for road injuries at the state level to meet the SDG goal.

Funding

Bill & Melinda Gates Foundation and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.

A comparative study of safe and unsafe signalized intersections from the view point of pedestrian behavior and perception

Signalized intersections with marked crosswalks enhance pedestrian safety by providing the designated right of way to pedestrians. However, a significant number of pedestrian fatalities occur at signalized intersections, which may primarily be due to pedestrians' violation behaviors. Since pedestrians' fatalities are not uniform across signalized intersections in a city, it may be expected that violations would also vary across the sites. It is thus worthwhile to investigate if the pedestrian signal violation is a good surrogate for fatal pedestrian crashes at signalized intersections, and if so, what behavioral, spatial, and built environment related factors influence such violations. To this end, present study analyzes pedestrian behavior and perceptions across twenty-four signalized intersections in Kolkata city, India, out of which twelve intersections did not record any fatal pedestrian crashes between 2011 and 2016 and the remaining twelve experienced at least three or more fatal pedestrian crashes over the same period. Using data from the video-graphic survey at these twenty-four signalized intersections violation behaviors are extracted along with personal attributes at the pedestrian level. Further, pedestrian perception surveys are carried out at each of the twenty-four sites, to obtain a user's perception of safety and satisfaction. Results indicate that pedestrians' signal violations behavior and dissatisfaction are statistically significantly higher at locations with recorded fatal pedestrian crashes. Results from different models and analysis clearly pointed out several planning and design deficiencies such as longer waiting time before crossing, higher pedestrian-vehicular interaction, pedestrian's state of crossing, and a number of personal level attributes such as pedestrian's intended mode of transportation and their state of journey, pedestrian's home location, pedestrian's socio-demographic characteristics as important predictors of pedestrians' violation behavior. The methodology and findings are useful not only for proactive safety improvement at signalized intersections but also to proactively identify potential unsafe sites.

Mapping the knowledge domain of road safety studies: A scientometric analysis

As a way of obtaining a visual expression of knowledge, mapping knowledge domain (MKD) provides a vision-based analytic approach to scientometric analysis which can be used to reveal an academic community, the structure of its networks, and the dynamic development of a discipline. This study, based on the Science Citation Index Expanded (SCIE) and Social Sciences Citation Index (SSCI) articles on road safety, employs the bibliometric tools VOSviewer and CitNetExplorer to create maps of author co-citation, document co-citation, citation networks, analyze the core authors and classic documents supporting road safety studies and show the citation context and development of such studies. It shows that road safety studies clustered mainly into four groups, whose we will refer to as "effects of driving psychology and behavior on road safety", "causation, frequency and injury severity analysis of road crashes", "epidemiology, assessment and prevention of road traffic injury", and "effects of driver risk factors on driver performance and road safety", respectively. Through our analysis, the core publications and their citation relationships were quickly located and explored, and "crash frequency modeling analysis" has been identified to be the core research topic in road safety studies, with spatial statistical analysis technique emerging as a frontier of this topic.

Barriers and facilitators of implementing child injury surveillance system

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.

Magnitude of road traffic accident related injuries and fatalities in Ethiopia

Background

In many developing countries there is paucity of evidence regarding the epidemiology of road traffic accidents (RTAs). The study determines the rates of injuries and fatalities associated with RTAs in Ethiopia based on the data of a recent national survey.

Methods

The study is based on the secondary data of the Ethiopian Demographic and Health Survey conducted in 2016. The survey collected information about occurrence injuries and accidents including RTAs in the past 12 months among 75,271 members of 16,650 households. Households were selected from nine regions and two city administrations of Ethiopia using stratified cluster sampling procedure.

