1
|
Mesic A, Stewart B, Opoku I, Wagenaar BH, Andoh Mohammed B, Abdul Matinue S, Jmaileh M, Damsere-Derry J, Gyedu A, Mock C, Kitali A, Hardy Wuaku D, Owusu Afram M, Feldacker C. "We are pleading for the government to do more": Road user perspectives on the magnitude, contributing factors, and potential solutions to road traffic injuries and deaths in Ghana. PLoS One 2024; 19:e0300458. [PMID: 38787863 PMCID: PMC11125548 DOI: 10.1371/journal.pone.0300458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 02/27/2024] [Indexed: 05/26/2024] Open
Abstract
Road traffic collisions disproportionately impact Ghana and other low- and middle-income countries. This study explored road user perspectives regarding the magnitude, contributing factors, and potential solutions to road traffic collisions, injuries, and deaths. We designed a qualitative study of 24 in-depth interviews with 14 vulnerable road users (pedestrians, occupants of powered 2- and 3-wheelers, cyclists) and ten non-vulnerable road users in four high-risk areas in November 2022. We used a mixed deductive (direct content analysis) and inductive (interpretive phenomenological analysis) approach. In the direct content analysis, a priori categories based on Haddon's Matrix covered human, vehicle, socioeconomic environment, and physical environment factors influencing road traffic collisions, along with corresponding solutions. We used inductive analysis to identify emerging themes. Participants described frequent and distressing experiences with collisions, and most often reported contributing factors, implementation gaps, and potential solutions within the human (road user) level domain of Haddon's Matrix. Implementation challenges included sporadic enforcement, reliance on road users' adherence to safety laws, and the low quality of the existing infrastructure. Participants expressed that they felt neglected and ignored by road safety decision-makers. This research emphasizes the need for community input for successful road safety policies in Ghana and other low- and middle-income countries, calling for greater governmental support an action to address this public health crisis. We recommend the government collaborates with communities to adapt existing interventions including speed calming, footbridges, and police enforcement, and introduces new measures that meet local needs.
Collapse
Affiliation(s)
- Aldina Mesic
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Barclay Stewart
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
- Harborview Injury Prevention and Research Center, Seattle, Washington, United States of America
| | - Irene Opoku
- Building and Road Research Institute, Kumasi, Ghana
| | - Bradley H. Wagenaar
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Bilal Andoh Mohammed
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sulemana Abdul Matinue
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Manal Jmaileh
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - James Damsere-Derry
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
| | - Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Charles Mock
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Surgery, University of Washington, Seattle, Washington, United States of America
- Harborview Injury Prevention and Research Center, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Angela Kitali
- Civil Engineering Program, University of Washington, Tacoma, Washington, United States of America
| | | | | | - Caryl Feldacker
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
2
|
Goel R, Tiwari G, Varghese M, Bhalla K, Agrawal G, Saini G, Jha A, John D, Saran A, White H, Mohan D. Effectiveness of road safety interventions: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2024; 20:e1367. [PMID: 38188231 PMCID: PMC10765170 DOI: 10.1002/cl2.1367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Background Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. Objectives The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. Search Methods The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. Selection Criteria The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. Data Collection and Analysis The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. Main Results The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. Authors' Conclusions The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.
Collapse
Affiliation(s)
- Rahul Goel
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Geetam Tiwari
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Kavi Bhalla
- Department of Public Health SciencesUniversity of ChicagoChicagoIllinoisUSA
| | - Girish Agrawal
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | | | - Abhaya Jha
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| | - Denny John
- Faculty of Life and Allied Health SciencesM S Ramaiah University of Applied Sciences, BangaloreKarnatakaIndia
| | | | | | - Dinesh Mohan
- Transportation Research and Injury Prevention CentreIndian Institute of Technology DelhiNew DelhiIndia
| |
Collapse
|
3
|
Malhotra SK, White H, Dela Cruz NAO, Saran A, Eyers J, John D, Beveridge E, Blöndal N. Studies of the effectiveness of transport sector interventions in low- and middle-income countries: An evidence and gap map. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1203. [PMID: 36951810 PMCID: PMC8724647 DOI: 10.1002/cl2.1203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND There are great disparities in the quantity and quality of infrastructure. European countries such as Denmark, Germany, Switzerland, and the UK have close to 200 km of road per 100 km2, and the Netherlands over 300 km per 100 km2. By contrast, Kenya and Indonesia have <30, Laos and Morocco <20, Tanzania and Bolivia <10, and Mauritania only 1 km per 100 km2. As these figures show, there is a significant backlog of transport infrastructure investment in both rural and urban areas, especially in sub-Saharan Africa. This situation is often exacerbated by weak governance and an inadequate regulatory framework with poor enforcement which lead to high costs and defective construction.The wellbeing of many poor people is constrained by lack of transport, which is called "transport poverty". Lucas et al. suggest that up to 90% of the world's population are transport poor when defined as meeting at least one of the following criteria: (1) lack of available suitable transport, (2) lack of transport to necessary destinations, (3) cost of necessary transport puts household below the income poverty line, (4) excessive travel time, or (5) unsafe or unhealthy travel conditions. OBJECTIVES The aim of this evidence and gap map (EGM) is to identify, map, and describe existing evidence from studies reporting the quantitative effects of transport sector interventions related to all means of transport (roads, rail, trams and monorail, ports, shipping, and inland waterways, and air transport). METHODS The intervention framework of this EGM reframes Berg et al's three categories (infrastructure, prices, and regulations) broadly as infrastructure, incentives, and institutions as subcategories for each intervention category which are each mode of transport (road, rail trams and monorail, ports, shipping, and inlands waterways, and air transport). This EGM identifies the area where intervention studies have been conducted as well as the current gaps in the evidence base.This EGM includes ongoing and completed impact evaluations and systematic reviews (SRs) of the effectiveness of transport sector interventions. This is a map of effectiveness studies (impact evaluations). The impact evaluations include experimental designs, nonexperimental designs, and regression designs. We have not included the before versus after studies and qualitative studies in this map. The search strategies included both academic and grey literature search on organisational websites, bibliographic searches and hand search of journals.An EGM is a table or matrix which provides a visual presentation of the evidence in a particular sector or a subsector. The map is presented as a matrix in which rows are intervention categories (e.g., roads) and subcategories (e.g., infrastructure) and the column outcome domains (e.g., environment) and subcategories as (e.g., air quality). Each cell contains studies of the corresponding intervention for the relevant outcome, with links to the available studies. Included studies were coded according to the intervention and outcomes assessed and additional filters as region, population, and study design. Critical appraisal of included SR was done using A Measurement Tool to Assess Systematic Reviews (AMSTAR -2) rating scale. SELECTION CRITERIA The search included both academic and grey literature available online. We included impact evaluations and SRs that assessed the effectiveness of transport sector interventions in low- and middle-income countries. RESULTS This EGM on the transport sector includes 466 studies from low- and middle-income countries, of which 34 are SRs and 432 impact evaluations. There are many studies of the effects of roads intervention in all three subcategories-infrastructure, incentives, and institutions, with the most studies in the infrastructure subcategories. There are no or fewer studies on the interventions category ports, shipping, and waterways and for civil aviation (Air Transport).In the outcomes, the evidence is most concentrated on transport infrastructure, services, and use, with the greatest concentration of evidence on transport time and cost (193 studies) and transport modality (160 studies). There is also a concentration of evidence on economic development and health and education outcomes. There are 139 studies on economic development, 90 studies on household income and poverty, and 101 studies on health outcomes.The major gaps in evidence are from all sectors except roads in the intervention. And there is a lack of evidence on outcome categories such as cultural heritage and cultural diversity and very little evidence on displacement (three studies), noise pollution (four studies), and transport equity (2). There is a moderate amount of evidence on infrastructure quantity (32 studies), location, land use and prices (49 studies), market access (29 studies), access to education facilities (23 studies), air quality (50 studies), and cost analysis including ex post CBA (21 studies).The evidence is mostly from East Asia and the Pacific Region (223 studies (40%), then the evidence is from the sub-Saharan Africa (108 studies), South Asia (96 studies), Latin America & Caribbean (79 studies). The least evidence is from Middle East & North Africa (30 studies) and Europe & Central Asia (20 studies). The most used study design is other regression design in all regions, with largest number from East Asia and Pacific (274). There is total 33 completed SRs identified and one ongoing, around 85% of the SR are rated low confidence, and 12% rated as medium confidence. Only one review was rated as high confidence. This EGM contains the available evidence in English. CONCLUSION This map shows the available evidence and gaps on the effectiveness of transport sector intervention in low- and middle-income countries. The evidence is highly concentrated on the outcome of transport infrastructure (especially roads), service, and use (351 studies). It is also concentrated in a specific region-East Asia and Pacific (223 studies)-and more urban populations (261 studies). Sectors with great development potential, such as waterways, are under-examined reflecting also under-investment.The available evidence can guide the policymakers, and government-related to transport sector intervention and its effects on many outcomes across sectors. There is a need to conduct experimental studies and quality SRs in this area. Environment, gender equity, culture, and education in low- and middle-income countries are under-researched areas in the transport sector.
Collapse
|
4
|
An SJ, Purcell LN, Mulima G, Charles AG. Characteristics and outcomes following motorized and non-motorized vehicular trauma in a resource-limited setting. Injury 2021; 52:2645-2650. [PMID: 33879340 PMCID: PMC8429052 DOI: 10.1016/j.injury.2021.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/29/2021] [Accepted: 04/07/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Despite the ubiquity of motorized vehicular transport, non-motorized transportation continues to be common in sub-Saharan Africa. METHODS We performed a retrospective analysis of trauma patients presenting to Kamuzu Central Hospital in Malawi from February 2008 to May 2018. Demographic and clinical variables including injury characteristics and outcomes were collected. We performed bivariate and multivariate logistic regression to determine predictors of mortality following non-motorized vehicular trauma. RESULTS This study included 36,412 patients involved in vehicular road injuries. Patients in the non-motorized group had a preponderance of men (84% versus 73%, p<0.01). The proportion of patients with Glasgow Coma Scale > 8 was slightly higher in the non-motorized group (99% versus 98%, p<0.01), though injury severity did not differ significantly between the two groups. A higher proportion in the motorized group had the most severe injury of contusions and abrasions (56% versus 50%, p<0.01). In contrast, the non-motorized group had a higher proportion of orthopedic injuries (24% versus 16%, p<0.01). The crude mortality rate was 4.51% and 2.15% in the motorized and non-motorized groups, respectively. After controlling for demographic factors and injury severity, the incidence rate ratio of mortality did not differ significantly between motorized and non-motorized trauma groups (IRR 0.91, p=0.35). CONCLUSIONS Non-motorized vehicular trauma remains a significant proportion of morbidity and mortality resulting from road traffic injuries. The injury severity and incidence rate ratio of mortality did not differ between motorized and non-motorized trauma groups. Health care providers should not underestimate the severity of injuries from non-motorized trauma.
Collapse
Affiliation(s)
- Selena J. An
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura N. Purcell
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Anthony G. Charles
- Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
5
|
Osuret J, Namatovu S, Biribawa C, Enock Balugaba B, Bayiga Zziwa E, Muni K, Ningwa A, Oporia F, Mutto M, Kyamanywa P, Guwatudde D, Kobusingye O. State of pedestrian road safety in Uganda: a qualitative study of existing interventions. Afr Health Sci 2021; 21:1498-1506. [PMID: 35222616 PMCID: PMC8843294 DOI: 10.4314/ahs.v21i3.62] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Pedestrians in Uganda account for 40% of road traffic fatalities and 25% of serious injuries annually. We explored the current pedestrian road traffic injury interventions in Uganda to understand why pedestrian injuries and deaths continue despite the presence of interventions. Methods We conducted a qualitative study that involved a desk review of road safety policy, regulatory documents, and reports. We supplemented the document review with 14 key informant interviews and 4 focus group discussions with participants involved in road safety. Qualitative thematic content analysis was done using ATLAS. ti 7 software. Results Five thematic topics emerged. Specifically, Uganda had a Non-Motorized Transport Policy whose implementation revealed several gaps. The needs of pedestrians and contextual evidence were ignored in road systems. The key programmatic challenges in pedestrian road safety management included inadequate funding, lack of political support, and lack of stakeholder collaboration. There was no evidence of plans for monitoring and evaluation of the various pedestrian road safety interventions. Conclusion The research revealed low prioritization of pedestrian needs in the design, implementation, and evaluation of pedestrian road safety interventions. Addressing Uganda's pedestrian needs requires concerted efforts to coordinate all road safety activities, political commitment, and budgetary support at all levels.
Collapse
|
6
|
Sundet M, Mulima G, Kajombo C, Gjerde H, Christophersen AS, Young S. Adult pedestrian and cyclist injuries in Lilongwe, Malawi: a cross-sectional study. Malawi Med J 2021; 32:197-204. [PMID: 34457204 PMCID: PMC8364799 DOI: 10.4314/mmj.v32i4.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Pedestrian and cyclist injuries are a major concern globally, but especially in low-income countries. Locally conducted research is needed to measure the size of the problem and advise policy on road safety interventions. We wanted to investigate the precise circumstances of these injuries in Lilongwe, Malawi and to identify risk factors for severe injuries. Methods Cross-sectional study of all adult pedestrian and cyclist injuries presenting to a large central hospital. This was a sub-study of a larger study with all types of road users included. All patients provided detailed information about the incidents leading to injury and were tested for alcohol. Results There were 222 pedestrians, 183 bicycle riders and 42 bicycle passengers among the 1259 adult road traffic injury victims that were treated at Kamuzu Central Hospital during a 90-day period in 2019. Of these injuries, 60.2% occurred while the victim was walking/cycling along the road and 22.3% when the victim was trying to cross the road. The majority of the victims were men (89.1%). Helmet use for bicyclists was almost non-existent. Only 1 patient had used reflective devices when injured in the dark, despite 44.7% of these injuries occurring in reduced light conditions. There was an increased risk for serious and fatal injuries for pedestrians compared with bicyclists, and also compared with all types of road users. Patients injured in rural areas and those hit by lorries were more severely injured. Consuming alcohol before being injured was associated with more severe injuries in bicyclists. Being injured while crossing the road at painted zebra crossings was associated with an increased risk of serious and potentially fatal injuries. Conclusion This study identified important risk factors for severe injuries in pedestrians and cyclists. Implications for preventive measures are presented in a Haddon Matrix.
Collapse
Affiliation(s)
- Mads Sundet
- Diakonhjemmet Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gift Mulima
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Chifundo Kajombo
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Hallvard Gjerde
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | | | - Sven Young
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.,College of Medicine, University of Malawi, Lilongwe, Malawi.,Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
7
|
Embolo FN, Bellamkonda N, Dickson D, Motwani G, Mbeboh SN, Mbiarikai M, Oben E, Oke R, Dicker RA, Juillard C, Christie SA, Chichom-Mefire A. Epidemiology of traumatic brain injury based on clinical symptoms amongst inhabitants of the Southwest Region of Cameroon: a community-based study. Brain Inj 2021; 35:1184-1191. [PMID: 34383629 DOI: 10.1080/02699052.2021.1957150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The majority of studies investigating the epidemiology of traumatic brain injury (TBI) in sub-Saharan Africa are primarily hospital-based, missing fatal, mild, and other cases of TBI that do not present to formal care settings. This study aims to bridge this gap in data by describing the epidemiology of TBI in the Southwest Region of Cameroon. METHODS This was a cross-sectional community-based study. Using a three-stage cluster sampling, local research assistants surveyed households with a pre-tested questionnaire to identify individuals with symptoms of TBI in nine health districts in the Southwest Region of Cameroon from 2016 to 2017. RESULTS Data gathered on 8,065 individuals revealed 78 cases of suspected TBI. Road traffic injury (RTI) comprised 55% of subjects' mechanism of injury. Formal medical care was sought by 82.1% of subjects; three subjects died at the time of injury. Following injury, 59% of subjects reported difficulty affording basic necessities and 87.2% of subjects were unable to perform activities of their primary occupation. CONCLUSIONS This study postulates an incidence of TBI in Southwest Cameroon of 975.57 per 100,000 individuals, significantly greater than prior findings. A large proportion of TBI is secondary to RTI.
Collapse
Affiliation(s)
- Frida N Embolo
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, California, USA
| | - Nikhil Bellamkonda
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Drusia Dickson
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, California, USA
| | - Girish Motwani
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, California, USA
| | - Susan N Mbeboh
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Mbianyor Mbiarikai
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, California, USA
| | - Eunice Oben
- Faculty of Health Sciences, University of Buea, Buea, Cameroon.,Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, California, USA
| | - Rasheedat Oke
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Rochelle A Dicker
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - Catherine Juillard
- Program for the Advancement of Surgical Equity, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA
| | - S Ariane Christie
- Center for Global Surgical Studies, Department of Surgery, University of California, San Francisco, California, USA
| | | |
Collapse
|
8
|
Sundet M, Mulima G, Kajombo C, Gjerde H, Christophersen AS, Madsen JE, Young S. Geographical mapping of road traffic injuries in Lilongwe, Malawi. Injury 2021; 52:806-813. [PMID: 33712299 DOI: 10.1016/j.injury.2021.02.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/24/2021] [Accepted: 02/12/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Road traffic injuries are a leading cause of death and disability, especially in low- and middle-income countries. Identifying injury hotspots are valuable for introducing preventive measures. This is usually accomplished by using police data, but these are often unreliable in low-income countries. This study aimed to identify hotspots for injuries by collecting geographical data in the emergency room. METHODS This was a cross-sectional study of adult road traffic injury patients presenting to the Casualty Department in the central hospital in Lilongwe, the capital of Malawi. An electronic tablet with downloaded maps and satellite photos was used to establish the exact location of the injuries. The geographical data were analyzed with geographic information software. RESULTS We included 1244 road traffic injured patients, of which 23.9% were car passengers or drivers, 18.6% were motorcyclists, 17.8% were pedestrians and 18.0% were cyclists or bicycle passengers. Heatmaps of the injuries identified 5 locations where the incidence of injuries was especially high, and 148 patients were injured in these hotspots during the 90 days of inclusion. Four of these hotspots were along the main road through the capital. Age over 55, rural setting, alcohol use before the injury, high speed limit at the site of injury and being a pedestrian or motorcyclist were significantly associated with a higher degree of injury severity. Around half of the patients that were injured in a four-wheeled vehicle did not use a seat belt, and these patients had a much higher risk of getting a more severe injury. CONCLUSION We have identified specific locations with a high incidence of road traffic injuries in Lilongwe, Malawi, with a simple methodology and within a short time frame. The study demonstrates the feasibility of collecting geographical data at admission to hospital.