Results

Of the 75,271 household members enumerated, 123 encountered RTAs in the reference period and rate of RTA-related injury was 163 (95% confidence interval (CI): 136–195) per 100,000 population. Of the 123 causalities, 28 were fatal, making the fatality rate 37 (95% CI: 25–54) per 100,000 population. The RTA-related injuries and fatalities per 100,000 motor vehicles were estimated as 21,681 (95% CI: 18,090–25,938) and 4,922 (95% CI: 3325–7183), respectively. Next to accidental falls, RTAs were the second most common form of accidents and injuries accounting for 22.8% of all such incidents. RTAs contributed to 43.8% of all fatalities secondary to accidents and injuries. Among RTA causalities, 21.9% were drivers, 35.0% were passenger vehicle occupants and 36.0% were vulnerable road users including: motorcyclists (21.0%), pedestrians (12.1%) and cyclists (2.9%). Approximately half (47.1%) of the causalities were between 15–29 years of age and 15.3% were either minors younger than 15 years or seniors older than 64 years of age. Nearly two-thirds (65.0%) of the victims were males.

Conclusion

RTA-related causalities are extremely high in Ethiopia. Male young adults and vulnerable road users are at increased risk of RTAs. There is a urgent need for bringing road safety to the country's public health agenda.

Maxillofacial Injuries in Motorcyclists Following the Implementation of Helmet

Background:

It has been reported that 20%–60% of all people injured in road traffic accidents (RTAs) tend to have some form of maxillofacial injury. Mangalore city, Karnataka State, India, traffic police has enforced the law to wear helmets to tackle the problem. The outcome of the initiative till date was not measured. Therefore, the objective of the study was to assess the prevalence of maxillofacial injuries among the victims of motorized two-wheeler RTAs, following the passing of the helmet law.

Materials and Methods:

The study was conducted at the Accident and Emergency Department of K.S. Hegde Medical College and Hospital and at the Department of Oral and Maxillofacial Surgery, A.B. Shetty Memorial Institute of Dental Sciences, Nitte (Deemed to be University), Mangalore, Karnataka, India. The inclusion criteria were the patients who had two-wheeler accidents during the time period of 2016–2017 was collected. The data related to age, gender, helmet wearing, diagnosis, and type of orthopedic injuries was included. A descriptive statistics was calculated along with 95% confidence interval; correlation coefficient and odds ratio using STATA software.

Results:

A total of N = 347 individuals were included in the study. The mean age of the individuals was 33.7 (2–85) years, and the median age was 32 years. 81.55% (N = 283) were male and 18.44% (N = 64) were female. Among the individuals, 51.5% (N = 179) were not wearing helmets and 44.38% (N = 154) of them were males. A total of 25.07 (N = 87) individuals had orthopedic injuries and 16.42% (N = 57) individuals had orthopedic injuries who were not wearing helmets.

Conclusion:

Under the limitations of the study, we conclude that majority of the two-wheelers are not wearing helmets. This study has demonstrated that the impact of wearing helmet on occurrence of craniofacial and orthopedic injuries is less.

Maternal mortality in Ifakara Health and Demographic Surveillance System: Spatial patterns, trends and risk factors, 2006 - 2010

Introduction

Maternal mortality was the subject of the United Nations’ fifth Millennium Development Goal which was to reduce the maternal mortality ratio by three quarters from 1990 to 2015. The Sustainable Development Goals (SDGs), target 3.1 requires participating countries to reduce their maternal mortality ratio to less than 70 deaths per 100,000 live births by 2030. Although much research has been conducted, knowing the spatial patterns and risk factors associated with maternal mortality in developing countries helps target scarce resources and intervention programmes to high risk areas for the greatest impact.

Methods

Data were analysed from a longitudinal open cohort of women aged 15 to 49 years, enrolled from 2006 to 2010. An inverse distance weighted method of interpolation was used to assess spatial patterns of maternal mortality. Cox proportional hazards regression analysis was used to identify risk factors associated with maternal mortality.