Collapse
Affiliation(s)
- Mads Sundet
- Diakonhjemmet Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Gift Mulima
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Chifundo Kajombo
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Hallvard Gjerde
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| | | | - Jan Erik Madsen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Sven Young
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi; College of Medicine, University of Malawi, Lilongwe, Malawi; Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
9
|
Sundet M, Kajombo C, Mulima G, Bogstrand ST, Varela C, Young S, Christophersen AS, Gjerde H. Prevalence of alcohol use among road traffic crash victims presenting to a Malawian Central Hospital: A cross-sectional study. TRAFFIC INJURY PREVENTION 2020; 21:527-532. [PMID: 33064031 DOI: 10.1080/15389588.2020.1819990] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/01/2020] [Accepted: 09/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Alcohol consumption is a well-known risk factor for sustaining road traffic injuries worldwide. Malawi is a low-income country with a large and increasing burden of road traffic injuries. It has generally been viewed as a country with relatively little alcohol consumption. This study investigates the role of alcohol in road traffic injuries in and around the capital Lilongwe. METHODS All patients presenting to the emergency department of Kamuzu Central Hospital after being injured in road traffic crashes were asked to participate in the study. Alcohol testing was done with a breathalyzer or a saliva test. Participants were asked about alcohol use before the injury as well as hazardous drinking using the AUDIT-C questionnaire. RESULTS Of 1347 patients age 18 years or older who were asked to participate, 1259 gave informed consent, and data on alcohol use (alcohol test results and/or self-reported intake) were available for 1251 participants. Of those, 251 (20.1%) tested positive for alcohol, whereas 221 (17.7%) reported alcohol use before the crash; in total 311 (24.9%, 95% CI 22.5-27.3) either tested positive, reported use, or both. Females had a low prevalence of alcohol use (2.5%), while 30.6% of males had consumed alcohol before the injuries. Pedestrians had the highest prevalence at 41.8% (95% CI 35.5-48.4), while car drivers had 23.8% (95% CI 18.2-30.5). Among male pedestrians, 49.5% had used alcohol before the injury. Alcohol-associated injuries had a peak in the evening and at night, especially in the weekends. Of the patients, 63.1% reported that they had not consumed alcohol during the last year, while 21.4% had an AUDIT-C score suggesting hazardous drinking, and 66.2% of those had used alcohol before the injury. CONCLUSIONS A large percentage of road traffic injured patients had been drinking alcohol before their injury, especially male pedestrians. A large proportion of the patients were abstaining from alcohol, but those not abstaining had a high prevalence both of alcohol use when injured and hazardous drinking identified by AUDIT-C. This has important implications for prevention.
Collapse
Affiliation(s)
- Mads Sundet
- Department of Orthopedics, Diakonhjemmet Hospital, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Chifundo Kajombo
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Gift Mulima
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Stig Tore Bogstrand
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Carlos Varela
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
- College of Medicine, University of Malawi, Lilongwe, Malawi
| | - Sven Young
- Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
- College of Medicine, University of Malawi, Lilongwe, Malawi
- Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| | | | - Hallvard Gjerde
- Department of Forensic Sciences, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
10
|
Rosenberg A, Ntirenganya F, Bagahirwa I, Mbanjumucyo G, Rutayisire L, Muneza S, Nzeyimana I, Benimana E, Nahayo E, Bhengu B, Nuhu A, Muhumuza A, Uwitonze C, Umwali G, Nkeshimana M, Nyinawankusi JD, Krebs E, Uwitonze JM, Kabagema I, Dushime T, Byiringiro JC, Ndayisaba G, Jayaraman S. First Rwanda National Trauma Symposium 2019: Challenges and priorities. J Glob Health 2020; 10:010201. [PMID: 32257131 PMCID: PMC7100625 DOI: 10.7189/jogh.10.010201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Ashley Rosenberg
- Virginia Commonwealth University Department of Surgery, Richmond, Virginia, USA
- Joint first authorship
| | - Faustin Ntirenganya
- University Teaching Hospital of Kigali Department of Surgery, Kigali, Rwanda
- Joint first authorship
| | | | - Gabin Mbanjumucyo
- University Teaching Hospital of Kigali Department of Accident and Emergency, Kigali, Rwanda
| | - Lambert Rutayisire
- University Teaching Hospital of Kigali Department of Surgery, Kigali, Rwanda
| | - Severien Muneza
- University Teaching Hospital of Kigali Department of Surgery, Kigali, Rwanda
| | - Innocent Nzeyimana
- University Teaching Hospital of Kigali Department of Surgery, Kigali, Rwanda
| | | | - Ernest Nahayo
- Rwanda Military Hospital Department of Accident and Emergency, Kigali, Rwanda
| | | | - Assuman Nuhu
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Arsene Muhumuza
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | | | - Ghislaine Umwali
- Collaboration for Evidence-based Healthcare and Public Health in Africa, Kigali, Rwanda
| | - Menelas Nkeshimana
- University Teaching Hospital of Kigali Department of Accident and Emergency, Kigali, Rwanda
| | | | - Elizabeth Krebs
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | | | - Igance Kabagema
- Service d’Aide Medicale Urgente- Rwanda Ministry of Health, Kigali, Rwanda
| | - Theophile Dushime
- Service d’Aide Medicale Urgente- Rwanda Ministry of Health, Kigali, Rwanda
| | - Jean Claude Byiringiro
- University Teaching Hospital of Kigali Department of Surgery, Kigali, Rwanda
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
| | - Gilles Ndayisaba
- Rwanda Biomedical Center, Department of Noncommunicable Diseases, Kigali, Rwanda
| | - Sudha Jayaraman
- Virginia Commonwealth University Department of Surgery, Richmond, Virginia, USA
- Virginia Commonwealth University Program for Global Surgery, Richmond, Virginia, USA
| | - on behalf of the participants for the first national Rwanda Trauma Symposium 2019 in Kigali, Rwanda
- Virginia Commonwealth University Department of Surgery, Richmond, Virginia, USA
- University Teaching Hospital of Kigali Department of Surgery, Kigali, Rwanda
- Rwanda Biomedical Center, Kigali, Rwanda
- University Teaching Hospital of Kigali Department of Accident and Emergency, Kigali, Rwanda
- Rwanda National Police, Kigali, Rwanda
- Rwanda Military Hospital Department of Accident and Emergency, Kigali, Rwanda
- University of Rwanda School of Nursing, Kigali, Rwanda
- University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
- Rwanda Association for Biomedical Engineering, Kigali, Rwanda
- Collaboration for Evidence-based Healthcare and Public Health in Africa, Kigali, Rwanda
- Service d’Aide Medicale Urgente- Rwanda Ministry of Health, Kigali, Rwanda
- Thomas Jefferson University, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
- Rwanda Biomedical Center, Department of Noncommunicable Diseases, Kigali, Rwanda
- Virginia Commonwealth University Program for Global Surgery, Richmond, Virginia, USA
- Joint first authorship
| |
Collapse
|
11
|
Reddy SP, Walsh MS, Paulino-Ramirez R, Florenzán J, Fernández J, Nwariaku FE, Abdelnaby A. Neurologic injuries following road traffic accidents in the Dominican Republic: Examining causes and potential solutions. TRAFFIC INJURY PREVENTION 2019; 20:690-695. [PMID: 31381379 DOI: 10.1080/15389588.2019.1643016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
Objective: Road traffic accidents (RTAs) are the number one cause of traumatic brain injuries (TBIs) worldwide. This study examines RTA-related TBIs in the Dominican Republic, a country in the Caribbean with the highest RTA fatality rate in the Western Hemisphere. Methods: We interviewed 117 adult patients or medical guardians of patients admitted to Hospital Traumatológico Dr. Ney Arias Lora in Santo Domingo following an RTA. Information regarding the type of accident, patient demographics, and injuries sustained was collected for each patient. Results: Most study participants were males (79.5%), and the most common method of transportation was motorized 2-wheeled vehicle (MTW; 74.4%). Of the 69 patients who suffered a TBI, 66.7% were classified as moderate-severe TBIs and 30.3% were classified as mild TBIs. The most common types of intracranial hemorrhage were subdural hemorrhage (12%) and subarachnoid hemorrhage (9.4%). Helmet use among admitted MTW riders was reported at 22.4%, and none of the 9 MTW riders who died in the hospital were wearing a helmet. Only 58.1% of patients lived in an area that offered 911 emergency response services at the time of the study. At 66.2%, the majority of people living within the 911 service area utilized emergency response services following an RTA. Multiple logistic regression determined that the utilization of 911 emergency response services was associated with a decrease in the likelihood of presenting with a moderate/severe TBI by a factor of 0.78 (adjusted odds ratio [OR]; P < .008; 95% confidence interval [CI], 0.65, 0.93). Nonuse of a helmet was associated with a 1.22 times increased risk of presenting with a moderate/severe TBI (adjusted OR; P < .04; 95% CI, 1.01, 1.61). Age and gender were not statistically significant in this model. Conclusions: The results of this study support 2 important avenues for reducing the burden of RTA-associated neurologic disease in the Dominican Republic. As with many other middle-income countries, MTWs represent an economical and efficient mode of transportation. Therefore, increasing helmet use may be the most effective way to reduce RTA-associated TBIs. In addition, continuing the expansion of postcrash emergency response services may mitigate the severity of RTA-associated neurologic disease.