Results

The overall maternal mortality rate for the 36 792 study participants for the five years was 0.79 per 1000 person years. The trend declined from 90.42 in 2006 to 57.42 in 2010. Marked geographical differences were observed in maternal mortality patterns. The main causes of maternal death were eclampsia (23%), haemorrhage (22%) and abortion-related complications (10%). There was a reduced risk of 82% (HR = 0.18, 95% CI:0.05–0.74) and 78% (HR = 0.22, 95% CI:0.05–0.92) for women aged 20–29 and 30–39 years, respectively, compared with those younger than 20 years. While being married had a protective effect of 94% (HR = 0.06, 95% CI: 0.01–0.51) compared with being single, women who were widowed had an increased risk of maternal death of 913% (HR = 9.13, 95% CI: 1.02–81.94). Women who belong to poorer, poor and least poor socioeconomic quintile had 84%, 71% and 72% reduction in risk of maternal mortality respectively compared to those in the poorest category (HR = 0.16, 95% CI: 0.06–0.42; HR = 0.29, 95% CI: 0.12–0.69; HR = 0.28, 95% CI: 0.10–0.80).

Conclusion

Maternal mortality has declined in rural southern Tanzania since 2006, with geographical differences in patterns of death. Eclampsia, haemorrhage and abortion-related complications are the three leading causes of maternal death in the region, with risk factors being younger than 20 years, being single or widowed, and having a low socioeconomic status.

Oral and maxillofacial trauma in motorcyclists in an Iranian subpopulation

BACKGROUND/AIMS

Road traffic accidents are considered a major cause of oral and maxillofacial trauma. Given that many traumatic injuries and deaths involve motorcyclists, the aim of this study was to investigate this vulnerable group in terms of oral and maxillofacial injuries following accidents.

MATERIALS AND METHODS

This cross-sectional study was conducted on 330 patients with oral and maxillofacial injuries at Shahid Rajaee Hospital in Shiraz, Iran, from April to September 2017. A questionnaire with questions regarding age, gender, helmet use, and driver's license was completed for all the patients and their injury type (including dental injuries). Data were analyzed using descriptive statistics and the chi-squared test with a significance level of 95%.

RESULTS

Of the 330 patients, 291 (88.2%) were male and 39 (11.8%) were female. There were 283 (85.75%) patients aged 21-30 years, and their mean age was 27.2 ± 6.5. Most of them (287, 87%) had not been wearing helmets at the time of the accident. Dental injuries were observed in 168 (50.9%) of the patients. Uncomplicated crown fractures were diagnosed in 25.4% of the patients, luxation injuries in 23.2%, and avulsion in 18.9%. Only 19.9% of the patients under the age of 25 had suffered facial injuries.

CONCLUSION

Most injuries in motorcycle accidents were dental trauma in men due to not wearing a helmet. Dental injuries had the highest frequency of damage.

Epidemiological and Clinical Profile of Fatality in Vulnerable Road Users at a High Volume Trauma Center

Background:

Motorized two-wheelers, pedestrians, and cyclists are termed vulnerable road users (VRUs).Globally up to 50% of road deaths involve VRU and up to 80% in developing and rapidly motorizing economies.

Objective:

The objective of this study is to study the prehospital and clinical profile of fatally injured VRU. This would help in informed decision-making regarding prevention and trauma care infrastructure.

Materials and Methods:

A hospital-based study was performed at a Trauma Centre in Puducherry from January 2013 to June 2014 (18 months). Puducherry is a union territory of India in the state of Tamil Nadu. A total of 193 deaths due to Road traffic accident were included in this study. The demographics, prehospital findings, and the clinical progress of fatally injured VRU are described.

Results:

More than 80% of road traffic collision/crash deaths involved VRU of which the elderly comprised a significant proportion. Alcohol was a serious issue even in the elderly pedestrian. This study revealed specific injury patterns and severity. Head injury was the most common cause of death. Early deaths, that is within 24 h of injury was common at 50%.

Conclusion:

The majority of deaths were in the early phase of trauma hence mandating a strong call for prevention, along with strengthening of trauma care.

Trauma burden in Tanzania: a one-day survey of all district and regional public hospitals

Background

Trauma contributes significantly to the burden of disease and mortality throughout the world, but particularly in developing countries. In Tanzania, there is an enormous research gap on trauma; the limited data available reflects realities in cities and areas with moderately- to highly-resourced treatment centers. Our aim was to provide a description of the injury epidemiology across all of Tanzania. Our data will serve as a basis for future larger studies.