Collapse
Affiliation(s)
- Sumanth P Reddy
- Office of Global Health, University of Texas Southwestern Medical School , Dallas , Texas
| | - Maura S Walsh
- Office of Global Health, University of Texas Southwestern Medical School , Dallas , Texas
| | - Robert Paulino-Ramirez
- Instituto de Medicina Tropical & Salud Global, Universidad Iberoamericana (UNIBE) , Santo Domingo , Dominican Republic
| | - Jomar Florenzán
- School of Medicine, Universidad Iberoamericana (UNIBE) , Santo Domingo , Dominican Republic
| | - Jaime Fernández
- School of Medicine, Universidad Iberoamericana (UNIBE) , Santo Domingo , Dominican Republic
- Department of Surgery, Hospital Traumatológico Dr. Ney Arias Lora , Santo Domingo , Dominican Republic
| | - Fiemu E Nwariaku
- Department of Surgery, University of Texas Southwestern Medical Center , Dallas , Texas
| | - Abier Abdelnaby
- Department of Surgery, University of Texas Southwestern Medical Center , Dallas , Texas
| |
Collapse
|
12
|
Symons J, Howard E, Sweeny K, Kumnick M, Sheehan P. Reduced Road Traffic Injuries for Young People: A Preliminary Investment Analysis. J Adolesc Health 2019; 65:S34-S43. [PMID: 31228988 DOI: 10.1016/j.jadohealth.2019.01.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/24/2018] [Accepted: 01/08/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Deaths and serious injuries from road accidents remain a serious issue in developing countries, including for young people, for whom they are the largest cause of death. This article provides an assessment of interventions to reduce these deaths and injuries for adolescents in 75 developing countries. METHODS We draw on new data on deaths and injuries by age, gender, and accident type for the 75 countries and on the road safety experience of developed and, more recently, developing countries. Critical tasks are to identify key interventions in road safety and estimate their impact and cost. We incorporate these impact and cost estimates in a modeling framework to calculate the reduction in deaths and serious injuries achieved out to 2030, relative to the base case. Finally, established methods are used to value the economic and social benefits arising from these reductions, and hence to calculate benefit-cost ratios. RESULTS For the unchanged policy case, we estimate that there will be about 3 million deaths and 7.4 million serious injuries from road accidents for persons aged 10-24 years in the 75 countries to 2030. The preferred interventions avert one million of these deaths and 3 million serious injuries, at a cost of $6.5 billion per annum over 2016-2030, or $1.2 per capita across the total population of these countries. After valuing the benefits of the deaths and serious injuries averted, we find a benefit-cost ratio of 7.6 for 2016-2030, but of 9.9 if the interventions continue to 2050. CONCLUSIONS Proven methods, suitably adjusted to local conditions, are available to reduce the tragic toll of road accidents in developing countries. These initiatives are likely to have strong economic and social returns, and should be given high priority.
Collapse
Affiliation(s)
- John Symons
- Victoria Institute of Strategic Economic Studies, Victoria University, Melbourne, Victoria, Australia
| | - Eric Howard
- Whiting Moyne P/L, Malvern East, Victoria, Australia
| | - Kim Sweeny
- Victoria Institute of Strategic Economic Studies, Victoria University, Melbourne, Victoria, Australia
| | - Margarita Kumnick
- Victoria Institute of Strategic Economic Studies, Victoria University, Melbourne, Victoria, Australia
| | - Peter Sheehan
- Victoria Institute of Strategic Economic Studies, Victoria University, Melbourne, Victoria, Australia.
| |
Collapse
|
13
|
McIlroy RC, Plant KA, Hoque MS, Wu J, Kokwaro GO, Nam VH, Stanton NA. Who is responsible for global road safety? A cross-cultural comparison of Actor Maps. ACCIDENT; ANALYSIS AND PREVENTION 2019; 122:8-18. [PMID: 30300797 DOI: 10.1016/j.aap.2018.09.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 06/08/2023]
Abstract
The traditional three 'E's approach to road safety (engineering, education, enforcement) has had, and will continue to have, a significant impact on road traffic casualty rates worldwide. Nevertheless, with rising motorisation in many countries, global fatality numbers have changed little over the past decade. Following calls for the application of sociotechnical systems thinking to the problem, we widen the road safety discussion with an additional four 'E's; economics, emergency response, enablement, and, the umbrella term for the approach taken, ergonomics. The research presents an application of Rasmussen's Risk Management Framework to the road safety systems of five distinct nations; Bangladesh, China, Kenya, the UK, and Vietnam. Following site visits, reviews of literature, and interviews with subject matter experts in each of the countries, a series of Actor Map models of the countries' road safety systems were developed. These are compared and discussed in terms of the wide variety of interconnecting organisations involved, their influences on road safety outcomes, the differences between nations, and the need to look beyond road users when designing road safety interventions.
Collapse
Affiliation(s)
- R C McIlroy
- Transportation Research Group, University of Southampton, UK.
| | - K A Plant
- Transportation Research Group, University of Southampton, UK
| | - M S Hoque
- Bangladesh University of Engineering and Technology, Dhaka, Bangladesh
| | - J Wu
- Tsinghua-Cambridge-MIT Future Transport Centre, Tsinghua University, Beijing, China
| | - G O Kokwaro
- Institute of Healthcare Management, Strathmore University, Nairobi, Kenya
| | - V H Nam
- National University of Civil Engineering, Hanoi, Viet Nam
| | - N A Stanton
- Transportation Research Group, University of Southampton, UK
| |
Collapse
|
14
|
Bonnet E, Lechat L, Ridde V. What interventions are required to reduce road traffic injuries in Africa? A scoping review of the literature. PLoS One 2018; 13:e0208195. [PMID: 30500856 PMCID: PMC6267971 DOI: 10.1371/journal.pone.0208195] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022] Open
Abstract
Road traffic accidents are the major cause of mortality among people aged 15–29 years in Africa. World Health Organisation (WHO) and the World Bank launched a Decade of Action for Road Safety in 2011 with the goal of halving the number of injuries and deaths on the roads. No progress has been reported in Low and Middle Income Countries (LMICs) and the number of deaths remains very high. To reach the target set, there is a need for interventions in several areas. This scoping review proposes to produce a synthesis by identifying the kinds of interventions and outcomes which have been carried out on the African continent. Using the scoping studies method, 23 articles were selected and analysed. The study shows that interventions were developed in four fields: road safety policy, health education, safety equipment and data collection. It shows also that there were records of interventions in only twelve countries, mostly in Eastern and Southern Africa. The main conclusion of this study reveals both a lack of road safety interventions and shortcomings in the assessment of those performed and selected for our study.
Collapse
Affiliation(s)
- Emmanuel Bonnet
- Institut de Recherche pour le Développement, UMI Résiliences, Bondy, France
- * E-mail:
| | | | - Valéry Ridde
- Institut de Recherche pour le Développement, UMR CEPED, Université Paris Descartes, Paris, France
| |
Collapse
|
15
|
Sundet M, Grudziak J, Charles A, Banza L, Varela C, Young S. Paediatric road traffic injuries in Lilongwe, Malawi: an analysis of 4776 consecutive cases. Trop Doct 2018; 48:316-322. [DOI: 10.1177/0049475518790893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This was a retrospective review of all children aged ≤16 who were treated in the casualty department at the central hospital in Lilongwe, Malawi, between 1 January 2009 and 31 December 2015. A total of 4776 children were treated for road traffic injuries (RTIs) in the study period. There was an increase in incidence from 428 RTIs in 2009 to a maximum of 834 in 2014. Child pedestrians represented 53.8% of the injuries, but 78% of deaths and 71% of those with moderate to severe head injuries. Pedestrians were mostly injured by cars (36%) and by large trucks, buses and lorries (36%). Eighty-four (1.8%) children were brought in dead, while 40 (0.8%) children died in the casualty department or during their hospital stay. There has been a drastic increase of RTIs in children in Lilongwe, Malawi. Child pedestrians were most affected, both in terms of incidence and severity.
Collapse
Affiliation(s)
- Mads Sundet
- Consultant Orthopedic Surgeon, Martina Hansens Hospital, Norway
- Consultant Orthopedic Surgeon, Diakonhjemmet Hospital, Norway
| | - Joanna Grudziak
- Resident in General Surgey, Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Anthony Charles
- Attending Trauma Surgeon, University of North Carolina, Chapel Hill, NC, USA
| | - Leonard Banza
- Consultant Ortopedic Surgeon, Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Carlos Varela
- Head of Department, Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Sven Young
- Consultant Orthopaedic Surgeon, Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi
- Honorary Senior Lecturer, College of Medicine, University of Malawi, Lilongwe. Malawi
- Consultant Orthopaedic Surgeon, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
16
|
Poswayo A, Kalolo S, Rabonovitz K, Witte J, Guerrero A. School Area Road Safety Assessment and Improvements (SARSAI) programme reduces road traffic injuries among children in Tanzania. Inj Prev 2018; 25:414-420. [PMID: 29778992 DOI: 10.1136/injuryprev-2018-042786] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 04/23/2018] [Accepted: 04/24/2018] [Indexed: 11/04/2022]
Abstract
PURPOSE To determine the impact of a paediatric road traffic injury (RTI) prevention programme in urban Sub-Saharan Africa. SETTING Dares Salaam, Republic of Tanzania. METHODS Household surveys were conducted in catchment areas around 18 primary schools in Dar es Salaam, Republic of Tanzania; the catchment areas were divided into control and intervention groups. Collected data included basic demographic information on all school-aged household members and whether or not they had been involved in an RTI in the previous 12 months, and, if so, what the characteristics of that RTI were. Based on these findings, a separate road safety engineering site analysis and consultation with the communities and other stakeholders, an injury-prevention programme was developed and implemented, consisting of infrastructure enhancements and a site-specific educational programme. The programme was initially implemented at the intervention schools. After 1 year, data were collected in the same manner. The control group received the same intervention after follow-up data were collected. RESULTS Data were collected on 12 957 school-aged children in the baseline period and 13 555 school-aged children in the post-intervention period, in both the control and intervention communities. There was a statistically significant reduction in RTIs in the intervention group and a non-significant increase in RTI in the control group. The greatest reduction was in motorcycle-pedestrian RTI, private vehicle-pedestrian RTI and morning RTI. CONCLUSION The programme demonstrated a significant reduction in paediatric RTI after its implementation, in very specific ways. This study demonstrates that for a reasonable investment, scientifically driven injury-prevention programmes are feasible in resource-limited settings with high paediatric RTI rates.