Methods

This is a subgroup analysis of a cross-sectional, prospective study of the clinical epidemiology of patients presenting at all public district and regional hospitals in Tanzania. The study was conducted between May 2012 and December 2012. A team of emergency doctors used a purpose-designed data collection sheet to gather the demographic and clinical information of all patients presenting during the day-site visit to each hospital. Descriptive statistics, including means, standard deviations, medians, and ranges are reported.

Results

A total of 5227 patients were seen in 24-h period in 105 (100% response rate) district (or designated district) and regional hospitals in mainland Tanzania. Of these patients, 508 (9.7%) presented with trauma-related complaints. Among patients with trauma-related complaints, 286 (56.3%) were male, and the overall median age of 30 (interquartile range of 22–35) years. Road traffic crash was the most common mechanism of injury, accounting for 227 (44.7%) complaints. Open wounds and bone fractures were the two most frequent diagnoses, with a combined 300 (59%) cases. Most of the patients - 325 (64%) - were discharged, 11 (2.2%) went to operating theatres and 4 (0.8%) of patients died while receiving care at the acute intake areas.

Conclusions

Trauma-related complaints constitute a substantial burden among patients seeking care in acute intake areas of hospitals across Tanzania. There is a need to develop, implement and study systems that can support the improvement of trauma care and optimize outcomes of trauma patients.

Is Brazil going to achieve the road traffic deaths target? An analysis about the sustainable development goals

OBJECTIVE

To describe the temporal relationship between the road traffic mortality rate and gross domestic product (GDP) per capita in Brazil, and make an annual prediction of the evolution of both indicators until 2020, the end of the Sustainable Development Goals (SDGs) monitoring period.

METHODS

Brazilian road traffic mortality rate official data were described from 2000 to 2015, while the GDP per capita official data were described from 2000 to 2013. GDP per capita and traffic mortality rate predictions were performed until 2020 using fractional polynomial analysis. Correlations were assessed using Pearson's correlation coefficient.

RESULTS

From 2000 to 2015, there were over 446 000 road crashes fatal victims in Brazil. The road traffic mortality rate was positively related to the Brazilian GDP per capita, with a strong correlation (r=0.89; p<0.001) from 2000 to 2013 and a mild correlation (r=0.55; p<0.001) considering the whole period (2000-2020). The predictions show a reduction on the road traffic mortality rates in Brazil; however, if this same reduction pace continues, we estimate that the country will reach 12.4 road crash deaths per 100 000 inhabitants in 2020, a reduction of only 13.4% compared with 2015.

CONCLUSION

If the same mortality reduction pace continues in Brazil, the country will not reach the proposed SDG, which is to reduce by half the number of deaths per 100 000 inhabitants. In addition, an intertwined conciliation between economical growth, sustainable development and public policies is needed in order to meet such an overwhelming goal.

Demographic and regional characteristics of road traffic injury deaths in Jiangsu Province, China

Background

The study investigates the magnitude and distribution of fatal road traffic injuries (RTIs) in the Chinese province of Jiangsu by road user.

Method

The 13 694 RTI deaths and years of potential life lost (YPLL) that occurred in 2012 were analysed; vulnerable and non-vulnerable road users were considered separately. Age-adjusted mortality and YPLL were compiled and the association between demographic characteristics and RTI mortality rate was analysed using negative binomial regression.

Results

The age-adjusted RTI mortality and YPLL in Jiangsu in 2012 were 18.14 (95% CI: 17.84-18.45) and 494.3 (95% CI: 492.7-496.0) per 100 000 population. Half of the deaths were among pedestrians and for vulnerable road users as a whole, male fatalities were over three times that of female (adjusted incidence rate ratio = 3.26, 95% CI: 1.89-3.77). Fatalities in the oldest age group (80+ years) were over 14 times that of the youngest one (0-9 years) (adjusted incidence rate ratio = 14.13, 95% CI: 9.49-21.01). Fatality rates in the central and northern regions surpassed that of the south.