Collapse
|
17
|
Effective interventions for unintentional injuries: a systematic review and mortality impact assessment among the poorest billion. LANCET GLOBAL HEALTH 2018; 6:e523-e534. [DOI: 10.1016/s2214-109x(18)30107-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 11/19/2022]
|
18
|
Miller TR, Levy DT, Swedler DI. Lives saved by laws and regulations that resulted from the Bloomberg road safety program. ACCIDENT; ANALYSIS AND PREVENTION 2018; 113:131-136. [PMID: 29407660 DOI: 10.1016/j.aap.2018.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/26/2017] [Accepted: 01/11/2018] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To estimate lives saved during 2008-2023 by traffic safety laws passed in six developing countries while participating in the Bloomberg Road Safety Program (BRSP). METHODS BRSP-funded local staff identified relevant laws and described enforcement to the study team. We analyzed road crash death estimates for 2004-2013 from the Global Burden of Disease and projected estimates absent intervention forward to 2023. We amalgamated developing country and US literature to estimate crash death reductions by country resulting from laws governing drink driving, motorcycle helmets, safety belt use, and traffic fines. RESULTS BRSP helped win approval of traffic safety laws in Brazil, China, Kenya, Mexico, Turkey, and Vietnam. In 2008-2013, those laws saved an estimated 19,000 lives. Many laws only took effect in 2014. The laws will save an estimated 90,000 lives in 2014-2023. Of the 109,000 lives saved, drink driving laws will account for 84%, increased motorcyclist protection for 13%, increased fines and penalty points for 2%, and safety belt usage mandates for 1%. Drink driving reductions in China will account for 56% of the savings and reduced drink driving and motorcycling deaths in Vietnam for 35%. The savings in China will result from a narrow intervention with just 4% estimated effectiveness against drink driving deaths. As a percentage of deaths anticipated without BRSP effort, the largest reductions will be 11% in Vietnam and 5% in Kenya. CONCLUSIONS Viewed as a public health measure, improving traffic safety provided large health gains in developing nations.
Collapse
Affiliation(s)
- Ted R Miller
- Pacific Institute for Research and Evaluation, Calverton, MD, USA; Curtin University School of Public Health, Perth, Australia.
| | | | - David I Swedler
- Pacific Institute for Research and Evaluation, Calverton, MD, USA
| |
Collapse
|
19
|
Azami-Aghdash S, Sadeghi-Bazarghani H, Heydari M, Rezapour R, Derakhshani N. Effectiveness of Interventions for Prevention of Road Traffic Injuries in Iran and Some Methodological Issues: A Systematic Review. Bull Emerg Trauma 2018; 6:90-99. [PMID: 29719838 DOI: 10.29252/beat-060202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective To review the effectiveness of Road Traffic Injuries (RTIs) interventions implemented for prevention of RTIs in Iran and to introduce some methodological issues. Methods Required data in this systematic review study were collected through searching the following key words: "Road Traffic Injuries", "Road Traffic accidents", "Road Traffic crashes", "prevention", and Iran in PubMed, Cochrane Library electronic databases, Google Scholar, Scopus, MagIran, SID and IranMedex. Some of the relevant journals and web sites searched manually. Reference lists of the selected articles were also checked. Gray literature search and expert contact was also conducted. Results Out of 569 retrieved articles, finally 8 articles included. Among the included studies the effectiveness of 10 interventions were assessed containing: seat belt, enforcements of laws and legislations, educational program, wearing helmet, Antilock Braking System (ABS), motorcyclists' penalty enforcement, pupil liaisons' education, provisional driver licensing, Road bumps and traffic improvement's plans. In 7 studies (9 interventions) reduction of RTIs rate were reported. Decreased rate of mortality from RTIs were reported in three studies. Only one study had mentioned financial issue (Anti-lock Brake System intervention). Inadequate data sources, inappropriate selection of statistical index and not mention about the control of Confounding Variables (CV), the most common methodological issues were. Conclusion The results of most interventional studies conducted in Iran supported the effect of the interventions on reduction of RTIs. However due to some methodological or reporting shortcoming the results of these studies should be interpreted cautiously.
Collapse
Affiliation(s)
- Saber Azami-Aghdash
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Mahdiyeh Heydari
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramin Rezapour
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naser Derakhshani
- Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
20
|
Where There is No EMS: Lay Providers in Emergency Medical Services Care - EMS as a Public Health Priority. Prehosp Disaster Med 2017; 32:593-595. [DOI: 10.1017/s1049023x17006811] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBy 2030, road traffic accidents are projected to be the fifth leading cause of death worldwide, with 90% of these deaths occurring in low- and middle-income countries (LMICs). While high-quality, prehospital trauma care is crucial to reduce the number of trauma-related deaths, effective Emergency Medical Systems (EMS) are limited or absent in many LMICs. Although lay providers have long been recognized as the front lines of informal trauma care in countries without formal EMS, few efforts have been made to capitalize on these networks. We suggest that lay providers can become a strong foundation for nascent EMS through a four-fold approach: strengthening and expanding existing lay provider training programs; incentivizing lay providers; strengthening locally available first aid supply chains; and using technology to link lay provider networks.DebenhamS, FullerM, StewartM, PriceRR. Where there is no EMS: lay providers in Emergency Medical Services care - EMS as a public health priority. Prehosp Disaster Med. 2017;32(6):593–595.
Collapse
|
21
|
Banstola A, Mytton J. Cost-effectiveness of interventions to prevent road traffic injuries in low- and middle-income countries: A literature review. TRAFFIC INJURY PREVENTION 2017; 18:357-362. [PMID: 27575954 DOI: 10.1080/15389588.2016.1212165] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 07/07/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The objective of this study was to identify, critically appraise, summarize, and synthesize evidence from cost-effectiveness analyses (CEAs) of interventions aimed at preventing road traffic injuries (RTIs) in low- and middle-income countries (LMICs) by age group and road users targeted. METHODS A search strategy was applied to 12 electronic databases for studies published between May 2002 and August 2015 that met prespecified inclusion criteria. Additional studies were identified by contacting authors and searching bibliographies. Included studies were critically appraised against published criteria and a narrative synthesis was conducted including a use of the strength of evidence criteria. RESULTS Five studies were included in the final review that reported 9 interventions. Only 2 out of 9 interventions (drink-drive legislation with enforcement via breath testing campaign and combined interventions for reducing RTIs) showed moderate evidence of being cost-effective, whereas the evidence of cost-effectiveness of other interventions was weak. Only 2 interventions (bicycle and motorcycle helmet use legislation and enforcement) were explicitly targeted to children, young people and vulnerable road users such as pedestrians and cyclists. The cost-effectiveness of interventions to prevent RTIs in LMICs ranged from US$4.14 per disability-adjusted life years (DALYs) averted for building speed bumps at the most dangerous junctions that caused 10% of junction deaths in the area studied to US$3,403 per DALYs averted for legislation and enforcement of helmet use by motorcyclists in the World Health Organization (WHO) sub-Saharan Africa region. CONCLUSIONS Evidence of cost-effectiveness of interventions to prevent RTIs in LMICs is limited, particularly for children, young people, and vulnerable road users. Evaluation of the effectiveness and cost-effectiveness of a larger number of possible road safety interventions in a variety of LMIC settings is warranted to generate the evidence base for effective traffic injury prevention programs.
Collapse
Affiliation(s)
- Amrit Banstola
- a Faculty of Health and Applied Sciences , The University of the West of England , Bristol , UK
- b Department of Research and Training , Public Health Perspective Nepal , Pokhara , Nepal
| | - Julie Mytton
- a Faculty of Health and Applied Sciences , The University of the West of England , Bristol , UK
| |
Collapse
|
22
|
Wesson HKH, Boikhutso N, Hyder AA, Bertram M, Hofman KJ. Informing road traffic intervention choices in South Africa: the role of economic evaluations. Glob Health Action 2016; 9:30728. [PMID: 27396485 PMCID: PMC4938892 DOI: 10.3402/gha.v9.30728] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Given the burden of road traffic injuries (RTIs) in South Africa, economic evaluations of prevention interventions are necessary for informing and prioritising public health planning and policy with regard to road safety. METHODS In view of the dearth of RTI cost analysis, and in order to understand the extent to which RTI-related costs in South Africa compare with those in other low- and middle-income countries (LMICs), we reviewed published economic evaluations of RTI-related prevention in LMICs. RESULTS Thirteen articles were identified, including cost-of-illness and cost-effectiveness studies. Although RTI-related risk factors in South Africa are well described, costing studies are limited. There is minimal information, most of which is not recent, with nothing at all on societal costs. Cost-effective interventions for RTIs in LMICs include bicycle and motorcycle helmet enforcement, traffic enforcement, and the construction of speed bumps. DISCUSSION Policy recommendations from studies conducted in LMICs suggest a number of cost-effective interventions for consideration in South Africa. They include speed bumps for pedestrian safety, strategically positioned speed cameras, traffic enforcement such as the monitoring of seatbelt use, and breathalyzer interventions. However, interventions introduced in South Africa will need to be based either on South African cost-effectiveness data or on findings adapted from similar middle-income country settings.
Collapse
Affiliation(s)
- Hadley K H Wesson
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Nkuli Boikhutso
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Adnan A Hyder
- International Injury Research Unit, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Melanie Bertram
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Karen J Hofman
- School of Public Health, University of Witwatersrand, PRICELESS SA, MRC/Wits Rural Public Health and Health Transitions Research Unit, Johannesburg, South Africa;
| |
Collapse
|
23
|
Staton C, Vissoci J, Gong E, Toomey N, Wafula R, Abdelgadir J, Zhou Y, Liu C, Pei F, Zick B, Ratliff CD, Rotich C, Jadue N, de Andrade L, von Isenburg M, Hocker M. Road Traffic Injury Prevention Initiatives: A Systematic Review and Metasummary of Effectiveness in Low and Middle Income Countries. PLoS One 2016; 11:e0144971. [PMID: 26735918 PMCID: PMC4703343 DOI: 10.1371/journal.pone.0144971] [Citation(s) in RCA: 99] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/25/2015] [Indexed: 11/19/2022] Open
Abstract
Background Road traffic injuries (RTIs) are a growing but neglected global health crisis, requiring effective prevention to promote sustainable safety. Low- and middle-income countries (LMICs) share a disproportionately high burden with 90% of the world’s road traffic deaths, and where RTIs are escalating due to rapid urbanization and motorization. Although several studies have assessed the effectiveness of a specific intervention, no systematic reviews have been conducted summarizing the effectiveness of RTI prevention initiatives specifically performed in LMIC settings; this study will help fill this gap. Methods In accordance with PRISMA guidelines we searched the electronic databases MEDLINE, EMBASE, Scopus, Web of Science, TRID, Lilacs, Scielo and Global Health. Articles were eligible if they considered RTI prevention in LMICs by evaluating a prevention-related intervention with outcome measures of crash, RTI, or death. In addition, a reference and citation analysis was conducted as well as a data quality assessment. A qualitative metasummary approach was used for data analysis and effect sizes were calculated to quantify the magnitude of emerging themes. Results Of the 8560 articles from the literature search, 18 articles from 11 LMICs fit the eligibility and inclusion criteria. Of these studies, four were from Sub-Saharan Africa, ten from Latin America and the Caribbean, one from the Middle East, and three from Asia. Half of the studies focused specifically on legislation, while the others focused on speed control measures, educational interventions, enforcement, road improvement, community programs, or a multifaceted intervention. Conclusion Legislation was the most common intervention evaluated with the best outcomes when combined with strong enforcement initiatives or as part of a multifaceted approach. Because speed control is crucial to crash and injury prevention, road improvement interventions in LMIC settings should carefully consider how the impact of improvements will affect speed and traffic flow. Further road traffic injury prevention interventions should be performed in LMICs with patient-centered outcomes in order to guide injury prevention in these complex settings.
Collapse
Affiliation(s)
- Catherine Staton
- Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
- * E-mail:
| | - Joao Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Enying Gong
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Nicole Toomey
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Rebeccah Wafula
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Jihad Abdelgadir
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Yi Zhou
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Chen Liu
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Fengdi Pei
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Brittany Zick
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Camille D. Ratliff
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Claire Rotich
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Nicole Jadue
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Luciano de Andrade
- Department of Nursing, State University of the West of Parana, Foz do Iguaçu, Parana, Brazil
| | - Megan von Isenburg
- Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America
| | - Michael Hocker
- Emergency Medicine, Duke University Medical Center, Durham, North Carolina, United States of America
| |
Collapse
|
24
|
Results of a large-scale randomized behavior change intervention on road safety in Kenya. Proc Natl Acad Sci U S A 2015; 112:E4661-70. [PMID: 26261326 DOI: 10.1073/pnas.1422009112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Road accidents kill 1.3 million people each year, most in the developing world. We test the efficacy of evocative messages, delivered on stickers placed inside Kenyan matatus, or minibuses, in reducing road accidents. We randomize the intervention, which nudges passengers to complain to their drivers directly, across 12,000 vehicles and find that on average it reduces insurance claims rates of matatus by between one-quarter and one-third and is associated with 140 fewer road accidents per year than predicted. Messages promoting collective action are especially effective, and evocative images are an important motivator. Average maximum speeds and average moving speeds are 1-2 km/h lower in vehicles assigned to treatment. We cannot reject the null hypothesis of no placebo effect. We were unable to discern any impact of a complementary radio campaign on insurance claims. Finally, the sticker intervention is inexpensive: we estimate the cost-effectiveness of the most impactful stickers to be between $10 and $45 per disability-adjusted life-year saved.
Collapse
|
25
|
Wesson HKH, Boikhutso N, Bachani AM, Hofman KJ, Hyder AA. The cost of injury and trauma care in low- and middle-income countries: a review of economic evidence. Health Policy Plan 2014; 29:795-808. [PMID: 24097794 PMCID: PMC4153302 DOI: 10.1093/heapol/czt064] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2013] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Injuries are a significant cause of mortality and morbidity, of which more than 90% occur in low- and middle-income countries (LMICs). Given the extent of this burden being confronted by LMICs, there is need to place injury prevention at the forefront of public health initiatives and to understand the costs associated with injury. The aim of this article is to describe the extent to which injury-related costing studies have been conducted in LMICs. METHODS A review of literature was performed to explore costing data available for injury and/or trauma care in LMICs. Study quality was described using recommendations from the Community Guide's quality assessment tool for economic evaluations. RESULTS The review identified 68 studies, of which 13 were full economic evaluations. Cost of injury varied widely with mean costs ranging from US$14 to US$17 400. In terms of injury-prevention interventions, cost per disability adjusted life year averted for injury-prevention interventions ranged from US$10.90 for speed bump installation to US$17 000 for drunk driving and breath testing campaigns in Africa. The studies varied in quality, ranging from very good to unsatisfactory. DISCUSSION There is a lack of injury-related economic evidence from LMICs. Current costing research has considerable variability in the costs and cost descriptions of injury and associated prevention interventions. The generalizability of these studies is limited. Yet the economic burden of injury is high, suggesting significant potential for cost savings through injury prevention. A standardized approach to economic evaluation of injury in LMICs is needed to further prioritize investing in injury prevention.
Collapse
Affiliation(s)
- Hadley K H Wesson
- International Injury Research Unit, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA, Department of Surgery, Virginia Commonwealth University Medical Center, 1200 East Broad Street, Richmond, VA 23298, USA, University of Witwatersrand Faculty of Health Sciences, School of Public Health, 27 St Andrews Road, Parktown, Johannesburg 2193, Medical Reserach Council, Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa International Injury Research Unit, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA, Department of Surgery, Virginia Commonwealth University Medical Center, 1200 East Broad Street, Richmond, VA 23298, USA, University of Witwatersrand Faculty of Health Sciences, School of Public Health, 27 St Andrews Road, Parktown, Johannesburg 2193, Medical Reserach Council, Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa
| | - Nonkululeko Boikhutso
- International Injury Research Unit, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA, Department of Surgery, Virginia Commonwealth University Medical Center, 1200 East Broad Street, Richmond, VA 23298, USA, University of Witwatersrand Faculty of Health Sciences, School of Public Health, 27 St Andrews Road, Parktown, Johannesburg 2193, Medical Reserach Council, Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa
| | - Abdulgafoor M Bachani
- International Injury Research Unit, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA, Department of Surgery, Virginia Commonwealth University Medical Center, 1200 East Broad Street, Richmond, VA 23298, USA, University of Witwatersrand Faculty of Health Sciences, School of Public Health, 27 St Andrews Road, Parktown, Johannesburg 2193, Medical Reserach Council, Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa
| | - Karen J Hofman
- International Injury Research Unit, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA, Department of Surgery, Virginia Commonwealth University Medical Center, 1200 East Broad Street, Richmond, VA 23298, USA, University of Witwatersrand Faculty of Health Sciences, School of Public Health, 27 St Andrews Road, Parktown, Johannesburg 2193, Medical Reserach Council, Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa
| | - Adnan A Hyder
- International Injury Research Unit, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205, USA, Department of Surgery, Virginia Commonwealth University Medical Center, 1200 East Broad Street, Richmond, VA 23298, USA, University of Witwatersrand Faculty of Health Sciences, School of Public Health, 27 St Andrews Road, Parktown, Johannesburg 2193, Medical Reserach Council, Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa
| |
Collapse
|
26
|
Raynor NJ, Mirzoev T. Understanding road safety in Kenya: views of matatu drivers. Int Health 2014; 6:242-8. [DOI: 10.1093/inthealth/ihu034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
27
|
Abegaz T, Berhane Y, Worku A, Assrat A. Effectiveness of an improved road safety policy in Ethiopia: an interrupted time series study. BMC Public Health 2014; 14:539. [PMID: 24886220 PMCID: PMC4052816 DOI: 10.1186/1471-2458-14-539] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 05/23/2014] [Indexed: 11/16/2022] Open
Abstract
Background In recent years, there has been an increasing interest in implementing road safety policy by different low income countries. However; the evidence is scarce on its success in the reduction of crashes, injuries and deaths. This study was conducted to assess whether road crashes, injuries and fatalities was reduced following the road safety regulation introduced as of September 2007 by Oromia Regional State Transport Bureau. Methods Routine road traffic accident data for the year 2002-2011were collected from sixteen traffic police offices. Data on average daily vehicle flow was obtained from the Ethiopian Road Authority. Interrupted time series design using segmented linear regression model was applied to estimate the effect of an improved road safety policy. Results A total of 4,053 crashes occurred on Addis Ababa - Adama/Hawassa main road. Of these crashes, almost half 46.4% (1,880) were property damage, 29.4% (1,193) were fatal and 24.2% (980) injury crashes, resulting 1,392 fatalities and 1,749 injuries. There were statistically significant reductions in non-injury crashes and deaths. Non-injury crash was reduced by 19% and fatality by 12.4% in the first year of implementing the revised transport safety regulation. Conclusion Although revised road safety policy helped in reducing motor vehicle crashes and associated fatalities, the overall incidence rate is still very high. Further action is required to avoid unnecessary loss of lives.