Conclusion

As in the rest of the country, RTIs are a considerable public health problem in Jiangsu where fatality and YPLL rates fall heavily on pedestrians, men, and older persons and are more pronounced in the less developed regions.

Child pedestrian safety knowledge, behaviour and road injury in Cape Town, South Africa

Pedestrian injuries are a leading cause of death among South African children, and young children residing in low-income communities are more at risk, due to various factors such as inadequate road infrastructure, exposure to traffic due to reliance on walking as a means of transport, and lack of supervision. This study used a cross-sectional, non-randomized self-report survey to assess pedestrian safety knowledge, road-crossing behaviour and pedestrian injuries of primary school children in selected low-income settings in Cape Town. The survey focused on three primary schools that had joined the Safe Kids Worldwide Model School Zone Project and was administered to 536 children aged 6-15 years, in their home language of isiXhosa. Descriptive and bivariate analyses as well as multivariate regression analyses were conducted to investigate potential predictor variables for pedestrian collision severity and unsafe road-crossing behaviour. Walking was the sole form of travel for 81% of the children, with a large proportion regularly walking unsupervised. Children who walk to or from school alone were younger and reported riskier road-crossing behaviour, although children who walk accompanied tended to have higher pedestrian collision severity. "Negligent Behaviour" related to road-crossing was significantly associated with higher pedestrian collision severity, with predictors of "Negligent Behaviour" including the lack of pedestrian safety knowledge and greater exposure to traffic in terms of time spent walking. More than half of the reported pedestrian collisions involved a bicycle, and older boys (10-15 years) were most at risk of experiencing a severe pedestrian injury. The findings substantiate emerging evidence that children in low-income settings are at greater risk for child pedestrian injury, and emphasise the need for evidence-based safety promotion and injury prevention interventions in these settings.

City planning and population health: a global challenge

Significant global health challenges are being confronted in the 21st century, prompting calls to rethink approaches to disease prevention. A key part of the solution is city planning that reduces non-communicable diseases and road trauma while also managing rapid urbanisation. This Series of papers considers the health impacts of city planning through transport mode choices. In this, the first paper, we identify eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transport use, while reducing private motor vehicle use. These interventions are destination accessibility, equitable distribution of employment across cities, managing demand by reducing the availability and increasing the cost of parking, designing pedestrian-friendly and cycling-friendly movement networks, achieving optimum levels of residential density, reducing distance to public transport, and enhancing the desirability of active travel modes (eg, creating safe attractive neighbourhoods and safe, affordable, and convenient public transport). Together, these interventions will create healthier and more sustainable compact cities that reduce the environmental, social, and behavioural risk factors that affect lifestyle choices, levels of traffic, environmental pollution, noise, and crime. The health sector, including health ministers, must lead in advocating for integrated multisector city planning that prioritises health, sustainability, and liveability outcomes, particularly in rapidly changing low-income and middle-income countries. We recommend establishing a set of indicators to benchmark and monitor progress towards achievement of more compact cities that promote health and reduce health inequities.

Identifying risk factors for household burdens of road traffic fatalities: regression results from a cross-sectional survey in Taiwan

BACKGROUND

Road traffic fatalities (RTF) are among the top ten causes of deaths in the world. The risk factors for RTF fatal victims have been extensively characterized, but studies of household burden of RTF have been very few in number. Accordingly, this article investigates post-crash impacts on RTF victims' family members, including the adverse impacts of lost income, occupational disruption, unfavorable family dynamics, and residential relocation.

METHODS

Survey data from 1291 RTF family members interviewed in Taiwan in 2012 provide the evidence of impact used in this article. Twelve variables related to the family member's socio-demographic background were used to predict the scope of the adverse impact of a fatal crash in regression models developed for this analysis.