Collapse
Affiliation(s)
- Teferi Abegaz
- School of Public and Environmental Health, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia.
| | | | | | | |
Collapse
|
28
|
Durrani M, Waseem H, Bhatti JA, Razzak JA, Naseer R. Associations of traffic safety attitudes and ticket fixing behaviours with the crash history of Pakistani drivers. Int J Inj Contr Saf Promot 2012; 19:351-6. [DOI: 10.1080/17457300.2011.635207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
|
29
|
Babigumira JB, Stergachis A, Veenstra DL, Gardner JS, Ngonzi J, Mukasa-Kivunike P, Garrison LP. Potential cost-effectiveness of universal access to modern contraceptives in Uganda. PLoS One 2012; 7:e30735. [PMID: 22363480 PMCID: PMC3281877 DOI: 10.1371/journal.pone.0030735] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 12/28/2011] [Indexed: 11/18/2022] Open
Abstract
Background Over two thirds of women who need contraception in Uganda lack access to modern effective methods. This study was conducted to estimate the potential cost-effectiveness of achieving universal access to modern contraceptives in Uganda by implementing a hypothetical new contraceptive program (NCP) from both societal and governmental (Ministry of Health (MoH)) perspectives. Methodology/Principal Findings A Markov model was developed to compare the NCP to the status quo or current contraceptive program (CCP). The model followed a hypothetical cohort of 15-year old girls over a lifetime horizon. Data were obtained from the Uganda National Demographic and Health Survey and from published and unpublished sources. Costs, life expectancy, disability-adjusted life expectancy, pregnancies, fertility and incremental cost-effectiveness measured as cost per life-year (LY) gained, cost per disability-adjusted life-year (DALY) averted, cost per pregnancy averted and cost per unit of fertility reduction were calculated. Univariate and probabilistic sensitivity analyses were performed to examine the robustness of results. Mean discounted life expectancy and disability-adjusted life expectancy (DALE) were higher under the NCP vs. CCP (28.74 vs. 28.65 years and 27.38 vs. 27.01 respectively). Mean pregnancies and live births per woman were lower under the NCP (9.51 vs. 7.90 and 6.92 vs. 5.79 respectively). Mean lifetime societal costs per woman were lower for the NCP from the societal perspective ($1,949 vs. $1,987) and the MoH perspective ($636 vs. $685). In the incremental analysis, the NCP dominated the CCP, i.e. it was both less costly and more effective. The results were robust to univariate and probabilistic sensitivity analysis. Conclusion/Significance Universal access to modern contraceptives in Uganda appears to be highly cost-effective. Increasing contraceptive coverage should be considered among Uganda's public health priorities.
Collapse
Affiliation(s)
- Joseph B Babigumira
- Global Medicines Program, Department of Global Health, School of Public Health, University of Washington, Seattle, Washington, United States of America.
| | | | | | | | | | | | | |
Collapse
|
30
|
Esperato A, Bishai D, Hyder AA. Projecting the health and economic impact of road safety initiatives: a case study of a multi-country project. TRAFFIC INJURY PREVENTION 2012; 13 Suppl 1:82-89. [PMID: 22414132 DOI: 10.1080/15389588.2011.647138] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The Road Safety in 10 Countries (RS-10) project will implement 12 different road safety interventions at specific sites within 10 low- and middle-income countries (LMICs). This evaluation reports the number of lives that RS-10 is projected to save in those locations, the economic value of the risk reduction, and the maximum level of investment that a public health intervention of this magnitude would be able to incur before its costs outweigh its health benefits. METHODS We assumed a 5-year time implementation horizon corresponding to the duration of RS-10. Based on a preliminary literature review, we estimated the effectiveness for each of the RS-10 interventions. Applying these effectiveness estimates to the size of the population at risk at RS-10 sites, we calculated the number of lives and life years saved (LYS) by RS-10. We projected the value of a statistical life (VSL) in each RS-10 country based on gross national income (GNI) and estimated the value of the lives saved using each country's VSL. Sensitivity analysis addressed robustness to assumptions about elasticity, discount rates, and intervention effectiveness. RESULTS From the evidence base reviewed, only 13 studies met our selection criteria. Such a limited base presents uncertainties about the potential impact of the modeled interventions. We tried to account for these uncertainties by allowing effectiveness to vary ± 20 percent for each intervention. Despite this variability, RS-10 remains likely to be worth the investment. RS-10 is expected to save 10,310 lives over 5 years (discounted at 3%). VSL and $/LYS methods provide concordant results. Based on our estimates of each country's VSL, the respective countries would be willing to pay $2.45 billion to lower these fatality risks (varying intervention effectiveness by ± 20 percent, the corresponding range is $2.0-$2.9 billion). Analysis based on $/LYS shows that the RS-10 project will be cost-effective as long as its costs do not exceed $5.14 billion (under ± 20% intervention effectiveness, the range = $4.1-$6.2 billion). Even at low efficacy, these estimates are still several orders of magnitude above the $125 million projected investment. CONCLUSION RS-10 is likely to yield high returns for invested resources. The study's chief limitation was the reliance on the world's limited evidence base on how effective the road safety interventions will be. Planned evaluation of RS-10 will enhance planners' ability to conduct economic assessments of road safety in developing countries.
Collapse
Affiliation(s)
- Alexo Esperato
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA
| | | | | |
Collapse
|
31
|
Ozgediz D, Chu K, Ford N, Dubowitz G, Bedada AG, Azzie G, Gerstle JT, Riviello R. Surgery in global health delivery. ACTA ACUST UNITED AC 2011; 78:327-41. [PMID: 21598260 DOI: 10.1002/msj.20253] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Surgical conditions account for a significant portion of the global burden of disease and have a substantial impact on public health in low- and middle-income countries. This article reviews the significance of surgical conditions within the context of public health in these settings, and describes selected approaches to global surgery delivery in specific contexts. The discussion includes programs in global trauma care, surgical care in conflict and disaster, and anesthesia and perioperative care. Programs to develop surgical training in Botswana and pediatric surgery through international partnership are also described, with a final review of broader approaches to training for global surgical delivery. In each instance, innovative solutions, as well as lessons learned and reasons for program failure, are highlighted.
Collapse
|
32
|
Babigumira JB, Levin A, Burgess C, Garrison LP, Bauch CT, Braka F, Mbabazi WB, Nabyonga JO, Simons E, Dabbagh A. Assessing the Cost-Effectiveness of Measles Elimination in Uganda: Local Impact of a Global Eradication Program. J Infect Dis 2011; 204 Suppl 1:S116-23. [DOI: 10.1093/infdis/jir132] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
33
|
Jayaraman S, Ozgediz D, Miyamoto J, Caldwell N, Lipnick MS, Mijumbi C, Mabweijano J, Hsia R, Dicker R. Disparities in injury mortality between Uganda and the United States: comparative analysis of a neglected disease. World J Surg 2011; 35:505-11. [PMID: 21181159 PMCID: PMC3032913 DOI: 10.1007/s00268-010-0871-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background The burden of global injury-related deaths predominantly affects developing countries, which have little infrastructure to evaluate these disparities. We describe injury-related mortality patterns in Kampala, Uganda and compare them with data from the United States and San Francisco (SF), California. Methods We created a database in Kampala of deaths recorded by the City Mortuary, the Mulago Hospital Mortuary, and the Uganda Ministry of Health from July to December 2007. We analyzed the rate and odds ratios and compared them to data from the U.S. Centers for Disease Control and Prevention and the California Department of Public Health. Results In Kampala, 25% of all deaths were due to injuries (812/3303) versus 6% in SF and 7% in the United States. The odds of dying of injury in Kampala were 5.0 times higher than in SF and 4.2 times higher than in the United States. Age-standardized death rates indicate a 93% greater risk of dying from injury in Kampala than in SF. The mean age was lower in Kampala than in SF (29 vs. 44 years). The adult injury death rate (rate ratio, or RR) was higher in Kampala than in SF (2.3) or the United States (1.5). Head/neck injury was reported in 65% of injury deaths in Kampala compared to 34% in SF [odds ratio (OR) 3.7] and 28% in the US (OR 4.8). Conclusions Urban injury-related mortality is significantly higher in Uganda than in the United States. Injury preferentially affects adults in the prime of their economically productive years. These findings serve as a call for stronger injury prevention and control policies in Uganda.
Collapse
Affiliation(s)
- Sudha Jayaraman
- Department of Surgery, University of California San Francisco, 513 Parnassus Avenue, S321, San Francisco, CA 94118, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Ziraba AK, Kyobutungi C, Zulu EM. Fatal injuries in the slums of Nairobi and their risk factors: results from a matched case-control study. J Urban Health 2011; 88 Suppl 2:S256-65. [PMID: 21630106 PMCID: PMC3132230 DOI: 10.1007/s11524-011-9580-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Injuries contribute significantly to the rising morbidity and mortality attributable to non-communicable diseases in the developing world. Unfortunately, active injury surveillance is lacking in many developing countries, including Kenya. This study aims to describe and identify causes of and risk factors for fatal injuries in two slums in Nairobi city using a demographic surveillance system framework. The causes of death are determined using verbal autopsies. We used a nested case-control study design with all deaths from injuries between 2003 and 2005 as cases. Two controls were randomly selected from the non-injury deaths over the same period and individually matched to each case on age and sex. We used conditional logistic regression modeling to identity individual- and community-level factors associated with fatal injuries. Intentional injuries accounted for about 51% and unintentional injuries accounted for 49% of all injuries. Homicides accounted for 91% of intentional injuries and 47% of all injury-related deaths. Firearms (23%) and road traffic crashes (22%) were the leading single causes of deaths due to injuries. About 15% of injuries were due to substance intoxication, particularly alcohol, which in this community comes from illicit brews and is at times contaminated with methanol. Results suggest that in the pervasively unsafe and insecure environment that characterizes the urban slums, ethnicity, residence, and area level factors contribute significantly to the risk of injury-related mortality.
Collapse
Affiliation(s)
- Abdhalah Kasiira Ziraba
- Faculty of Epidemiology and Population Health, Department of Population Studies, London School of Hygiene and Tropical Medicine, Room LG21, Keppel Street, London WC1E 7HT, UK.
| | | | | |
Collapse
|
35
|
Bhatti JA, Sobngwi-Tambekou J, Lagarde E, Salmi LR. Situational factors associated with road traffic crashes: A case–control study on the Yaoundé–Douala road section, Cameroon. Int J Inj Contr Saf Promot 2010; 17:215-22. [DOI: 10.1080/17457301003728510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
36
|
Hulme P. Mechanisms of trauma at a rural hospital in Uganda. Pan Afr Med J 2010; 7:5. [PMID: 21918694 PMCID: PMC3172623 DOI: 10.4314/pamj.v7i1.69110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Accepted: 10/02/2010] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Trauma is an increasing cause of mortality worldwide with road traffic accidents (RTAs) causing 1.3 million deaths annually with 90% of this mortality occurring in low and middle income countries. The rise in trauma deaths has been neglected with infectious diseases taking precedence. More research needs to be conducted in resource poor countries to establish the main causes of trauma and find better solutions to the rising trend in mortality. Much of the trauma research in resource poor countries has focused on urban areas. This study aims to find the leading causes of trauma at a rural Ugandan hospital. METHODS A retrospective case note review was performed on all adult patients admitted to Kuluva Hospital with trauma related injuries in 2007. Kuluva Hospital is a rural 250 bed hospital in North-West Uganda. RESULTS 490 trauma patients were admitted in 2007 accounting for 9.4% of admissions. 70.2% (n=344) were males and 29.8% (n=146) were females. The mean age of patients was 31.3 years and the mean length of stay was 7.4 days. In 2007 9 patients died following trauma, 6 from RTAs, 2 from burns and one after an assault. RTAs were the leading cause of trauma with 64.2% of admissions (n=315), followed by assaults with 16.5% (n=81) of admissions. Soft tissue injuries with 28.4% (n=149) and lacerations with 27.3% (n=143) were the most common diagnoses after trauma with fractures making up 18.7% of injuries (n=99). CONCLUSION RTAs were an important cause of morbidity and mortality in a rural Ugandan hospital as they also are in urban areas. Low cost initiatives to reduce speed, prevent alcohol impaired driving, improve public education and wider access to high quality trauma care are vital to reducing the mortality and morbidity caused by RTAs in Africa.
Collapse
Affiliation(s)
- Peter Hulme
- Trafford General Hospital, Moorside Road, Davyhulme, Manchester, UK
| |
Collapse
|
37
|
Sobngwi-Tambekou J, Bhatti J, Kounga G, Salmi LR, Lagarde E. Road traffic crashes on the Yaoundé-Douala road section, Cameroon. ACCIDENT; ANALYSIS AND PREVENTION 2010; 42:422-426. [PMID: 20159062 DOI: 10.1016/j.aap.2009.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2009] [Revised: 09/08/2009] [Accepted: 09/09/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Developing countries account for more than 85% of all road traffic deaths in the world. Our aims were to estimate road morbidity and mortality and to describe the main characteristics of road traffic crashes on a heavy traffic road section in Cameroon. METHODS We conducted a study of police reports of the 2004-2007 period retrieved from the 13 police stations in charge of the 243 km Yaoundé-Douala road section in Cameroon. RESULTS The estimated overall number of people killed per 100 million kilometres driven was 73, more than 35 times higher than on similar roads in the US or Europe. The most severe crashes were those involving vulnerable road users (97 deaths) and vehicles travelling in opposite directions (136 deaths). The main causes of fatal crashes were mechanical failures (28%), two-thirds being tyre problems, hazardous overtaking (23%), and excessive speed (20%). CONCLUSIONS The burden of road traffic injuries on heavy traffic roads in Cameroon calls for urgent interventions. Traffic calming measures and control of vehicle condition appear to be the most cost-effective interventions.
Collapse
Affiliation(s)
- Joëlle Sobngwi-Tambekou
- Equipe Avenir Prévention et Prise en Charge des Traumatismes, Institut Nationale de Santé et de Recherche Médicale Unité 897 (INSERM U897), F-33076 Bordeaux, France
| | | | | | | | | |
Collapse
|
38
|
Jayaraman S, Mabweijano JR, Lipnick MS, Caldwell N, Miyamoto J, Wangoda R, Mijumbi C, Hsia R, Dicker R, Ozgediz D. First things first: effectiveness and scalability of a basic prehospital trauma care program for lay first-responders in Kampala, Uganda. PLoS One 2009; 4:e6955. [PMID: 19759831 PMCID: PMC2736400 DOI: 10.1371/journal.pone.0006955] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Accepted: 08/02/2009] [Indexed: 12/02/2022] Open
Abstract
Background We previously showed that in the absence of a formal emergency system, lay people face a heavy burden of injuries in Kampala, Uganda, and we demonstrated the feasibility of a basic prehospital trauma course for lay people. This study tests the effectiveness of this course and estimates the costs and cost-effectiveness of scaling up this training. Methods and Findings For six months, we prospectively followed 307 trainees (police, taxi drivers, and community leaders) who completed a one-day basic prehospital trauma care program in 2008. Cross-sectional surveys and fund of knowledge tests were used to measure their frequency of skill and supply use, reasons for not providing aid, perceived utility of the course and kit, confidence in using skills, and knowledge of first-aid. We then estimated the cost-effectiveness of scaling up the program. At six months, 188 (62%) of the trainees were followed up. Their knowledge retention remained high or increased. The mean correct score on a basic fund of knowledge test was 92%, up from 86% after initial training (n = 146 pairs, p = 0.0016). 97% of participants had used at least one skill from the course: most commonly haemorrhage control, recovery position and lifting/moving and 96% had used at least one first-aid item. Lack of knowledge was less of a barrier and trainees were significantly more confident in providing first-aid. Based on cost estimates from the World Health Organization, local injury data, and modelling from previous studies, the projected cost of scaling up this program was $0.12 per capita or $25–75 per life year saved. Key limitations of the study include small sample size, possible reporter bias, preliminary local validation of study instruments, and an indirect estimate of mortality reduction. Conclusions Lay first-responders effectively retained knowledge on prehospital trauma care and confidently used their first-aid skills and supplies for at least six months. The costs of scaling up this intervention to cover Kampala are very modest. This may be a cost-effective first step toward developing formal emergency services in Uganda other resource-constrained settings. Further research is needed in this critical area of trauma care in low-income countries.
Collapse
Affiliation(s)
- Sudha Jayaraman
- Department of Surgery, University of California San Francisco, San Francisco, California, United States of America
| | | | - Michael S. Lipnick
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States of America
| | - Nolan Caldwell
- School of Medicine, University of California San Francisco, Office of Medical Education, San Francisco, California, United States of America
| | - Justin Miyamoto
- School of Medicine, University of California San Francisco, Office of Medical Education, San Francisco, California, United States of America
| | - Robert Wangoda
- Department of Accident and Emergency, Mulago Hospital and Makerere University, Kampala, Uganda
| | - Cephas Mijumbi
- Department of Anaesthesia, Mulago Hospital and Makerere University, Kampala, Uganda
| | - Renee Hsia
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, United States of America
| | - Rochelle Dicker
- Department of Surgery, San Francisco General Hospital, San Francisco, California, United States of America
| | - Doruk Ozgediz
- Division of Pediatric Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| |
Collapse
|