RESULTS

RTF victims' spouses with relatively low personal incomes and strong dependence upon the crash victims were found to be most likely to experience a marked decrease in post- crash quality of life. RTF victims' family members who lived with few other adult cohabitants and had more juvenile dependents and were emotionally dependent on the victims were found to be quite likely to experience post- crash setbacks in occupational stability. RTF victims' family members who were emotionally dependent on the victims were found to be more likely to experience major family life disruptions. The younger the RTF victims' family members, and the more years since the crash, the higher the likelihood of residential relocation taking place.

CONCLUSIONS

The results noted help identify those RTF victims' families that will most likely be adversely affected by the crash. The true societal costs of RTF crashes should include the adversities suffered by the fatal crash victims' families. Social welfare policies, mental health support, and timely supplemental resources should be made available to those surviving families most at risk of major life disruptions.

Analysis of trauma admission data at an urban hospital in Maputo, Mozambique

Background

Trauma is a major public health concern. Worldwide, injuries resulted in 4.8 million deaths in 2013, an increase of 11 % since 1990. The majority of deaths from trauma in low-and middle-income countries occur in a pre-hospital setting. Morbidity from trauma contributes significantly to disability in these countries. Mozambique has experienced a rise in injury-related morbidity and mortality. Efforts are underway to prioritize surgical and anesthesiology care in the post-2015 Global Surgery agenda that will build on momentum of the Millennium Development Goals. Injury surveillance remains vital to defining priorities and implementing policy changes.

Methods

We performed a cross-sectional study between June and September, 2010 at the Hospital Central de Maputo (HCM). Data were collected on all patients admitted to the HCM emergency surgical services with a diagnosis of trauma. We describe patient characteristics and mechanism of traumatic injury by calculating simple proportions (for dichotomous or categorical variables) or medians with interquartile ranges (IQR) for continuous variables. Multivariable logistic regression analysis was used to estimate the mechanisms of trauma most associated with alcohol consumption.

Results

A total of 517 patients were approached for inclusion in this study. Of these, 441 (91.5 %) participants were followed from admission until discharge. Three hundred twenty-four participants (73.5 %) were male. The most common age group was 20–29 years old. The three principal mechanisms of injury were road traffic injury, fighting, and falls, accounting for 74 % of injuries recorded. Traumatic injury involving alcohol consumption was nine times more likely to occur at a recreation/sporting event (OR 9.0, 95 % CI 3.01–27.13, p ≤ 0.0001).

Conclusions

As Mozambique prepares to respond to the post-2015 international development agenda, urgent action is required to scale-up its national injury surveillance networks. Injury prevention efforts in Mozambique should focus attention on improving road safety regulations and their implementation, as well as on interventions targeting violence reduction and the reduction of alcohol consumption at sporting events.

Rural-urban disparity in knowledge and compliance with traffic signs among young commercial motorcyclists in selected local government areas in Oyo State, Nigeria

This study compared knowledge and compliance with traffic signs among young commercial motorcyclists in rural and urban communities in Oyo state, Nigeria. Information on knowledge and compliance with 10 common traffic signs was obtained from 149 rural and 113 urban commercial motorcyclists aged 18-35 years. Aggregate knowledge scores were computed and categorized as good (≥5) and poor (<5) knowledge. Overall, 98.7% rural versus 61.1% urban motorcyclists had poor knowledge of traffic signs (p < 0.05). After controlling for age, level of education and years of commercial riding, motorcyclists in the rural areas were more likely to have poor knowledge of the traffic signs (OR = 58.15; 95% CI = 11.96-282.79). A higher proportion of rural than urban motorcyclists never obeyed any of the traffic signs. Young rural commercial motorcyclists' knowledge and compliance with the road signs was poorer than their urban counterparts. Interventions to improve the rural motorcyclists' knowledge and ultimately compliance with road signs are urgently required.

Road Traffic Injury Trends in the City of Valledupar, Colombia. A Time Series Study from 2008 to 2012

OBJECTIVE

To analyze the behavior temporal of road-traffic injuries (RTI) in Valledupar, Colombia from January 2008 to December 2012.

METHODOLOGY

An observational study was conducted based on records from the Colombian National Legal Medicine and Forensic Sciences Institute regional office in Valledupar. Different variables were analyzed, such as the injured person's sex, age, education level, and type of road user; the timeframe, place and circumstances of crashes and the vehicles associated with the occurrence. Furthermore, a time series analysis was conducted using an auto-regressive integrated moving average.

RESULTS

There were 105 events per month on an average, 64.9% of RTI involved men; 82.3% of the persons injured were from 18 to 59 years of age; the average age was 35.4 years of age; the road users most involved in RTI were motorcyclists (69%), followed by pedestrians (12%). 70% had up to upper-secondary education. Sunday was the day with the most RTI occurrences; 93% of the RTI occurred in the urban area. The time series showed a seasonal pattern and a significant trend effect. The modeling process verified the existence of both memory and extrinsic variables related.

CONCLUSIONS

An RTI occurrence pattern was identified, which showed an upward trend during the period analyzed. Motorcyclists were the main road users involved in RTI, which suggests the need to design and implement specific measures for that type of road user, from regulations for graduated licensing for young drivers to monitoring road user behavior for the promotion of road safety.

The prevalence and effective factors of crash helmet usage among motorcyclists in Iran

Background:

Crash helmet plays an important role in protecting the deriver's head during crashes and reduces the rate of severe injuries and fatalities. Although it has been proved that wearing the crash helmet can save the deriver’s life by around 42%; previous studies showed that the rate of wearing crash helmet has not been acceptable in Iran. Due to the huge number of motorcyclists on the roads in Iran, the use of crash helmet is an important area of research. The aim of this study was to assess the factors that could possibly relate to or affect the use of crash helmet by the motorcyclists.

Methods:

This is an observational study on 414 motorcyclists in Shiraz, Southern Iran. All participants completed a questioner containing demographic features, crash helmet use, motorcycle license, and the reasons for using motorcycles.

Results:

All the participants were males and aged from16 to 64 years with mean age 27±9.28. The results of logistic regression model revealed that only the drivers who had motorcycle license (OR=2.73, C.I: 1.40-7.24), employed the motorcycle for reasons other than pleasure (OR=3.18, C.I: 1.42-7.37) and been driving for 10 or more years (OR=1.92 95% C.I: 1.12-3.30) had greater rate of wearing crash helmet. Interestingly, educational levels, age, and other demographical variables had no relationship with crash helmet usage.

Conclusions:

It is believed that in order to increase the rate of crash helmet use, it is necessary to enact obligatory requirement for driving license by motorcyclists and increase the legal age for motorcycle driving.

Effects of excessive speeding and falling asleep while driving on crash injury severity in Ethiopia: a generalized ordered logit model analysis

The severity of injury from vehicle crash is a result of a complex interaction of factors related to drivers' behavior, vehicle characteristics, road geometric and environmental conditions. Knowing to what extent each factor contributes to the severity of an injury is very important. The objective of the study was to assess factors that contribute to crash injury severity in Ethiopia. Data was collected from June 2012 to July 2013 on one of the main and busiest highway of Ethiopia, which extends from the capital Addis Ababa to Hawassa. During the study period a total of 819 road crashes was recorded and investigated by trained crash detectors. A generalized ordered logit/partial proportional odds model was used to examine factors that might influence the severity of crash injury. Model estimation result suggested that, alcohol use (Coef.=0.5565; p-value=0.017), falling asleep while driving (Coef.=1.3102; p-value=0.000), driving at night time in the absence of street light (Coef.=0.3920; p-value=0.033), rainfall (Coef.=0.9164; p-value=0.000) and being a minibus or vans (Coef.=0.5065; p-value=0.013) were found to be increased crash injury severity. On the other hand, speeding was identified to have varying coefficients for different injury levels, its highest effects on sever and fatal crashes. In this study risky driving behaviors (speeding, alcohol use and sleep/fatigue) were a powerful predictor of crash injury severity. Therefore, better driver licensing and road safety awareness campaign complimented with strict police enforcement can play a pivotal role to improve road safety. Further effort needed as well to monitor speed control strategies like; using the radar control and physical speed restraint measures (i.e., rumble strips).